Abstract

Pregnant and parenting women who have substance use and mental health problems face barriers to accessing health and social services, including stigma, fear of losing child custody, and complex needs exacerbated by homelessness and poverty. Integrated treatment programs for this population operate at the intersection of multiple service systems, including specialized substance use and mental health, child welfare, and social services.

Pregnant belly and a needle shooting up in the left arm

This presentation will describe the process and findings from a large, multisite study of integrated treatment programs in Ontario, Canada (Canada’s most populous province, ~14 million people). The mixed methods study included semi-structured interviews and focus groups with service providers and women, and a population-based analysis of administrative data. Although there is wide variability across programs in the specific complement of services that are available to women, it is possible to distill the service model down to a number of core, higher-order principles that drive collaboration and service delivery. Mental health and trauma services were almost universally offered, while primary health care and services for children were rare. Relative to control or standard substance use treatment programs in Ontario, the integrated treatment programs offered a wider array of services. Women’s perceptions of care were also more positive in integrated treatment programs relative to control programs, and engagement in services (measured in terms of retention and treatment intensity) was high. The therapeutic relationship emerged as a central element, with programs supporting women in emotion regulation and problem solving. This work is embedded within a larger program of research evaluating the process and outcomes of treatment programs for women, recognizing the unique contexts, strengths, and challenges faced by women and mothers with substance use problems.

Karen Urbanoski

Dr. Karen Urbanoski is a Scientist with the Canadian Institute for Substance Use Research and an Assistant Professor in Public Health and Social Policy at the University of Victoria. She holds the Canada Research Chair in Substance Use, Addictions and Health Services Research. She draws from her training in epidemiology to study the social determinants of substance-related problems and addiction, and how these affect access to health care.

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