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Screening and Intervention Programs

New York Office of Alcoholism and Substance Abuse Services (OASAS) Bureau of Prevention and Cross-Systems Services

Intervention Type

FASD Prevention Subcontractors
(Project CHOICES)

Project Contact Information

New York Office of Alcoholism and Substance Abuse Services (OASAS) Bureau of Prevention and Cross-Systems Services
Margo B. Singer, MPA, FASD Project Manager, FASD State Coordinator
1450 Western Avenue
Albany , NY 12203
Phone: 518-457-4384
Fax: 518-485-9480
E-mail: MargoSinger@oasas.ny.gov

Project Summary Statement

Brief Overview:

The New York State Office of Alcoholism and Substance Abuse Services (OASAS) is the designated lead State agency for the FASD prevention initiative. The goal of New York’s FASD initiative Project CHOICES is to reduce the number of alcohol-exposed pregnancies for women enrolled in substance abuse treatment, by eliminating alcohol use and providing effective contraceptive choices. The target audience is non-pregnant women age 18-44. Project CHOICES began in 2008, with an overall projection to screen 800 women through May 2012. Current Project CHOICES providers participating in Year OY2 are: Palladia, Camelot Counseling, and Phoenix House of Long Island. Odyssey House withdrew from project in December 2009.

OY2 Objectives.

The OY2 objectives reflect the actual performance from Year One, while incorporating new data for the new sites. There are nine Process Objectives (population, services and systems) and six Outcome Objectives. Process objectives focus on data collection after women are admitted to treatment; Project CHOICES screenings/assessments, MI and Contraceptive Visit participation, tracking and follow-up data. Three distinct outcome objectives were created for alcohol use and use of an effective contraception at: the End-of-Program (EOP), 6-month post intervention and 12-month post-intervention. The objectives were designed from data collected through these data sources: the providers’ Monthly Reports, the ACCESS database, and through site visits/TA.

The principal strategies remain to integrate the Project CHOICES protocol into the clinical framework of each treatment provider, and to provide FASD educational components to address the varying extent that assessments, education, and access related to women’s reproductive health and family planning are included in treatment programs.

In addition to the annual Project CHOICES training, the OASAS Project Team provides a FASD 101 Train-The-Trainers model to train the sites’ staff; on-going training in using MI in Project CHOICES. Another strategy was having each site develop written administrative Policies & Procedures for screening, assessment of women, and overall project implementation.

In Years One and Two, there were three residential provider sites located in NYC, one on Long Island; and a fifth site, an outpatient treatment program in Jamaica, Queens. In OY2, using the OASAS Client Data Base database, all admissions of men and women (18 years and older) totaled 1152 for these sites. To understand the target population, we calculated the total number of women admitted and broke that into two categories

  1. all women ages 18 years and older was 492 (42.7% of total admissions), and
  2. 402 women were 18 to 44 years (82% of all women admitted).

For residential sites, there were 1016 total admissions of men and women. There were 377 women ages 18 years and older (37% of total admissions); of which 298 women were 18 to 44 years (79%). There were 136 admissions of women at the one outpatient site. The total number of women screened was 224 women after data cleaning. Of the 103 (46%) women who were eligible, and 96 (93%) agreed to participate. In OY3, the OASAS Project Team will encourage programs to screen and assess all women who are admitted to treatment, and use their MI to encourage participation.

Methods:

Our Needs Assessment conducted in May 2008 provided the basic information upon which we planned our implementation strategies. Our vision was to start the Project in residential sites and then each year add new treatment sites and geographic locations.

During Years One and Year Two, we learned important implementation lessons which enabled us to develop training and address specific issues to be more successful. Motivational Interviewing (MI) supervision is critical for Project CHOICES (PC) counseling staff for implementation fidelity; the need to educate staff and other patients at the sites on FASD. The OASAS Project Team developed training models to address these issues, including a “FASD 101” Train-the-Trainer for provider staff at the sites who will conduct educational presentations for patients and other staff. The training model includes two formats:

  1. didactic presentations where the Project CHOICES staff presents the information in groups, and
  2. additional training using MI techniques, so PC counselors can conduct individual counseling or group sessions.

During OY2, we recognized another system need to provide coaching of MI sessions which we will accomplish through the development of peer-lead MI coaching and Northrop Grumman’s TA mentoring for PC staff. These combined methods will support implementation fidelity to the Project CHOICES model. Another modification will be the transition in Year 03 to performance contracting for data collection through a tiered incentive payment plan.

Current Accomplishments/Results:

One consistent theme the project experienced at all sites has been staff turnover, organizational overhaul, and management changes. One agency with two participating sites (Odyssey House) had to withdraw from Project CHOICES as a result of such changes. The OY2 Implementation Plan addressed these issues through scheduled site monitoring, monthly conference calls, and customized technical assistance to meet site-specific needs.

In Year Two we observed that our residential programs were having more difficulty than our outpatient site in attracting and retaining women in Project CHOICES. Working with the sites and Northrop Grumman, we devised changes in the screening process, including the delay of when the screening would occur so that potential participants would be more stabilized and ready to participate. The use of patient incentives at various project milestones was also encouraged.

The plan for OY3 is to add more outpatient programs and expand into Upstate NY. In July 2010 we added new outpatient sites in the Capital Region (in Albany), and in the Western region (near Buffalo). This strategy will help to establish Project CHOICES within the entire NYS OASAS service delivery system as we build project sustainability. However, the integration of an evidence-based practice (EBP) into established treatment systems will need at least three full years to become established and considered part of the systems’ natural treatment procedure.

The FASD Task Force, composed of representatives from all Project CHOICES sites, OASAS staff, maternal/child health representatives, community stakeholders, and FASD experts, meets quarterly to advise project implementation. The Task Force also experienced turnover of members and a reduction in attendance. The OASAS Project Team modified the quarterly schedules to accommodate members with phone/video meetings due to travel and fiscal restraints. During the next two years, the Task Force will assist the OASAS Project Team in issues concerning Project CHOICES sustainability and implementation across the OASAS service delivery system.