cross-disciplinary specialist care for substance-abusing pregnant women and their infants – team...
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Cross-disciplinary specialist care for substance-abusing pregnant
women and their infants – Team Haga
Maternity and Child Health Care
in
Primary Care
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Primary Care
Dept of Substance Abuse, Sahlgrenska University Hospital
Team Haga-
Cross-disciplinary care
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Antenatal Health Care in Sweden
• 100% attendance and very high credibility among population• Free of charge• Standardized nationwide• Midwife-centered (teamwork with physicians)• Total abstention from alcohol recommended during pregnancy• Motivational interview on alcohol (incl. AUDIT), drugs, medications
and tobacco with midwife, within one week of positive pregnancy test• Extremely low maternal and perinatal mortality and morbidity
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Child Health Care in Sweden• 100% attendance and very high credibility among
population• Free of charge• Standardized nationwide• From birth to age 6• Nurse-centered (teamwork w physician)• Restraint with alcohol recommended during
breastfeeding and in relation to parenting
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Team Haga
Cross-disciplinary specialist unit run by Primary Health Care System in Gothenburg, established in April, 2007
Close collaboration with, and located in, Dept of Substance Abuse, Sahlgrenska University Hospital
Target group: pregnant women/new mothers with substance abuse (current or up to one year previously) and their babies
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Goals
• Protect the fetus from substance-abuse effects, • support women to stop abuse during pregnancy
and • to stay substance-free after delivery
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Team members2 Midwives
2 Child Health nurses
Social worker
Psychiatric nurse
Team assistant/nurse
Obstetrician
Pediatrician
Psychiatrist
Manager
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
How to contact Team Haga?
The majority of the women are referred by antenatal care centers.
Some are referred from substance abuse clinics,
a small number referred from social services or criminal justice system and
some come on their own initiative.
Some repeat pregnancies
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Specialist Health Care during pregnancy and infancy
Liberal exploration of ambivalence in many cases; good professional network with abortion services
If pregnancy is continued, standard antenatal care plus:At least weekly midwife appointmentsAll women see obstetrician, liberal use of ultrasound to envisage fetusRegular monitored urine tests in almost all casesAppointment with the child health nurse around week 25
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Contact with psychiatric nurse or psychiatrist in selected cases
Team conferences determine individualized care and support for each women, postpartum follow-up for mothers and individualized child health care according to infant´s and family’s needs
Repeated home visits beginning shortly after birthAll infants are seen and assessed by pediatricianNetworking with local child health care centers to which babies are eventually referred
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Continued teamwork and extensive collaboration with social services, psychiatry and the local child health care system is essential
Long-term follow-up is often required
Social worker often involved in order to collaborate with social services and investigate woman’s and the family requirements for support
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Challenges
• Psychiatric morbidity complicates many cases, • resources for care/support of fathers-to-be (majority are
substance abusers), • some substance-abusers are unmotivated to
attend the specialist care,• social services with diverging policies/knowledge/time
perspectives/resources regarding substance abuse, psychiatric ill-health and parenting
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Results
A majority of the patients stay substance-free during pregnancy, and no cases of FASD or other serious neonatal effects of substance abuse have been diagnosed so far
An evaluation of the unit is in progress. The evaluation shows the benefical effects of themultidisciplinary team, continuity, treatment and the individualised, structured but at thesame time flexible support for the women
The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012
Thank You
Team Haga-
Cross-disciplinary specialist care for substance-
abusing pregnant women and their infants
Gothenburg
Sweden
Antonia Reuter
Manager
E-post: [email protected]