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The Co-Creating Evidence (CCE) Project has been a first-of-its-kind-in-Canada national evaluation involving 8 different programs serving women at high risk of having an infant with FASD or prenatal substance exposure.
The goals have been to:
- Bring together many of Canada’s holistic FASD prevention programs to share promising approaches and practices;
- Evaluate the effectiveness of multi-service programs serving women with substance use and complex issues;
- Identify characteristics that make these programs successful.
Representatives of the eight programs and researchers from Note Bene Consulting Group and the Centre of Excellence for Women’s Health have collaborated since 2017 to achieve the following:
- 256 program participant interviews, 108 staff interviews, and 60 interviews with community partners of the services
- A detailed report of all study findings (96 pages) for all audiences
- 12 info sheets on key components found to be helpful, to support the work of service providers
- 4 journal articles, to bring awareness of the findings to researchers and health system planners
- Webinars to share what was learned
- A booklet on culturally grounded approaches within wraparound programs for all audiences (24 pages)
- A digital handbook highlighting key components of wraparound programming found to be helpful, for service providers and peer mentors wishing to start a wraparound program or enhance the work they already offering
The 8 programs were guided by a similar set of theoretical approaches, including being trauma-informed, relationship-based, women-centred, culturally-grounded, and harm-reducing.
The range of services offered by wraparound services is key for women in finding what works for them, and in having the opportunity to choose the order and pace of services they will use.
The study has demonstrated that pregnant and early parenting women experiencing problematic substance use and other complex issues benefit from programs that include: Wraparound services – Knowledgeable and empathetic program staff – Indigenous (re)connection – Opportunities for community/peer support.
Further, the following elements are important characteristics that contributed to the programs’ success: Well conceptualized, evidence-based approaches – Strong partnership relationships – Flexible, multi-dimensional models – Keeping clients engaged over time.
The Digital Handbook on Wraparound Programs is a key legacy of the CCE Project. The handbook was developed with multiple audiences in mind, including program planners, managers and staff, service partners from a variety of health and social sectors, funders, researchers, community members, and families affected by perinatal substance use.
The Handbook is a remarkable, accessible collection of resources about:
- Relationship-based practice
- Trauma- informed approaches
- Culturally safe care
- Harm reduction approaches
- FASD informed approaches
- Indigenous cultural programming
- Attachment focused practice
- Transitioning from wraparound services
- Building partnerships
- Cross sectoral work
- Wraparound programs as good investments
- Data collection approaches and more

The Handbook supports one of the implications arising from the study:
“Ongoing learning opportunities, focusing on integrated, culturally grounded, trauma informed, relational practice, are important to practitioners in all fields and need to be actively supported.”
See the Executive Summary of the Co-Creating Evidence Evaluation Report for all the implications identified: 6 directed to practitioners, 5 for health system planners, and 6 government policy makers and funders.
Next month’s blog will feature, A Mustard Seed of Hope, a booklet created through the CCE Project about culturally grounded approaches within wraparound care for Indigenous pregnant and parenting women dealing with substance use and trauma.
Funding for this project was received from the Public Health Agency of Canada. The views expressed do not necessarily represent the views of the Public Health Agency of Canada.