SUPPORTING PREGNANT AND PARENTING WOMEN WHO USE SUBSTANCES What Communities are Doing to Help

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1 SUPPORTING PREGNANT AND PARENTING WOMEN WHO USE SUBSTANCES What Commnities are Doing to Help Commnities across Canada are becoming increasingly aware of isses related to pregnancy, alcohol and sbstance se, Fetal Alcohol Spectrm Disorder, and child health and development. In many commnities, the needs of pregnant women with sbstance se isses are of particlar concern as they often intersect with isses sch as poverty, nsafe or inadeqate hosing, violence and abse, food insecrity, and other health and social isses. Many people are asking qestions abot how to spport women and their babies/yong children so that they can have a healthy and safe start in life. In the early 1990s, several commnities began to develop integrated responses to addressing the needs of pregnant and parenting women with sbstance se isses. These early programs inclded Sheway in Vancover s Downtown Eastside and Breaking the Cycle in Toronto. Nearly 20 years later, the research evidence clearly spports this type of program as an effective way of addressing the needs of pregnant and parenting women who se sbstances. While all these programs are different in philosophy and mandate, they all seek to provide a range of services nder one roof (a onestop shop or single-access model), address women s needs from a holistic perspective, provide practical and emotional spport, and strive to redce barriers to accessing care and spport. Another important similarity is that all of these programs started as a niqe network of cross-sectoral partnerships that developed a common vision, vales, and goals. In this docment, we profile the development of single-access programs in for different commnities and talk abot why this type of program works. Canada FASD Research Network s Action Team on Prevention from A Women s Health Determinants Perspective

2 Common Problems, Local Soltions How it all began Often, individals and grops can see the challenges that women in their commnities are facing, bt aren t sre where to start in spporting them. In the following profiles, yo ll see that the starting place varies - it can be an idea at a meeting of service providers, a health crisis in the commnity, or people finding that old ways of doing things aren t working anymore. Developing a commnity approach Each of these programs developed a niqe approach to addressing the concerns of their commnity. Individals and organizations drew pon the research evidence, talked to women with sbstance se isses abot what they needed, and fond ways of bringing together and sharing resorces. In each profile, yo ll hear abot how people got involved and how they decided to shape and organize their program over time. Lessons learned Each of the programs profiled is in different stages of development and has gone in different directions from the program models first developed in the 1990s. Bt there are also many similarities between programs and sggestions for others who may be thinking abot starting a similar program in their commnity or who are trying to better nderstand the isses that women who se sbstances are facing. PROGRAM PROFILES Maxxine Wright Place Project for High Risk Pregnant and Early Parenting Women (Srrey, BC) Opened in 2005 H.E.R. (Healthy, Empowered, Resilient) Pregnancy Program (Streetworks Program) (Edmonton, AB) Opened in 2008 HerWay Home (Victoria, BC) Opened in 2012 The Mothering Project (Winnipeg, MB) Opening in 2013

3 MAXXINE WRIGHT PLACE HOW THE PROGRAM BEGAN Today, the Maxxine Wright Place Project in Srrey, BC incldes a commnity health centre, daycare, emergency shelter, and longer term hosing for women and their children. Bt, the idea for the project came from service providers in the commnity seeing how many women were facing isses sch as violence, abse, sbstance se, poverty, racism, HIV/AIDS, nsafe or inadeqate hosing, food insecrity, and other health and social isses. These women were not getting the spport they needed. Not only was the health of both women and their babies/yong children being affected, mothers and children were often being separated. In 2001, a grop of health and social service providers started meeting reglarly to develop a Sheway-like program for Srrey. The meetings were spearheaded by Atira Women s Resorce Society (an anti-violence women s organization), and inclded representatives from Fraser Health (FHA), the Ministry of Child and Family Development (MCFD), and ten other non-profit commnity agencies. Atira also obtained fnding for a Project Coordinator, who began to provide spport and advocacy for pregnant and early parenting women while the program was being developed. A SMALL COMMUNITY HEALTH CENTRE OPENS IN 2005 The program first opened in a small daycare bilding. The comprehensive, mlti-disciplinary commnity health centre was open for drop-in Monday-Friday afternoons and provided a hot lnch for the first hor. The centre also provided free clothing, baby items, diapers, and food bank hampers for the families. Staff inclded a receptionist, family doctor, nrse practitioner, pblic health nrses, dental hygienist, social worker, Aboriginal women s otreach worker, Concrrent Disorders Therapist, Wraparond Coordinator, cook, ntritionist, pregnancy otreach worker, and two Program Coordinators (one from FHA and one from Atira). Most of the staff were part-time. Approximately half of the staff were existing positions from FHA, Atira, or MCFD that were re-located to Maxx Wright. The MCFD social worker position was deliberately created to be non-delegated in that she did not have the athority to remove children from their families. The family doctor had one session per week, and was the only doctor in Srrey that cold provide both pre-natal care and methadone prescriptions. In the first year, 59 women and 30 children had open files at Maxx Wright. 3

