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Green CR, Harding KD, Unsworth K, Kaminsky K, Roberts N, Nagpal TS, Cook JL. Reporting on Health Care and Social Service Provider Approaches to Promoting Alcohol Abstinence During Pregnancy. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:422-433. [PMID: 38713493 DOI: 10.1080/19371918.2024.2323136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Despite the known detrimental health effects of alcohol use during pregnancy, there are still health care (HCP) and social service providers (SSP) who do not promote complete abstinence. The purpose of this study was to explore the current practices of HCPs and SSPs when discussing alcohol use during pregnancy, and to understand their rationale for their specific recommendations. An online survey was completed by 1123 HCPs (n = 588) and SSPs (n = 535) that asked them to identify their approach to discussing alcohol and pregnancy. Participants had the option to further explain their current recommendations regarding alcohol use during pregnancy in an open-ended format. Open-ended responses were analyzed using a content analysis approach (n = 156). The majority of respondents recommend abstinence (83.9% of HCPs, n = 493; 78.4% of SSPs, n = 419), while 9.8% of HCPs (n = 57) and 2.2% of SSPs (n = 12) responded that low levels of consumption may be acceptable. HCPs may recommend low levels of consumption based on other international guidelines, limited evidence to suggest that one unit of alcohol is harmful, and as a harm reduction strategy. SSPs stated that they refer clients to HCPs for recommendations related to alcohol consumption, and that they prefer to provide information based on public health guidelines. This exploratory work may inform the development of resources to support HCPs and SSPs to recommend abstinence from alcohol throughout gestation.
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Affiliation(s)
- Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
| | - Kelly D Harding
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
- Psychology Department, Laurentian University, Sudbury, ON, Canada
| | - Kathy Unsworth
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
| | - Kyla Kaminsky
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
| | | | - Taniya S Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
- The University of Ottawa, Ottawa, ON, Canada
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Mathias H, Foster LA, Rushton A. Programs and practices that support pregnant people who use drugs' access to sexual and reproductive health care in Canada: a scoping review. BMC Pregnancy Childbirth 2024; 24:72. [PMID: 38254076 PMCID: PMC10804510 DOI: 10.1186/s12884-023-06225-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pregnant people who use unregulated drugs (PPWUD) are at high risk of health complications yet experience a range of barriers to sexual and reproductive health care. Given that improving maternal health and access to reproductive health care are key targets underpinning the Sustainable Development Goals (SDG), there is an urgent need to improve access to appropriate supports and services for this population. Little is known about what programs and practices exist to support PPWUD's access to sexual and reproductive health care. This scoping review aimed to identify the available literature on these programs and practices in Canada. METHODS A scoping review was conducted using JBI methodology and reported using PRISMA guidelines. Scholarly databases and grey literature sources were searched to identify literature published between 2016-2023 in English or French that discussed, defined, conceptualised, or evaluated programs and practices that support PPWUD's access to sexual and reproductive health care in Canada. Identified literature was screened using Covidence. Data were extracted from included texts, then analysed descriptively. Frequencies and key concepts were reported. RESULTS A total of 71 articles were included, most of which were grey literature. Of the total, 46 unique programs were identified, as well as several useful practices. Most programs were in urban centres in Western Canada, and most programs offered holistic 'wrap-around services.' Several programs delivered these services on-site or as 'drop-in' programs with the support of staff with lived/living experience of substance use. Most frequent program outcomes included keeping parents and children together, improving connection to other services, and reducing substance use harms. Noted helpful practices included non-judgmental care and the use of harm-reduction strategies. CONCLUSIONS Several programs and practices that support PPWUD exist in Canada, though few focus exclusively on sexual and reproductive health. There remain opportunities to improve access to programs, including expanding geographic availability and range of services. The review has clinical application by providing an overview of available programs that may support clinicians in identifying services for PPWUD. Future research should consider client perspectives and experiences of these programs. REVIEW REGISTRATION NUMBER Open Science Framework https://osf.io/5y64j .
