Tracy R Nichols PhD Margaret Brown MPH Paula Hernandez BA Christina Dobson amp Susan Cupito Why do we care Adverse outcomes for infants born to substance using mothers Low birth weight ID: 157901
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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
CupitoSlide2
Why do we care?
Adverse outcomes for infants born to substance using mothersLow birth weightPreterm delivery
Birth defects
Learning and behavioral problemsSlide3Slide4
Treatment
Limited opportunities in general5-10% of pregnant drug users receive treatmentWomen access treatment at 1/3 the rate of menApproximate similar level of need
Children can be both barrier and catalyst for seeking treatment
Fear of losing custodial privileges
No place to send children while in treatment
Want to get better for childrenDifferent treatment needs
Greater co-morbidityFamilial barriersParenting skillsSlide5
Gender-Specific Treatment
Components Children are welcomed during in-patient servicesFear of splitting up the family/losing custody resolvedParenting classes
Counseling for children
Acknowledge trauma and provide counseling for underlying causes/co-morbid conditions
Job training/support
Bonding to community/re-entryPositive outcomes in terms of relapse and parentingFew
programs existSlide6
YWCA Background
YWCA programs supporting women at risk of adverse birth outcomesTeen Parent Mentor ProgramHealthy Moms Healthy BabiesYWCA 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)Slide7
YWCA Perinatal
Substance Abuse CommitteeExplore 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 educationSlide8
YWCA Perinatal
Substance Abuse CommitteeCommittee Membership
Hospitals
Maternal and child health (Healthy Start, FSP, Guilford Coalition on Infant Mortality)
Department of Social Services - Child welfare/CPS
ADSSubstance use treatment providersShelters
UniversitiesLocal & State enthusiasmNetworking
Alcohol/Drug Council of North CarolinaSlide9
YWCA Perinatal
Substance Abuse CommitteeQuarterly 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 KandallPanel 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 ThompsonSlide10
Aims & Questions
Identify & document needed and available resources for P&P female substance usersWhat resources are needed for population?
What resources are available for population?
Identify & document challenges to providing care for P&P female substance users
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?Slide11
Design
Grounded TheoryUses qualitative methodologyAllows theory to emerge from the data using systematic strategiesCyclical
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”Slide12
Sampling
Initial Sampling
Advisory committee meetings
Meeting minutes, pubic documents & reports pertaining to
perinatal
substance use
Service providers & agency coordinators working with populationPublished literature on provider experiences, policy & population experienceTheoretical Sampling
Dependent upon emerging categoriesSlide13
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 changeSlide14
Participant Observations
Faculty member has been Advisory Committee member since its inceptionDetailed notes taken at each meetingFocus on information shared, questions raised, action proposed and taken, and identified issuesObservations during “
s
pin-off” meetings may occurSlide15
Document & Literature Review
Review of Advisory Committee documents
Minutes, agendas, attendance, shared notices, etc
Review of public documents
e.g. County-level data on
perinatal drug use treatment
Review of literatureResearch literatureJournalismMemoirsSlide16
First Steps
Aim 1: Identify & document needed and available resourcesDeveloping database of agencies in and around GCReviewed initial field notes & minutes for resource references
Aim 2: Identify & document challenges to providing care
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 care2 participant observations conducted & compared
Initial document review of minutes, agendas, & field notes Slide17
Sample Database
Agency
Purpose
Services
Vision
ADS
Private, non-profit agency providing substance abuse education, prevention, and treatment service to residents of Guilford County and surrounding areas.
*Outpatient & intensive outpatient treatment
*
Prevention & Education
*
Methadone Services
*DWI Assessments & Treatment *Corporate Training & Workplace Workshops
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.
Healthy Start, FSP
Healthy Start is a home-based program that works with pregnant and new parents (children 0-2yrs) with stress factors that make parenting an even tougher job. Case workers help parents nurture their children's development by helping creat a positive, safe living environment for their families.
*Developmental expectations for infants *Parenting information
*
Selection of childcare provider *Child nutrition, health and safety issues *Referrals to other community resources *Opportunities to be a part of a group of other moms with
similiar
life situations.
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.
Room at the Inn
A unique and comprehensive program that helps homeless, single, pregnant women (with or without previous children), during pregnancy and after the birth of their babies.
*Shelter
*Food
*Clothing
*
Case Management
*
In-house daycare *Transportation
*
Life Skills Education and counseling
Help families have new lives of healthy, hope-filled self sufficiency.Slide18
Emerging Categories
Legal vs illegal drug useMaternal vs fetal rights
Personal belief
vs
evidenceShame & Guilt
StigmaAccessScreening criteria & proceduresNetworkingSlide19
Next Steps
Coding transcripts & field notesCollection county & state-wide documents & statisticsConstant comparative analysisAdditional interviews & participant observationsSlide20
Implications
LocalAssist YWCA & Advisory Committee with missionIncrease resources & coordination of care in Guilford CountyNational
Speak to the larger conversation happening across the nation on maternal versus fetal rights & legislation targeting pregnant and parenting women
Ethan’s law
Personhood AmendmentSlide21
Questions?