The Stepping Stones Study

• Research type

  Research Study

• Full title

  Evaluating Models of care, best practice and care pathways for women who are dependent on drugs and their infants, from preconception to 18 months postnatal

• IRAS ID

  309152

• Contact name

  Polly Radcliffe

• Contact email

  polly.radcliffe@kcl.ac.uk

• Sponsor organisation

  King's College London

• Duration of Study in the UK

  2 years, 5 months, 1 days

• Research summary

  Summary of Research

  This study will involve a detailed investigation of the experiences of women who use drugs pregnancy. These women often have commplex needs. Babies born to mothers who use drugs sometimes require treatment for drug withdrawal symptoms after they are born, experience problems with their early health and development, and are more likely to be taken into care. We will explore how outcomes can be improved.

  1.An ‘expert advisory group’ made up of services users and professionals will be set up to work with the research team throughout the project - providing information, advice and feedback on all aspects of the research.
  2. A review of books, reports and articles on ways of providing care for pregnant women and years after a baby is born will be carried out to see which models of care improves outcomes and reduce inequalities. We will also examine best practice by reviewing documents for professionals (clinical guidelines, treatment protocols and good practice guidance).
  3.We will explore women’s experiences of care, and their care journeys, from pregnancy to 18 months after their babies' birth. We will ask women to draw timelines of their experiences and record audio diaries. We will also interview staff and senior managers to seek their views of care for these women.

  The study will be carried out in four areas (two in Scotland, two in England) that have different ways of providing care, cultures, types of drug use, and health and social care policies. The study will try to establish the best way of providing care for women who use drugs, from pregnancy to 18 months after the birth of their baby, which meets the needs of women and achieves the best outcomes for children, families and society as a whole
  
  Summary of Results

  The Stepping Stones Study used research and consulted experts to look at ways to improve services for women who use or are in treatment for using drugs in pregnancy and up to a year after giving birth. Experts included those working in the field and those using services.
  The study had three parts.
  1. We reviewed 111 UK guidelines for good care, to improve outcomes and reduce inequalities.
  Documents recommended staff in drug treatment and maternity services work more closely together. We also reviewed 197 research studies that looked at how to improve support for women who use drugs in the perinatal period and found women appreciate services that are in one place and easy to access.
  2. We carried out up to 5 interviews, approximately 4 months apart, with 36 women from maternity services in 4 sites in England and Scotland to explore experiences of support. Many women were anxious about social services involvement. Women often felt stigmatised in hospital following the birth of their baby. Access to residential treatment services and mental health support was uneven and support for women who had lost care of their babies was poor. Focus group interviews with staff found they had high numbers of patients to treat, staff turnover, and training gaps contributed to challenges to providing care.
  3. We identified what changes might be needed for better care. We developed a framework to describe key requirements to deliver improved services for women and their babies. These mainly related to how organisations work together, training and support and how resources are prioritised.
  

• REC name

  North of Scotland Research Ethics Committee 2

• REC reference

  22/NS/0047

• Date of REC Opinion

  9 May 2022

• REC opinion

  Further Information Favourable Opinion