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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. [ABSTRACT FROM AUTHOR]

As increasing resources are now being directed towards addressing the growing U.S. opioid epidemic, the long-term care of children from opioid-affected families has been relatively neglected. While an array of evidence suggests long-term negative developmental, medical, and social impacts to children related to their parents' opioid use, there remains much to be learned about how best to support children and families to promote healthy outcomes. Here, we report on the launch of an innovative family-centered pediatric medical home for opioid-affected families in Boston. We describe the program, the patient cohort, and early lessons learned. Important themes include the vulnerability of families with infants whose parents are in early recovery, and the need for compassionate, high-touch, high-continuity, team-based care that views the needs of the family as a whole. We recommend a future emphasis on non-stigmatizing, trauma-informed care; centering the needs of the family by addressing social and logistics barriers and by expanding models of parent-child dyadic care; investing in attachment and mental health interventions; developing strategies for prevention of opioid use disorder (OUD) in the next generation; and grounding our advocacy and actions in a social justice approach. [ABSTRACT FROM AUTHOR]