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Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
| | - Lesley Ann Foster
- Department of Cultural Studies, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Ashleigh Rushton
- Faculty of Health Sciences, The University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C, V2R 0N3, Canada
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Flannigan K, Murphy L, Pei J. Integrated Supports for Women and Girls Experiencing Substance Use and Complex Needs. Subst Abuse 2023; 17:11782218231208980. [PMID: 37954218 PMCID: PMC10637139 DOI: 10.1177/11782218231208980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 11/14/2023]
Abstract
There is strong research to support integrated and gender-sensitive harm reduction approaches for supporting women, girls, and gender diverse people. For individuals who are pregnant, flexible and integrated treatment approaches may be especially important. In this study, we report on an integrated program in rural Canada designed to support pregnant women, girls, and gender diverse people experiencing substance use and other complex needs. Program data (N = 393) from the 2nd Floor Women's Recovery Centre (2nd Floor) at the Lakeland Centre for Fetal Alcohol Spectrum Disorder (LCFASD) was analyzed with several aims. Study goals were to (1) describe characteristics and needs of clients, (2) identify factors associated with program completion, and (3) for a subset of clients, examine resources, wellbeing, and social and behavioral outcomes after treatment. Clients (Mage = 27.4 years, range 15-64) presented at the 2nd Floor with complex medical and mental health needs, and experiences of significant socioenvironmental adversity. However, almost two-thirds (63.4%) successfully completed the program, which was more likely for clients who had stable housing at intake and a possible or confirmed diagnosis of FASD. After treatment, clients reported high levels of wellbeing, and most were connected to health care and community resources. In the year after program completion, clients who were contacted for follow-up maintained strong connection to resources and reported notable improvements in social and behavioral functioning. Many were working or volunteering, most were in stable home environments, rates of substance use and legal involvement were substantially reduced, and many clients were actively caring for their children. This study offers important findings to inform future research, practice, and policy for supporting health and wellbeing for women, children, families, and communities.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Lisa Murphy
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
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Townsel C, Irani S, Buis C, Lasser S, Menke N, Preston Y, Kountanis JA, Skoczylas M, Menke R, Getty B, Stout M, Muzik M. Partnering for the future clinic: A multidisciplinary perinatal substance use program. Gen Hosp Psychiatry 2023; 85:220-228. [PMID: 37992465 DOI: 10.1016/j.genhosppsych.2023.10.009] [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: 01/17/2023] [Revised: 05/29/2023] [Accepted: 10/13/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE The current model of obstetric care does not integrate multiple subspecialty services for high-risk pregnancies with substance use disorder (SUD), resulting in fragmented care. We describe the framework of our multidisciplinary and integrated perinatal substance use clinic and provide recent clinical outcomes. METHODS We detail the Partnering for the Future (PFF) clinic, which integrates numerous subspecialty and support services for patients with SUDs and complex mental health needs. Additionally, a retrospective chart review of patients receiving care in the PFF clinic from 2017 to 2021 was completed. RESULTS Seven integrated services are detailed with a focus on reducing stigma, providing trauma-informed care and mitigating harm. During the study period, 182 patients received care in PFF clinic, with opioid use disorder the most common indication for care. Co-occurring mental illness was common (81%). NICU admissions and severe NOWS diagnosis declined after the implementation of Eat-Sleep-Console. Social services identified care coordination, transportation assistance and adjustment counseling as the most common needs. A novel virtual behavioral health consultation service was successfully launched. CONCLUSIONS Our integrated care model supports the holistic care of pregnant people with SUD and mental health disease. Patient-centered care and co-located services have improved perinatal outcomes, particularly for opioid-exposed pregnancies.
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Affiliation(s)
- Courtney Townsel
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Sanaya Irani
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America; University of Michigan Medical School, United States of America
| | - Carol Buis
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Sheryl Lasser
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Nathan Menke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Yolanda Preston
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Joanna A Kountanis
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Maria Skoczylas
- University of Michigan Medical School, United States of America; Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States of America
| | - Rena Menke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America
| | - Barbara Getty
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Molly Stout
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | - Maria Muzik
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America; Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States of America.
