Levels and predictors of participation in integrated treatment programs for pregnant and parenting women with problematic substance use

Abstract

BackgroundWomen who are seeking services for problematic substance use are often also balancing responsibilities of motherhood. Integrated treatment programs were developed to address the diverse needs of women, by offering a holistic and comprehensive mix of services that are trauma- and violence-informed, and focus on maternal and child health promotion and the development of healthy relationships.MethodsUsing system-level administrative data from a suite of outpatient integrated programs in Ontario, Canada, we described the clients and rates and predictors of treatment participation over a 7-year period (2008–2014; N = 5162).ResultsAll participants were either pregnant or parenting children under 6 years old at admission to treatment. Retention (length of time between the first and last visit) averaged 124.9 days (SD = 185.6), with episodes consisting of 14.6 visits (SD = 28.6). The vast majority of women attended more than one visit (87.2%), typically returning within 2 weeks (mean 12.3 days, SD = 11.1). In addition to being pregnant or new mothers experiencing problematic substance use, most were unemployed, on social assistance, and single.ConclusionsPrograms appeared to be able to successfully engage most women in treatment once they accessed the programs. Although rates of treatment participation did vary across subgroups defined by sociodemographic and admission characteristics, effect sizes tended to be small on average, providing little evidence in general of sociodemographic inequities in participation. Further work is needed to study the influence of program-level factors on participation, and how these link to maternal and child outcomes.

“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

“…These programs can be provided through various models including outreach, multi-service co-located agencies, or a network of community-based services [ 15 ]. Research in this area has shown that integrated support models can improve maternal and fetal outcomes and successfully support women to reduce alcohol use in pregnancy [ 15 , 19 , 32 , 61 , 77 ].…”

“…Moreover, as these programs offer comprehensive, wraparound services for pregnant and parenting women with substance use concerns, they are developed to match community needs and resources [ 81 ]. In Canada, researchers have evaluated both integrated substance use treatment programs in Ontario [ 20 , 74 , 77 , 81 ] as well as multi-service community-based FASD prevention programs [ 32 , 61 ].…”

Supporting pregnant and parenting women who use alcohol during pregnancy: A scoping review of trauma-informed approaches

“…34 A number of studies indicated that staff understood, recognized, and accounted for the complexities of trauma for women, and sometimes children. 44 , 52 , 53 , 62 , 64 , 67 , 68 , 70 , 76 – 79 While only one study explicitly stated that staff were trained in complex trauma and trauma-informed care, 60 Tarasoff et al 75 noted that the 12 integrated treatment programs being studied embraced a trauma-informed philosophy in the ways programs were delivered as well as how staff worked with pregnant and parenting women by considering client histories and experiences of trauma in their program delivery. Hser et al 57 drew attention to how women are more likely to have coexisting complexities related to gender-specific social determinants of health when thinking about trauma.…”

Nurturing families: One year pilot outcomes for a modified Parent Child Assistance Program in Australia

“…Pregnancy is a good time to intervene as it provides a strong motivation for reducing substance use, and risk for drug abuse is substantially reduced through to the postpartum period [23]. However, engaging and retaining women in substance use interventions requires a trauma-focused and woman-centred approach that is responsive to the concerns and needs of the mother [16,21,24]. For example, Australian research has found that women who use methamphetamine in pregnancy report concerns that disclosing this may result in child removal [16,21].…”