Specifications include, but are not limited to: Qualified integrated perinatal care collaboratives must demonstrate evidence that the entity has policies, services, and partnerships to support interdisciplinary, integrated care. Specifically, a qualified integrated perinatal care collaborative must: (1) Help patients seek and obtain treatment for substance use disorders. (2) Help patients get needed health care, mental health services, social services, and other needed care by bridging cultural gaps and using community-based paraprofessionals such as doulas and community health workers. (3) Give culturally specific and culturally supportive patient education about prenatal care, birthing, and postpartum care, and document how patient education is provided. (4) Integrate child welfare case planning with substance abuse treatment planning and monitoring, as appropriate. (5) Systematize screening and care for behavioral and social risks known to be associated with low birth weight and preterm delivery within the community. (6) Help patients get ongoing care including postpartum and pediatric care, continued treatment for substance abuse and other mental health conditions, continued medication management for chronic diseases, and appropriate referrals to tribal or county-based social services agencies and tribal or county-based public health nursing services. (7) Collect and use data on metrics of quality such as health outcomes to implement ongoing quality improvement activities.
