1
|
Gulbransen K, Thiessen K, Ford N, Phillips Beck W, Watson H, Gregory P. Interprofessional Care Models for Pregnant and Early-Parenting Persons Who Use Substances: A Scoping Review. Int J Integr Care 2024; 24:24. [PMID: 38855026 PMCID: PMC11160395 DOI: 10.5334/ijic.7589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Use of substances during pregnancy is a global health concern. Interprofessional care teams can provide an optimal care approach to engage individuals who use substances during the perinatal period. The purpose of this scoping review is to provide a comprehensive summation of published literature reporting on interprofessional care models for perinatal individuals who use substances. Methods We conducted a systematic search for articles from health-related databases. The Preferred Reporting Items for Systematic Reviews for Scoping Reviews (PRISMA-ScR) was followed. Data were extracted and synthesized to identify the interprofessional care team roles, program and/or provider characteristics, and care outcomes of these models. Results We screened 645 publications for full text eligibility. Eleven articles met full inclusion criteria and were summarized. Programs were built on co-location of services, partnership with other agencies, available group/peer support and approaches inclusive of cultural care, trauma informed care, and harm reduction principles. Discussion There is growing evidence supporting integrated care models that are inclusive of relational care providers from multiple health care professions to achieve wraparound care. Conclusions Many of the interprofessional care models studied have successfully blended social, primary, pregnancy, and addictions care. The success and sustainability of programs varies, and more work is needed to evaluate program and patient outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Heather Watson
- Max Rady College of Medicine, University of Manitoba, CA
| | | |
Collapse
|
2
|
Hubberstey C, Rutman D, Van Bibber M, Poole N. Wraparound programmes for pregnant and parenting women with substance use concerns in Canada: Partnerships are essential. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2264-e2276. [PMID: 34841607 DOI: 10.1111/hsc.13664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 06/13/2023]
Abstract
Wraparound programmes, wherein multiple services are offered at one location, are effective in engaging pregnant or parenting women experiencing substance use and other complex challenges while also addressing gaps in services between the health, child welfare and addictions fields. Evaluations of these programmes have demonstrated positive outcomes; nevertheless, few studies have focused on how programmes' cross-sectoral partnerships are structured and the difference these partnerships make. Drawing on the Co-Creating Evidence study, a three-year Canadian evaluation of eight multi-service programmes in six provinces, this article examines the partnerships that make wraparound service delivery possible. The study used a mixed-methods design involving interviews, questionnaires, output and de-identified client data; this article reports on qualitative findings only. Sixty service partners and 108 programme staff were interviewed in 2018 and 2019. Qualitative data analysis techniques were applied; NVivo12 software (QRS International, Melbourne, Australia) was utilised to facilitate the analyses. In terms of the programmes' partnership characteristics, overall, programmes more commonly formed partnerships with child welfare, health services (e.g. primary care, public health and perinatal care) and specialised health services such as mental health services, maternal addictions and Opioid Agonist Therapy. The programmes had fewer partnerships with housing, income assistance, Indigenous cultural programming, infant development and legal services. Key benefits of partnerships included: clients' improved access to health and social care, addressing social determinants of health; partners' increased knowledge about the significance of trauma in relation to women's substance use; improved child welfare outcomes and strengthened cultural safety and (re)connection. Key challenges included: tensions between partners regarding differing perceptions, mandates and responsibilities; personal differences and systemic barriers. Lastly, by means of steady dialogue and collaboration, partners increased their appreciation and use of the trauma-informed, harm reduction approaches that are central to wraparound programmes.
Collapse
Affiliation(s)
| | | | | | - Nancy Poole
- Centre of Excellence for Women's Health, Vancouver, BC, Canada
| |
Collapse
|
3
|
Guille C, Hall C, King C, Sujan A, Brady K, Newman R. Listening to women and pregnant and postpartum people: Qualitative research to inform opioid use disorder treatment for pregnant and postpartum people. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100064. [PMID: 36845990 PMCID: PMC9948937 DOI: 10.1016/j.dadr.2022.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
Abstract
Background The diagnosis of Opioid Use Disorder (OUD) during pregnancy has increased 2-to-5-fold over the past decade and barriers to treatment are significant. Technology-based solutions have the potential to overcome these barriers and deliver evidence-based treatment. However, these interventions need to be informed by end-users. The goal of this study is to gain feedback from peripartum people with OUD and obstetric providers about a web-based OUD treatment program. Methods Qualitative interviews were conducted with peripartum people with OUD (n = 18) and focus groups were conducted with obstetric providers (n = 19). Feedback from these interviews informed the development of text message-based screening, brief phone-based intervention and referral to treatment program, called Listening to Women and Pregnant and Postpartum People (LTWP). Once developed, further qualitative interviews with peripartum people with OUD (n = 12) and obstetric providers (n = 21) were conducted to gather feedback about the LTWP program. Results Patients reported that a relationship with a trusted provider is paramount for treatment engagement. Providers reported that time constraints and complex patient needs prohibit them from treating OUD and that evidence-based Screening, Brief Intervention and Referral to Treatment (SBIRT) are not implemented effectively in routine prenatal care. Neither patients nor providers were enthusiastic about our web-based intervention for OUD; thus, results were used to guide the development of LTWP to improve implementation of SBIRT during prenatal care. Conclusions End-user informed, technology-enhanced SBIRT has the potential to improve the implementation of SBIRT during routine prenatal care, and in turn, improve maternal and child health.
