Upload
christmas
View
18
Download
0
Tags:
Embed Size (px)
DESCRIPTION
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. - PowerPoint PPT Presentation
Citation preview
Community Community Approaches to Approaches to
Prevention and Early Prevention and Early InterventionIntervention
Jan Campbell, R.N., B.S.N.Sue Spooner, R.N., C.P.N.P.
January 2007
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.
“Hand of Hope”
The ProblemThe Problem
Perinatal Substance AbusePerinatal Substance Abuse
National Pregnancy and National Pregnancy and Health SurveyHealth Survey
Illicit drugsIllicit drugs 5.5%5.5% CocaineCocaine 1.9%1.9% MarijuanaMarijuana
2.9%2.9% AlcoholAlcohol 18.8%18.8% TobaccoTobacco 20.4%20.4%
CRT vs. SAMHSA Data:CRT vs. SAMHSA Data:Substance Use in Substance Use in
PregnancyPregnancy
0%
5%
10%
15%
20%
25%
Alcohol Tobacco IllicitDrugs
CRT/4P'sPlusSAMHSA
Riverside CountyRiverside CountySubstance-Exposed Substance-Exposed
BabiesBabies Preliminary data indicate 13% of Preliminary data indicate 13% of
women screen positive for substance women screen positive for substance useuse
In 2004, there were 29,545 birthsIn 2004, there were 29,545 births
Applying 13%, which is considered a Applying 13%, which is considered a low estimate, 3,841 babies were born low estimate, 3,841 babies were born exposed to drugs and/or alcoholexposed to drugs and/or alcohol
San Luis Obispo CountySan Luis Obispo CountySubstance-Exposed Substance-Exposed
BabiesBabies• Preliminary data indicate 38.5% of Preliminary data indicate 38.5% of
women screen positive for substance women screen positive for substance useuse
• In 2005, there were 2,640 birthsIn 2005, there were 2,640 births
• Applying 38.5% which is considered a Applying 38.5% which is considered a low estimate, 1,016 babies were born low estimate, 1,016 babies were born exposed to drugs and/or alcoholexposed to drugs and/or alcohol
Substance Use Rates Substance Use Rates Across California Across California
CountiesCounties
0%5%
10%15%20%25%30%35%40%45%50%
M B SL SB V H A F R
Alcohol Use Patterns Alcohol Use Patterns After Knowledge of After Knowledge of
Pregnancy:Pregnancy:San Luis Obispo, Riverside San Luis Obispo, Riverside
vs. CAvs. CA
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Daily 3-6d/ wk 1-2d/ wk <1d/ wk
SLORiversideCA
Predictors of Low Birth Predictors of Low Birth WeightWeight
Tobacco has a 3x greater Tobacco has a 3x greater impact than cocaine on impact than cocaine on
predicting low birth predicting low birth weightweight
TobaccoTobacco Decreases oxygen to fetusDecreases oxygen to fetus Baby is born too early Baby is born too early Small babies (low birth Small babies (low birth weight) weight) Nicotine withdrawalNicotine withdrawal More likely to die from More likely to die from SIDSSIDS Learning and behavioral Learning and behavioral problems problems
MarijuanaMarijuana Right after birthRight after birth
Hard time respondingHard time responding ShakesShakes Hard time comfortingHard time comforting
Long-term affectsLong-term affects Trouble paying attentionTrouble paying attention Aggressive behaviorsAggressive behaviors
Baby Exposed to Baby Exposed to CocaineCocaine
Cocaine, Cocaine, Methamphetamines, Methamphetamines,
HeroinHeroin Drugs can starve parts of the baby’s Drugs can starve parts of the baby’s body and body and prevent it from growingprevent it from growing
Can cause stroke or heart attack in Can cause stroke or heart attack in the wombthe womb
Can cause miscarriage, early birth Can cause miscarriage, early birth and nervous and nervous system problemssystem problems
SIDSSIDS
Learning and behavioral problemsLearning and behavioral problems
AlcoholAlcohol
Low birth weightLow birth weight Small brain with brain Small brain with brain
damagedamage Heart problemsHeart problems Kidney problemsKidney problems MalformationsMalformations Facial dysmorphologyFacial dysmorphology
Newborn baby boy with pronounced features of FAS and severe heart disease. Birth weight and length less than 5th percentile for gestational age.
Prenatal alcohol Prenatal alcohol exposure is the leading exposure is the leading
preventable cause of preventable cause of birth defects, birth defects, developmental developmental
disorders, and mental disorders, and mental retardation in children retardation in children
Journal of the National Association of Journal of the National Association of Neonatal Nurses 2005Neonatal Nurses 2005
Cause of Cause of FAS/FASDFAS/FASD
The sole cause of FAS/FASD The sole cause of FAS/FASD is women is women drinking alcoholic beverages drinking alcoholic beverages during during pregnancy.pregnancy.
