Perinatal and Substance Use Care in North Carolina Jails: A Qualitative Organizational Context Ideal-Type Analysis

Around 55,000 pregnant individuals enter US jails annually, with over one-third having a substance use disorder (SUD), putting them at risk of perinatal morbidity and mortality. Yet, uptake of perinatal/SUD care best-practices into jails is slow, impacted by many organizational factors. This study explores the organizational contexts that shape decision-making structures and policy development regarding perinatal/SUD care in North Carolina (NC) jails.

We conducted semi-structured interviews with employees at 26 NC jails in 2023. Interview transcripts were de-identified and analyzed using ideal-type analysis methodology. Two team members created organizational context summaries, proposed ideal-types (i.e., categories based on shared characteristics), and categorized each interviewed jail. A third team member performed a credibility check, and discrepancies were resolved through team consensus.

We constructed three jail ideal-types based on organizational capacity to implement new care policies, identify medical care alternatives to incarceration through community and judiciary connections, and foster collaborative decision making between custody and medical staff regarding perinatal/SUD care. Proactive and Collaborative jails (n = 6) had recently implemented evidence-based programs and/or policies, facilitated referrals to alternatives to incarceration, and collaborated across roles in perinatal/SUD care innovation. Responsive and Coordinated jails (n = 15) had more limited perinatal/SUD implementation experience, fewer connections for alternatives to incarceration, and less management collaboration. Traditional jails (n = 5) had not implemented new programs and/or policies, did not identify local alternatives to incarceration, and maintained centralized and siloed decision-making structures.

These typologies provide a conceptual framework for understanding leadership structures and care innovation in NC jails regarding perinatal/SUD care. This framework can be applied to collaborative initiatives with jails to help develop context-specific implementation teams and strategies for integrating perinatal/SUD best-practices. Understanding these organizational contexts is crucial for developing tailored approaches that support jails in their uptake and delivery of perinatal/SUD evidence-based practice to ultimately improve perinatal outcomes.