Serving Families during the Opioid Epidemic: A Phenomenological Study

Background and Purpose: Over the past decade, the rate of opioid use during pregnancy has nearly doubled, leading to a heightened occurrence of Neonatal Abstinence Syndrome and increased health care costs. While pregnancy can increase a woman’s motivation to seek treatment for opioid use disorder, the pregnancy itself can become a barrier to treatment due to a lack of treatment programs that can meet her needs and risks of being reported to child protective services or prosecuted for child maltreatment. Given these barriers and the high rates of co-occurring disorders among this group, more research examining evidenced-based practice is needed. In addition to empirically supported interventions and client preferences, professional expertise is essential to delivering evidence-based treatment. The purpose of this study is to better understand the experiences of helping professionals working with women and families in the midst of the opioid epidemic to inform best practices with this high-risk group.  

Methods: We conducted and recorded 12 in-depth, semi-structured interviews with healthcare professionals working with pregnant women using opioids. Participants were recruited by email and telephone from local community organizations in an urban area, and data was collected until saturation of themes was achieved. We transcribed the interviews and conducted a phenomenological analysis utilizing ATLAS.ti software for data management. Data analysis consisted of reading the data line-by-line, identifying themes, and coding categories to uncover relationships between themes and categories.

Results: Five major themes emerged from the data including: (1) the importance and challenges of supporting client’s self-determination/managing counter-transference, (2) the role of stigma, (3) fear of child welfare involvement, (4) the need for post-natal support, and (5) the role of culture. Participants reported that while they value a woman’s right to self-determination regarding her health care, they also experienced moments of frustration and concern for the fetus. When working with motivated clients, participants also reported the importance of addressing internalized stigma, shame, and guilt with their clients. In fact, if left unmanaged, feelings of guilt and shame may cue relapse. Fear of child welfare involvement may also be an important treatment target. Participants reported that many women have had previous experience with child protective services (CPS) and want to avoid further involvement. Whether working within or outside of CPS, these concerns should be addressed. Participants highlighted preparation for post-natal stress as a treatment target, as well as a need for more supportive post-natal resources. Finally, findings suggest that it is important to consider the protective factors and risk factors associated with a woman’s cultural background.  

Conclusions and Implications: These findings indicate the need for supervision and guidance for healthcare professionals when managing counter-transference and frustration regarding a client’s level of motivation around managing their pregnancy. These findings echo previous studies asserting that social workers have a responsibility to maintain a nonjudgmental attitude towards women who abuse substances while pregnant and to advocate for these women with the obstetric community who may perpetuate stigma and judgment.