Overview of a treatment program for pregnant women with addictions in a family medicine clinic
A recent issue of Canadian Family Physician has an overview of the Toronto Centre for Substance Use in Pregnancy (T-CUP) which is a program that provides prenatal care and addiction treatment in a family medicine setting. The article reports on a retrospective chart review for 121 women who received care at T-CUP from August 2000 to January 2006.
The program consists of a team of family doctors, a nurse clinician and a social worker and uses a “one-stop” access model to provide prenatal and postnatal medical care, addiction counseling, and assistance with complex psychosocial needs. It is based on a harm-reduction and woman-centred philosophy of care. (The article describes one component of being woman-centred as providing women choice in and control over health care and other services; harm reduction focuses on decreasing the harmful consequences of drug use instead of focusing on complete cessation of drug use).
Here are some of the outcomes from the evaluation:
- Housing: Before attending T-CUP, 81.8% of the women had stable housing, 9.9% were living in shelters, and 8.3% had no fixed address. By the time of delivery, more women were living in stable housing (84.3%) and fewer had no fixed address (3.3%). In addition, the number of women who were living with substance-using household members decreased from 33.9% in the first trimester to 22.3% by delivery.
- Addictions treatment: Of the 121 women, 39 commenced formal treatment programs; 26 completed the treatment, 9 dropped out, and 4 were on waiting lists.
- Custody: Most infants (74.4%) were discharged home with their mothers, while another 19.8% were taken into child protective custody, 4.1% were adopted, and 1.7% were sent home with family members. A significant relationship was found between duration of care with T-CUP and custody at the time of discharge. Ninety-four percent of women who started care in the first trimester had custody of their children at discharge, whereas 67.8% and 64.3% who came in the second and third trimesters, respectively, retained custody. The longer a woman received care at T-CUP, the more likely she was to retain custody of her child.
Ordean, A. and Kahan, M. (2011). Comprehensive treatment program for pregnant substance users in a family medicine clinic. Canadian Family Physician, 57 (11): e430-e435. Free full-text here.