FASD Prevention: Alcohol Screening And Brief Intervention In The WIC Program Tracey Waller MBA, RD/LD WIC Program Supervisor Public Health - Dayton & Montgomery County [email protected] 225-5814
Jan 13, 2016
FASD Prevention:
Alcohol Screening And Brief Intervention
In The WIC Program
Tracey Waller MBA, RD/LD
WIC Program Supervisor
Public Health - Dayton & Montgomery County
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!