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Turning the Tide

Turning the Tide promotes universal screening and stigma-free care for families impacted by substance use.
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About Turning the Tide

Turning the Tide is Colorado’s statewide perinatal quality improvement initiative focused on improving outcomes for pregnant and postpartum people and their infants affected by perinatal substance use. Based upon an Alliance for Innovation on Maternal Health (AIM) Patient Safety Bundle, this annual initiative provides hospital-based teams with evidence-based tools, clinical best practices, and implementation support to enhance substance use screening, brief intervention, and referral to recovery treatment services. Turning the Tide promotes a compassionate, family-centered approach that reduces stigma by framing perinatal substance use disorder as a chronic and treatable medical condition.

Through active engagement in Turning the Tide—one of CPCQC’s quality improvement initiatives—hospitals can meet the quality improvement requirement set by Colorado Senate Bill 24-175.

Why

Substance use during pregnancy is a growing public health concern linked to serious complications, including preterm birth, low birth weight, neonatal withdrawal, and increased risk of maternal illness or death. In Colorado, where 97% of births take place in hospitals, these care settings offer a critical window to identify and support individuals affected by perinatal substance use.

Perinatal substance use is more than a medical issue—it’s a matter of health equity. Too often, people who use substances during pregnancy face stigma, criminalization, and inconsistent care. These barriers worsen health outcomes and erode trust in the healthcare system. Turning the Tide seeks to change that narrative by supporting hospitals in delivering trauma-informed, non-punitive, and family-centered care. The initiative focuses on connecting patients with treatment and recovery supports, building coordinated systems of care, and ensuring that every person receives respectful, compassionate services that protect the health of both parent and baby.

Results

Hospitals participating in Turning the Tide are making meaningful improvements in care for birthing people affected by substance use. Key achievements to date include:

  • Expanded universal screening for substance use during pregnancy using validated, evidence-based tools
  • Stronger referral pathways and linkage to treatment and recovery supports for patients with substance use disorders
  • Increased staff training on trauma-informed, non-stigmatizing, person-centered care
  • Improved coordination between obstetric, pediatric, behavioral health, and social work teams to ensure seamless, wraparound support

As the initiative continues to grow, Turning the Tide is focused on advancing key measures of success:

75%

By December 2025, participating hospitals will increase the percentage of patients who screen positive for substance use and receive comprehensive care before discharge from 24% (2024 baseline) to at least 42%—a 75% increase.
 Comprehensive care includes:

  1. A social work consultation before hospital discharge
  2. Receipt of or referral to recovery treatment services
  3. Scheduling a postpartum follow-up visit before discharge

Expand training

Participating sites will also increase the number of providers trained alongside people with lived experience and demonstrate significant improvement in provider attitudes toward perinatal substance use, as measured by pre- and post-training assessments.

Advanced Improvements for Perinatal Substance Use

As part of the Turning the Tide initiative, hospitals that meet core program requirements—such as implementing universal screening and referral practices—can choose to deepen their work through two advanced tracks. 

These advanced options allow hospitals to customize their approach based on local needs and capacity, while continuing to receive targeted guidance and real-time data feedback from CPCQC’s quality improvement team.

Maternal Overdose Matters Plus (MOMs+)

This program supports hospitals in expanding access to medication for opioid use disorder MOUD, managing withdrawal during the hospital stay, and providing naloxone for overdose prevention. Participating hospitals receive specialized coaching from addiction medicine experts and pharmacists to update clinical workflows and improve care for pregnant and postpartum patients with substance use disorders.

Dyadic (mother-infant) Care Integration

This program helps Turning the Tide hospitals strengthen care coordination between maternal and infant care teams through a partnership with the Colorado Hospital Substance-Exposed Newborns (CHoSEN) program. Dyadic Care Integration supports hospitals in improving care for mother-infant pairs by developing clear processes for Plans of Safe Care, aligning toxicology testing policies, and promoting safe, supported breastfeeding. Participating teams receive tailored assistance to map current workflows, gather dyadic data, and implement family-centered, equitable improvements that bridge maternal and newborn care.

 

Program Partners

Turning the Tide is made possible through collaboration with:

  • Colorado Department of Human Services, Office of Behavioral Health
  • Colorado Department of Public Health & Environment (CDPHE)
  • Hospitals and health systems statewide
  • Substance use treatment providers
  • Parent and family advocacy organizations
  • Community-based care coordinators and perinatal behavioral health specialists

Together, these partners are building a system of care that treats substance use in pregnancy not with punishment, but with support, compassion, and connection.

Resources

Fact Sheet
Download Fact Sheet
5 R’s to Successful Implementation
Download 5 R’s
Validated Screening Tools
Download AUDIT C+2
Download 5Ps
Perinatal Substance Use Clinical Care Checklist
Download Checklist
Words Matter Poster
Download Poster
Staff Scripting for a Positive Screen
Download Document
MOMs+ website
Visit Site

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