National Evaluation of Canadian Multi-Service FASD Prevention Programs: Interim Findings from the Co-Creating Evidence Study

Abstract

Since the 1990s, a number of multi-service prevention programs working with women who have substance use, mental health, or trauma and/or related social determinants of health issues have emerged in Canada. These programs use harm reduction approaches and provide outreach and “one-stop” health and social services on-site or through a network of services. While some of these programs have been evaluated, others have not, or their evaluations have not been published. This article presents interim qualitative findings of the Co-Creating Evidence project, a multi-year (2017–2020) national evaluation of holistic programs serving women at high risk of having an infant with prenatal alcohol exposure. The evaluation utilizes a mixed-methods design involving semi-structured interviews, questionnaires, focus groups, and client intake/outcome “snapshot” data. Findings demonstrated that the programs are reaching vulnerable pregnant/parenting women who face a host of complex circumstances including substance use, violence, child welfare involvement, and inadequate housing; moreover, it is typically the intersection of these issues that prompts women to engage with programs. Aligning with these results, key themes in what clients liked best about their program were: staff and their non-judgmental approach; peer support and sense of community; and having multiple services in one location, including help with mandated child protection.

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

“…For the interviews with clients, program staff and services partners, qualitative data analysis techniques were utilized; NVivo12 software (QRS International, Melbourne, Australia), was utilized to facilitate the analyses. See [5,17] for additional information about the study's data analysis techniques.…”

“…A national Advisory Committee was created at the beginning of the project and has met 2-3 times a year to provide guidance and feedback on key facets of the project, including data collection and knowledge translation. For more information about the study design, see [5].…”

“…Immediately following the interview, women were invited to complete the Client Questionnaire, which was most often administered verbally by the research team member. Additional information about on-site data collection by the project team is provided elsewhere (see [5,17]).…”

“…Women's substance use is often intertwined with an array of issues, including physical, emotional, or sexual abuse, intimate partner violence, mental health concerns, child welfare involvement, physical health problems, and challenges related to social determinants of health such as low social support, deep poverty, precarious living conditions and homelessness [1][2][3][4][5][6]. Research contextualizing women's substance use has identified pathways, including women's experiences of trauma, partner violence, the child welfare system, racism, the impacts of colonization, mental health concerns and their mother's use of alcohol during pregnancy [7].…”

“…Systemic barriers also exist: substance use services and child protection services typically have operated discretely with their own set of goals, policies, philosophies, expectations, and legislative regulations and timelines, resulting in high rates of child apprehensions and reluctance to positively sanction parenting by women who use substances [12][13][14]. Nevertheless, pregnancy has been shown to be a pivotal time when women are interested in contemplating or making a significant life change, partly as a result of their desire to keep their newborn in their care and to regain custody of older children, and thus they are receptive to engaging with services [5,[15][16][17][18][19].…”