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Indiana Prenatal Substance Use Prevention Program

The Indiana Prenatal Substance Use Prevention Program (PSUPP) aims to reduce adverse birth outcomes by targeting substance use in pregnant women. Established in 1988, the program serves high-risk populations across 14 sites in 25 counties. The evaluation reveals significant outcomes, such as a 49.6% reduction in smoking among participants and a considerable increase in knowledge about the harms of substance use during pregnancy. PSUPP demonstrates a strong return on investment, preventing numerous pre-term and low birth weight deliveries, ultimately saving millions in healthcare costs.

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Indiana Prenatal Substance Use Prevention Program

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  1. Indiana Prenatal Substance Use Prevention Program Terrell W. Zollinger, DrPH Evaluation Consultant Healthy Women, Healthy Hoosiers Conference October 7, 2011

  2. Colleagues… • Robert M. Saywell, Jr, PhD, MPH • Health Economist • Jennifer Burba, BS • Data Manager • PSUPP team • State Director • Site Directors

  3. Outline • Mission • History, Locations, Target Population • Staff, Services Provided • Methods/ Processes Used for Monitoring and Evaluation • Outcomes: • Reduction/quit rate • Changes in beliefs/knowledge/attitudes • Satisfaction with program • Return on investment • Next Steps

  4. Mission of PSUPP:To prevent birth defects, low birth weight deliveries, premature births, and other adverse outcomes associated with substance use during pregnancy

  5. History of PSUPP • Began in 1988 as a Indiana State Department of Health initiative (Lynn Bailey) • Funded by the Division of Mental Health and Addictions • Included 5 sites: Gary, Ft. Wayne, Indianapolis, Jasper, Terre Haute serving 5 counties • Now 14 sites serving 25 counties

  6. Location of PSUPP Sites

  7. Target Population • High-moderate risk of poor birth outcome due to substance use: 57.3% of those screened in FY 2010 • Young: 32.4% less than age 21 • Racial minorities: 27.2% PSUPP vs. 13.0% in Indiana • Hispanics: 16.8% PSUPP vs. 5.4% in Indiana • Less educated: 38.6% have less than high school education

  8. Staff • Nurses, Social Workers, Counselors • Trained in the best practices to counsel substance users • Required to participate in continuing education • Hosted by clinics, health departments, and similar organizations

  9. Services Provided • Screening pregnant women at first prenatal care visit to identify those at risk • Provide a series visits for individual counseling sessions • Provide printed material • Connect clients to other services • Provide information to health care providers • Provide information to the community

  10. Evaluation Methods/Processes • At the first visit, administer a screening tool and administer baseline knowledge/attitude survey • At delivery administer a substance use survey • At termination (3-6 months after delivery) administer a substance use survey • At termination administer follow-up knowledge/attitude survey • Administer satisfaction survey to a sample

  11. Data Flow • Screening, Knowledge/Attitude, and Satisfaction questionnaires completed by client using a paper form • The paper form is copied, copy for medical record, original to evaluators • Paper forms are scanned, verified, and placed in an electronic database • Delivery and Termination forms completed by PSUPP staff and entered directly into the database • Provide quarterly and annual data reports

  12. Results

  13. 2010 Screenings/Clients • 4,609 individuals screened • 1,348 PSUPP clients delivered • 2,074 PSUPP clients terminated • 190 at delivery • 678 1-3 months post-partum • 411 3-6 months post-partum • 752 before delivery

  14. Reduction Rates • 49.6% of 700 smokers at entry reduced or quit before delivery; 28.7% quit • 84.0% of 50 alcohol users at entry reduced or quit before delivery; 16.0% quit • 75.3% of 85 drug users reduced or quit before delivery; 24.7% quit

  15. Changes in Knowledge/Attitudes • Comparing the follow up survey responses to the baseline respondents found that participants were substantially more knowledgeable or had stronger beliefs that substance use during pregnancy was harmful • Examples: • “Definitely not Okay” for pregnant women to smoke: 67.6% to 84.9% • Exposure to secondhand smoke considered “very harmful”: 77.9% to 90.1%

  16. Satisfaction with PSUPP • 51.4% of smokers indicated that the information provided by PSUPP helped them cut down or quit • 70.3% of alcohol usersindicated that the information provided by PSUPP helped them cut down or quit • 80.5% of drug usersindicated that the information provided by PSUPP helped them cut down or quit

  17. Return on Investment • PSUPP prevented an estimated 79 pre-term deliveries • PSUPP prevented an estimated 17 low birth weight deliveries • Total health care costs averted was $4.8 million • Cost of PSUPP was $915,000 • ROI =$5.25 for every dollar spent on PSUPP

  18. Objectives Met • Targets were set for 20 objectives (reduction in substance use, number of contacts, low birth weight rates, number of presentations given, etc.) • Target values were achieved for 16 of the 20 objectives

  19. Next Steps

  20. Future Focus of PSUPP • Enrolling high risk women • Particular focus on tobacco use during and after pregnancy • Improving the value of PSUPP services. • Increasing the knowledge of pregnant women about effects of substance use • Improving the efficiency of PSUPP

  21. FY 2012 PSUPP Goals • GOAL 1: PROVIDE SERVICE TO SUBSTANCE USING CLIENTS (comparing Screening and Delivery forms) • GOAL 2: REDUCE SUBSTANCE USE AMONG CLIENTS DURING PREGNANCY (comparing Screening and Delivery forms) • GOAL 3: REDUCE SUBSTANCE USE AMONG CLIENTS POST-PARTUM (comparing Screening and Termination forms) • GOAL 4: CLIENTS WILL FIND PSUPP TO BE VALUABLE (from Client Satisfaction Survey) • GOAL 5: CLIENTS WILL BE MORE KNOWLEDGEABLE ABOUT THE HARMFUL EFFECTS OF SUBSTANCE USE (from Delivery or Termination Client Opinion Survey)

  22. Evaluation Focus • Reduce number of objectives from 20 to 8 • More focus on outcome, less on process • Improve ROI estimates • Give sites reasonable targets for objectives • Gather success stories

  23. Questions???

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