Photo by: Sirisak Chaiyasook

Screening

Assessment

Referral &

Treatment

Our Community’s Efforts• The Carroll County Fetal/Infant Mortality Review

Board and Community Providers noticed an increase in substance abusing pregnant women

• A Community forum was held in April 2008 by the Carroll County Health Department (CCHD). In attendance were various community agencies and providers.

• Following the Community forum, the CCHD and

Alcohol and Drug Abuse Administration (ADAA) attended the monthly Obstetrician’s meeting at Carroll Hospital Center (CHC) to address the concerns of practitioners about methadone dosing in the community.

Our Community’s Efforts• The Local Management Board, CCHD, CHC,

Partnership for a Healthier Carroll County, and Carroll Community College invited Dr. Ira Chasnoff, of the Children’s Research Triangle in Chicago, to speak at workshops on June 17 (providers) and June 18 (community) 2009. 24 practitioners and 165 community members attended.

• A workshop on September 2, 2009 was planned with a speaker from the National Organization on Fetal Alcohol Syndrome (NoFAS). The training offered CEU’s and CME’s.

Scope of the Problem

Carroll County (in County birth data)

• 10/08- 9/09 CHC Deliveries 1,145

• Positive Toxicology Screen 115 (10% of 1,145)

• Special Care Nursery Admissions 248

• Neonatal Abstinence Syndrome admissions 11

Carroll StatisticsFiscal Year Total # of

PregnanciesProjected #

using Alcohol

Actual Referrals to

TX

FY081,749(CY)

All Carroll County births

175(10% of total)

26(15% of

projected #)

FY091,572(CY)

All Carroll County births

157(10% of total)

15(9.5% of

projected #)

FY101,178

Carroll Hospital

Center only

118(10% of total)

12(10% of

projected #)

Common Myths About Substance-Abusing Women

1. Only poor, minority women use drugs and alcohol during pregnancy

2. Women will stop using drugs when they find out they are pregnant

3. If you give an addicted woman a choice between her baby and her drug, she will always choose her baby

Common Myths About Substance-Abusing Women

4. Treatment doesn’t work5. Traditional drug treatment methods

are equally effective for all populations, even across gender and culture

6. By third trimester, it is too late to do anything that will help the baby

Substance Abuse Newborn Complications

• Low birth weight• Prematurity• Failure to thrive

• Sudden Infant Death Syndrome

• Malformations • Brain damage

Review of Pre-Test Questions

Our Community’s ResponseLeadership Institute at Children's Research Triangle Carroll County Team:

Cathy Baker, RN, CCHD, Assistant Director Bureau of AddictionsDr. Michael Beardsley, Carroll County PediatricianMartha Clark, PhD, LCSW, Department of Human Resources, State of Maryland, Policy AnalystSusan Doyle, RN, CCHD, Director Bureau of AddictionsDr. Teresa Fuller, CHC, In House PediatricianLinda Grogan, RN, CHC, Director of Nursing for OB and PediatricsDiane Jackson, MA, Adult Drug Treatment Court CoordinatorCindy Marucci-Bosley, CRNP-OB/GYN, CCHD, Director of NursingJolene Sullivan, Director of Citizens ServicesSuzette Tucker, ADAA, Regional Director & State oversight of

Senate Bill 512Dr. Imelda Udo, Carroll County Obstetrician

Carroll County SART Plan

VisionIt is our vision to:

• Identify pregnant women who use substances and/or who are at risk for depression and domestic violence through uniform screening• Refer at-risk women to programs that will

provide treatment and support• Ensure all children are brought home to a safe

and nurturing environment with ongoing supportive services

Carroll County SART PlanFoundational Beliefs

This plan is based on the following research based knowledge:

1. No amount of alcohol, tobacco, or illicit drug use in pregnancy is safe

2. Parents who are healthy, nurturing, and free from substance use and violence can provide the home that a child needs for healthy growth and development

3. Quality health and human services are effective if they are well matched to the needs of the persons; i.e., gender-specific and culturally appropriate

4. Prevention and early intervention services save lives and save money

5. The health of our community depends on our ability to work together across organizational boundaries

Carroll County SART PlanThree Guiding Concerns

This plan depends on dynamic balance of three guiding concerns:

The health and well-being of children and families affected by alcohol, tobacco, and illicit drugs; depression; and domestic violence

The success of care providers; and The responsible allocation of resources

Carroll County SART Plan

Healthy Children and Families

Successful Effective and Care ProvidersResponsible

Use of

Resources

Role of the Primary Care Provider

• Identify all pregnant women at risk for substance use

• Conduct a field assessment on women who screen positive

• Conduct a brief intervention with all women who have a positive field assessment

• Refer any woman who needs further assessment or treatment to an appropriate program

• Screen for related problems such as: HIV, Hepatitis B, & Hepatitis C infection, depression, and domestic violence

Successful Screening

• Is only a first step in the process of screening, assessment, referral, and treatment

• Over-identifies women at risk for substance abuse, depression, and domestic violence

• Is fast, simple, cost effective, and efficient

The SART System

• Screening

•Assessment

•Referral

• Treatment

Screening Instrument

• Identifies women at risk• Takes only a few minutes • Requires minimal training or expertise• Is most successful when integrated into

the context of primary health care• Is completed at two points during the

woman’s care – at first prenatal visit and at admission to labor and delivery

The 4P’s Plus© Screen for Substance Use in Pregnancy

Parents

• Did either of your parents ever have a problem with drugs or alcohol?

The 4P’s Plus© Screen for Substance Use in Pregnancy

Partner• Does your partner have a problem with

drugs or alcohol?• Is your partner’s temper ever a problem

for you?• Does your partner threaten to hurt or

punish you?

The 4P’s Plus© Screen for Substance Use in Pregnancy

Past• Have you ever drunk beer/wine/liquor?• Have you ever felt out of control or

helpless?• In the past two weeks, have you ever felt

down, depressed, or hopeless? • In the past two weeks, have you lost

interest in doing the things that used to be fun for you?

The 4P’s Plus© Screen for Substance Use in Pregnancy

Pregnancy • In the month before you knew you

were pregnant, how many cigarettes did you smoke?

• In the month before you knew you were pregnant, how much beer/wine/liquor did you drink?

• In the month before you knew you were pregnant, how much marijuana did you smoke?

The 4P’s Plus© Screen for Substance Use in PregnancyFollow-up Questions• Sometimes women feel depressed, nervous,

or stressed out. When this happens to you, do any of the following help you feel better or to relax?– List of positive and negative coping mechanisms

on SART form• And last month, about how many days a

week did you usually drink beer/wine/liquor?• And last month, about how many days a

week did you usually smoke a cigarette?

The 4P’s Plus© Screen for Substance Use in Pregnancy

Follow-up Questions

• And last month, about how many days a week did you usually use marijuana?

• During the month before you knew you were pregnant, about how many days a week did you usually use any drug such as methamphetamine, cocaine, or heroin?

The 4P’s Plus© Screen for Substance Use in Pregnancy

Thank you…

Questions?