- freely available
Int. J. Environ. Res. Public Health 2019, 16(18), 3299; https://doi.org/10.3390/ijerph16183299
Co-Creating Evidence Evaluation Study
- What women hoped to get from engaging in their program;
- How women used their program’s services/activities; and
- The most significant changes that women experienced as a result of their program.
2. Materials and Methods
2.1. Study Design
2.2. Data Collection Processes and Instruments
- The project team is undertaking two visits with each site, to conduct face-to-face, semi-structured, qualitative interviews, focus groups and questionnaires with staff, clients, and program partners.
- The program manager/coordinator at each site is compiling and remitting quantitative output data and client-based data from April 2018 to September 2019, for a total of 18 months.
2.3. On-site Data Collection by Project Team
2.4. Participants and Sampling Approach
2.5. Data Analysis
2.6. Ethics Approval
3.1. Overview of the Programs’ Services
3.2. What Women Hoped to Get from Participating in Their Program
- Wanted support in relation to problematic substance use and/or trauma
- Wanted support with child welfare and/or mother–child connection
- Wanted support and information related to pregnancy
- Wanted help in getting housing
- Wanted help in getting connected to health care or prenatal care
- Wanted healthy peer connections or peer support
- Brief discussion of the key themes follows.
3.2.1. Wanted Support in Relation to Problematic Substance Use and/or Trauma
I wanted to get sober. I wanted my children back, my family back. …. I was using drugs and alcohol. I was going through a rough time—breaking up with my partner who was abusive mentally and emotionally.[I wanted] better housing, support to keep me away from drugs and alcohol, and help with nutrition. [I wanted] to keep my baby.[I wanted] connections with other mothers and knowing that there were groups I could do that would help me with being a mother with trauma and addiction.
3.2.2. Wanted Support with Child Welfare and/or Mother–Child Connection
I wanted a different way of bonding with my child, a different community.I wanted connections with other mothers and knowing that there were groups I could do that would help me with being a mother with trauma and addiction.I wanted sobriety and to learn to parent my kids; I had lost custody.I wanted to get support and bring my child home and parent in a healthy lifestyle for her and for me.
To start with, I only wanted to get my children back. Now I want a better quality of life for me and my kids.I also wanted to connect with a therapist. I wanted to have a stable foundation to work with. I knew [child protection] would be involved, so I wanted to create a healthy foundation for that involvement.
3.2.3. Wanted Support and Information Related to Pregnancy
I was pregnant and had addictions and I wanted to have support through my pregnancy.Initially, I didn’t know where or how I’d go with the pregnancy. I needed guidance and support. When I first found out I was pregnant, I cried for 48 hours straight. I also wanted information. I didn’t know where to go and what my next step would be.Support to keep moving forward. I wanted to make changes in my life.
3.2.4. Wanted Help in Getting Housing
Support, because I have [child protection] involvement. I wanted support and stable housing and getting addictions out of the way. I want to go home with my baby.I was in a really shitty situation. I was living with a friend; she was using drugs. I ended up in a shelter. I needed resources to help me with my pregnancy and with raising my baby, and I wanted help getting into different housing.
3.2.5. Wanted Help in Getting Connected to Health Care or Prenatal Care
My family doctor set me up with a maternity doctor who specialized in working with women with addictions. She suggested that I network with someone. I was afraid that the nurses at the hospital would see my medical history, see that I was on suboxone, and be judgmental and call child welfare.I was looking for prenatal care. I was looking for programs and people to help support me to have a healthy pregnancy.
3.2.6. Wanted Healthy Peer Connections or Peer Support
I was looking for support and advocacy for my situation. I was needing a group for women like me who have been through years of trauma and abuse. I did not want to be the only woman in the room with that kind of lived experience.[I wanted] to open up more; learn how to speak to others when they needed help; to share my story with others who were struggling; to help guide others on a positive path.
The sense of community here. Support group. I didn’t know other pregnant women.
