Literature Collection

PURPOSE: Opioid use disorder among women of childbearing age has reached epidemic proportions. In rural regions of the United States, recruiting perinatal women who use nonmedical opioids to participate in research is wrought with challenges, including barriers such as community stigma, lack of transportation, and time constraints. The current study describes our process and challenges of recruiting pregnant and postpartum women in rural Indiana consisting of women who misuse opioids and those who do not. DESCRIPTION: We employed multiple strategies to recruit participants. Methods included (1) sampling from healthcare facilities based on referrals from front-desk staff and frontline healthcare workers; (2) dissemination of flyers and brochures within healthcare facilities and the community, supported with onsite research assistant presence; (3) digital methods coupled with snowball sampling; and (4) local community talks that provided information about the study. ASSESSMENT: Our multiple recruitment efforts revealed that building relationships with community stakeholders was key in recruiting women who use nonmedical opioids, but that digital methods were more effective in recruiting a larger sample of pregnant and postpartum women in a short amount of time. CONCLUSION: We conclude by making several recommendations to enhance academic-community partnerships in order to bolster sample sizes for prolonged research studies. Furthermore, we highlight the need to destigmatize addiction in order to better serve hard-to-reach populations through research and practice.

There is global interest in integrated care, often associated with how to improve system efficiency, strengthen clinical and cost-effectiveness, avoid gaps in patient care, and improve patient experiences and outcomes, through improved coordination across services. Despite considerable activity in both delivering and evaluating integrated care, evaluations have not greatly helped to understand how to 'do' it better. Evaluations of integrated care have often arrived at similar conclusions, frequently including the generic finding that results are patchy and context dependent. In this article, we explore and discuss these challenges to evaluation, how these challenges are understood in recent key publications, and suggest an alternative perspective. We explore technical inadequacies of evaluations (concerning definitions, metrics, and timing) as well as deeper problems (such as integrated care being dynamic and relational, and operating across multiple, larger systems). In re-framing how to evaluate integrated care, we propose an approach that involves a recursive evaluation architecture. This draws on systems thinking. This approach also recognises that we can better understand evaluations of integrated care as co-producing knowledge and applying this to learning and adaptation.

Though overall death from opioid overdose are increasing in the United States, the death rate in some states and population groups is stabilizing or even decreasing. Several states have enacted a Naloxone Accessibility Laws to increase naloxone availability as an opioid antidote. The extent to which these laws permit layperson distribution and possession varies. The aim of this study is to investigate differences in provisions of Naloxone Accessibility Laws by states mainly in the Northeast and West regions, and the impact of naloxone availability on the rates of drug overdose deaths.This cross-sectional study was based on the National Vital Statistics System multiple cause-of-death mortality files. The average changes in drug overdose death rates between 2013 and 2017 in relevant states of the Northeast and West regions were compared according to availability of naloxone to laypersons.Seven states in the Northeast region and 10 states in the Western region allowed layperson distribution of naloxone. Layperson possession of naloxone was allowed in 3 states each in the Northeast and the Western regions. The average drug overdose death rates increased in many states in the both regions regardless of legalization of layperson naloxone distribution. The average death rates of 3 states that legalized layperson possession in the West region decreased (-0.33 per 100,000 person); however, in states in the West region that did not allow layperson possession and states in the Northeast region regardless of layperson possession increased between 2013 and 2017.The provision to legalize layperson possession of naloxone was associated with decreased average opioid overdose death rates in 3 states of the West region.

Childbearing families in the United States, especially in rural communities, face inconsistent access to high-quality maternity care, with many experiencing sparse and fragmented services. In response to long-standing disparities in Alabama, we created the Women and Children Health Initiative (WACHI), a coordinated hub that advances midwifery workforce growth, expands practice partnerships, and catalyzes policy change to support collaborative, risk-appropriate care. Central to WACHI is integrating certified nurse-midwives (CNMs) within systems that have historically imposed practice barriers. Grounded in the belief that Alabama can do better, WACHI convenes academic fields, health systems, public health sectors, and community partners to codesign and implement evidence-informed interventions. Program pillars include (1) reopening and expanding the state's nurse-midwifery education pathway, (2) embedding Nurse-Family Partnership home visiting with integrated behavioral health, (3) launching the Moms and Kids Mobile Health Clinic to reach underserved rural areas, and (4) building durable CNM-physician collaborations and standardized protocols for team-based care. These coordinated strategies align workforce development, health care delivery, and policy to increase first-trimester prenatal entry, improve postpartum follow-up, and reduce preventable complications. Early results include growth in the CNM workforce, new rural practice partnerships, and health-system engagement with respectful, team-based models that prioritize patient preferences and cultural safety. In this article we describe the WACHI model and early outcomes to inform adaptation and support replication by diverse regional coalitions and systems nationwide.

As the aging population in the United States grows, the need for an integrated approach to support older adults has become increasingly urgent. The SUNSHINE framework, Seniors Uniting Nationwide to Support Health, INtegrated Care, and Evolution, offers a model for advancing resilience, defined as the capacity of individuals, families, systems, and communities to adapt and thrive in the face of adversity. SUNSHINE promotes this goal through the alignment of older and aging adults, families, healthcare systems, public health agencies, social services, and community resources. Using the Theory of Change modeling, SUNSHINE emphasizes whole-person health, interdisciplinary collaboration, and the strategic use of technology to address the evolving needs of aging populations. The framework promotes systems integration supported by research infrastructure and multi-sector collaboration to enhance the well-being of older adults and family caregivers. SUNSHINE places a strong emphasis on mental health, particularly depression, and highlights the importance of social connection and prevention in addressing health disparities and care gaps associated with aging. It conceptualizes resilience as both a desired outcome and a driver of transformation, guiding the redesign and evaluation of health and social systems. The framework also identifies opportunities to leverage artificial intelligence and machine learning (AI/ML) technologies, grounded in scientific evidence, to support personalized prevention, treatment, and care strategies. These technologies are critical for optimizing decision-making, improving care delivery, and enhancing system flexibility. Finally, SUNSHINE aspires to advance a future of aging that is healthy, resilient, and fair, guided by principles of equity, defined as fairness and impartiality in health opportunities and outcomes.