4 EXPANDING THE PROGRAM A prpose-bilt three-story strctre was completed in 2010, with a daycare on the grond floor, significantly expanded clinic space on the main floor, and 12 nits of emergency hosing on the top floor. The 12-nit Maxxine Wright Shelter serves women who are pregnant or have a newborn and need a safe place to stay. Women can access the shelter at any point dring their pregnancy, and potentially stay ntil their baby is 6 months old. The shelter is staffed 24/ 7 and staff provides a wide range of emotional and practical spport, parenting spport, advocacy, accompaniments, child-care, information and help connecting with other resorces. By 2011, approximately 450 women and 300 children were accessing services at Maxx Wright, demonstrating the sccess of the program in engaging hard to reach women and children. There have been challenges, however, in providing adeqate services with the available staff. Maxx Wright has narrowed its mandate somewhat to address this, by only accepting women who are pregnant or have a baby less than six months old, and providing services only ntil their yongest child is for years old (originally, women who had a child less than two years of age were accepted, and services provided ntil the yongest was six). While women are typically motivated to redce their sbstance se dring pregnancy, women who are in absive relationships may not be able to do so. Stress, physical pain, emotional distress, or the controlling inflence of abse can make redcing or abstaining from sbstance se more difficlt or impossible. Maxx Wright Place profile contribted by Lynda Dechief LESSONS LEARNED Involve women in the development of the program model so that it works for them Inform neighbors early in the development process to avoid NIMBY (Not In My Back Yard ). When commnity members nderstand more abot the project and the needs of women and their children, they are likely to give their spport. Partnerships can be challenging and ongoing effort is needed to integrate services across different organizations, disciplines and philosophies e.g., the medical model and feminism, child-centered and women-centered care. Evalation is important to bild in from the beginning Don t ndervale the importance of practical spport otreach workers, transportation, food, diapers, etc. An intake process that is not oneros or intrsive is key to women coming back. Having a non-delegated social worker (i.e., a social worker that cannot apprehend children) and a policy that child removals will not happen on site is essential in women bilding trst with child welfare services Maxx Wright provides spport to pregnant/parenting women experiencing abse or violence as well as those strggling with their se of drgs or alcohol. This two-year snapshot shows how abot one third (35%) of the women have only sbstance se isses; abot 14% have only violence/ abse in their lives; 51% of all the women accessing Maxx Wright are experiencing both problematic sbstance se AND violence/abse in their relationships.

