Wraparound programmes for pregnant and parenting women with substance use concerns in Canada: Partnerships are essential

Abstract

Wraparound programmes, wherein multiple services are offered at one location, are effective in engaging pregnant or parenting women experiencing substance use and other complex challenges while also addressing gaps in services between the health, child welfare and addictions fields. Evaluations of these programmes have demonstrated positive outcomes; nevertheless, few studies have focused on how programmes' cross-sectoral partnerships are structured and the difference these partnerships make. Drawing on the Co-Creating Evidence study, a three-year Canadian evaluation of eight multi-service programmes in six provinces, this article examines the partnerships that make wraparound service delivery possible. The study used a mixed-methods design involving interviews, questionnaires, output and de-identified client data; this article reports on qualitative findings only. Sixty service partners and 108 programme staff were interviewed in 2018 and 2019. Qualitative data analysis techniques were applied; NVivo12 software (QRS International, Melbourne, Australia) was utilised to facilitate the analyses. In terms of the programmes' partnership characteristics, overall, programmes more commonly formed partnerships with child welfare, health services (e.g. primary care, public health and perinatal care) and specialised health services such as mental health services, maternal addictions and Opioid Agonist Therapy. The programmes had fewer partnerships with housing, income assistance, Indigenous cultural programming, infant development and legal services. Key benefits of partnerships included: clients' improved access to health and social care, addressing social determinants of health; partners' increased knowledge about the significance of trauma in relation to women's substance use; improved child welfare outcomes and strengthened cultural safety and (re)connection. Key challenges included: tensions between partners regarding differing perceptions, mandates and responsibilities; personal differences and systemic barriers. Lastly, by means of steady dialogue and collaboration, partners increased their appreciation and use of the trauma-informed, harm reduction approaches that are central to wraparound programmes.