Indiana Prenatal Substance Use Prevention Program Terrell W

Indiana Prenatal Substance Use Prevention Program Terrell W. Zollinger, Dr. PH Evaluation Consultant Healthy Women, Healthy Hoosiers Conference October 7, 2011

Colleagues… � Robert M. Saywell, Jr, Ph. D, MPH ◦ Health Economist � Jennifer Burba, BS ◦ Data Manager � PSUPP team ◦ State Director ◦ Site Directors

Outline � Mission � History, Locations, Target Population � Staff, Services Provided � Methods/ Processes Used for Monitoring and Evaluation � Outcomes: ◦ ◦ Reduction/quit rate Changes in beliefs/knowledge/attitudes Satisfaction with program Return on investment � Next Steps

Mission of PSUPP: To prevent birth defects, low birth weight deliveries, premature births, and other adverse outcomes associated with substance use during pregnancy

History of PSUPP � Began in 1988 as a Indiana State Department of Health initiative (Lynn Bailey) � Funded by the Division of Mental Health and Addictions � Included 5 sites: Gary, Ft. Wayne, Indianapolis, Jasper, Terre Haute serving 5 counties � Now 14 sites serving 25 counties

Location of PSUPP Sites

Target Population � High-moderate risk of poor birth outcome due to substance use: 57. 3% of those screened in FY 2010 � Young: 32. 4% less than age 21 � Racial minorities: 27. 2% PSUPP vs. 13. 0% in Indiana � Hispanics: 16. 8% PSUPP vs. 5. 4% in Indiana � Less educated: 38. 6% have less than high school education

Staff � Nurses, Social Workers, Counselors � Trained in the best practices to counsel substance users � Required to participate in continuing education � Hosted by clinics, health departments, and similar organizations

Services Provided � Screening pregnant women at first prenatal care visit to identify those at risk � Provide a series visits for individual counseling sessions � Provide printed material � Connect clients to other services � Provide information to health care providers � Provide information to the community

Evaluation Methods/Processes � At the first visit, administer a screening tool and administer baseline knowledge/attitude survey � At delivery administer a substance use survey � At termination (3 -6 months after delivery) administer a substance use survey � At termination administer follow-up knowledge/attitude survey � Administer satisfaction survey to a sample

Data Flow � Screening, Knowledge/Attitude, and Satisfaction questionnaires completed by client using a paper form � The paper form is copied, copy for medical record, original to evaluators � Paper forms are scanned, verified, and placed in an electronic database � Delivery and Termination forms completed by PSUPP staff and entered directly into the database � Provide quarterly and annual data reports

Results

2010 Screenings/Clients � 4, 609 individuals screened � 1, 348 PSUPP clients delivered � 2, 074 PSUPP clients terminated ◦ ◦ 190 678 411 752 at delivery 1 -3 months post-partum 3 -6 months post-partum before delivery

Reduction Rates � 49. 6% of 700 smokers at entry reduced or quit before delivery; 28. 7% quit � 84. 0% of 50 alcohol users at entry reduced or quit before delivery; 16. 0% quit � 75. 3% of 85 drug users reduced or quit before delivery; 24. 7% quit

Changes in Knowledge/Attitudes � Comparing the follow up survey responses to the baseline respondents found that participants were substantially more knowledgeable or had stronger beliefs that substance use during pregnancy was harmful � Examples: ◦ “Definitely not Okay” for pregnant women to smoke: 67. 6% to 84. 9% ◦ Exposure to secondhand smoke considered “very harmful”: 77. 9% to 90. 1%

Satisfaction with PSUPP � 51. 4% of smokers indicated that the information provided by PSUPP helped them cut down or quit � 70. 3% of alcohol users indicated that the information provided by PSUPP helped them cut down or quit � 80. 5% of drug users indicated that the information provided by PSUPP helped them cut down or quit

Return on Investment � PSUPP prevented an estimated 79 pre-term deliveries � PSUPP prevented an estimated 17 low birth weight deliveries � Total health care costs averted was $4. 8 million � Cost of PSUPP was $915, 000 � ROI =$5. 25 for every dollar spent on PSUPP

Objectives Met � Targets were set for 20 objectives (reduction in substance use, number of contacts, low birth weight rates, number of presentations given, etc. ) � Target values were achieved for 16 of the 20 objectives

Next Steps

Future Focus of PSUPP � Enrolling high risk women � Particular focus on tobacco use during and after pregnancy � Improving the value of PSUPP services. � Increasing the knowledge of pregnant women about effects of substance use � Improving the efficiency of PSUPP

FY 2012 PSUPP Goals � � � GOAL 1: PROVIDE SERVICE TO SUBSTANCE USING CLIENTS (comparing Screening and Delivery forms) GOAL 2: REDUCE SUBSTANCE USE AMONG CLIENTS DURING PREGNANCY (comparing Screening and Delivery forms) GOAL 3: REDUCE SUBSTANCE USE AMONG CLIENTS POSTPARTUM (comparing Screening and Termination forms) GOAL 4: CLIENTS WILL FIND PSUPP TO BE VALUABLE (from Client Satisfaction Survey) GOAL 5: CLIENTS WILL BE MORE KNOWLEDGEABLE ABOUT THE HARMFUL EFFECTS OF SUBSTANCE USE (from Delivery or Termination Client Opinion Survey)

Evaluation Focus � Reduce number of objectives from 20 to 8 � More focus on outcome, less on process � Improve ROI estimates � Give sites reasonable targets for objectives � Gather success stories

Questions? ? ?