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

Abstract

Background: In Canada, several community-based, multi-service programs aimed at reaching vulnerable pregnant or parenting women with substance use and complex issues have emerged. These programs offer basic needs and social supports along with perinatal, primary, and mental health care, as well as substance use services. Evaluations of these 'one-stop' programs have demonstrated positive outcomes; nevertheless, few published studies have focused on how these programs are structured, on their cross-sectoral partnerships, and on clients' perceptions of their services. Methods: The Co-Creating Evidence (CCE) project was a three-year evaluation of eight multi-service programs located in six Canadian jurisdictions. The study used a mixed-methods design involving semi-structured interviews, questionnaires, output data, and de-identified client data. This article focuses on qualitative interviews undertaken with 125 clients during the first round of site visits, supplemented by interview data with program staff and service partners. Results: Each of the programs in the CCE study employs a multi-service model that both reflects a wrap-around approach to care and is intentionally geared to removing barriers to accessing services. The programs are either operated by a health authority (n = 4) or by a community-based agency (n = 4). The programs' focus on the social determinants of health, and their provision of primary, prenatal, perinatal and mental health care services is essential; similarly, on-site substance use and trauma/violence related services is pivotal. Further, programs' support in relation to women's child welfare issues promotes collaboration, common understanding of expectations, and helps to prevent child/infant removals. Conclusions: The programs involved in the Co-Creating Evidence study have impressively blended social and primary care and prenatal care. Their success in respectfully and flexibly responding to women's diverse needs, interests and readiness, within a community-based, wraparound service delivery model paves the way for others offering pre-and postnatal programming.

Provider Characteristics Associated with Trust When Caring for Women Experiencing Substance Use Disorders in the Perinatal Period

“…One participant stated, “I'm still connected with the nurse practitioner here. She's the only health care provider I'll see because she knows me and my history.” 37 Participants were comfortable disclosing their substance use and were more likely to return for follow‐up appointments as the result of health care providers who were understanding and supportive of their substance use treatment efforts.…”

Wraparound programmes for pregnant and parenting women with substance use concerns in Canada: Partnerships are essential

“…• Evidence of benefits of partnerships, both for clients of wraparound programmes and for staff and service partners of these programmes. Pepler et al, 2014;Rutman et al, 2020). These multiservice programmes do not use addiction as the entry point, but rather focus on addressing the health needs of pregnant and early parenting women who also have substance use and other complex challenges.…”

“…Complementing but distinct from integrated treatment programmes, wraparound programmes—wherein multiple services are offered at one location—have been shown to be effective in engaging pregnant or parenting women experiencing substance use and other complex challenges (Andrews et al., 2018; Motz et al., 2019; Pepler et al., 2014; Rutman et al., 2020). These multi‐service programmes do not use addiction as the entry point, but rather focus on addressing the health needs of pregnant and early parenting women who also have substance use and other complex challenges.…”

“…Previous articles on the CCE project have focused on the study's interim findings (Rutman & Hubberstey, 2019), clients' perspectives on why they sought help as well as their most significant changes (Hubberstey et al., 2019), programme structure and clients' perspectives on the programmes' approaches (Rutman et al., 2020), and on wraparound from an Indigenous perspective (Van Bibber et al, submitted for publication). This article focusses on partnerships as an essential component of service delivery and addresses the questions: What are the characteristics of partnerships in wraparound programmes; What are the benefits of partnerships and, What are the challenges associated with partnerships? …”

“…Partnerships between programmes that place a high value on harm reduction and trauma‐informed practice, as wraparound programmes do, and other agencies such as provincial child welfare organisations, require a willingness to embrace a certain degree of risk‐taking. At the same time, wrapround programmes typically rely on a mix of formal and informal partnerships and cross‐sectoral relationships to offer their array of services (Nathoo et al., 2013; Rutman et al., 2020). Trust informs both types of partnerships with intersectoral informal relationships between practitioners often providing the basis for overcoming perspectives on risk that can take longer to manage within the formal partnerships structure.…”