Curriculum standards
Entrustable Professional Activities
LG 9: Managing substance use in pregnancy
Managing substance use in pregnancy
Manage substance use during pregnancy using a harm minimisation and multidisciplinary framework
This activity requires the ability to:
- use advanced communication skills to develop a therapeutic relationship with the patient
- assess the patient’s substance use
- undertake a psychiatric and psychosocial history with a specific focus on current strengths and vulnerabilities
- undertake a risk assessment
- integrate history, physical findings, and psychosocial assessment to develop a problem list
- collaborate with the patient, colleagues, and relevant services to develop treatment goals and a patient-centred management plan
- contribute to ongoing monitoring of progress during and after the pregnancy, and participate in multidisciplinary care planning
Professional practice framework domain
Medical expertise
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- use a comprehensive addiction medicine assessment as a framework to assess and manage pregnant patients
- integrate assessment findings, with knowledge of pharmacology and toxicology of substances, in determining risks relating to the pregnancy
- develop management plans, based on:
- patients’ mental health and social circumstances
- patients’ readiness for change
- relevant legislation and reporting obligations
- risks associated with ongoing use
- risks of withdrawal
- the pattern of substance use
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- elicit patient-centred histories considering psychosocial factors
- perform accurate physical examinations
- recognise and correctly interpret abnormal findings
- synthesise information to direct the clinical encounter
- develop appropriate management plans
Communication
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- communicate with patients, partners, family, or support people involved in antenatal care, in a way that encourages engagement and increases motivation to change
- involve patients, partners, family, or support people in the development of the management plan, taking into account patients’ preferences and social circumstances
- discuss the risks associated with ongoing substance use, and the benefits and risks of various therapeutic options
- communicate with other professionals involved in patients’ care in an effective, respectful, and timely manner
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- adopt a patient-centred communication style
- discuss risks in a way that may overly alarm the pregnant person, risking disengagement
- develop a potentially clinician-centred management plan
Quality and safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- manage processes in place for screening pregnant patients for substance use, including appropriate pathways for referral
- document management plans clearly
- demonstrate safety skills, including infection control, adverse event reporting, and effective clinical handover
- inform patients of the benefits and risks associated with their choices and proposed management plans
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- undertake infection control measures
- document management plans
- conduct adequate handovers
- possibly over-emphasise risks, with outcome of reduced patient engagement
- assess child safety, and have knowledge of reporting obligations
Teaching and learning
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- discuss the opportunities associated with pregnancy for behaviour change
- set defined objectives for clinical teaching encounters, and solicit feedback on mutually agreed goals
- reflect regularly and self-evaluate professional development
- obtain informed consent before involving patients in teaching activities
- use clinical activities as an opportunity to teach, appropriate to the setting
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- set general goals and objectives for self-learning
- self-reflect on occasions
- deliver teaching considering learners’ level of training
Research
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- compile, analyse, interpret, and evaluate information relevant to the research subject
- use relevant resources to assist with resolving clinical problems, including practice guidelines and current literature
- consider evidence from clinical trials and applicability to pregnancy
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- refer to guidelines and medical literature to assist in clinical assessments when required
- demonstrate an understanding of the limitations of evidence, and the challenges of applying research in daily practice
- refer to colleagues to assist with research or finding resources to resolve clinical problems
Cultural safety
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- demonstrate effective and culturally safe communication and care for Aboriginal and Torres Strait Islander people and Māori, and members of other cultural groups
- collaborate with Aboriginal and Torres Strait Islander and Māori midwifery streams and professionals in ensuring responses are suitable and culturally safe
- acknowledge patients’ beliefs and values, and how these might impact on health
- use professional interpreters, health advocates, or family or community members to assist in communication with patients, to ensure cultural safety
- use plain language patient education materials, demonstrating cultural and linguistic sensitivity
- encourage family involvement to support treatment during prenatal and postnatal periods
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- display respect for patients’ cultures, and attentiveness to social determinants of health
- display an understanding of at least the most prevalent cultures in society, and an appreciation of their sensitivities
- appropriately access interpretive or culturally safe focused services
Ethics and professional behaviour
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- communicate with patients regarding the choices they have regarding treatment and non-treatment
- explain access options for treatments now and in the future
- facilitate interactions within multidisciplinary teams, respecting values, encouraging involvement, and engaging all participants in decision making
- demonstrate critical reflection on personal beliefs and attitudes, including how these may affect patient care and health care policy
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- facilitate patient-centred care
- communicate medical management plans as part of multidisciplinary plans
- where possible, establish patients’ wishes and preferences about care
- contribute to building a productive culture within teams
Judgement and decision making
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- evaluate the need for patients’ autonomy against fetus’s wellbeing
- evaluate the intensity of interventions against risks of alienating patients
- recognise the need for escalation of care, and escalate to appropriate services or agencies
- reconcile conflicting advice from other specialties, applying judgement in making clinical decisions in the presence of uncertainty
- seek advice from senior colleagues in high-stakes, difficult clinical situations
- assess for risk of interpersonal violence, and be able to respond appropriately when this is identified
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- obtain advice when making decisions around competing interests
- have difficulty achieving an appropriate balance, resulting in treatment hesitancy
- recognise situations in which to ask for help
Leadership, management, and teamwork
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- collaborate respectfully with midwifery, obstetric, mental health, paediatric clinicians, and child protection professionals to optimise outcomes through multidisciplinary care planning and case reviews
- provide leadership and advocacy regarding issues around substance use
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- collaborate with other relevant health professionals
- participate in multidisciplinary meetings
Health policy, systems, and advocacy
Ready to perform without supervision
Expected behaviours of a trainee who can routinely perform this activity without needing supervision
The trainee will:
- address stigma through advocating and educating health practitioners
- advocate for improved screening and referral pathways for pregnant women using substances
- advocate for support services being adequately resourced
- manage treatment escalation protocols
- collaborate with Aboriginal and Torres Strait Islander and Māori communities to improve access, appropriateness, and cultural safety of addiction services for pregnant people
Requires some supervision
Possible behaviours of a trainee who needs some supervision to perform this activity
The trainee may:
- practice in accordance with guidelines and organisational policies for perinatal care