Collapse
Affiliation(s)
- Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Casey Hall
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Courtney King
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
| | - Ayesha Sujan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Psychological and Brain Sciences, Indiana University – Bloomington, Bloomington, IN, USA
| | - Kathleen Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Psychological and Brain Sciences, Indiana University – Bloomington, Bloomington, IN, USA
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
4
|
Anderson C, Braverman A, Maes P, Reising V. Lessons Learned From the Implementation of an Integrated Prenatal Opioid Use Disorder Program. Nurs Womens Health 2022; 26:215-225. [PMID: 35568062 DOI: 10.1016/j.nwh.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate key lessons learned from efforts at increasing engagement in integrated prenatal and opioid use disorder services. DESIGN An interdisciplinary team consisting of a board-certified obstetrician and registered nurse led the implementation of this multipronged approach driven by several plan-do-study-act cycles to develop an integrated prenatal and opioid use disorder program. SETTING/LOCAL PROBLEM An urban community health center in Chicago, Illinois, where mental health issues, including substance use, are the leading cause of death for pregnant people. PARTICIPANTS Connections were made with local harm reduction agencies, substance use treatment facilities, and community outreach programs to develop partnerships with organizations providing existing addiction and maternal-child services in the community. INTERVENTION/MEASURES Partnership building was achieved through organization needs assessments, dissemination of information about integrated services, and sustained communication. Referral workflow guides and patient education cards were created and distributed to community partners. Incoming referrals were tracked at the clinic site. Use of the referral materials was evaluated via online surveys distributed to community partners. RESULTS In the 18 weeks of enhanced integration, three patients engaged in services and were initiated on medication for opioid use disorder, two of whom had been referred from agencies targeted in the outreach efforts. Surveys showed that community partners believe the referral guides were easy to use and that the harm reduction information on the patient cards was useful. CONCLUSION An urban community health center was equipped to provide comprehensive, integrated services to pregnant people with opioid use disorder, but barriers such as community unawareness and stigma impeded engagement. Sustained collaboration with community partners serving pregnant people with opioid use disorder supports program development and linkage to care. Integrated prenatal and opioid use disorder care is feasible, us destigmatizing in nature, and can lead to improved maternal and fetal outcomes.
Collapse
|
5
|
Hooker SA, Sherman MD, Lonergan-Cullum M, Nissly T, Levy R. What is success in treatment for opioid use disorder? Perspectives of physicians and patients in primary care settings. J Subst Abuse Treat 2022; 141:108804. [DOI: 10.1016/j.jsat.2022.108804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/05/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
|
6
|
Virtual Peer Support in Women's Health for Pregnant People and Mothers With Substance Use Disorder. Nurs Womens Health 2022; 26:226-233. [PMID: 35460640 DOI: 10.1016/j.nwh.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/10/2022] [Accepted: 03/03/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a virtual peer support group associated with a women's health unit for mothers and pregnant people with substance use disorder. DESIGN The project was guided by the Centers for Disease Control and Prevention's Framework for Program Evaluation in Public Health. Pre-/postintervention surveys were used to evaluate outcomes. SETTING Women's health unit in a 325-bed hospital with 900 births a year in the U.S. Midwest and a virtual online meeting format. PARTICIPANTS Thirteen people with substance use disorder. INTERVENTION/MEASUREMENTS Participants were recruited by nurses on the women's health unit and in existing online meetings. Participants attended a 12-week session of facilitated substance use disorder peer support meetings through an online virtual format. Surveys included the Depression, Anxiety, and Stress Scale; the Alcoholics Anonymous Intention Scale; and pre-/postintervention surveys developed by the authors. Descriptive statistics and narrative description of qualitative data were used. RESULTS The Depression, Anxiety, and Stress Scale scores were reduced, on average, by 25%, indicating that participants showed improvement in these conditions. Responses to open-ended questions showed that participants found the meetings helpful for developing coping mechanisms. The virtual space was seen as a comfortable, safe space where participants were able to develop community. CONCLUSION Substance use disorder treatment continues to challenge health care providers across the United States. Peer support meetings have been effective in the treatment of people with substance use disorder. Nursing has the holistic historical precedence of creating effectual education and support programs. This program evaluation exemplifies that women's health units are an appropriate location where nurses can integrate this established evidence-based treatment modality.
Collapse
|
7
|
Leiner C, Antono B, Ostrach B. Perinatal OUD Treatment Provider Understandings of Rural Patients' Experiences. J Addict Med 2022; 16:177-182. [PMID: 35289773 DOI: 10.1097/adm.0000000000000858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To present perspectives of substance use treatment providers offering perinatal opioid use disorder (OUD) treatment in a largely rural, Appalachian region. To demonstrate the extent to which providers sought to understand their patients' experiences accessing treatment and how this understanding informed providers' approach to offering patient-centered care. METHODS A qualitative study combining semi-structured interviews and participant-observation with perinatal substance use treatment providers, conducted within a comprehensive program. Using purposive and opportunistic sampling with key informants (n = 10), a saturation sample was achieved. Data were analyzed using modified Grounded Theory. RESULTS Perinatal substance use treatment providers had a good understanding of their patients' experiences seeking treatment for opioid use disorder, including being aware of obstacles patients encountered. This understanding allowed providers to better address patients' needs in and out of the clinic. CONCLUSIONS Participants demonstrated a good understanding of what their largely rural, Appalachian patients experienced when attempting to access perinatal OUD treatment. This understanding may enable more patient-centered care.