Alcohol is a teratogen.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 FactsFASD Facts 100 percent 100 percent
preventablepreventable Leading cause of Leading cause of
preventable mental preventable mental retardationretardation
Not caused on purposeNot caused on purpose Can occur anywhere Can occur anywhere
and anytime pregnant and anytime pregnant women drinkwomen drink
Not caused by biologic Not caused by biologic father’s alcohol usefather’s alcohol use
Not a new disorderNot a new disorder
FASD and the BrainFASD and the Brain Prenatal alcohol exposure Prenatal alcohol exposure
causes brain damage.causes brain damage.
Effects of FASD last a Effects of FASD last a lifetime.lifetime.
People with an FASD can People with an FASD can grow, improve, and function grow, improve, and function well in life with proper well in life with proper support.support.
FAS and the BrainFAS and the Brain
Effects of Alcohol on Effects of Alcohol on the Brainthe Brain
FAS: CNS EffectsFAS: CNS Effects
Mental retardationMental retardation Developmental delaysDevelopmental delays HyperactivityHyperactivity Behavior problemsBehavior problems Speech/language dysfunctionSpeech/language dysfunction
People with FASD have People with FASD have difficulty:difficulty:
Following instructions Following instructions Discerning the difference between truth Discerning the difference between truth
and fictionand fiction Thinking about abstract conceptsThinking about abstract concepts Organizing Organizing Storing and retrieving informationStoring and retrieving information Understanding social expectationsUnderstanding social expectations Comprehending and responding to other Comprehending and responding to other
people’s feelingspeople’s feelings Bonding or building personal attachment Bonding or building personal attachment
and trustand trust
Alcohol DoseAlcohol Dose 1 drink/week1 drink/week
Hyperactive and aggressive behaviorsHyperactive and aggressive behaviors
Moderate to heavy useModerate to heavy use Delinquent behavior and overall Delinquent behavior and overall
problem behaviorproblem behavior
Any alcohol use pregnancyAny alcohol use pregnancy 3.2 x risk for delinquent behavior3.2 x risk for delinquent behavior
Comparing FASD to OtherComparing FASD to OtherBirth DefectsBirth Defects
0
5000
10000
15000
20000
25000
30000
35000
40000
HIV MD Spina DS FAS FASD
Estimated Number of Estimated Number of FASFAS
Fetal Alcohol Syndrome (FAS)Fetal Alcohol Syndrome (FAS)1 in 500 births1 in 500 births
Combined estimated number of Combined estimated number of FASDFASD
5 in 500 births5 in 500 births
Journal of the National Association of Neonatal Nurses 2005Journal of the National Association of Neonatal Nurses 2005
Economic Cost of FASEconomic Cost of FAS
Cost the nation Cost the nation $5,400,000,000 in 2003.$5,400,000,000 in 2003.
Each individual with FAS will Each individual with FAS will cost US $1,500,000 to cost US $1,500,000 to $3,000,000 in his or her $3,000,000 in his or her lifetime.lifetime.
If you are pregnant If you are pregnant or think you could be or think you could be
pregnantpregnantDO NOT USE ANY:DO NOT USE ANY:
Alcohol (beer, wine, liquor)Alcohol (beer, wine, liquor) Tobacco/MarijuanaTobacco/Marijuana Illicit drugs Illicit drugs
(methamphetemines, heroine, (methamphetemines, heroine, cocaine)cocaine)
Message
What Now?What Now?
Community Community CollaborationCollaboration
Development of a Development of a Community TeamCommunity Team
Who Should be on a Who Should be on a Community Team?Community Team?
