Division of General Academic Pediatrics, Massachusetts General Hospital for Children (DM Schiff, S Patridge, and EM Taveras), Boston, Mass.
Division of General Academic Pediatrics, Massachusetts General Hospital for Children (DM Schiff, S Patridge, and EM Taveras), Boston, Mass.
Acad Pediatr. 2022 Jan-Feb;22(1):125-136. doi: 10.1016/j.acap.2021.04.016. Epub 2021 Apr 24.
We sought to 1) identify models of integrated care that offer medical care and social services for children and families impacted by opioid use disorder (OUD) in the postpartum year; and 2) describe how each program was developed, designed, and sustained, and explore facilitators and barriers to implementation of a dyadic, two-generation approach to care.
In-depth semi-structured interviews (n = 23) were conducted with programs for women and children affected by OUD across North America. Using a phenomenologic approach, key program components and themes were identified. Following thematic saturation, these results were triangulated with experts in program implementation and with a subset of key informants to ensure data integrity.
Five distinct types of programs were identified that varied in the degree of medical and behavioral care for families. Three themes emerged unique to the provision of dyadic care: 1) families require supportive, frequent visits with a range of providers, but constraints around billable services limit care integration across the perinatal continuum; 2) individual program champions are critical, but degree and reach of interdisciplinary care is limited by siloed systems for medical and behavioral care; and 3) addressing dual, sometimes competing, responsibilities for both parental and infant health following recurrence of parental substance use presents unique challenges.
The key components of dyadic care models for families impacted by OUD included prioritizing care coordination, removing barriers to integrating medical and behavioral services, and ensuring the safety of children in homes with ongoing parental substance use while maintaining parental trust.
我们旨在 1）确定为受阿片类药物使用障碍（OUD）影响的儿童和家庭提供医疗和社会服务的综合护理模式；2）描述每个项目的开发、设计和维持方式，并探讨实施双代护理方法的促进因素和障碍。
对北美受 OUD 影响的妇女和儿童的项目进行了深入的半结构式访谈（n=23）。采用现象学方法，确定了关键项目组成部分和主题。在主题饱和后，将这些结果与方案实施方面的专家以及关键信息提供者的一部分进行三角剖分，以确保数据完整性。
确定了五种不同类型的项目，它们在为家庭提供医疗和行为护理的程度上有所不同。提供双代护理有三个独特的主题：1）家庭需要与一系列提供者进行支持性、频繁的访问，但计费服务的限制限制了围产期护理的整合；2）个体项目拥护者至关重要，但医疗和行为护理的跨学科护理的程度和范围受到医疗和行为护理孤立系统的限制；3）在父母再次使用物质后，同时处理父母和婴儿健康的双重、有时相互竞争的责任，带来了独特的挑战。
受 OUD 影响的家庭双代护理模式的关键组成部分包括优先考虑护理协调、消除整合医疗和行为服务的障碍，以及在持续存在父母物质使用的家庭中确保儿童安全，同时保持父母的信任。
