Identifying the Prevalence of Perinatal Substance Abuse in Santa Clara County

1
Identifying the Prevalence of Perinatal Substance
Abuse in Santa Clara County
Karen Miyamoto, PHN Maternal, Child Adolescent
Health Program

• September 2004

2
Background Information
Senate Bill 2669

• In 1990, California Senate Bill 2669 was passed
  requiring positive toxicology screening of
  infants at the time of delivery for women
  assessed for substance abuse.
• Toxicology positive infants were to be reported
  to local Public Health Departments. Counties
  were mandated to establish protocols for local
  hospitals to screen and assess these women.

3
Prior to SB 2669

• No data available at the county or state level
  to determine the prevalence of perinatal
  substance abuse.
• No standardized protocols or procedures for
  hospitals when reporting
• No concerted effort to identify perinatal
  substance abuse until 1994

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What happened after SB 2669 was introduced?

• In 1994, a multidisciplinary team of health
  professionals from the PHD was established to
  educate birthing hospital staff regarding SB
  2669.
• Staff were trained on protocols for assessing
  women.
• Staff were provided instructions on reporting
  toxicology positive infants to the PHD.
• 2000 a user friendly Perinatal Substance Abuse
  (PSA) website was developed.

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Santa Clara County, CaliforniaPerinatal
Substance Abuse Protocol
PRENATAL SCREENING ASSESSMENT

• This protocol presupposes that all women of
  childbearing age will have been given
  information by their health care provider
  regarding the health effects of alcohol and drugs
  including tobacco.
• Purpose
• To assist prenatal care providers in screening
  and assessing a pregnant womans risk for alcohol
  and/or other drug abuse and determining if
  referrals for further services are indicated.
• When to Use
• On all new obstetrical patients
• Should be repeated each trimester or
  periodically, as indicated

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Supplemental Prenatal Screening Health
Questionnaire
Negative Prenatal Screening Questionnaireperiod
ic inquiries about alcohol/drug use at prenatal
visits
Positive Prenatal Screening QuestionnaireRefer
for Substance Abuse Assessment
If drugs/alcohol becomes and issue or concern
Assessment indicates no alcohol/drug problem.
Inform prenatal care provider.

• Assessment indicates alcohol/drug problem Joint
  planning with prenatal care provider regarding
• Referral to treatment
• Obtaining consent for Inter-Agency communication
• Continuing assessment for potential risk to
  infant after delivery
• Referral to Public Health Nurse or home care
  agency for follow-up

Periodic inquiries by prenatal care provider
about alcohol/drug use at prenatal visits.
If drugs/alcohol becomes an issue or concern

• At subsequent prenatal visits
• Follow up teaching
• Reinforce referrals
• Monitor fetus as medically indicated

Distribution Send copy of questionnaire and any
assessments with prenatal record to hospital (or
record results in prenatal record).
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Substance Abuse Assessment Guide Review
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Objectives

• Identify prevalence rates of perinatal substance
  abuse in Santa Clara County
• Assess the resource needs of hospital and other
  health professional staff.

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MethodsApproach developed

• Identification of a toxicology positive infant is
  reported by a Perinatal Medical Social Worker at
  each birthing hospital to the Public Health
  Department.
• Perinatal Protocol Hospital Data Collection Form
  is completed and data is entered by the PMSW to
  the Perinatal Substance Abuse website

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MethodsWebsite Developed

• All Perinatal Medical Social Workers (PMSW) have
  access to the PSA Website. They are given
  passwords and are oriented on how to report via
  website.
• This website is also a venue for the PMSW to
  access information about upcoming trainings,
  exchange information, and receive quarterly
  updates and reports.

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Hospital Activity

• Data Entry Activity - 01/01/2004 to 08/27/2004
• Comm. Hospital of Los Gatos 2 4.65
• El Camino Hospital 2 4.65
• Good Samaritan Hospital 5 11.63
• Kaiser Hospital - Santa Clara 6 13.95
• Kaiser Hospital - Santa Teresa 3 6.98
• O'Connor Hospital 5 11.63
• Other Hospitals 0 0.00
• Regional Medical Center of San Jose 5 11.63
• Saint Louise Regional Hospital 0 0.00
• San Jose Medical Center 0 0.00
• Santa Clara Valley Medical Center 13 30.23
• Stanford University Medical Center 2 4.65
• 43 Grand Total record(s)

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Hospital Activity
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Interventions

• Social Workers report the toxicology positive
  infants to DSS (Department of Social Services)
  and not law enforcement
• Refer the mother infant to the Healthy
  Pregnancy Early Parenting Program (HPEP)

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MethodsQuarterly Meetings

• Communication increased significantly because of
  personal contact with Social Workers via
  quarterly meetings. The meetings are coordinated
  by the PSA Unit.
• At these meetings staff provide technical
  assistance, encourage participation and adherence
  to legislation, and social workers are provided
  an avenue to network and exchange experiences and
  concerns.

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MethodsOur Departments Role.

• Planning, implementing and evaluating all
  activities related to reporting according to SB
  2669 regulations

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Results

• Prior to 2003, 80 of birthing hospitals were
  adhering to the reporting requirement of
• SB 2669.
• Since the convening of the quarterly meetings,
  100 of the birthing hospitals in Santa Clara
  County began reporting.

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Results (continued)

• From 2003 to 2004 there was a 95 increase in the
  number of reports submitted!
• Staff have established a streamlined system of
  reporting, and have developed an environment that
  promotes collaboration and integration of
  expertise.

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Conclusions What are the lessons learned?

• Collaboration sharing of expertise has proven
  to be the greatest component to the success of
  this project.
• Coordination of interaction at regular intervals
  is essential!

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Conclusions What will we do different in
future?

• Equal emphasis will be placed on developing
  similar relationships with OB/GYN practitioners
  and other allied health staff

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Conclusions What is our greatest barrier
facing implementation?

• Demonstrating to practitioners the importance of
  screening and assessing ALL of their perinatal
  patients for substance abuse has been the
  greatest barrier.
• The lack of resources and the ability to access
  all practitioners has also been a challenge.

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Our take home message to you

• We hope you understand that early intervention
  services for infants, and comprehensive substance
  abuse treatment programs for mothers are
  important components to breaking the cycle of
  perinatal substance abuse.

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What are we going to do with the data we are
collecting?

• Data will be used to determine allocation of
  resources and assist in developing intervention
  strategies for improving service delivery in this
  population.