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Milligan K, Tarasoff LA, Rodrigues ER, Iwajomo T, Gomes T, de Oliveira C, Brown HK, Urbanoski KA. Neonatal outcomes of pregnant women attending integrated and standard substance use treatment programs in Ontario, Canada. Birth 2024; 51:284-294. [PMID: 37983747 DOI: 10.1111/birt.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/01/2023] [Accepted: 09/22/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Substance use in pregnancy raises concern given its potential teratogenic effects. Given the unique needs of parenting people and the potential impact for developing children, specialized substance use treatment programs are increasingly being implemented for this population. Substance use treatment is associated with more positive neonatal outcomes compared with no treatment, however treatment models vary limiting our understanding of key treatment components/modelsFew studies have explored the influence of treatment model type (i.e., integrated treatments designed for pregnant clients compared with standard treatment models) and no studies have examined the influence of treatment model on neonatal outcomes using Canadian data. METHOD We conducted a population-based cohort study of clients who were pregnant when initiating integrated (n = 564) and standard (n = 320) substance use treatment programs in Ontario, Canada. RESULTS Neonatal outcomes did not significantly differ by treatment type (integrated or standard), with rates of adverse neonatal outcomes higher than published rates for the general population, despite receipt of adequate levels of prenatal care. While this suggests no significant impact of treatment, it is notable that as a group, clients engaged in integrated treatment presented with more risk factors for adverse neonatal outcomes than those in standard treatment. While we controlled for these risks in our analyses, this may have obscured their influence in relation to treatment type. CONCLUSION Findings underscore the need for more nuanced research that considers the influence of client factors in interaction with treatment type. Pregnant clients engaged in any form of substance use treatment are at higher risk of having children who experience adverse neonatal outcomes. This underscores the urgent need for further investment in services and research to support maternal and neonatal health before and during pregnancy, as well as long-term service models that support women and children beyond the perinatal and early childhood periods.
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Affiliation(s)
- Karen Milligan
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Lesley A Tarasoff
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Erica R Rodrigues
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tara Gomes
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Karen A Urbanoski
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
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Poland CA, Shadur JM, Cinader M, Felton JW. Co-Locating Obstetrics and Addiction Medicine Clinics to Improve Attendance in Services for Pregnant People with Opioid Use Disorder. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 6:36-41. [PMID: 38854870 PMCID: PMC11154810 DOI: 10.1176/appi.prcp.20230033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 06/11/2024] Open
Abstract
Objective Pregnant people receiving treatment for opioid use disorders (OUD) are at significant risk of return to use during the postpartum period. Recently, practice groups and other national organizations have called for the co-location of addiction medicine and obstetric care to reduce the burden on pregnant and postpartum people with OUD associated with engaging in treatment. This paper examines the effectiveness of co-locating services in retaining pregnant people with OUD in care following childbirth. Methods A records review of pregnant people receiving medication for OUD between 2012 and 2017 in stand-alone addiction medicine clinic (n = 23) and from 2017 to 2021 following the creation of an integrated addiction medicine-obstetric care clinic (n = 67) was conducted to compared rates of attendance in both obstetric and addiction medicine services. Results Findings from this study suggest that individuals receiving services in a co-located clinic had significantly fewer missed appointments during the postpartum period relative to individuals who sought care at separate addiction medicine and obstetric care clinics. Conclusions Results from this study support the potential for co-locating clinics to reduce barriers to accessing obstetric and addiction medicine services, as well as support continued attendance in care across a vulnerable period.
