Supporting pregnant and parenting women who use alcohol during pregnancy: A scoping review of trauma-informed approaches

Abstract

Alcohol is legalized and used for a variety of reasons, including socially or as self-medication for trauma in the absence of accessible and safe supports. Trauma-informed approaches can help address the root causes of alcohol use, as well as the stigma around women’s alcohol use during pregnancy. However, it is unclear how these approaches are used in contexts where pregnant and/or parenting women access care. Our objective was to synthesize existing literature and identify promising trauma-informed approaches to working with pregnant and/or parenting women who use alcohol. A multidisciplinary team of scholars with complementary expertise worked collaboratively to conduct a rigorous scoping review. All screening, extraction, and analysis was independently conducted by at least two authors before any differences were discussed and resolved through team consensus. The Joanna Briggs Institute method was used to map existing evidence from peer-reviewed articles found in PubMed, CINAHL, PsycINFO, Social Work Abstracts, and Web of Science. Data were extracted to describe study demographics, articulate trauma-informed principles in practice, and gather practice recommendations. Thirty-six studies, mostly from the United States and Canada, were included for analysis. Studies reported on findings of trauma-informed practice in different models of care, including live-in treatment centers, case coordination/management, integrated and wraparound supports, and outreach—for pregnant women, mothers, or both. We report on how the following four principles of trauma-informed practices were applied and articulated in the included studies: (1) trauma awareness; (2) safety and trustworthiness; (3) choice, collaboration, and connection; and (4) strengths-based approach and skill building. This review advances and highlights the importance of understanding trauma and applying trauma-informed practice and principles to better support women who use alcohol to reduce the risk of alcohol-exposed pregnancies. Relationships and trust are central to trauma-informed care. Moreover, when applying trauma-informed practices with pregnant and parenting women who use alcohol, we must consider the unique stigma attached to alcohol use.

Investigating the unique service and treatment needs of women with alcohol use disorder: Literature review and key informant perspectives in British Columbia

“…A trauma-informed approach is also beneficial, encompassing a collaborative and promising intervention which adapts a holistic perspective on treatment allowing for a safe and collaborative environment and acknowledging one's life experience by providing awareness, safety, choice, and connection. 18 Comprehensive services incorporating women's socioeconomic context, such as employment and housing, and community-based supports like childcare, transportation, and job training, can provide Harm reduction more incentives to seeking treatment. 15,19 To provide more inclusive care, treatment for co-occurring emotional and mental health problems can improve treatment utilization and satisfaction.…”

Integrated Supports for Women and Girls Experiencing Substance Use and Complex Needs

“…9,26,27 Trauma-informed approaches are increasingly recognized within best practice for supporting individuals who are pregnant with substance use challenges, incorporating trauma awareness; safety and trust; opportunities for choice, collaboration, and connection; and strengths-based perspectives. 28 Moreover, there is growing evidence to support programs delivered through a “one stop shop,” or integrated, model versus fragmented services to meet the dynamic needs and empower women and girls with substance use challenges in a tailored and coordinated way. 29,30 These integrated multi-service programs blend social and primary care to provide collaborative, community-based wraparound support for clients, and have been shown to improve outcomes related to substance use, prenatal and postnatal support, basic needs, nutrition, housing, parenting and parent-child connection, child welfare, health and wellness of both parent and child, (re)connection with culture, as well as peer and social connection.…”