Family Planning and Pregnancy within Assertive Community Treatment: Convergent and Divergent Perspectives from Providers and Participants

Background and Purpose:

Assertive Community Treatment (ACT) provides treatment, rehabilitation and support to persons with severe mental illness (SMI) who experience difficulties in independent living.  Ongoing research indicates that ACT reduces rates of hospitalization and increases independent living.  ACT in New York State (NYS) has recently transitioned from a service for life to one service on the road to community integration and recovery.

We know that people with behavioral health challenges become parents; however little is known of ACT Providers’ function when it comes to ACT Participants’ parenting roles.  Especially unclear is the role of ACT Providers in relation to family planning, pregnancy and parenting preparation.  As ACT transitions from a life-long service to a time-limited one, it is increasingly important for ACT Providers to be aware of Participants’ parenting-related goals beyond their time in ACT

Methods:

Through intensive interviews with 15 ACT Participants Parents and five focus groups with providers we collected qualitative data to gather Participant’s thoughts about parenting and the scope of Provider’s work with these parents.  Both interviews and focus groups were audiotaped and transcribed. We followed the principles of content analysis to identify codes and overarching themes.

Results:

While data was gathered about ACT Participants’ broader parenting related needs and strengths, here we focus on the particularly notable theme of family planning, with clear convergence and divergence between the perceptions of Providers and Participants.  Prominent convergent perceptions included: 1) uncertainty of how to address family planning and future parenting goals, 2) needed support, (social, informational, and structural support for Participants and training and resource support for Providers), and 3) apprehension among Providers related to parenting among Participants.

Participants and Providers showed a clear divergence in perceptions of family planning in three key areas: 1) varying understandings of the level of recovery needed for Participants to take on a parenting role, 2) belief in Participants’ capacity to become parents, and 3) outlook on family planning, with Providers tending toward birth control and Participants seeking a parenting role.

Conclusions and Implications:

Both ACT Providers and Participants recognize the dearth of resources to adequately address family planning, especially in complex community-based coordinated specialty care settings such as ACT.  Both respondent groups expressed uncertainty related to Participants becoming parents, though these sentiments diverged over time, and participants ultimately felt joy and hope, while providers considered pregnancy as a “crisis”.   Perspectives also diverged regarding confidence in a successful parenting role- with Participants believing they have the capacity and providers tending to caution against this.  Providers also viewed parenting as a strain on resources and a trigger for symptoms, whereas Participants viewed parenting as a source of motivation and resilience.  Our findings suggest a need to establish tools and resources for providers and participants to address parenting goals and needs, while maintaining sensitivity to cultural and individual variations.  Lastly, this data supports the need to develop strategies within broader care systems to incorporate family planning from early on in service provision, rather than after someone becomes pregnant.