Lessons From HerWay Home: Building Community Bridges for Women and Families Affected by NAS

Transcription

1 Disclosure: Disclosure LESSONS FROM HERWAY HOME Building community bridges for women and families affected by NAS Lenora Marcellus is an Associate Professor in the School of Nursing at the University of Victoria. She has no conflicts of interest to declare. Lenora Marcellus VON Congress 2014 Objectives Our story... Explain the impact of intersections between substance use, violence/trauma and mental health during pregnancy and the early parenting years; Describe key components of an integrated continuum of health and social care for families affected by NAS; Identify the benefits and barriers to developing an integrated continuum of care; and Generate ideas together on your next steps to building these bridges in your own community. Socially complex women and their pregnancies trends in BC and Victoria Society s response How are we currently supporting women? How would we like to be supporting women? The difference - HerWay Home Our Community Statistics What do women tell us they need? There are an estimated 300 babies born EACH YEAR at Victoria General Hospital who have been exposed to substances during the prenatal period 25% (300) of the homeless in Victoria are women between the ages 21 to 30 10% earn their primary income from the sex trade Many of these women are fleeing abusive relationships and 25% have children with those partners Non Judgmental environment Affordable Housing Counsellors/support workers Detox Prenatal/Parenting classes Nurses/Midwives/Doctors/ Dentists Referrals/connections to other support services Supportive and non judgmental MCFD workers Photo by: Ann Regina November 2,

2 Intersections A View of the Complexity (Poole, 2004) Disability Punishment/incarceration Poverty Experience of loss Resilience HIV/AIDS Experience of violence/trauma Mental illness Substance use/misuse Racial discrimination Context/isolation Public Policy Age Sexual orientation Systemic discrimination Society s Response, in General Punishment Blame Stigma Think best response is to remove children What happens in your community? Mothering Partnership/friendship Access to health care The Six Points of Intervention: Exploring the Role of NICU Teams Nurse Family Partnership 1. Pre-pregnancy awareness of substance use effects 2. Prenatal screening and Initiate enhanced assessment prenatal services 3. Identification CHILD and assessment PARENTS at birth 4. Ensure infant s health 5. Identify and respond to and safety; identify and parent s needs respond to infant s needs Universal Prenatal Registration Perinatal Redesign Process Elements HerWay Home 6. Transition to and support in community Collaborative Maternity Clinic Systems Ethics - Evaluation 4 Levels of Prevention (2008) Level 2 - Discussion of alcohol use and related risks with all women of childbearing years and their support networks Level 3 - Specialized, holistic support of pregnant women with alcohol and other health/ social problems Level 1 - Broad awareness building and health promotion efforts Level 4 - Postpartum support for new mothers assisting them to maintain/initiate changes in their health and social networks and to support the development of their children Innovative Programs Sheway (Downtown Eastside) Maxxine Wright Place (Surrey) Breaking the Cycle (Toronto) H.E.R. (Edmonton) Mothering Project (Winnipeg) November 2,

3 Sheway Program: Reducing Harms on Key Determinants of Health Program Elements Nutritional Support and Services Pre and postnatal Medical Care and Nursing Services Support/ Counselling on Substance Use/Misuse issues Support on HIV, Hepatitis C and STD issues Support to build networks - both friendship and ongoing service support networks Healthy Babies, Infant/Child Development Advocacy and Support on Access, Custody and other Legal issues Drop In Out Reach Crisis Intervention Advocacy Support Advocacy and Support on Housing Connecting with other services & Parenting issues Support in reducing exposure to violence and building supportive relationships Reducing barriers to care Why this Model? Sheway s Outcomes vs. 91- percent of pregnant women who had no prenatal or medical support before Sheway to physician or midwife support for their deliveries 79 vs. 4 - percent of pregnant women with nutritional concerns before and after Sheway (six months postnatal) 86 percent of women having healthy weight babies with Sheway services (in wealthier communities, the per cent of healthy weight babies is lower) 27 and 65 vs. 6 - percent of pregnant women homeless or with housing concerns vs. six months after birth with Sheway The hidden costs.. Strong Community Engagement.. 60 percent of children with FASD who will become involved with the criminal justice system $20,000 cost per year to keep a youth under community supervision $31,170 cost per year to keep a child or youth in foster care $215,000 cost per year to keep a youth in custody $3,000 cost per day to keep a woman on the antepartum unit at VGH or a baby in the NICU $1.5 million estimated lifetime costs for one individual with FASD How is HerWay Home Different? Range of networked services under one roof Low threshold Based on understanding of women s experiences woman-centred, harm reduction, non-judgmental Focused on attachment parenting THREE key program facilities 1. One stop drop in centre 2. Short term stabilization housing for women exiting detox 3. Longer term supported housing with wrap around November 2,

4 Evidence for Theoretical Framework of Service Delivery Non-judgmental approach Women-centered Trauma-informed Strength-based perspective Trans theoretical model/ planned change process Harm reduction Culturally safe Photo by: Ann Regina Evergreen Terrace Low Income Housing How Will HerWay Home Complement Existing Services? Non-judgmental staff, services and environment Range of networked services under one roof Low threshold access to services Based on understanding of women s experiences woman-centred, harm reduction, non-judgmental, strengths-based Focused on attachment parenting Program designed with the understanding that safe, stable housing on a continuum is key Our protective factors.. Our Risk Factors... Continued dedication of representatives from community agencies and researchers (although many are feeling fatigued) Committed support and participation from senior administrative levels in VIHA Committed support funding has been pledged by the Queen Alexandra Foundation for Children s Health Breathless anticipation from health care and social service providers to be able to refer women Continued poor economic context Continued restructuring of community agencies, including layoffs and amalgamation Normal and increased turnover of connections continued need for developing and sustaining relationships Volunteer fatigue Still need to strengthen relationships with Aboriginal health and social service agencies Continued tensions for us to be mindful of.. Child focused, women centred, family oriented different priorities for different members of the multidisciplinary team and sponsors While HWH is envisioned as a harm reduction integrated intervention, any substance use by women during the reproductive period is regarded as fundamentally problematic by the vast majority of providers and other stakeholders Thinking about your own communities.. Possibilities? November 2,

5 Some Ways to Connect... Providing information to community providers (ie. prenatal educators, primary care providers, pregnancy support groups, social workers) on NAS Support other hospital team members depending on shifts in are models (ie. postpartum and pediatric staff) Providing information and support to parents and caregivers (ie. birth parents, kinship caregivers, foster parents, adoptive parents) Contribute to system wide and community wide guidelines, protocols. Questions and Thank You Dr. Lenora Marcellus November 2,