PROJECT SUMMARY
In the past two decades, the rate of opioid use disorder (OUD) among pregnant women has more than
quadrupled, constituting a U.S. public health crisis. For affected women and their children, OUD presents a
unique set of healthcare challenges across a continuum of care, with most research on this population focused
on pregnancy and the birth hospitalization. However, within a primary care setting, there remains a lack of
rigorous research on how best to support mothers with OUD and their children given the complexity of their
medical and psychosocial care needs. The current paradigm of well child care (WCC) comprised of 15-minute
pediatric visits provides limited opportunity for building maternal trust, addressing information needs, and
engaging mothers as key participants in their child’s health.
The objective of this project is to develop and evaluate a comprehensive group model of WCC for
mothers with OUD and their children that is clinically tailored for opioid-exposed infants, is trauma informed,
and is embedded within a maternal OUD treatment program. As a novel alternative to routine care, group well
child visits consist of a 2-hour facilitated session with several mothers and their infants grouped together,
resulting in increased time with the pediatrician, peer-to-peer learning, and enhanced focus on behavior
change and self-care. All study procedures will occur at the Maternal Addiction Treatment Education &
Research (MATER) program at Thomas Jefferson University, which provides comprehensive medical and
behavioral health programming for pregnant and parenting women with OUD. In Aim 1, we will develop and
standardize a modular, manualized group-based well child care curriculum for this population, using an
iterative, qualitative process of feedback from patients and providers. In Aim 2, we will demonstrate the
feasibility and acceptability of implementing group WCC within a maternal OUD treatment program. One
hundred and eight mother-infant dyads will be randomized to either group well child care or traditional well
child care, and studied over the first 18 months of life. Qualitative and quantitative data from patients and
treatment center staff will be collected. Finally in Aim 3, we will evaluate the efficacy of group WCC to improve
WCC utilization and experience and parenting knowledge and quality compared with traditional WCC.
This project responds to AHRQ's special emphasis notice of interest for health services research on the
opioids crisis (NOT-HS-18-015) by addressing the experience and outcomes of women and children, AHRQ
priority populations. This project also responds to AHRQ’s interest in primary care innovations to address
social determinants of health (NOT-HS-19-011). Given the volume of children affected by maternal OUD who
incur higher risks of maladaptive parenting, intergenerational effects of trauma, and adverse health outcomes,
we anticipate this research will be of significant impact.