Nicola's Churchill Adventure

Meeting with Dr Erin Lund

Santa Rosa Community Clinic

I meet with Dr Lund in the small office she shares with Dr Deidre Bernard-Pearl and other other physician. Dr Lund runs through the details of the program rapid fire and with the practice of someone who has made this pitch many times and has many other demands on her time. It is an impressive and exciting program – ticking all the boxes regarding early intervention, prevention, disrupting cycles of intergenerational trauma, multi disciplinary, client focused. As Deidre says when Erin has finished comprehensively outlining the many facet and foci of New Beginnings

‘Now that is what you call trauma informed practice’

DB-P 2022

My overview of what Dr Lund share is detailed below:

Program seeks to address challenges facing many people trying to access and navigate care. The disconnection and siloing of services. Particularly when people are presenting with multifaceted issues as they are often are when they struggle to addiction. Dr Lund spoke about the complete disconnect between addiction and perinatal services, and experiences where she saw the most complex patients being treated by the least experiences physicians. She wanted to establish an integrated care team approach, with case management  and wrap around care.

The program is designed for women at highest risk of having their children removed by Child Protective Services. To keep babies with their mothers. To reduce the amount of times it all ends up ‘happening’ at the hospital – that is mothers arrive to give birth having received little or no antenatal care, CPS become aware of addiction or other issues, and babies are taken into CPS care – a terrible and distressing outcome for all concerned.

Dr Lund outlines the length of the program – pregnancy to child one year of age is based on well established research regarding drug use in mothers. Usage goes down during pregnancy, without intervention, but postnatally it rebounds straight back up to pre-pregnancy levels within the first year.

The target for the program: active drug users, methadone etc users, women in jail or residential treatment programs, as well as members of the homeless community which has been increasing since the fires in 2017. Many community members are still living in tent camps, Dr Lund has heard of women giving birth in these camps for fear of babies being taken by CPS if they present to hospital. The program also serves people with serious mental health issues such as schizophrenia or psychosis.

Other key points:

Patient cohort: 75% substance use issues; 25% combination of all the rest

During pregnancy begin with regular visits – every 1-2 weeks, moving to monthly visits if all going well and things are stable

Reduce barriers to attend visits by provision of bus passes, Lyft rides and co-ordination with community health to provide transport

NOT a mandated service

Social worker in team does check ins, motivational interviewing, assesses emotional state, ACEs, crisis support, connection with other services. 

Particularly talented at eliciting childhood trauma during assessment.

Social worker with permission shares with the treatment team what the patient has gone through to demonstrate their experiences and resilience

Nurse provides perinatal education, information regarding symptoms, birthing, feeding, provides clinical triage of phone calls – incredibly helpful for these mothers who would may not seek information and care from other services due to fear of judgement and prior bad experiences.

Substance use counsellor with a lived experience offers case management, phone outreach as well as outreach into communities such as tent camps. Aim is to build relationships and trust to see if women will come into the clinic for care.

Also does substance use screening, interface with treatment programs.

Works with ‘substance use navigators’ who work within hospitals

Postpartum – follow mum, child (siblings, father…) for first year

‘Aggressively’ screen for depression and anxiety 

Support and reflect on attachment – actively encouraging any positive behaviours – ‘look how he looks at you, see how she is listening to you’

Can see mothers for subsequent pregnancies, they don’t need to have relapsed to regain entry

Can do ongoing care at times, some families they are seeing the children are now 3 & 5 years old

Dyad care in the first year – one appointment for mom, and one for baby.

Clinic runs 2 x per week on Tuesday and Friday.