South Carolina Pilot Program for Treatment of Perinatal Substance Use Disorders - PROJECT ABSTRACT The South Carolina (SC) Office of Substance Use Services (OSUS), in collaboration with the Medical University of South Carolina (MUSC), will implement SC's Pilot Program for the Treatment of Pregnant and Postpartum Women (PPW-PLT), delivering integrated, family-centered treatment, recovery, and prenatal care to pregnant and postpartum women with perinatal substance use disorder (PSUD) and co-occurring perinatal mental health (PMH) conditions across eight rural counties in the Upper Pee Dee region. The project extends SC's existing statewide Perinatal Psychiatry Access Program and Peer Recovery Doula (PRD) infrastructure into a coordinated rural system of care, serving 150 unduplicated women over three years (45 in Year 1, 50 in Year 2, 55 in Year 3) and reaching additional women through the broader care coordination and screening network. Geographic Area and Population. The catchment comprises eight contiguous rural counties (Chesterfield, Darlington, Dillon, Florence, Lancaster, Lee, Marion, and Marlboro) in one of SC's most economically distressed regions, all designated as whole or partial Medically Underserved Areas and Mental Health Professional Shortage Areas with high rates of neonatal abstinence syndrome, opioid overdose, and maternal vulnerability. The population of focus is women of reproductive age (15-44) with a primary diagnosis of PSUD, with emphasis on perinatal opioid use disorder (POUD), and high rates of co-occurring depression, anxiety, and trauma-related disorders, together with their infants and minor children. Women served carry concentrated clinical and social needs, including housing instability, transportation and childcare barriers, and child welfare involvement. Strategies and Interventions. The overarching goal is to improve maternal and infant outcomes associated with untreated PSUD/POUD and co-occurring PMH by addressing gaps in the continuum of treatment, recovery, and obstetric care throughout pregnancy and the postpartum year for the mother-infant dyad and family unit. To achieve this, the project will (1) provide immediate access to specialized POUD/PSUD and PMH treatment, including medications for opioid use disorder (MOUD), through telehealth and embedded care coordination; (2) deliver PRD services combining lived experience, peer recovery support, and doula care for PPW and their families across community, treatment, and hospital settings; (3) implement a standardized, EHR-embedded clinical pathway and shared decision-making model to ensure continuity through prenatal care, labor and delivery and postpartum for dyads at two regional delivery hospitals; (4) offer provider training and real-time psychiatric consultation; (5) conduct outreach and referral from non-traditional entry points; (6) deliver family-strengthening and wrap-around services, including overdose prevention; and (7) convene a regional multi-sector consortium to coordinate and sustain a rural system of family-based care. Goals and Measurable Objectives. The project advances three goals aligned with SAMHSA's Strategic Priorities of evidence-based practice, prevention, and recovery: (1) deliver a coordinated continuum of evidence-based SUD, mental health, and prenatal care for PPW with POUD and cooccurring PSUD/PMH; (2) engage and retain high-risk PPW and their families in outreach, family strengthening, and recovery support across the perinatal period; and (3) coordinate and sustain a rural system of family-based care through cross-sector partnership and strategic planning. Measurable objectives include providing specialized treatment including MOUD to 150 PPW; delivering PRD services to 60 PPW; implementing the clinical pathway at two delivery hospitals by the end of Year 2; establishing PRD-led outreach at 10 non-traditional entry points; connecting 100% of participants to wrap-around recovery and overdose prevention services; and convening a regional consortium.
