Realist evaluation of an Integrated Pregnancy and Parenting Support Service (IPPSS) for mothers with drug and alcohol problems in Scotland

Aitken-Arbuckle, Alix

Abstract

Background
Integrated multidisciplinary team approaches have been widely promoted for maternity services for women with drug and alcohol problems to support sharing of information, coordination of care and improve maternal and infant outcomes. National Institute for Clinical Excellence (2010) guidelines recommend woman-centred care, colocation of services, integration of multi-agency approach and non-discriminatory practices for this population. However there has been little research to evaluate the impact of this approach in the UK context.

Aim
To evaluate a local service in Scotland to identify how the service works, for whom and in what way and what context to achieve effective communication, information sharing and service user engagement in order to achieve improved maternal and infant outcomes.

Methods
The evaluation was in three phases: developing initial programme theories, testing theories and refining theories. A mixed methods approach included: shadowing practitioners, and conducting interviews and questionnaires with service users, staff and key stakeholders. Middle Range Theories including Trust Level Theory and Interactionist theories were utilised throughout the study to support theory development, testing and refinement.

Findings
Findings include:
1. Relational based practices reduce barriers to support and engage service users longer term.
2. Service ethos must be consistent across all agencies in policy agenda and practice to support integration.
3. Transparent approaches promote compassionate team working, improving staff morale and communication.
4. Stigma remains embedded within the wider social context and affects the interactions and success service users have with services.

Conclusion
To support the wider holistic needs, practitioners should be encouraged to embrace personal approaches moving away from professional facades. Overall, services should consider what practices and interactions might contribute to stigmatising and discriminatory experiences for this population. These findings advocate for reflection on organisational integration, promotion of relational based practices and consideration of the barriers to integration such as incongruent policies, guidelines, agendas and practices.

• Thesis Type: Thesis
• Deposit Date: Aug 18, 2023
• Publicly Available Date: Aug 18, 2023
• DOI: https://doi.org/10.17869/enu.2023.3170283
• Award Date: Jul 7, 2023