Have a personal or library account? Click to login
Interprofessional Care Models for Pregnant and Early-Parenting Persons Who Use Substances: A Scoping Review Cover

Interprofessional Care Models for Pregnant and Early-Parenting Persons Who Use Substances: A Scoping Review

International Journal of Integrated Care
Volume 24 (2024): Issue 2
By: Kristen Gulbransen,  Kellie Thiessen,  Natalie Ford,  Wanda Phillips Beck,  Heather Watson and  Patricia Gregory  
Open Access
|Jun 2024

Figures & Tables

ijic-24-2-7589-g1.png
Figure 1

Preferred reporting items for systematic reviews and meta-analyses (PRISMA-ScR)–Scoping Review Extension flow diagram [32].

Table 1

Interprofessional Care Delivery Programs for pregnant through postpartum individuals who use substances.

INTERPROFESSIONAL PROGRAM, COUNTRY, & PUBLICATION DATEPROGRAM TEAM MEMBERSDESCRIPTION OF STUDY & DATA COLLECTION METHODSTUDY PARTICIPANTSPROGRAM AND PATIENT OUTCOME FINDINGS
Collaborative Outreach and Adaptable Care at Hallmark Health (COACHH) program. United States 2019. [33].Nurse practitioner, social worker, executive director, community health worker.Qualitative.
Interviews.		COACHH program team members (n = 40).

  • High prenatal engagement.

  • Initiating and maintaining opioid use disorder treatment.

  • Increased mother-infant togetherness (custody, bonding).

  • Improved life planning outcomes (secure housing).

Eight multiservice wraparound programs. Canada. 2021. [35].Varied among sites but included: Obstetrician, midwife, nurse, nurse practitioner, social worker, addictions counsellor, family physician, psychiatry, case manager, art therapist, music therapist, dental hygienist & cultural liaison.Mixed Methods.
Survey & Interviews.		Service partners (n = 60) and program staff (n = 108) from 8 different programs.

  • Wraparound care improved access to services, health equity, and addressed social determinants of health.

  • Partnerships increased providers understanding of clients’ experiences, challenges, and impacts of trauma and interconnected issues related to substance use.

  • Increased integration of Indigenous cultural connections.

  • Improved mother-child connection and child welfare outcomes.

Center for Addiction and Pregnancy (CAP) co-location program. United States. 1996. [20].Obstetrician, pediatrician, midwife, addictions counsellor, lactation consultant,Program retrospective report.
Chart review.		CAP program patients (n = 100).

  • Increased prenatal care attendance at appointments.

  • Decreased preterm deliveries.

  • Decreased neonatal intensive care unit admissions.

TIDES collaborative care program. United States. 2021. [35].Obstetrician, peer support, addictions counsellor, family physician, psychiatry, spiritual care.Evaluation report.
Chart review.		Patients from TIDES (n = 57 pregnant).

  • 73% reporting no opioid use.

  • 100% had full custody of their newborns.

Comprehensive care approach model. United States. 2022. [36].Obstetrician, pediatrician, social worker, addictions counsellor, psychiatry, psychology, case manager, anesthesiology.Best Practice Guideline. Commentary.NA

  • Integration of the interdisciplinary approach is best practice to improve maternal outcomes, patient engagement, and maternal and neonatal outcomes.

Multidisciplinary clinic offering integrated, holistic care. United Kingdom. 2003. [37].Obstetrician, pediatrician, midwife, nurse.Program report.
Chart Review.		Patients from the integrated clinic (n = 146).

  • Increased prenatal attendance.

  • Clients reported stabilization and reduction of substance use.

  • Safer substance use (not sharing needles).

The Women and Newborn Drugs and Alcohol Services (WANDAS) program. 2016. Australia. [38].Obstetrician, pediatrician, midwife, social worker, addictions counsellor, psychiatry.Program report.
Chart Review.		Patients from the WANDAS program (n = 354).

  • 90% attendance rate at appointments.

  • mean gestation of 38 weeks and mean birth weight of 3000 grams.

  • 2% admitted to the nursery for neonatal abstinence syndrome.

  • 26 babies were placed into care by Child Protection and Family Support.

Toronto Centre for Substance Use in Pregnancy (T-Cup) program. Canada. 2011. [39].Obstetrician, pediatrician, nurse, social worker, addictions counsellor, family physician, case manager, anesthesiologist.Retrospective Study.
Chart Review.		Patients from the T-Cup program(n = 121).

  • High compliance rate with prenatal care attendance.

