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FASD Research Review

Screening and Intervention Programs

Public Health Dayton and Montgomery County (WIC)

Intervention Type

FASD Prevention Subcontractors
(Brief Intervention)

Project Contact Information

Public Health Dayton and Montgomery County (WIC)
Barbara Jacobs, M.A., RD/LD, Supervisor Bureau of Nutrition FASD Project
117 South Main Street
Dayton, OH 45422
Phone: 937-225-4542
Fax: 937-225-4919
E-mail: BJacobs@phdmc.org

Project Summary Statement

Public Health—Dayton & Montgomery County has integrated the Screening and Brief Intervention project within the WIC prenatal services in Montgomery County, Ohio. The goal of this project is to obtain alcohol abstinence in pregnant women at WIC. The service delivery organization is the Montgomery County WIC Program; clinics are located at five sites within the Montgomery County/Dayton area.

The target population for this project is the women who participate in WIC while pregnant. The Screening and Brief Intervention project supports WIC’s goals of promoting healthy pregnancy outcomes, reducing infant mortality, and providing children with a healthy start in life. Demographics Data The alcohol screening form is given to all pregnant women at WIC as part of the registration process, thus 100% of the women are screened. For OY2, the target population totaled 3,143 women. The race of the target population consisted primarily of White (58.5%) and African Americans (42.1%). For educational status, 52.3% of our target women reported having a 12th grade education or higher, while 26.2% reported less than a high school education. The average age of our target population was 24 years, and only 18.6% of our population reported being married.

Screening

The Montgomery County FASD program uses the TWEAK form for screening for alcohol use. For the target population, 5.9% of the women screened were eligible for the brief intervention. Of those that screened positive, 92% agreed to have the brief intervention.

Baseline Characteristics among Women Who Qualified Based on Screener Score and Women who Qualified Based on Past-30-Day Alcohol Use

Of the women who screened positive for alcohol use, the median number of days that women drank in the past 30 days was 2. These women had a median number of 2 drinks and 50% of these women had 4 or more drinks in one day in the past 30 days. No referrals for additional alcohol treatment services were made.

Intervention Services among Women Who Qualified Based on Screener Score and Women Who Qualified Based on Past-30-Day Alcohol Use

Of the women who agreed to participate in the Brief Intervention, 100% of women did participate based on the past 30 day use. Of those that qualified based on screener score, 99.2% participated. The percent of women who completed the intervention (including 36-week follow-up) was 32.5% for those based on screener score, and 25.9% for those based on past 30 day use. Follow-ups for this program were conducted by phone calls to the women when they reached 36 weeks gestation.

Alcohol Use Outcomes

The percent of women who reported using alcohol in the past 30 days, participated in at least one brief intervention, and then reported a decrease in alcohol use was 92.9%. This percent increased to 97.4 for those women who did not report using alcohol in the past 30 days and participated in at least one brief intervention. One hundred percent of women who reported drinking 1 or more drinks on a typical day when drinking alcohol in the past 30 days at screening, participated in at least 1 BI session, and completed the follow-up visit form at 36+ weeks pregnancy decreased their alcohol use.

Alcohol Use Outcomes among Women Who Qualified Based on Screener Score and Women Who Qualified Based on Past-30-Day Alcohol Use

The percent of women reporting alcohol abstinence at the program exit was 97.7% for those based on the screener score and 92.9% for those based on past 30 day alcohol use. The women who reported abstinence after one brief intervention was 94.7% for those based on the screener score and 85.7% for those based on past 30 day alcohol use.

Post-Partum Follow-up

The percent of women who completed the intervention and agreed to have their maternal alcohol history sent to the child’s physician was 1.9%. Of those who agreed, 100% were sent to the child’s physician. Population Needs Identified and Addressed The following items were identified as barriers of our population at the start of this project:

  • Wait is too long WIC room lacking activities for the children
  • Waiting room overcrowded and noisy Transportation
  • Difficulties getting off work
  • Too much paperwork
  • Appointment too long

Results from the needs assessment found that waiting too long was the most frequently reported barrier to using services. This is particularly relevant to the screening and brief intervention for alcohol use by pregnant women because women receiving the screening and brief intervention will have an additional 15-20 minutes added to their appointment. Long waiting times may contribute to creating an environment at WIC that is noisy and crowded, which was also listed as a leading barrier to accessing WIC services. This in turn could be responsible for another leading barrier to accessing WIC services, that there is nothing for children to do while at WIC. In order to address those population needs, the following steps were taken:

  1. The nutritionists are trained to prioritize the information gathered during the nutrition assessment and provide appropriate counseling. The current WIC nutrition guidelines require the nutritionists to focus on only one or two priority areas per visit, and alcohol use will be a top priority, requiring them to limit conversation in other diet areas and thereby minimize the time it takes to incorporate the brief intervention into the WIC appointment.
  2. If the brief intervention is needed, the nutritionist will have two options, depending on clinic flow and the pregnant woman’s ability to increase her visit time.
    • If possible, the WIC nutritionist will escort the pregnant woman to an unused clinic office to complete the brief intervention privately. The nutritionist will be available to assist and answer questions. The participant’s coupons will be printed while she is completing the brief intervention to assist in time management.
    • If clinic timing does not allow the brief intervention to occur at the initial visit, then she will be scheduled to return to the WIC clinic within one month of the initial visit. Her coupons will be printed at the initial visit for only one month to provide an incentive to return to receive the rest of the coupons.

Annual Evaluation Report 2010-2011 [ 280 KB PDF icon ]