5 H.E.R. (HEALTHY, EMPOWERED, RESILIENT) PREGNANCY PROGRAM HOW THE PROGRAM BEGAN In , Edmonton experienced a sharp rise in overall rates of syphilis. Health professionals noticed an increase in the nmber of babies being born with congenital syphilis, which is often a life-threatening infection in babies. A physician from the Edmonton STD Centre approached the Streetworks program at Boyle Street Commnity Services. She was interested in collaborating on a project that wold address syphilis infections for street-involved, highrisk pregnant women. Many women in this grop were not accessing prenatal care and, as a reslt, were not getting screened for infectios diseases. The Streetworks program, at that time, did not specifically work with pregnant women. Bt, throgh its reglar activities, the program had developed strong relationships with people who were streetinvolved, worked from a harm redction perspective, and had a history of hiring employees with a street backgrond who cold connect with the poplation it served. The STD Centre provided fnding for the development of a pregnancy-focsed component of the Streetworks program. The Women in the Shadows program (which later evolved into the H.E.R. program) started in The program was initially comprised of two otreach workers (who had Little things can make a hge difference. Pregnancy otreach workers are helping street-involved women listen to the heart beat of their babies. This has been a great way for workers to connect with women, bt also a tool to spport women in staying focsed on their goals. We ve had women rn into the office and say, I feel like sing! I need to listen to the baby s heartbeat! This provides them with a way to refocs, connect, and avoid sing sbstances. similar backgronds to the women they were trying to reach) and a nrse. STREET OUTREACH When the program started, staff had to first find ot why pregnant women were avoiding prenatal care. They learned that mistrst and fear of child apprehension were the two major challenges. The two Pregnancy Spport Workers (PSWs) were trained in how to do some very basic nrsing skills, sch as measre fetal heart rates, fndal heights, weights, and kick conts, etc. This was not intended to be for the prposes of diagnosis or medical care. It was a tool that the workers sed in engaging with pregnant women who were living on the streets. The otreach workers did street otreach, connected moms with the program nrse and a physician who worked one day per week in the Streetworks program. In the first year, 78 women accessed the program and only one had an nderweight baby. The H.E.R. team works with the Streetworks program at the Boyle Street Commnity Services, a mltiservice agency with programs sch as mental health, a yoth nit, hosing, family program, Indian Residential School Srvivors program, and others. Children s Services has an office in the basement of the bilding. The team also works closely with the Nrse Practitioners at the Boyle McCaley Health Centre. LOOKING FOR NEW SOLUTIONS The program initially ran for two years from with fnds from the STD Centre. In 2011, the Alberta government fnded the program for three additional years. The new fnding allowed for a larger staff complement and greater access to needed materials and spplies. 5

6 The program now consists of 2.4FTE Pregnancy Spport Workers, one Social Worker and one Registered Nrse. The PSWs do on-foot and van otreach in an attempt to connect with women who are hiding. The program Social Worker assists women with isses sch as income assistance, hosing, and child welfare. The nrse provides onsite care and refers women to other service providers who can help meet their individal needs. The Streetworks physician also sees women and ensres they have the proper testing and referrals. Staff will often connect women with Children s Services workers, so they have a clear nderstanding of what they need to do to be able to avoid apprehension and to develop a trsted relationship with a worker from the agency they fear the most. The program staff rns a pregnancy drop-in once a week where moms are welcome to come and learn abot pregnancy and meet other women in similar circmstances. There is also a focs on healthy activity, healthy recreation, healthy eating and Aboriginal cltral spport. The program is also working to address isses sch as: edcation for health professionals on sbstance se and pregnancy and cltral competence; helping to provide street-involved women with better access to birth control, if that is what they wish; spporting women arond 6-8 weeks post-partm when they are more likely to experience isses leading to Children s Services involvement. LESSONS LEARNED Women who have been there, done that have the best chance of connecting with women who are hiding, ashamed, frightened and afraid to bond with service providers. Having otreach workers accompany women to appointments bilds trst and confidence. In Alberta, technically, Children s Services are not to be involved with a fets ntil the moment of birth. This means that many women do not have the opportnity to learn abot what they need to have in place in order to be able to parent. Having Children s Services workers come into the pictre early in a pregnancy means that many more children are going home with their mothers. Street-involved women often have had a tramatic life history and/or have grown p in foster care. This has meant that trama-informed services are very important. Also, spporting women who have had few role models in becoming mothers reqires attention to isses like learning how to play or how to find and take advantage of low or no cost recreation. H.E.R. Pregnancy Program profile contribted by Marliss Taylor Canada FASD Research Network s Action Team on Prevention from A Women s Health Determinants Perspective

7 Why These Programs Work While all of these programs are different from each other in terms of fnding, service delivery model, philosophies, and mandates, they share common elements that evalation stdies show work. OUTREACH PRACTICAL SUPPORT MOTHER HARM REDUCTION INTEGRATED + CHILD = SUCCESS TRAUMA + SAFETY Otreach services work with women where they are - on the streets, in their homes, in the hospital. Otreach provides flexibility for service providers in how they work with women. They can accompany women to appointments, share information informally, and help overcome barriers like lack of transportation and distrst of formal settings. Withot practical spport, women cannot scceed in meeting other goals like redcing or stopping their sbstance se or learning parenting skills. Food vochers, free prenatal vitamins, socks, bs tickets, and spport in finding hosing are jst a few things that meet women s immediate needs. A harm redction approach means that abstinence is jst one possible goal for women and that care and spport do not reqire women to address their sbstance se isses ntil they are ready. Harm redction allows for flexible, respectfl, and non-jdgmental approaches to engaging with and caring for women and their children. Stdies have shown that women who se sbstances have difficlties accessing services that meet their needs. An integrated one stop shop model recognizes that no single service provider or agency can meet the often complex needs of women and that formal and non-traditional partnerships are reqired (e.g., between childfocsed and adlt-focsed services). All these programs view the needs of women and the needs of fets/ children as being linked. Programs that focs only on women s health or only on child health miss a big part of the pictre. Approaches that view women s sbstance se otcomes, child development otcomes, and parenting otcomes as linked lead to sccess. Sbstance se is often tied to women s experiences of violence and trama as well as histories of colonization and migration. Attention to isses of empowerment, trst and safety, cltral awareness, and social jstice have shaped the development and sccess of these programs. See the resorces section for links to evalation stdies and smmaries. 7