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Affiliation(s)
- Cara A. Poland
- Department of Obstetrics, Gynecology and Reproductive HealthMichigan State UniversityEast LansingMichiganUSA
| | - Julia M. Shadur
- School of Integrative Studies and Human Development and Family ScienceGeorge Mason UniversityFairfaxVirginiaUSA
| | - Morgan Cinader
- Department of PsychiatryMichigan State UniversityEast LansingMichiganUSA
| | - Julia W. Felton
- Center for Health Policy & Health Services ResearchHenry Ford HealthDetroitMichiganUSA
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Goodman DJ, Saunders EC, Frew JR, Arsan C, Xie H, Bonasia KL, Flanagan VA, Lord SE, Brunette MF. Integrated vs nonintegrated treatment for perinatal opioid use disorder: retrospective cohort study. Am J Obstet Gynecol MFM 2022; 4:100489. [PMID: 34543754 DOI: 10.1016/j.ajogmf.2021.100489] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/31/2021] [Accepted: 09/09/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pregnant women with opioid use disorder and their infants often experience worse perinatal outcomes than women without opioid use disorder, including longer hospitalizations after delivery and a higher risk for preterm delivery. Integrated treatment models, which combine addiction treatment and maternity care, represent an innovative approach that is widely endorsed, however, limited studies have compared the outcomes between integrated and standard, nonintegrated programs from real-world programs. OBJECTIVE This study aimed to evaluate the perinatal and substance use outcomes for pregnant women with opioid use disorder receiving coordinated, colocated obstetrical care and opioid use disorder treatment (integrated treatment) and to compare it with those of women receiving obstetrical care and opioid use disorder treatment in distinct programs of care (nonintegrated treatment). STUDY DESIGN In this observational, retrospective cohort study, we abstracted the perinatal and opioid use disorder treatment data from the records of pregnant women with opioid use disorder (n=225) who delivered at a rural, academic medical center from 2015 to 2017. The women either received integrated (n=92) or nonintegrated (n=133) opioid use disorder treatment and obstetrical care. Using inverse probability weighted regression models to adjust for a potential covariate imbalance, we evaluated the impact of the treatment model on the risk for preterm delivery and positive meconium or umbilical cord toxicology screens. We explored whether the number of obstetrical visits mediated this relationship by using a quasi-Bayesian Monte Carlo algorithm. RESULTS Women receiving integrated treatment were less likely to deliver prematurely (11.8% vs 26.6%; P<.001) and their infants had shorter hospitalizations (6.5±4.8 vs 10.7±16.2 days). Using a robust inverse probability weighted model showed that receiving integrated treatment was associated with a 74.7% decrease in the predicted probability of preterm delivery (average treatment effect, -0.19; standard error, 0.14; P<.001). There were no differences in the risk for a positive meconium or umbilical cord toxicology screen, a marker for second and third trimester substance use, between women receiving integrated treatment and those receiving coordinated treatment (29.4% vs 34.6%; P=.41), however, integrated treatment was associated with significantly lower rates of positive maternal urine toxicology screens at the time of delivery (35.9% vs 74.4%; P<.001). CONCLUSION Among a cohort of rural pregnant women with opioid use disorder, receiving integrated obstetrical care and opioid use disorder treatment was associated with a reduced risk for preterm birth, a lower risk for positive maternal urine toxicology screen at the time of delivery, and shorter infant hospitalization. This relationship was mediated by the number of obstetrical visits attended during pregnancy, suggesting that increased engagement with obstetrical care through integration of services may contribute to improved perinatal outcomes.
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Affiliation(s)
- Daisy J Goodman
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr Goodman and Ms Flanagan); The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH (Dr Goodman)
| | - Elizabeth C Saunders
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette).
| | - Julia R Frew
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette)
| | - Cybele Arsan
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette); Department of Psychiatry, Los Angeles County and Keck Medical Center of University of Southern California, Los Angeles, CA (Dr Arsan)
| | - Haiyi Xie
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette)
| | - Kyra L Bonasia
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette)
| | - Victoria A Flanagan
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr Goodman and Ms Flanagan)
| | - Sarah E Lord
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette)
| | - Mary F Brunette
- Dartmouth Geisel School of Medicine, Hanover, NH (Drs Goodman, Saunders, Frew, Arsan, Xie, Bonasia, Lord, and Brunette); Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Drs Frew, Arsan, Lord, and Brunette)
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Stormshak EA, Matulis JM, Nash W, Cheng Y. The Family Check-Up Online: A Telehealth Model for Delivery of Parenting Skills to High-Risk Families With Opioid Use Histories. Front Psychol 2021; 12:695967. [PMID: 34305753 PMCID: PMC8294463 DOI: 10.3389/fpsyg.2021.695967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Growing opioid misuse in the United States has resulted in more children living with an adult with an opioid use history. Although an abundance of research has demonstrated a link between opioid misuse and negative parenting behaviors, few intervention efforts have been made to target this underserved population. The Family Check-Up (FCU) has been tested in more than 25 years of research, across multiple settings, and is an evidence-based program for reducing risk behavior, enhancing parenting skills, and preventing the onset of substance use. It is designed to motivate parents to engage in positive parenting practices and to change problematic parenting and has been tested across a variety of ages including early childhood and adolescence. It is highlighted in NIDA’s Principles of Substance Use Prevention for Early Childhood: A research-based guide as one of only three effective selective prevention programs for substance abuse among families with young children. Recently, we developed an online version of the FCU that has now been adapted for early childhood and families with opioid use histories. The online platform and telehealth model allow for wide-scale dissemination, ease of training with community providers, and increased public health reach for families in remote, rural areas. This is particularly important when targeting families with opioid misuse and addiction because there are high rates of addiction in remote areas, yet few services available. In this article, we describe the FCU Online and review new content in the model that targets a population of young adult parents with substance abuse histories, including opioid use. New modules include content focused on harm reduction for this high-risk population of parents, such as safety in the home, substance use while parenting, and managing conflict with partners and friends.
