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
Why do we care?
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Adverse outcomes for infants born
to substance using mothers
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Low birth weight
Preterm delivery
Birth defects
Learning and behavioral problems
Treatment
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Limited opportunities in general
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Women access treatment at 1/3 the rate of men
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Approximate similar level of need
Children can be both barrier and catalyst for seeking
treatment
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5-10% of pregnant drug users receive treatment
Fear of losing custodial privileges
No place to send children while in treatment
Want to get better for children
Different treatment needs
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Greater co-morbidity
Familial barriers
Parenting skills
Gender-Specific Treatment
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Components
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Children are welcomed during in-patient services
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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
YWCA Background
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YWCA programs supporting women at risk of adverse
birth outcomes
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Teen Parent Mentor Program
Healthy Moms Healthy Babies
YWCA success promoting healthy births among at risk
women
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Teens – 100% vs. 87.8% in Guilford County (2011)
Adults – 93.5% vs. 88.8% in Guilford County (2011)
YWCA
Perinatal Substance Abuse Committee

Explore how the YWCA can apply its system of
psychosocial support to women dealing with addiction
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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
YWCA
Perinatal Substance Abuse Committee
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Committee Membership
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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
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Networking
Alcohol/Drug Council of North Carolina
YWCA
Perinatal Substance Abuse Committee
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Quarterly Meetings (March 2011 to present)
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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, Lylan Wingfield –
Youth Focus
Teen Moms and Substance Abuse – Dr. Lisa Parnell
CPS Intake Policies and Procedures in the Context of Perinatal
Substance Abuse – Donna Thompson
Aims & Questions
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Identify & document needed and available resources for P&P female
substance users
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Identify & document challenges to providing care for P&P female
substance users
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What resources are needed for population?
What resources are available for population?
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
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How does the committee work towards the integration of care for
population?
How do the aims of the committee change over time?
Design
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Grounded Theory
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Uses qualitative methodology
Allows theory to emerge from the data using systematic
strategies
Cyclical
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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)
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Interpretive approach: “neither data nor theories are discovered”
Sampling
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Initial Sampling
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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
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Dependent upon emerging
categories
Interviews
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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
Participant Observations
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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
Document & Literature Review
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Review of Advisory Committee documents
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Review of public documents
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Minutes, agendas, attendance, shared notices, etc
e.g. County-level data on perinatal drug use treatment
Review of literature
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Research literature
Journalism
Memoirs
First Steps
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Aim 1: Identify & document needed and available
resources
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Aim 2: Identify & document challenges to providing care
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Developing database of agencies in and around GC
Reviewed initial field notes & minutes for resource references
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
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2 participant observations conducted & compared
Initial document review of minutes, agendas, & field notes
Sample Database
Agency
ADS
Healthy Start, FSP
Room at the Inn
Purpose
Private, non-profit agency providing
substance abuse education,
prevention, and treatment service to
residents of Guilford County and
surrounding areas.
Services
*Outpatient & intensive outpatient
treatment
*Prevention & Education
*Methadone Services
*DWI Assessments & Treatment
*Corporate Training & Workplace
Workshops
Healthy Start is a home-based
*Developmental expectations for infants
program that works with pregnant *Parenting information
and new parents (children 0-2yrs)
*Selection of childcare provider
with stress factors that make
*Child nutrition, health and safety issues
parenting an even tougher job. Case *Referrals to other community resources
workers help parents nurture their *Opportunities to be a part of a group of
children's development by helping other moms with similiar life situations.
creat a positive, safe living
environment for their families.
A unique and comprehensive
*Shelter
program that helps homeless, single, *Food
pregnant women (with or without
*Clothing
previous children), during pregnancy *Case Management
and after the birth of their babies.
*In-house daycare
*Transportation
*Life Skills Education and counseling
Vision
Provide an arry of culturally accessible
services that promote health and wellness
to individuals and families impacted by the
use and abuse of alcohol, tobacco, and
other drugs.
Building safe and healthy families. Provide
accessible, affordable, high quality
counseling to families and individuals who
are experiencing problems in dealing with
crises in their lives. Aim to raise public
awareness on issues that affect the
stability of society. Believe in providing
services to anyone without discrimination.
Help families have new lives of healthy,
hope-filled self sufficiency.
Emerging Categories
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Legal vs illegal drug use
Maternal vs fetal rights
Personal belief vs evidence
Shame & Guilt
Stigma
Access
Screening criteria & procedures
Networking
Next Steps
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Coding transcripts & field notes
Collection county & state-wide documents & statistics
Constant comparative analysis
Additional interviews & participant observations
Implications
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Local
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Assist YWCA & Advisory Committee with mission
Increase resources & coordination of care in Guilford County
National
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Speak to the larger conversation happening across the nation
on maternal versus fetal rights & legislation targeting pregnant
and parenting women
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Ethan’s law
Personhood Amendment
Questions?