Indiana Prenatal Substance Use Prevention Program

1. Indiana Prenatal Substance Use Prevention Program Terrell W. Zollinger, DrPH Evaluation Consultant Healthy Women, Healthy Hoosiers Conference October 7, 2011

2. Colleagues… • Robert M. Saywell, Jr, PhD, MPH • Health Economist • Jennifer Burba, BS • Data Manager • PSUPP team • State Director • Site Directors

3. Outline • Mission • History, Locations, Target Population • Staff, Services Provided • Methods/ Processes Used for Monitoring and Evaluation • Outcomes: • Reduction/quit rate • Changes in beliefs/knowledge/attitudes • Satisfaction with program • Return on investment • Next Steps

4. Mission of PSUPP:To prevent birth defects, low birth weight deliveries, premature births, and other adverse outcomes associated with substance use during pregnancy

5. History of PSUPP • Began in 1988 as a Indiana State Department of Health initiative (Lynn Bailey) • Funded by the Division of Mental Health and Addictions • Included 5 sites: Gary, Ft. Wayne, Indianapolis, Jasper, Terre Haute serving 5 counties • Now 14 sites serving 25 counties

6. Location of PSUPP Sites

8. Target Population • High-moderate risk of poor birth outcome due to substance use: 57.3% of those screened in FY 2010 • Young: 32.4% less than age 21 • Racial minorities: 27.2% PSUPP vs. 13.0% in Indiana • Hispanics: 16.8% PSUPP vs. 5.4% in Indiana • Less educated: 38.6% have less than high school education

9. Staff • Nurses, Social Workers, Counselors • Trained in the best practices to counsel substance users • Required to participate in continuing education • Hosted by clinics, health departments, and similar organizations

10. Services Provided • Screening pregnant women at first prenatal care visit to identify those at risk • Provide a series visits for individual counseling sessions • Provide printed material • Connect clients to other services • Provide information to health care providers • Provide information to the community

11. Evaluation Methods/Processes • At the first visit, administer a screening tool and administer baseline knowledge/attitude survey • At delivery administer a substance use survey • At termination (3-6 months after delivery) administer a substance use survey • At termination administer follow-up knowledge/attitude survey • Administer satisfaction survey to a sample

12. Data Flow • Screening, Knowledge/Attitude, and Satisfaction questionnaires completed by client using a paper form • The paper form is copied, copy for medical record, original to evaluators • Paper forms are scanned, verified, and placed in an electronic database • Delivery and Termination forms completed by PSUPP staff and entered directly into the database • Provide quarterly and annual data reports

13. Results

14. 2010 Screenings/Clients • 4,609 individuals screened • 1,348 PSUPP clients delivered • 2,074 PSUPP clients terminated • 190 at delivery • 678 1-3 months post-partum • 411 3-6 months post-partum • 752 before delivery

15. Reduction Rates • 49.6% of 700 smokers at entry reduced or quit before delivery; 28.7% quit • 84.0% of 50 alcohol users at entry reduced or quit before delivery; 16.0% quit • 75.3% of 85 drug users reduced or quit before delivery; 24.7% quit

16. Changes in Knowledge/Attitudes • Comparing the follow up survey responses to the baseline respondents found that participants were substantially more knowledgeable or had stronger beliefs that substance use during pregnancy was harmful • Examples: • “Definitely not Okay” for pregnant women to smoke: 67.6% to 84.9% • Exposure to secondhand smoke considered “very harmful”: 77.9% to 90.1%

17. Satisfaction with PSUPP • 51.4% of smokers indicated that the information provided by PSUPP helped them cut down or quit • 70.3% of alcohol usersindicated that the information provided by PSUPP helped them cut down or quit • 80.5% of drug usersindicated that the information provided by PSUPP helped them cut down or quit

18. Return on Investment • PSUPP prevented an estimated 79 pre-term deliveries • PSUPP prevented an estimated 17 low birth weight deliveries • Total health care costs averted was $4.8 million • Cost of PSUPP was $915,000 • ROI =$5.25 for every dollar spent on PSUPP

19. Objectives Met • Targets were set for 20 objectives (reduction in substance use, number of contacts, low birth weight rates, number of presentations given, etc.) • Target values were achieved for 16 of the 20 objectives

20. Next Steps

21. Future Focus of PSUPP • Enrolling high risk women • Particular focus on tobacco use during and after pregnancy • Improving the value of PSUPP services. • Increasing the knowledge of pregnant women about effects of substance use • Improving the efficiency of PSUPP

22. FY 2012 PSUPP Goals • GOAL 1: PROVIDE SERVICE TO SUBSTANCE USING CLIENTS (comparing Screening and Delivery forms) • GOAL 2: REDUCE SUBSTANCE USE AMONG CLIENTS DURING PREGNANCY (comparing Screening and Delivery forms) • GOAL 3: REDUCE SUBSTANCE USE AMONG CLIENTS POST-PARTUM (comparing Screening and Termination forms) • GOAL 4: CLIENTS WILL FIND PSUPP TO BE VALUABLE (from Client Satisfaction Survey) • GOAL 5: CLIENTS WILL BE MORE KNOWLEDGEABLE ABOUT THE HARMFUL EFFECTS OF SUBSTANCE USE (from Delivery or Termination Client Opinion Survey)

23. Evaluation Focus • Reduce number of objectives from 20 to 8 • More focus on outcome, less on process • Improve ROI estimates • Give sites reasonable targets for objectives • Gather success stories

24. Questions???