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Morton Ninomiya ME, Almomani Y, Dunbar Winsor K, Burns N, Harding KD, Ropson M, Chaves D, Wolfson L. Supporting pregnant and parenting women who use alcohol during pregnancy: A scoping review of trauma-informed approaches. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057221148304. [PMID: 36744547 PMCID: PMC9905036 DOI: 10.1177/17455057221148304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alcohol is legalized and used for a variety of reasons, including socially or as self-medication for trauma in the absence of accessible and safe supports. Trauma-informed approaches can help address the root causes of alcohol use, as well as the stigma around women's alcohol use during pregnancy. However, it is unclear how these approaches are used in contexts where pregnant and/or parenting women access care. Our objective was to synthesize existing literature and identify promising trauma-informed approaches to working with pregnant and/or parenting women who use alcohol. A multidisciplinary team of scholars with complementary expertise worked collaboratively to conduct a rigorous scoping review. All screening, extraction, and analysis was independently conducted by at least two authors before any differences were discussed and resolved through team consensus. The Joanna Briggs Institute method was used to map existing evidence from peer-reviewed articles found in PubMed, CINAHL, PsycINFO, Social Work Abstracts, and Web of Science. Data were extracted to describe study demographics, articulate trauma-informed principles in practice, and gather practice recommendations. Thirty-six studies, mostly from the United States and Canada, were included for analysis. Studies reported on findings of trauma-informed practice in different models of care, including live-in treatment centers, case coordination/management, integrated and wraparound supports, and outreach-for pregnant women, mothers, or both. We report on how the following four principles of trauma-informed practices were applied and articulated in the included studies: (1) trauma awareness; (2) safety and trustworthiness; (3) choice, collaboration, and connection; and (4) strengths-based approach and skill building. This review advances and highlights the importance of understanding trauma and applying trauma-informed practice and principles to better support women who use alcohol to reduce the risk of alcohol-exposed pregnancies. Relationships and trust are central to trauma-informed care. Moreover, when applying trauma-informed practices with pregnant and parenting women who use alcohol, we must consider the unique stigma attached to alcohol use.
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Affiliation(s)
- Melody E Morton Ninomiya
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, ON, Canada,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada,Melody E Morton Ninomiya, Department of Health Sciences, Wilfrid Laurier University, Rm. BA0546, 75 University Avenue West, Waterloo, ON N2L 3C5, Canada.
| | - Yasmeen Almomani
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | | | - Nicole Burns
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Kelly D Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada,School of Liberal Arts, Laurentian University, Sudbury, ON, Canada
| | - Megan Ropson
- Memorial University, St. John’s, NL, Canada,Labrador-Grenfell Health, Happy Valley-Goose Bay, NL, Canada
| | - Debbie Chaves
- Library, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Lindsay Wolfson
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada,Centre of Excellence for Women’s Health, Vancouver, BC, Canada
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Culp F, Wu Y, Wu D, Ren Y, Raynor P, Hung P, Qiao S, Li X, Eichelberger K. Understanding Alcohol Use Discourse and Stigma Patterns in Perinatal Care on Twitter. Healthcare (Basel) 2022; 10:2375. [PMID: 36553899 PMCID: PMC9778089 DOI: 10.3390/healthcare10122375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: perinatal alcohol use generates a variety of health risks. Social media platforms discuss fetal alcohol spectrum disorder (FASD) and other widespread outcomes, providing personalized user-generated content about the perceptions and behaviors related to alcohol use during pregnancy. Data collected from Twitter underscores various narrative structures and sentiments in tweets that reflect large-scale discourses and foster societal stigmas; (2) Methods: We extracted alcohol-related tweets from May 2019 to October 2021 using an official Twitter search API based on a set of keywords provided by our clinical team. Our exploratory study utilized thematic content analysis and inductive qualitative coding methods to analyze user content. Iterative line-by-line coding categorized dynamic descriptive themes from a random sample of 500 tweets; (3) Results: qualitative methods from content analysis revealed underlying patterns among inter-user engagements, outlining individual, interpersonal and population-level stigmas about perinatal alcohol use and negative sentiment towards drinking mothers. As a result, the overall silence surrounding personal experiences with alcohol use during pregnancy suggests an unwillingness and sense of reluctancy from pregnant adults to leverage the platform for support and assistance due to societal stigmas; (4) Conclusions: identifying these discursive factors will facilitate more effective public health programs that take into account specific challenges related to social media networks and develop prevention strategies to help Twitter users struggling with perinatal alcohol use.
