Heidi Coupland, Maja Lindegaard Moensted, Sharon Reid, Bethany White, John Eastwood, Paul Haber, Carolyn Day, Developing a model of care for substance use in pregnancy and parenting services, Sydney, Australia: Service provider perspectives, Journal of Substance Abuse Treatment,
2021,108420, ISSN 0740-5472,
A model of care for supporting pregnant women and mothers with substance use disorder needs to include both perinatal care and services providing long-term community based parenting support.
A harm reduction approach was crucial for promoting engagement of women with services, particularly child protection services.
Implementation of the model of care could be undermined by threats to integration of service delivery and continuity of care.
Further research is urgently needed, particularly involving of consumers, to refine the model of care and work towards building the evidence base for best practice in this field.
The absence of a clear model of care for services supporting pregnant women and mothers with substance use disorders has impeded opportunities to build an evidence base for the effectiveness of these services. Previous research has typically focused on the needs of pregnant women or mothers, as two distinct groups. This paper explores service providers’ perceptions of key components of a model of care, extending from perinatal care to community-based support for up to 17 years post-delivery. A model of care is outlined and feasibility factors affecting implementation are highlighted.
Qualitative methods were adopted as a first step to informing development of the model of care. Semi-structured in-depth interviews were conducted with thirty-eight staff providing a range of substance use in pregnancy and parenting services (SUPPS) in hospital and community-based agencies, in a metropolitan health district in Sydney, Australia. Interview data was entered into NVivo and analysed using constant comparative methods.
Guiding principles for the model of care included integrated care, harm reduction and person-centredness. Practice approaches integral to the model of care were promoting engagement with women, flexible service provision, trauma-informed care, and continuity of care. Feasibility factors influencing implementation of the model of care included fragmentation or siloing of the service network and workforce sustainability.
A harm reduction approach was crucial for promoting engagement of women with SUPPS, particularly child protection services. A greater focus on providing ongoing community-based support for mothers also has the potential to achieve sustainable positive outcomes for women and children. Implementation of the SUPPS model of care could be undermined by threats to integration of service delivery and continuity of care. Further research is needed to explore consumer perspectives and inform the model of care as a framework for evaluation.