An Example of Key Principles in Action

From: Exposure to Psychotropic Medications and Other Substances during Pregnancy and Lactation: A Handbook for Health Care Providers

Sheway is an innovative outreach and drop-in program located in the Downtown Eastside of Vancouver. With a service philosophy that respects and supports women’s self-determination in the level and pace of change in their lives, Sheway provides holistic services to pregnant women with substance use problems, and support to mothers and families until their children are 18 months old.

Sheway was established in 1993 in response to a growing understanding of the high levels of substance use by pregnant and parenting women, the low birth weights of their infants and the very high rates of their children’s apprehension by child protection authorities. Sheway’s services are located in an accessible drop-in setting, and include such key features as:

practical supports (e.g., hot meals and vitamins, bus tickets, donated clothing and baby equipment, and advocacy on housing and other basic needs)
health-related and other support by a multidisciplinary team of professionals and paraprofessionals.

Sheway’s care providers take a woman-centred, harm reduction–based and culturally focused approach to providing these services.

A 2000 evaluation of Sheway’s work brought attention to the difficult lives of pregnant women and new mothers in the Downtown Eastside. It also highlighted the positive role that harm reduction approaches have had in the care of women who use substances and are at high risk, and of their families. The study looked at the outcomes for women who had accessed Sheway’s services in 1998, and found that the program had been successful in a number of ways:

Engaging women who use substances and are at high risk in prenatal and postnatal care on a range of health and social issues. At intake, 30 per cent of women had no medical or prenatal care, and by the time of their deliveries 91 per cent of women were connected to a physician or midwife (for the remaining nine per cent, the existence of prenatal and postnatal care was not known).
Supporting women as they improve their nutritional status. Of the women accessing services, 79 per cent had nutritional concerns at intake, whereas only four per cent had nutritional concerns at six months postnatal. (Nutritional concerns were defined as fewer than three meals a day, lack of money to buy adequate food, lack of knowledge of nutrition and food resources [e.g., food banks] or lack of kitchen facilities.) Women who use Sheway’s services are provided prenatal vitamins, hot lunches and information about food banks and community kitchens, as well as nutritional counselling—all of which may have contributed to this improvement in nutritional status.
Supporting women as they improve their housing. At intake, 27 per cent of the women had no fixed address, and 65 per cent in total had housing concerns. By six months after the birth of the child, only six per cent of the women had any housing concerns. (Housing concerns were defined as having no housing or having housing of an inadequate size; in a poor location; with overcrowding problems; or with safety, health or structural problems.)
Increasing the number of children with healthy birth weights. Eighty-six per cent of the babies whose mothers accessed care at Sheway were known to have a healthy birth weight (over 2,500 grams).
Helping women retain custody of their children. Over half (58 per cent) of mothers who used Sheway’s services were able to retain custody of their children (22 per cent had no involvement by the Ministry for Children and Families, and 36 per cent had ministry involvement for support only). The remaining 42 per cent of mothers did have their children apprehended; in these cases, 37 per cent were later returned to the care of the birth mother or her immediate family.

The evaluation also found that while using Sheway’s services, most women had not been able to completely stop using alcohol or other drugs, nor had they been able to participate in intensive substance use treatment. However, Sheway staff have found that stabilization and reduction in substance use are more possible when stability is established in basic life areas such as housing and food security.

Sheway staff, allied service providers and the women themselves see Sheway’s service philosophy as critical for women to feel safe and to access the help they need. The positive findings of this 2000 evaluation continue to inform harm reduction–based and woman-centred approaches to work with pregnant women and mothers who use substances and face a range of other health and social problems. In the face of known risks to the health of both mothers and children from substance use and exposure to the dangers of life in Vancouver’s Downtown Eastside, Sheway staff continue to expand their practice and understanding of how best to encourage pregnant women with substance use problems to engage in prenatal and postnatal care, and to take realistic, small steps toward change.

Poole, N. (2007). Improving outcomes for women and their children: Evaluation of the Sheway Program. In N. Poole & L. Greaves (Eds.), Highs & Lows: Canadian Perspectives on Women and Substance Use. Toronto: Centre for Addiction and Mental Health. Adapted with permission from the Evaluation Report of the Sheway Project for High-Risk Pregnant and Parenting Women, authored by Nancy Poole and published in Vancouver by the British Columbia Centre of Excellence for Women’s Health in 2000. The full study is available from the centre’s website in PDF format.

Exposure to Psychotropic Medications and Other Substances during Pregnancy and Lactation: A Handbook for Health Care Providers

General issues and background

Psychotropic medications and other substances: Properties, effects and recommendations

Resources

Index of drugs

An Example of Key Principles in Action

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