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Affiliation(s)
- Fritz Culp
- College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA
| | - Yuqi Wu
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Dezhi Wu
- College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA
| | - Yang Ren
- College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA
| | - Phyllis Raynor
- College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - Peiyin Hung
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Shan Qiao
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Kacey Eichelberger
- Prisma Health Upstate, University of South Carolina School of Medicine Greenville, Greensville, SC 29605, USA
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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.
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Affiliation(s)
| | | | | | - Nancy Poole
- Centre of Excellence for Women's Health, Vancouver, BC, Canada
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Nichols TR, Gringle MR, Welborn A, Lee A. “We Have to Keep Advocating and Helping and Doing What We Can”: Examining Perinatal Substance Use Services in the Absence of Integrated Treatment Programs. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221092771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effective treatment of substance-exposed pregnancies requires gender-responsive care coordinated across agencies and systems. A deeper understanding of the perspectives, experience, and practices of professionals providing these services is needed to improve care. This study examines service provision for perinatal substance use through the perspectives and experiences of healthcare and social service professionals. Using a constructivist grounded theory design, data were collected over a 7-year period. Data collection consisted of interviews and focus groups with professionals as well as observations of professional meetings and workshops where practices and procedures were discussed. A multi-level model of service delivery is described. The role of affect, particularly around issues of custody, is discussed along with structural level actions that develop in the absence of integrated treatment. Structural support both within and across systems of care is crucial to developing coordinated and compassionate care and to increasing engagement in care services.
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Affiliation(s)
| | | | - Amber Welborn
- Beaver College of Health Science, Appalachian State University, Boone, NC, USA
| | - Amy Lee
- University of North Carolina Greensboro, Greensboro, NC, USA
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9
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Flannigan K, Pei J, McLachlan K, Harding K, Mela M, Cook J, Badry D, McFarlane A. Responding to the Unique Complexities of Fetal Alcohol Spectrum Disorder. Front Psychol 2022; 12:778471. [PMID: 35145454 PMCID: PMC8821085 DOI: 10.3389/fpsyg.2021.778471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/31/2021] [Indexed: 11/20/2022] Open
Abstract
Fetal alcohol spectrum disorder (FASD) is a multifaceted disability, characterized not only by brain- and body-based challenges, but also high rates of environmental adversity, lifelong difficulties with daily living, and distinct sociocultural considerations. FASD is one of the most common neurodevelopmental disabilities in the Western world and associated with significant social and economic costs. It is important to understand the complexities of FASD and the ways in which FASD requires unique consideration in research, practice, and policy. In this article, we discuss our perspectives on factors that distinguish FASD from other disabilities in terms of complexity, co-occurrence, and magnitude. We provide an overview of select literature related to FASD as a socially rooted disability with intergenerational impacts and multiple layers of stigma. These social issues are intertwined with notable experiences of adversity across the lifespan and high rates of co-occurring health concerns for individuals with FASD, all of which present unique challenges for individuals, caregivers, families, service providers, and policy makers. Understanding these factors is the first step in developing and implementing specialized initiatives in support of positive outcomes for individuals with FASD and their families. Future directions are proposed for advancing research, practice, and policy, and responding to the unique complexities of FASD.
