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Screening and Intervention Programs

Pine Belt Mental Healthcare Resources

Intervention Type

FASD Prevention Subcontractors
(Project CHOICES)

Project Contact Information

Pine Belt Mental Healthcare Resources
Jackie McDougle, M.Ed, M.S., LPC, NCC, FASD Project Director
103 South 19th Avenue
Hattiesburg, MS 39401
Phone: 601-544-4222, ext. 147
Fax: 601-584-4053

Project Summary Statement

Pine Belt Mental Healthcare Resources (PBMHR) is a community mental health service provider in south Mississippi. PBMHR offers a comprehensive system of care which utilizes multiple evidence-based practices and case management services to improve the quality of life of persons suffering from mental illness. Over the past five years, PBMHR incorporated prevention interventions into this system of care, including initiatives designed to prevent HIV/AIDS and alcohol/substance abuse. Given the scientific evidence which indicates a nexus between mental illness and alcohol abuse, incorporating a prevention intervention aimed at curbing alcohol-involved pregnancies indeed fits within PBMHR’s mission.

Project CHOICES was selected as the mechanism to combat fetal alcohol spectrum disorders. The primary objectives of PBMHR’s FASD Prevention Project are to reduce and/or eliminate alcohol consumption and increase effective contraception use of sexually active women who are able to become pregnant. PBMHR has integrated Project CHOICES as a component of treatment for women who are ages 18-44, able to become pregnant, and failing to use effective contraception. Potential participants are generally drawn from three points of interception:

  1. current clients,
  2. new clients, and
  3. the Forrest County jail.

Potential participants are pre-screened to identify obvious exclusionary criteria (e.g., hysterectomy). Women meeting eligibility criteria who are interested in the program then complete the comprehensive screening process. Those meeting eligibility criteria are then placed in the CHOICES program. Project CHOICES utilizes motivational interviewing sessions as a mechanism of behavior change. Clinicians delivering the motivational interviewing sessions focus on providing prevention messages in various formats (e.g., brochures, presentations, etc.) in order to increase participants’ commitment to change their behaviors regarding alcohol consumption and effective contraception use.

The CHOICES intervention consists of four motivational interviewing sessions and a contraceptive counseling session. Participants are assessed at baseline (screening), completion (end of program), six months post-completion, and twelve months post-completion.

PBMHR has accomplished several important project milestones. First, key staff members have received training regarding the delivery of the CHOICES intervention. Utilizing multiple clinicians to deliver the intervention allows PBMHR to provide CHOICES as a treatment option in multiple locations. Second, a CHOICES Task Force has been established to provide guidance to and oversight of project staff. The Task Force is multidisciplinary and includes people with backgrounds in mental health, prevention, and research. Third, PBMHR has developed agency policies which govern identification, referral, and service delivery procedures of the CHOICES initiative. Additionally, PBMHR staff members who are not directly associated with the project are well informed about the purpose and availability of CHOICES as a treatment component for female clients. Finally, PBMHR has fully integrated CHOICES into its system of care, which will facilitate the continuation of FASD preventions efforts subsequent to the end of the project’s funding period.

During this reporting period, 58 of the 59 referred for comprehensive screening were eligible to receive the CHOICES intervention. All eligible women agreed to participate. Participants included women in residential treatment and women in community-based settings. In total, 25 women (43.1%) completed the CHOICES intervention, 26 women (44.8%) left treatment AMA (and therefore discontinued the program), and 7 women are still active participants. Of the 11 women who were eligible for six month follow-up, 3 were lost and efforts to locate the remaining 8 are currently underway. No participants were eligible for 12 month follow-up. As such, results regarding alcohol consumption and effective contraceptive use only reflect behavior changes from screening to end of program assessment.

To date, preliminary results indicate that the CHOICES intervention is indeed successful at reducing and/or eliminating alcohol consumption and increasing effective contraception use of women who are able to become pregnant. Women in both residential treatment and community settings decreased alcohol consumption in multiple categories, including the average number of days drinking, average number of drinks per day, and instances of binge drinking. Although no women in community settings reported abstinence from alcohol at End of Program (EOP), 100% of women in residential treatment reported abstinence.

Regarding contraception, 50% of women in residential treatment and 27% of women in the community reported effective use. Although preliminary results are extremely positive, several key issues remain to be addressed. First, women in residential treatment settings have less access to alcohol and contraceptive devices than their community counterparts. As such, alcohol use among this population may be reflective of access rather than behavior change and measures of alcohol use may be overestimated. Concomitantly, measures of effective contraception use may be underestimated. Second, no follow-up information was available during this reporting period.

Although current data indicate that CHOICES has had a positive impact, the magnitude of that impact can only be measured at time points subsequent to the EOP assessment. This issue is certainly applicable to the residential treatment population and women in jail, in that participation in residential treatment requires abstinence from alcohol and the availability of alcohol in jails is somewhat sparse.

Finally, PBMHR must work to increase completion rates for CHOICES participants. Although a completion rate of 43% is certainly a positive process indicator, more focus should be placed on retention efforts. Specifically, many of the women who dropped out of the program began CHOICES activities while in jail. Many women had no desire to continue the program subsequent to their release. As such, specific attention will be given to finding a remedy to combat attrition rates among this group.

In conclusion, Project CHOICES has had a positive impact on many PBMHR clients and women in jail. Current service identification, referral, and delivery procedures seem to be working well, and agency staff members have come to accept CHOICES as an excellent treatment component. Although some barriers have been identified (e.g., low follow-up rates, low completion rates of women in jail, etc.), CHOICES staff continue to collaborate on methods to improve program operations.