CEREMONY: Culturally Engaged REcovery - MOms connected through Native community

摘要：项目1典礼 怀孕和产后的美洲印第安人和阿拉斯加原住民（原住民母亲）面临着两个以上- 与非西班牙裔白色母亲相比，产妇死亡风险高出一倍。与药物有关的死亡 使用（SU）和心理健康状况反映了可预防的孕产妇死亡的主要原因， 包括土著母亲，使这些条件成为降低孕产妇死亡率的一个有力目标 和发病率。犹他州孕产妇死亡率审查委员会（MMRC）已确定获得物质使用 阿片类药物使用障碍（SUD）治疗，包括阿片类药物使用障碍（MOUD）药物治疗，精神卫生保健，改善 社会支持，减少对SUD的污名，以及护理协调，特别是在产后期间 (when大多数死亡发生）作为可采取行动的干预点。我们研究的目的，文化上- MOMs通过本地社区（CEREMONY）连接，是为了适应基于证据的 将妊娠和产后护理与SU/SUD治疗和护理相结合的围产期护理模式， 原住民母亲的需求。与我们的合作伙伴在神圣圈诊所，一个联邦部落合同诊所经营 由戈舒特保留地的联合部落，我们是独一无二的准备回应表达的 土著母亲和利益攸关方的需求，他们认为缺乏文化融合的SUD护理是 土著母亲的围产期护理存在重大差距。我们要做的是建立在强有力的证据上- 基于我们的犹他州大学的综合围产期SUD诊所称为物质使用和 妊娠-恢复，成瘾和依赖（SUPeRAD）。SUPeRAD模型直接解决了 由MMRC确定的可采取行动的干预点，以防止与SUD相关的孕产妇死亡，但 特别适合土著母亲的需要。这项研究的基本原理是， 在适应和实施专门针对土著居民的综合围产期SUD护理方面存在差距 妈妈们CEREMONY研究将通过使SUPeRAD临床模型适应以下需求来填补这一空白： 使用经验证的ADAPT-ITT适应框架的本地母亲，以人为本的设计为依据 和基于社区的参与性研究（目标1）;然后测试适应，文化融合， 在Sacred Circle诊所使用混合1型有效性实施的围产期SUD护理干预 研究（目标2a和b）。混合1型设计将提供关于以下临床有效性的重要、可靠数据： 为土著母亲提供文化上适应的围产期SUD护理（目标2a），同时还产生了关于 实施过程（目标2b）。成功完成这些目标将提供实施和 可用于指导适应和实施文化适应的围产期SUD的培训方案 在美国各地的其他设置护理。本研究具有创新性和重要意义，因为它采用了强有力的 社区参与原则和强大的实施科学方法，以产生新的临床 有效性和实施数据，可以迅速传播，以显着改善护理 土著母亲与SUD和降低孕产妇死亡率和发病率的风险。

ABSTRACT: PROJECT 1 CEREMONY Pregnant and postpartum American Indian and Alaska Native people (Native mothers) face a more than two- fold higher risk of maternal mortality compared to non-Hispanic White mothers. Deaths related to substance use (SU) and mental health conditions reflect a leading cause of preventable maternal mortality, including among Native mothers, making these conditions a strong target for reducing maternal mortality and morbidity. The Utah Maternal Mortality Review Committee (MMRC) has identified access to substance use disorder (SUD) treatment including medication for opioid use disorder (MOUD), mental health care, improved social support, decreased stigma against SUD, and care coordination, particularly in the postpartum period (when the majority of deaths occur) as actionable intervention points. The objective of our study, Culturally- Engaged REcovery – MOms connected through Native CommunitY (CEREMONY), is to adapt evidence-based perinatal care models that integrate pregnancy and postpartum care with SU/SUD treatment and care to meet the needs of Native mothers. With our partners at Sacred Circle Clinic, a federal Tribal Contract clinic operated by the Confederated Tribes of the Goshute Reservation, we are uniquely poised to respond to the expressed needs of Native mothers and stakeholders, who identified a lack of culturally-integrated SUD care as a significant gap in perinatal care for Native mothers. We will do this by building upon the strong, evidence- based foundation of our University of Utah integrated perinatal SUD clinic called Substance Use and Pregnancy – Recovery, Addiction, and Dependence (SUPeRAD). The SUPeRAD model directly addresses the actionable intervention points identified by the MMRC to prevent SUD-related maternal deaths, but is not specifically adapted to Native mothers’ needs. The rationale for this study is that there is a critical knowledge gap in the adaptation and implementation of integrated perinatal SUD care specifically for Native mothers. The CEREMONY study will fill this gap by adapting the SUPeRAD clinic model to the needs of Native mothers using the validated ADAPT-ITT adaptation framework, informed by human centered design and community-based participatory research (Aim 1); and then testing the adapted, culturally-integrated perinatal SUD care intervention at Sacred Circle Clinic using a Hybrid Type 1 effectiveness-implementation study (Aim 2a&b). The Hybrid Type 1 design will provide important, reliable data on the clinical effectiveness of culturally adapted perinatal SUD care for Native mothers (Aim 2a) while also producing novel data on the implementation process (Aim 2b). Successful completion of these Aims will provide implementation and training protocols that can be used to guide adaptation and implementation of culturally-adapted perinatal SUD care in other settings across the US. Our study is innovative and significant because it employs strong community engagement principles and a robust implementation science approach to produce novel clinical effectiveness and implementation data that can be rapidly disseminated to dramatically improve the care of Native mothers with SUD and reduce risks for maternal mortality and morbidity.