a study of the service needs of pregnant addicted women in manitoba

A STUDY OF THE SERVICE NEEDS
OF
PREGNANT ADDICTED WOMEN
IN MANITOBA
Caroline L. Tait
June 2000
A policy research project funded by Manitoba Health
and conducted in cooperation with the
Prairie Women’s Health Centre of Excellence
PRAIRIE WOMEN’S HEALTH
CENTRE OF
EXCELLENCE
RESEARCH
COMMUNITY
POLICY
Administrative Centre:
Regina Site:
Saskatoon Site:
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WEBSITE: www.pwhce.ca
A STUDY OF THE SERVICE NEEDS
OF PREGNANT ADDICTED WOMEN IN MANITOBA
Caroline L. Tait
A policy research project funded by Manitoba Health
and conducted in cooperation with the
Prairie Women’s Health Centre of Excellence
© 2000 Manitoba Health
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The full text of this report is available
on the Manitoba Health website at:
www.gov.mb.ca
A STUDY OF THE SERVICE NEEDS OF
PREGNANT ADDICTED WOMEN IN MANITOBA
CONTENT
S
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . i C. DETOXIFICATION AND TREATMENT
PROGRAMS . . . . . . . . . . . . . . . . . . . . . . . . . . 29
1. Detoxification and Outpatient Withdrawal
Executive Summary and Key Recommendations ii
Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
2. Outpatient and Day Treatment . . . . . . . . . 31
PART 1: INTRODUCTION . . . . . . . . . . . . . . 1
3. Residential Treatment . . . . . . . . . . . . . . . . . 32
4. Aftercare . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
A. BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . 1
5. Self-help and Support Groups . . . . . . . . . . 33
B. PROJECT COMMITTEES
1. PWHCE Project Working Group . . . . . . . . 1 PART 3: THE WOMEN’S EXPERIENCES 35
2. Project Advisory Committee . . . . . . . . . . . . 2
A. PROFILE OF THE WOMEN INTERVIEWED
35
1.
Socio-economic
Status
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
36
C. METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . 2
a. Employment . . . . . . . . . . . . . . . . . . . . . 36
1. Determinants of Health . . . . . . . . . . . . . . . . . 1
b. Income . . . . . . . . . . . . . . . . . . . . . . . . . 37
2. Research Strategies . . . . . . . . . . . . . . . . . . . . 4
c. The Impact of Poverty . . . . . . . . . . . . . 37
3. Sample Population . . . . . . . . . . . . . . . . . . . . 7
2. Age Cohorts . . . . . . . . . . . . . . . . . . . . . . . . . 39
4. Methodological Limitations . . . . . . . . . . . . . 8
3. Problems of Substance Misuse . . . . . . . . . . 40
D. STEPPING AWAY FROM THE CONCEPT
OF ADDICTION . . . . . . . . . . . . . . . . . . . . . . . . 9
PART 2: THE RANGE OF PROGRAMS
AND SERVICES AVAILABLE TO
PREGNANT WOMEN WITH SUBSTANCE
MISUSE PROBLEMS . . . . . . . . . . . . . . . . . 10
A. PREVENTION PROGRAMS . . . . . . . . . . . .
1. Defining Risk . . . . . . . . . . . . . . . . . . . . . . . .
2. Prevention for School-aged Children
and Adolescents . . . . . . . . . . . . . . . . . . . . . .
a. Health Education . . . . . . . . . . . . . . . . . .
b. Birth Control Education . . . . . . . . . . . .
c. “Baby Think It Over” . . . . . . . . . . . . . .
3. Prevention for Pregnant Women and
Women of Childbearing Age . . . . . . . . . . .
a. Public Health Messages . . . . . . . . . . . .
b. Mentor Programs . . . . . . . . . . . . . . . . .
c. Community Wellness . . . . . . . . . . . . . .
10
10
13
13
14
15
a. Participants’ Substance Use . . . . . . . . .
b. Substances Used . . . . . . . . . . . . . . . . . .
c. Familial Substance Addiction . . . . . . . .
d. Foster Care . . . . . . . . . . . . . . . . . . . . . .
4. Other Factors . . . . . . . . . . . . . . . . . . . . . . . .
a. Mental Health Problems . . . . . . . . . . . .
b. Sexual Assault and Abuse . . . . . . . . . .
c. Physical Violence . . . . . . . . . . . . . . . . .
d. Extreme Physical, Emotional, and
Sexual Abuse and Neglect . . . . . . . . . .
