TY - JOUR
AU - M. Ramage
AU - C. E. Martin
AU - C. Tak
AU - K. Simcox
AU - E. Johnson
AU - P. M. Hughes
AU - A. Ollendorff
A1 - 
AB - Substance use disorder (SUD) during pregnancy and the postpartum period presents unique clinical and structural challenges that require integrated, evidence-based care. The intensity of perinatal care visits creates a critical opportunity to embed treatment for SUD within routine medical services. While many models of perinatal SUD (PSUD) care exist, they vary widely in structure and scope. A foundational and adaptable framework is needed to support implementation, promote consistency, and evaluate care quality across diverse health care settings. This manuscript presents a tiered framework for outpatient PSUD care, adapted from the SAMHSA-HRSA Integrated Behavioral Health model. The framework outlines 3 core domains: (1) Team Scope of Services, (2) Systematic Communication, and (3) Degree of Coordination stratified across 3 tiers that reflect increasing levels of integration and service maturity. By defining the components of integrated PSUD care, this model provides a shared language for clinical teams, researchers, and policymakers. The framework is illustrated through examples from established PSUD programs in Virginia and North Carolina, highlighting real-world application. Common challenges and regional considerations, including the unique needs of Appalachian populations and financial sustainability, are also discussed. This framework serves as a beginning tool for quality improvement, research, and health system planning. It prioritizes patient-centered care and scalability, supporting risk-appropriate models of PSUD treatment. By promoting consistency in service delivery, this approach aimed to improve mother-baby dyad outcomes and reduce overdose-related mortality.
AD - North Carolina Perinatal Substance Use Disorder Network, Asheville, NC, USA.; Department of Obstetrics and Gynecology, Virginia Commonwealth University Institute for Drug and Alcohol Studies, Richmond, VA, USA.; Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.; Department of Obstetrics and Gynecology, Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.; UNC Horizons, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, NC, USA.; Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Johnson City, NY, USA.; North Carolina State University, Raleigh, NC, USA.
AN - 42157099
BT - Subst Use Addctn J
C5 - Healthcare Disparities; Opioids & Substance Use
DA - 05/2026
DO - 10.1177/29767342261448442
DP - NLM
ET - 20260519
JF - Subst Use Addctn J
LA - eng
N2 - Substance use disorder (SUD) during pregnancy and the postpartum period presents unique clinical and structural challenges that require integrated, evidence-based care. The intensity of perinatal care visits creates a critical opportunity to embed treatment for SUD within routine medical services. While many models of perinatal SUD (PSUD) care exist, they vary widely in structure and scope. A foundational and adaptable framework is needed to support implementation, promote consistency, and evaluate care quality across diverse health care settings. This manuscript presents a tiered framework for outpatient PSUD care, adapted from the SAMHSA-HRSA Integrated Behavioral Health model. The framework outlines 3 core domains: (1) Team Scope of Services, (2) Systematic Communication, and (3) Degree of Coordination stratified across 3 tiers that reflect increasing levels of integration and service maturity. By defining the components of integrated PSUD care, this model provides a shared language for clinical teams, researchers, and policymakers. The framework is illustrated through examples from established PSUD programs in Virginia and North Carolina, highlighting real-world application. Common challenges and regional considerations, including the unique needs of Appalachian populations and financial sustainability, are also discussed. This framework serves as a beginning tool for quality improvement, research, and health system planning. It prioritizes patient-centered care and scalability, supporting risk-appropriate models of PSUD treatment. By promoting consistency in service delivery, this approach aimed to improve mother-baby dyad outcomes and reduce overdose-related mortality.
PY - 2026
SN - 2976-7342
SP - 29767342261448442
ST - A Tiered Framework for Outpatient Perinatal Substance Use Disorder Services
T1 - A Tiered Framework for Outpatient Perinatal Substance Use Disorder Services
T2 - Subst Use Addctn J
TI - A Tiered Framework for Outpatient Perinatal Substance Use Disorder Services
U1 - Healthcare Disparities; Opioids & Substance Use
U3 - 10.1177/29767342261448442
VO - 2976-7342
Y1 - 2026
ER -