"Supporting Change: Women, Alcohol and Pregnancy" Presenter: Karen OGorman MSW, RSW This information is derived and or adapted from a variety of sources: women who struggle with substances, BC Centre for Excellence Womens Health, Best Start, Health Canada, AWARE, Mothercraft and AADAC 1 Helpers Reflection: Values, Attitudes and Beliefs 2 So Why Dont They Just Quit? Whats wrong with her? A better question is: What happened to her? Sex and Gender Differences in Substance Use: Policy and Practice Responses to Improve the Care of Women Nancy Poole & Cristine Urquhart 3 MOTHERS OF 160 CHILDREN WITH FETAL ALCOHOL SYNDROME Study: Astley, S. Jet al - A comprehensive profile of 80 birth mothers of children with FAS. Alcohol and Alcoholism, 35(5), 40 could not be contacted due to confidentiality issues 40 had died, or had disappeared and were presumed dead Slide Source : BC Centre for Excellence Womens Health N. Poole 4 Study: Astley, S. J., et all Of The 80 Women Interviewed: 100% had been seriously sexually, physically or emotionally abused 80% had major mental illness 80% lived with men who did not want them to quit drinking Slide Source : BC Centre for Excellence Womens Health N. Poole, 6 FASD is preventable 100% of the time in THEORY ONLY. In REALITY, it is not. Understanding the social context of womens use of alcohol in pregnancy explains why not. Mothercraft (Breaking the Cycle) & Canadian Centre on Substance Abuse 2004 Mothers Alcohol Use Stress Nutrition Social Support Prenatal Care Safety Other Drug Use Housing POVERTY VIOLENCE STIGMA THE COMPLEXITIES Adapted from Poole, N. (2003). 7 Support That Is Most Effective is Based On: A continuum of options for safety, change and growth and Is collaborative with other services 8 Engagement Strategies 9 INTRODUCTION Develop rapport and establish a relationship WHERE DO YOU START? AT THE BEGINNING 10 11 Respectful, Trauma Sensitive Strategies: Let women know what to expect in their contact with you What areas you will ask about and why Where you are going in the conversation That they can choose to not answer a question, if they do not want to Limits to confidentiality ENGAGING WOMEN USING SUBSTANCES 1.Understanding Consequences for her in admitting her use. Explain the limits to confidentiality. 2.Explore the function substance use serves in her life. Acknowledge the positive role substance use can play in the womans life. 12 13 Women tend to adopt their male partners pattern of use. Changes in her use may not be supported or even discouraged by her partner. It is important to ask about situation - is she safe and how her partner views her substance use. ENGAGING WOMEN USING SUBSTANCES 3.While no amount of alcohol is safe during pregnancy, - for women who cannot or will not stop - Encourage any and all small changes Mothercraft (Breaking the Cycle) & Canadian Centre on Substance Abuse 2004 3.Recognize The context of a pregnant womans life. 4.Talk about both the mother and the baby. 5. Avoid blame. Mothercraft (Breaking the Cycle) & Canadian Centre on Substance Abuse 2004 ENGAGING WOMEN USING SUBSTANCES 15 16 ENGAGING WOMEN USING SUBSTANCES 6. Be sensitive to trauma issues. 7.Explore the womans values about changing her use. 8.Acknowledge the social context of substance use. Mothercraft (Breaking the Cycle) & Canadian Centre on Substance Abuse 2004 17 The Process of Change THE PROCESS OF CHANGE (Prochaska & DiClemente) PRECONTEMPLATION Not me CONTEMPLATION Maybe PREPARATION What? How? When? ACTION Ill do it MAINTENANCE Achieved RELAPSE - Oops 18 PRECONTEMPLATION: My girlfriend ________ all the time, and her baby was fine. Possible Service Provider Responses: Has anyone ever given you information about _____ and pregnancy? Do you have information about _____ and pregnancy? As part of providing health information I like to offer women this information about _____ and pregnancy would you be interested? 19 Offer Factual Information About The Risks Of Alcohol/Drug Use During Pregnancy The Effects Series, Alberta Alcohol and Drug Abuse Commissioni.e. Has any one ever spoken to you about the possible effects of _______ during pregnancy? 20 CONTEMPLATION : Sometimes I wonder if I should stop ______ but my boyfriend always asks me to have a _________. Possible Service Provider Responses: What is it that makes you wonder if you should stop? What is it that makes you think, its ok to not stop? You mentioned that your boyfriend asks you to have a ______ what would happen if you said no? (or asked for his support in stopping? 21 PREPARATION Id like to stop but I dont know how to have fun without drinking. Possible Service Provider Responses: If you were to drink less or stop drinking, what things could you do to still have fun? What would help you change your drinking? 22 ACTION - I didnt drink this weekend but I was lonely I stayed home all weekend. Possible Service Provider Responses: What could you and your friends (or husband) do on weekends instead? Can I help you get connected with __________? 23 MAINTENANCE - I feel better but sometimes I worry about starting again after the baby is born. Possible Service Provider Responses: Well lets talk about what supports we could put in place to help you after the baby is born? 24 RELAPSE I drank this weekend, and I feel really guilty. Possible Service Provider Responses: Well, lets talk about what you would want to differently next time? What would be helpful to you right now ? 25 26 What am I thinking? What am I doing? What am I feeling? Where are we going, and whos deciding? Are we dancing or wrestling? HELPERS REFLECTION: Some questions to ask yourself when in conversation or after a conversation with a client: Based On Key Principles Of: Safety Hope Building Skills, Interpersonal Connections And Connection To Services For The Service Provider - Attention To Building Alliance, Showing Compassion, Giving Women Control, Modeling, Asking For Feedback Slide Source: Nancy Poole 27