3.3. Clients’ Experiences of Utilizing Their Program’s Services/Activities
3.4. Most Significant Change(s) That Women Experienced (as a Result of Their Program)
- Quit or reduced substance use;
- Strengthened mother–child connection;
- Kept/regained custody/care of child(ren);
- Improved wellness/mental health;
- Increased support;
- Safer, improved housing.
3.4.1. Quit or Reduced Substance Use
If I hadn’t been at this program, it would have been harder to stay sober, and my baby would have gone to live with my mom.Because the staff care so much about their clients, I’ve gotten clean. I’ve been in and out of addiction for 18 years, but because of them, my using time has reduced—it’s down to two days. They’ve reached out to me. They’ve made a huge difference to me.
3.4.2. Strengthened Mother–Child Connection
My baby and I have a home. We know we’re not alone—both because I can call the [program] staff and because of other women. Without [program], I probably wouldn’t have had my baby.My stress level has gone down quite a bit. I know that no matter what, they’ll be here. The program helps with everything: prenatal care, housing, [child protection] advocacy, baby stuff. Before coming into this program, I felt hopeless.
3.4.3. Kept/Regained Custody/Care of Child(ren)
Getting my daughter back from foster care and having my baby come home from the hospital with me. Getting my kids back is the biggest thing. That showed me I’m done with my past lifestyle.I’ve been clean and sober for 22 months. Getting clean changed my whole life. I got my son back, and I’m about to get the older two children back in September.
3.4.4. Improved Wellness/Mental Health
Our household is more balanced. I know my triggers and deal with anger better. I am more balanced emotionally.Coming to [the program] is getting us out of our shells. My daughter and I, we really needed this. It’s really made a difference in terms of our health, mental health and well-being
3.4.5. Increased Support
I’m about to reach out for support. I couldn’t do that before.
3.4.6. Safer, Improved Housing
Getting suitable housing and reuniting with my son. We were in the single room occupancy apartment when I had the baby. Then he went into a foster home. Then we got housing and the baby was returned to us.
3.4.7. Additional “Significant Changes”/Outcomes
- Increased self-confidence/self-esteem;
- Reduced isolation and/or increased connection to peers;
- Increased self-compassion/self-determination.
They’ve helped me open up more. I feel more self-confident and happier. I’ve opened up a lot more.I got back into my culture. I’m teaching my daughter how to smudge and do drumming.I’m happy, have lots of friends. I’ve connected again with family, and I’m sober.It helped me—the therapy and the groups—to reflect on myself, and I wanted to do that for myself. I have a better understanding of myself. They give us the tools to help ourselves.
3.5. Summary of Key Findings
Conflicts of Interest
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|Program Site||Herway Home||Sheway||Maxx Wright||HER||Raising Hope||Mothering Project||Breaking the Cycle||Baby Basics||Total|
|Number of participants|
|Cultural background (top 3)|
|Mixed Race||3||6||5||0||0||3||1||0||18 (15%)|
|Length of time participating in program|
|<1 month||0||0||1||1||0||0||0||1||3 (2%)|
|1–6 months||3||3||3||4||5||5||3||1||27 (22%)|
|7–12 months||1||5||2||4||3||2||2||1||20 (16%)|
|1–3 years||3||12||4||0||1||7||3||3||33 (27%)|
|>3 years||1||15||10||0||1||11||0||2||40 (33%)|
|Service/Activity||Number of Programs Offering Service/Activity on Site via Program Staff or Service Partners||Number of Programs Linking Clients to Service/Activity via Referral to Service Partners||Total Number of Programs Offering or Facilitating Access to Service|
|Basic needs support||8||0||8|
|Child assessment and early intervention||5||2||7|
|Child care on site||7||0||7|
|Child welfare support||7||0||7|
|Drop in; peer connection||8||0||8|
|Health; medical services||6||2||8|
|Mental health; trauma||8||0||8|
|Prenatal and postnatal care||7||1||8|
|Substance use counselling||7||1||8|
|Service/Activity||Examples of Ways That Clients Utilized the Service/Activity|
|Basic needs support||Lots of practical support such as a bag of clothes for the baby and items for myself such as a sports bra when I gave birth recently.|
I got help with income security.