Collapse
Affiliation(s)
- Catherine Leiner
- UNC Health Sciences at MAHEC, Asheville, NC (CL); Family Medicine Residency Program, Mountain Area Health Education Center, Asheville, NC (BA); Medical resident in a program partially supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,656,886 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. (This statement is required by HRSA to be included in all publications on which a HRSA-funded medical resident is listed as an author.) (BA); Department of Research, UNC Health Sciences at MAHEC, Asheville, NC (BO); Boston University School of Medicine, Boston, MA (BO)
| | | | | |
Collapse
|
8
|
Olding M, Cook A, Austin T, Boyd J. "They went down that road, and they get it": A qualitative study of peer support worker roles within perinatal substance use programs. J Subst Abuse Treat 2021; 132:108578. [PMID: 34373170 DOI: 10.1016/j.jsat.2021.108578] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Perinatal substance use programs employ multidisciplinary teams to support women who use drugs through pregnancies and parenting, with some programs expanding to include peer support workers with lived experience of parenting and substance use. Research has shown peer support to enhance care in substance use treatment; however, little research exists that examines this model of support within perinatal substance use programs. We explore the current and potential role of peer support workers within perinatal substance use programs, from the perspectives of mothers accessing these programs. METHODS We conducted focus groups with 20 mothers enrolled in three perinatal substance use programs serving the greater Vancouver area, including two community-based programs that employed peer workers and an acute care maternity ward that did not. We recorded focus groups, had them professionally transcribed, and analyzed them thematically. RESULTS Participants characterized peer support workers as extending and complementing informal care practices already occurring within programs, including mother-to-mother support with breastfeeding, childcare, and system navigation. Integrating peer workers shifted care relations and practices in ways that participants found beneficial. Participants emphasized how support workers with similar social locations and life experiences-beyond just their substance use-helped to foster trust and safety for mothers in the program. Indigenous mothers discussed the importance of having Indigenous support workers whose practice is grounded in their cultures and experiences under colonization. Participants ascribed an aspirational status to peer support workers, conveying that it was motivational to see other mothers working in the program, and described the role as a means of maintaining connection and community. However, some expressed concerns about managing professional-personal boundaries and being emotionally "triggered" by the work. CONCLUSION This study evidences benefits of employing peer support workers within perinatal substance use programs, while also indicating the need for organizational processes to ensure that peer staff are integrated equitably and supported adequately.
Collapse
Affiliation(s)
- Michelle Olding
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Ainslie Cook
- BC Women's Hospital + Health Centre, Vancouver, BC, Canada
| | - Tamar Austin
- British Columbia Centre on Substance Use, Vancouver, BC, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
9
|
Graves L, Carson G, Poole N, Patel T, Bigalky J, Green CR, Cook JL. Guideline No. 405: Screening and Counselling for Alcohol Consumption During Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 42:1158-1173.e1. [PMID: 32900457 DOI: 10.1016/j.jogc.2020.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To establish national standards of care for screening and counselling pregnant women and women of child-bearing age about alcohol consumption and possible alcohol use disorder based on current best evidence. INTENDED USERS Health care providers who care for pregnant women and women of child-bearing age. TARGET POPULATION Pregnant women and women of child-bearing age and their families. EVIDENCE Medline, EMBASE, and CENTRAL databases were searched for "alcohol use and pregnancy." The results were filtered for a publication date between 2010 and September 2018. The search terms were developed using Medical Subject Headings terms and keywords, including pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring, and brief intervention. Evidence was included from clinical trials, observational studies, reviews, systematic reviews and meta-analyses, guidelines, and conference consensus. VALIDATION METHODS The content and recommendations in this guideline were drafted and agreed upon by the authors. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework. BENEFITS, HARMS, COSTS Implementation of the recommendations in these guidelines using validated screening tools and brief intervention approaches may increase obstetrical care provider recognition of alcohol consumption and problematic alcohol use among women of child-bearing age and those who are pregnant. It is anticipated that health care providers will become confident and competent in managing and supporting these women so they can achieve optimal health and pregnancy outcomes. SUMMARY STATEMENTS (GRADE RATINGS IN PARENTHESES) RECOMMENDATIONS (GRADE RATINGS IN PARENTHESES).
Collapse
|
10
|
Stockwell T, Benoit C, Card K, Sherk A. Problematic substance use or problematic substance use policies? HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2021; 40:135-142. [PMID: 32529972 DOI: 10.24095/hpcdp.40.5/6.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This special issue on substance use issues comes at a critical time for Canadian health policy makers and researchers. Most attention is currently focussed on the opioid crisis and the potential impacts of cannabis legalization. However, our most widely used and harmful substances continue to be alcohol and nicotine. Our policies to reduce harms from these substances are failing. While alcohol control policies are being gradually abandoned, opportunities to maximize the harm reduction potential of new, alternative and safer nicotine delivery devices are not being grasped. More generally, a greater focus is needed on harm reduction strategies that are informed by the experience of marginalized people with severe substance use-related problems so as to not exacerbate health inequities. In order to better inform policy responses, we recommend innovative approaches to monitoring and surveillance that maximize the use of multiple data sources, such as those used in the Canadian Substance Use Costs and Harms (CSUCH) project. Greater attention to precision in defining patterns of risky use and harms is also needed to support policies that more accurately reflect and respond to actual levels of substance use-related harm in Canadian society.