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Affiliation(s)
- Katherine Flannigan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
| | - Jacqueline Pei
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Kaitlyn McLachlan
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Kelly Harding
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychology, Laurentian University, Sudbury, ON, Canada
| | - Mansfield Mela
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jocelynn Cook
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Dorothy Badry
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Audrey McFarlane
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC, Canada
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10
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Darlington CK, Compton PA, Teitelman AM, Alexander K. Non-pharmacologic interventions to improve depression and anxiety among pregnant and parenting women who use substances: An integrative literature review. DRUG AND ALCOHOL DEPENDENCE REPORTS 2021; 2:100017. [PMID: 36845894 PMCID: PMC9949346 DOI: 10.1016/j.dadr.2021.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
Pregnant and parenting women who use substances report high rates of comorbid depression and anxiety. Due to the significant impact of this comorbidity on treatment adherence and maternal/child outcomes, effective psychosocial and behavioral interventions to address depression and anxiety in this population are necessary. A directed search of PubMed, PsycINFO, and CINAHL databases produced 22 articles from 20 distinct studies examining non-pharmacologic interventions with an effect on depression and anxiety among pregnant or parenting women using substances. Of the 20 studies reviewed, 8 were randomized controlled trials, 7 were quasi-experimental studies, and 5 were cohort studies. Results revealed a wide array of interventions targeting intrapersonal, interpersonal, and/or structural factors within these women's lives. Parenting therapy and psychosocially enhanced treatment programs had the strongest evidence for positive treatment effect in improving symptoms of depression and anxiety. The use of contingency-management, case-managed care, patient or wellness navigators, mindfulness-based therapy, maternal-child relationship-focused therapy, family therapy, peer support, and therapeutic community-based interventions show promise but warrant further experimental exploration. Comprehensive and gender-specific residential treatment was observationally associated with improvements in depression and anxiety; however, the specific modality of efficacy is unclear. Future research should focus on identifying which modalities are most cost-effective, feasible, and acceptable among this uniquely vulnerable population.
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Affiliation(s)
- Caroline K. Darlington
- University of Pennsylvania School of Nursing, Address: 418 Curie Blvd, Philadelphia, PA 19104, USA
- Corresponding author.
| | - Peggy A. Compton
- University of Pennsylvania School of Nursing, Address: 418 Curie Blvd, Philadelphia, PA 19104, USA
| | - Anne M. Teitelman
- University of Pennsylvania School of Nursing, Address: 418 Curie Blvd, Philadelphia, PA 19104, USA
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11
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Henry MC, Sanjuan PM, Stone LC, Cairo GF, Lohr-Valdez A, Leeman LM. Alcohol and other substance use disorder recovery during pregnancy among patients with posttraumatic stress disorder symptoms: A qualitative study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2021; 1:100013. [PMID: 36843908 PMCID: PMC9948915 DOI: 10.1016/j.dadr.2021.100013] [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: 08/30/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
Background About 5% of women are pregnant at substance use disorder (SUD) treatment entry, and pregnant women with SUD often belong to marginalized groups experiencing social, economic, and health care barriers associated with stigma from prenatal substance use. Pregnant women in SUD treatment have high rates of trauma and posttraumatic stress disorder (PTSD). This study sought to (1) examine the lived experiences of pregnant individuals with PTSD symptoms in SUD treatment and (2) understand the roles of systematic or contextual barriers to the pursuit of prenatal abstinence. Methods We draw upon in-depth semi-structured interviews to examine relationships between SUD, psychological trauma/PTSD experience, social resources, and lived experiences among patients in prenatal SUD treatment with PTSD symptoms. Our sample was pregnant patients (N = 13) with prior DSM-5 Criterion A trauma and current PTSD symptoms enrolled in a comprehensive program integrating prenatal care, substance use counseling, medication for opioid use disorder and case management at three sites affiliated with an urban academic medical center in New Mexico. Results Using thematic analysis, four main themes identified structural forces influencing alcohol and drug use: (a) lack of access or ability to obtain resources, (b) substance use to cope with negative affect, (c) social stigma, and (d) interpersonal relationships. Conclusions Despite receiving high-quality integrated prenatal and SUD care, these pregnant patients with PTSD symptoms in SUD treatment still experienced substantial social and structural hurdles to achieving abstinence during pregnancy.
