The evidence suggests that women are less likely to engage in problematic substance use than their male counterparts, but we have also seen the prevalence of drug use, among women aged 15– 34 years, double between 2002/03 and 2019/20 from 4.2% to 8.4%. This could be the result of the significant increase in the use of cocaine among women aged 15-24 years, up from 1.10% in 2002/2003 to 4.5% in 2019/2020. Across Europe women now make up about 20% of all new patients in specialised drug treatment programs and about 25% of all individuals with major problematic substance use. For many, being a woman with problematic substance use provides a double stigma, being a pregnant woman or a mother, creates very complex challenges.

In response to very specific unmet needs the Family Health Project, instigated by the Finglas Cabra Local Drug and Alcohol Task Force (FCLDATF), was set up in 2022 to provide services to women and their families, focusing on the pre-and post-natal support period. This is regarded as a time when many women, living with problematic substance use, seek support for the first time and are in contact with health services for an extended period. In addition, this period is observed as both an opportunity and a barrier. An opportunity: to seek treatment and support for their recovery, a barrier; as it may bring them into contact with official child protection agencies and health care professionals, many of whom have risk assessment responsibilities for the welfare of newborn and existing children. In order to explore the impact of the project a transformation mixed method investigation was conducted. A quantitative analysis of service users (n=70) retrospective data (2022-2023) was undertaken, in addition to qualitative interviews with a nested sample of service users (n=13) and external service providers (n=12). These interviews provided a deep dive into the lived experiences of those engaged with the service. It also provided feedback on the project from the perspective of external agencies and stakeholders. The findings highlighted the importance of the service which positively impacted on the quality of life of those who sought support and help at a time of great need and vulnerability. The characteristics of the service users, provides testimony of the unique holistic support required and also the need for individual trauma informed care.

The majority of the service users were female (86%), including 3 grandmothers, who collectively represented 155 children under the age of 18 years. Nearly 50% of these children were in state care, and 42% were under 4 years old. Despite the current housing crisis, 73% of clients described themselves as being in stable accommodation, with 37% of the women living alone with their children. This is more than double the national average for single parent households. A further 8.5% lived in a mixed household with their family of origin. At the time of presentation to the service 36% of the women were pregnant.

Of the seventy service users who sought support, over 48% had a history of childhood sexual abuse. Considering research findings, that 1 in 20 children in the UK have been sexually abused (NSPCC, 2021), this figure is extremely high. On further investigation it was also discovered that nearly 33% had been raped, 74% had been sexually assaulted and over 67% had been abused by their intimate partner. The findings suggest that there is a significant association between the number of service users who were subjected to childhood sexual abuse and intimate partner abuse as adults. Considering this level of trauma, it is not surprising that 48% (n= 33) of service users were diagnosed with a mental health condition, and nearly 75% of those were living with a diagnosis of depression. This is in keeping with international evidence which suggests a correlation between mental health and problematic substance use.

Prior to accessing the service, individuals described themselves as desperate, suicidal, misinformed and at rock bottom. The service intervention has changed their quality of life considerably. Post intervention individuals described themselves as actually living, confident and hopeful. The service provided was bespoke to each individual, timely and flexible. The Family Health Worker provided practical daily crisis interventions, from facilitating maternity appointments and advice to support with child access and treatment options. The external service providers acknowledged the benefits of the service, which enabled them to focus on their core area of responsibility, knowing that daily care and support was being maintained in the community. The Family Health Worker was identified as a connecting bridge between many of the services, operating in a truly multidisciplinary and collaborative way. Her independence was also considered an invaluable factor to external agencies, acting as an advocate, mediator and negotiator in very complex systems which were described as “not very integrated or flexible”. Stakeholders identified the growing need for this service across their area of operation, as they had witnessed the growing number of pregnant women with problematic substance use which required gender specific treatment, support and aftercare. 

The building of trust between the service user and the Family Health Worker benefited everyone concerned and was a critical element of the support. The connection with the Family Health Worker provided a solid foundation for building relationships with other organisations including health care, schools, treatment and recovery support. As a result, the service user was more open to accessing additional services. From the external service providers point of view, this relationship of trust, enabled them to have focused conversations with the service user in a safe space, were they were supported and engaged, for everyone’s benefit. The service provided by the Family Health Worker was described as critical and one that should be available in all Community Health Organisations (CHOs) areas, as stakeholders understood it was not available in other areas. The service offered a real opportunity to end the cycle of family trauma and problematic substance use, as it was rooted in a philosophy of harm reduction and was trauma informed. It also provided an intervention at the earliest possible time in a child’s life, at birth. The service is also in keeping with the ethos of the National Drug Strategy (2017) which holds that recovery is personal. The service is also targeted at a marginalised group identified in that strategy being women who harmfully use drugs, including those who are pregnant or have children (Reducing Harm, Supporting Recover, 2017-2025, p.44).