Collapse
Affiliation(s)
- Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada.,Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Cecilia Benoit
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada.,Department of Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Kiffer Card
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Adam Sherk
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
11
|
Lyall V, Guy J, Egert S, Pokino LA, Rogers L, Askew D. "They Were Willing to Work with Me and Not Pressure Me": A Qualitative Investigation into the Features of Value of a Smoking Cessation in Pregnancy Program for Aboriginal and Torres Strait Islander Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010049. [PMID: 33374701 PMCID: PMC7793509 DOI: 10.3390/ijerph18010049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022]
Abstract
With tobacco commonly used for stress relief, smoking cessation during pregnancy can present challenges for women facing stressful circumstances. This can be pronounced for Aboriginal and Torres Strait Islander women who experience disproportionately high smoking rates during pregnancy and also have a greater intersection of stressors from social disadvantage, institutional racism and trauma. To contribute understandings into how women can be best supported at this time, this study identified the features of value of an Aboriginal and Torres Strait Islander pregnancy smoking cessation program that addressed the contexts of women's lives in culturally affirming and strength-based ways. A narrative methodology using a yarning approach was used to interview 7 pregnant women, 6 significant others, 3 case managers, and 4 healthcare professionals. Data were analyzed using thematic analysis, guided by an Indigenist research practice of deep and reflexive researcher listening. Features of value included: relationship-based care, holistic wraparound care, flexibility, individualized care, and culturally orientated care. Combined, they enabled highly relevant and responsive women-centered, trauma-informed, and harm-reducing smoking cessation support that was well received by participants, who achieved promising smoking changes, including cessation. This approach strongly departs from standard practices and provides a blueprint for meaningful support for pregnant women experiencing vulnerabilities.
Collapse
Affiliation(s)
- Vivian Lyall
- School of Clinical Medicine, Primary Care Clinical Unit, Level 8 Health Sciences Building, Royal Brisbane & Women’s Hospital, The University of Queensland, Herston, QLD 4029, Australia;
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, P.O. Box 52, Inala, QLD 4077, Australia; (J.G.); (S.E.); (L.-A.P.); (L.R.)
| | - Jillian Guy
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, P.O. Box 52, Inala, QLD 4077, Australia; (J.G.); (S.E.); (L.-A.P.); (L.R.)
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, P.O. Box 52, Inala, QLD 4077, Australia; (J.G.); (S.E.); (L.-A.P.); (L.R.)
| | - Leigh-Anne Pokino
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, P.O. Box 52, Inala, QLD 4077, Australia; (J.G.); (S.E.); (L.-A.P.); (L.R.)
| | - Lynne Rogers
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, P.O. Box 52, Inala, QLD 4077, Australia; (J.G.); (S.E.); (L.-A.P.); (L.R.)
| | - Deborah Askew
- School of Clinical Medicine, Primary Care Clinical Unit, Level 8 Health Sciences Building, Royal Brisbane & Women’s Hospital, The University of Queensland, Herston, QLD 4029, Australia;
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, P.O. Box 52, Inala, QLD 4077, Australia; (J.G.); (S.E.); (L.-A.P.); (L.R.)
- Correspondence: ; Tel.: +61-421972078
| |
Collapse
|
12
|
Graves DL, Carson DG, Poole N, Patel DT, Bigalky J, Green CR, Cook JL. Directive clinique n o 405 : Dépistage et conseils en matière de consommation d'alcool pendant la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1174-1192.e1. [PMID: 32900458 DOI: 10.1016/j.jogc.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIF Établir des normes pancanadiennes fondées sur les meilleures données probantes actuelles sur le dépistage et les conseils en matière de consommation d'alcool et de troubles de consommation d'alcool chez les femmes enceintes ou en âge de procréer. PROFESSIONNELS CONCERNéS: Les fournisseurs de soins qui prodiguent des soins aux femmes enceintes et aux femmes en âge procréer. POPULATION CIBLE Les femmes enceintes, les femmes en âge de procréer et leurs familles. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, Embase et CENTRAL avec le thème « alcohol use and pregnancy ». Les résultats ont été filtrés de façon à obtenir des publications parues entre 2010 et septembre 2018. Les termes de recherche ont été mis au point à partir des termes du thésaurus de référence biomédicale MeSH et de mots clés, dont les suivants : pre-pregnancy, pregnant, breastfeeding, lactation, female, women, preconception care, prenatal care, fetal alcohol spectrum disorder, prenatal alcohol exposure, drinking behavior, alcohol abstinence, alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol consumption, alcohol abuse, benzodiazepines, disulfiram, naltrexane, acamprosate, ondansetron, topiramate, cyanamide, calcium carbimide, alcohol deterrents, disease management, detoxification, Alcoholics Anonymous, alcohol counselling, harm reduction, pre-pregnancy care, prenatal care, incidence, prevalence, epidemiological monitoring et brief intervention. Les données probantes retenues proviennent d'essais cliniques, d'études observationnelles, de revues de la littérature, d'analyses systématiques et méta-analyses, de lignes directrices et de conférences de consensus. MéTHODES DE VALIDATION: Les auteurs ont rédigé et accepté le contenu et les recommandations de la présente directive. Le conseil d'administration de la Société des obstétriciens et gynécologues du Canada a approuvé la version définitive aux fins de publication. La qualité des données probantes a été évaluée au moyen des critères de l'approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation) (consulter les tableaux A1 et A2 de l'annexe en ligne). BéNéFICES, RISQUES, COûTS: La mise en œuvre des recommandations de la présente directive à l'aide d'outils de dépistage validés et de stratégies d'intervention brève peut améliorer la capacité des fournisseurs de soins obstétricaux à reconnaître la consommation d'alcool et la consommation problématique d'alcool chez les femmes enceintes ou en âge de procréer. Il est attendu des fournisseurs de soins de santé qu'ils deviennent confiants et compétents en matière de prise en charge et de soutien de ces femmes afin qu'elles puissent avoir la meilleure santé possible et une issue de grossesse optimale. DÉCLARATIONS SOMMAIRES (CLASSEMENT GRADE ENTRE PARENTHèSES): RECOMMANDATIONS (CLASSEMENT GRADE ENTRE PARENTHèSES).
