Shirley Lewis is an experienced qualitative researcher and registered social worker at the University of Sheffield. Her research explores the experiences of children and adults who have been affected by involvement with children’s social care. She is currently co-leading a research study exploring the impact of pre-birth assessments on women who use substances or are in treatment for substance use, from the perspectives of women and social workers.

Abstract

Pre-birth assessments in the context of substance use: the experiences of women and social workers

Aims: Social workers undertake pre-birth assessments when there are safeguarding concerns about an unborn child. The Willow Study aimed to investigate 1.How women who use substances in pregnancy experience social work pre-birth assessments, and the kind of support they receive. 2. Social workers’ perspectives on conducting pre-birth assessments with women who use and receive treatment for using substances. 3. Assessment outcomes for women and babies.

Methods: The mixed method study has a critical realist approach. This included semi-structured interviews and focus groups with women who have undergone pre-birth assessments and focus groups with social workers. We accessed routinely collected local authority data to explore the prevalence of substance use in pre-birth assessments. We will work with parents and professionals to co-produce practice recommendations to improve outcomes for women and babies.

Results: Qualitative findings showed that women needed clear expectations from social workers about substance use. Women reported undergoing repeated urine testing and high levels of distrust. Women with social workers based in specialist pre-birth teams reported better relationships than those in generic teams. Social workers reported limited training in substance use in pregnancy. Their understanding was variable and relied on experience, professional curiosity and multiagency working.

Conclusions: Women who use substances in pregnancy have multiple and complex needs and have barriers engaging with services. Social work involvement can increase these barriers and compound feelings of stigma. However, assessments that are undertaken in a relational way with support alongside can help mitigate risks associated with substance use in pregnancy and reduce rates of separation between mothers and babies.