Utilizing Patient and Staff Voices to Promote Screening Practices among Perinatal Patients with Substance Use Histories

Objectives: National and international guidance recommends verbal screening to identify perinatal patients with substance use problems. However, perinatal patients report negative medical experiences and a rational fear of disclosing substance use due to negative consequences for disclosure. To improve screening experiences and accuracy, this study focused on the input of patients and staff with substance use disorders. Methods: Participants were perinatal patients with substance use histories in a gender-specific treatment program (n=6) or staff (peer support specialists, paraprofessionals, or Qualified Providers) working with perinatal patients (n=14) in a gender-specific substance use disorder treatment program. Qualitative information was gathered in three ways: 1) focus groups with perinatal patients, 2) focus groups with paraprofessionals and QPs, and 3) three individual interviews were conducted. A descriptive phenomenological approach was used for analysis. Results: The three themes that emerged from the perinatal patients with substance use histories group were provider fear of Child Protective Services (CPS), provider competency, and provider compassion. Three themes also emerged from the staff: methods to improve the assessment, concerns related to CPS, and challenges when working with healthcare professionals. Both groups recommended that (1) the screener’s introduction needs to provide information about CPS reporting, (2) patients receive a list of treatment resources, and (3) healthcare providers are trained in compassionate screening. Discussion: Participants recommended that pregnant patients with substance use histories are more likely to share their substance use history if there is a sense of safety through compassionate care. Before screening, healthcare providers should be committed to seeking training to treat perinatal substance use, adopt stigma-free language, support autonomy to disclose substance use history due to previous encounters, and be transparent about the use of the information and outcome, and have treatment resources readily available to reduce the harms of mandatory reporting to CPS.