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 Jean Larson, MS, RN, St. Louis County Public Health

and Human Services Dennis Falk, PhD, University of Minnesota, Duluth

Superior Babies:What’s in a Name?

St. Louis County, Minnesota

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).

Program Goals1. 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 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 Assessment & Education

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 Support & Advocacy

Support Groups 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

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 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

13 staff members about program strengths and weaknesses.

15 program participants about program processes and outcomes.

Results: Screening & Referral

80% of pregnant WIC clients were screened (122 of 154)

Few WIC clients referred directly to SB

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,

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).

Results:Participant Drug Use PatternsEarly & 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

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%).

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.

Results:Assessments Completed 100% completion

MCH data bases AP database & teaching checklists

80 - 95 % completion Denver II PP data bases Growth charts

Results: Extensive Contact

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: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

Results: Participant FeedbackThose 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 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 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 Staff turnover Large amount of data collection

challenging for staff Referrals of WIC clients needs

improvement

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.

Conclusions Program implementation was successful. Executive summary & full report available

http://www.d.umn.edu/~dfalk/SBeval.html