BREAKING the CYCLE Measures of Progress 1 Toronto

BREAKING the CYCLE: Measures of Progress 1 Toronto Public Health

PROGRAM DESCRIPTION 2

PRINCIPLES AND FEATURES • A collaborative, community-based response • A comprehensive, integrated, cross-sectoral system response • Prevention through early identification 3 • Improved parenting skills and the prevention of child abuse • “Single access” model • Evaluation

PARTNERS Mothercraft Jean Tweed Centre Motherisk Program – Hospital for Sick Children Toronto Public Health 4 Children’s Aid Society of Toronto Catholic Children’s Aid Society Funder: Health Canada – Community Action Program for Children Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

ADMISSION CRITERIA Breaking the Cycle serves women: • Who are pregnant and/or parenting at least one child under the age of 6 years and 5 • Who are experiencing problems of substance use or recovery 3) Who desire support around their substance use or recovery Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

CHARACTERISTICS OF WOMEN SERVED • • • MEAN AGE = 30 MEAN OF 2 CHILDREN EACH [range of 1 -12] (1/3 in mother’s care; 1/3 in care of a family member; 1/3 in foster care) TRAUMA (82% report physical abuse; 84% report emotional abuse; 70% report sexual abuse) OVER 4/5 OF MOTHERS HAD BEEN CROWN WARDS OR HAD BEEN IN FOSTER CARE EMOTIONAL/PSYCHOLOGICAL PROBLEMS (Depression, anxiety disorder, eating disorders, violent thoughts or feelings, fears/phobias, amnesia) 6 SUICIDE ATTEMPTS (46. 6%) SELF-HARM BEHAVIOURS (26. 8%) POVERTY (86% earn < $14, 999 per annum) SUBSTANCE USE IN FAMILY PRIMARY DRUGS OF CHOICE: CRACK/COCAINE (39%) AND ALCOHOL (34%) MEAN LENGTH OF USE: 10 YEARS CURRENT LEGAL PROBLEMS (37. 8%)

PROGRAMS AND SERVICES 7 Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

PROGRMS AND PROGRAMS AND SERVICES 8 Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

EVALUATION FINDINGS (1995 -2000) N=192 9

EARLY IDENTIFICATION AND ENGAGEMENT • 24% pregnant at admission • 29% were in their first trimester of 10 pregnancy • 70% were using substances while pregnant Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

IMPACT OF EARLY ENGAGEMENT “Early identified”: Identified in 1 st and 2 nd trimesters “Late-identified”: Identified in 113 rd trimester Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

“EARLY-IDENTIFIED” VS “LATE-IDENTIFIED” • Fewer prenatal risk factors • Reduced prenatal substance exposure (53. 8% of “early-identified” vs. 91. 7% of “late 12 identified” mothers had used some substance in pregnancy) • Higher birth weight Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

“EARLY-IDENTIFIED” VS. LATE-IDENTIFIED” • Fewer birth complications (16. 7% vs. 45%) • Better postnatal health (0% vs. 31. 6%) • Reduced length of hospital stay 13 • Decreased mother-infant separations (37. 5% vs. 77. 8%) Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

SINGLE-ACCESS MODEL “Addicts sometimes have a hard time getting their act together and controlling their lives. A lot of places will help you with one thing, but you have to go across town to get something else you need. 14 BTC is a one-stop shop. Here, they deal with you, your children, parenting, and emotions all under one roof. ” A BTC Client Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

INTEGRATED, CROSSSECTORAL MODEL “It’s not just about quitting drugs, but about changing your whole lifestyle …The children are the main focus here … that’s how they help us break the cycle. ” 15 A BTC Client Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

BREAKING CYCLES “At first I only came here because CAS told me to. But I’ve learned so much about being a mother and now I’m coming by choice. I wasn’t ready to change until after my daughter was born … At first I didn’t care about my daughter — I didn’t care if they took her away from me. Now, I wouldn’t lose her for anything in the 16 world. Everyone in my family — my mom, my dad, my brothers — has a drug problem. I want to stop the cycle before my daughter has a problem too. ” - A BTC Client Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

Drug Addiction and Pregnant/Parenting Women: Factors Affecting Client Engagement (1997) 17 Lisa Hicks

FACTORS AFFECTING ENGAGEMENT RATES • Homelessness • Use of crack cocaine as a primary drug of 18 choice • Low level of educational attainment

