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Preventing Substance Abuse in Pregnancy and Beyond: The Superior Babies Evaluation

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. Julie Burns, MS, RN, St. Louis County Public Health and Human Services

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Preventing Substance Abuse in Pregnancy and Beyond: The Superior Babies Evaluation

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  1. 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

  2. Presenters • Julie Burns, MS, RN, St. Louis County Public Health and Human Services • Jean Larson, MS, RN, St. Louis County Public Health and Human Services • Dennis Falk, PhD, University of Minnesota, Duluth

  3. Superior Babies:What’s in a Name?

  4. St. Louis County, Minnesota

  5. Scope of the Problem • 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).

  6. 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.

  7. Superior Babies Intervention • 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.

  8. Superior Babies Intervention • Assessment & Education • MCH Data Bases • NCAST Tools & Scales • Teaching, Feeding, DLC, CLS • Home Safety Checklist • Denver II Developmental Screening • Regular Drug Screening • Relapse Prevention

  9. Superior Babies Intervention • Support & Advocacy • Support Groups • Referrals to Community Resources • Transportation • Housing • Mental Health • Education & Employment • Parenting

  10. 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?

  11. Evaluation Methods: Screening Pregnant WIC clients • 10% sample of WIC participants (N=154) • Record review for screening of chemical misuse • Record review for program referral based on screening results

  12. Evaluation Methods:Existing Data • 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

  13. Evaluation Methods: Interviews • 13 staff members about program strengths and weaknesses. • 15 program participants about program processes and outcomes.

  14. Results: Screening & Referral • 80% of pregnant WIC clients were screened (122 of 154) • Few WIC clients referred directly to SB

  15. Results: Participant Characteristics • 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,

  16. Results:Participant Characteristics • 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).

  17. Results:Participant Drug Use Patterns Early & often Daily or almost daily use in the past year • 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

  18. Results:Participant Drug Use Reasons • Likes feeling high (85%) • To cope with stress (81%) • To relax or unwind (78%) • Trying to forget problems (74%) • Everyone in network uses (59%).

  19. Results:Participant Symptoms of Abuse • 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.

  20. Results:Assessments Completed • 100% completion • MCH data bases • AP database & teaching checklists • 80 - 95 % completion • Denver II • PP data bases • Growth charts

  21. PHN Averages / client 4.3 AP home visits 2.7 PP home visits 2.8 office visits 17 phone calls 21 collaterals CD Averages / client 5.7 home visits 3.3 office visits 13 phone calls 22 collaterals Results: Extensive Contact

  22. Results:Preliminary Outcomes • N = 20 births, all live, good Apgars • 90% of moms & 100% babies had negative toxicology screening at birth • 10 dyads had toxicology screening • 85% babies were full term (>37 weeks) • 85% babies had normal birth weight

  23. 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.

  24. Results: Participant Feedback • 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”.

  25. Program Strengths • 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

  26. Program Weaknesses • Staff turnover • Large amount of data collection • challenging for staff • Referrals of WIC clients needs improvement

  27. Conclusions • 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.

  28. Conclusions • Program implementation was successful. • Executive summary & full report available • http://www.d.umn.edu/~dfalk/SBeval.html

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