Overview of a treatment program for pregnant women with addictions in a family medicine clinic

St. Joseph's Health Centre, Toronto, image via http://www.stjoe.on.ca

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).

The program also has community links to women-only addiction treatment programs such as Breaking the Cycle, the Pathways program at Jean Tweed Centre, and Women’s Own Withdrawal Management Centre.

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.

Reference:

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.