Transcript Pregnant and Addicted Women

Pregnant Addicted Women:
Manitoba’s Experience
Dawn Ridd
Manitoba Health
September 9, 2002
The Lives of Women with
Addictions are Characterized
by...
Multiple Risk Factors
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Poverty
Violence
Chaotic living conditions
Trouble with the law
Alienation from
community health &
social service providers
A Study of the Service Needs of
Pregnant Addicted Women in Manitoba
C. Tait
• 1997 Supreme Court decision in the case of Winnipeg
Child and Family Services v. G.
• The “Ms G.” case involved the forced detainment and
treatment of a pregnant woman in order to protect her
unborn fetus from her solvent addiction.
• The Supreme Court of Canada dismissed the case
stating that detainments of this nature would require
changes to the law.
• Prairie Women’s Health Centre of Excellence was
commissioned to manage a research study into the
barriers for pregnant women seeking addiction
treatment.
Significant Barriers
Prevent women from accessing treatment
and health care
For example:
– Childcare
– Transportation
– Housing
– Culture
– Coordination of service
Pregnant Addicted Women Study
• Five research questions:
• What are the experiences of pregnant addicted
women in accessing treatment for addictions and
maintaining recovery?
• What range of programs currently exist?
• What are the particular challenges in meeting the
needs of pregnant Aboriginal women?
• Are the existing programs meeting the needs of
pregnant women with addiction problems?
• What are the characteristics of effective programs
and services for pregnant addicted women?
Methodology
• Determinants of health approach with a
holistic view of the variables that impact on
women’s health.
• Research strategies:
• in-depth open-ended interviews with consumers
and service providers
• questionnaires
• focus groups
• community meetings and conferences
• collection of written information
Profile of Women Interviewed
Annual income:
• <$10,000
Substance Misuse:
• Polydrug user
• Addicted parent
Other Factors:
• Mental health problems
• Suicide attempts
51%
68%
59%
92%
11%
Profile of Women Interviewed
Abuse:
• Rape or sexual assault
• Partner physically violent
• Emotional, sexual or
physical abuse and/or neglect
Pregnancy:
• Used during pregnancy
• Cut down for a period
• Used because partner using
33%
45%
71%
80%
61%
50%
Report Results - Barriers
89% of women reported experiencing barriers that
prevented them from accessing treatment.
Six areas:
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psychological barriers
barriers related to a woman’s children
barriers related to social support networks
barriers related to socio-geographic factors
barriers related to stigma
barriers related to treatment programs themselves.
Report Results - Programs
• Multiple approaches and varied services are
required to address the service needs of pregnant
women who struggle with substance misuse.
• A collaborative approach among service providers is
needed.
• Treatment programs offering specialized gendersensitive programming and individual counselling
supported by group decisions had the most positive
impact.
• Preparation to enter addiction treatment programs
and effective aftercare services for women were
identified as serious gaps in service delivery.
Report Results - Aboriginal Women
• 77% of the women interviewed were of Aboriginal
descent.
• The study found that this over-representation is
related to being the most impoverished group of
people in Manitoba, historical events, and low levels
of education and chronic unemployment.
• The study found that, in general, Aboriginal women
preferred treatment programs that addressed their
cultural beliefs and the historical realities of Aboriginal
people.
Key Themes: Recommendations
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Training
Public Awareness
New Service Models
Improve/Expand Existing
Service Models
Child Related Issues
Aboriginal Employment Equity
More Research
Recommendations
Training
To provide training and information to
practitioners, service providers, women and
the general public regarding the need for
prevention and early intervention initiatives.
• Re-educate a broad range of service providers
• Resources for low literacy youth and young women.
• Training for correctional workers, RCMP, and health
care providers.
Recommendations
Public Awareness
To increase awareness about the risks of
bingeing during pregnancy, and to destigmatize pregnant women who abuse
substances.
• Crisis card resource with harm reduction information
provided to front line workers
Recommendations
New/Enhanced Services
• Develop the service capacity of gender-sensitive
outreach services
• Support programming for women under the
age of 25.