8 HERWAY HOME Sccess is not always based on abstinence. Harm redction approaches offer practical, non-jdgmental services that seek to minimize drg-related harm to both the individal and society. HOW THE PROGRAM BEGAN In the 1990s, a grop at the Victoria General Hospital, called Together for Edcation on Addiction and Mothering (TEAM), began meeting to talk abot improving how we spport pregnant and parenting women with sbstance se isses. Over the next fifteen years, or commnity partners noted a gradal increase in the nmber of women in Victoria who needed services that were more comprehensive and coordinated than what was crrently available. Over time we also came to recognize that sbstance se, mental illness, and violence and trama are often concrrent challenges in the lives of women. In 2008, a grop of organizations met at the downtown Blanshard Commnity Centre to begin planning and advocating for a model of service like Sheway in Vancover or Breaking the Cycle in Toronto. The local children s fondation, the Qeen Alexandra Fondation for Children s Health, expressed interest in contribting to improve the otcomes of this grop of mothers and babies and joined or efforts. In 2011, the Qeen Alexandra Fondation and a nmber of commnity donors committed to fnding the first five years of or program and or doors opened in the fall of CREATING A ONE-STOP SHOP Prior to developing or program, pregnant women with addictions had to travel arond Victoria to mltiple programs to address all of their health and social concerns. Women told s they felt vlnerable, and jdged negatively, and were often not able to access the services they needed. HerWay Home was conceptalized as a collaborative one stop shop program where commnity partners (sch as or regional health athority, pregnancy otreach programs, midwifery and nrse practitioner programs, mental health and addictions conselling, anti-violence services, parenting spports, and child welfare organizations) agreed to collaborate to spport women in one place, in an environment that was respectfl and non-jdgmental. Early on in the planning process, several members of or planning team joined the Prevention from a Women s Health Determinants Perspective Network Action Team (part of the Canada FASD Research Network) and gained valable knowledge abot the elements and practices needed to spport pregnant and newly parenting women effectively. The consenss statement 10 Fndamental Components of FASD prevention from a Women s Health Determinants Perspective developed by this team provided s with the philosophical fondation on which to bild or program (inclding principles sch as woman-centered care, harm redction, trama informed care, and cltral safety). GETTING STARTED From a governance perspective, program operations are being coordinated throgh the Vancover Island Health Athority in partnership with the commnity. We have a commnity advisory concil that incldes representatives from the fonding organizations, primarily women and child serving agencies, to ensre that the program stays tre to the original philosophy and that it aligns with Canada FASD Research Network s Action Team on Prevention from A Women s Health Determinants Perspective

