The investigators seek to adapt a collaborative care model (CCM) for community-based, low-resource obstetric settings and to test the effects of this adapted CCM on health outcomes among Pregnant, postpartum, and parenting person (PPPP) with Opioid use disorder (OUD) and their families. To achieve this goal, investigators will conduct a nonrandomized, 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 medication for OUD (MOUD) initiation and continuation, decrease overdose and reduce child removal rates among PPPP with OUD.

Specifically, investigators will:

1. Conduct an intervention adaptation project to adapt the Pregnancy and Women's Recovery Center (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.

Investigators will also:

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.

Inclusion Criteria:

(Stakeholder Participant)

1. 18 years or older
2. Providing care at participating obstetric site
3. English speaking

(Patient Participant)

1. 18 years or older
2. Receiving care at participating obstetric site
3. English speaking

Exclusion Criteria:

1. Unwillingness to have participation audio recorded.

A core team of clinical providers at each obstetric site (i.e., nurse case manager, peer navigator, advanced practice provider, behavioral health provider, and lead obstetrician/gynecologist) have already committed to providing clinical care for the adapted CCM and participate in all stages of the research process. As such, they will not need to be recruited for participation.

Maternal and child outcome data will be collected retrospectively from the EHR and individual patients will not be recruited to participate in the study. A small subset of pregnant women (n=50) who meet DSM-V criteria for OUD and who receive care at obstetric sites will be recruited for a one-time, semi-structured qualitative interview.

HEAL Data Platform (HDP01418); NAHDAP data repository.

Before publishing and/or at the end of the study period with results.

Public Access and Data Sharing Plan: A Public Access and Data Sharing Plan describes the plan for releasing Publications and sharing the Underlying Primary Data for an NIH HEAL Initiative Research Project.