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Affiliation(s)
- Elizabeth A Stormshak
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Jordan M Matulis
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Whitney Nash
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
| | - Yijun Cheng
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
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Chou JL, Cooper-Sadlo S, Diamond RM, Muruthi BA, Beeler-Stinn S. An Exploration of Mothers' Successful Completion of Family-Centered Residential Substance Use Treatment. FAMILY PROCESS 2020; 59:1113-1127. [PMID: 31617203 PMCID: PMC7160039 DOI: 10.1111/famp.12501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
Behavioral health and substance use centers have started focusing efforts on creating, adopting, and implementing evidence-based practices and programs that effectively address the needs of women and, particularly, mothers entering treatment with children. However, women with substance use disorders (SUDs) remain an underserved and understudied population; even less studied are the complexities and unique SUD treatment needs of women who have children. Family therapists' systemic training is a valued approach in conceptualizing and implementing treatment for mothers with SUDs and their families. This study explored the construct of mothering children during family-centered substance use treatment using a transcendental phenomenological approach. Analysis revealed themes related to motherhood, parenting, and support for mothers and children. Two themes emerged from the data: (a) grappling with motherhood and addiction leading to the decision for treatment and (b) specific aspects of the treatment program conducive to motherhood. Results indicated the positive impact of mothers' experiences in family-centered substance use treatment, aligning with previous literature that suggests mothers are more engaged in treatment when their children remain in their care. The insights gleaned from the participants in this study provide suggestions for further improving programming that supports mothers and their children during the recovery process. Treatment considerations are offered for family therapists working with mothers with SUDs and their families.
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Affiliation(s)
- Jessica L Chou
- Department of Counseling and Family Therapy, Drexel University, Philadelphia, PA
| | - Shannon Cooper-Sadlo
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO
| | - Rachel M Diamond
- Couple and Family Therapy Department, Adler University, Chicago, IL
| | - Bertranna A Muruthi
- Department of Counseling Psychology and Human Services, Couples and Family Therapy Program, University of Oregon, Eugene, OR
| | - Sara Beeler-Stinn
- George Warren Brown School of Social Work, Washington University in Saint Louis, Saint Louis, MO
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Martin FS. Engaging with motherhood and parenthood: A commentary on the social science drugs literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:147-153. [PMID: 30630710 DOI: 10.1016/j.drugpo.2018.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/01/2022]
Abstract
The majority of qualitative social scientific research on the topic of parenthood and substance use focuses on mothers who use illicit drugs and their experiences of social marginalization and stigmatization. This commentary argues that new and important insights might be gained about parenting in the context of substance use by engaging more closely with everyday experiences of mothering and with contemporary theorising around motherhood and parenthood. Drawing on recent sociological studies of family life influenced by late-modern individualism and by new expert attention on the quality of parent-child relationships, the commentary proposes directions for future social research on the identities and experiences of mothers and fathers who use alcohol and other drugs.
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Affiliation(s)
- Fiona S Martin
- Department of Sociology and Social Anthropology, Dalhousie University, Canada.
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Luchenski S, Maguire N, Aldridge RW, Hayward A, Story A, Perri P, Withers J, Clint S, Fitzpatrick S, Hewett N. What works in inclusion health: overview of effective interventions for marginalised and excluded populations. Lancet 2018; 391:266-280. [PMID: 29137868 DOI: 10.1016/s0140-6736(17)31959-1] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/16/2017] [Accepted: 07/05/2017] [Indexed: 12/28/2022]
Abstract
Inclusion health is a service, research, and policy agenda that aims to prevent and redress health and social inequities among the most vulnerable and excluded populations. We did an evidence synthesis of health and social interventions for inclusion health target populations, including people with experiences of homelessness, drug use, imprisonment, and sex work. These populations often have multiple overlapping risk factors and extreme levels of morbidity and mortality. We identified numerous interventions to improve physical and mental health, and substance use; however, evidence is scarce for structural interventions, including housing, employment, and legal support that can prevent exclusion and promote recovery. Dedicated resources and better collaboration with the affected populations are needed to realise the benefits of existing interventions. Research must inform the benefits of early intervention and implementation of policies to address the upstream causes of exclusion, such as adverse childhood experiences and poverty.
