Transcript Karen Miyamoto, BSN - Santa Clara County Public

Identifying the Prevalence of
Perinatal Substance Abuse in
Santa Clara County
Karen Miyamoto, PHN
Maternal, Child & Adolescent
Health Program
September 2004
Background Information
Senate Bill 2669
In 1990, California Senate Bill 2669 was
passed requiring positive toxicology
screening of infants at the time of delivery
for women assessed for substance abuse.
Toxicology positive infants were to be
reported to local Public Health
Departments. Counties were mandated to
establish protocols for local hospitals to
screen and assess these women.
Prior to SB 2669

No data available at the county or state
level to determine the prevalence of
perinatal substance abuse.

No standardized protocols or
procedures for hospitals when
reporting

No concerted effort to identify perinatal
substance abuse until 1994
What happened after
SB 2669 was introduced?




In 1994, a multidisciplinary team of health
professionals from the PHD was
established to educate birthing hospital
staff regarding SB 2669.
Staff were trained on protocols for
assessing women.
Staff were provided instructions on
reporting toxicology positive infants to the
PHD.
2000 a user friendly Perinatal Substance
Abuse (PSA) website was developed.
Santa Clara County, California
Perinatal Substance Abuse Protocol
PRENATAL SCREENING & ASSESSMENT
This protocol presupposes that all women of child—
bearing age will have been given information by
their health care provider regarding the health
effects of alcohol and drugs including tobacco.
Purpose:
To assist prenatal care providers in screening and
assessing a pregnant woman’s risk for alcohol
and/or other drug abuse and determining if
referrals for further services are indicated.
When to Use:
1.
On all new obstetrical patients
2.
Should be repeated each trimester or
periodically, as indicated
Supplemental Prenatal Screening Health Questionnaire
Positive: Prenatal Screening
Questionnaire—Refer for
Substance Abuse Assessment
Assessment indicates no alcohol/drug
problem. Inform prenatal care provider.
Negative: Prenatal Screening
Questionnaire—periodic inquiries about
alcohol/drug use at prenatal visits
If drugs/alcohol becomes and issue
or concern
Assessment indicates alcohol/drug problem: Joint
planning with prenatal care provider regarding
Periodic inquiries by prenatal care provider
about alcohol/drug use at prenatal visits.
•Referral to treatment
•Obtaining consent for Inter-Agency communication
•Continuing assessment for potential risk to infant after
delivery
If drugs/alcohol becomes an
issue or concern
•Referral to Public Health Nurse or home care agency for
follow-up
At subsequent prenatal visits:
•Follow up teaching
•Reinforce referrals
•Monitor fetus as medically indicated
Distribution: Send copy of questionnaire and any assessments with prenatal
record to hospital (or record results in prenatal record).
Substance Abuse
Assessment Guide
Review
Objectives
1. Identify prevalence rates of perinatal
substance abuse in Santa Clara
County
2. Assess the resource needs of hospital
and other health professional staff.
Methods:
Approach developed

Identification of a toxicology positive
infant is reported by a Perinatal
Medical Social Worker at each
birthing hospital to the Public Health
Department.

Perinatal Protocol Hospital Data
Collection Form is completed and
data is entered by the PMSW to the
Perinatal Substance Abuse website
Methods:
Website Developed

All Perinatal Medical Social Workers
(PMSW) have access to the PSA
Website. They are given passwords
and are oriented on how to report via
website.

This website is also a venue for the
PMSW to access information about
upcoming trainings, exchange
information, and receive quarterly
updates and reports.
Hospital Activity
Data Entry Activity - 01/01/2004 to 08/27/2004
Comm. Hospital of Los Gatos
2
4.65%
El Camino Hospital
2
4.65%
Good Samaritan Hospital
5
11.63%
Kaiser Hospital - Santa Clara
6
13.95%
Kaiser Hospital - Santa Teresa
3
6.98%
O'Connor Hospital
5
11.63%
Other Hospitals
0
0.00%
Regional Medical Center of San Jose
5
11.63%
Saint Louise Regional Hospital
0
0.00%
San Jose Medical Center
0
0.00%
Santa Clara Valley Medical Center
13
30.23%
Stanford University Medical Center
2
4.65%
43
Grand Total record(s)
Hospital Activity
Data Entry Activity
5% 5%5%
12%
29%
13%
0%
12%
0%
12%
7%
CHLG
ECH
GSH
K-SC
K-ST
OCH
Other
RMCSJ
SLRH
SJMC
SCVMC
SUMC
Interventions


Social Workers report the
toxicology positive infants to DSS
(Department of Social Services)
and not law enforcement
Refer the mother & infant to the
Healthy Pregnancy Early Parenting
Program (HPEP)
Methods:
Quarterly Meetings


Communication increased significantly
because of personal contact with Social
Workers via quarterly meetings. The
meetings are coordinated by the PSA
Unit.
At these meetings staff provide technical
assistance, encourage participation and
adherence to legislation, and social
workers are provided an avenue to
network and exchange experiences and
concerns.
Methods:
Our Department’s Role….
Planning, implementing and
evaluating all activities related to
reporting according to SB 2669
regulations
Results

Prior to 2003, 80% of birthing
hospitals were adhering to the
reporting requirement of
SB 2669.

Since the convening of the
quarterly meetings, 100% of the
birthing hospitals in Santa Clara
County began reporting.
Results (continued)

From 2003 to 2004 there was a
95% increase in the number of
reports submitted!

Staff have established a
streamlined system of reporting,
and have developed an
environment that promotes
collaboration and integration of
expertise.
Conclusions:
What are the lessons learned?
Collaboration & sharing of expertise
has proven to be the greatest
component to the success of this
project.
Coordination of interaction at regular
intervals is essential!
Conclusions:
What will we do different in
future?
Equal emphasis will be placed on
developing similar relationships
with OB/GYN practitioners and
other allied health staff
Conclusions:
What is our greatest barrier
facing implementation?
Demonstrating to practitioners the
importance of screening and
assessing ALL of their perinatal
patients for substance abuse has
been the greatest barrier.
The lack of resources and the
ability to access all practitioners
has also been a challenge.
Our take home message to you…

We hope you understand that early
intervention services for infants, and
comprehensive substance abuse
treatment programs for mothers are
important components to breaking
the cycle of perinatal substance
abuse.
What are we going to do with the
data we are collecting?

Data will be used to determine
allocation of resources and
assist in developing
intervention strategies for
improving service delivery in
this population.