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Affiliation(s)
- Melissa C. Henry
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
| | - Pilar M. Sanjuan
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
- Department of Family and Community Medicine, University of New Mexico School of Medicine MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, United States
| | - Lisa Cacari Stone
- College of Population Health, University of New Mexico Health Science Center, 1001 Medical Arts Ave NE, Albuquerque, NM 87102, United States
| | - Grace F. Cairo
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
| | - Anthony Lohr-Valdez
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, 2650 Yale Boulevard, SE, Albuquerque, NM 87106, United States
| | - Lawrence M. Leeman
- Department of Family and Community Medicine, University of New Mexico School of Medicine MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, United States
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, MSC08 4720, 1 University of New Mexico, Albuquerque, NM 87131, United States
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12
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Bonnett TH, McCorquodale L, Schouten KR. Capturing the voices of mothers: Delivery and content efficacy of a community attachment parenting program. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:2330-2347. [PMID: 34269472 DOI: 10.1002/jcop.22669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/13/2021] [Accepted: 06/24/2021] [Indexed: 06/13/2023]
Abstract
This qualitative case study sought to examine the delivery and content efficacy of a community attachment parenting program developed and hosted by an attachment and trauma-informed organization that services infants and their pre- or postnatal mothers in Ontario, Canada. A focus group and participant reflective journals were employed to amplify the voices of mothers who engaged in the 8-week program. Five overarching themes surfaced in the data which include (1) infant/mother attachment, (2) program delivery validations and recommendations, (3) program content validations and recommendations, (4) facilitator delivery, content and relational competencies and (5) connections with others. The findings of this study are intended to inform future offerings of this program, as well as incite further research to illuminate the voices of mothers and other participants who engage in attachment-postured community parenting programs across the globe.
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Affiliation(s)
| | | | - Karen R Schouten
- Executive Director of Attachment & Trauma Parenting Organization, Ontario, Canada
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13
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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.
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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.
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14
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Wolfson L, Schmidt RA, Stinson J, Poole N. Examining barriers to harm reduction and child welfare services for pregnant women and mothers who use substances using a stigma action framework. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:589-601. [PMID: 33713525 PMCID: PMC8251798 DOI: 10.1111/hsc.13335] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/16/2021] [Accepted: 02/17/2021] [Indexed: 05/04/2023]
Abstract
Pregnant women and mothers who use substances often face significant barriers to accessing and engaging with substance use services. A scoping review was conducted in 2019 to understand how stigma impacts access to, retention in and outcomes of harm reduction and child welfare services for pregnant women and mothers who use substances. The forty-two (n = 42) articles were analysed using the Action Framework for Building an Inclusive Health System developed by Canada's Chief Public Health Officer to articulate the ways in which stigma and related health system barriers are experienced at the individual, interpersonal, institutional and population levels. Many articles highlighted barriers across multiple levels, 19 of which cited barriers at the individual level (i.e., fear and mistrust of child welfare services), 18 at the interpersonal level (i.e., familial and relational influence on accessing substance use treatment), 30 at the institutional level (i.e., high organisational expectations on women) and 17 at the population level (i.e., negative stereotypes and racism). Our findings highlight the interconnectedness of stigma and related barriers and the ways in which stigma at the institutional and population levels pervasively influence individual and interpersonal experiences of stigma. Despite a wealth of literature on barriers to treatment and support for pregnant women and mothers who use substances, there has been minimal focus on how systems can address these formidable barriers. This review highlights the ways in which the barriers are connected and identifies opportunities for service providers and policymakers to better support pregnant women and mothers who use substances.
