Prevention Strategies for PreNatal Exposure to ATOD: Data from the Zero Exposure Prevention ZEP Proj

1
Prevention Strategies for Pre-Natal Exposure to
ATOD Data from the Zero Exposure Prevention
(ZEP) Project

• M. Scott Young, Ph.D.
• syoung_at_fmhi.usf.edu
• Department of Mental Health Law Policy
• Florida Mental Health Institute
• University of South Florida

Linda Mann, LCSW DACCO Womens Services Cindy
Stephens, BS, CVE DACCO Womens Services
11/17/2005
2
Participating Sites

• Rural Health Clinics (44.8 of screens)
• Dover, Plant City, Ruskin
• Hispanic population, bilingual WRS
• Urban Health Clinic (25.6 of screens)
• Lee Davis
• Other agencies (29.6 of screens)
• Had suspicion or concern about mothers risk for
  substance use (DCF)

3
Womens Resource Specialist (WRS) Data Collection
Procedures

• WRS explains study
• Informed consent obtained
• 2 Brief screening measures administered
• Negative Screen WRS determines appropriateness
  of administering additional measures
• Positive Screen additional measures administered
• Appropriate service referrals made
• Monthly follow-up interviews
• Attempts made to complete monthly follow-up
  interviews to determine service utilization and
  symptom improvement
• Completed until 3 months post delivery /
  pregnancy termination

4
Common Service Referrals

• Parenting classes
• Healthy pregnancy classes
• Comprehensive Evaluation for SA Tx
• Psychiatric evaluation
• Individual case management
• AA / Support Groups

5
Measures

• Baseline Interviews
• Initial Screening
• 4Ps
• TWEAK
• Intensive Screening
• Demographics
• Addiction Severity Index (ASI) Alcohol and Drug
  sections
• AOD Simple Screening Instrument (SSI)
• Treatment Services Review (TSR)
• Trauma Symptom Checklist-40 (TSC-40)
• MINI Mental Health screen (MINI)
• Follow-Up Interviews
• Demographics, ASI, TSR, TSC-40

6
Why Screen Mental Health?

• Mental health symptoms are common in pregnant and
  postpartum women
• Marcus et al., 2003 20 of 3472 pregnant women
  scored above cutoff score on CES-D depression
  measure
• Yet only 13.8 of those positive screens reported
  receiving formal treatment of depression

7
Why the TWEAK?

• Developed by Russell (1994) as an alcohol
  screening tool specifically for pregnant women
• Adopted items from the MAST, CAGE, and T-ACE
• Focuses on current or recent use as opposed to
  historical use
• Dawson et al., 2001
• 404 lifetime drinkers presenting for initial
  visit at 9 prenatal clinics in DC
• Cooney et al, 1995
• Administered to 4,743 African-American women
• More sensitive than either the CAGE or MAST
• Chang, 1999
• 135 pregnant women in Boston
• Sobell et al. (1994)
• Adequate psychometric properties
• Good predictive and concurrent validity

8
Screening with TWEAK

• Tolerance How many drinks does it take for you
  to feel high?
• 2 points if gt5
• Withdrawal Have close friends or relatives
  worried or complained about your drinking in the
  last yr.?
• 2 points if yes
• Eye Opener Do you sometimes take a drink in the
  morning when you first awake?
• 1 point if yes
• Amnesia Has a friend or family member ever told
  you about things you said or did while you were
  drinking that you could not remember?
• 1 point if yes
• Cut Down Do you sometimes feel the need to cut
  down on your drinking?
• 1 point if yes
• Scores Range from 0 to 7
• Cutoff Score
• Positive screen if score 2

9
Why the 4Ps?

• Screening instrument designed to identify
  pregnant women at risk for alcohol or other drug
  use
• Assesses recent alcohol or tobacco use
• Chasnoff, 2003
• Field tested with 1,528 Medicaid-eligible
  pregnant women in Chicago
• 80 African-American, 20 Hispanic
• 27 found to be at risk
• Of positive screens, clinical assessment
  indicated that 35 were actively using alcohol or
  illicit drugs

10
Screening with the 4Ps

• Parents Did either of your parents have
  problems with drugs or alcohol?
• Not scored
• Partner
• Does your partner have any problems with drugs or
  alcohol?
• Is your partners temper ever a problem for you?
• Not scored
• Past Have you ever drunk beer/wine/liquor?
• Not scored
• Pregnancy In the month before you knew you were
  pregnant
• How many cigarettes did you smoke? (1 point if
  any)
• How much wine/beer/liquor did you drink? (1 point
  if any)
• Stop 4Ps if No to both Pregnancy items
• Scores range from 0 to 10
• Cutoff Score
• Positive screen if score 1

11
Screening with 4Ps The Part

• When depressed, nervous, or stressed out, do you
• Smoke marijuana (1 point if yes)
• Have an alcoholic beverage (1 point if yes)
• Take some type of pill or medication (1 point if
  yes)
• Last month
• days per week drank alcohol (1 point if any)
• days per week used marijuana (1 point if any)
• days per week used any drug (1 point if any)
• Month before you knew you were pregnant
• days used marijuana (1 point if any)
• days used any drug (1 point if any)

12
Summary TWEAK vs. 4Ps
13
Screening Rates
Baseline Screens Providing Consent(N125)
Notes Percents represent of total sample.16
participants had positive 4Ps and TWEAK.
14
Positive Screen Rates Urban / Rural
Differences
15
Positive Screens Race
Hispanic
Caucasian
African-American
Positive screen defined as positive on TWEAK OR
4Ps.
16
Positive Screens Marital Status
Other
Married
Living w/ Significant Other
Divorced
Single
Positive screen defined as positive on TWEAK OR
4Ps.
17
Positive Screens Months Pregnant at First
Screen
1 2 Months
8 9 Months
7 8 Months
2 3 Months
6 7 Months
5 6 Months
3 4 Months
4 5 Months
Positive screen defined as positive on TWEAK OR
4Ps.
18
Positive Screens Pregnancy Trimester
3rd Trimester
1st Trimester
2nd Trimester
Positive screen defined as positive on TWEAK OR
4Ps.
19
Additional Substance Use Data Collected from
Positive Screens

• Simple Screening Instrument (SSI)
• Past 6-Month Alcohol and Drug Use
• Addiction Severity Index (ASI) Alcohol and Drug
  Composite Scores
• Past 30-Day Alcohol and Drug Use

20
Positive Screens AOD Simple Screening
Instrument Data
21
Positive Screens Addiction Severity Index
Data
22
Positive Screens MINI Mental Health
Screening Data
23
Positive Screens TSC-40 Subscale Data
24
Positive Screens TSC-40 Total Score Data
25
Conclusions

• High screening rates
• Screening in health clinics can increases access
  to services for a needy population
• 4Ps yields higher screening rates than TWEAK
• Favors 4Ps because screening should cast the
  net wide
• Minimize false negatives
• Tolerate false positives
• Positive screens with either instrument
  identified persons with elevated risk for
  substance use and mental health problems as
  verified by other measures.