Collapse
|
13
|
Rutman D, Hubberstey C, Poole N, Schmidt RA, Van Bibber M. Multi-service prevention programs for pregnant and parenting women with substance use and multiple vulnerabilities: Program structure and clients' perspectives on wraparound programming. BMC Pregnancy Childbirth 2020; 20:441. [PMID: 32746789 PMCID: PMC7397660 DOI: 10.1186/s12884-020-03109-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, several community-based, multi-service programs aimed at reaching vulnerable pregnant or parenting women with substance use and complex issues have emerged. These programs offer basic needs and social supports along with perinatal, primary, and mental health care, as well as substance use services. Evaluations of these 'one-stop' programs have demonstrated positive outcomes; nevertheless, few published studies have focused on how these programs are structured, on their cross-sectoral partnerships, and on clients' perceptions of their services. METHODS The Co-Creating Evidence (CCE) project was a three-year evaluation of eight multi-service programs located in six Canadian jurisdictions. The study used a mixed-methods design involving semi-structured interviews, questionnaires, output data, and de-identified client data. This article focuses on qualitative interviews undertaken with 125 clients during the first round of site visits, supplemented by interview data with program staff and service partners. RESULTS Each of the programs in the CCE study employs a multi-service model that both reflects a wrap-around approach to care and is intentionally geared to removing barriers to accessing services. The programs are either operated by a health authority (n = 4) or by a community-based agency (n = 4). The programs' focus on the social determinants of health, and their provision of primary, prenatal, perinatal and mental health care services is essential; similarly, on-site substance use and trauma/violence related services is pivotal. Further, programs' support in relation to women's child welfare issues promotes collaboration, common understanding of expectations, and helps to prevent child/infant removals. CONCLUSIONS The programs involved in the Co-Creating Evidence study have impressively blended social and primary care and prenatal care. Their success in respectfully and flexibly responding to women's diverse needs, interests and readiness, within a community-based, wraparound service delivery model paves the way for others offering pre- and postnatal programming.
Collapse
Affiliation(s)
- Deborah Rutman
- Principal, Nota Bene Consulting Group, 1434 Vining St, V8R 1P8 Victoria, BC Canada
| | - Carol Hubberstey
- Principal, Nota Bene Consulting Group, 1434 Vining St, V8R 1P8 Victoria, BC Canada
| | - Nancy Poole
- Centre of Excellence for Women’s Health, V6H 3N1 Vancouver, BC Canada
| | - Rose A. Schmidt
- Centre of Excellence for Women’s Health, V6H 3N1 Vancouver, BC Canada
| | - Marilyn Van Bibber
- Principal, Nota Bene Consulting Group, 1434 Vining St, V8R 1P8 Victoria, BC Canada
| |
Collapse
|
14
|
A Process Evaluation of a Substance Use Program for Pregnant Women: Lessons Learned from the Field. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00374-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
15
|
Costello MJ, Sousa S, Ropp C, Rush B. How to Measure Addiction Recovery? Incorporating Perspectives of Individuals with Lived Experience. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-018-9956-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
16
|
Contextual Influences Experienced by Queensland Midwives: A Qualitative Study Focusing on Alcohol and Other Substance Use During Pregnancy. INTERNATIONAL JOURNAL OF CHILDBIRTH 2019. [DOI: 10.1891/2156-5287.9.2.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSETo understand the experiences and contextual factors that influence the ability of midwives to provide appropriate support to women regarding alcohol and other drug (AOD)e use during pregnancy, in the Queensland context.DESIGNUsing a qualitative approach underpinned by critical realism, we explored the experiences of eleven midwives using semi-structured interviews. Thematic analysis was utilized, which was inductive and deductive, as it aimed to explicate different contextual factors at play, based on the experiences of the current sample of midwives.MAJOR FINDINGSExperiences of midwives in the current study were influenced by five overarching contextual factors: (a) patient-level factors (complexities experienced by women and lack of knowledge regarding maternity care options); (b) provider/patient-level factors (importance of midwives building relationships with women and importance of continuity of care); (c) provider-level factors (importance of taking a supportive approach, midwife confidence, engagement in AOD screening, variable attitudes and knowledge); (d) organizational-level factors (lack of support and training, concerns regarding communication, time constraints and organizations that limited midwife involvement); (e) broader system-level factors (lack of effective services and inconsistent messages regarding AOD use during pregnancy).CONCLUSIONSThe current study has highlighted a range of practice areas and potential implementation strategies across a number of contextual levels that could be beneficial in the Queensland context to improve maternity care provision for women who are experiencing AOD use challenges during pregnancy.
