1. Cross-disciplinary specialist care for substance-abusing pregnant women and their infants – Team Haga Maternity and Child Health Care in Primary Care

2. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Primary Care Dept of Substance Abuse, Sahlgrenska University Hospital Team Haga- Cross-disciplinary care

3. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Antenatal Health Care in Sweden 100% attendance and very high credibility among population Free of charge Standardized nationwide Midwife-centered (teamwork with physicians) Total abstention from alcohol recommended during pregnancy Motivational interview on alcohol (incl. AUDIT), drugs, medications and tobacco with midwife, within one week of positive pregnancy test Extremely low maternal and perinatal mortality and morbidity

4. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Child Health Care in Sweden 100% attendance and very high credibility among population Free of charge Standardized nationwide From birth to age 6 Nurse-centered (teamwork w physician) Restraint with alcohol recommended during breastfeeding and in relation to parenting

5. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Team Haga Cross-disciplinary specialist unit run by Primary Health Care System in Gothenburg, established in April, 2007 Close collaboration with, and located in, Dept of Substance Abuse, Sahlgrenska University Hospital Target group: pregnant women/new mothers with substance abuse (current or up to one year previously) and their babies

6. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Goals Protect the fetus from substance-abuse effects, support women to stop abuse during pregnancy and to stay substance-free after delivery

7. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Team members 2 Midwives 2 Child Health nurses Social worker Psychiatric nurse Team assistant/nurse Obstetrician Pediatrician Psychiatrist Manager

8. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 How to contact Team Haga? The majority of the women are referred by antenatal care centers. Some are referred from substance abuse clinics, a small number referred from social services or criminal justice system and some come on their own initiative. Some repeat pregnancies

9. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Specialist Health Care during pregnancy and infancy Liberal exploration of ambivalence in many cases; good professional network with abortion services If pregnancy is continued, standard antenatal care plus: At least weekly midwife appointments All women see obstetrician, liberal use of ultrasound to envisage fetus Regular monitored urine tests in almost all cases Appointment with the child health nurse around week 25

10. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Contact with psychiatric nurse or psychiatrist in selected cases Team conferences determine individualized care and support for each women, postpartum follow-up for mothers and individualized child health care according to infant´s and family’s needs Repeated home visits beginning shortly after birth All infants are seen and assessed by pediatrician Networking with local child health care centers to which babies are eventually referred

11. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Continued teamwork and extensive collaboration with social services, psychiatry and the local child health care system is essential Long-term follow-up is often required Social worker often involved in order to collaborate with social services and investigate woman’s and the family requirements for support

12. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Challenges Psychiatric morbidity complicates many cases, resources for care/support of fathers-to-be (majority are substance abusers), some substance-abusers are unmotivated to attend the specialist care, social services with diverging policies/knowledge/time perspectives/resources regarding substance abuse, psychiatric ill-health and parenting

13. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Results A majority of the patients stay substance-free during pregnancy, and no cases of FASD or other serious neonatal effects of substance abuse have been diagnosed so far An evaluation of the unit is in progress. The evaluation shows the benefical effects of the multidisciplinary team, continuity, treatment and the individualised, structured but at the same time flexible support for the women

14. The Future of Primary Care in Europe IV, Gothenburg 3-4 sept 2012 Thank You Team Haga- Cross-disciplinary specialist care for substance- abusing pregnant women and their infants Gothenburg Sweden Antonia Reuter Manager E-post: toni.reuter@vgregion.se