PROJECT SUMMARY The overarching goal of my program of research is to develop and inform preventive interventions to improve parent–child outcomes for families affected by substance use. The focus of this K23 award is to inform and adapt an evidenced-based preventive parenting intervention, the Family Check-Up (FCU), to improve parent– child outcomes among pregnant women with opioid use disorder (OUD). OUD is often accompanied by co- occurring psychosocial challenges (e.g., mental health, compromised interpersonal relationships) that impact caregiving quality. Existing parenting interventions for women with OUD largely begin postnatally, with the few extant prenatal interventions narrowly focused on parenting education and skills and ending at or shortly after birth. Further, existing interventions are often ill-equipped to address the common and complex psychosocial challenges of women with OUD. As such, existing parenting interventions miss opportunities to intervene to prevent the development of parenting challenges before the child’s birth and to intervene during pregnancy, which is a peak window of engagement in OUD treatment services and enhanced motivation to engage in recovery. This proposal addresses the need for parenting interventions for pregnant women with OUD that begin during pregnancy and address co-occurring psychosocial challenges. Accordingly, the proposed project will use qualitative and quantitative research methods to adapt and pilot the FCU for delivery during pregnancy within a prenatal primary care setting for women with OUD. Aim 1 will qualitatively characterize the parenting needs of women with OUD across the perinatal period, barriers to engagement in parenting interventions, and desired outcomes of intervention. Aim 2 will adapt the FCU intervention for pregnancy using the ADAPT-ITT framework and data collected during Aim 1. Aim 3 will conduct a pilot study of the prenatal FCU assessing engagement and short-term outcomes including maternal psychosocial functioning (mental health and interpersonal functioning) and parent–child relationship quality and self-efficacy. To achieve the proposed goals and transition to independence, I require training in perinatal opioid use, applied qualitative and mixed-methods research, and methods for developing and testing preventive interventions. An experienced team will guide my training. Dr. Shaw (co-primary mentor) is a clinical and developmental psychologist and co-developer of the postpartum FCU with expertise in parenting interventions and prevention science. Dr. Krans (co-primary mentor) is an obstetrician-gynecologist and substance use treatment provider with expertise in perinatal OUD and women’s health. Dr. Chang (co-mentor) is an obstetrician-gynecologist with expertise in qualitative research methods and women’s health. The training and research plan will form the basis to support an R-level proposal with the goal of bridging pre- and postnatal parenting interventions to op...