Using human-centered design to map the perinatal ecosystem for pregnant people with substance use disorders.

OBJECTIVE: Given the profound impacts of substance use in pregnancy on the health and well-being of parents and newborns, improving the organization and delivery of perinatal services for this population is a priority. The objective of this study was to characterize the perinatal ecosystem for pregnant people with substance use disorders (SUDs) and identify operational gaps and opportunities to strengthen care delivery. METHODS: We used process mapping, a human-centered design (HCD) methodology, to characterize the steps involved with care delivery across the perinatal care continuum. Clinical and community-based staff within a safety-net healthcare system participated in group and individual process mapping sessions in which they responded to 39 structured questions spanning prenatal through postpartum care. Following an HCD approach to qualitative analysis, we identified themes and generated opportunities. RESULTS: Forty-seven stakeholders participated in process mapping. Analysis revealed three major themes: (1) divergent understandings of policies and procedures among providers, (2) challenges with care coordination, and (3) lack of standardized procedures for engaging Child Protective Services. These themes led to the identification of 13 actionable opportunities to strengthen perinatal care delivery. CONCLUSIONS: Process mapping is a valuable methodology for improving systems of care for pregnant people with SUDs. In our ecosystem, process mapping revealed a lack of clear policies and challenges with care coordination. Strengthening healthcare systems is essential to improving consistency, quality, and outcomes for families affected by SUDs in pregnancy.