FIR SQUARE COMBINED CARE UNIT

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FIR SQUARE COMBINED CARE UNIT BC WOMENS
HOSPITAL 4500 OAK STREET VANCOUVER BRITSH
COLUMBIA V6H 3N1 CANADA
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BACKGROUND
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Vancouvers Downtown Eastside, the poorest
neighbourhood in Canada, hosts a significant
drug and sex trade
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A study of alcohol and drug use by pregnant women
in the DTES indicated low birth weights and
frequent removals of babies by child welfare
officials
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In response, Sheway, a drop-in and outreach
program for parenting and pregnant women,
developed within the neighbourhood
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In 1993, BC Womens Hospital partnered with
Sheway to provide medical detoxification for
pregnant women, and in 2003 opened a
strengths-based harm reduction maternity unit
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PROGRAM AND STRUCTURE
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• Withdrawal management
• Parenting classes
• Alcohol and Drug counselling
• Alcohol and Drug group
• Recreation therapy

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• Talking circle
• Music therapy
• Acupuncture
• Access to 12 step meetings

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PHILOSOPHY AND PRACTICE APPROACH
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• Reframing concepts in health management of
  substance-using pregnant women
• Providing a safe foundation for family health and
  family unity

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• Supporting and educating substance-using mothers
  to reduce harm and risks
• Supporting safe substance use instead of no
  substance use for patients unable to practice
  abstinence

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• Revolving door strategy to promote access to
  medical care
• Strength-based practice, supporting and promoting
  womens self-determination

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• The Fir Square multidisciplinary team includes
• Dedicated physician group
• Senior Practice Leader
• Dedicated nursing team
• Dedicated social worker
• Half-time addictions counsellor
• Half-time life skills/parenting counsellor

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• Staff assist women in achieving an optimum level
  of pre- and post-natal health
• This model and intervention are intended to
  reduce the effects of
• malnutrition
• homelessness
• poverty
• problematic substance use for mothers and infants

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PROGRAM OBJECTIVES

• 1. Reduce substance use and related risks
• 2. Improve infant health outcomes
•   birth weights, growth and development
• reduced risk of HIV infant Sudden Infant
  Death Syndrome
• reduced effects of substance exposure

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3. Increase the percentage of mothers able to
safely retain custody of their infants 4.
Increase the numbers of women seeking treatment
and their readiness to enter treatment 5.
Increase access to medical services for
substance-using women
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Referral Criteria  Substance-Using Women
Women may self- refer to Fir Square. This option
reduces potential barriers to care, allowing
substance-using pregnant women to easily access
supportive, non-judgmental ante-natal and
post-natal healthcare
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• Obstetrical or medical needs associated with
  substance use which cannot be managed on an
  ambulatory basis
• Detoxification or substance use management where
  required admission is for a defined period of
  time in order to achieve stabilization and/or
  abstinence

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• Psychosocial needs (e.g. emotional/physical
  safety, lack of housing ) that place the mother
  and fetus at significant risk, cannot be managed
  on an ambulatory basis, and where placement
  options are not available.
• Suspected drug overdose

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• Referral Criteria
• Substance Exposed Newborns
• Infants requiring management of symptoms of
  withdrawal or pharmacologic toxicity following
  prenatal substance exposure, born at BC Womens.

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• Infants withdrawing from prenatal substance
  exposure where other options to manage withdrawal
  symptoms are not available, born outside of BC
  Womens. Whenever possible, mothers will be
  admitted to a companion room in order to stay
  with their babies.
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Research is currently underway to evaluate
social, health and child welfare outcomes. The
study is being conducted by the Centre
of Excellence for Womens Health, British
Columbia. Two staff members of Fir Square, the
Senior Practice Leader and the Social Worker,
have been retained as researchers to assist with
this research project. The following anecdotal
evidence of positive outcomes are unsolicited
letters from former patients on Fir Square.
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I just want you to know how much we do
appreciate your kindness and dedication. I came
in here all hurt and broken up with not a lot of
purpose in life. You guys (and gals) have
treated me with respect and tenderness. I once
again felt human. After a while as I became
healthier you made me feel worthy and whole
again. Life started to have purpose and meaning.
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When I first met you I thought of myself as
worthless and was quite used to being treated
that way by every person that I had come into
contact with.
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Your easy kindness was felt immediately and I
remember that you gave me that shred of hope that
I so desperately needed. I think you should know
that your belief in me and your kindness and
non-judgment played a huge part in how my life is
today
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They gave me a warm and safe place to stay away
from violence and drugs. I never would have
gotten to keep my baby without coming here, and
it saved me from a life of drugs and abuse.
Thanks to the staff, I get to take my baby home
today and get a fresh start.
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For more information contact Sarah Payne, MA, RN
Senior Practice Leader spayne_at_cw.bc.ca Sydney
Weaver, MSW, RSW Social Worker sweaver_at_cw.bc.ca