Collapse
|
17
|
Ashford RD, Brown AM, Dorney G, McConnell N, Kunzelman J, McDaniel J, Curtis B. Reducing harm and promoting recovery through community-based mutual aid: Characterizing those who engage in a hybrid peer recovery community organization. Addict Behav 2019; 98:106037. [PMID: 31330467 PMCID: PMC6708724 DOI: 10.1016/j.addbeh.2019.106037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 06/25/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Peer-based support services are often used within harm reduction organizations, and more recently within recovery community organizations (RCO). Identifying the characteristics of individuals who engage with these novel RCOs is needed. Additionally, conducting collaborative research with communities of people who use drugs (PWUD) or are in recovery is an effective and rewarding approach that allows individuals to take ownership and play a critical role in the study. METHODS This exploratory study employs a community-based participatory research (CBPR) framework in partnership with a peer-led hybrid recovery community organization, Rebel Recovery, in Florida. Peer staff participated in all phases of the study, helping to inform the study protocol, data collection, analysis, interpretation, and results write-up. A cross-sectional survey instrument was used to collect consumer intake data. Pearson Chi-square tests and multivariate binomial logistic regressions were used to examine relationships between consumer characteristics and service utilization. RESULTS Consumers (n = 396) of Rebel Recovery peer support services had a mean age of 35.60 years (SD = 9.74). Many were experiencing homelessness (35.4%), unemployed (69.7%), high school graduates or GED holders (68.2%) and had a last year income of less than $10,000 (58.3%). The majority were users of heroin primarily (70.7%), with intravenous use being the preferred route of administration (63.9%). Exploratory analysis found that gender, marital status, and involvement in the child welfare system were significantly related to primary substance of use. Past 30-day engagement in recovery meetings had several statistically significant predictors including primary substance of use, age, housing status, annual income level, past-30-day arrests, tobacco use, and alcohol harm perception. Process findings from the CBPR methods used reconfirm the value of including peers in research involving PWUD and individuals in recovery. CONCLUSIONS Results suggest that peer-based support services at a hybrid recovery community organization can successfully engage populations that are often underserved (i.e., experiencing homelessness, involved in drug court, intravenous users, etc.). Significant relationships identified in the exploratory analysis suggest that additional education concerning overdose and the potential benefits of recovery meetings may be useful for specific consumers. Additionally, several recommendations and benefits of engaging in community-based participatory research with peer-led organizations are made for future research.
Collapse
Affiliation(s)
- Robert D Ashford
- Substance Use Disorders Institute, University of the Sciences, Philadelphia, PA, United States of America.
| | - Austin M Brown
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States of America.
| | | | | | | | - Jessica McDaniel
- Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States of America.
| | - Brenda Curtis
- National Institutes of Health, National Institute on Drug Abuse, Baltimore, MD, United States of America.
| |
Collapse
|
18
|
National Evaluation of Canadian Multi-Service FASD Prevention Programs: Interim Findings from the Co-Creating Evidence Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101767. [PMID: 31109087 PMCID: PMC6572203 DOI: 10.3390/ijerph16101767] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 01/07/2023]
Abstract
Since the 1990s, a number of multi-service prevention programs working with women who have substance use, mental health, or trauma and/or related social determinants of health issues have emerged in Canada. These programs use harm reduction approaches and provide outreach and “one-stop” health and social services on-site or through a network of services. While some of these programs have been evaluated, others have not, or their evaluations have not been published. This article presents interim qualitative findings of the Co-Creating Evidence project, a multi-year (2017–2020) national evaluation of holistic programs serving women at high risk of having an infant with prenatal alcohol exposure. The evaluation utilizes a mixed-methods design involving semi-structured interviews, questionnaires, focus groups, and client intake/outcome “snapshot” data. Findings demonstrated that the programs are reaching vulnerable pregnant/parenting women who face a host of complex circumstances including substance use, violence, child welfare involvement, and inadequate housing; moreover, it is typically the intersection of these issues that prompts women to engage with programs. Aligning with these results, key themes in what clients liked best about their program were: staff and their non-judgmental approach; peer support and sense of community; and having multiple services in one location, including help with mandated child protection.
Collapse
|
19
|
Paterno MT, Low M, Gubrium A, Sanger K. Mothers and Mentors: Exploring Perinatal Addiction and Recovery Through Digital Storytelling. QUALITATIVE HEALTH RESEARCH 2019; 29:545-556. [PMID: 29871558 DOI: 10.1177/1049732318777474] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Substance use disorders (SUDs) are a growing problem for pregnant and parenting women. Woman-to-woman peer support may positively influence perinatal outcomes but little is known about the impact of such support on the women who are providing support. The purpose of this study was to describe experiences of addiction in pregnancy, recovery, and subsequently serving as a peer mentor to other pregnant women with active SUD among women in recovery in a rural setting. We conducted one digital storytelling workshop with five women serving as peer mentors with lived experience of perinatal SUD. The mentors faced significant stigma in pregnancy. They had each done the "inside work" to achieve recovery, and maintained recovery by staying balanced. Peer mentoring supported their own recovery, and story sharing was integral to this process. Peer-led support models may be an effective, self-sustaining method of providing pregnancy-specific peer support for SUD.
