Research projects

Substance Using Mothers and depression – A Multi professional Intervention (SUMMIT)

Principal researchers

Gail Gilchrist1, Susan Nicolson1, Jacqui Cameron1, Paddy Moore2, Megan Galbally2

Institution

1 The University of Melbourne;

2 The Transitions Clinic, The Mercy Hospital for Women

Funding

$50,000

Award type

beyondblue Victorian Centre of Excellence

Project completion year

2007

Project brief

The SUMMIT pilot study aimed to build on the existing service framework in Melbourne by developing a collaborative, integrated, women-centered intervention for reducing depression (including postnatal depression) among maternal drug users, using triangulated data gathered from interviews with service providers and consumers, case studies, the views of an expert panel and a review of the literature. [Triangulation is where several methods of data are compared to validate findings]. Thereafter, consumer participants were contacted by telephone to ascertain the acceptability of the intervention. 

The study took place at the Transitions Clinic (TC) at the Mercy Hospital for Women (MHW). The TC was established in 2000 to provide a specialised maternity service for Aboriginal and Torres Strait Islander, adolescent and drug dependent women. The clinic has a multidisciplinary team consisting of midwives, social workers, obstetricians, a paediatrician, a psychiatrist, and an Aboriginal Liaison Officer. 

Pregnant women attending the TC were eligible to participate in the study if they were identified by clinic staff as chemically dependent and if their expected delivery date was before 31 October 2006 (due to the 12 month duration of the project). Consumer participants were re-interviewed six weeks postpartum to coincide with their six week postnatal review appointment at the clinic. Participants’ carers (service providers) were contacted following the birth of their child, with their consent, to ascertain how the system had worked or failed in offering care to the participant. Service providers were also asked more general questions about service provision for maternal drug users.  Interviews were completed with nine carers including an alcohol and drug counsellor, two Maternal and Child Health Nurses, a Care Worker, a Support Worker, a Case Manager, two staff from the Victorian Aboriginal Health Service and a GP Psychiatrist. In addition four staff from the TC were interviewed as they had been identified by participants as their carers. To supplement these interviews, data from previous interviews with eight methadone prescribing General Practitioners in Melbourne conducted by Susan Nicolson in May 2005 and the views of the expert panel were considered. The expert panel consisted of 17 members from general practice, Psychiatry, Obstetrics, Psychology, Victorian Aboriginal Health Service, Turning Point Alcohol and Drug Centre, Child Protection Services, Social Work, Maternal & Child Health and consumers. The literature on pregnancy, drug dependence and treatment, especially in relation to reducing depression was reviewed using MEDLINE and PsycINFO electronic databases during 1996 to 2006. 

Main outcomes/key project findings

Nine chemically dependent participants were recruited prenatally from the TC. The recruitment rate among eligible (chemically dependent and delivery date before 31 October 2006) attendees to the clinic was 56.3 per cent (9/16).    

All participants spoke positively about prenatal care at the TC, citing the following reasons: that time was taken to explain what would happen, that they received follow up phone calls and reminders from staff, that the staff were caring and non judgemental, and the environment was comfortable. Participants thought the following should be offered to maternal drug users throughout their pregnancy: knowledge about services, accessible services, counselling, relapse prevention, support to stop drug use, positive reinforcement, compassion and understanding and information about the impact of drug use on infants, and the impact of substance use on mothering (e.g. information on breastfeeding while taking methadone).  When asked what support they considered maternal drug users needed in the year postpartum mothers’ clubs, maternal and child health nurses (including home visiting service), drug counselling (including group and art therapies) and counselling were listed.

The triangulation of data determined commonalities and discrepancies in what service users, their carers, methadone prescribing GPs, the expert panel and the literature, considered should be included in a service to address the complex needs of maternal drug users.  There was agreement that the service should include:

  • Longer term care/extended postnatal care
  • Access to wider range of services and treatment options, especially access to mental health services, and drug treatment including relapse prevention, pharmacotherapy, detoxification, and rehabilitation
  • Parenting support, childcare and respite services
  • Case management in pregnancy and after birth
  • Shared care/co-ordinated care
  • Multidisciplinary care
  • Continuity of care
  • Effective communication/ information sharing with other service providers
  • Consistency of information, knowledgeable staff
  • Flexibility of services, compassionate and non judgmental staff
  • Attention to wider issues, especially access to housing
  • The findings of the SUMMIT pilot project clearly indicate that there is great value in the current provision of specialist multidisciplinary care to drug dependent pregnant women in Melbourne
  • The findings also clearly indicate that there is a gap in the current care framework that must be addressed if the rates of recurrent maternal drug-dependence and child protection rates are to be reduced
  • At present, the opportunities taken to change chaotic lifestyles for drug dependent pregnant women are not reliably continued into motherhood beyond the first few weeks
  • This represents a failure of maintenance and preventive care for a known chronic, relapsing condition which can have devastating effects on Victorian families from one generation to the next
  • Implications for policy and practice are that existing services in Melbourne should be enhanced in both pregnancy and in the early parenting years to build a service model that incorporates the key ingredients identified by the SUMMIT project and which can be trialed to test whether it improves long term outcomes for drug-affected families.

Implications for policy and practice

  • The findings of the SUMMIT pilot project clearly indicate that there is great value in the current provision of specialist multidisciplinary care to drug dependent pregnant women in Melbourne.
  • The findings also clearly indicate that there is a gap in the current care framework that must be addressed if the rates of recurrent maternal drug-dependence and child protection rates are to be reduced.
  • At present, the opportunities taken to change chaotic lifestyles for drug dependent pregnant women are not reliably continued into motherhood beyond the first few weeks.
  • This represents a failure of maintenance and preventive care for a known chronic, relapsing condition which can have devastating effects on Victorian families from one generation to the next.
  • Implications for policy and practice are that existing services in Melbourne should be enhanced in both pregnancy and in the early parenting years to build a service model that incorporates the key ingredients identified by the SUMMIT project and which can be trialed to test whether it improves long term outcomes for drug-affected families.

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