Implementation of Dyadic Care to Support Clinical, Administrative, and Service Wraparound Needs for the Opioid-Exposed Mother and Infant.

Abstract

Although a dyadic approach to clinical care is recommended for opioid-exposed mothers and their infants, there is a lack of practice-based guidance on clinical implementation. To address this knowledge gap, a comparative evaluation of outpatient dyadic care practice models in the US was conducted. This 2-phase qualitative study was designed to identify essential commonalities and distinctions in dyadic practice across 3 domains: clinical, administrative, and service wraparound. Five programs serving urban and rural communities participated from private, academic, and federally qualified health centers (FQHC) with business models spanning grant-funded, fee-for-service, and FQHC. Data were analyzed by applying descriptive statistics. Across programs (1 rural, 4 urban), dyadic care was consistently defined but variably operationalized across clinical, administrative, and service wraparound domains. Clinically, all programs treated the mother-infant dyad as a single unit, yet care delivery was typically fragmented across time and setting due to resource constraints. Administratively, billing practices were heterogeneous, with reliance on existing obstetric, pediatric, maternal mental health, and family therapy codes; no program used dyad-specific billing mechanisms. All programs incorporated wraparound services, including food, housing, transportation, lactation support, infant supplies, and parenting education, though the extent and integration of these services varied. Despite challenges, including funding, space, and coordination across clinicians/departments associated with providing dyadic care, key practice-based elements were identified that can facilitate the implementation of dyadic care across clinical, administrative, and service wraparound domains. Consideration should be given to address common resource limitations to significantly improve mother-infant dyad care across these domains.