{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T14:44:13Z","timestamp":1791989053673,"version":"4.4.0"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009490","name":"San Francisco General Hospital Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009490","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Given the profound impacts of substance use in pregnancy on the health and well\u2010being 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used process mapping, a human\u2010centered design (HCD) methodology, to characterize the steps involved with care delivery across the perinatal care continuum. Clinical and community\u2010based staff within a safety\u2010net 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty\u2010seven 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70252","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T12:19:03Z","timestamp":1770034743000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Using human\u2010centered design to map the perinatal ecosystem for pregnant people with substance use disorders"],"prefix":"10.1002","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1787-2417","authenticated-orcid":false,"given":"Christina N.","family":"Schmidt","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology Mass General Brigham  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin S.","family":"Alpers","sequence":"additional","affiliation":[{"name":"Department of Surgery University of California San Francisco  San Francisco California USA"},{"name":"The Better Lab University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devika","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery University of California San Francisco  San Francisco California USA"},{"name":"The Better Lab University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Chehab","sequence":"additional","affiliation":[{"name":"Department of Surgery University of California San Francisco  San Francisco California USA"},{"name":"The Better Lab University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeti","family":"Doshi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Briscoe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcy","family":"Spaulding","sequence":"additional","affiliation":[{"name":"Department of Maternal, Child and Adolescent Health Department of Public Health  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Ocegueda","sequence":"additional","affiliation":[{"name":"Department of Maternal, Child and Adolescent Health Department of Public Health  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Sammann","sequence":"additional","affiliation":[{"name":"Department of Surgery University of California San Francisco  San Francisco California USA"},{"name":"The Better Lab University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Department of Health and Human Services; Substance Abuse and Mental Health Services Administration (SAMHSA).2020.Results From the 2019 National Survey on Drug Use and Health: Detailed Tables."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000000472"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6731a1"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2018.304771"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000004649"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40352\u2010015\u20100015\u20105"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.4137\/SART.S23328"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000991"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2016.09.002"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2018.01.026"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2019.107652"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2010.02.003"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh\u20102020\u2010200799"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0886260513505711"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2014.4872"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000001016"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2015.10.003"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1499"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7425.1219"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000843"},{"key":"e_1_2_11_22_1","unstructured":"Ideo.The Field Guide to Human Centered Design. Accessed December 15 2021.https:\/\/www.designkit.org\/resources\/1."},{"key":"e_1_2_11_23_1","volume-title":"This Is Service Design Thinking: Basics, Tools, Cases","author":"Stickdorn M.","year":"2012"},{"key":"e_1_2_11_24_1","volume-title":"Delft Design Guide: Design Strategies and Methods","author":"Boeijen A.","year":"2014"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1080\/24735132.2019.1582741"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcsop.2021.100006"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocpiqo.2019.07.004"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000648"},{"key":"e_1_2_11_29_1","unstructured":"Children and Family Futures.System Walkthrough. Accessed September 22 2022.http:\/\/www.cffutures.org\/files\/publications\/Walkthrough%20Flowchart%20Template.pdf."},{"key":"e_1_2_11_30_1","unstructured":"Turning Insights into Opportunities.Bridge Innovate. Accessed September 22 2022.https:\/\/www.bridgeinnovate.com\/blog\/2017\/12\/19\/turning\u2010insights\u2010into\u2010opportunities."},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2019.104037"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.23"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2021.100453"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2021.306214"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/0002716220979520"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12552\u2010021\u201009316\u20105"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1093\/sf\/soy093"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hjdsi.2015.12.002"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010021\u201006609\u20108"},{"key":"e_1_2_11_40_1","unstructured":"American College of Obstetricians and Gynecologists.Opposition to Criminalization of Individuals During Pregnancy and the Postpartum Period. Accessed September 21 2022.https:\/\/www.acog.org\/en\/clinical\u2010information\/policy\u2010and\u2010position\u2010statements\/statements\u2010of\u2010policy\/2020\/opposition\u2010criminalization\u2010of\u2010individuals\u2010pregnancy\u2010and\u2010postpartum\u2010period."},{"key":"e_1_2_11_41_1","volume-title":"Clinical Drug Testing of Pregnant Women and Newborns","author":"National Advocates for Pregnant Women","year":"2019"},{"key":"e_1_2_11_42_1","unstructured":"Kotter J.Leading Change: Why Transformation Efforts Fail. Accessed September 24 2022.https:\/\/hbr.org\/1995\/05\/leading\u2010change\u2010why\u2010transformation\u2010efforts\u2010fail\u20102."}],"container-title":["Pregnancy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmf2.70252","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pmf2.70252","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmf2.70252","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:44:17Z","timestamp":1791985457000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pmf2.70252"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":41,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/pmf2.70252"],"URL":"https:\/\/doi.org\/10.1002\/pmf2.70252","archive":["Portico"],"relation":{},"ISSN":["2997-9684","2997-9684"],"issn-type":[{"value":"2997-9684","type":"print"},{"value":"2997-9684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]},"assertion":[{"value":"2025-08-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70252"}}