Examining Substance Use/Abuse Services for

Pregnant and Parenting Females in Guilford

County

Tracy R. Nichols, Ph.D.Margaret Brown, MPHPaula 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

5-10% of pregnant drug users receive treatment 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 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 What 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?

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

Minutes, agendas, attendance, shared notices, etc Review of public documents

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 Developing database of agencies in and around GC Reviewed 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 care 2 participant observations conducted & compared Initial document review of minutes, agendas, & field notes

Sample DatabaseAgency 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.

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?