New York’s Statewide FASD Prevention Initiative

1. New York’s Statewide FASD Prevention Initiative Presentation to BFSS Conference May 10, 2006 Margo B. Singer, MPA NYS Office of Alcoholism and Substance Abuse Services

2. New York was one of ten states funded by Northrop Grumman IT-Health Solutions in November 2004 Overall Project Goal: Reduce the number of cases of FASD by eliminating alcohol consumption by pregnant women

3. The Initiative has Two Phases: PHASE I: November 2004 -- August 2005: • Convene a Statewide Task Force • Conduct a Needs Assessment • Develop a Strategic Plan, including an Implementation & an Evaluation Plan • Funded at $145,000

4. PHASE II: September 2005 -- August 2009 Subcontractors will: • Implement plans • Collect Evaluation data • Document the Implementation process • Funding of up to $325,000 for each of four years is available

5. NYS FASD Project Team Located within the NYS OASAS Division of Prevention & Treatment Services, Bureau of Systems Development & Public Education • Margo B. Singer • Dr. Pat Perry • Dianne O’Connor

6. Required Scope of Work Five required elements: • Create state-level administrative focus • Provide for long-term or sustained funding of FASD services/activities • Develop FASD policies & procedures • Integrate FASD Services into service delivery system (s) • Organize ongoing surveillance and evaluation

7. The Original OASAS Proposal Prevent and reduce FASD Births in NYS by: • Increased outreach, identification & referral of at-risk pregnant women and women of child-bearing years; • Training on FASD for health care professionals working with at-risk women; and • Increased awareness by women of childbearing years about the dangers of alcohol consumption during pregnancy

8. Our Identified Target Audience • Women of childbearing years • Pregnant Women • Women at risk for an alcohol problem

9. State Rates of Female “At Risk” DrinkingFemales age 18-44 years, Past Month Binge or Heavy Drinking Estimated from 2002 BRFSS; U.S. average was 14.9%, or 8.4 million females

10. PIES -- New York’s 4-Pronged Approach • Policy • Intervention • Education • Surveillance

11. POLICY: Statewide FASD Task Force Representatives from: • Five State agencies • Statewide Addictions, Maternal Health and Prevention/Treatment Organizations • Three Intervention Sites (added in Phase II) • FASD “Experts” • Consumers/family members Quarterly Meetings in Albany Advisory role Policy & Information-sharing

12. Task Force Development of 15-point Program & Policy Action Plan • Public Awareness • OASAS-Systems Collaboration • Surveillance • Education & Training

13. INTERVENTION: Possible Service Delivery Systems identified in initial proposal • AOD prevention & treatment system • Family Planning services • Community Health services • Medical services (e.g. OB/GYN services) • Perinatal Health Networks • WIC services • Healthy Families NY Home Visiting Program • Native American communities

14. Task Force Selection of Three Pilot Sites for FASD Interventions: • OASAS treatment system (Kingsboro Addiction Treatment Center) • Family planning clinic (Planned Parenthood of South Central NY) • Healthy Families NY Home Visiting Program (Buffalo Prenatal Network) Each site has a different target population that varies by level of risk for alcohol consumption and effective use of contraception.

15. Our Interventions to Prevent Alcohol- Exposed Pregnancies in NYS • Motivational Interviewing (based on “Project Choices”) • Alcohol Screening & Brief Interventions (NIAAA) • Referral to Family Planning for More Effective Contraceptive Methods Sites are providing FASD educational materials to all consumers – men and women – who access their services

16. Kingsboro Addiction Treatment Center (KATC), Brooklyn Inpatient 28-day Chemical Dependence treatment program Also houses a discrete 20 bed women’s treatment program and a 22 bed women’s residence Funded by: NYS OASAS Target population: Women in treatment 13 state-operated Addiction Treatment Centers Intervention strategies: Up to four MI sessions to reduce alcohol consumption and enhance the effective use of family planning (adaptation of “Project Choices”) Male patients to watch the “Recovering Hope” FASD and have FASD education session

17. Kingsboro Addiction Treatment Center, (KATC) Brooklyn Outcomes to-date: FASD Training conducted for all clinic staff Motivational Interviewing training conducted for all clinic staff (by Linda Sobell) Patients served between January - March 2006: Screened: 69 Received Intervention: 15 Received FASD Education: 69

18. Buffalo-Prenatal-Perinatal Network, Buffalo System: Healthy Families NY home visiting programs Funded by: NYS Office of Children & Family Services Target population: Women at risk for child abuse/neglect --program promotes positive parenting and healthy childhood outcomes 29 program sites (HF is also a national program model) Intervention strategies: Family Support workers will use T-ACE screening and MI techniques to reduce alcohol consumption (for non-pregnant women) and eliminate alcohol consumption (for pregnant woman), and enhance the use of effective family planning services

19. Buffalo-Prenatal-Perinatal Network, Healthy Families NY Home Visiting Program, Buffalo Outcomes to-date: FASD Training conducted for all program staff Motivational Interviewing training conducted for all clinic staff (by Linda Sobell) plus “refresher” training Patients served between January and March 2006: Screened: 110 Received Intervention: 14 Received FASD Education: 55

20. Planned Parenthood of South Central New York, Inc. Binghamton System: Reproductive health providers Funded by: NYS Department of Health 59 family planning service sites at 110 locations Target population: Women of Childbearing Age Intervention strategies: Alcohol Screening and Brief intervention for all women having an initial or annual examination; referral to alcohol treatment if indicated CEO wants to implement interventions at all 6 clinic locations

21. Planned Parenthood of South Central New York, Binghamton Outcomes to-date: FASD Training conducted for all clinic staff Alcohol Screening/Brief Interventions training conducted for all clinic staff Patients served between January - March 2006: Screened: 259 Received Intervention: 64 Received FASD Education: 259

22. Initial findings from the Pilot Sites • Motivational Interviewing techniques fits well with a strength-based approach to working with families in many problem areas • Use of Motivational Interviewing can be a challenge for traditional addiction treatment counselors • Men and non-child bearing women are also interested in FASD information • Clinicians will become more comfortable with interventions over time • Some women were surprised that their drinking placed them at-risk

23. EDUCATION: Current Efforts • NACASA American Indian Regional FASD Trainings Ten tribal Nations and urban populations Any prevention programming targeting Native communities must be consistent with their culture, beliefs and values Subcontractor: Native American Council on Alcoholism & Substance Abuse Inc. www.nacasa.org • FASD Training to WIC Provider Staff System managed by the NYS Department of Health 110 agency sites serving 100,000+ women annually

24. SURVEILLANCE • Goal: Organize ongoing FASD surveillance and evaluation and make recommendations for improvement • Task Force Workgroup Convened in Phase II to examine existing surveillance systems: • CMR - Birth Defects Registry • Statewide surveys to identify Alcohol Consumption among Women of Childbearing Age • Statewide surveys to identify Alcohol Consumption among Pregnant Women • Recommendations to be presented to the Task Force in June

25. OVERALL Project Challenges • Oversight of three “pilot” projects simultaneously • Staff training issues – staff turnover, staff resistance, etc. • Integrating a 'best practice' into a clinical setting as a non-research project • Forging new ground– e.g.. evaluating what is “effective contraception” • Working within state government/political environment • Managing Statewide Task Force with very busy people! • Project sustainability/long-term funding

26. Any questions? Contact me: Margo B. Singer NYS OASAS Division of Prevention & Treatment Services Bureau of Systems Development & Public Education • 518 - 457 – 6206 • 518 - 485 – 2147 FAX • Email: margosinger@oasas.state.ny.us