The social support systems of mothers with problematic substance use in their infant's first year

The infants of women with histories of problematic alcohol and other drug use are among the most vulnerable children known to statutory child protection services, which they enter at a younger age, and in which they remain longer. The net results include overwhelmed child protection systems and the birth of subsequent children conceived to ease women's grief at the loss their infants. Without adequate and appropriate support to the mother and her family, the pattern repeats. Obstetric services have an important role to play in the assessment of risk and protective factors in the perinatal period and in determining pathways to service provision. A comprehensive assessment considers the availability and quality of informal support prior to activation of formal systems of support, both statutory, where engagement is mandated, and non-statutory, where support is offered on a voluntary basis. This paper uses quantitative methods to explore the social networks of women with problematic substance use in the transition to motherhood and the relationship between formal and informal support systems and infant outcomes. Surveys were held with two counsellors from the Women's Alcohol and Drug Service (WADS), a specialist obstetric clinic in Melbourne, Australia, and with 18 child protection workers. In addition, the Norbeck Social Support Questionnaire (Norbeck, 1984; Norbeck et al., 1983) was administered with 20 participating mothers to measure levels of formal and informal support, as well as the type and quality of support available to mothers over a 12-month period, and to consider the provision of social support against known outcomes for infants. The findings demonstrate that WADS counsellors made several referrals for most women but that there was little in the way of long-term follow-up by non-statutory service providers, with most women experiencing a dramatic drop in support over the 12-month period. Women whose main informal support was from a domestically violent partner, and those who had been in out-of-home care in their own childhood, were particularly vulnerable to losing the care of their infant. The role of child protection varied markedly across the 12-month period, particularly in relation to the extent that a relationship between formal and informal systems of support for mothers and their infants could be established. Overall, the study findings demonstrate that mothers experienced diminishing formal and informal support over time and that the quality of social support available to the mother was more important in terms of outcomes for women and their infants than the quantity.