Within Canada, several specialized multi-service prevention programs work with highly vulnerable pregnant and early parenting women with substance use issues. Experiences of trauma, mental health, poverty, and other factors associated with the social determinants of health complete the picture. Program evaluations have demonstrated their value, but less has been said as to women’s reasons for choosing to seek help from these programs, what they were hoping to gain, or what difference they believe has occurred as a result. The Co-creating Evidence project is a multi-year (2017–2020) national evaluation of holistic programs serving women at high risk of having an infant with prenatal alcohol or substance exposure. The evaluation uses a mixed methods design involving quarterly program output and “snapshot” client data, as well as in-person, semi-structured interviews and questionnaires with clients, program staff, and program partners. This article presents findings from interviews with women regarding why they sought help, how they used the services, and what they perceived to be the most significant change in their lives as a result. Obtaining help with substance use was the top theme for what women hoped to get from their participation in their program; however, women’s reasons were often intertwined. Additional motivations included wanting information, support or assistance with: child welfare; pregnancy; housing; getting connected to health care or prenatal care; and opportunities for peer support. With respect to the most significant life change, themes included: reduced substance use; improved housing; stronger mother–child connection; and improved wellness and social connections. Findings demonstrated that vulnerable, marginalized pregnant and parenting women who are using substances will seek help when health and social care services are configured in such a way as to take into consideration and address their unique roles, responsibilities, and realities.

In this study, two groups of women caregivers, older family caregivers, and women who do "double duty" caregiving (paid health care professionals who simultaneously are unpaid elder caregivers in their 'off' time), participated in daylong research workshops in which they first identified dimensions of an "ideal" caregiving situation and then, using a critical incident technique, explored the meaning of "power"-feeling powerful and powerless-for them as caregivers. This article is devoted to examining the ways in which women understand the notion of "powerfulness" and "powerlessness" in their work as caregivers. Themes emerging from caregivers' critical incidents are discussed and considered in light of previous literature. The article concludes by drawing implications from the project's findings for policy, practice, advocacy, and conceptual development.

Although teen pregnancy is on the rise in Canada, and while adolescent mothering in general has received considerable recent attention from researchers, there is a paucity of information about the particular experiences of young women who become mothers while in government care. Emerging out of a study guided by a grounded theory methodology to address this knowledge gap, this paper examines the experiences and perspectives of government‐based social workers who work with young mothers in/from care. Our findings indicated that social workers reflect prevailing middle class values, including norms about ‘good’ and ‘bad’ parenting, and centred around the belief that adolescent pregnancy is, in and of itself, bad. One of the most significant ramifications of workers’ values was their belief about the inevitability of ‘the cycle’: of children in care begetting children who ultimately came into care. Ironically, though workers and young mothers were both preoccupied by the concept of ‘the cycle’, and each were determined to break it, the two groups had very different ideas about what the cycle was all about and what perpetuated it. Unfortunately, this disjunction in perspectives, along with major recent shifts in the direction of child welfare policy and practice and related constraints in the resources at workers’ disposal, conjoined to create significant barriers to what workers and young women both recognized as supportive practice with youth in care.

There is growing appreciation among health and social care providers, especially those working in community-based programs with women or young people with substance use problems and/or who have experienced violence, maltreatment, or trauma, that a high number of their program participants may have been prenatally exposed to alcohol or have fetal alcohol spectrum disorder (FASD). This article provides a conceptualization of the key components of an FASD-informed approach. Drawing on the emerging literature and the author’s research identifying the support needs and promising approaches in working with women, young adults, and adults with FASD, as well as evaluations of FASD-related programs, the article discusses what an FASD-informed approach is, why it is centrally important in working with women, adults, and young people who may have FASD, underlying principles of an FASD-informed approach, and examples of FASD-informed adaptations to practice, programming, and the physical environment. In this discussion, the benefits of using an FASD-informed approach for service providers and women living with FASD and their families, as well as conceptualization of FASD-informed policy and systems are highlighted.

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.