Creating Safe Pathways to Perinatal Care for People Using Substances: An Academic Community Partnership

Background & Purpose: Perinatal substance use is a public health concern that has grown over the last decade. Recent data confirm the prevalence of illicit drug and alcohol use among Montana pregnant people as 11.6% and 8.9%, respectively. Substance use during pregnancy may result in multiple poor health outcomes for both pregnant people and their infant; but these outcomes can be mitigated by the presence of safe and trusted pathways to prenatal care, including trauma-informed and culturally responsive care for substance use and mental health conditions. This project utilizes collaborative efforts between Montana State University, University of Montana, and the Missoula County Perinatal Substance Use Network. Guided by the CoCreative collaborative innovation approach, the PSU Network identified two aims for this research project. The aims of this study are: (1) to better understand the experiences of people who used substances during the perinatal period, and (2) to identify trusted entries into care, and to strengthen a community-based, trauma-informed, culturally-safe pathways to care.

Methods: This community-based participatory research study engaged seven individuals, including individuals with lived experience of perinatal substance use and spouses, in weekly focus groups conducted over eight weeks. Data collection included facilitated focus groups centered on experiences with healthcare, social services, and child welfare systems, along with in-depth qualitative interviews using a dialogical phenomenological approach. Focus groups were audio-recorded, transcribed verbatim, and analyzed thematically.

Results: Major themes including stigma, trust, punitive measures, and community support were identified. Following the Engaging for Equity process and integrating focus group data, participants assisted the researchers in building a model of care with the intent of systemic change. Model creation followed a systematic approach to comprise four components of change: contexts, partnership processes, intervention and research, and outcomes.

Conclusions & Implications: Structural changes supporting home-visit nursing, residential treatment facilities for families, and peer support were identified as potential facilitators to accessing perinatal care.