Identifying the needs of mothers in substance use treatment services using electronic health records

Mothers comprises a significant proportion of women in substance use treatment services. These women have particular needs that, if not addressed, can negatively impact treatment engagement and outcomes, and the right to care for their children. This study explores data from electronic health records(EHRs) to identify individual, clinical and childcare charactericts of mothers receiving treatment for substance use problems. Two approaches were applied. Firstly, structured data (coded) was analysed to identify and describe who the mothers receiving substance use treatment are. Secondly, an in-depth qualitative investigation of unstructured data (free-text notes) was conducted to understand how issues related to childcare are being reported in substance use treatment services.

The study extracted data from EHRs of women attending addiction services in South East London, England. For the qualitative analysis, clinical case notes and other documents (e.g., referrals, risk assessment conference) of 50 mothers of dependent child(ren)(aged <18 years old), were analysed using thematic analysis.

Mothers comprised 39.6%(N=1730) of the cohort(N=4370), of whom 1340(77.4%) had dependent child(ren). Of the mothers of dependente child(ren), 54.3% did not disclose the care of the child(ren) and 37.5% indicated that at least one of their child(ren) was in alternative care. Compared to women without children, mothers were more likely to be young, experience housing problems, use opioids and/or crack-cocaine and experience lifetime domestic violence victimizations. Qualitative analysis of free-text notes identified five themes regarding which information that might impact the mothers’ ability to care for their children is being documented by practitioners: childcare arrangement, family context, safeguarding issues, factors that might impact treatment plan and the care of the child, and communication between the healthcare and child welfare systems.

The study highlights the need for substance use services to invest in implementing effective family-centered strategies including approaches to improve mothers’ disclosure of parenting and childcare issues.