Social Capital as Community Infrastructure: Supporting Mothers, Families, and Recovery

The opioid epidemic has left no community untouched, but its effects are not only a public health crisis. In economically distressed communities, it also exposes weaknesses in the systems that support family stability, workforce participation, and community well-being. Although communities may have health departments, social service agencies, nonprofits, treatment providers, and public safety organizations working in the same community, residents can still struggle to access help. Primarily, because these institutions operate independently, have limited resources, or are unable to share information and coordinate their work.

These challenges are especially consequential for pregnant individuals with Opioid Use Disorder (OUD). In Cabarrus, Rowan, and Stanly counties, mothers seeking recovery have encountered stigma, fragmented care systems, transportation and resource barriers. Many are also confronting significant economic instability. The Substance Use Network (SUN) Project was designed to change that reality. By building a cross-sector, collaborative system of care, the project demonstrates how social capital, the networks, trust, and shared norms that connect people and institutions, can be mobilized to improve health outcomes for mothers and infants.

Among the SUN project participants, 79 percent were unemployed when they entered care. For community economic development practitioners, these conditions raise an important question: How can communities strengthen the relationships and institutional capacity needed to support residents in achieving good health, family well-being, and economic stability?

The SUN project offers an answer. Rather than creating another isolated program, the SUDA institute developed a cross-sector system of care connecting hospitals, local health departments, social service agencies, nonprofits, recovery providers, law enforcement, and state partners. The project demonstrates how social capital, networks, trust, and shared norms that connect people and institutions, can become a form of community infrastructure.

In my recent bulletin, Breaking Down Social Capital: What Is It and What Does It Mean for Community Development Organizations?, I described how social capital is often the “connective tissue” of community development. The SUN Project illustrates what that connective tissue looks like in practice. It shows that community development depends not only on financial investment, programs, or physical assets, but also on whether local institutions can build trust, coordinate resources, and respond collectively to residents facing complex challenges.

Building Community Capacity through Social Capital

The SUN Project’s goal is to create a collaborative, compassionate system of care for pregnant mothers with OUD, their infants, and families (Jäderholm et al., 2025). This work is also relevant to community economic development. Communities cannot achieve lasting economic stability when residents face barriers to health care, treatment, transportation, family support and other resources needed to participate fully in the community. By bringing together hospitals, local health departments, nonprofits, and state agencies, SUN transforms fragmented services into a coordinated network. The network functions as a form of community infrastructure, helping local institutions share information, mobilize resources, reduce duplication, and respond more effectively to residents with complex needs. The strength of that network is based on social capital, which is experienced in three primary forms: bonding, bridging, and linking (Szreter & Woolcock, 2004; Williams et al., 2021). 

Bonding Social Capital refers to strong ties within close-knit groups, including family networks, peer support specialists, or patient cohorts. These relationships foster solidarity, trust, and a sense of belonging. Many pregnant individuals facing OUD struggle with isolation, stigma, and fear of legal consequences. Peer support specialists, individuals with lived experience of recovery, play a critical role in the SUN Project. They offer not only empathy but also a trusted bridge to treatment. By helping mothers remain engaged in care, bonding social capital supports the personal and family stability that is foundational to longer-term social and economic well-being.

Bridging Social Capital develops through connections across different groups and institutions. Health providers, social service agencies, law enforcement, and nonprofits, that expand knowledge, unlock resources, and increase access. Connecting these organizations can expand access, improve referrals, and help residents navigate systems that might otherwise remain fragmented.

The SUN Project convenes a monthly care coordination team that includes the Cabarrus Health Alliance, Atrium Health, local departments of social services, law enforcement, recovery centers, and nonprofits like Endless Opportunities. Partners that traditionally operated in silos, now coordinate around shared goals: healthy mothers, healthy babies, and sustainable recovery. By creating a structure for communication across professional and institutional boundaries, SUN broadens perspectives, improves coordination, reduces service duplication and increases the community’s ability to use existing resources effectively.

Linking Social Capital describes relationships with those in positions of authority or control over resources, such as funders, state agencies, and policymakers. These vertical connections allow communities to address barriers that individual residents or service organizations cannot resolve on their own.

