Transcript Preventing Substance Abuse in Pregnancy and Beyond:

Preventing Substance Abuse in
Pregnancy and Beyond: The
Superior Babies Evaluation
An Evaluation of a Collaborative
Home Visiting Model
Presented at APHA on November 8, 2004
Presenters
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Julie Burns, MS, RN, St. Louis County
Public Health and Human Services
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Jean Larson, MS, RN, St. Louis County Public Health
and Human Services
Dennis Falk, PhD, University of Minnesota, Duluth
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Superior Babies:
What’s in a Name?
St. Louis County, Minnesota
Scope of the Problem
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MN ranks 4th in US for frequent drinking among
childbearing women (CDC, BRFSS, 1995).
Chronic drinking among childbearing women:
18-24 (42.4%), 25-34 (25.6%), 35-44 (15.5%)
(Block, Bridge to Health Survey, 2000).
“Alcohol and alcohol related problems” ranked
#1 problem affecting residents of St. Louis
County (SLC Community Assessment, 2003).
Program Goals
1. Reduce the incidence of Fetal Alcohol
Spectrum Disorders (FASD), and other
chemically related health effects by identifying
and serving pregnant women suspected of or
known to use or abuse alcohol and other
drugs.
2. Promote healthy birth outcomes, normal
growth and development and positive
parenting.
Superior Babies Intervention
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Collaborative case-management
 Discipline specific visit protocols
Multidisciplinary Approach
 PHN, LADC, SW
Multiple types of contacts
 Home visits (primarily), office visits,
telephone contacts, collateral
contacts, support groups.
Superior Babies Intervention
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Assessment & Education
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MCH Data Bases
NCAST Tools & Scales
 Teaching, Feeding, DLC, CLS
Home Safety Checklist
Denver II Developmental Screening
Regular Drug Screening
Relapse Prevention
Superior Babies Intervention
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Support & Advocacy
 Support Groups
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Referrals to Community Resources
 Transportation
 Housing
 Mental Health
 Education & Employment
 Parenting
Evaluation Questions
1. Were WIC participants properly screened and
referred to the Superior Babies program?
2. What was the nature of participation in the
program and characteristics of the participants?
3. What services were provided in the Superior
Babies program?
4. What were the preliminary outcomes of the
Superior Babies program?
Evaluation Methods:
Screening Pregnant WIC clients
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10% sample of WIC participants (N=154)
Record review for screening of chemical
misuse
Record review for program referral based
on screening results
Evaluation Methods:
Existing Data
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Individual Tracking Forms - participant
characteristics and services provided
Women's Chemical Dependency
Inventory - chemical use
(equivalent of a Rule 25 Assessment)
Monthly Statistical Report - program
activities & interventions
Chart abstraction
Evaluation Methods: Interviews
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13 staff members about program
strengths and weaknesses.
15 program participants about program
processes and outcomes.
Results: Screening & Referral
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80% of pregnant WIC clients were
screened (122 of 154)
Few WIC clients referred directly to SB
Results:
Participant Characteristics
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Participant characteristics consistent with the
proposed target population
N =27 SB clients,
Generally young, 74% were < 30 yrs old,
About half entered SB in the first trimester,
Almost half had previous chemical
dependency treatment,
Results:
Participant Characteristics
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Over half had income below Federal Poverty
Guidelines,
17 clients (63%) were enrolled in Minnesota
Family Investment Program (TANF),
One-third of the women had previous criminal
justice system involvement,
Over one-fourth met definition for serious and
persistent mental illness (SPMI).
Results:
Participant Drug Use Patterns
Early & often
Daily or almost daily use in the past year
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tobacco (70%),
marijuana or hashish (30%),
alcohol (19%),
methamphetamines (15%)
Average first use
 alcohol and tobacco - 13 years old
 marijuana or hashish - 14 years old
Results:
Participant Drug Use Reasons
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Likes feeling high (85%)
To cope with stress (81%)
To relax or unwind (78%)
Trying to forget problems (74%)
Everyone in network uses (59%).
Results:
Participant Symptoms of Abuse
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Frequent intoxications / highs
Preoccupation with use
Hidden use / denial of use
Rapid use / use until supply is gone
Using more than planned / when not
planned
Increase in tolerance / loss of effects.
Results:
Assessments Completed
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100% completion
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MCH data bases
AP database & teaching checklists
80 - 95 % completion
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Denver II
PP data bases
Growth charts
Results: Extensive Contact
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PHN Averages / client
 4.3 AP home visits
 2.7 PP home visits
 2.8 office visits
 17 phone calls
 21 collaterals
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CD Averages / client
 5.7 home visits
 3.3 office visits
 13 phone calls
 22 collaterals
Results:
Preliminary Outcomes
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N = 20 births, all live, good Apgars
90% of moms & 100% babies had
negative toxicology screening at birth
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10 dyads had toxicology screening
85% babies were full term (>37 weeks)
85% babies had normal birth weight
Results: Participant Feedback
Those interviewed:
 All were able to state prenatal alcohol &
drug use effects on the fetus.
 Most (87%) reported abstinence or
reduced alcohol or drug use.
 All thought other families in a similar
situation could benefit from SB.
Results: Participant Feedback
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80% rated the overall benefits of SB as
“outstanding” or “very good”.
87% felt that the SB program helped
them with parenting.
87% reported things were going “much
better” for them; 13% reported that
things were “somewhat better”.
Program Strengths
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Serving appropriate clients
Interdisciplinary model is effective
Frequent communication between team
members; regular clinical staffing
Toxicology screening, regular UA’s
Extensive client contact
Good birth outcomes
Program Weaknesses
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Staff turnover
Large amount of data collection
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challenging for staff
Referrals of WIC clients needs
improvement
Conclusions
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Significant advantage to partner PHN’s &
staff with chemical dependency expertise.
Gaining and maintaining client trust is an
integral part of the program.
Flexibility and practical problem solving are
key elements.
Conclusions
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Program implementation was successful.
Executive summary & full report available
 http://www.d.umn.edu/~dfalk/SBeval.html