Development of a co-produced Theory of Change for optimal health and social care services for women who use drugs or are in treatment for drug use during the perinatal period.

Background Women who use drugs in the perinatal period can have complex health and social needs requiring additional support during and after pregnancy yet there is wide variation in availability of services and women may avoid engaging due to fears of surveillance and judgement. This study addressed this issue through exploring women’s experiences and care pathways. An aim of the study was to co-produce recommendations for optimal perinatal services for women who use or are in treatment for drug use during and after pregnancy. Methods We used a co-production approach to develop a Theory of Change that sets out key requirements for optimal care services. Working with a multidisciplinary group of experts including peer advisors, we integrated experiential knowledge with primary and secondary research data in a series of co-production workshops. Findings The Theory of Change sets out key recommendations to improve services for women who use drugs during the perinatal period. These include: person-centred and trauma informed policy development and commissioning, shared values throughout services and co-production of guidance involving women with lived experiences; support for staff training and infrastructure; service level interventions such as provision of community hubs, care co-ordination and advocacy, and non-stigmatising, relational based care. Conclusions Using the Theory of Change we found that adding services in one area may not be effective if the whole system of care is not considered. Most of the recommendations are directed at organisational/strategic and service level with fewer recommendations at individual staff level. This is in recognition that staff are only able to provide optimum care when service infrastructure, resources, training, and shared values enable them to do so. Consideration of a whole service approach is necessary to deliver safe, person centred services to women who use or are in treatment for drug use and their infants.