Welcome to Sanctum Care Group

SANCTUM 1.5

Sanctum 1.5 will be a step towards keeping mothers and babies together vs. ongoing systemic outcomes that foster a mother and baby divide.

Why a HIV prenatal home?

Sanctum’s vision is to provide a community for individuals requiring supportive care to attain their optimum level of health, while maximizing their control and dignity. Incorporating the following existing community services in Sanctum’s safe and supportive environment, the HIV Prenatal home will work preventively to meet the health and social needs of the proposed population more effectively and efficiently, thereby decreasing the risk of vertical transmission and improving family planning.  It is anticipated that there will be an increase in the potential for meaningful and lasting change for women who are motivated by their pregnancy. 

Through the collaboration of health and child welfare, Sanctum 1.5 will reduce the financial burden of caring for HIV positive babies on the healthcare system and decrease the cost and more importantly the long-term detrimental impacts on children involved with the foster care system. Sanctum will achieve this by eliminating the current fragmented model of care provided to HIV positive prenatal mothers by incorporating the right services at the right time to allow for the necessary health and social interventions to have the most effective outcomes.

Sanctum will incorporate the following services into our model of care:

  • Intensive HIV Case Management (SHR)
  • Intensive family support (601)
  • Medication management
  • Connection with detox services
  • Methadone assisted recovery
  • Family planning
  • Healthy Mother Healthy Baby
  • Elder support
  • Parenting skills and mentorship
  • Peer support
  • Access to housing support
  • Spiritual care
  • Mental health and addiction outreach services
sanctum1.5

Program

Sanctum ascribes to a harm reduction philosophy. Harm-reduction services will recognize the importance of providing ongoing education with a focus on pragmatic rather than moralistic interventions. Clients will not be required to abstain from drugs or alcohol to receive services, provided their behavior does not pose a risk to others. We will attempt as much as possible to control substance use without imposing conditions that make care inaccessible. Our philosophy is that substance abuse is like any other disease; therefore, we have an obligation to help the client manage it.

Pregnancy is often an opportunity to support women in improving their health, including efforts to decrease or stop substance use or increase safer use of drugs. Harm reduction approaches are a pragmatic response to addressing substance use. Sanctum recognizes that substance use is just one factor among many that shapes a healthy pregnancy and that reducing or stopping substance use at any time during pregnancy can have positive effects on women’s health and the health of the unborn baby.

HIV positive pregnant women with substance misuse problems still want the best outcomes for their children. Mothers who struggle to manage their substance use during their pregnancy can be left with a profound sense of guilt if they have been unsuccessful. Social isolation, problems associated with crime and illicit drug use, and psychological problems including depression and anxiety, contribute to adverse outcome for the mother and her unborn baby. Abstinence is typically a requirement for keeping one’s child. Prenatal intervention is both timely and critical in achieving this.

While there are Canadian programs that have demonstrated their successes in using a harm reduction approach to engage pregnant women with problematic substance use, there is no program in Saskatchewan that comprehensively and simultaneously addresses all of the issues in a woman’s life in pregnancy.

Sanctum will attempt to bridge the gaps in the current system with a three-pronged approach to care at Sanctum 1.5:

  • Harm reduction and housing: Sanctum will provide supportive and transitional housing to women who are at high risk for vertical transmission and child apprehension. By providing supportive housing through a harm reduction lens, Sanctum will reduce the chaos associated with unstable housing and substance use and allow for the provision of addiction services including methadone assisted recovery to reduce the harm associated with drug/ alcohol use during pregnancy.
  • Pre-natal health care: Sanctum will connect the residents of 1.5 to appropriate prenatal care. This will include connection to specialized nursing, Infectious Disease Specialist, family physician, gynecologist and adherence to ARV’s.
  • Child Protection Prevention: Sanctum will provide the supports and planning necessary to prevent children from entering the foster care system. Sanctum will connect mothers with the appropriate supports to empower women in planning for their children. By working with the mothers prenatally, Sanctum will be able to plan with the mothers to give their children the best start in life. This could include managing sobriety and connection to parenting classes for mothers to parent their children, making connections to healthy family that can parent their children, adoption planning, or connection to supportive living for mother who require support in parenting their children.

 

background information

  • In 2009, the incidence rate of HIV infection in the Saskatoon Health Region was more than three times the national rate. Although the rate has decreased, the 2011 rate in the region was still double that seen nationally.
  • Saskatoon Health Region has some of the highest rates of HIV/AIDS related deaths in North America.
  • A large percentage of persons living with HIV in the region also suffer from mental illness, addictions, homelessness and poverty.
  • HIV positive women who are on ARV’S reduce the chances of vertical transmission to less than 1% If not treated 1 in 4 babies will be born HIV positive
  • With a viral load less 1,000 (achieved through ARV med adherence) mothers can have a vaginal birth vs. C-section reducing complications and decreasing hospital stays
  • Saskatchewan had 3 HIV positive births in 2015/16 compared to 0 in the year previous
  • Research suggests that infant health outcomes are more closely related to factors like homelessness, poverty, poor nutrition, stress, and infections than to drug use itself
  • Combining safe and supportive housing with a variety of services for pregnant and parenting women who use substances can be key to helping women access health care, improving birth outcomes, and increasing the chance that moms will be able to care for their babies successfully after birth.
  • Women who use substances during pregnancy face a number of systemic barriers and due to this they do not seek health care, treatment or other services. One of the noted barriers is fear of apprehension of their baby from social services. Associated to the fear of apprehension and other barriers to access care, are many poor health outcomes and risks for the mother and child. Researchers indicate that mothers who have their babies apprehended at the hospital are discharged to the streets where the cycle of poverty and homelessness begins again
  • There are currently no supportive housing programs in Saskatchewan geared towards the needs of HIV positive women who are pregnant and struggling with polysubstance use
  • The current child welfare system will currently only provide intervention after the child is born and once the child has been apprehended, preventing essential attachment thus decreasing the chances for mothers to parent their parent children.
  • Sanctum 1.5 will be a step towards keeping mothers and babies together vs. ongoing systemic outcomes that foster a mother and baby divide. after birth. The

Therefore, while different agencies are able to manage pre-natal care and issues related to children entering the foster care system, few, if any, are able to manage the health of HIV-positive mothers to prevent vertical transmission while also addressing the social factors such as addiction, poverty and homelessness that lead to children entering the foster care system. 

Community impact

Sanctum 1.5 is a program that will reduce the chances of vertical transmission and increase healthy outcomes for both mother and baby through an integrated model of care. By working upstream through a prevention lens Sanctum 1.5 will have a positive impact not just on the mother, child and their families but the community as whole. Sanctum will demonstrate that the integration of health, social and psychosocial supports delivered through a harm reduction lens in a safe setting will allow for increased opportunity for med adherence, engagement in care and appropriate and timely planning for children at risk of apprehension. This approach will allow for broader, systematic changes that will have a lasting impact on the way in which services are delivered to high risk populations.

The following graphs are from data collected at Westside Community Clinic in Saskatoon and reflect the real need for this type of program in Saskatoon.
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