1. Pregnant Addicted Women: Manitoba’s Experience Dawn Ridd Manitoba Health September 9, 2002

2. The Lives of Women with Addictions are Characterized by... Multiple Risk Factors PovertyPoverty ViolenceViolence Chaotic living conditionsChaotic living conditions Trouble with the lawTrouble with the law Alienation from community health & social service providersAlienation from community health & social service providers

3. A Study of the Service Needs of Pregnant Addicted Women in Manitoba 1997 Supreme Court decision in the case of Winnipeg Child and Family Services v. G. The “Ms G.” case involved the forced detainment and treatment of a pregnant woman in order to protect her unborn fetus from her solvent addiction. The Supreme Court of Canada dismissed the case stating that detainments of this nature would require changes to the law. Prairie Women’s Health Centre of Excellence was commissioned to manage a research study into the barriers for pregnant women seeking addiction treatment. C. Tait

4. Significant Barriers Prevent women from accessing treatment and health care For example: –Childcare –Transportation –Housing –Culture –Coordination of service

5. Pregnant Addicted Women Study Five research questions: What are the experiences of pregnant addicted women in accessing treatment for addictions and maintaining recovery? What range of programs currently exist? What are the particular challenges in meeting the needs of pregnant Aboriginal women? Are the existing programs meeting the needs of pregnant women with addiction problems? What are the characteristics of effective programs and services for pregnant addicted women?

6. Methodology Determinants of health approach with a holistic view of the variables that impact on women’s health. Research strategies : in-depth open-ended interviews with consumers and service providers questionnaires focus groups community meetings and conferences collection of written information

7. Profile of Women Interviewed Annual income: <$10,00051% Substance Misuse: Polydrug user68% Addicted parent59% Other Factors: Mental health problems92% Suicide attempts11%

8. Profile of Women Interviewed Abuse: Rape or sexual assault33% Partner physically violent45% Emotional, sexual or physical abuse and/or neglect71% Pregnancy: Used during pregnancy80% Cut down for a period 61% Used because partner using50%

9. Report Results - Barriers 89% of women reported experiencing barriers that prevented them from accessing treatment. Six areas: psychological barriers barriers related to a woman’s children barriers related to social support networks barriers related to socio-geographic factors barriers related to stigma barriers related to treatment programs themselves.

10. Report Results - Programs Multiple approaches and varied services are required to address the service needs of pregnant women who struggle with substance misuse. A collaborative approach among service providers is needed. Treatment programs offering specialized gender- sensitive programming and individual counselling supported by group decisions had the most positive impact. Preparation to enter addiction treatment programs and effective aftercare services for women were identified as serious gaps in service delivery.

11. Report Results - Aboriginal Women 77% of the women interviewed were of Aboriginal descent. The study found that this over-representation is related to being the most impoverished group of people in Manitoba, historical events, and low levels of education and chronic unemployment. The study found that, in general, Aboriginal women preferred treatment programs that addressed their cultural beliefs and the historical realities of Aboriginal people.

12. Key Themes: Recommendations 1Training 2Public Awareness 3New Service Models 4Improve/Expand Existing Service Models 5Child Related Issues 6Aboriginal Employment Equity 7More Research

13. Recommendations Training To provide training and information to practitioners, service providers, women and the general public regarding the need for prevention and early intervention initiatives. Re-educate a broad range of service providers Resources for low literacy youth and young women. Training for correctional workers, RCMP, and health care providers.

14. Recommendations Public Awareness To increase awareness about the risks of bingeing during pregnancy, and to de- stigmatize pregnant women who abuse substances. Crisis card resource with harm reduction information provided to front line workers

15. Recommendations New/Enhanced Services Develop the service capacity of gender-sensitive outreach services Support programming for women under the age of 25. Recognized the link between substance misuse and mental health problems and address gaps in services. Improving aftercare services available to women, including effective follow-up services to connect women with positive supports in their home communities.

16. Service Inventory Inventory/database of services and resources currently available to ‘at-risk’ women and women who are pregnant and addicted in Manitoba. Phase 1 (2002-03): Compile a basic contact list of services and resources to determine the extent of referral resources available and new or existing gaps. Phase 2 (2003): Gather more in-depth information to develop more detailed profiles of these services and resources.

17. Recommendations - Children Recognize the role of Child and Family Services in the lives of women with substance misuse issues and find ways to improve supports and services to them upon the apprehension of their children including: formal written agreements between CFS and women as to the requirements necessary for children to be returned to her care. training for CFS workers in addiction prevention and treatment regular visitation schedules Make safe and accessible child care services available to women near to where they attend treatment.

18. Recommendations Aboriginal Services Promote aboriginal employment equity in areas where aboriginal women comprise a large service population. Recognize that Aboriginal agencies are in the best position to create meaningful programs and services for Aboriginal women and to work with Aboriginal off- and on-reserve addiction services.

19. Recommendations Existing Services - STOP FAS The STOP FAS program was implemented in 1998 at two Winnipeg sites. Expansion of the STOP FAS program to The Pas and Thompson occurred in 2000.

20. STOP FAS Mission Statement - To work with high-risk mothers with addiction problems to avoid the birth of children affected by alcohol and drug use. Enrollment Criteria : –Pregnant (or within 2 months post-partum) –Heavy alcohol or drug use during pregnancy –Not effectively connected to community resources

21. Assess Needs, Strengths & Weaknesses Develop a Plan Make Connections Evaluate Progress Ongoing Advocacy Case management on a 1:1 basis Personalized support over a 3 year period Mentors work with no more than 15 women Work out in the community STOP FAS: A Holistic Approach

22. We believe that … –women will encounter setbacks –women should never be asked to leave the program –the program should connect women with direct service –the program should connect with the highest need women Principles of STOP FAS Mentor Strengths... –they believe in the women they work with –recognize and build on strengths –believe change is possible –have a shared history –believe that every woman wants what is best for her children –Never give up

23. Is a single woman in her later 20’s, born to substance abusing parents used other drugs in addition to alcohol during her pregnancy has not completed high school does not use birth control or plan her pregnancies; she has more than 3 children with only one in her care is abused by her current partner, has unstable housing, and social assistance is her main source of income is unlikely to be involved with any kind of supportive social group STOP FAS - Typical Client

24. Top Four Identified Goals –Someone to talk to who really cares –Housing –Treatment –Custody of their children STOP FAS - Goal Setting

25. Women who obtained some form of alcohol/drug treatment STOP FAS - EVALUATION 88% 71% 80% 32% Treatment is completed or in progress Abstinence from alcohol or using reliable birth control method for at least 6 months Currently using reliable birth control regularly and abstinent from alcohol

26. Target child resides with : Mother STOP FAS - EVALUATION 32% 12% 40% 12% Bio Father Other family Adoption Province/band 4%

27. Stop FAS: Cost Savings Cost of the Stop FAS Program –$3400 per woman Cost Savings –Preventing FAS in one child saves $48,000/yr. –Keeping one youth out of a correctional facility saves $46,000 per year –A child with FAS cost about $1.5 million over their lifetime –Keeping one child out of foster care saves $16,000 per year

28. Pregnant Addicted Women: Manitoba’s Experience