Working with street involved pregnant women


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Working with street involved pregnant women

  1. 1. Morgan Chalifoux, PSWPatricia Gladue, PSWMarissa Nakoochee, PSWMay 2013Streetworks, Edmonton 1H.E.R. Pregnancy ProgramStreetworksEdmonton, AB
  2. 2.  Involved in the street lifestyle Working in the sex trade Illicit drug use and addictions Current or past Children’s Services involvement Involvement or fear of the criminal justicesystem Unaddressed past trauma Highly stressed, undernourished, homeless unhealthy relationships Preexisting or undiagnosed health problems(HIV, mental health,STIs,PTSD,FASD)May 2013Streetworks, Edmonton 2
  3. 3. May 2013Streetworks, Edmonton 3
  4. 4.  ID’s go missing Contact information frequently changes Homelessness – no place for your stuff, noconsistent bed, no safe space High rate of abuse and trauma – sexual, verbal,physical, systemic, stigma, discrimination Difficulties navigating systems Previous negative experiences with serviceproviders Ability to read peopleMay 2013Streetworks, Edmonton 4
  5. 5.  Lack of knowledge on how and where to accessresources Fear of social systems/health systems Fear of “Authority” figures Fear of judgment or hesitation as a result of pastjudgment AddictionsMay 2013Streetworks, Edmonton 5
  6. 6. May 2013Streetworks, Edmonton 6
  7. 7.  Limited nutrition AISH and SFI limited incomes $627.00/month. $304.00 for essentials ofwhich $143.00 is for food, (housed) $323.00- Essentials- for women without a home Don’t all get a buspass Basic needs take priority (food vs. bus pass) Often need additional income- Cognitive issues- FASD, brain injuries,developmental delays, mental health issues,institutionalization Abstinence isn’t always realisticMay 2013Streetworks, Edmonton 7
  8. 8.  Street Language – swearing, slang Never alone – no privacy, lonely when livingindependently Street friends may be unsupportive of positivechanges Difficulties with trusting relationshipsMay 2013Streetworks, Edmonton 8
  9. 9.  Fear of Children’s Services Extreme guilt about what they are doing Potentially sexual abuse survivors Potentially working in the sex trade Share their story frequently A proper diet with regular fresh fruits,vegetables and milk is unattainable Harm Reduction - Clean needle is better than adirty needle, less use is big step, smokingmarijuana is better than drinking alcoholMay 2013Streetworks, Edmonton 9
  10. 10.  Previous negative experience with a health care provider(from physicians to receptionists) and lack ofunderstanding by health care personnel about the realitiesof street-involved lives Fear of judgement by mainstream service providers (race,age, income, addictions etc.) Services and care focus on the fetus with limited womanspecific opportunities Labeled as a mother vs. a woman who is pregnant Lack of knowledge about pregnancy issues and theimportance of prenatal careMay 2013Streetworks, Edmonton 10
  11. 11.  Building relationships Outreach Non-Judgmental environment Meeting women where “they are at” A multidisciplinary team Networking and Collaboration – agencies, programs,hospitals, Children’s Services, etc. Staff with similar past/shared experiences Informal setting Focus on the women Capable of “going with” Fetal heart rates for bonding and engagement IncentivesMay 2013Streetworks, Edmonton 11
  12. 12.  Client centered Offering inner-city prenatal classes Recreational activities Consistent weekly drop-ins Social media Networking with other agencies Flexible(no appt necessary) Having Harm Reduction supplies handy Be consistent Use street or common language Make a “safe place”May 2013Streetworks, Edmonton 12
  13. 13.  Address her concerns before addressing yours Focus attention on your conversation with her(don’t do multi tasking) Having an open ear- willing to listenMay 2013Streetworks, Edmonton 13
  14. 14.  Long Intakes (what do you really need to know- Prioritize) Repeatedly asking about drug use Don’t let personal bias effect care Don’t give incorrect info about drug use + Pregnancy Don’t tell her “ you have to quit” when she brings up heruse Don’t cut her off of services if she misses an appointment Don’t use complex language- in person and on hand-outs.May 2013Streetworks, Edmonton 14
  15. 15. May 2013Streetworks, Edmonton 15
  16. 16. Increasing the number of pregnant women who use drugs whoreceive prenatal care requires systems-level rather than onlyindividual-level changes. These changes require a paradigm shiftto viewing drug use in context of the person and society andacceptance of responsibility for unintended consequences ofpublic health bureaucratic procedures and messages abouteffects of drug use during pregnancy.” Roberts, S. C. M., & Pies, C. (March 2010). ComplexCalculations: How drug use during pregnancy becomes abarrier to prenatal care. Maternal Child Health Journal, 15,333-341.“Before you were born I carried you under my heart. From the momentyou arrived in this world until the moment I leave it, I will always carryyou in my heart”.May 2013Streetworks, Edmonton 16
  17. 17. He knows I’m pregnant.I told him last night.He doesn’t think it’s his.I m sure it is.He told me to quit using.While he sat there and lit up.Is he going to leave me?But he said he wouldn’tWill he stop hitting me?He said he would….May 2013Streetworks, Edmonton 17
  18. 18. May 2013Streetworks, Edmonton 18
  19. 19.  Samantha Hardeman, BScN RN 780-238-4632 Brittney Willetts, RSW 780-990-7411 Morgan Chalifoux, Pregnancy Support Worker 780-239-2872 Marissa Nakoochee, Pregnancy Support Worker 780-239-5609 Patricia (Trish) Gladue, Pregnancy Support Worker 780-238-4862May 2013Streetworks, Edmonton 19