A Tiered Framework for Outpatient Perinatal Substance Use Disorder Services

Area of Science:

• Perinatal Health
• Addiction Medicine
• Health Services Research

Background:

• Pregnancy and postpartum substance use disorder (SUD) present complex care challenges.
• Perinatal care visits offer a key opportunity for integrated SUD treatment.
• Existing perinatal SUD (PSUD) care models lack standardization.

Purpose of the Study:

• To present a foundational, adaptable tiered framework for outpatient PSUD care.
• To standardize and improve the quality of integrated PSUD services.
• To provide a shared language for clinicians, researchers, and policymakers.

Main Methods:

• Adapted the SAMHSA-HRSA Integrated Behavioral Health model into a tiered framework.
• Defined 3 core domains: Team Scope of Services, Systematic Communication, and Degree of Coordination.
• Stratified integration across 3 tiers reflecting increasing service maturity.

Main Results:

• The framework provides a structured approach to outpatient PSUD care.
• Illustrated with examples from Virginia and North Carolina PSUD programs.
• Discusses challenges like regional needs and financial sustainability.

Conclusions:

• The tiered framework promotes patient-centered, scalable, and risk-appropriate PSUD treatment.
• Aims to enhance mother-baby dyad outcomes and reduce overdose mortality.
• Serves as a tool for quality improvement, research, and health system planning.