“Coming together is a beginning; keeping together is progress; working together is success” —Henry Ford
By Lenora Marcellus, Associate Professor, UVic School of Nursing
The care and support of women who are pregnant or newly parenting and also coping with problematic substance use continues to be significant community issue across Canada. In addition to the effects of substance use, families also often experience mental health issues, violence and trauma, poverty, unsafe or unstable housing, limited access to prenatal care, and other social challenges. Maternity care teams in Victoria have a long history of collaborating to address these complex issues. In the late 1990s the TEAM group was formed (Together for Education about Addiction and Mothering) through the leadership of Azeita Harding, the Manager of Perinatal Services at Victoria General Hospital. Over the past twenty years there has been significant work done at local, health authority, provincial and national levels to improve models of care, provide education to providers, and increase awareness in the community.
Lenora Marcellus, Associate Professor in the School of Nursing, has been involved in these developments from the early days. “I completed my NICU specialty education program in 1986 and worked for many years as an RN in Neonatal Intensive Care Units in Alberta and BC. Initially there was little to no awareness of the impact of substance use during pregnancy. If an infant was irritable or jittery, it was usually attributed to other clinical circumstances, and substance use was not identified as a differential diagnosis. When I began working with the BC Ministry for Children and Family Development in 1996 to develop the Safe Babies program (an education and support program for foster parents who care for infants with prenatal substance exposure) I began to learn much more about the fields of Fetal Alcohol Spectrum Disorder and women’s experiences of substance use. When I moved into my role as the Perinatal Lead for Island Health there were many initiatives underway in British Columbia addressing these issues.”
One initiative that was emerging in Victoria was the collaborative visioning and planning by representatives from about 30 community based agencies to develop a specialized program to support women during this important period of time. Members of this group were very familiar with similar existing programs such as Breaking the Cycle (Toronto), Sheway (Downtown Eastside) and Maxxine Wright (Surrey). This model of program has been found to improve outcomes for infants, women, families, and communities(1). Spearheaded by Betty Poag, an Island Health public health nurse, six years ofplanning work came to fruition in 2013 when the HerWay Home program was launched.
Throughout the planning and implementation phases, a number of productive research and funding partnerships were developed. Children’s Foundation of Vancouver Island has been a major supporter of the program, having committed $3.3 million over five years, and sees this support as a key way to meet their mission of providing island children with disabilities and health challenges — and those at significant risk of developing these — with every possible opportunity to thrive. From a research and evaluation perspective, Lenora collaborated with Dr. Cecilia Benoit and a BC Centre for Addiction Research team to access funding from the Canadian Institutes for Health Research. This research funding supported development of a women’s advisory council for the HerWay Home program, a vital mechanism for actively engaging clients in program planning. Lenora, Betty, and Amanda Seymour, the program coordinator, are members of the Canada FASD Partnership Research Team on the Prevention of FASD from a Women’s Determinants of Health Perspective. Participation on this team, led by Dr. Nancy Poole from the BC Center of Excellence for Women’s Health has connected the HerWay Home group to other similar programs across the country, creating an emerging community of practice.
Amanda, as coordinator of the HerWay Home program, has found great value in these partnerships. “Lenora, along with other academics, has conducted research into best practices for neonatal health when working with women who are using substances. The development of published research papers helped us develop a strong case for the need for a program like HerWay Home in Victoria.”
The HerWay Home team hosted a successful community conference in September 2014, bringing over 200 members of the community together for education and networking opportunities and to highlight best practices in working with this population. The team was overwhelmed by this interest in the community. The connections made through the community-university partnership enabled the team to bring leaders in the area of women’s services, parenting, substance use, pregnancy, trauma informed, culturally safe and harm reduction work to this conference.
Also participating in this conference were undergraduate nursing students from the University of Victoria School of Nursing. The HerWay Home community-university partnership not only supports research, but also provides practice opportunities for undergraduate nursing students. Kathleen Leangen is a new graduate who has recently completed her BSN. While taking a senior childbearing family course with Lenora, she and another student had the opportunity to work with the HerWay Home program. Kathleen shared that this practicum allowed her the opportunity to gain a deeper understanding of the challenges some families face in our communities. “It is so hard to sum up everything I learned during this time. This experience taught me the importance of practicing from an empathetic, non-judgmental, and trauma-informed care approach, which will help to enrich and strengthen the relationships she develops with clients of all ages.” Kathleen will be putting this learning into practice in her first nursing role. She has been offered a full time position in the perinatal program in the hospital in Fort St. John and the manager of the patient care centre has asked Kathleen to help their clinical team understand and learn about trauma informed care.
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1. Nathoo T, Poole N, Bryans M, Dechief L, Hardeman S, Marcellus L, Poag E, Taylor M. (2013). Voices from the community: Developing effective community programs to support pregnant and early parenting women who use alcohol and other substances. First Peoples and Children and Family Review, 8(1): 93-106.
2. Milligan, K., Niccols, A., Sword, W., Thabane, L., Henderson, J., & Smith, A. (2010). Maternal substance use and integrated treatment programs for women with substance abuse issues and their children: A meta-analysis. Substance Abuse Treatment, Prevention, and Policy, 5, 21.
From the 2015 Spring Communiqué — In Collaboration with Island Health
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