Substance-Exposed Pregnancy Prevention: An Environmental Scan of Local Health Department Practices Molly Schlife, MPH

Floyd RL, Jack BW, Cefalo R, Atrash H, Mahoney J, Herron A, Husten C, Sokol RJ. The clinical content of preconception care: Alcohol, tobacco, and illicit drug exposures. American Journal of Obstetrics and Gynecology 2008; 199(6):S333-S % of pregnant women (and 29.5% of non-pregnant women of reproductive age) reported tobacco use 11.8% of pregnant women (and 53% non-pregnant women of reproductive age) reported alcohol use 4% of pregnant women (and 10% of non-pregnant women of reproductive age) reported using illicit drugs

Key Questions What are local health departments and their community partners doing to address the problem of substance-exposed pregnancies? What opportunities exist to expand the use of existing effective interventions and develop new interventions?

Definitions "Substance-exposed pregnancies” (SEPs) are defined as those that include prenatal exposure to: alcohol tobacco illicit drugs and/or prescription drugs (misused/abused)

increasing community knowledge and awareness of the risks of substance use before and during pregnancy; decreasing unintended pregnancies among women who use substances; increasing health care and social service provider knowledge and improving practices around substance use screening and brief intervention; increasing public health department involvement in prevention activities. SEP Prevention activities include those aimed at:

Methods An environmental scan/survey was developed 136 MCH leaders in urban local health departments contacted (April-May 2011) 59 responses received Response rate = 43%

Who responded?

Is SEP a problem in your community?

Considers SEP Prevention a priority

Perceived Readiness to Prevent SEPs

What substances are you addressing?

Funding Sources Used for SEP Prevention Activities? *Respondent can check all that apply

Consumer groups targeted *Respondent can check all that apply

SEP Prevention Activities Individual Interventions with Women at Risk for SEPs – Project CHOICES, Intensive Case Management, counseling services provided by LCSWs, Community Health Workers and Substance Abuse Counselors Pre/inter-conceptual Programs – Education for high risk newly delivered (interconceptual) women, preconception peer education, birth control for at risk youth; tobacco and substance abuse screening in school-based health centers Collaboration/Coordination – Working with providers/hospitals who serve higher risk groups, Human Services, family planning, Children Services, community SA treatment providers – Coordination of referrals (especially with high risk women seen by WIC or in STD clinics) coordinating/participating on multiple Task Forces/Coalitions

Are you well-equipped in terms of… %

Which programs include SEP prevention activities? *Respondent can check all that apply

Who is the lead organization coordinating SEP prevention activities?

Implications (overall) Better understanding of current public health practice in the area of substance exposed pregnancies; Understanding priorities in this area at the local level Identification of needs in this area Help inform planning of future collaborative efforts

Implications for Preconception Health Opportunity for LHD leadership coordination role (e.g., data needs, programs, policy levers) Potential for bundling of substance use screening and intervention activities How to incorporate these issues into a broad women’s health umbrella?

Limitations Low response rate Self-reporting Geographic limitations

Development of capacity- building opportunities for local health departments Promotion of increased community and clinical collaboration to reduce substance-exposed pregnancies Additional data analysis performed and a summary report disseminated (Fall 2011)

Acknowledgements R. Louise Floyd, DSN, RN Team Leader, FAS Prevention Team Joe Sniezek, MD, MPH Chief, Prevention Research Branch Mary Kate Weber, MPH Public Health Analyst Prevention Research Branch Molly Schlife, MPH Project Coordinator Katie Brandert, MPH, CHES Acting Associate Director of Programs Laurin Kasehagen Robinson, MA, PhD Senior CDC MCH Epidemiologist Assignee to CityMatCH Adjunct Assistant Professor in Pediatrics

Contact for more information Molly Schlife, MPH Project Coordinator, CityMatCH (402)