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Community Approaches to Prevention and Early Intervention. Jan Campbell, R.N., B.S.N. Sue Spooner, R.N., C.P.N.P. January 2007. “Hand of Hope”. The tiny hand of 21-week-old fetus Samuel Alexander Armas emerges from the mother’s uterus to grasp the finger of Dr. Joseph Bruner. The Problem.

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Community approaches to prevention and early intervention

Community Approaches to Prevention and Early Intervention

Jan Campbell, R.N., B.S.N.

Sue Spooner, R.N., C.P.N.P.

January 2007


Community approaches to prevention and early intervention

“Hand of Hope”

The tiny hand of 21-week-old fetus Samuel Alexander Armas emerges from the mother’s uterus to grasp the finger of Dr. Joseph Bruner.


The problem

The Problem

Perinatal Substance Abuse


National pregnancy and health survey
National Pregnancy and Health Survey

  • Illicit drugs 5.5%

    • Cocaine 1.9%

    • Marijuana 2.9%

  • Alcohol 18.8%

  • Tobacco 20.4%


Crt vs samhsa data substance use in pregnancy
CRT vs. SAMHSA Data:Substance Use in Pregnancy


Riverside county substance exposed babies
Riverside CountySubstance-Exposed Babies

  • Preliminary data indicate 13% of women screen positive for substance use

  • In 2004, there were 29,545 births

  • Applying 13%, which is considered a low estimate, 3,841 babies were born exposed to drugs and/or alcohol


San luis obispo county substance exposed babies
San Luis Obispo CountySubstance-Exposed Babies

  • Preliminary data indicate 38.5% of women screen positive for substance use

  • In 2005, there were 2,640 births

  • Applying 38.5% which is considered a low estimate, 1,016 babies were born exposed to drugs and/or alcohol



Alcohol use patterns after knowledge of pregnancy san luis obispo riverside vs ca
Alcohol Use Patterns After Knowledge of Pregnancy:San Luis Obispo, Riverside vs. CA


Predictors of low birth weight
Predictors of Low Birth Weight

Tobacco has a 3x greater impact than cocaine on predicting low birth weight


Tobacco

Tobacco

Decreases oxygen to fetus

Baby is born too early

Small babies (low birth weight)

Nicotine withdrawal

More likely to die from SIDS

Learning and behavioral problems


Marijuana
Marijuana

  • Right after birth

    • Hard time responding

    • Shakes

    • Hard time comforting

  • Long-term affects

    • Trouble paying attention

    • Aggressive behaviors



Cocaine methamphetamines heroin

Cocaine, Methamphetamines, Heroin

Drugs can starve parts of the baby’s body and

prevent it from growing

Can cause stroke or heart attack in the womb

Can cause miscarriage, early birth and nervous

system problems

SIDS

Learning and behavioral problems


Alcohol
Alcohol

  • Low birth weight

  • Small brain with brain damage

  • Heart problems

  • Kidney problems

  • Malformations

  • Facial dysmorphology


Community approaches to prevention and early intervention

Newborn baby boy with pronounced features of FAS and severe heart disease.  Birth weight and length less than 5th percentile for gestational age.


Community approaches to prevention and early intervention

Prenatal alcohol exposure is the leading preventable cause of birth defects, developmental disorders, and mental retardation in children Journal of the National Association of Neonatal Nurses 2005


Community approaches to prevention and early intervention

Cause of FAS/FASD of birth defects, developmental disorders, and mental retardation in children

  • The sole cause of FAS/FASD is women

    drinking alcoholic beverages during

    pregnancy.

  • Alcohol is a teratogen.

“ Of all the substances of abuse (including cocaine,

heroin, and marijuana), alcohol produces by far the most

serious neurobehavioral effect in the fetus”

IOM report to Congress 1996


Fasd facts
FASD Facts of birth defects, developmental disorders, and mental retardation in children

  • 100 percent preventable

  • Leading cause of preventable mental retardation

  • Not caused on purpose

  • Can occur anywhere and anytime pregnant women drink

  • Not caused by biologic father’s alcohol use

  • Not a new disorder


Fasd and the brain
FASD and the Brain of birth defects, developmental disorders, and mental retardation in children

  • Prenatal alcohol exposure causes brain damage.

  • Effects of FASD last a lifetime.

  • People with an FASD can grow, improve, and function well in life with proper support.


