Research Update

Alcohol Use and Pregnancy: An Important Canadian Public Health and Social Issue

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8.7 Canadian Models

Even though they were cited to illustrate one or another of the elements of good practice, the Canadian programs identified in the above discussion generally encompass all of these elements; in fact, it is the integration of these multifaceted elements into program structure that results in successful engagement and opportunities for support.²⁸⁸ The two Canadian programs working with high-risk pregnant women that are best documented are Sheway and Breaking the Cycle. The Sheway program, located in the Downtown Eastside of Vancouver, takes a women-centred, harm reduction, culturally focused approach to working with pregnant women with substance use problems and supporting mothers and their children until the children are 18 months of age. An evaluation of the program published in 2000 found the following key components contributed to Sheway's success²⁸⁹:

• a service philosophy respectful and supportive of women's self-determination in making needed change
• the provision of practical supports, such as hot meals and vitamins, advocacy on housing and other basic needs, bus tickets, clothing and baby equipment
• outreach to engage women in prenatal care and to assist them in connecting with other needed services
• the full range of assistance found in a multidisciplinary team of professionals in an accessible drop-in setting
• leisure and creative programming for women and their families
• an active approach in assisting women to face and meet child protection standards of care

Breaking the Cycle (BTC) in Toronto uses a one-stop service delivery model to serve "highrisk drug-involved pregnant women and families who have a history of family/partner abuse, few supports and experience chaotic, unstable and often violent environments."²⁹⁰ A 2002 evaluation report concluded that BTC services are:

"contributing to fewer birth complications, decreased postnatal diagnoses and shorter hospital lengths of stay. In addition, BTC children had better maternal health ratings, fewer health concerns, fewer separations from their mothers and fewer developmental concerns as expressed by mothers.... Mothers reported significant knowledge, attitudinal and behaviour changes related to parenting skills, which affect the mother–infant attachment.... Mothers reported less use of inappropriate discipline, more mother–child activities, and increased positive feelings about parenting.... BTC children made substantial growth during the evaluation periods and continued developmentally-appropriate progress could be anticipated."²⁹¹

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