Mothers more likely to stay in substance abuse treatment programs than pregnant women

By Suelan Toye

Integrated treatment programs are doing a good job in engaging mothers who use substances in treatment and keeping them there.

The research findings for the study (opens in new window) , “Healthy Mothers, Health Families,” will be presented this morning at an event at the St. James Cathedral Centre, 65 Church Street, Toronto.

This study comes on the heels of the Motherisk Commission  (PDF file) report (external link)  released in February, which recommended, among other things, that there should be more support for “family-inclusive substance use treatment programs.”

More than one third of all people who receive treatment for substance use and addictions are women – and more than half have children, or are pregnant. Many women also have experienced trauma in their lives and other barriers to substance use treatment.

The four-year study, funded by CIHR (Canadian Institutes of Health Research) and the Ontario Ministry of Health and Long-Term Care, looks at models of service delivery for pregnant and parenting women with problematic substance use, describing the types of services and collaborations that support the well-being of mothers and their children.

“Ontario has the largest number of integrated programs in Canada,” said the study’s co-principal investigator Karen Milligan, a psychology professor at Ryerson University’s Faculty of Arts. “We are in a leadership position to evaluate the overall impact of these programs on treating pregnant and parenting mothers with problematic substance use.”

Integrated substance use programs are holistic, said Milligan. In addition to providing women with help with addiction issues, they differ from standard programs in that they offer a greater range of other services such as maternal mental health, parenting skills, childcare, and transportation support. These services are important for engaging women and keeping them in treatment.

“We know from previous research that women who are pregnant, or have young children, tend to avoid getting treatment because they’re afraid of being stigmatized, or having their children taken away by child welfare agencies,” said Karen Urbanoski, a co-principal investigator and the Canada Research Chair in Substance Use, Addictions and Health Services Research. Urbanoski is also a scientist at the Canadian Institute for Substance Use Research and an assistant professor at the School of Public Health and Social Policy at the University of Victoria.

The research team were interested in:

·  the nature of the partnerships formed between integrated programs and service providers (housing, legal, child agencies, pre-natal care etc.);

·  mothers’ perceptions of care while in treatment;

·  service capacity and women’s engagement with the treatment programs; and

·  maternal and child health outcomes and program cost effectiveness.

The team conducted site visits with various programs across Ontario in large urban centres and smaller communities where they interviewed program staff, from front-line counsellors to senior level staff. They also spoke to service providers from health and social services that the program staff worked with on a regular basis to understand the different roles that they played and how they supported the treatment programs.

The researchers also met with 106 women in integrated treatment programs to evaluate their perceptions of care and compared this data with 207 women attending standard programs. Finally, the researchers analysed data based on more than 5,000 women receiving integrated treatment at 29 agencies to examine their level of engagement in these programs.

The team found that older mothers tended to stay, on average, more than 11 days longer compared to younger mothers and pregnant women. Staying longer in treatment is associated with better outcomes (less substance use, better health, etc.). Mothers who were not mandated by the court system to undergo treatment tended to visit their counsellor more often.

In addition, those attending integrated treatment programs perceived their care more positively than those in standard programs.

The team also found that the integrated programs, although successful in developing partnerships with different service providers, ran into barriers when the funding sources of these providers came from a myriad of government ministries, many of whom have different mandates and different understandings of how to address substance use problems.

Finally, the researchers found that integrated programs had more limited partnerships with prenatal services (i.e. birthing centres/hospitals) or some physician-based services (i.e. medication-assisted treatment).

Milligan says that that the key ingredient in these programs is relationships.

“Strong relationships between service partners make for a stronger treatment system. Women also told the team that it is the relationship with their counsellor that makes the difference,” said Milligan. “When mothers are emotionally supported, it is easier for them to learn and apply new skills, navigate services, and care for their children in a sensitive manner.”

Lucy Hume, executive director of the Jean Tweed Centre and Knowledge Translation Partner for the study, echoed the focus on relationships between traditional distinct service providers.

“I really believe our success is, in large part, a result of an integrated response.  By working with other sectors/services, we can respond to multiple determinants of health, and build capacity at the same time. To sustain this in the long term, however, the system needs to incentivize organizations by committing to integrated supports including those for children which are limited.”

Deborah Goodman, director of the Children’s Aid Society’s Child Welfare Institute, emphasized the importance of the study on helping agencies to develop better approaches to reduce the stigma and barriers to treatment for young mothers and pregnant women  who tend to drop out of programs earlier.

“As the great poet and playwright Maya Angelou aptly noted, ‘When you know better, do better.’ We now know better and so it is time for us to do better.”

Led by Drs. Milligan and Urbanoski, the research team comprises Lucy Hume (Director of Clinical Services, Jean Tweed Centre), Claire de Oliveira (Independent Scientist and Health Economist, CAMH), Joanna Henderson (Director of the Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, CAMH), Tara Gomes (Scientist, Li Ka Shing Knowledge Institute, St. Michael’s Hospital), and Alison Niccols (Clinical Director of the Infant-Parent Program, McMaster Children’s Hospital). Three postdoctoral fellows (Amelia Usher, Lesley Tarasoff, Karen Le), graduate students (Tamara Meixner, Gillian Kolla, among many other students and volunteers), and a committed panel of experts in substance use treatment, policy, and research also significantly contributed to the research report.