PROJECT SUMMARY ELEVATE CENTER Accidental drug overdose and suicide were the leading causes of pregnancy-associated death in Utah from 2015-2020, accounting for nearly 40% of all pregnancy-associated deaths over that time period. At-risk populations, including those in rural settings and those who identify as American Indian or Alaska Native are disproportionately affected by maternal morbidity. We bring together a transdisciplinary team with expertise in obstetrics, addiction medicine, simulation training, experiential learning, bias and disparity reduction, community engagement and implementation science. Together, this collaborative team will establish the ELEVATE Maternal Health Center of Excellence. ELEVATE is named to encompass our mission to Expand our reach across Utah and the Mountain West, LEVerage existing infrastructure, And Treat pregnant and postpartum people with substance use disorder (SUD) who experience disparities to achieve Equity. In response to our community partners and needs of disproportionately affected populations, we propose three projects in years 1-5, which will be scaled up and implemented statewide and disseminated nationally in years 6 and 7. Project 1 (CEREMONY) will implement a culturally appropriate and multidisciplinary perinatal care clinic for individuals with SUD at Sacred Circle Clinic, which is a clinic serving Native mothers. Project 2 (INSPIRE) will develop, implement and test a modular learning intervention, anchored in simulation training, for interprofessional members of the healthcare team to reduce bias related to SUD in pregnancy. A robust train- the-trainer curriculum will allow us to implement the program across the state and reach rural communities. Project 3 (MEMORIES) will refine and test an expanded informant interview tool to ascertain community and systems contributions to maternal deaths, and the role of discrimination in deaths from SUD. The tool will then be disseminated nationally to Maternal Mortality Review Committees. Our ELEVATE Center aims are to: (1) provide integrated and efficient leadership of the three proposed projects, maximizing coordination with community partners and incorporating research training across all elements of the ELEVATE Center; (2) mature our existing community partnerships and statewide networks in order to facilitate future implementation science and effectiveness trials to reduce maternal morbidity and mortality in Utah, and (3) reduce maternal morbidity in Utah and nationally through implementation of community-driven interventions and training of health care practitioners. The ELEVATE Center will rigorously investigate and identify contributors to maternal morbidity and mortality from SUD with a focus on rural and Native populations. The multipronged approach of the ELEVATE Center will reduce maternal morbidity from substance use in Utah while training the next generation of scientists focused on morbidity reduction. Our efforts can ultimately be expanded nationally to address a leading cause of pregnancy-associated death in the U.S.

PROJECT NARRATIVE ELEVATE CENTER Substance use and mental health disorders are the leading cause of maternal deaths in the U.S., and individuals living in rural communities and those who identify as Native American or Alaska Native are disproportionately affected. The ELEVATE Maternal Health Center of Excellence will complete three research projects focused on reducing maternal morbidity from substance use disorder. Information gleaned from these projects will then be disseminated across Utah, and nationally, to improve outcomes for pregnant and postpartum people with substance use disorder with a broad goal of reducing maternal morbidity.