FIR SQUARE COMBINED CARE UNIT BC WOMEN’S HOSPITAL 4500 OAK STREET VANCOUVER BRITSH COLUMBIA

1. FIR SQUARE COMBINED CARE UNIT BC WOMEN’S HOSPITAL 4500 OAK STREET VANCOUVER BRITSH COLUMBIA V6H 3N1 CANADA

2. BACKGROUND

3. Vancouver’s Downtown Eastside, the poorest neighbourhood in Canada, hosts a significant drug and sex trade

5. A study of alcohol and drug use by pregnant women in the DTESindicated low birth weights and frequent removals of babies by child welfare officials

6. In response, Sheway, a drop-in and outreach program for parenting and pregnant women, developed within the neighbourhood

7. In 1993, BC Women’s Hospital partnered with Sheway to provide medical detoxification for pregnant women, and in 2003 opened a strengths-based harm reduction maternity unit

8. PROGRAM AND STRUCTURE

9. Withdrawal management • Parenting classes • Alcohol and Drug counselling • Alcohol and Drug group • Recreation therapy

10. Talking circle • Music therapy • Acupuncture • Access to 12 step meetings

11. PHILOSOPHY AND PRACTICE APPROACH

12. Reframing concepts in health management of substance-using pregnant women • Providing a safe foundation for family health and family unity

14. Supporting and educating substance-using mothers to reduce harm and risks • Supporting ‘safe substance use’ instead of ‘no substance use’ for patients unable to practiceabstinence

15. Revolving door strategy to promote access to medical care • Strength-based practice, supporting and promoting womens’ self-determination

16. The Fir Square multidisciplinary team includes: • Dedicated physician group • Senior Practice Leader • Dedicated nursing team • Dedicated social worker • Half-time addictions counsellor • Half-time life skills/parenting counsellor

17. Staff assist women in achieving an optimum level of pre- and post-natal health • This model and intervention are intended to reduce the effects of • malnutrition • homelessness • poverty • problematic substance use for mothers and infants

18. PROGRAM OBJECTIVES • 1.Reduce substance use and related risks • 2. Improve infant health outcomes • birth weights, growth and development • reduced risk of HIV+ infant Sudden Infant Death Syndrome • reduced effects of substance exposure

19. 3. Increase the percentage of mothers able to safely retain custody of their infants 4. Increase the numbers of women seeking treatment and their readiness to enter treatment 5. Increase access to medical services for substance-using women

20. Referral Criteria  Substance-Using Women Women may self- refer to Fir Square. This option reduces potential barriers to care, allowing substance-using pregnant women to easily access supportive, non-judgmental ante-natal and post-natal healthcare

21. Obstetrical or medical needs associated with substance use which cannot be managed on an ambulatory basis • Detoxification or substance use management where required admission is for a defined period of time in order to achieve stabilization and/or abstinence

22. Psychosocial needs (e.g. emotional/physical safety, lack of housing ) that place the mother and fetus at significant risk, cannot be managed on an ambulatory basis, and where placement options are not available. • Suspected drug overdose

23. Referral Criteria • Substance Exposed Newborns • Infants requiring management of symptoms of withdrawal or pharmacologic toxicity following prenatal substance exposure, born at BC Women’s.

24. Infants withdrawing from prenatal substance exposure where other options to manage withdrawal symptoms are not available, born outside of BC Women’s. Whenever possible, mothers will be admitted to a “companion room” in order to stay with their babies.

25. Research is currently underway to evaluate social, health and child welfare outcomes. The study is being conducted by the Centre of Excellence for Women’s Health, British Columbia. Two staff members of Fir Square, the Senior Practice Leader and the Social Worker, have been retained as researchers to assist with this research project. The following ‘anecdotal’ evidence of positive outcomes are unsolicited letters from former patients on Fir Square.

26. “I just want you to know how much we do appreciate your kindness and dedication. I came in here all hurt and broken up with not a lot of purpose in life. You guys (and gals) have treated me with respect and tenderness. I once again felt human. After a while as I became healthier you made me feel worthy and whole again. Life started to have purpose and meaning.”

27. ‘When I first met you I thought of myself as worthless and was quite used to being treated that way by every person that I had come into contact with.’

28. ‘Your easy kindness was felt immediately and I remember that you gave me that shred of hope that I so desperately needed. I think you should know that your belief in me and your kindness and non-judgment played a huge part in how my life is today’

29. “They gave me a warm and safe place to stay away from violence and drugs. I never would have gotten to keep my baby without coming here, and it saved me from a life of drugs and abuse. Thanks to the staff, I get to take my baby home today and get a fresh start”.

31. For more information contact Sarah Payne, MA, RN Senior Practice Leader spayne@cw.bc.ca Sydney Weaver, MSW, RSW Social Worker sweaver@cw.bc.ca