5. The Experience of Pregnancy . . . . . . . . . . .
a. Abortion . . . . . . . . . . . . . . . . . . . . . . . .
b. Birth Control . . . . . . . . . . . . . . . . . . . . .
c. Substance Use During Pregnancy . . . . .
6. The Women’s Children . . . . . . . . . . . . . . . .
a. Children’s Health Problems Related to
Mother’s Substance Use . . . . . . . . . . . .
b. Apprehension of Children . . . . . . . . . . .
16
16 B. ADDICTION TREATMENT . . . . . . . . . . . . .
18
1. Reasons Why Women Enter Addiction
20
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .
a. Force or Coercion . . . . . . . . . . . . . . . . .
B. SECONDARY PREVENTION AND EARLY
b. Freely Choosing Treatment . . . . . . . . .
INTERVENTION PROGRAMS . . . . . . . . . . 22
2. Barriers to Accessing Addiction
1. Programs for Pregnant Women and
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .
Women of Childbearing Age . . . . . . . . . . . 22
a. Psychological Barriers . . . . . . . . . . . . .
a. Pregnancy Programs . . . . . . . . . . . . . . . 22
b. Barriers Related to Women’s Children .
b. Community Services for Women . . . . . 23
c. Barriers Related to Social Networks . . .
c. Place versus Program . . . . . . . . . . . . . . 25
d. Barriers Related to Socio-geographic
d. Health Care Providers . . . . . . . . . . . . . . 26
Factors . . . . . . . . . . . . . . . . . . . . . . . . .
e. Child and Family Services . . . . . . . . . . 27
e. Stigma . . . . . . . . . . . . . . . . . . . . . . . . . .
f. Poverty and Service Delivery . . . . . . . . 29
f. Treatment Program Barriers . . . . . . . . .
40
40
41
42
44
44
45
45
46
46
47
47
48
52
53
53
56
56
57
59
61
61
63
70
71
72
73
3. The Treatment Experience . . . . . . . . . . . . 76
a. Positive Aspects of Treatment Identified
by Participants . . . . . . . . . . . . . . . . . . . 77
b. Negative Aspects of Treatment Identified
by Participants . . . . . . . . . . . . . . . . . . . 78
c. Program Environments and Attitudes . 79
d. Duration of Treatment Program . . . . . . 81
e. Separation from Children . . . . . . . . . . . 82
f. Treatment Location . . . . . . . . . . . . . . . 83
g. Other Clients . . . . . . . . . . . . . . . . . . . . 83
h. Male Clients and staff . . . . . . . . . . . . . 84
i. Privacy . . . . . . . . . . . . . . . . . . . . . . . . . 86
j. Treatment Philosophy . . . . . . . . . . . . . . 86
4. Dropping Out of Treatment . . . . . . . . . . . 87
a. Reasons for Leaving Treatment . . . . . . 87
b. Social Environments . . . . . . . . . . . . . . 99
c. Treatment Programs . . . . . . . . . . . . . . . 88
5. Maintaining Recovery . . . . . . . . . . . . . . . . 89
a. Reasons for Relapse . . . . . . . . . . . . . . . 89
b. Aftercare Services . . . . . . . . . . . . . . . . 90
c. Pressure from Family and Friends . . . . 91
d. Returning to the Community . . . . . . . . 91
6. Aboriginal Women and Addiction
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . 91
7. Participants’ Treatment
Recommendations . . . . . . . . . . . . . . . . . . . 93
PART 4: CONCLUSION 95
Appendix A: List of Recommendations . . . . . . . 97
Appendix B: Consent Form (Key Informant
Interview) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Appendix C: Service Provider Questionnaire
Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Appendix D: Service Provider Questionnaire . 104
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
ACKNOWLEDGMEN
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—i—
Caroline L. Tait, M.A.
Native Mental Health Team
McGill University and
Sir Mortimer B. Davis-Jewish General Hospital
Montreal, Quebec
— ii —
A STUDY OF THE SERVICE NEEDS OF
PREGNANT ADDICTED WOMEN IN MANITOBA
EXECUTIVE SUMMARY AND KEY
RECOMMENDATIONS
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— iii —
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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KEY RECOMMENDATION 20: That Manitoba
Health recognize that Aboriginal agencies, such as Métis
Child and Family Services, Friendship Centres, and the
Aboriginal Health and Wellness Centre in Winnipeg are
in key positions to work directly with high-risk pregnant
women and communities which they serve under their
current mandates, and are in the best position to create
meaningful programs and services for Aboriginal women
and to work with Aboriginal off- and on-reserve
addiction services.