9 other services in Victoria (we want to avoid dplicating services or creating frther gaps in services). With fnding from the Canadian Instittes of Health Research, we have been able to develop and spport a women s advisory concil, which is composed of women who have had personal experience with the isse of sbstance se while they were pregnant or new mothers. Consltation with the women s advisory concil provides information with respect to program development, design and delivery. For example, the concil has been invalable in determining the kinds of services that will be beneficial to those accessing the program and where the program shold be located. We also developed a research and evalation working grop right at the beginning of or planning. Working with local researchers and evalators helped s access national research fnding and increase or profile within the commnity. Over the next five years we hope to develop an evidence base and evalation profile that confirms the vale of this program philosophy and service model. We will be exploring evalation from a broad range of perspectives, inclding developmental, feminist and gender informed, Indigenos, and democratic perspectives, with the intention of learning what women themselves see as meaningfl. LESSONS LEARNED Patience. It s hard to be patient when yo can see the need for a program like this in yor commnity right away. Contining to move forward, however slowly, provides time to develop an excellent and well-designed model. Persistence. It takes time to make the case in yor commnity that this kind of specialized program will improve the system of care and make a difference in otcomes for mothers and babies. Keep on bilding relationships and keep reaching ot. Partners. We had a core grop of planners from a nmber of commnity agencies that facilitated reglar meetings and strategic planning. It is critical to work across sectors, inclding commnity nonprofit, government, health care and interested commnity members. Or door was always open to people who were interested in contribting to this vision. We also conslted freqently with staff at other similar Canadian programs. Team members in these programs were spportive and open to sharing all of their own lessons learned over their years of operation. Planning. To get to the point of lanching the program reqired years of sstained relationship bilding and commnity development planning. Power. We recognized and experienced the challenge of negotiating between sectors, and contine to focs on respecting each others vales and priorities and ensring that all voices are eqally valed and considered, keeping or destination always in view. HerWay Home profile contribted by Lenora Marcells and Betty Poag Why Do Women Use Sbstances Dring Pregnancy? Many people strggle with nderstanding the reasons why a woman wold se alcohol and drgs dring pregnancy. There are as many answers to this qestion as there are women. Bt, it is important to remember that sbstance se and misse spans all segments of society. Some women who have a difficlt time stopping sbstances dring pregnancy have a history of complex backgrond factors, inclding trama, childhood abse, mental illness, violence, and poverty. Rarely is information and advice abot the harm of sbstance se the main isse. Programs that shift attention to the nderlying cases of why pregnant women se sbstances and that involve the entire commnity in finding soltions have been shown to be the most sccessfl. 9

10 THE MOTHERING PROJECT HOW THE PROGRAM BEGAN The Mont Carmel Clinic (MCC) was established in Winnipeg in 1926 and has evolved into a commnity health centre whose prpose is to create and promote healthy inner city commnities. In the mid-2000s, the Clinic noticed that the needs of pregnant and early parenting street-involved/ sbstance-sing women and their children in the neighborhood of North Point Doglas (the neighborhood that it primarily serves) were not being met. An idea for a commnity project to provide pregnancy spport and parenting spport to women affected by systemic marginalization and sbstance se and their children from conception to 3 years of age was born. A Commnity Advisory Committee was established in September 2011 and incldes partners sch as the regional health athority, the Addictions Fondation of Manitoba, Child and Family Services representatives, Winnipeg-based commnity health clinics, and other commnity agencies. This advisory grop has been working to develop a working model for the program and will ltimately serve as an advisory grop to the program as a whole. As part of this process, it was decided that the project wold spport not only mothers whose children live with them, bt also mothers whose children have been placed in care. And, becase the demographic of the neighborhood incldes a significant poplation of Aboriginal people, it is believed that many of the program participants are likely to have Aboriginal heritage. As a reslt, isses of cltral competence and cltral safety are key components of the model. BUILDING ON MCC S STRENGTHS Althogh Mont Carmel Clinic does not have a specific backgrond in delivering addiction-focsed programs, it does have a significant commitment to integrating harm redction principles into program delivery. It also has a strong backgrond in early childhood edcation and perinatal care and has been involved with delivering teen parenting programs, obstetric and midwifery care, home-based parenting spport, and early literacy programs. Over the past few years, the Anne Ross Day Nrsery program has been ndergoing a hge renewal and renovation and the Mothering Project will co-evolve with the changes to this program, inclding expanding the poplation served to inclde infants. Additionally Mont Carmel Clinic has been a leader in providing street involved women and sex trade workers with access to low-threshold healthcare and social spport throgh Sage Hose, a drop-in that has been in operation for approximately 20 years. Mont Carmel Clinic has sccessflly served a significant homeless poplation with severe and persistent mental illness sing a cltral model in care delivery throgh the Assertive Commnity Treatment Team. The Mothering Project will rely heavily on the expertise of colleages in these programs to inform the program development of this project. A COMPREHENSIVE DROP-IN PROGRAM The Mothering Project will start by implementing the otreach component of the program as the bilding renovations will not be completed by the program start date. The Mothering Project s Pregnancy Otreach Team will be based ot of Mont Carmel Clinic s Commnity Services bilding and will be comprised of a clinical team lead, a for member otreach team, a family spport worker, nrsing staff, and the program manager. The second phase of the Mothering Project will be a drop-in program where pregnant women Canada FASD Research Network s Action Team on Prevention from A Women s Health Determinants Perspective

