Factors that influence mother-child reunification for mothers with a history of substance use: A systematic review of the evidence to inform policy and practice in Australia

© 2015 Elsevier B.V. Background: An estimated 60-70% of Australian children in out of home care have a parent with a substance use disorder (SUD). The assessment of a parent's history and needs and the design of supportive interventions, particularly for mothers who are often the primary carers of children, are important considerations in deciding whether or not family reunification is desirable and possible. It is not clear from the research how the needs of families can be best met. There are no systematic reviews that provide evidence to inform the development of preventative and remedial interventions and related policy options. We undertook a systematic review to examine maternal characteristics and program features that facilitate or pose a barrier to mother-child reunification in contexts where mothers have a SUD. Methods: A structured search of nine databases was undertaken to identify peer reviewed literature in English between 2004 and 2014 and examine factors that influenced mother-child reunification in mothers with SUD. We employed a narrative synthesis design to analyse the findings sections of all papers as the methods of the various studies did not permit the pooling of data. Results: A total of 11 studies were included in this review. Findings show that factors such as timeliness of treatment entry, treatment completion and the receipt of matched services, and programs that provided a greater level of integrated care are positively related to reunification. The presence of a mental health disorder, use of opiates and having a greater number of children were barriers to reunification. Conclusion: Women with SUD who have a child in out of home care appear to have multiple unmet needs. Accessible, stigma free and comprehensive integrated care services, as well as greater access to primary health care that address social and medical issues must be considered to improve the physical and psycho-social outcomes of these women and their children

Studying the vulnerability reduction and physical-spatial organization of Bojnord city through the urban land use planning (case study: flood)

Flood is one of the most important natural disasters that cause the casualties and losses every year. Today, the massive growth of the population, the leveling of the land and the occupation of rivers and waterway s, along with the climatic and physiographic factors in big cities, have caused the urban flood spread. Bojnourd City has a high degree of vulnerability to natural hazards due to its geographical location in the Kopet Dag and Aladagh mountains, and the presence of rivers and waterway s inside it, on the one hand, and placing on the faults on the other hand.In this research, a descriptive-analytical method and the aerial maps have been used to collect the information.The results of the research indicated that Bojnord City is highly expected to flood in terms of the probability of flood-related vulnerability

The needs and experiences of pregnant women and new mothers with a history of injecting drug use

University of Technology Sydney. Faculty of Health.: Maternal substance use disorders are a significant public health issue in Australia and globally. While it does not necessarily lead to inadequate parenting, it is linked to poorer health and social outcomes for their infants. Women with substance use disorders can present with complex histories, mental health disorders and trauma from intimate partner violence. Additionally, it is estimated that many of these women have children. Women who inject drugs face multiple challenges and are some of the most vulnerable women in society. Yet, there is a dearth of literature in Australia and internationally that describes these women’s needs, experiences and preferences for care. : This study aimed to determine the health and psychosocial needs and experiences of pregnant women and women who have recently given birth and are recent or current injecting drug users in NSW, Australia. It explored experiences of accessing care and examine how service providers can best support, plan and deliver appropriate evidence-based care to meet the needs of these women. : A mixed-methods exploratory case study design was employed. This included a situational analysis, a guideline review, quantitative instruments and a series of qualitative interviews. Thirteen women, 13 health and social care providers and six Department of Community and Justice workers participated in interviews : This is the first known Australian study that identifies the health care experiences and needs of pregnant women and new mothers who are current injecting drug users. Findings indicate these women have multiple unmet health and psychosocial needs, and at times health and social care systems are not providing the required care. Women interacted with systems that held power over them, failed to recognise their strengths and at times, basic needs such as housing were not met. The complexities within these women’s lives including intimate partner violence, mental health, trauma and substance use meant stability was difficult to achieve. : Policies, guidelines and a one-stop-shop model of integrated primary health care that holistically meets the needs of women has the potential to break the cycle of adversity by addressing multiple layers of health and psychosocial issues. A trial of models of care that proactively targets women with substance use disorders in their pregnancy and beyond such as nurse-led models of care and a Sustained Home Visiting Program are urgently required. Change is possible, but committed action is essential

Medical termination of pregnancy in general practice in Australia: A descriptive-interpretive qualitative study

© 2017 The Author(s). Background: Australian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs. Methods: We undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically. Results: Three main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted. Conclusions: Exploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition, formalised referral pathways to the public sector are required to ensure timely care in the case of complications or the provision of surgical options. Leadership and coordination across the health sector is needed to facilitate integrated abortion care particularly for rural and low income women

Single-visit hepatitis C point-of-care testing, linkage to nursing care, and peer-supported treatment among people with recent injecting drug use at a peer-led needle and syringe program: The TEMPO Pilot Study.

BACKGROUND: Point-of-care hepatitis C virus (HCV) RNA testing can facilitate single-visit diagnosis and treatment. This study evaluated a single-visit test and treat intervention integrating point-of-care HCV RNA testing, linkage to nursing care, and peer-supported engagement/delivery of treatment among people with recent injecting drug use at a peer-led needle and syringe program (NSP). METHODS: TEMPO Pilot is an interventional cohort study of people with recent injecting drug use (previous month) recruited between September 2019-February 2021 from one peer-led NSP in Sydney, Australia. Participants received point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick), linkage to nursing care, and peer-supported engagement/delivery of treatment. The primary endpoint was the proportion initiating HCV therapy. RESULTS: Among 101 people with recent injecting drug use (median age 43; 31% female), 27% (n = 27) were HCV RNA detectable. Treatment uptake was 74% (20 of 27; sofosbuvir/velpatasvir, n = 8; glecaprevir/pibrentasvir, n = 12). Among people initiating treatment (n = 20), 45% (n = 9) initiated treatment at the same visit, 50% (n = 10) in the next 1-2 days, and 5% on day 7 (n = 1). Two participants initiated treatment outside the study (overall treatment uptake 81%). Reasons for not initiating treatment included loss to follow-up (n = 2), no reimbursement (n = 1), not suitable for treatment (mental health) (n = 1), and inability to perform liver disease assessment (n = 1). In the full analysis set, 60% (12 of 20) completed treatment and 40% (8 of 20) had a sustained virological response (SVR). In the evaluable population (excluding people without an SVR test), SVR was 89% (8 of 9). CONCLUSION: Point-of-care HCV RNA testing, linkage to nursing, and peer-supported engagement/delivery led to high HCV treatment uptake (majority single-visit) among people with recent injecting drug use attending a peer-led NSP. The lower proportion of people with SVR highlights the need for further interventions to support treatment completion