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FASD Prevention: Alcohol Screening And Brief Intervention In The WIC Program

FASD Prevention: Alcohol Screening And Brief Intervention In The WIC Program. Tracey Waller MBA, RD/LD WIC Program Supervisor Public Health - Dayton & Montgomery County twaller@phdmc.org 225-5814. Montgomery County, Ohio. Urban area of Dayton and surrounding suburbs, some rural outskirts

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FASD Prevention: Alcohol Screening And Brief Intervention In The WIC Program

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  1. FASD Prevention:Alcohol Screening And Brief Intervention In The WIC Program Tracey Waller MBA, RD/LD WIC Program Supervisor Public Health - Dayton & Montgomery County twaller@phdmc.org 225-5814

  2. Montgomery County, Ohio • Urban area of Dayton and surrounding suburbs, some rural outskirts • Hard hit by recession- auto manufacturing collapse affected everyone • Approx. 7,000 births per year • About 60% access WIC services • Overall infant mortality rate is 7.6 • 11th in the nation overall • 5th in the nation for African Americans • 5th largest WIC program in Ohio with average monthly caseload of 13,100

  3. Meet our Team Without their passion, support and willingness to be innovative and work hard to make a difference, we wouldn’t be successful!

  4. ASBI Background • Public Health Foundation Enterprises Management Solutions Special Supplemental Nutrition Program for Women, Infants, and Children (PHFE-WIC) conducted an efficacy study on brief intervention as a technique to help low income minority women achieve abstinence from alcohol during pregnancy • Results showed that women in the brief intervention condition were five times more likely to report abstinence after intervention compared to women in the assessment only condition. • Newborns whose mothers received brief intervention had higher birth weights and birth lengths, and fetal mortality rates were 3 times lower. American Journal of Public Health, 2007; 97(2):252-258) http://www.ajph.org/cgi/content/abstract/97/2/252

  5. The “Perfect Storm” • Timing • Enthusiasm/Energy • Support downstream-- Incredible WIC Staff • Support upstream-- Incredible WIC management at the local and state level • Luck! The right thing at the right time

  6. The Prevention Project Goals: • Screen all pregnant women enrolling in the WIC Program in Montgomery County • Provide Brief Intervention to all who screen positive • Follow women receiving Brief Intervention during their pregnancies • Develop a process for referral to treatment services • Incorporate maternal alcohol history in infant’s pediatric file

  7. ASBI Works! FINDINGS: Screening • 11,159 total screened (100%) • Very little resistance screening • Brief Intervention (BI) • 546 eligible for BI (5%) • 519 BI given (95% of those eligible) • 35% reported drinking during 30 days prior to screen • across all trimesters • 65% received BI because of TWEAK score only- no current use

  8. Results: • Point of initial BI: • 46% first trimester • 37% second trimester • 17% third trimester • 2.5% high school age <18 • 16.0% under drinking age <21 • 9.9% age 35 or older • 21% less than HS • 41% HS grad/GED • 38% College • 98% non-Hispanic • 2% Hispanic • 45% African American • 53% White • 12% Other • 88% Unmarried • 12% Married

  9. Trimester Data Point of initial BI: 46% first trimester 56% drinking 37% second trimester 14% drinking 17% third trimester 11% drinking

  10. Results: 97% abstain from further alcohol use after initial Brief Intervention and 99% after 2 Brief Interventions

  11. Revised Screening Tool 1. Before you were pregnant, how often did you drink beer, wine, or other alcoholic beverages?  4 or more times a week  2-3 times a week  2-4 times a month  Monthly or less  Never 2. Currently, how often do you drink beer, wine, or other alcoholic beverages?  4 or more times a week  2-3 times a week  2-4 times a month  Monthly or less  Never 3. Currently, how many drinks do you usually have at one time? 10 or more 9 8 7 6 5 4 3 2 1 0 4. Within the last month, how many times have you had 3 or more drinks at one time? 10 or more 9 8 7 6 5 4 3 2 1 0 5. How many drinks does it take until you feel the effects of alcohol? 10 or more 9 8 7 6 5 4 3 2 1 0

  12. Conclusions: • Enhanced screening identifies more alcohol use than standard WIC questions • Brief Intervention halts alcohol use during pregnancy • Misinformation about alcohol use during pregnancy rampant • Alcohol use during pregnancy not limited to one demographic • ASBI can be fully integrated into many existing systems Social change takes time Brief Interventions can make it happen!

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