11 and mothers can choose from a variety of programs and activities most relevant to their needs and interests. As the project evolves, we are contining to gain spport from other commnity agencies and grops and to bild new partnerships. In 2011, we received fnding from Health Canada to develop a women s concil. This grop of experiential women are informing the development of the program by drawing pon their lived experience, knowledge of or commnity, and awareness of how things like gender and cltre shape parenting. This grop is also involved in the Advisory Committee and in program development. As well, in May 2012, the government of Manitoba annonced increased fnding spport for or project as part of its FASD Strategy. LESSONS LEARNED Rely on experiential women to keep the project on the right path. The Women s Advisory Concil has consistently and gently reminded the program manager of what the key featres of this program need to be which has informed how we roll ot the program and prioritize what comes first. Use the evidence. The work being done by the Canada FASD Network has been invalable in bilding commnity spport, gaining government interest and informing the development of or program philosophy and practice model. Flexibility. This program is being invented as we go and the key for s in bilding spport has been or willingness to change gears when sggestions are made, to avoid dplication by bilding strong commnity partnerships, and or desire to be as effective as possible. This flexibility is possible de to or commitment to evalate the varios aspects of the program and to then act on the reslts of the evalation and to not remain stbbornly attached to things that aren t serving the people they shold be. The Mothering Project profile contribted by Margaret Bryans Fear of child apprehension and cstody loss is a barrier to accessing prenatal care and spport for many pregnant women who se sbstances. Connecting with women earlier in a pregnancy gives time for relationships to bild and options to be explored. With timely spport, many women can sccessflly care for their children. Other women can be spported in choosing other models of mothering sch as part-time parenting, open adoption, kinship and elder spport, and extended family. The Evidence Is In Twenty years of evalation research has shown s that these programs are sccessfl in a lot of ways. Early engagement of pregnant women who se sbstances has been shown to affect a range of otcomes related to maternal, fetal, and child otcomes, inclding improved infant birth weight. (Low birth weight has been linked to varios health problems sch as learning disabilities, slower growth rates, respiratory difficlties, and delayed development). Women who participate in these programs are more likely to keep cstody of their child and have higher rates of accessing and completing addictions treatment. Children who are involved with their mothers in a comprehensive program of spport have been shown to have enhanced developmental otcomes. 11

12 RESOURCES Learn more abot the philosophy, development, and otcomes of this type of program in other commnities in Canada. All the resorces listed below are available for free and online. Best Start. (2002). Redcing the Impact: working with pregnant women who live in difficlt life sitations. Toronto, ON: Best Start: Ontario s Maternal, Newborn and Early Child Development Resorce Centre. Download from FASD Network Action Team on FASD Prevention from a Women s Health Determinants Perspective. (2010). 10 Fndamental components of FASD prevention from a women s health determinants perspective. Download from FASD Network Action Team on FASD Prevention from a Women s Health Determinants Perspective. (2009). Taking a relational approach: the importance of timely and spportive connections for women. Download from Leslie, M. (ed) (2007). BTC Compendim, Vol. 1, The Roots of Relationship. Toronto: The Mothercraft Press. Motz, M., Leslie, M., Pepler, D. J., Moore, T. E. & Freeman, P.A. (2006). Breaking the Cycle: Measres of Progress JFAS; 4:e22 Nov. 10, 2006 The Hospital for Sick Children Poole, N. (2000). Evalation Report of the Sheway Project for High-Risk, Pregnant and Parenting Women. Vancover: British Colmbia Centre of Excellence for Women s Health. Streetworks Program website. Resorces for clients and service providers, inclding the book Oh Shit, I m Pregnant: Yor Gide to Being Pregnant on the Street. Boyle Street Commnity Services, Edmonton, Alberta. Download from Srrey High Risk Pregnancy and Early Parenting Planning Committee. (2003). Maxxine Wright Place Project For High Risk Pregnant And Early Parenting Women: Exective smmary and Program Model. This overview of commnity programs that spport pregnant and parenting women who se sbstances was developed by members of the Canada FASD Research Network s Action Team on FASD Prevention from a Women s Health Determinants Perspective. To learn more abot or work, visit September 2012 Canada FASD Research Network s Action Team on Prevention from A Women s Health Determinants Perspective