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Affiliation(s)
| | | | - Julie Stinson
- Centre of Excellence for Women's HealthVancouverBCCanada
| | - Nancy Poole
- Centre of Excellence for Women's HealthVancouverBCCanada
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15
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Lyall V, Wolfson L, Reid N, Poole N, Moritz KM, Egert S, Browne AJ, Askew DA. "The Problem Is that We Hear a Bit of Everything…": A Qualitative Systematic Review of Factors Associated with Alcohol Use, Reduction, and Abstinence in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3445. [PMID: 33810338 PMCID: PMC8037183 DOI: 10.3390/ijerph18073445] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 01/09/2023]
Abstract
Understanding the factors that contribute to women's alcohol use in pregnancy is critical to supporting women's health and wellness and preventing Fetal Alcohol Spectrum Disorder. A systematic review of qualitative studies involving pregnant and recently postpartum women was undertaken to understand the barriers and facilitators that influence alcohol use in pregnancy (PROSPERO: CRD42018098831). Twenty-seven (n = 27) articles were identified through EMBASE, CINAHL, PsycINFO, PubMed and Web of Science. The included articles were thematically analyzed using NVivo12. The analysis was informed by Canada's Action Framework for Building an Inclusive Health System to articulate the ways in which stigma and related barriers are enacted at the individual, interpersonal, institutional and population levels. Five themes impacting women's alcohol use, abstention and reduction were identified: (1) social relationships and norms; (2) stigma; (3) trauma and other stressors; (4) alcohol information and messaging; and (5) access to trusted equitable care and essential resources. The impact of structural and systemic factors on prenatal alcohol use was largely absent in the included studies, instead focusing on individual choice. This silence risks perpetuating stigma and highlights the criticality of addressing intersecting structural and systemic factors in supporting maternal and fetal health.
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Affiliation(s)
- Vivian Lyall
- Primary Care Clinical Unit, University of Queensland, Brisbane, QLD 4006, Australia; (V.L.); (D.A.A.)
| | - Lindsay Wolfson
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC V5R OA4, Canada
| | - Natasha Reid
- Child Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia; (N.R.); (K.M.M.)
| | - Nancy Poole
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC V5R OA4, Canada
| | - Karen M. Moritz
- Child Health Research Centre, University of Queensland, Brisbane, QLD 4101, Australia; (N.R.); (K.M.M.)
- School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD 4072, Australia
| | - Sonya Egert
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Inala, QLD 4077, Australia;
| | - Annette J. Browne
- School of Nursing, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Deborah A. Askew
- Primary Care Clinical Unit, University of Queensland, Brisbane, QLD 4006, Australia; (V.L.); (D.A.A.)
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Inala, QLD 4077, Australia;
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HerWay Home Program for Pregnant and Parenting Women Using Substances: A Brief Social Return on Investment Analysis. CANADIAN JOURNAL OF ADDICTION 2020. [DOI: 10.1097/cxa.0000000000000086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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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.
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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
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Missing in Action: Sex and Gender in Substance Use Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072352. [PMID: 32244297 PMCID: PMC7177376 DOI: 10.3390/ijerph17072352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 01/12/2023]
Abstract
Substance use and misuse is a significant global health issue that requires a sex- and gender-based analysis. Substance use patterns and trends are gendered: that is, women and men, girls and boys, and gender-diverse people often exhibit different rates of use of substances, reasons for use, modes of administration, and effects of use. Sex-specific effects and responses to substances are also important, with various substances affecting females and males differentially. Nevertheless, much research and practice in responding to substance use and misuse remains gender blind, ignoring the impacts of sex and gender on this important health issue. This special issue identifies how various aspects of sex and gender matter in substance use, illustrates the application of sex- and gender-based analyses to a range of substances, populations and settings, and assists in progressing sex and gender science in relation to substance use.
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