Does perinatal treatment for opioid use disorder increase family stability? A county-level analysis

Background

In 2020, 51.4% of U.S. infant out-of-home placements were due to parental substance use —an 85% increase since 2000—consistent with opioid use disorders (OUD) among birthing individuals rising 500% from 2000 to 2014 and remained high through 2021. Recovery outcomes and infant health improve with family stability, making comprehensive perinatal OUD treatment a promising approach. Even so, evidence of its effectiveness in preserving families remains limited. North Carolina’s Substance Use Network (SUN), implemented in 2019, is a community-based perinatal OUD treatment model; we assessed its county-level impact on infant out-of-home placements across seven years.

Methods

We used county-level data from NC to compare infant out-of-home placements in SUN intervention counties to the remaining 91 NC non-intervention counties (excluding 7 counties with similar perinatal interventions) pre- and post-SUN’s 2019 implementation (2015-2021, inclusive). Through descriptive statistics, we assessed out-of-home placement outcomes in terms of rates, mean time in placement, and placement stability.

Results

We saw no change in rates of out-of-home placement. However, the mean number of days infants spent in out-of-home placement decreased 181.93 days after SUN’s implementation compared to prior years; non-intervention counties decreased 74.11 days during the same time period. SUN counties also experienced an increase in their placement stability; the percentage of infants who only experienced a single placement increased 25% in SUN pre-post implementation, with no changes in non-intervention counties.

Discussion

SUN’s implementation was positively associated with improved infant placement outcomes, supporting that comprehensive OUD treatment can enhance stability by reducing time in and number of placements, though overall rates may not change. Our findings can help guide public health and child welfare systems when responding to pregnant and postpartum peoples’ needs.

Key messages

• Supporting pregnant and postpartum people’s recovery from opioid use disorder through comprehensive perinatal treatment was associated with fewer and shorter out-of-home placements for their infants.

• Integrating comprehensive OUD treatment into child welfare and perinatal health systems may strengthen coordinated responses to support pregnant and postpartum people and reduce family disruption.