Women who use alcohol and other drugs during pregnancy: exploring the complexity of client engagement and their compliance with human service expectations.

Women who use drugs during pregnancy are required to intersect with numerous services in relation to their and their unborn child's well-being. The purpose of this article is to stimulate practitioner debate and consideration of the ways in which substance using women engage with diverse services and specific professional groups during pregnancy and the extent to which they may comply with the various treatment plans developed for them – or not. Drawing on literature, different ways to conceptualise engagement and compliance in health and welfare interventions are discussed and key practice issues related to these concepts are identified for this client cohort. Insights from an amalgamated case exemplar informed by practice and the available literature comprehensively draws together and highlights the personal challenges women face, whilst at the same time required to navigate inconsistent expectations between the health, alcohol and other drugs treatment and child protection systems, along with the ever-present threat of removal of their infant at birth. The role of social workers in hospital and community settings in bridging the perceived divide between clients and child protection services and also in promoting collaboration is explored. Recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]