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— viii —
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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A STUDY OF THE SERVICE NEEDS OF
PREGNANT ADDICTED WOMEN IN MANITOBA
PART 1:
INTRODUCTION
A.
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Page 1
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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PART 3: THE WOMEN’S
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Page 35
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
TABLE 1:
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Winnipeg
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Total
11
(15%)
3
(4%)
5
(6%)
1
(1%)
2
(3%)
1
(1%)
11
(15%)
41
18
15
74
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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Total (N=74)
The Pas (N=15)
TABLE 2:
PARTICIPANTS’
ANNUAL INCOME
LEVELS
Thompson (N=18)
Winnipeg (N=41)
b. Income
8QGHU
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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Total
The Pas
Thompson
TABLE 3:
PARTICIPANTS’ AGES
Winnipeg
2. Age Cohorts
8QGHU\HDUV
\HDUV
22
(30%)
\HDUV
26
(35%)
\HDUV
12
(16%)
\HDUV
2YHU\HDUV
Total
6
(8%)
6
2
(3%)
41
18
15
74
(8%)
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Page 39
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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b. Substances Used
TABLE 5:
SUBSTANCES USED BY
PARTICIPANTS*
Total
(N=74)
3. Problems of Substance Misuse
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(N=15)
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First substance used
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Page 40
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
Main substance used
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Page 41
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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43
59%
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TABLE 7:
PARTICIPANTS’
FOSTER CARE
EXPERIENCES*
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Number in more than
5 foster placements
Percentage
Percentage
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Number
TABLE 6: SUBSTANCE ADDICTIONS
IN PARTICIPANTS’ FAMILIES
Number
c. Familial Substance Addiction
7KRPSVRQ1 7KH3DV1 Total (N=74)
28
38%
24
33%
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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Page 43
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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68
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TABLE 8:
PARTICIPANTS’
REPORTED MENTAL
HEALTH PROBLEMS*
Total
(N=74)
a. Mental Health Problems
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Page 44
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TABLE 9: PARTICIPANTS WHO
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TABLE 10: PARTICIPANTS’ WHO
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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c. Substance Use During Pregnancy
Total (N=74)
The Pas (N=15)
Thompson (N=18)
TABLE 13:
PARTICIPANTS’
SUBSTANCE USE
DURING PREGNANCY
Winnipeg (N=41)
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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Page 49
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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TABLE 14: PARTICIPANTS’
REASONS FOR INCREASING
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Page 51
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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193
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TABLE 15 (Continued)
7
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6. The Women’s Children
TABLE 15:
PARTICIPANTS’
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a. Children’s Health Problems Related to
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Page 53
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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Total (N=74)
The Pas (N=15)
Thompson (N=18)
TABLE 16:
APPREHENSION OF
PARTICIPANTS’
CHILD(REN)
Winnipeg (N=41)
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Page 55
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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Page 56
Total
(N=74)
The Pas
(N=15)
Thompson
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TABLE 17:
PARTICIPANTS IN
TREATMENT
Winnipeg
(N=41)
B. ADDICTION TREATMENT
1XPEHURISDUWLFLSDQWVLQ
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(19%)
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The Pas
(N=15)
Number of women who
had been in an addiction
treatment program
Thompson
(N=18)
TABLE 18:
PARTICIPANTS’
REASONS FOR
SEEKING
TREATMENT
Winnipeg
(N=41)
1. Reasons Why Women Enter Addiction
Treatment
TABLE 18 Continued
Thompson
(N=18)
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
7
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Page 57
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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Total
