Referral linkages to support pregnant and postpartum individuals with opioid use disorders in Florida: a social network analysis

BACKGROUND: Opioid Use Disorder (OUD) has emerged as a critical public health issue among pregnant and postpartum individuals. To address this concern, it is of utmost importance that healthcare institutions, community-based programs, and other agencies collaborate to improve the support offered to the concerned population in their OUD recovery journey. A social network analysis was conducted to understand collaborations among multisectoral agencies serving or having potential to serve pregnant and postpartum individuals with OUD. METHODS: Collaborations among agencies (n = 79), including three Continuous And Data-drivEN CarE (CADENCE) program clinics, in a large Florida county were mapped. A cross-sectional web-based survey was distributed to these agencies to capture inter-agency collaborations, including services provided (e.g., housing, transportation, etc.), interaction frequency, and perceptions of partner agency confidence, dependence, and value. Open-ended questions identified champion agencies and needs of agencies to better serve the population. Network maps of the agencies were generated to characterize the nature of existing collaborations and identify opportunities for strengthening interagency coordination. RESULTS: Twenty-six out of 79 enlisted agencies (33%) responded, describing connections with 72 enlisted agencies. The social network analysis of total 376 ties among these agencies demonstrated low density (0.108) but high clustering (0.637), indicating a connected core with tightly knit subgroups and cross-sector bridges especially through social services. CADENCE clinics were inter-linked; CADENCE Co-located pediatric/ psychiatric/Maternal-Fetal Medicine clinic was most connected (38 ties), followed by CADENCE Outpatient Prenatal Care clinic (16 ties), and CADENCE Addiction Medicine (9 ties). Collaboration frequency varied, with 34% of referral ties used only once a year or less, 13% used daily, and 17% never used. Agencies reported having confidence in 82% of collaborations, yet more than half (56%) were considered non-essential (no or little dependency) to achieving patient care goals. Qualitative insights emphasized integrated, trauma-informed care, standardized referral pathways and shared data; destigmatization, and harm reduction; simpler resource navigation and supports for housing and transportation. CONCLUSION: Overall, the county possesses a multisector perinatal OUD network that is yet underutilized. Strengthening structured referrals, interoperability, and wraparound, stigma-free services leveraging CADENCE could reduce fragmentation and improve maternal-infant outcomes. TRIAL REGISTRATION: ClinicalTrails.gov (NCT05609669). November 02, 2022.