Cross-Training Family Planning and Behavioral Health Providers for Integrated Care and Improved Outcomes


The number of pregnant people with opioid use disorder has more than quadrupled in recent years, with the heightened stress, loneliness, and anxiety driven by the Covid-19 pandemic further exacerbating the ongoing opioid crisis. In addition, only about 50% of women and men with substance use disorders report using contraception. Addressing both sexual and reproductive health (SRH) and substance use disorder (SUD) challenges requires new tools and clinical workflows for health care providers in both fields. While evidence indicates that integrating these disciplines can lead to improved health outcomes, barriers include a lack of comfort discussing SUD, fear of patient reactions, and time constraints.

With funding from the Office of Population Affairs, Altarum launched a 4-year cross-training program designed to increase SUD screenings and referrals in family planning clinics and increase family planning screening and referrals within SUD services. Due to the crucial nature of the provider linkages formed, the pilot program was called Link Study.


After recruiting clinics in Alaska, Georgia, and Nevada, Altarum conducted 1.5-day interactive cross-trainings for SRH and behavioral health (BH) providers. The trainings included evidence-based SUD screen tools, information on motivational interviewing and person-centered care, and the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. After the trainings, we provided six months of technical assistance to participating providers, including assistance with data sharing through electronic health records systems.

To measure changes in provider knowledge, self-efficacy, and screening and referral services, Altarum conducted an evaluation of the program, including pre- and post-training surveys and the collection of screening and referral data before the training, and at different intervals post-training.


As a result of the Link Study cross-training program, screening for both SUD and SRH services increase significantly as providers gained the knowledge and self-efficacy. Providers from both disciplines gained greater knowledge of the SUD and SRH services available for referral in their communities and built sustained relationships. Participants felt the training activities were interactive and encouraged open dialogue with SRH and SUD health care providers and clinic staff. They also appreciated having the opportunity to learn from each other and generate ideas collaboratively.

With rising rates of substance use and ongoing changes to sexual and reproductive health measures in the U.S., lessons learned from care integration studies like Link Study will be critical to improve health outcomes for persons with substance use disorders, as well as those at risk of developing these disorders.

“My goal was just to find a way to connect the two [sexual and reproductive health and substances use services] comfortably, to where you can easily transition from one to the other during visits.”

—Link Study Participant


Jessica McDuff
Program Director, Behavioral Health
Megan Higdon
Program Director, Sexual and Reproductive Health