Fas and the brain
FAS and the Brain of birth defects, developmental disorders, and mental retardation in children


Effects of alcohol on the brain
Effects of Alcohol on the Brain of birth defects, developmental disorders, and mental retardation in children


Fas cns effects
FAS: CNS Effects of birth defects, developmental disorders, and mental retardation in children

  • Mental retardation

  • Developmental delays

  • Hyperactivity

  • Behavior problems

  • Speech/language dysfunction


People with fasd have difficulty
People with FASD have difficulty: of birth defects, developmental disorders, and mental retardation in children

  • Following instructions

  • Discerning the difference between truth and fiction

  • Thinking about abstract concepts

  • Organizing

  • Storing and retrieving information

  • Understanding social expectations

  • Comprehending and responding to other people’s feelings

  • Bonding or building personal attachment and trust


Alcohol dose
Alcohol Dose of birth defects, developmental disorders, and mental retardation in children

  • 1 drink/week

    • Hyperactive and aggressive behaviors

  • Moderate to heavy use

    • Delinquent behavior and overall problem behavior

  • Any alcohol use pregnancy

    • 3.2 x risk for delinquent behavior


Comparing fasd to other birth defects
Comparing FASD to Other of birth defects, developmental disorders, and mental retardation in children Birth Defects


Estimated number of fas
Estimated Number of FAS of birth defects, developmental disorders, and mental retardation in children

  • Fetal Alcohol Syndrome (FAS)

    1 in 500 births

  • Combined estimated number of FASD

    5 in 500 births

    Journal of the National Association of Neonatal Nurses 2005


Economic cost of fas
Economic Cost of FAS of birth defects, developmental disorders, and mental retardation in children

  • Cost the nation $5,400,000,000 in 2003.

  • Each individual with FAS will cost US $1,500,000 to $3,000,000 in his or her lifetime.


If you are pregnant or think you could be pregnant do not use any

Message of birth defects, developmental disorders, and mental retardation in children

If you are pregnant or think you could be pregnantDO NOT USE ANY:

  • Alcohol (beer, wine, liquor)

  • Tobacco/Marijuana

  • Illicit drugs (methamphetemines, heroine, cocaine)


What now
What Now? of birth defects, developmental disorders, and mental retardation in children


Community collaboration

Community Collaboration of birth defects, developmental disorders, and mental retardation in children

Development of a Community Team


Who should be on a community team
Who Should be on a Community Team? of birth defects, developmental disorders, and mental retardation in children

  • People with passion

  • Respected leaders in the community

  • People with passion

  • People with the authority to commit resources and make decisions

  • People with passion


Community team considerations
Community Team Considerations of birth defects, developmental disorders, and mental retardation in children

  • Knowledge

    • Obstetrics

    • Public Health Nursing

    • Child Protective Services

    • Mental Health

    • Substance Abuse Treatment

    • Healthy Start ( if it exists in the community)

  • Community orientation

  • Authority and influence

  • Size

  • Compatibility

  • Consumer representation


Community team example

Director Maternal and Child Health of birth defects, developmental disorders, and mental retardation in children

Director Mental Health

Director Substance Abuse Treatment

Director Child Protective Services

Director Healthy Start

Public Health Nursing

Obstetrician

Pediatrician

County Board of Supervisors

Presiding Judge, Drug Dependency Court

Community Team Example


The community team considerations
The Community Team Considerations of birth defects, developmental disorders, and mental retardation in children

  • Make sure there is representation from “the basic six”

  • Recruit people with a community orientation

  • Seek people who are respected in the community

  • Invite those with authority of influence

  • Keep the group a manageable size: 8-12

  • Make sure team members are compatible

  • Involve consumers in a useful and respectful way


The leadership institute
The Leadership Institute of birth defects, developmental disorders, and mental retardation in children

  • A 3½ day learning and planning experience

  • Intended to give the team a shared understanding of the key issues in substance use among pregnant and parenting women

  • Designed to produce an initial plan for the team to use as the members return to their community


The core intervention
The Core Intervention of birth defects, developmental disorders, and mental retardation in children


Where do we start
Where of birth defects, developmental disorders, and mental retardation in children Do We Start?


Successful implementation of a perinatal screening assessment referral and treatment program
Successful Implementation of birth defects, developmental disorders, and mental retardation in children of a Perinatal Screening, Assessment, Referral and Treatment Program


How do we begin
How Do We Begin? of birth defects, developmental disorders, and mental retardation in children

Build your support services

  • Referral and treatment

    • Mental Health

    • Drug and Alcohol

    • Private psychologist and therapist


Training
Training of birth defects, developmental disorders, and mental retardation in children

  • It is important to train your provider prior to implementation of the SART Program

    • Dinner with providers and wives/husbands

    • Key note speaker - a physician knowledgeable and respected in the area of perinatal substance use


Establish a good support system
Establish a Good of birth defects, developmental disorders, and mental retardation in children Support System

  • Needs to be integrated as a routine part of prenatal care (not a psychosocial issue but a health issue)

    • This is a health issue for all pregnant women

  • Present the program as a complete package

    • Provide assessment forms

    • Instructions/staff training (ongoing basis)

