Multilevel Predicators of Tailored Services and Childcare for Pregnant Women in Treatment for Opioid Use Disorder

Univ Of Arkansas For Med Scis, Little Rock AR

Investigators

Abstract

RESEARCH PROJECT 3: PROJECT SUMMARY/ABSTRACT Opioid use disorder (OUD) among pregnant/postpartum women is increasing. Pregnant/postpartum women with OUD have complex needs and often must navigate fragmented health systems. Medication for OUD (MOUD) is recommended by all major medical organizations for pregnant/postpartum women with OUD. OUD treatment facilities may improve outcomes for mothers and infants by offering tailored services, such as integrating addiction and pregnancy services or comprehensively assessing mental health and postpartum depression. In addition, treatment facilities that offer childcare for parents in treatment may further improve maternal and infant outcomes by alleviating a critical healthcare barrier. However, rural women with OUD are among the least likely to receive MOUD. These gaps in access are especially pronounced in IDeA states and are shaped by system-level barriers that affect rural communities. As a result, there remains a high unmet need for women-centered drug treatment models that tailor services specifically for pregnant/postpartum women and parents with OUD. Understanding how legal and neighborhood characteristics affect access to MOUD services tailored to the needs of pregnant/postpartum women is vital to inform policies that address these unmet needs. The study will create a national epidemiologic profile to describe where such facilities are located, identify mechanisms that influence variation in access, and assess state policies about substance use during pregnancy. Our approach conceptualizes the multilevel nature of health services access. We considered the competing influence of treatment facility characteristics, the neighborhoods around the facility, and varying state policy environments. Geographic context plays a critical role in shaping healthcare and MOUD access for pregnant individuals. We will use a national dataset of all known treatment facilities that offer MOUD to describe the geographic distribution of and map MOUD treatment facilities across the United States that offer tailored services for pregnant/postpartum women and childcare (Aim 1). We will use multilevel and spatial models to test for associations between the surrounding community’s composition, rurality and whether a facility provides tailored services and childcare (Aim 2). We will conclude by exploring how state health policies impact access to tailored services and childcare (Aim 3). Better understanding variation in the location of pregnancy related MOUD treatment is needed to inform the distribution of health resources. This project will position Dr. Pro to submit an R01 addressing system-level factors of maternal health and substance use, which aligns with NIDA priorities of using “complex modeling to identify key determinants of MOUD outcomes and related comorbidities” and “applying multilevel models to illuminate interactions between healthcare, neighborhood, and regulatory systems.”