The job of a home visitor is unique. You play an important role in the lives of expectant families. During your visits, you will see families’ daily routines and challenges, which can help you notice their strengths and needs. This closeness helps build trust. With trust, you are better able to help caregivers make positive changes, like reducing or avoiding substance use. Pregnancy often inspires families to make healthy choices, and you can support them in making those choices for themselves and their baby.

Gather Important Information

Know the facts about substance use and pregnancy. Substance use can affect pregnancy in many ways. When it is appropriate, share information that is easy to understand.

Learn about local support services. Find local services for substance use, mental health, parenting support, and early intervention for newborns. Many people (up to 70%) with a substance use disorder also have a mental health concern. Be ready to help families find and use these resources.

Stay informed about how to help families. Learn new skills, such as motivational interviewing, to better support families.

Set up your own sources of support. Find co-workers or supervisors who can guide and support you emotionally. Find out if your agency offers reflective supervision, peer coaching, or mentoring. Reach out to your program’s mental health consultant for support and guidance.

Understand your agency’s policies and your reporting requirements. Know your agency’s policies and procedures for when a report to child welfare may be needed. Understand state, territorial, or tribal laws about reporting substance use and families’ rights. Get guidance from a supervisor or colleague if you need to. Ask about trainings to better understand your responsibilities as a mandated reporter.

Talking with Families About Substance Use Disorders

Taking time to prepare and plan helps make conversations about sensitive topics successful. Reflect on your own biases about a topic and consider the families’ point of view.

Prepare

Planning for these conversations is essential. It allows you to talk about sensitive topics in a respectful, supportive way that is more likely to help families make healthy decisions. Follow these tips to prepare for conversations:

• Build trust first. Start by building a relationship. Talk about the family’s strengths, ask about their needs, and share resources as needed. Unless there is a safety risk to the child, avoid discussing sensitive topics right away. Bring up topics like substance use after you’ve built a relationship.
• Find a good time. Pregnancy can be a natural time for positive changes. Use this time to share information on healthy choices, including how to avoid substances that could harm the pregnant woman or baby.
• Use supportive language. Avoid language that might blame or shame. Focus on positive actions. For example, say, “You can create a safe, healthy space for your baby to grow.”
• Make safety your priority. Always be aware of safety during visits. Talk to your supervisor and colleagues about ways to stay safe in homes. These might include wearing agency identification, being aware of others in the home, being aware of safety concerns in the community, and having emergency numbers.

Discuss

When talking about substance use, make sure your approach is respectful and kind. Pregnancy is a time when people are more likely to make positive health changes. Does the person you’re working with seem ready and willing to make a change? Where do they fall on the Stages of Change model?

Focus on family strengths. Celebrate the family’s efforts and desire to keep their baby healthy. Talk about times when the caregiver chose not to use substances and explore what helped them during those times.

Use these conversation starters:

• “You are giving your baby a healthy start by getting health care during pregnancy. Are you getting any other care, including mental health care? If so, do your providers know you’re pregnant?”
• “I see how much care and attention you are putting into getting ready for the baby! Are you having any pregnancy aches or pains? How are you managing those aches and pains?”

Learn what the family knows. Different families may have different ideas about substances. Ask questions to understand their knowledge and beliefs.

Use these conversation starters:

• “There is so much information about what you should or should not do when pregnant. Are there any habits, medications, or substances that you are worried may not be healthy for you or the baby?”
• “What have you heard helps with morning sickness?”
• “Have you ever been prescribed painkillers like codeine, oxycodone, morphine, or fentanyl? What was that experience like? Are you taking any of these now?”

Share other ways to stay healthy. Explain other things the family can do for a healthy pregnancy, such as going to prenatal appointments, eating healthily, and staying active if possible.

Encourage social support. Support from family and friends can help caregivers make healthy choices. Ask about the people around the family and how they may be involved.

Use these conversation starters:

• “Who do you turn to for support when you need it? Do you have friends, family, or neighbors who could help with doctor’s appointments or give you a break when the baby is here?”
• “What kinds of help would you like from others once the baby is born? What tasks could you ask them to do?”

Assess health literacy. Make sure the family receives information in a way they can understand.

Plan for stress management. Becoming a parent can be stressful, which can sometimes lead to substance use. Talk with the family about healthy ways to manage stress after the baby arrives.

Use these conversation starters:

• “The arrival of a new baby is exciting but can also be stressful! How do you unwind and de-stress now? Do you think you’ll be able to do those things after the baby arrives?”
• “It’s very common for new parents to feel overwhelmed at times. Let’s make a plan for what you can do if life feels overwhelming once the baby is here.”

When Substance Use Is a Concern

If you have concerns about substance use, start the conversation carefully, with respect and a clear plan.

Give the family control by asking if they are open to discussing substance use. If they’re not ready, wait and try again later, unless there is a safety risk to children or others in the home.

Share simple, correct information. Keep messages short, practical, and focused on positive choices.

Take advantage of your community resources. If someone in the family wants to reduce substance use, help them connect to local programs. Offer to help with phone calls or to make introductions.

Use these conversation starters:

• “Do you know about local resources or support groups that can help you when the baby arrives? Would you like to hear about some in our community?”
• “Do you have concerns about anyone in your household using prescription painkillers or other substances?”

By preparing and using a respectful, strengths-based home visiting approach, you can help expectant families make healthy choices for themselves and their baby.

Last Updated: June 12, 2025