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

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

MEET OUR TEAMWithout their passion, support and willingness to be

innovative and work hard to make a difference, we wouldn’t be successful!

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

The “Perfect Storm”

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

ASBI Works!

FINDINGS: ScreeningFINDINGS: 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

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

Trimester Data

Point of initial BI:

46% first trimester

56% drinking

37% second trimester

14% drinking

17% third trimester

11% drinking

0

10

20

30

40

50

60

70

80

90

100

1st Trimester 2nd Trimester 3rd Trimester

Drinking

At Risk

RESULTS:

97% abstain from further alcohol use after initial Brief Intervention and

99% after 2 Brief Interventions

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

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!