Collapse
Affiliation(s)
- Mary T Paterno
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Maud Low
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Aline Gubrium
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Kirk Sanger
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| |
Collapse
|
20
|
Hodgins FE, Lang JM, Malseptic GG, Melby LH, Connolly KA. Coordinating Outpatient Care for Pregnant and Postpartum Women with Opioid Use Disorder: Implications from the COACHH Program. Matern Child Health J 2019; 23:585-591. [DOI: 10.1007/s10995-018-2683-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
21
|
Oni HT, Buultjens M, Abdel-Latif ME, Islam MM. Barriers to screening pregnant women for alcohol or other drugs: A narrative synthesis. Women Birth 2018; 32:479-486. [PMID: 30528816 DOI: 10.1016/j.wombi.2018.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Maternal alcohol or other drug use during pregnancy is associated with a range of adverse health outcomes for mothers and their unborn child. The antenatal period presents an opportunity for health professionals to offer routine screening for alcohol or other drugs, to then provide intervention and referral for treatment and/or specialised support services. However, literature indicates that limited screening practices currently exist in maternity care settings. AIM To identify barriers to screening pregnant women for alcohol or other drugs in maternity care settings, from the perspectives of healthcare professionals. METHODS A comprehensive literature search was conducted in October 2017 to identify relevant studies. Seven databases that index health and social sciences literature, and google scholar, were searched. Eligible articles were subjected to critical appraisal. Extracted data from the eligible studies were synthesised using narrative synthesis. FINDINGS Nine studies were eligible for this review. The review identified seven key barriers to screening for alcohol or other drugs in pregnancy, namely competing priorities and time constraint; lack of adequate screening skills and clear protocol; relationship between healthcare providers and pregnant women; healthcare providers' perceptions; under-reporting or none/false disclosure; inconclusive evidence regarding the risk of alcohol or other drug use in pregnancy; and concerns about guilt and anxiety. CONCLUSIONS The narrative review revealed a range of barriers to screening for alcohol or other drugs in pregnancy. Further research in minimising the barriers is required to establish women-centred, evidence-base screening practices.
Collapse
Affiliation(s)
- Helen T Oni
- Department of Public Health, La Trobe University, Health Sciences Building 2, Bundoora, VIC 3086, Australia.
| | - Melissa Buultjens
- Department of Public Health, La Trobe University, Health Sciences Building 2, Bundoora, VIC 3086, Australia
| | | | - M Mofizul Islam
- Department of Public Health, La Trobe University, Health Sciences Building 2, Bundoora, VIC 3086, Australia
| |
Collapse
|
22
|
Geraghty S, Doleman G, De Leo A. Midwives' attitudes towards pregnant women using substances: Informing a care pathway. Women Birth 2018; 32:e477-e482. [PMID: 30270017 DOI: 10.1016/j.wombi.2018.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to identify midwives' attitudes towards women using substances during pregnancy, which informed the development of an integrated care pathway for the provision of optimal care. METHODS A mixed methods research design was used, that included an online survey via the online survey tool Qualtrics™ which collected quantitative data, and interviews and focus groups were used to collect qualitative data. FINDINGS Participants held a positive or neutral view towards women who used substances during pregnancy, and the participants had an empathetic perception of the issue of substance use within pregnancy, believing that women were using substances due to the environment and circumstances that they lived in, and that they had been raised and socialised in. CONCLUSION Caring for women during pregnancy with substance misuse issues is complex and requires coordination and multidisciplinary care. Midwives have the capacity to provide sensitive midwifery care but require the framework to ensure women needing additional resources during pregnancy receive the services available and specific to their needs. The midwives in this study were supportive of developing an integrated care pathway to allow for collaborative care, and to enable a specialised midwifery approach.
Collapse
Affiliation(s)
- Sadie Geraghty
- Edith Cowan University, Perth, Western Australia, Australia.
| | - Gemma Doleman
- Edith Cowan University, Perth, Western Australia, Australia
| | | |
Collapse
|
23
|
Kramlich D, Kronk R, Marcellus L, Colbert A, Jakub K. Rural Postpartum Women With Substance Use Disorders. QUALITATIVE HEALTH RESEARCH 2018; 28:1449-1461. [PMID: 29651928 DOI: 10.1177/1049732318765720] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The incidence of perinatal opioid use and neonatal withdrawal continues to rise rapidly in the face of the growing opioid addiction epidemic in the United States, with rural areas more severely affected. Despite decades of research and development of practice guidelines, maternal and neonatal outcomes have not improved substantially. This focused ethnography sought to understand the experience of accessing care necessary for substance use disorder recovery, pregnancy, and parenting. Personal accounts of 13 rural women, supplemented by participant observation and media artifacts, uncovered three domains with underlying themes: challenges of getting treatment and care (service availability, distance/geographic location, transportation, provider collaboration/coordination, physical and emotional safety), opportunities to bond (proximity, information), and importance of relationships (respect, empathy, familiarity, inclusion, interactions with care providers). Findings highlight the need for providers and policy makers to reduce barriers to treatment and care related to logistics, stigma, judgment, and lack of understanding of perinatal addiction.
Collapse
Affiliation(s)
| | - Rebecca Kronk
- 1 Duquesne University, Pittsburgh, Pennsylvania, USA
| | | | | | - Karen Jakub
- 1 Duquesne University, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
24
|
Rhodes BE, Gottfredson NC, Hill LM. Desistance and Treatment Seeking Among Women With Substance Use Disorders. QUALITATIVE HEALTH RESEARCH 2018; 28:1330-1341. [PMID: 29671376 PMCID: PMC7470472 DOI: 10.1177/1049732318767637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Addiction rates are rising faster among women than men. However, women with substance use disorders are less likely to enter treatment than males. This study seeks to understand how turning-point events and other maturational processes affect "life course persistent" women's motivations for seeking treatment for their disorder. We conducted semi-structured in-depth interviews with 30 women who were receiving treatment for addiction using thematic analysis. Recurring themes were as follows: experiences of rock-bottom events prior to entering treatment, feeling "sick and tired" in regard to both their physical and mental health, and shifting identities or perceptions of themselves. We discuss the importance of motivating shifts in identity to prevent women from entering treatment as a result of more traumatic mechanisms as well as the possibility of intercepting women with substance dependence and chronic health conditions in primary care or hospital settings with the aim of encouraging treatment.