In practice, linking social capital means engaging with the systems that establish policies, control funding and determine how services can be delivered. One of the SUN Project’s greatest challenges was the “confidentiality conundrum.” Federal and state privacy laws made it difficult for providers to share information across sectors. The SUN project executive team connected with UNC faculty members, Mark Botts and Kristi Nickodem, to assist with navigating these legal challenges. Rather than seeing the law as a barrier, UNC faculty members created a memorandum of understanding, patient release forms, and training to enable cross-agency information sharing. By mobilizing linking social capital, the partners created legal and administrative infrastructure that protects patient privacy while strengthening collaboration. This illustrates an important community development function of linking capital: helping local organizations access the knowledge, authority, and resources needed to change systems rather than merely work around them.

Outcomes: What Coordinated Community Infrastructure Makes Possible

The outcomes of the SUN project are notable given the complex and interconnected challenges facing the population it serves (Jäderholm et al., 2025). A 2026 review of medical records for 29 SUN participants found that two-thirds (66%) had poly-substance use involving opioids, 59% disclosed a history of trauma, and 79% were unemployed at the time they entered care. Almost half (44%) were involved with the legal system before or during their time in the program. These conditions demonstrate why OUD cannot be addressed solely as an individual medical issue. Health, employment, housing, transportation, legal involvement, family stability, and access to supportive services are closely connected. For community economic development practitioners, the SUN Project illustrates how coordinated local systems can help residents achieve the stability needed to pursue recovery, care for their families, and participate more fully in community and economic life.

The results of the SUN Project include:

• From July 2020-June 2025, 167 pregnant and postpartum clients served since July 2019
• Zero recorded maternal and infant deaths
• 87% of births at term (37-week gestation or later), with every mother who entered care in her first trimester delivering at term and at a healthy birth weight
• 90% of infants born at a healthy birth weight (5 lbs. 8 oz. or more)
• 94% adherence to medication-assisted treatment
• 93% of participants believe the services and support they receive at the SUN clinic will help their long-term recovery goals
• 97% of participants found SUN helpful in accessing counseling, and 93% in accessing parenting and family support
• 93% of participants feel safe in the SUN Clinic, treated with respect, and able to trust the partners of the SUN collaboration network
• 86% report that the services and support provided by SUN have helped them become stronger or more self-reliant
• Among participants with available custody data at one year postpartum, 84% retained custody of their infant, a meaningful outcome for a population that too often faces the threat of family separation. High rates of missing data temper the confidence with which these trends can be interpreted, but the available evidence points toward the kind of stability that coordinated, relationship-centered care is designed to make possible (Jäderholm & Williams, 2024).

These outcomes are not solely the product of medical interventions. They also result from relationships built across systems, providers who trust one another, patients who feel heard and respected, and funders, policymakers and institutional leaders who are engaged in solving shared problems. SUN demonstrates that social capital can increase both individual access to support and the collective capacity of community institutions.

Community Development Lessons from the SUN Project

The SUN Project offers three lessons for organizations and leaders working in community economic development:

1. Access to social capital supports stability. By co-locating services and centering the patient, SUN made treatment and support more accessible for individuals who might otherwise fall through the cracks. Accessible systems can help residents achieve the improved health outcomes and family stability needed to pursue broader social and economic goals.
2. Mobilization of social networks improves community responses. Relationships are not enough. When SUN activated its network through case reviews, referrals, and regular coordination, families received faster and more integrated support. Mobilization turned relationships into tangible resources for residents.
3. Utilization of social capital sustains community capacity. By formalizing memoranda of understanding, release forms, training, and information-sharing practices, SUN reduced its dependence on informal relationships. These structures make collaboration more durable and strengthen the community’s capacity to respond to future challenges.

Together, these lessons reflect the stages of accessing, mobilizing, and utilizing social capital described in “Breaking Down Social Capital.” They also demonstrate a central principle of community economic development: communities are strengthened not only through new programs or financial investment, but also by improving the relationships, institutions, and systems that allow residents and organizations to thrive.

By Teshanee Williams and Gina Hofert

Teshanee Williams is a School of Government faculty member focusing on nonprofit management, partnerships between nonprofits and local governments, and community engagement. Gina Hofert is the Chief Executive Officer of The Suda Institute, a non-profit focusing on cross-sector systems change, strategic partnerships, and innovative approaches to improving maternal, child, and family health, particularly for those impacted by substance use disorder.