(N=74)
The Pas
(N=15)
Thompson
(N=18)
TABLE 19: NUMBER
OF PARTICIPANTS
WHO HAVE BEEN
FORCED OR
COERCED INTO
TREATMENT
Winnipeg
(N=41)
a. Force or Coercion
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Page 58
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Page 59
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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APPENDIX A: LIST OF RECOMMENDATIONS
Recommendation 1:7KDW0DQLWRED+HDOWKGHYHORS
DVWDQGDUGL]HG´JXLGHOLQHRIULVNµIRUVHUYLFH
SURYLGHUVZKRFRXQVHOSUHJQDQWZRPHQFRQ
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Recommendation 2: 7KDW0DQLWRED+HDOWKHQVXUH
WKDWSUHYHQWLRQVWUDWHJLHVWKDWWDUJHWVFKRRO
DJHGFKLOGUHQDQGDGROHVFHQWVLQFOXGHRQJRLQJ
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Recommendation 3: 7KDW0DQLWRED+HDOWKHQVXUH
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Recommendation 4: 7KDW0DQLWRED+HDOWK
DGYRFDWHWKDWSUHYHQWLRQSURJUDPPLQJGLUHFWHG
WRZDUGZRPHQSDUWLFXODUO\DGROHVFHQWJLUOVEH
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Recommendation 5: 7KDW0DQLWRED+HDOWK
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Recommendation 6:7KDW0DQLWRED+HDOWK
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Recommendation 7: 7KDW0DQLWRED+HDOWKHQVXUH
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KEY RECOMMENDATION 8:7KDW0DQLWRED
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Recommendation 9: 7KDW0DQLWRED+HDOWKVXSSRUW
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WKURXJKRXWUHDFKSURJUDPVLQFRPPXQLWLHVZLWK
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Recommendation 10: 7KDW0DQLWRED+HDOWKDVVLVW
SUHJQDQF\RXWUHDFKSURJUDPVDQGUHVLGHQWLDO
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Recommendation 11: 7KDW0DQLWRED+HDOWKDVVLVW
UHVLGHQWLDOKRPHVIRUSUHJQDQWZRPHQLQ
SURYLGLQJRULQKHOSLQJZRPHQWRILQGFKLOG
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Recommendation 12: 7KDW0DQLWRED+HDOWK
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Page 99
A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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Recommendation 14:7KDW0DQLWRED+HDOWK
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Recommendation 15: 7KDW0DQLWRED+HDOWK
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Recommendation 16: 7KDW0DQLWRED+HDOWK
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Recommendation 17: 7KDW0DQLWRED+HDOWK
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SURYLGHVXSSRUWVHUYLFHVWRSUHJQDQWZRPHQ
ZKRPLVXVHVXEVWDQFHVSDUWLFXODUO\LQKLJKULVN
JHRJUDSKLFDODUHDV
Recommendation 18: 7KDW0DQLWRED+HDOWK
VXSSRUWWKHKLULQJRIPRUHSXEOLFKHDOWKQXUVHV
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Recommendation 19: 7KDW0DQLWRED+HDOWK
H[SORUHZD\VLQZKLFKPLGZLYHVFRXOGZRUNDV
IURQWOLQHVHUYLFHSURYLGHUVIRUSUHJQDQWZRPHQ
Page 100
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KEY RECOMMENDATION 20: 7KDW0DQLWRED
+HDOWKUHFRJQL]HWKDW$ERULJLQDODJHQFLHVVXFK
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Recommendation 21: 7KDW0DQLWRED+HDOWKLQ
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KEY RECOMMENDATION 22:7KDW0DQLWRED
+HDOWKGHYHORSVHUYLFHVIRUSUHJQDQWZRPHQ
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Recommendation 23: 7KDW0DQLWRED+HDOWKHQVXUH
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Recommendation 24: 7KDW0DQLWRED+HDOWKHQVXUH
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Recommendation 25: 7KDW0DQLWRED+HDOWKLQ
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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Recommendation 26: 7KDW0DQLWRED+HDOWKDVVLVW
SURJUDPVIRUZRPHQZLWKORQJZDLWLQJOLVWVE\
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Recommendation 32:7KDW0DQLWRED+HDOWK
UHFRJQL]HWKDWZRPHQLQDOOVRFLRHFRQRPLF
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Recommendation 27:7KDW0DQLWRED+HDOWK
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Recommendation 28: 7KDW0DQLWRED+HDOWKLQ
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Recommendation 29: 7KDWZKHQFRQVLGHULQJWKH
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Recommendation 30:7KDW0DQLWRED+HDOWKLQ
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Recommendation 31:7KDW0DQLWRED+HDOWK
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Recommendation 33: 7KDW0DQLWRED+HDOWK
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Recommendation 35:7KDW0DQLWRED+HDOWKLQ
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Recommendation 36:7KDW0DQLWRED+HDOWKLQ
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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Recommendation 37:7KDW0DQLWRED+HDOWK
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Recommendation 38:7KDW0DQLWRED+HDOWK
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Recommendation 39:7KDW0DQLWRED+HDOWKLQ
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A Study of the Service Needs of Pregnant Addicted Women in Manitoba
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a study of the service needs of pregnant addicted women in manitoba

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