Examining Substance Use/Abuse Services for Pregnant and Parenting Females in Guilford County

1. Examining Substance Use/Abuse Services for Pregnant and Parenting Females in Guilford County Tracy R. Nichols, Ph.D. Margaret Brown, MPH Paula Hernandez, BA Christina Dobson & Susan Cupito

2. Why do we care? • Adverse outcomes for infants born to substance using mothers • Low birth weight • Preterm delivery • Birth defects • Learning and behavioral problems

4. Treatment • Limited opportunities in general • 5-10% of pregnant drug users receive treatment • Women access treatment at 1/3 the rate of men • Approximate similar level of need • Children can be both barrier and catalyst for seeking treatment • Fear of losing custodial privileges • No place to send children while in treatment • Want to get better for children • Different treatment needs • Greater co-morbidity • Familial barriers • Parenting skills

5. Gender-Specific Treatment • Components • Children are welcomed during in-patient services • Fear of splitting up the family/losing custody resolved • Parenting classes • Counseling for children • Acknowledge trauma and provide counseling for underlying causes/co-morbid conditions • Job training/support • Bonding to community/re-entry • Positive outcomes in terms of relapse and parenting • Few programs exist

6. YWCA Background • YWCA programs supporting women at risk of adverse birth outcomes • Teen Parent Mentor Program • Healthy Moms Healthy Babies • YWCA success promoting healthy births among at risk women • Teens – 100% vs. 87.8% in Guilford County (2011) • Adults – 93.5% vs. 88.8% in Guilford County (2011)

7. YWCA Perinatal Substance Abuse Committee • Explore how the YWCA can apply its system of psychosocial support to women dealing with addiction • Explore the legal and logistical issues around substance use during pregnancy • Define the rights and responsibilities of pregnant women • Clarify referral process of YWCA program participants to providers of substances abuse assessment and treatment • Acceptance of referrals by the YWCA from substance abuse treatment providers of pregnant and parenting women in need of perinatal support and health education

8. YWCA Perinatal Substance Abuse Committee • Committee Membership • Hospitals • Maternal and child health (Healthy Start, FSP, Guilford Coalition on Infant Mortality) • Department of Social Services - Child welfare/CPS • ADS • Substance use treatment providers • Shelters • Universities • Local & State enthusiasm • Networking • Alcohol/Drug Council of North Carolina

9. YWCA Perinatal Substance Abuse Committee • Quarterly Meetings (March 2011 to present) • Local needs and programs; hospital policies; legal issues • UNC Horizons program, Connie Renz • Alcohol and Pregnancy, Dr. Kathy Sulik – UNC • Advocacy for Substance Using Women, Dr. Stephen Kandall • Panel of Local Programs, Suzan Rand – ADS, LylanWingfield – Youth Focus • Teen Moms and Substance Abuse – Dr. Lisa Parnell • CPS Intake Policies and Procedures in the Context of Perinatal Substance Abuse – Donna Thompson

10. Aims & Questions • Identify & document needed and available resources for P&P female substance users • What resources are needed for population? • What resources are available for population? • Identify & document challenges to providing care for P&P female substance users • What challenges arise for service providers as they care for population? • What gaps exist in the coordination of care for population? • How does access to available resources differ by age? • How does access to available resources differ by type of drug used? • Describe & document development of advisory committee as they address coordination of care for P&P female substance users • How does the committee work towards the integration of care for population? • How do the aims of the committee change over time?

11. Design • Grounded Theory • Uses qualitative methodology • Allows theory to emerge from the data using systematic strategies • Cyclical • Compare, contrast & memo at each step to identify potential categories • Use theoretical sampling to collect additional data that both fleshes out and identifies new categories • Constructivist approach – Charmaz (2006) • Interpretive approach: “neither data nor theories are discovered”

12. Sampling • Initial Sampling • Advisory committee meetings • Meeting minutes, pubic documents & reports pertaining to perinatal substance use • Service providers & agency coordinators working with population • Published literature on provider experiences, policy & population experience • Theoretical Sampling • Dependent upon emerging categories

13. Interviews • Advisory Committee members initially, then snowball sampling • Approximately 25-30 interviews • Approximately 45 minutes to an hour • Audio-taped and transcribed verbatim • Focus on experiences with population: major tasks, recruitment, referral, challenges, areas for change

14. Participant Observations • Faculty member has been Advisory Committee member since its inception • Detailed notes taken at each meeting • Focus on information shared, questions raised, action proposed and taken, and identified issues • Observations during “spin-off” meetings may occur

15. Document & Literature Review • Review of Advisory Committee documents • Minutes, agendas, attendance, shared notices, etc • Review of public documents • e.g. County-level data on perinatal drug use treatment • Review of literature • Research literature • Journalism • Memoirs

16. First Steps • Aim 1: Identify & document needed and available resources • Developing database of agencies in and around GC • Reviewed initial field notes & minutes for resource references • Aim 2: Identify & document challenges to providing care • 3 interviews conducted, transcribed & compared • Identifying initial categories from interviews & field notes • Aim 3: Describe & document development of advisory committee as they address coordination of care • 2 participant observations conducted & compared • Initial document review of minutes, agendas, & field notes

17. Sample Database

18. Emerging Categories • Legal vs illegal drug use • Maternal vs fetal rights • Personal belief vs evidence • Shame & Guilt • Stigma • Access • Screening criteria & procedures • Networking

19. Next Steps • Coding transcripts & field notes • Collection county & state-wide documents & statistics • Constant comparative analysis • Additional interviews & participant observations

20. Implications • Local • Assist YWCA & Advisory Committee with mission • Increase resources & coordination of care in Guilford County • National • Speak to the larger conversation happening across the nation on maternal versus fetal rights & legislation targeting pregnant and parenting women • Ethan’s law • Personhood Amendment

21. Questions?