Models of Care for Substance Use During Pregnancy
Creators: Liu, Florence L.
Publisher: name: University of Alberta Library
Year: 2022

<p>Purpose: The purpose of this research is to identify and describe models of care in Alberta for substance use during pregnancy. This work will inform the development and implementation of a strategy for the care of pregnant patients experiencing problematic substance use, at the Lois Hole Hospital for Women, in Edmonton, Alberta.<br>
Methods: The research consisted of two parts. First, a scoping review was conducted to synthesize the relevant literature on models of care for programs supporting pregnant patients experiencing problematic substance use in Alberta. The scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. A search strategy was formulated and applied to nine health-related databases. This was supplemented with Google searches and targeted searching of websites of relevant organizations and associations. Data from the scoping review was analyzed using numerical summary and inductive thematic analysis. Following the scoping review, the data was contextualized at a local level by eliciting the experiences of health care providers in a circle or interview format. Five health care providers shared their experiences of providing care to pregnant patients experiencing problematic substance use, ideas on priorities and areas for change, and perspectives on key elements of a model of care. These findings were then analyzed using inductive thematic analysis and participants were invited to provide feedback on the themes. <br>
Results: The scoping review identified nine programs, specifically, the Parent Child Assistance Program (PCAP), First Steps, 2nd Floor Women’s Recovery Centre, Mothers-To-Be-Mentorship, H.E.R. Pregnancy Program, Aventa Pregnancy Program, EMBRACE Program, Pregnancy Pathways, and Concurrent Disorders Enhanced Service. All programs were either designed for or prioritized the admission of pregnant patients experiencing problematic substance use. Analysis of the scoping review findings revealed four overarching patterns or themes: i) Services/Activities, ii) Philosophical/Theoretical Approaches, iii) Service Delivery, and iv) Research Approaches. Regarding the circle and interview with health care providers, an inductive thematic analysis revealed the following five themes that encompass key elements of a model of care: i) Service Delivery, ii) Philosophical/Theoretical Approaches, iii) Education and Training, iv) Infrastructure, and v) Services/Activities. The results from the scoping review and the consultations with health care providers largely yielded similar results. <br>
Conclusions: This research identified key elements of a model of care for pregnant patients experiencing problematic substance use in Alberta. These elements include partnerships or collaboration between community organizations, outreach, wraparound support, and multidisciplinary teams. Both the scoping review and health care providers identified similar philosophical/theoretical approaches to care largely based on the following principles: individualized care, relationship based, patient-centered, harm reduction, cultural humility, trauma-informed, non-judgmental, and anti-oppressive. Health care providers further highlighted the importance of addressing the social determinants of health and recognizing that a patient’s substance use may be influenced by factors such as unstable housing or food insecurity. Next, in describing their experiences of learning to provide care, many health care providers emphasized the important role of mentorship and collaboration. Therefore, it is important to provide these opportunities to the next generation of health care providers as many participants shared that they had not received much practical training in a formal setting. Lastly, health care providers described the importance of designing a suitable physical space to facilitate the delivery of care that reflects certain key elements of a model of care. This is important because in the absence of a suitable space and the necessary resources, a strategy for the care of pregnant patients experiencing problematic substance use cannot be successfully implemented. <br>
Keywords: models of care, pregnancy, substance use, Alberta, scoping review, circle, interview</p>