|Child assessment and early intervention||A speech language pathologist was linked to my son—the referral from [the program] sped up the process.|
We were referred to the hospital and introduced to a dentist for the children. The staff made sure the children were up to date for their immunizations and referred them to an Infant Development worker.
|Child care on site||My baby is in daycare sometimes. I want to get a regular spot in the daycare.|
They have the daycare here. You can take “self-care” breaks and have the kids go into daycare.
|Child health||My son had vaccinations with the Public Health Nurse and saw the dental hygienist. He is getting dental surgery soon as a result.|
I brought my older daughter to see the doctor; my baby is in care still.
|Child welfare support||When my partner assaulted me in November, child welfare was automatically involved. I was concerned they would take my kids away. I met with child protection services with [program] as my support.|
[The program] advocated for me to get my kids back early and to have visits, and then extended visits with my kids—and then my kids came back to me.
|Cultural programming||I went to the Round Dance organized by [program’s partner organization].|
I do drumming and Talking Circle here.
|Drop in; peer connection||A lot of the women who come here I’ve known since childhood. Now we’re moms together. All my friends are here; they’re getting sober and are moms. The other women are role models—they help us develop skills and increase confidence.|
I have connections with other women coming to [the program].
|Food; nutrition||Lunch program; weekly bag of nutrition; fresh bread; prenatal and postnatal minerals and supplements plus education and workshops on healthy nutrition.|
Every week I get a four-liter jug of milk, eggs and cheese. That weekly food bag really helps.
|Health; medical||I see the Public Health Nurse at the [program] regularly. She is the one who wanted me on Methadone—she said would it be better for the baby than T3s.|
We discuss sexual health information in group.
|Housing||I got help with housing through another agency but [the program] helped me to switch the lease to be in my name, which means that I have to be more responsible.|
My support worker got me into a nice place for women. People are getting their kids back and staying off drugs.
|Life skills||We had someone come and talk about the food guide.|
The nurse from [program’s partner organization] provided nutrition education. We learned how to make baby food and we did fire prevention education.
|Mental health; trauma||I spoke with the trauma counsellor about some of the things I have seen in the last year. I’ve been living a very high-risk life—drugs, violence, lots of money.|
I’m working with the trauma worker now. I’m doing that to get my son back.
|Outreach||My Outreach Worker is my mainstay.|
My Outreach Worker will go to court with me as an advocate.
|Parenting programs||I took a couple of parenting groups. That helps me with how I play with my daughter. I learned about her development and how to talk with my teenage son.|
I’ve done lots of programs, like wellness, circle of security, and rediscovering parenting. They are all very useful because as my kids age, new problems arise and I retake the group to see how the information applies to my current situation. I like that the groups repeat regularly.
|Prenatal; postnatal care||I’m seeing the doctor here, getting Methadone, and going to prenatal classes.|
They give me rides to [program’s partner organization] for prenatal care. We learn about breastfeeding, traditional teachings, abuse and violence there.
|Substance use counselling||I had stopped cocaine and alcohol in 2017. [The program] helps me deal with and address the urges. Fear of [child protection] also motivates me. I have a one-to-one counsellor I was seeing weekly until recently. Now we meet biweekly.|
I’m going to be starting Group (struggling with addictions group) tomorrow. I talk with the counsellor all the time about my use and where I live. It is hard to stop using when you are selling drugs all the time.
|What Women Hoped to Get from Participating in Their Program||Women’s Most Significant Change|
|Support with problematic substance use and/or trauma (n = 61)||Quit, reduced or safer substance use (n = 51)|
Improved wellness/mental health (n = 39)
|Support with child welfare and/or mother-child connection (n = 58)||Strengthened mother – child connection (n = 49)|
Women keep/regain children in their care (n = 43)
|Support and information re: pregnancy (n = 37)|
Help in accessing health care or prenatal care (n = 29)
|Increased support (n = 34)|
|Help in getting safe, stable housing (n = 32)||Safer, improved housing (n = 29)|
|Healthy peer connections or peer support (n = 23)||Reduced isolation/connection to identity, peers, culture (n = 19)|
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