1. 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

2. 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

3. Superior Babies: What’s in a Name?

4. St. Louis County, Minnesota

5. 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).

6. Program Goals 1. 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.

7. 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.

8. 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

9. Superior Babies Intervention Support & Advocacy Support Groups Referrals to Community Resources Transportation Housing Mental Health Education & Employment Parenting

10. 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?

11. 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

12. 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

13. Evaluation Methods: Interviews 13 staff members about program strengths and weaknesses. 15 program participants about program processes and outcomes.

14. Results: Screening & Referral 80% of pregnant WIC clients were screened (122 of 154) Few WIC clients referred directly to SB

15. 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,

16. 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).

17. Results: Participant Drug Use Patterns Early & 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

18. 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%).

19. 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.

20. Results: Assessments Completed 100% completion MCH data bases AP database & teaching checklists 80 - 95 % completion Denver II PP data bases Growth charts

21. 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

22. 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

23. Results: Participant Feedback Those 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.

24. 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”.

25. 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

26. Program Weaknesses Staff turnover Large amount of data collection challenging for staff Referrals of WIC clients needs improvement

27. 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.

28. Conclusions Program implementation was successful. Executive summary & full report available http://www.d.umn.edu/~dfalk/SBeval.html