1. Identifying the Prevalence of Perinatal Substance Abuse in Santa Clara County September 2004 Karen Miyamoto, PHN Maternal, Child & Adolescent Health Program

2. Background Information 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. Senate Bill 2669

3. 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

4. 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.

5. Santa Clara County, California Perinatal Substance Abuse Protocol 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 PRENATAL SCREENING & ASSESSMENT

6. Supplemental Prenatal Screening Health Questionnaire Positive: Prenatal Screening Questionnaire—Refer for Substance Abuse Assessment 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 Referral to treatment Obtaining consent for Inter-Agency communication Continuing assessment for potential risk to infant after delivery 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). Assessment indicates no alcohol/drug problem. Inform prenatal care provider. Periodic inquiries by prenatal care provider about alcohol/drug use at prenatal visits. If drugs/alcohol becomes an issue or concern

7. Substance Abuse Assessment Guide Review

8. 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.

9. 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

10. 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.

11. HospitalActivity Data Entry Activity - 01/01/2004 to 08/27/2004 Comm. Hospital of Los Gatos24.65% El Camino Hospital24.65% Good Samaritan Hospital511.63% Kaiser Hospital - Santa Clara613.95% Kaiser Hospital - Santa Teresa36.98% O'Connor Hospital511.63% Other Hospitals00.00% Regional Medical Center of San Jose511.63% Saint Louise Regional Hospital00.00% San Jose Medical Center00.00% Santa Clara Valley Medical Center1330.23% Stanford University Medical Center24.65% 43Grand Total record(s)

12. Hospital Activity

13. 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)

14. 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.

15. Methods: Our Department’s Role…. Planning, implementing and evaluating all activities related to reporting according to SB 2669 regulations

16. 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.

17. 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.

18. 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!

19. 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

20. 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.

21. 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.

22. 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.