• Recognized the link between substance misuse and
mental health problems and address gaps in
services.
• Improving aftercare services available to women,
including effective follow-up services to connect
women with positive supports in their home
communities.
Service Inventory
Inventory/database of services and resources currently
available to ‘at-risk’ women and women who are
pregnant and addicted in Manitoba.
• Phase 1 (2002-03): Compile a basic contact list of
services and resources to determine the extent of referral
resources available and new or existing gaps.
• Phase 2 (2003): Gather more in-depth information to
develop more detailed profiles of these services and
resources.
Recommendations - Children
• Recognize the role of Child and Family Services in the lives of
women with substance misuse issues and find ways to improve
supports and services to them upon the apprehension of their
children including:
• formal written agreements between CFS and women as
to the requirements necessary for children to be returned
to her care.
• training for CFS workers in addiction prevention and
treatment
• regular visitation schedules
• Make safe and accessible child care services available to
women near to where they attend treatment.
Recommendations
Aboriginal Services
• Promote aboriginal employment equity in areas
where aboriginal women comprise a large service
population.
• Recognize that Aboriginal agencies are in the best
position to create meaningful programs and services
for Aboriginal women and to work with Aboriginal offand on-reserve addiction services.
Recommendations
Existing Services - STOP FAS
• The STOP FAS
program was
implemented in 1998 at
two Winnipeg sites.
• Expansion of the STOP
FAS program to The
Pas and Thompson
occurred in 2000.
STOP FAS
• Mission Statement - To work with high-risk
mothers with addiction problems to avoid the birth of
children affected by alcohol and drug use.
• Enrollment Criteria:
– Pregnant (or within 2 months post-partum)
– Heavy alcohol or drug use during pregnancy
– Not effectively connected to community resources
STOP FAS: A Holistic Approach
• Assess Needs,
Strengths &
Weaknesses
• Develop a Plan
• Make Connections
• Evaluate Progress
• Ongoing Advocacy
• Case management on
a 1:1 basis
• Personalized support
over a 3 year period
• Mentors work with no
more than 15 women
• Work out in the
community
Principles of STOP FAS
• We believe that …
– women will encounter
setbacks
– women should never
be asked to leave the
program
– the program should
connect women with
direct service
– the program should
connect with the
highest need women
• Mentor Strengths...
– they believe in the women
they work with
– recognize and build on
strengths
– believe change is possible
– have a shared history
– believe that every woman
wants what is best for her
children
– Never give up
STOP FAS - Typical Client
• Is a single woman in her later 20’s, born to
substance abusing parents
• used other drugs in addition to alcohol during
her pregnancy
• has not completed high school
• does not use birth control or plan her
pregnancies; she has more than 3 children with
only one in her care
• is abused by her current partner, has unstable
housing, and social assistance is her main
source of income
• is unlikely to be involved with any kind of
supportive social group
STOP FAS - Goal Setting
Top Four
Identified
Goals
– Someone to talk to who
really cares
– Housing
– Treatment
– Custody of their children
STOP FAS - EVALUATION
• Women who obtained some form
of alcohol/drug treatment
88%
• Treatment is completed or in
progress
71%
• Abstinence from alcohol or using
reliable birth control method for
at least 6 months
80%
• Currently using reliable birth
control regularly and abstinent
from alcohol
32%
STOP FAS - EVALUATION
Target child resides with:
• Mother
32%
• Bio Father
12%
• Other family
40%
• Province/band
12%
• Adoption
4%
Stop FAS:
Cost Savings
• Cost of the Stop FAS Program
– $3400 per woman
• Cost Savings
– Preventing FAS in one child saves
$48,000/yr.
– Keeping one youth out of a
correctional facility saves $46,000
per year
– A child with FAS cost about $1.5
million over their lifetime
– Keeping one child out of foster care
saves
$16,000 per year
Pregnant Addicted Women:
Manitoba’s Experience