Opioid use disorder (OUD) during pregnancy is a major contributor to maternal morbidity and mortality in the United States. Pregnant, postpartum, and parenting person (PPPP) with OUD face numerous, complex challenges that create barriers to treatment engagement in pregnancy and sustained treatment after delivery. While medication for OUD (MOUD) use substantially reduces the risk of overdose and preterm birth, many PPPP with OUD do not initiate or sustain MOUD treatment. Further, gender-related co-morbidities including high rates of trauma and exposure to violence, multi-dimensional abuse and coercion from partners, and undertreated mental health conditions contribute to an increased risk of return to use, overdose, and death in the first year postpartum. In this context, collaborative care models (CCM) have emerged as an innovative and comprehensive way to address the complex needs of PPPP with OUD. CCMs are designed to integrate care from multidisciplinary healthcare, peer, and social services providers to address the social, behavioral, and physical health needs of patients in addition to providing MOUD. Typically, CCMs are located in academic medical centers due to financial and organizational factors. As such, the feasibility, effectiveness, and sustainability of CCMs for PPPP with OUD living low-resource and rural settings is unknown – despite the fact that these settings often have a high burden of OUD-related morbidity. In this application, we seek to adapt a CCM for community-based, low-resource obstetric settings and to test the effects of this adapted CCM on health outcomes among PPPP with OUD and their families. To achieve this goal, we will conduct a non- randomized, Type 1 hybrid implementation-effectiveness study across 3 community-based, low-resource obstetric sites in Northwest PA, a region with rates of maternal opioid-related diagnoses 4 times higher than national averages. Our central hypothesis is that person-centered, recovery supports, provided in the CCM will increase MOUD initiation and continuation, decrease overdose and reduce child removal rates among PPPP with OUD. Specifically, in the R61 Phase, we will: 1) Conduct an intervention adaptation project to adapt the PWRC CCM for rural and low-resource obstetric settings; and 2) Create a common data model to harmonize variables across data sources and data collection processes across study sites. In the R33 Phase, we will: 1) Evaluate the effects of the adapted PWRC CCM on outcomes among PPPP with OUD; 2) Determine if improvements in person-centered, recovery supports mediate the relationship between PWRC Community and outcomes using causal mediation methods; and 3) Identify PWRC Community adaptations that are associated with increased MOUD access, improved outcomes and that facilitate sustainability and scalability. Research findings will: 1) provide high-quality evidence on how CCMs affect service delivery and health outcomes for PPPP with OUD, 2) inform stakeholders about ways to adapt CCMs for low-resource and rural healthcare settings, and 3) inform policymakers about the adaptations necessary to replicate these models widely.

Opioid use disorder (OUD) during pregnancy is a major contributor to maternal morbidity and mortality in the United States, and particularly in rural and low-resource obstetric settings. Collaborative care approaches to substance use treatment – which are designed to comprehensively treat the social, behavioral, and physical health needs of patients – have emerged as a way to address the complex needs of pregnant, postpartum, and parenting persons with OUD. This research project will adapt an innovative comprehensive care model for low- resource obstetric settings and will test the implementation and effects of the care model on maternal, infant, and family health outcomes.