A Mothers Arms: Sanctum 1.5; A novel approach to treating substance misuse in pregnant woman and preventing infant apprehension at birth.

Author: Katelyn Roberts, Morris Markentin

Theme: Models of Care Year: 2023

In Saskatchewan, Canada, HIV and HCV infection rates continue to surpass the national average, particularly among women and Indigenous people. High rates of vertical transmission of HIV in Saskatchewan are related to poor prenatal engagement based on historical trauma of infant apprehension at birth and high rates of homelessness and substance use.

Description of model of care/intervention:
Sanctum 1.5 is a ten-bed pre- and post-natal home supporting pregnant women in Saskatoon, Saskatchewan, who are living with HIV and/or inject drugs. Our program aims to improve prenatal engagement and prevent vertical transmission of HIV and reduce infant apprehension at birth through a harm-reduction, trauma-informed model of care.

Since opening in 2019, Sanctum 1.5 has served 113 mothers and their infants (82% of whom identify as Indigenous). 100% of mothers on admission actively use substances, with only 3% indicating stable substance use support. Further, 60% have been exposed to violence, and 62% were in foster care as children.

Upon discharge:
-93% (105/113) have stable pre- and post-natal engagement (vs. 15% (19/113) on admission)
-There have been 0 cases of vertical transmission of HIV
-76% (86/113) of the mothers who graduate do so with their infants in their care.
oAn additional 66 children have been reunified with their mothers (n=86) from foster care after graduating from the program.
-81% (92/113) have stable substance use support (vs. 3% (3/113) on admission)
-60% (68/113) of mothers reported no substance use (vs. 81% (92/113) reporting daily use on admission)

Conclusion and next steps:
Sanctum 1.5 is an innovative intervention shown to reduce substance misuse and increase prenatal engagement through a mother-centered approach. To date, it has shown to be highly effective in preventing infant apprehension at birth. Our learnings can be applied to other programs to address the complex needs of pregnant women who use drugs.

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