Sometimes when youre on heroin or drinking they think you dont care A needs assessment with health c

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Sometimes when youre on heroin or drinking they
think you dont careA needs assessment with
health care services for women with alcohol and
drug problems in Aberdeenshire

• Anni Stonebridge
• Jane Livingston
• Aberdeenshire ADAT
• October 2005

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Background

• Needs assessment, evaluation mapping
• Contrast between numbers of drug alcohol
  exposed pregnancies
• Normative behaviour within normal population
• Rises in womens drinking
• Increased levels of binge drinking
• Local services specialising in drugs
• GOPR framework
• SE guidelines on reproductive health stress
  family and parenting
• Confusing government guidelines

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Methodology

• Literature search
• Mail questionnaire 126 staff (48 return rate)
• Four focus groups (18 staff)
• Thirteen personal interviews
• Perceptions questionnaire to focus groups (gt50
  return rate)
• Qualitative analysis

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Four factor model
Focus on pregnancy antenatal care
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Foetal Alcohol Syndrome (FAS) FASD

• Large prevalence underestimates
• 125 FAS cases reported annually
• Expected rate full FAS 600 annually
• Expected rate FASD 6000 annually
• Lack of national data on maternal drinking
• Diagnostic challenges
• Ineffective assessment
• Little acknowledgement of maternal drinking
• Misdiagnosis confusion with other disorders

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Drinking in pregnancy the economic benefit of
intervention
Attachment problems Social function
problems Dont recognise danger Hypersensitivity C
haotic home life Difficult to parent Educational
failure
Incomplete education Mental health
issues Substance use Criminality Unemployment Inpa
tient care Family breakdown Homelessness Death
COSTS TO THE INDIVIDUAL
Personal concern Changing behaviour
1 in 24 Scottish women develop drinking problems
Provision of information and advice regarding
healthy drinking for women
Screening Information and advice Specialist
support to reduce/abstain
Diagnosis/assessment Specialist educational
input Specialist interventions Foster care Family
support
Social support Housing Criminal justice
costs Inpatient care Substance misuse
treatment Family support Physical illness Etc.
COSTS TO THE PUBLIC
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FAS lifetime costs

• Each FAS birth carries lifetime health costs of
  between 860,000 and 4.2million (US figures
  Harwood 2003)
• US National costs
• Direct costs 3.9billion
• Indirect costs 1.5billion
• Direct costs (actual use of goods or services)
  health care social care criminal justice costs
• Indirect costs (foregone future productivity)
  mortality morbidity disability and criminal
  justice incarceration

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Service delivery factors in Aberdeenshire

• Commitment to joint working
• Wide variations in service availability
• Unclear referral routes specialist support
• Local development of response
• Inconsistent response

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Disclosure

• At the moment I feel ill-equipped to deal with
  it.
• Health Visitor
• 71 of staff surveyed did not feel confident in
  discussing alcohol or drugs
• 77 of staff did not feel competent discussing
  alcohol or drugs
• 50 did not feel comfortable
• 67 requested further training on assessment
  skills, alcohol drugs in pregnancy, management
  strategies for identifying and working with FAS

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Expanded Four Factor Model
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Learning from international good practice

• Collaborative, community-based response
• Comprehensive strategic planning
• Management and care protocols
• Prevention and early identification
• Holistic assessment and program, which
  incorporates education, prevention and
  intervention
• Single Access Model
• Rigorous evaluation
• Even the most high-risk woman can be part of the
  process of planning for her infant

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Routine Enquiry

• When you think of alcoholics you have a vision
  of a down and out.
• Removes the pressure on the midwife to ask the
  right questions in the right way
• Starts to expand the sphere of responsibility for
  identifying individuals with problems
• Has an ongoing impact on culture and attitudes  
• Has an instant effect on displacing sole
  responsibility and increasing confidence  

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Recommendations
Recommendation The chief recommendation we make
is that the current structure requires more
detailed strategic planning and leadership in
this area. Responsible partners within the AADAT
need to work together to identify the core values
that underpin service delivery.
Recommendation In areas services exist, but
often work in isolation. Work is required to
develop referral routes between primary care and
specialist services in all areas across
Aberdeenshire.
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Recommendations II
Recommendation If the decision is taken to find
funding for a new specialist role, we recommend
that the post be divided between education,
awareness raising and research, and clinical
support to midwives as they work in their local
area. Recommendation Based on the data we
have analysed and global responses to substance
misuse in pregnancy, local management protocols
and guidelines not only could be easily produced,
but have been requested by primary care staff in
this study, working in an area where they are
expected to on the whole be generalists rather
than specialists.
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Recommendations III
Recommendation We recommend that action is
taken to develop the Healthy Drinking Homework
booklet and a discreet support service. Recommend
ation Funding has been secured from the
Scottish Executive for initial training events.
Further work is required with midwifery training
to increase the emphasis on substance misuse and
related issues.
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Healthy Drinking Homework Booklet

• Following Routine Enquiry approach
• Early intervention
• Removing pressure on midwife time
• Measuring drinking and delivering advice,
  information and support
• Discussing substance use as a family issue
• Self-completion activity
• Issued to all newly pregnant women at booking

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Recommendations IV

• Recommendation This study has several
  implications for further local research in
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• Evaluating the existing specialist service that
  has informally developed in Fraserburgh
• Developing, piloting and evaluating the Healthy
  Drinking homework booklet
• Evaluating the provision of a discreet
  information and advice support service through
  the internet or help line

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Contact details

•  
• Anni Stonebridge, Aberdeenshire ADAT
• Jane Livingston, Aberdeenshire ADAT
• Ground Floor
• Blelack House
• Logie Coldstone
• Aboyne AB34 5NH
• Email anni.stonebridge_at_aberdeenshire.gov.uk
•