Cross-disciplinary specialist care for substance-abusing pregnant

women and their infants – Team Haga

Maternity and Child Health Care

in

Primary Care

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Primary Care

Dept of Substance Abuse, Sahlgrenska University Hospital

Team Haga-

Cross-disciplinary care

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Antenatal Health Care in Sweden

• 100% attendance and very high credibility among population• Free of charge• Standardized nationwide• Midwife-centered (teamwork with physicians)• Total abstention from alcohol recommended during pregnancy• Motivational interview on alcohol (incl. AUDIT), drugs, medications

and tobacco with midwife, within one week of positive pregnancy test• Extremely low maternal and perinatal mortality and morbidity

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Child Health Care in Sweden• 100% attendance and very high credibility among

population• Free of charge• Standardized nationwide• From birth to age 6• Nurse-centered (teamwork w physician)• Restraint with alcohol recommended during

breastfeeding and in relation to parenting

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Team Haga

Cross-disciplinary specialist unit run by Primary Health Care System in Gothenburg, established in April, 2007

Close collaboration with, and located in, Dept of Substance Abuse, Sahlgrenska University Hospital

Target group: pregnant women/new mothers with substance abuse (current or up to one year previously) and their babies

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Goals

• Protect the fetus from substance-abuse effects, • support women to stop abuse during pregnancy

and • to stay substance-free after delivery

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Team members2 Midwives

2 Child Health nurses

Social worker

Psychiatric nurse

Team assistant/nurse

Obstetrician

Pediatrician

Psychiatrist

Manager

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

How to contact Team Haga?

The majority of the women are referred by antenatal care centers.

Some are referred from substance abuse clinics,

a small number referred from social services or criminal justice system and

some come on their own initiative.

Some repeat pregnancies

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Specialist Health Care during pregnancy and infancy

Liberal exploration of ambivalence in many cases; good professional network with abortion services

If pregnancy is continued, standard antenatal care plus:At least weekly midwife appointmentsAll women see obstetrician, liberal use of ultrasound to envisage fetusRegular monitored urine tests in almost all casesAppointment with the child health nurse around week 25

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Contact with psychiatric nurse or psychiatrist in selected cases

Team conferences determine individualized care and support for each women, postpartum follow-up for mothers and individualized child health care according to infant´s and family’s needs

Repeated home visits beginning shortly after birthAll infants are seen and assessed by pediatricianNetworking with local child health care centers to which babies are eventually referred

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Continued teamwork and extensive collaboration with social services, psychiatry and the local child health care system is essential

Long-term follow-up is often required

Social worker often involved in order to collaborate with social services and investigate woman’s and the family requirements for support

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Challenges

• Psychiatric morbidity complicates many cases, • resources for care/support of fathers-to-be (majority are

substance abusers), • some substance-abusers are unmotivated to

attend the specialist care,• social services with diverging policies/knowledge/time

perspectives/resources regarding substance abuse, psychiatric ill-health and parenting

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Results

A majority of the patients stay substance-free during pregnancy, and no cases of FASD or other serious neonatal effects of substance abuse have been diagnosed so far

An evaluation of the unit is in progress. The evaluation shows the benefical effects of themultidisciplinary team, continuity, treatment and the individualised, structured but at thesame time flexible support for the women

The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012

Thank You

Team Haga-

Cross-disciplinary specialist care for substance-

abusing pregnant women and their infants

Gothenburg

Sweden

Antonia Reuter

Manager

E-post: toni.reuter@vgregion.se