Understanding the motivations and behaviors behind prenatal substance use is central to effective, compassionate FASD prevention. The study “Mental health clinicians’ perceptions on patient motivations and intervention engagement for prenatal cannabis use” offers valuable insights from licensed mental health clinicians working in a structured perinatal substance use program. Using both surveys and interviews, the research highlights how clinicians support pregnant individuals through patient-centered approaches such as motivational interviewing, harm reduction, and psychoeducation—especially when patients use cannabis to manage pregnancy symptoms like nausea, anxiety, or poor sleep. The findings also explore how factors like therapeutic rapport, patient readiness, and broader mental health needs influence whether and how people engage with interventions.
This research is particularly relevant to FASD Prevention Conversation Facilitators, as it reinforces the importance of non-judgmental, individualized conversations that respect people’s lived experiences, motivations, and goals during pregnancy.
Abstract
Background
Mental health clinicians are uniquely suited to support and provide important insights about substance use among pregnant patients. This mixed-methods study explored how mental health clinicians perceive and address prenatal cannabis use.
Methods
Participants were licensed mental health clinicians from Kaiser Permanente Northern California’s Early Start perinatal substance use screening and counseling program. Participants aimed to support patients’ goals for a healthy pregnancy. ESS completed a survey (N= 26; 100% Female; 73.1% White; Mage=48.1) and semi-structured interview (n = 14) on their perceptions about patients’ prenatal cannabis use and engagement in the ES program. Interviews were recorded, transcribed coded, and thematically analyzed.
Results
Survey results indicated clinicians perceive that nausea/morning sickness was the most common motive for prenatal cannabis use, and pregnant individuals were most likely to get information about prenatal cannabis use from their peers. Survey and interview results indicated clinicians most often used motivational interviewing, harm reduction, and psychoeducation to address cannabis use. Clinicians reported on psychotherapeutic factors (patient readiness, therapeutic rapport, and mental health support) that facilitate engagement and willingness to quit and/or reduce cannabis use during pregnancy. Other themes included ESS utilization of expertise in complementary mental health topics to support their work.
Conclusions
In this mixed-methods study, clinicians described several approaches to increase pregnant patients’ willingness to engage in perinatal substance use interventions, including eliciting motives for cannabis use and using patient-centered interventions focused on establishing rapport and addressing readiness to quit. Future interventions for patients might incorporate harm reduction and psychoeducation, address motivations for use and readiness to engage in care, emphasize peer support, and support the implementation of complementary interventions.
Reflection for FASD Prevention Conversation Facilitators
This study highlights the value of patient-centered, non-judgmental approaches—core principles that align with the messaging we share in our prevention conversations. Mental health clinicians emphasized how readiness, rapport, and harm reduction strategies can support people who use cannabis during pregnancy.
For facilitators delivering professional development, this reinforces the importance of training service providers to:
- Avoid stigma and lead with empathy
- Understand cannabis use as often symptom-driven (e.g., for nausea, anxiety, or sleep)
- Offer clear, evidence-informed alternatives without pressure
- Respect autonomy and support informed decision-making