BTC PREGNANCY OUTREACH PROGRAM GOALS • To decrease the isolation of pregnant women using substances • To increase the knowledge of pregnant women using substances regarding resources available to them • To promote the use of services such as primary health care, prenatal care, medically-supervised withdrawal programs and methadone programs. 19 • To increase maternal involvement in planning for herself and her expected infant • To enhance efforts to build an integrated and responsive community referral network Mothercraft. Jean. Tweed. Centre. Motherisk. Toronto. Public. Health. Children’s. Aid&Catholic. Children’s. Aid. Societiesof. Toronto

BTC PREGNANCY OUTREACH PROGRAM SAMPLE N = 53 20 January 1. 01 - June 30. 02

PROGRAM ACTIVITES • • Street outreach Liaison with street-based agencies Provision of information and resources Provision of food/milk coupons Provision of transportation to appointments 21 Referrals Accompaniment to appointments Access to BTC Satellite group

REFERRAL SOURCES Self-referrals Hospitals Addiction Treatment System Breaking the Cycle Shelter/Hostel Drop-In Centres Another Client Mothercraft 22 26. 42% 15. 10% 5. 66% 3. 77% 1. 89%

SUBSTANCE USE AT ADMISSION YES NO N = 49 N= 4 92. 45% 23 7. 55%

PRIMARY ADDICTION (N = 49) Crack/Cocaine Alcohol Marijuana Heroin Other opiate Prescription N = 29 N = 11 N= 5 N= 3 N= 1 24 56. 60% 20. 75% 9. 43% 5. 66% 1. 89%

HOUSING STATUS (N = 53) No fixed address/street/Tent City Shelter/hostel/Out of the Cold Detoxification Centre Sharing with friends/family Subsidized/supportive housing Apartment House N = 11 N = 14 N= 3 N= 1 N = 19 N =4 25 52. 83% live in conditions of “visible homelessness” 47. 18% live in conditions of “hidden homelessness” 20. 76% 26. 41% 5. 66% 1. 89% 35. 85% 7. 55%

INCOME STATUS (N = 53) General Welfare/PNA No income ODSP UI Employment Income No response N = 20 N = 19 N= 7 N= 2 N= 3 26 37. 74% 35. 85% 13. 21% 3. 77% 5. 66%

RELATIONSHIP STATUS (N = 53) Single Common-law relationship Married Separated/divorced No response N = 45 N= 3 N= 0 N= 2 N= 1 27 84. 91% 5. 66% 0. 00% 3. 77% 5. 66%

GESTATIONAL AGE AT ADMISSION Two months Three months Four months Five months Six months Seven months Eight months Nine months Baby born Missing data N N= 6 N = 14 N= 5 N= 7 N= 5 N= 4 N= 0 N= 3 N= 2 % 11. 32% 26. 41% 9. 43% 13. 21% 9. 43% 7. 55% 0. 00% 5. 66% 3. 77% Cumulative % 28 11. 32% 37. 73% 47. 16% 60. 37% 73. 58% 83. 01% 90. 56% 96. 22% 99. 99%

REFERRALS MADE TO: Health Care Services 52. 84% Addiction Treatment Services 49. 05% Housing Supports BTC Satellite Program/Breaking the Cycle Counselling Services 29 50. 96% 64. 15% 5. 67%

BTC “SATELLITE” PILOT PROJECT GOAL: To assess the effectiveness of a joint hospital/community-based model to support homeless, pregnant women who are struggling with substance use 30 Partners: Breaking the Cycle; St. Joseph’s Health Centre – Dept. of Family and Community Medicine; Parkdale Parents Primary Prevention Project Funder: Health Canada – Canada Prenatal Nutrition Program

CUSTODY STATUS OF PREVIOUS CHILDREN N=86 Mother and father Family member Children’s Aid Society Adoption Living Independently No response N= 0 N= 4 N = 15 N = 19 N = 27 N= 3 31 0. 00% 4. 65% 17. 44% 22. 09% 31. 40% 3. 49%

CUSTODY OF BTC-POP BABIES N=53 Mother Children’s Aid Society Planned Termination Planned Adoption Miscarriage Unknown N = 11 * N= 9 N= 3 N= 2 N= 1 N = 27 32 20. 75% 16. 98% 5. 66% 3. 77% 1. 89% 50. 94% *Average birth weight – 7 lbs. 3 ozs. All born full term No birth complications or perinatal diagnoses

NETWORK FOR HEALTHY CHOICES Breaking the Cycle Child Welfare Hospitals/Health Care Providers Addiction Treatment System Providers 33 Transitional/Supportive Housing Providers Shelter/Hostel Providers Young Parent Resource Centres