ASAP I
The Alcohol Screening Assessment in Pregnancy (ASAP) Project was developed in collaboration with the Massachusetts Title V agency, Massachusetts Department of Public Health (MDPH) Bureau of Family and Community Health (BFCH), MDPH/Bureau of Substance Abuse Services (BSAS), and the Institute for Health and Recovery (IHR) to motivate prenatal care providers to universally screen pregnant women for alcohol and other drug use and abuse and to provide a brief intervention and referral for services when indicated.
The goals of the ASAP Project were to train prenatal care staff to screen pregnant women for alcohol and other substance use and abuse, to normalize conversations about these issues, to motivate obstetric care staff to universally screen pregnant women, and to deliver brief interventions in the event of a positive screen. Findings from the training evaluation data, Screening Checklist and discussions with obstetric provider staff indicate that the ASAP Project successfully achieved its goals.
ASAP Project staff trained 118 obstetric care staff on the 5 P’s Screening Tool and the rationale behind universally screening pregnant women and 175 obstetric care staff on Brief Interventions Interviews with staff and patients both during the Project and at the end of the Project also showed support for the ASAP Screening Tool, Brief Interventions and protocols.
The data show that pregnant women were far more likely to screen positively if the 5 P’s Screening Tool included parental, peer, partner, past, and smoking rather than just current use alone. Together, these questions identified another 32% of the population as being at risk for substance use/abuse, supporting the use of these questions in future screening protocols to identify the greatest number of at-risk women and promote healthy birth outcomes.
Pregnant women screened at the participating community health centers and Harvard Vanguard's multi-specialty private practices received ASAP Brief Interventions more than half the time (57%), regardless of whether or not they had screened positive to any substance use or abuse risk factors. More than three-quarters (77%) of the pregnant women who screened positive for a risk factor appropriately received a Brief Intervention.
Prenatal staff participating in the ASAP Project generally considered it a positive experience and often mentioned feeling that the Screening Tool was effective. Most sites stated that they will continue to use the Screening Tool after Project termination. Some staff said that the tool made it easier for them to discuss alcohol and other substance use with their patients and felt that their patients were more likely to talk about their use in the context of looking at risk factors other than solely their own use. Staff mentioned that the Screening Tool and the ASAP Brief Intervention made it easier to initiate interventions than it had been prior to ASAP because ASAP helped formalize protocols.
The ASAP Project clearly fulfilled its goal of motivating obstetric care staff to universally screen pregnant women. The data indicate that using a “wider” screening tool utilizing the 5 substance use/abuse risk factors plus smoking rather than “Current Use” alone will identify significantly more pregnant women who are at-risk for substance use and abuse. The results of this evaluation support the continued use of the Screening Tool in obstetric care practices. Furthermore, the ASAP training and support model proved to be an effective way to distribute information and materials and to support prenatal staff in adopting the Screening Tool and Brief Intervention Protocols into their practices.
ASAP II
"The ASAP model is an exceptional model."
"It helped by pinpointing areas of higher risk for an OB patient" and "gave another way to frame the conversation by giving concrete suggestions on how to talk with patients about this issue."
"The training and continued technical assistance has allowed us to enhance our awareness of substance abuse programs for our pregnant patients. We are much more comfortable in strongly recommending a "no use" standard for all patients to give the newborn a better start in life."
The Alcohol Screening Assessment in Pregnancy 2 (ASAP2) Project is built on the success of the original ASAP Project (ASAP 1) by addressing lessons learned and expanding the project to include two additional screening protocols, evaluation of the screening and brief intervention protocols and tools, and patient follow-up procedures. The ASAP2 Project is a three-year project funded by the federal Maternal and Child Health Bureau though the Massachusetts Department of Public Health Bureau of Family and Community Health in collaboration with The Institute for Health and Recovery to:
- motivate prenatal care providers to routinely screen for alcohol and other drugs during three routine prenatal visits
- train prenatal care providers in the value and use of the screening tool
- establish protocols for the determination and utilization of appropriate interventions
- facilitate adoption of screening and brief intervention tools through technical assistance, ongoing consultation and training
- strengthen the cross-system linkages for resources
- create practice-based knowledge products for routine screening, intervention and referral.
To motivate prenatal care providers to routinely screen for alcohol and other drugs, the ASAP2 Project engages participating prenatal care providers by providing information and training concerning the impact of alcohol and drug use in pregnancy.
To train prenatal care providers in the value and use of the 5 P'S screening tool, based on the 4 P'S developed by Hope Ewing, M.D. (1990) and adapted by IHR (1999), participating prenatal care providers are assisted in embedding the 5 P'S into a self-administered questionnaire designed by each site.
To establish protocols for the determination and utilization of appropriate interventions, the ASAP2 Project trains clinical staff at each site in NIAAA's brief intervention model and works with the staff to incorporate this model into their existing framework of patient counseling and education.
To develop a support system of care to provide ongoing screening and appropriate brief intervention, the ASAP2 Project provides ongoing support for providers for problem solving and resource identification that is easily accessible and available during prenatal care office hours. A public education/media campaign was implemented to normalize the conversations about use of alcohol and other drugs during pregnancy. The project continues to be showcased at national and statewide conferences and through provider mailings.
To strengthen the cross-system linkages for resources, the ASAP2 Project provides opportunities for interaction between providers of prenatal services and substance abuse services. In addition, both service delivery systems are educated about the services the other provides and methods by which they can be accessed.
To create practice-based knowledge products for routine screening, intervention and referral, the ASAP Project developed a training curriculum for prenatal providers on the use of the screening tool, brief intervention and clinical decision tree/protocols to foster the replication of the ASAP model. The Alcohol Screening Assessment in Pregnancy Curriculum is a compilation of the resources and training from ASAP, and is designed to assist prenatal care staff in replicating the ASAP model. These materials were designed to answer questions about alcohol, tobacco and other drugs and pregnant women; to increase the level of comfort on the part of prenatal care staff to talk with women about these issues; and to assist in the implementation of alcohol, tobacco and other drug use screening and brief interventions for pregnant women. The information included in the curriculum is a collection of training materials, research and resources that will give prenatal care staff the tools and confidence to normalize the conversation around substance use. The curriculum was written in an accessible format that will make implementation possible and practical. For information on how to purchase this curriculum, please refer to IHR "Products."
Evaluation of the ASAP2 Project is conducted by Health and Addictions Research, Inc. and works in collaboration with other organizations and professionals in designing and implementing research and evaluation projects that have practical applications for practice and policy. The fundamental concept guiding the evaluation is that success will require a participatory process among multiple stakeholders. Evaluation will focus on seven primary questions:
- Can prenatal care staff be motivated to provide screening and brief intervention as part of their routine practice during three prenatal visits?
- Can the system of prenatal care be improved through integration of the alcohol/drug use screening tool into three routine prenatal visits?
- Can the system of prenatal care be improved by linking screening for alcohol and other drug use to a brief intervention during the same prenatal visit?
- Will technical assistance, consultation and training delivered by project staff facilitate the implementation of project?
- Are linkages between prenatal care providers and substance abuse providers strengthened by this project?
A variety of materials and methods are utilized including Training Evaluation Forms, a Monthly Contact Log, a Provider Background Information Form, and a Screening/Intervention Checklist.