BREAKING the CYCLE:

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BREAKING the CYCLE

• Measures of Progress

Toronto Public Health
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• PROGRAM DESCRIPTION

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PRINCIPLES AND FEATURES

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

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PARTNERS

• Mothercraft
• Jean Tweed Centre
• Motherisk Program Hospital for Sick
• Children
• Toronto Public Health
• Childrens Aid Society of Toronto
• Catholic Childrens Aid Society
• Funder Health Canada Community Action Program
  for Children

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ADMISSION CRITERIA

• Breaking the Cycle serves women
• Who are pregnant and/or parenting at least one
  child under the age of 6 years
• and
• Who are experiencing problems of substance use or
  recovery
• 3) Who desire support around their substance use
  or recovery

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CHARACTERISTICS OF WOMEN SERVED

• MEAN AGE 30
• MEAN OF 2 CHILDREN EACH range of 1-12 (1/3 in
  mothers 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)
• SUICIDE ATTEMPTS (46.6)
• SELF-HARM BEHAVIOURS (26.8)
• POVERTY (86 earn lt 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)

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PROGRAMS AND SERVICES
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PROGRMS AND PROGRAMS AND SERVICES
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• EVALUATION FINDINGS
• (1995-2000)
• N192

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EARLY IDENTIFICATION AND ENGAGEMENT

• 24 pregnant at admission
• 29 were in their first trimester of pregnancy
• 70 were using substances while pregnant

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IMPACT OF EARLY ENGAGEMENT

• Early identified Identified in 1st and 2nd
  trimesters
• Late-identified Identified in 3rd trimester

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EARLY-IDENTIFIED VSLATE-IDENTIFIED

• Fewer prenatal risk factors
• Reduced prenatal substance exposure
• (53.8 of early-identified vs. 91.7 of
  late-identified mothers had used some substance
  in pregnancy)
• Higher birth weight

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EARLY-IDENTIFIED VS.LATE-IDENTIFIED

• Fewer birth complications (16.7 vs. 45)
• Better postnatal health (0 vs. 31.6)
• Reduced length of hospital stay
• Decreased mother-infant separations (37.5 vs.
  77.8)

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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.
• BTC is a one-stop shop. Here, they deal with
  you,
• your children, parenting, and emotions all under
• one roof.
• A BTC Client

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INTEGRATED, CROSS-SECTORAL MODEL

• Its not just about quitting drugs, but
• about changing your whole lifestyle
• The children are the main focus here
• thats how they help us break the cycle.
• A BTC Client

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BREAKING CYCLES

• At first I only came here because CAS told me
  to.
• But Ive learned so much about being a mother
  and now
• Im coming by choice. I wasnt ready to change
  until after
• my daughter was born At first I didnt care
  about my
• daughter I didnt care if they took her away
  from me.
• Now, I wouldnt lose her for anything in the
  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

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

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FACTORS AFFECTING ENGAGEMENT RATES

• Homelessness
• Use of crack cocaine as a primary drug of choice
• Low level of educational attainment

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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.
• To increase maternal involvement in planning for
  herself and her expected infant
• To enhance efforts to build an integrated and
  responsive community referral network

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BTC PREGNANCY OUTREACH PROGRAM

• SAMPLE
• N 53
• January 1.01 - June 30.02

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PROGRAM ACTIVITES

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

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REFERRAL SOURCES

• Self-referrals 26.42
• Hospitals 26.42
• Addiction Treatment System 15.10
• Breaking the Cycle 15.10
• Shelter/Hostel 5.66
• Drop-In Centres 5.66
• Another Client 3.77
• Mothercraft 1.89

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SUBSTANCE USE AT ADMISSION

• YES N 49 92.45
• NO N 4 7.55

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PRIMARY ADDICTION(N 49)

• Crack/Cocaine N 29 56.60
• Alcohol N 11 20.75
• Marijuana N 5 9.43
• Heroin N 3 5.66
• Other opiate N 3 5.66
• Prescription N 1 1.89

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HOUSING STATUS(N 53)

• No fixed address/street/Tent City N 11 20.76
• Shelter/hostel/Out of the Cold N 14 26.41
• Detoxification Centre N 3 5.66
• Sharing with friends/family N 1 1.89
• Subsidized/supportive housing N 1 1.89
• Apartment N 19 35.85
• House N 4 7.55
• 52.83 live in conditions of visible
  homelessness
• 47.18 live in conditions of hidden homelessness

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INCOME STATUS(N 53)

• General Welfare/PNA N 20 37.74
• No income N 19 35.85
• ODSP N 7 13.21
• UI N 2 3.77
• Employment Income N 2 3.77
• No response N 3 5.66

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RELATIONSHIP STATUS(N 53)

• Single N 45 84.91
• Common-law relationship N 3 5.66
• Married N 0 0.00
• Separated/divorced N 2 3.77
• No response N 1 5.66

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GESTATIONAL AGE AT ADMISSION

• N Cumulative
• Two months N 6 11.32 11.32
• Three months N 14 26.41 37.73
• Four months N 5 9.43 47.16
• Five months N 7 13.21 60.37
• Six months N 7 13.21 73.58
• Seven months N 5 9.43 83.01
• Eight months N 4 7.55 90.56
• Nine months N 0 0.00 90.56
• Baby born N 3 5.66 96.22
• Missing data N 2 3.77 99.99

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REFERRALS MADE TO

• Health Care Services 52.84
• Addiction Treatment Services 49.05
• Housing Supports 50.96
• BTC Satellite Program/Breaking the Cycle 64.15
• Counselling Services 5.67

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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
• Partners Breaking the Cycle St. Josephs Health
  Centre Dept. of Family and Community
  Medicine Parkdale Parents Primary Prevention
  Project
• Funder Health Canada Canada Prenatal
  Nutrition Program

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CUSTODY STATUS OF PREVIOUS CHILDRENN86

• Mother N 0 0.00
• Mother and father N 4 4.65
• Father N 15 17.44
• Family member N 15 17.44
• Childrens Aid Society N 19 22.09
• Adoption N 27 31.40
• Living Independently N 3 3.49
• No response N 3 3.49

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CUSTODY OF BTC-POP BABIESN53

• Mother N 11 20.75
• Childrens Aid Society N 9 16.98
• Planned Termination N 3 5.66
• Planned Adoption N 2 3.77
• Miscarriage N 1 1.89
• Unknown N 27 50.94
• Average birth weight 7lbs. 3ozs.
• All born full term
• No birth complications or perinatal diagnoses

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NETWORK FOR HEALTHY CHOICES

• Breaking the Cycle
• Child Welfare
• Hospitals/Health Care Providers
• Addiction Treatment System Providers
• Transitional/Supportive Housing Providers
• Shelter/Hostel Providers
• Young Parent Resource Centres