People with passionPeople with passion Respected leaders in the Respected leaders in the
communitycommunity People with passionPeople with passion People with the authority to People with the authority to
commit resources and make commit resources and make decisionsdecisions
People with passionPeople with passion
Community Team Community Team ConsiderationsConsiderations
KnowledgeKnowledge1.1. ObstetricsObstetrics2.2. Public Health NursingPublic Health Nursing3.3. Child Protective ServicesChild Protective Services4.4. Mental HealthMental Health5.5. Substance Abuse TreatmentSubstance Abuse Treatment6.6. Healthy Start ( if it exists in the Healthy Start ( if it exists in the
community)community) Community orientationCommunity orientation Authority and influenceAuthority and influence SizeSize CompatibilityCompatibility Consumer representationConsumer representation
Community Team Community Team ExampleExample
Director Maternal and Child HealthDirector Maternal and Child Health Director Mental HealthDirector Mental Health Director Substance Abuse TreatmentDirector Substance Abuse Treatment Director Child Protective ServicesDirector Child Protective Services Director Healthy StartDirector Healthy Start Public Health NursingPublic Health Nursing ObstetricianObstetrician PediatricianPediatrician County Board of SupervisorsCounty Board of Supervisors Presiding Judge, Drug Dependency Presiding Judge, Drug Dependency
CourtCourt
The Community Team The Community Team ConsiderationsConsiderations
Make sure there is representation from “the Make sure there is representation from “the basic six”basic six”
Recruit people with a community Recruit people with a community orientationorientation
Seek people who are respected in the Seek people who are respected in the communitycommunity
Invite those with authority of influenceInvite those with authority of influence Keep the group a manageable size: 8-12Keep the group a manageable size: 8-12 Make sure team members are compatibleMake sure team members are compatible Involve consumers in a useful and Involve consumers in a useful and
respectful wayrespectful way
The Leadership InstituteThe Leadership Institute
A 3½ day learning and planning A 3½ day learning and planning experienceexperience
Intended to give the team a shared Intended to give the team a shared understanding of the key issues in understanding of the key issues in substance use among pregnant and substance use among pregnant and parenting womenparenting women
Designed to produce an initial plan for Designed to produce an initial plan for the team to use as the members return the team to use as the members return to their communityto their community
The Core The Core InterventionIntervention
SScreecreenn
Screen all pregnant women for substance use. Screen all pregnant women for substance use. Largely this is accomplished by making Largely this is accomplished by making screening a fixed part of primary prenatal care.screening a fixed part of primary prenatal care.
AAssesssesss
Those women who screen positive are given a Those women who screen positive are given a field assessment to determine if they are in fact field assessment to determine if they are in fact using drugs. using drugs.
RRefereferThose women who are found to be using drugs Those women who are found to be using drugs are referred to an appropriate type of drug are referred to an appropriate type of drug treatment.treatment.
TTreatreatThose women who are referred to drug Those women who are referred to drug treatment receive quality, gender-specific drug treatment receive quality, gender-specific drug treatment that is appropriate for their treatment that is appropriate for their circumstances.circumstances.
Where Where DoDo We Start? We Start?
Successful Successful ImplementationImplementation
of a Perinatal Screening, of a Perinatal Screening, Assessment, Referral Assessment, Referral
and Treatment Programand Treatment Program
How Do We Begin?How Do We Begin?
Build your support servicesBuild your support services Referral and treatmentReferral and treatment
Mental HealthMental Health Drug and AlcoholDrug and Alcohol Private psychologist and Private psychologist and
therapisttherapist
TrainingTraining It is important to train your It is important to train your
provider prior to implementation provider prior to implementation of the SART Programof the SART Program
Dinner with providers and Dinner with providers and wives/husbandswives/husbands
Key note speaker - a physician Key note speaker - a physician knowledgeable and respected in the knowledgeable and respected in the area of perinatal substance usearea of perinatal substance use
Establish a Good Establish a Good Support SystemSupport System
Needs to be integrated as a routine part of Needs to be integrated as a routine part of prenatal care (not a psychosocial issue but prenatal care (not a psychosocial issue but a health issue)a health issue) This is a health issue for all pregnant womenThis is a health issue for all pregnant women
Present the program as a complete packagePresent the program as a complete package Provide assessment formsProvide assessment forms Instructions/staff training (ongoing basis)Instructions/staff training (ongoing basis) Collection of DataCollection of Data Educational MaterialsEducational Materials
““I am concerned” brief interventionI am concerned” brief intervention PamphletsPamphlets
Referral ProcessReferral Process Easy to useEasy to use
Clear easy to use formsClear easy to use forms Minimal information to fill outMinimal information to fill out Contact numbers answered by a personContact numbers answered by a person
Followed up in a timely mannerFollowed up in a timely manner Contact clients within 2 to 3 days Contact clients within 2 to 3 days
Feedback to the physicianFeedback to the physician Respond back to referring physician Respond back to referring physician
regarding outcome of referralregarding outcome of referral
Share DataShare Data Give feedback on screening data Give feedback on screening data
to physician on a regular basisto physician on a regular basis
Physician’s practice compared to Physician’s practice compared to overall overall
county resultscounty results
Value of RespectValue of Respect Respect professionalism of OB Respect professionalism of OB
providers byproviders by Providing scientific proofProviding scientific proof Best PracticesBest Practices
Respect provider’s time by Respect provider’s time by Bringing all necessary materials Bringing all necessary materials Providing training and ongoing supportProviding training and ongoing support
Respect provider as a partner byRespect provider as a partner by Visiting as often as necessaryVisiting as often as necessary What can we do for youWhat can we do for you
Respect provider’s commitment Respect provider’s commitment to SART byto SART by
Acknowledging their contributionAcknowledging their contribution
Respect provider’s commitment Respect provider’s commitment to their to their patients’ meanspatients’ means
Providing accurate and timely Providing accurate and timely feedback feedback
Respect provider’s interest in Respect provider’s interest in real results real results meansmeans
Working with other agencies to Working with other agencies to make sure make sure referrals are acted uponreferrals are acted upon
What does a What does a screening screening
program look program look like?like?
