Terrell W. Zollinger, DrPH Evaluation Consultant Healthy Women, Healthy Hoosiers Conference October 7, 2011

 Robert M. Saywell, Jr, PhD, MPH ◦ Health Economist  Jennifer Burba, BS ◦ Data Manager  PSUPP team ◦ State Director ◦ Site Directors

 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

 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

 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

 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

 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

 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

 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

 4,609 individuals screened  1,348 PSUPP clients delivered  2,074 PSUPP clients terminated ◦ 190 at delivery ◦ months post-partum ◦ months post-partum ◦ 752 before delivery

 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

 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%

 51.4% of smokers indicated that the information provided by PSUPP helped them cut down or quit  70.3% of alcohol users indicated that the information provided by PSUPP helped them cut down or quit  80.5% of drug users indicated that the information provided by PSUPP helped them cut down or quit

 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

 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

 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

 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)

 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