    • Collection of Data

    • Educational Materials

      • “I am concerned” brief intervention

      • Pamphlets


Referral process
Referral Process of birth defects, developmental disorders, and mental retardation in children

  • Easy to use

    • Clear easy to use forms

    • Minimal information to fill out

    • Contact numbers answered by a person

  • Followed up in a timely manner

    • Contact clients within 2 to 3 days

  • Feedback to the physician

    • Respond back to referring physician regarding outcome of referral


Share data
Share Data of birth defects, developmental disorders, and mental retardation in children

  • Give feedback on screening data to physician on a regular basis

    • Physician’s practice compared to overall

      county results


Value of respect
Value of Respect of birth defects, developmental disorders, and mental retardation in children

  • Respect professionalism of OB providers by

    • Providing scientific proof

    • Best Practices

  • Respect provider’s time by

    • Bringing all necessary materials

    • Providing training and ongoing support

  • Respect provider as a partner by

    • Visiting as often as necessary

    • What can we do for you


Community approaches to prevention and early intervention

Respect provider’s commitment to SART by of birth defects, developmental disorders, and mental retardation in children

Acknowledging their contribution

Respect provider’s commitment to their

patients’ means

Providing accurate and timely feedback

Respect provider’s interest in real results

means

Working with other agencies to make sure

referrals are acted upon


What does a screening program look like

What does a screening program look like? of birth defects, developmental disorders, and mental retardation in children


The sart system
The of birth defects, developmental disorders, and mental retardation in children SART System

  • Screening

  • Assessment

  • Referral

  • Treatment


Screening
Screening of birth defects, developmental disorders, and mental retardation in children

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

  • PartnerDoes your partner have a problem with alcohol or drugs?

  • PastHave you ever drunk alcohol?

  • 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 many beers did you drink?

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


Assessment
Assessment of birth defects, developmental disorders, and mental retardation in children

  • What?

  • When?

  • How much?


Referral a brief intervention
Referral: A Brief Intervention of birth defects, developmental disorders, and mental retardation in children

  • “I am concerned….”

  • Abstain from drugs or alcohol

  • “I see you are upset….”

  • Come to consensus

  • Refer: a “warm handoff”


Treatment level of care
Treatment: Level of Care of birth defects, developmental disorders, and mental retardation in children

neg “handshake”

pos FA - brochure

4P’s+FA+pretreatment

group

outpatient

residential

I

II

IIIa

IIIb

IVa

IVb


The perinatal substance abuse 4p s plus assessment program
The Perinatal Substance Abuse of birth defects, developmental disorders, and mental retardation in children 4P’s PlusAssessment Program

  • Seeks to address the impact of alcohol, tobacco and illicit drug use during pregnancy and the benefits of early intervention

  • Works with prenatal providers on integrating substance abuse screening, assessment and referral as a routine part of prenatal care

  • Focuses on the education of the professional community and the community at large regarding the impact of alcohol, tobacco and illicit drugs during pregnancy and the benefits of early intervention


Funding
Funding of birth defects, developmental disorders, and mental retardation in children


Community approaches to prevention and early intervention

Helped fund Leadership Team of birth defects, developmental disorders, and mental retardation in children

Funded 2 years of training and consultation with

National Training Institute (Dr. Ira Chasnoff)

Provided funding for infrastructure for Beginnings


March of dimes
March of Dimes of birth defects, developmental disorders, and mental retardation in children

  • Funded

    • Printing of brochures, posters

    • Trainings

    • Media campaigns


Maternal child and adolescent heath title v funds
Maternal Child and Adolescent Heath of birth defects, developmental disorders, and mental retardation in children Title V Funds

  • Licensure of 4P’s Plus assessment tool

  • Purchase of “I am concerned” brief intervention books

  • Printing of 4P’s Plus assessment tool

  • Staff two positions for perinatal substance abuse program

  • Educational materials


The california endowment
The California Endowment of birth defects, developmental disorders, and mental retardation in children

  • Pamphlets

  • Website

  • Posters


Federal grants
Federal Grants of birth defects, developmental disorders, and mental retardation in children

  • Healthy Start


Local resources
Local Resources of birth defects, developmental disorders, and mental retardation in children

  • Universities

    • Cal Poly San Luis Obispo

      • Graphic arts and photography for poster

      • Web design

  • Community Foundations

    • Preventive Health Grants

  • Hospitals


Community approaches to prevention and early intervention

We Can Make A Difference of birth defects, developmental disorders, and mental retardation in children


For more information please call for questions or additional information
For more information… of birth defects, developmental disorders, and mental retardation in children Please call for questions or additional information:

Jan Campbell, MCAH Director, San Luis Obispo

(805) 781-5592

Sue Spooner, MCAH Director, Riverside

(951) 358-5192


Thank you
Thank you of birth defects, developmental disorders, and mental retardation in children