Healthy Mothers, Healthy Families

The Healthy Mothers, Healthy Families Program was established by Dr. Karen Urbanoski, Canada Research Chair II in Substance Use, Addictions, and Health Services at the Canadian Institute for Substance Use Research and Associate Professor at the University of Victoria.  Within this program of research, we have worked in partnership with community-based programs who provide comprehensive supports and/or intervention for mothers and caregivers of diverse genders who used or used substances and have experienced social and structural barriers to accessing community supports and services (“integrated programs” or integrated substance use programs”). We strive to ask questions that are meaningful to clients and service providers that will contribute to understanding and improve equitable access to services and the well-being of caregivers and families. We strive to approach this work in collaboration and partnership with interest holders, including people with lived experience and service providers to support accessible, trauma-. gender- and culturally-informed processes that are safe and equity promoting.

Healthy Mothers Health Families Provincial Evaluation (2014-2018, and ongoing secondary research)

Rates of substance use are on the rise for Canadian women. Addressing problematic substance use in this population necessitates an understanding of the unique profiles of risk and barriers to care experienced by women and the treatment processes and outcomes they prioritize and see as important. Most women in substance use treatment are mothers. This role can increase motivation to engage in treatment while at the same time present barriers to care (e.g., fear of stigma and child welfare involvement, lack of childcare). Many women with problematic substance use treatment have co-occurring mental health challenges, including depression, anxiety and trauma and violence (present and past). Housing, food security, and other social determinants of health also frequently magnify challenges experienced. Parenting in the context of these risks understandably increases parenting stress and for some can be associated with a greater parenting challenge. 

Recognition of these unique needs has led to the development of integrated treatment approaches that bring together substance use treatment with maternal and child health and social services. Within Ontario’s addiction treatment system, there are currently 34 integrated programs, funded by the Ontario Ministry of Health and a Long-term Care’s (MOHLTC) Early Childhood Development Addiction Initiative. Many of these programs have been in operation for 10-20 years, while others are in the earlier stages of development. There isn’t a single treatment model employed by these programs – rather they tend to be locally developed based on the needs, strengths, and resources of the local community.

Building on our prior work with the CIHR-funded Connections team (Niccols, 2008-2013), we received funding from the MOHLTC and a CIHR Partnerships for Health Systems Improvement Grant to evaluate the ECD programs. Using a mixed-methods approach, including qualitative interviews and administrative data analysis, our current research aims to:

• Describe the characteristics of women attending integrated programs.
• Define the integrated services model and describe how it is being implemented in Ontario.
• Evaluate the effectiveness of integrated programs (women’s perceptions of care, attendance and engagement, maternal and child health outcomes, cost-effectiveness).

Selected Publications: 

•   Milligan, K., Meixner, T., Tremblay, M., Tarasoff, L. A., Usher, A., Smith, A., Niccols, A., & Urbanoski, K. A. (2020). Parenting Interventions for Mothers With Problematic Substance Use: A Systematic Review of Research and Community Practice. Child Maltreatment, 25(3), 247–262, https://doi.org/10.1177/1077559519873047

• Le, T. L., Kenaszchuk, C., Milligan, K., & Urbanoski, K. (2019). Levels and predictors of participation in integrated treatment programs for pregnant and parenting women with problematic substance use. BMC public health, 19(1), 154. https://doi.org/10.1186/s12889-019-6455-4

• Urbanoski, K., Joordens, C., Kolla, G., & Milligan, K. (2018). Community networks of services for pregnant and parenting women with problematic substance use. PloS one, 13(11), e0206671. https://doi.org/10.1371/journal.pone.0206671

• Tarasoff, L.A., Milligan, K., Le, T.L., Usher, A.M., & Urbanoski, K. (2018). Integrated treatment programs for pregnant and parenting women with problematic substance use: Service descriptions and client perceptions of care. Journal of Substance Abuse Treatment, 90, 9-18.

• Milligan, K., Usher, A.M., & Urbanoski, K. (2017). Supporting pregnant and parenting women with substance-related problems by addressing emotion regulation and executive function needs. Addiction Research & Theory, 25(3), 251-261.

• Meixner, T., Milligan, K., Urbanoski, K., & McShane, K. (2016). Conceptualizing integrated service delivery for pregnant and parenting women with addictions: Defining key factors and processes. Canadian Journal of Addiction, 7(3), 57-65.

Research snapshots – These summaries of the above-published articles have been created in collaboration with EENet to highlight key findings in a way that is accessible to the broader community:  

• Professionals’ thoughts on best practice for integrated treatment for pregnant and parenting women with addictions

• Addressing emotional regulation and problem-solving needs in pregnant and parenting women with substance-related problems

• How pregnant and parenting women in integrated substance use programs feel about their care

Video: Women’s views of treatment received in Ontario’s ECD programs  Click here

Healthy Mothers Healthy Families Knowledge Sharing Event (May, 2018)

We hosted a knowledge-sharing event highlighting our study findings and discussing future directions for research and action. Here are the slides from the presentation by Drs. Karen Milligan and Karen Urbanoski, as well as a press release highlighting some of our findings. Findings have also been shared at national conferences including Issues of Substance (November 2017), Addictions and Mental Health Ontario (May 2018), Canadian Association for Health Services and Policy Research (CAHSPR, May 2018), and the Canadian Association of Perinatal and Women’s Health Nurses (CAPWHN, October 2018). We look forward to presenting in Oslo, Norway in May 2018 at the It Take a Village Conference on families experiencing substance use, mental health, or physical health challenges.

Drs. Karen Milligan and Karen Urbanoski at the Healthy Mothers Knowledge Sharing Event on May 17 2018

Dr. Deborah Goodman (Child Welfare Institute, Children’s Aid Society of Toronto), Lucy Hume (Jean Tweed Centre), Dr. Karen Urbanoski (Canadian Institute for Substance Use Research), Dr. Karen Milligan (Department of Psychology, Ryerson University)

Attendees at the Healthy Mothers Knowledge Sharing Event at the Cathedral Centre, St. James Cathedral, in downtown Toronto