Collapse
Affiliation(s)
- Blythe E. Rhodes
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nisha C. Gottfredson
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lauren M. Hill
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
25
|
Benoit C, Smith M, Jansson M, Magnus S, Maurice R, Flagg J, Reist D. Canadian Sex Workers Weigh the Costs and Benefits of Disclosing Their Occupational Status to Health Providers. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2018; 16:329-341. [PMID: 31423291 PMCID: PMC6669194 DOI: 10.1007/s13178-018-0339-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prostitution stigma has been shown to negatively affect the work, personal lives, and health of sex workers. Research also shows that sex workers have much higher unmet health care needs than the general population. Less is known about how stigma obstructs their health-seeking behaviors. For our thematic analysis, we explored Canadian sex workers' accounts (N = 218) of accessing health care services for work-related health concerns. Results show that participants had mixed feelings about revealing their work status in health care encounters. Those who decided not to disclose were fearful of negative treatment or expressed confidentiality concerns or lack of relevancy. Those who divulged their occupational status to a health provider mainly described benefits, including nonjudgment, relationship building, and comprehensive care, while a minority experienced costs that included judgment, stigma, and inappropriate health care. Overall, health professionals in Canada appear to be doing a good job relating to sex workers who come forward for care. There is still a need for some providers to learn how to better converse with, diagnose, and care for people in sex work jobs that take into account the heavy costs associated with prostitution stigma.
Collapse
Affiliation(s)
- Cecilia Benoit
- Canadian Institute for Substance Use Research and Department of Sociology, University of Victoria, 2300 McKenzie Ave., Victoria, BC V8N 5M8 Canada
| | - Michaela Smith
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC Canada
| | - Mikael Jansson
- Canadian Institute for Substance Use Research and Department of Sociology, University of Victoria, 2300 McKenzie Ave., Victoria, BC V8N 5M8 Canada
| | - Samantha Magnus
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC Canada
| | - Renay Maurice
- Department of Sociology, University of Victoria, Victoria, BC Canada
| | - Jackson Flagg
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC Canada
| | - Dan Reist
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC Canada
| |
Collapse
|
26
|
Marcellus L. A Grounded Theory of Mothering in the Early Years for Women Recovering From Substance Use. JOURNAL OF FAMILY NURSING 2017; 23:341-365. [PMID: 28795852 DOI: 10.1177/1074840717709366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Women in recovery from addiction experience significant sociostructural barriers to reestablishing self, family, and home after having a baby. The aim of this grounded theory study was to describe pathways that women and their families followed and how transitions were experienced in the early years after receiving services through an integrated community-based maternity program. Eighteen women completed questionnaires and participated in a series of semistructured interviews over 2 years. The overall process women experienced was that of holding it together, which women did by restoring their sense of self during recovery, becoming a strong center for their family, and creating a sense of home no matter what the circumstances. Key elements supporting women in their transition to recovery and parenthood included longer term health, social, and recovery programs and services that addressed determinants of health (in particular, gender, housing, and income), and receiving support provided from strengths-based perspectives.
Collapse
|
27
|
Shahram SZ, Bottorff JL, Kurtz DLM, Oelke ND, Thomas V, Spittal PM. Understanding the Life Histories of Pregnant-Involved Young Aboriginal Women With Substance Use Experiences in Three Canadian Cities. QUALITATIVE HEALTH RESEARCH 2017; 27:249-259. [PMID: 27401489 DOI: 10.1177/1049732316657812] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Despite attention paid to substance use during pregnancy, understandings of young Aboriginal women's experiences based on their perspectives have been virtually absent in the published literature. This study's objective was to understand the life experiences of pregnant-involved young Aboriginal women with alcohol and drugs. Semi-structured interviews to gather life histories were conducted with 23 young Aboriginal women who had experiences with pregnancy, and alcohol and drug use. Transcribed interviews were analyzed for themes to describe the social and historical contexts of women's experiences and their self-representations. The findings detail women's strategies for survival, inner strength, and capacities for love, healing, and resilience. Themes included the following: intersectional identities, life histories of trauma (abuse, violence, and neglect; intergenerational trauma; separations and connections), the ever-presence of alcohol and drugs, and the highs and lows of pregnancy and mothering. The findings have implications for guiding policy and interventions for supporting women and their families.
Collapse
Affiliation(s)
- Sana Z Shahram
- The University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Addictions Research of BC, University of Victoria, British Columbia, Canada
| | - Joan L Bottorff
- The University of British Columbia, Kelowna, British Columbia, Canada
- Australian Catholic University, Melbourne, Australia
| | - Donna L M Kurtz
- The University of British Columbia, Kelowna, British Columbia, Canada
| | - Nelly D Oelke
- The University of British Columbia, Kelowna, British Columbia, Canada
- Department of Community Health Services, Cumming School of Medicine, University of Alberta, Alberta, Canada
| | - Victoria Thomas
- Wuikinuxv Nation, Vancouver, British Columbia, Canada
- The Cedar Project, Vancouver, British Columbia, Canada
| | | |
Collapse
|
28
|
Pei J, Tremblay M, McNeil A, Poole N, McFarlane A. Neuropsychological Aspects of Prevention and Intervention for FASD in Canada. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2016. [DOI: 10.1007/s40817-016-0020-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|