Examining Substance Use/Abuse Services for Pregnant and Parenting Females in Guilford County Tracy R. Nichols, Ph.D. Margaret Brown, MPH Paula Hernandez, BA Christina Dobson & Susan Cupito Why do we care? Adverse outcomes for infants born to substance using mothers Low birth weight Preterm delivery Birth defects Learning and behavioral problems Treatment Limited opportunities in general Women access treatment at 1/3 the rate of men Approximate similar level of need Children can be both barrier and catalyst for seeking treatment 5-10% of pregnant drug users receive treatment Fear of losing custodial privileges No place to send children while in treatment Want to get better for children Different treatment needs Greater co-morbidity Familial barriers Parenting skills Gender-Specific Treatment Components Children are welcomed during in-patient services Fear of splitting up the family/losing custody resolved Parenting classes Counseling for children Acknowledge trauma and provide counseling for underlying causes/co-morbid conditions Job training/support Bonding to community/re-entry Positive outcomes in terms of relapse and parenting Few programs exist YWCA Background YWCA programs supporting women at risk of adverse birth outcomes Teen Parent Mentor Program Healthy Moms Healthy Babies YWCA success promoting healthy births among at risk women Teens – 100% vs. 87.8% in Guilford County (2011) Adults – 93.5% vs. 88.8% in Guilford County (2011) YWCA Perinatal Substance Abuse Committee Explore how the YWCA can apply its system of psychosocial support to women dealing with addiction Explore the legal and logistical issues around substance use during pregnancy Define the rights and responsibilities of pregnant women Clarify referral process of YWCA program participants to providers of substances abuse assessment and treatment Acceptance of referrals by the YWCA from substance abuse treatment providers of pregnant and parenting women in need of perinatal support and health education YWCA Perinatal Substance Abuse Committee Committee Membership Hospitals Maternal and child health (Healthy Start, FSP, Guilford Coalition on Infant Mortality) Department of Social Services - Child welfare/CPS ADS Substance use treatment providers Shelters Universities Local & State enthusiasm Networking Alcohol/Drug Council of North Carolina YWCA Perinatal Substance Abuse Committee Quarterly Meetings (March 2011 to present) Local needs and programs; hospital policies; legal issues UNC Horizons program, Connie Renz Alcohol and Pregnancy, Dr. Kathy Sulik – UNC Advocacy for Substance Using Women, Dr. Stephen Kandall Panel of Local Programs, Suzan Rand – ADS, Lylan Wingfield – Youth Focus Teen Moms and Substance Abuse – Dr. Lisa Parnell CPS Intake Policies and Procedures in the Context of Perinatal Substance Abuse – Donna Thompson Aims & Questions Identify & document needed and available resources for P&P female substance users Identify & document challenges to providing care for P&P female substance users What resources are needed for population? What resources are available for population? What challenges arise for service providers as they care for population? What gaps exist in the coordination of care for population? How does access to available resources differ by age? How does access to available resources differ by type of drug used? Describe & document development of advisory committee as they address coordination of care for P&P female substance users How does the committee work towards the integration of care for population? How do the aims of the committee change over time? Design Grounded Theory Uses qualitative methodology Allows theory to emerge from the data using systematic strategies Cyclical Compare, contrast & memo at each step to identify potential categories Use theoretical sampling to collect additional data that both fleshes out and identifies new categories Constructivist approach – Charmaz (2006) Interpretive approach: “neither data nor theories are discovered” Sampling Initial Sampling Advisory committee meetings Meeting minutes, pubic documents & reports pertaining to perinatal substance use Service providers & agency coordinators working with population Published literature on provider experiences, policy & population experience Theoretical Sampling Dependent upon emerging categories Interviews Advisory Committee members initially, then snowball sampling Approximately 25-30 interviews Approximately 45 minutes to an hour Audio-taped and transcribed verbatim Focus on experiences with population: major tasks, recruitment, referral, challenges, areas for change Participant Observations Faculty member has been Advisory Committee member since its inception Detailed notes taken at each meeting Focus on information shared, questions raised, action proposed and taken, and identified issues Observations during “spin-off” meetings may occur Document & Literature Review Review of Advisory Committee documents Review of public documents Minutes, agendas, attendance, shared notices, etc e.g. County-level data on perinatal drug use treatment Review of literature Research literature Journalism Memoirs First Steps Aim 1: Identify & document needed and available resources Aim 2: Identify & document challenges to providing care Developing database of agencies in and around GC Reviewed initial field notes & minutes for resource references 3 interviews conducted, transcribed & compared Identifying initial categories from interviews & field notes Aim 3: Describe & document development of advisory committee as they address coordination of care 2 participant observations conducted & compared Initial document review of minutes, agendas, & field notes Sample Database Agency ADS Healthy Start, FSP Room at the Inn Purpose Private, non-profit agency providing substance abuse education, prevention, and treatment service to residents of Guilford County and surrounding areas. Services *Outpatient & intensive outpatient treatment *Prevention & Education *Methadone Services *DWI Assessments & Treatment *Corporate Training & Workplace Workshops Healthy Start is a home-based *Developmental expectations for infants program that works with pregnant *Parenting information and new parents (children 0-2yrs) *Selection of childcare provider with stress factors that make *Child nutrition, health and safety issues parenting an even tougher job. Case *Referrals to other community resources workers help parents nurture their *Opportunities to be a part of a group of children's development by helping other moms with similiar life situations. creat a positive, safe living environment for their families. A unique and comprehensive *Shelter program that helps homeless, single, *Food pregnant women (with or without *Clothing previous children), during pregnancy *Case Management and after the birth of their babies. *In-house daycare *Transportation *Life Skills Education and counseling Vision Provide an arry of culturally accessible services that promote health and wellness to individuals and families impacted by the use and abuse of alcohol, tobacco, and other drugs. Building safe and healthy families. Provide accessible, affordable, high quality counseling to families and individuals who are experiencing problems in dealing with crises in their lives. Aim to raise public awareness on issues that affect the stability of society. Believe in providing services to anyone without discrimination. Help families have new lives of healthy, hope-filled self sufficiency. Emerging Categories Legal vs illegal drug use Maternal vs fetal rights Personal belief vs evidence Shame & Guilt Stigma Access Screening criteria & procedures Networking Next Steps Coding transcripts & field notes Collection county & state-wide documents & statistics Constant comparative analysis Additional interviews & participant observations Implications Local Assist YWCA & Advisory Committee with mission Increase resources & coordination of care in Guilford County National Speak to the larger conversation happening across the nation on maternal versus fetal rights & legislation targeting pregnant and parenting women Ethan’s law Personhood Amendment Questions?