The Provincial Perinatal Substance Use Project

Led by the BC Women’s Hospital + Health Centre, the Provincial Perinatal Substance Use Project is leading the province in transforming perinatal substance use services to improve the experiences of women and people affected by substance use, as well as the experiences of their families. The ultimate deliverable of the project is a Provincial Blueprint for a Perinatal Substance Use Continuum of Care which adapts evidence, leading practice and wise practices into 38 recommendations that describe a pathway for program planning and service enhancements for pregnant and parenting women and people who are using substances.

The project, which is funded by the BC Ministry of Health and BC Ministry of Mental Health and Addictions, launched in 2018 in response to a lack of appropriate perinatal substance use services, and to address enormous barriers to accessing services and supports due to stigma, judgement, shame, racism and discrimination and fear of losing child custody and histories of trauma. It aims to support healthy families and babies while ensuring those who are pregnant, postpartum or parenting and using substances can embark on a health care journey filled with hope, optimism while acknowledging their strengths and resiliency.

The project has led a number of provincial initiatives to learn from communities and women with lived and living experiences in order to change the landscape of services and supports. To date, new education and training has supported 9,163 health care providers over the past three years to adopt practices such as trauma and violence-informed care as well as care models which emphasize keeping the parent and baby together. The team also engaged Indigenous Elders and Indigenous-led organizations in an effort to decolonize perinatal substance use care. Dr. Elder Roberta Price, Coast Salish, Snuneymuxw and Cowichan Nations, and Elder Glida Morgan, Tla’amin First Nation, are members of the project team and have led the creation of an Elders Visioning for Perinatal Substance Use Toolkit which supports integrating Elders as a standard practice in both health care and community settings.

Additionally, the team led the renewal of a model of care at the Families in Recovery unit at BC Women’s Hospital + Health Centre to align with evidence-informed and wise practices. The renewed model has helped inform acute care planning across the province on how to best support pregnant and parenting women using substances.

Nineteen community organizations, half of which are Indigenous-led organizations and Aboriginal Friendship Centres, have expanded direct care programming and services such as enhanced support provided by peers to help women and families feel safer and more empowered. As a result, between April 2019 and October 2021, 1,789 mother-baby dyads new to receiving perinatal substance use services, and 7,040 women overall, were served. The project has also partnered with the BC Association for Pregnancy Outreach Programs to deliver hospital-based in-reach at 10 sites in the province to provide system navigation support and connect women affected by substance use with community wraparound supports.

Key to the project’s success has been its focus on building relationships and embedding principles of Indigenous cultural safety and compassionate, trauma-informed care. In order to sustain its work, the project’s team has engaged 300+ stakeholders to collaborate on provincial, regional and local system improvements. As well, five regional working groups led by health authorities’ executive leaders in perinatal health were established in order to improve the continuity of care as pregnant or parenting women move through different sectors.

“The Provincial Perinatal Substance Use Project has changed the landscape for how perinatal substance use services are designed, accessed and delivered throughout the province. Through leading a number of layered and complex initiatives, the project has both created and sustained significant momentum in transforming perinatal substance use-related education and training, revitalizing service design and decolonizing perinatal substance use services. The collaborative and partnership-based approach of this project is truly a model for how to engage meaningfully and how to honour Indigenous ways of being and knowing. As runner-up for the Optimizing the Early Years, it is important recognition for this project team for their exemplary commitment and passion for this work and the women, people and families we serve.”
— Susan Wannamaker, Executive Vice President, Clinical Service Delivery, PHSA

All of the partnerships, collaborations and remarkable achievements in advancing perinatal substance use care would not have been possible without the leadership of Denise Bradshaw, Director, Provincial Health Initiatives, BC Women’s Hospital + Health Care Centre. In June 2021, Denise passed away suddenly and unexpectedly and the entire province grieved the loss of an extraordinary, dedicated champion for women and people using substances. This project was the culmination of her drive, passion and commitment to supporting women using substances on their recovery journey. Her leadership on the project served to ensure a clear vision for inclusive, non-stigmatizing, compassionate and culturally safe perinatal substance use services. The project team continues and dedicates this work as an important contribution to Denise’s legacy. In the words of Dr. Elder Roberta Price and Elder Glida Morgan, “Our beautiful matriarch Denise continues to watch over us and guide us in the spirit world.”