Community networks of services for pregnant and parenting women with problematic substance use

Abstract

Integrated treatment programs for pregnant and parenting women who use substances operate at the intersection of multiple service systems, including specialized substance use services, the broader health system, child protection, and social services. Our objectives were to describe the composition and structure of community care networks surrounding integrated treatment programs in selected communities in Ontario, Canada. We used a two-stage snowball method to collect network data from 5 purposively selected integrated treatment programs in communities in Ontario. Front-line staff with integrated treatment programs identified their top 5 service partners, who were then contacted and asked to provide the same information (n = 30). We used social network analysis to measure the cohesiveness, reciprocity, and betweenness centrality in the integrated treatment program’s ego network. We described network composition in terms of representation of different service types. Across communities, common service partners were child protection, substance use or mental health services, parenting and child support, and other social services. Primary and pre-natal care, opioid agonist therapy, and legal services were rarely named as partners. Networks varied in network cohesiveness, as indicated by connectivity between the service partners and reciprocal ties to the integrated treatment programs. Integrated treatment programs commonly brokered the connections between other service partners. Findings suggest that these integrated treatment programs have achieved a level of success in developing cross-sectoral partnerships, with child protection services, parenting and child support, and social services featuring prominently in the networks. In contrast, there was a lack of close connections with physician-based services, highlighting a potential target for future quality improvement initiatives in this sector.

Multi-service prevention programs for pregnant and parenting women with substance use and multiple vulnerabilities: Program structure and clients’ perspectives on wraparound programming

“…These programs were designed to overcome the systemic barriers typically associated with more conventional fragmented service delivery structures and similarly offer a range of services that address women's physical, mental, and social-economic well-being. [26,27] Evaluations of community-based women-centred, relationship-based, 'one-stop' approaches have demonstrated positive outcomes. Findings include increased prenatal visits, improved birth outcomes, reduced substance use, increased support and connection to services, improved health and wellness, improved housing, increased connection and/or custody of infants and children, and reduced isolation [4,17,19,20,[28][29][30][31][32].…”

“…Similarly, there is a paucity of research on clients' perceptions of their care at these programs. A small literature exists in the context of integrated treatment programs: two studies in one Canadian province identified the most common networks of partnerships amongst integrated treatment programs and described the categories of services that exist as a result [25,26]. In these studies, the most common cross-sectoral networks were between the integrated treatment programs and: substance use or mental health services; child protection services; parenting programming, developmental assessment and childcare; and other social services [26].…”

“…Less common partnerships included key forms of physician-based health care, such as primary care, prenatal care, and opiate agonist therapy, resulting in these services being only periodically available. [25,26] There was considerable variability amongst the integrated treatment programs with respect to provision of services related to housing support, assistance with transportation, and therapeutic childcare, despite these services being perceived as important to achieving positive outcomes [25]. Nevertheless, both studies accentuated the importance of such connections in addressing the broad range of physical health and social determinants of health issues experienced by women with problematic substance use.…”

“…These programs were designed to overcome the systemic barriers typically associated with more conventional fragmented service delivery structures and similarly offer a range of services that address women’s physical, mental, and social-economic well-being. [ 26 , 27 ]…”

“…A small literature exists in the context of integrated treatment programs: two studies in one Canadian province identified the most common networks of partnerships amongst integrated treatment programs and described the categories of services that exist as a result [ 25 , 26 ]. In these studies, the most common cross-sectoral networks were between the integrated treatment programs and: substance use or mental health services; child protection services; parenting programming, developmental assessment and childcare; and other social services [ 26 ]. Less common partnerships included key forms of physician-based health care, such as primary care, prenatal care, and opiate agonist therapy, resulting in these services being only periodically available.…”