The The SARTSART System System
SScreeningcreening
AAssessmentssessment
RReferraleferral
TTreatmentreatment
ScreeningScreening PParentsarents Did either of your parents ever have aDid either of your parents ever have a
problem with alcohol or drugs?problem with alcohol or drugs? PPartnerartner Does your partner have a problem withDoes your partner have a problem with
alcohol or drugs?alcohol or drugs? PPastast Have you ever drunk alcohol?Have you ever drunk alcohol?
PPregnancyregnancy In the month before you knew you were pregnant, In the month before you knew you were pregnant,
how many how many cigarettescigarettes did you smoke? did you smoke? In the month before you knew you were pregnant, In the month before you knew you were pregnant,
how many how many beers beers did you drink?did you drink? In the month before you knew you were pregnant, In the month before you knew you were pregnant,
how much how much marijuanamarijuana did you smoke? did you smoke?
AssessmentAssessment
What?What? When?When? How How
much?much?
Referral: A Brief Referral: A Brief InterventionIntervention
““I am concerned….”I am concerned….” Abstain from drugs or Abstain from drugs or
alcoholalcohol ““I see you are upset….”I see you are upset….” Come to consensusCome to consensus Refer: a “warm handoff”Refer: a “warm handoff”
Treatment: Level of Treatment: Level of CareCare
negneg “handshakehandshake”
pospos FA - FA - brochurebrochure
4P’s+4P’s+ FA+FA+ pretreatmentpretreatment
groupgroup
outpatientoutpatient
residentialresidential
I
II
IIIa
IIIb
IVaIVb
The Perinatal Substance Abuse The Perinatal Substance Abuse
4P’s Plus4P’s PlusAssessment ProgramAssessment Program
Seeks to address the impact of alcohol, tobacco Seeks to address the impact of alcohol, tobacco and illicit drug use during pregnancy and the and illicit drug use during pregnancy and the benefits of early interventionbenefits of early intervention
Works with prenatal providers on integrating Works with prenatal providers on integrating substance abuse screening, assessment and substance abuse screening, assessment and referral as a routine part of prenatal carereferral as a routine part of prenatal care
Focuses on the education of the professional Focuses on the education of the professional community and the community at large regarding community and the community at large regarding the impact of alcohol, tobacco and illicit drugs the impact of alcohol, tobacco and illicit drugs during pregnancy and the benefits of early during pregnancy and the benefits of early interventionintervention
FundingFunding
Helped fund Leadership TeamHelped fund Leadership Team
Funded 2 years of training and Funded 2 years of training and consultation with consultation with
National Training Institute (Dr. Ira National Training Institute (Dr. Ira Chasnoff)Chasnoff)
Provided funding for infrastructure for Provided funding for infrastructure for BeginningsBeginnings
March of DimesMarch of Dimes
Funded Funded Printing of brochures, Printing of brochures,
postersposters Trainings Trainings Media campaignsMedia campaigns
Maternal Child and Adolescent Maternal Child and Adolescent HeathHeath
Title V FundsTitle V Funds
Licensure of 4P’s Plus assessment Licensure of 4P’s Plus assessment tooltool
Purchase of “I am concerned” brief Purchase of “I am concerned” brief intervention booksintervention books
Printing of 4P’s Plus assessment Printing of 4P’s Plus assessment tooltool
Staff two positions for perinatal Staff two positions for perinatal substance abuse programsubstance abuse program
Educational materialsEducational materials
The California The California EndowmentEndowment PamphletsPamphlets WebsiteWebsite PostersPosters
Federal GrantsFederal Grants
Healthy Healthy StartStart
Local ResourcesLocal Resources Universities Universities
Cal Poly San Luis ObispoCal Poly San Luis Obispo Graphic arts and photography for posterGraphic arts and photography for poster Web designWeb design
Community FoundationsCommunity Foundations Preventive Health GrantsPreventive Health Grants
HospitalsHospitals
We Can Make A Difference
For more information…For more information…Please call for Please call for
questions or additional questions or additional information:information:
Jan Campbell, MCAH Director, San Jan Campbell, MCAH Director, San Luis ObispoLuis Obispo
(805) 781-5592(805) 781-5592
Sue Spooner, MCAH Director, Sue Spooner, MCAH Director, RiversideRiverside
(951) 358-5192(951) 358-5192
Thank youThank you