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
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
Superior Babies:What’s in a Name?
St. Louis County, Minnesota
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).
Program Goals1. 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.
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.
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
Superior Babies Intervention Support & Advocacy
Support Groups Referrals to Community Resources
Transportation Housing Mental Health Education & Employment Parenting
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?
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
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
Evaluation Methods: Interviews
13 staff members about program strengths and weaknesses.
15 program participants about program processes and outcomes.
Results: Screening & Referral
80% of pregnant WIC clients were screened (122 of 154)
Few WIC clients referred directly to SB
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,
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).
Results:Participant Drug Use PatternsEarly & 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
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%).
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.
Results:Assessments Completed 100% completion
MCH data bases AP database & teaching checklists
80 - 95 % completion Denver II PP data bases Growth charts
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
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
Results: Participant FeedbackThose 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.
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”.
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
Program Weaknesses Staff turnover Large amount of data collection
challenging for staff Referrals of WIC clients needs
improvement
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.
Conclusions Program implementation was successful. Executive summary & full report available
http://www.d.umn.edu/~dfalk/SBeval.html