BMC Public Health 2007, 7:322 http://www.biomedcentral.com/1471-2458/7/322 have been developed [5,6], which have proved to be clin- ically and economically effective [7-9]. A special child welfare clinic (SCWC) was set up in the city of Kristiansand in 1994 to work with substance abusing pregnant women and mothers with young children, with the aim of helping these women stop their substance abuse without replacement therapy [10]. Pregnancy is not an indication for opioid replacement therapy in Norway. The services offered by the SCWC focused both on the pregnancy and the substance abuse, always with a main focus on the wellbeing of the foetus or child. As pregnancy is called a window of opportunity for substance abusing women to change their way of life, the main objectives of the SCWC were twofold. Firstly, the clinic wanted to establish contact with all pregnant women that were sub- stance abusers or who had recently stopped. Secondly, the clinic intended to support and motivate the women to enable them to end their substance abuse as early as pos- sible in pregnancy in order to prevent their children from being harmed by the substances. The Special Child Welfare Clinic in Kristiansand is a low threshold initiative organised within the primary health care system as a child welfare clinic reinforced with extra staff. The staff consists of a midwife, a community nurse, a social worker, and a general practitioner, and is specially trained in topics related to substance abuse, addiction and psychiatry. As the SCWC is a low threshold and voluntarily initiative, the pregnant women do not need referrals, but the coun- selling initiatives in the community, the public health service, and others have referred most of the users to the clinic. From the very beginning the clinic has made an effort to offer individual service to the users. Appoint- ments were made as often as once a week, and it was con- sidered important to register and help with the users' special needs concerning housing, economy and neces- sary health service as soon as possible. We also made social network maps to clarify and cooperate with the human resources close to the users. In addition, we con- ducted normal pregnancy checkups in close collaboration with the regular general practitioner and the hospital, and made contracts for the frequency with which the user was to provide urine specimens. If the user had a regular gen- eral practitioner, we cooperated with him/her about med- ical issues and pregnancy checkups. If the user did not have a regular general practitioner, she was assigned the doctor at the SCWC. If a user did not keep her appoint- ment, we contacted her by phone or paid a visit to her home in order to set up a new appointment very soon. For all the users we tried to set up network groups consisting of the user, her relatives and the necessary professionals. These groups then met regularly to consider the further progression of the treatment. Since the clinic's inception in 1994, staff turnover has been very low. The routines have also remained relatively unchanged, with the excep- tion that we have tried to increase the frequency of urine specimens. The service is free of charge, as it is for all preg- nant women in Norway. We consider this model to be low cost, as the need for resources to hire and train new staff has been low, and the resources required to meet the spe- cial needs of each user were provided from existing resources (Figure 1). The role of the SCWC is merely to be the hub of the wheel. The object of this paper is to describe the socioeconomic status and concurrent health and social problems among the users of the SCWC. Furthermore, we want to explore the changes in substance abuse during pregnancy, the impact of service utilization, and finally, predictors for stopping substance abuse during pregnancy. Methods During the period between 1994 and 2002, 102 pregnant, substance abusing women came through the SCWC. At entry, they had abused substances to such a degree that they had dropped out from school or work. They were all known by the substance abuse counselling or the health care systems in the community to have serious substance abuse problems, and their substance abuse was the main reason for referral to SCWC when they got pregnant. Thirteen of the 102 women had abortions, eight sponta- neous and five induced. These have been excluded from 0 1 2 3 12 19,35% 26 41,94% 5 8,06% 19 30,65% iTFnoigptuarelrgnenu1amnbcyer of contacts with other initiatives than SCWC Total number of contacts with other initiatives than SCWC in pregnancy. Page 2 of 8 (page number not for citation purposes)