  • Most reported reduction in a variety of substances use categories. Significant differences were found among those who presented earlier in their pregnancies.

  • Neonatal outcomes were satisfactory and approximately 75% of newborns were discharged with their mothers.

Wraparound Programs. Canada. 2020. [5].Varied between sites but included: Obstetrician, midwife, nurse, nurse practitioner, social worker, addictions counsellor, family physician, psychiatry, case manager, art therapist, music therapist, dental hygienist & cultural liaison.Mixed Methods.
Interview and Survey Data.		Service partners (n = 60) and program staff (n = 108) from 8 different programs.

  • Resulted in better access for clients to health and social care, addressing trauma, and improved child welfare outcomes.

  • Increased access to women’s mental health services, access for children’s health assessments and referrals, access to cultural programming, increased prenatal support and attendance at appointments, increased connection with peers for parenting programs.

Integrated Care Models. Canada & United States. 2018. [40].Varied between sites but included: Obstetrician, pediatrician, midwife, nurse, nurse practitioner, addictions counsellor, family physician, psychiatry, peer support, psychology, pharmacist, case manager, patient navigator, childcare, pharmacist, occupational therapist, nutritionist, resource coordinator.Qualitative Phenomenological.
Interviews.		Program leaders from across North America (n = 23).

  • Families require frequent, supportive visits. Billable services can restrain this.

  • Provider program champions are important but interprofessional care can still remain siloed.

  • Addressing dual needs (newborn and parents) can be difficult if caregivers continue substance use.

Comprehensive Care Program. Canada. 1984. [41].Obstetrician, pediatrician, addictions counsellor, psychology, child development educators.Evaluation report.
Chart Review.		Prenatal patients (n = 219) and Pre-pregnancy obstetrical patients (n = 191).

  • In four-fifths of the cases there were at least 5 prenatal visits.

  • The dose of methadone at delivery remained stable.

  • 5.2% had premature rupture of membranes, and obstetrical complications were absent in nearly two thirds of the cases.

  • Newborn gestational age and birthweight were improved over outcomes for those that receive little or no prenatal care.

Table 2

Care Model Approaches.

STUDYCO-LOCATION OF SERVICESCULTURAL CARETRAUMA INFORMEDHARM REDUCTIONPARTNERSHIP WITH OTHER AGENCIESGROUP/PEER SUPPORT
Collaborative Outreach and Adaptable Care at Hallmark Health (COACHH) [33].✓
Eight multiservice wraparound programs [34].✓✓✓✓✓✓
Center for Addiction and Pregnancy (CAP) [20].✓✓
TIDES collaborative care program. [35].✓✓✓
Comprehensive care approach model. [36].✓
Multidisciplinary clinic. [37]✓✓
The Women and Newborn Drugs and Alcohol Services (WANDAS) program [38].✓✓✓
Toronto Centre for Substance Use in Pregnancy (T-Cup) [39].✓✓✓
Eight multiservice wraparound programs. [5].✓✓✓✓✓✓
Integrated Care Models [40].✓
Comprehensive Care Program [41].✓✓✓
Table 3

Reported Care Provider Characteristics.

STUDYNON-JUDGMENTALTRUSTRESPECTSHARED DECISION MAKINGRELATIONAL
Collaborative Outreach and Adaptable Care at Hallmark Health (COACHH) [33].✓✓✓✓✓
Eight multiservice wraparound programs [34].✓✓✓
Center for Addiction and Pregnancy (CAP) [20].None reported.
TIDES collaborative care program [35].✓
Comprehensive care approach model [36].✓
Multidisciplinary clinic [37].✓
The Women and Newborn Drugs and Alcohol Services (WANDAS) program [38].✓✓
Toronto Centre for Substance Use in Pregnancy (T-Cup) [39].✓
Eight multiservice wraparound programs. [5].✓✓✓
Integrated Care Models [40].✓✓
Comprehensive Care Program [41].None reported.
DOI: https://doi.org/10.5334/ijic.7589 | Journal eISSN: 1568-4156
Journal RSS Feed
Language: English
Submitted on: Feb 10, 2023
Accepted on: May 21, 2024
Published on: Jun 6, 2024
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
substance use,
pregnancy,
postpartum,
birth,
interprofessional care

© 2024 Kristen Gulbransen, Kellie Thiessen, Natalie Ford, Wanda Phillips Beck, Heather Watson, Patricia Gregory, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Previous articleVolume 24 (2024): Issue 2Next article