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Affiliation(s)
- Serena Luchenski
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK.
| | - Nick Maguire
- Department of Psychology, University of Southampton, Southampton, UK
| | - Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Andrew Hayward
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK
| | - Alistair Story
- Find and Treat Service, University College London Hospitals, London, UK
| | - Patrick Perri
- Center for Inclusion Health, Allegheny Health Network, Pittsburgh, PA, USA; Street Medicine Institute, Ingomar, PA, USA
| | | | | | - Suzanne Fitzpatrick
- Institute for Social Policy, Housing and Equalities Research, Heriot-Watt University, Edinburgh, UK
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Henderson J, Milligan K, Niccols A, Thabane L, Sword W, Smith A, Rosenkranz S. Reporting of feasibility factors in publications on integrated treatment programs for women with substance abuse issues and their children: a systematic review and analysis. Health Res Policy Syst 2012; 10:37. [PMID: 23217025 PMCID: PMC3547724 DOI: 10.1186/1478-4505-10-37] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 11/28/2012] [Indexed: 11/16/2022] Open
Abstract
Background Implementation of evidence-based practices in real-world settings is a complex process impacted by many factors, including intervention, dissemination, service provider, and organizational characteristics. Efforts to improve knowledge translation have resulted in greater attention to these factors. Researcher attention to the applicability of findings to applied settings also has increased. Much less attention, however, has been paid to intervention feasibility, an issue important to applied settings. Methods In a systematic review of 121documents regarding integrated treatment programs for women with substance abuse issues and their children, we examined the presence of feasibility-related information. Specifically, we analysed study descriptions for information regarding feasibility factors in six domains (intervention, practitioner, client, service delivery, organizational, and service system). Results On average, fewer than half of the 25 feasibility details assessed were included in the documents. Most documents included some information describing the participating clients, the services offered as part of the intervention, the location of services, and the expected length of stay or number of sessions. Only approximately half of the documents included specific information about the treatment model. Few documents indicated whether the intervention was manualized or whether the intervention was preceded by a standardized screening or assessment process. Very few provided information about the core intervention features versus the features open to local adaptation, or the staff experience or training required to deliver the intervention. Conclusions As has been found in reviews of intervention studies in other fields, our findings revealed that most documents provide some client and intervention information, but few documents provided sufficient information to fully evaluate feasibility. We consider possible explanations for the paucity of feasibility information and provide suggestions for better reporting to promote diffusion of evidence-based practices.
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Affiliation(s)
- Joanna Henderson
- Child, Youth and Family Program, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Jack SM, Dobbins M, Sword W, Novotna G, Brooks S, Lipman EL, Niccols A. Evidence-informed decision-making by professionals working in addiction agencies serving women: a descriptive qualitative study. Subst Abuse Treat Prev Policy 2011; 6:29. [PMID: 22059528 PMCID: PMC3224771 DOI: 10.1186/1747-597x-6-29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 11/07/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Effective approaches to the prevention and treatment of substance abuse among mothers have been developed but not widely implemented. Implementation studies suggest that the adoption of evidence-based practices in the field of addictions remains low. There is a need, therefore, to better understand decision making processes in addiction agencies in order to develop more effective approaches to promote the translation of knowledge gained from addictions research into clinical practice. METHODS A descriptive qualitative study was conducted to explore: 1) the types and sources of evidence used to inform practice-related decisions within Canadian addiction agencies serving women; 2) how decision makers at different levels report using research evidence; and 3) factors that influence evidence-informed decision making. A purposeful sample of 26 decision-makers providing addiction treatment services to women completed in-depth qualitative interviews. Interview data were coded and analyzed using directed and summative content analysis strategies as well as constant comparison techniques. RESULTS Across all groups, individuals reported locating and using multiple types of evidence to inform decisions. Some decision-makers rely on their experiential knowledge of addiction and recovery in decision-making. Research evidence is often used directly in decision-making at program management and senior administrative levels. Information for decision-making is accessed from a range of sources, including web-based resources and experts in the field. Individual and organizational facilitators and barriers to using research evidence in decision making were identified. CONCLUSIONS There is support at administrative levels for integrating EIDM in addiction agencies. Knowledge transfer and exchange strategies should be focussed towards program managers and administrators and include capacity building for locating, appraising and using research evidence, knowledge brokering, and for partnering with universities. Resources are required to maintain web-based databases of searchable evidence to facilitate access to research evidence. A need exists to address the perception that there is a paucity of research evidence available to inform program decisions. Finally, there is a need to consider how experiential knowledge influences decision-making and what guidance research evidence has to offer regarding the implementation of different treatment approaches within the field of addictions.
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Affiliation(s)
- Susan M Jack
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Hamilton, Ontario, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Wendy Sword
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Gabriela Novotna
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sandy Brooks
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ellen L Lipman
- Offord Centre for Child Studies, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Alison Niccols
- Offord Centre for Child Studies, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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