# Presentation: 254486

## Colorado

- Fetal Alcohol Syndrome Prevention Program

## FAS Prevention Project

- Funded by Centers for Disease Control and Prevention
- Five year cooperative agreement (2003-2008)
- Eight states
- Three parts
- Prevention of alcohol exposed pregnancies
- Monitoring of FAS births
- Linking children and families with services

## Project Partners

- Colorado Department of Public Health and Environment (CDPHE)
- Colorado Responds to Children with Special Needs
- University of Colorado Health Sciences Center (UCHSC)
- UCHSC/AHEC State FAS Prevention Outreach Project
- UCHSC/JFK Partners Program
- OMNI Research & Training Institute of Denver (Evaluation)

## Colorado Primary Investigators

- Dr. Pamela Gillen, RN, ND, CAC III
- April Montgomery, MHA

## CDPHE-CRCSN Background

- Based at state health department
- Colorado Responds to Children with Special Needs (CRCSN) – Birth defects monitoring and prevention program established in 1989
- FAS prevention and surveillance since 1991 with funding from CDC
- One of 5 states to develop a population-based surveillance system for FAS (FASSNet)

##  CRCSN Activities

- Registers 7000 children annually
- Refers 3000 children annually to 64 local public health departments
- Surveillance and/or prevention
- Birth defects		Neural tube defects
- Autism			Muscular dystrophy
- Fetal alcohol syndrome

## UCHSC Background  

- FAS Prevention Outreach Project
- Statewide prevention program since 1996 funded by ADAD
- Steering Committee member National FASD Center for Excellence

## UCHSC/AHEC Activities

- Statewide training and technical assistance
- Health & human service providers
- Families & children affected by prenatal alcohol exposure
- FAS curriculum development
- Women in alcohol treatment programs
- Substance abuse treatment providers
- Health and human service providers

## Colorado FAS Prevention Project

- Goal One:  Prevent prenatal alcohol exposure to children born to women at high risk of consuming alcohol during pregnancy
- Goal Two:  Identify cases of FAS and generate population-based estimates of the prevalence of FAS

- Goal Three:  Link children affected by prenatal alcohol exposure and their families to appropriate services
- Goal four:  Assure that providers receive education and training on: FAS case identification, identification of high risk women, and appropriate services

## Colorado Activities

- Intervention with women
- FAS case identification
- Linking children and families with services
- Training of service providers
- Evaluation

## Case Identification

- Adapt and simplify the Colorado FASSNet System to identify cases and generate population-based estimates of the  prevalence of FAS

## Surveillance Project Area

- Eight Counties
- Adams 		Arapahoe
- Boulder		Brighton
- Denver		Douglas
- Jefferson		Larimer

## Linking to Services

- Identify  children with FAS and prenatal alcohol affects
- FASLink (surveillance) sources
- Referrals from agencies
- Health Care Program for Children (HCP) with Special Needs
- Public health programs such as WIC, Family Planning,
- 	public health nurses
- Social services
- Alcohol and drug treatment

## Linking to Services

- Identify appropriate services and address barriers to accessing those services

## Linking to Services

- Provide assistance in referring children and families to services
- Health Care Program for Children (HCP) with Special Needs
- Family support groups
- Early intervention - Part C of IDEA
- Part B of IDEA
- Educational system
- Other

## Education and Training

- Train providers and professionals to identify children with prenatal alcohol exposure and refer them to appropriate services and resources

## Expected Outcomes of Stepped-Care Intervention and Community Level Intervention

- A reduction in alcohol use rates among childbearing age women
- An increase in contraceptive measures
- An increase in self-efficacy and improvement in quality of life indices
- A decrease in unplanned pregnancies

## Recruitment MethodsStepped Care Intervention

- Incentives
- Brochures
- Provider
- Client
- Posters
- On-site recruitment
- Referral sources

## Referral Sources

- Family Planning
- WIC
- Pregnancy Testing/ Medicaid Eligibility
- Department of Human Services
- Mental Health
- Schools
- Shelters
- Judicial
- Health care providers

-    Self Referral
-    Community Level
-    Detox
-    Treatment Centers

## Recruitment MethodsCommunity Level Intervention

- Radio show
- Radio/commercial
- Clinic video
- TV ad
- Bus ads
- Newspaper- article and press release
- Online paper
- Posters, flyers, brochures

## Intervention Messages

- -If you party, Party Wise
- -Missed a period? Don’t drink period
- -If you drink don’t get pregnant, if you’re pregnant don’t drink
-    Unprotected sex
- + Risk Drinking
- -----------------------------
- = Alcohol Exposed Pregnancy

## Media Campaign Messages

- Pregnancy - NOT NOW!
- If you drink don’t get pregnant. Drinking alcohol while pregnant is
- the leading known cause of preventable mental retardation and birth
- defects.
- Thinking About Pregnancy...
- Drinking alcohol while pregnant is the leading known cause of
- preventable mental retardation and birth defects.
- Pregnant...
- Now is the time to stop drinking! No kind of alcohol is safe to drink during
- pregnancy. Drinking alcohol while pregnant is the leading known cause of
- preventable mental retardation and birth defects.

## Intervention Activities

- Identify women who are high-risk for consuming alcohol during pregnancy
- Pregnant women – risk drinking
- Women with prenatally alcohol exposed children
- Women of childbearing age who drink at risk levels and use contraception ineffectively

## Intervention Activities

- Stepped care Model– Public Health Nurse/Social Worker
- Group Intervention
- Brief intervention (2 visits, 2 follow-up phone calls)
- Short term case management (3-6 months)
- Specialized intensive case management (3 years)

## Community Level

- Personal Decisions is a “self-guided” phone
- intervention program for changing risky
- alcohol-related choices among women in their
- childbearing years.
- Women will receive
- Personalized feedback from a healthcare professionals
- 	(those who qualify)
- Step-by-step motivational tools to improve healthdecisions (those who qualify)
- Program resources about alcohol use and abuse
- Do’s and Don'ts of contraceptive use
- Detailed information on fetal alcohol spectrum disorders
- Clinic information to receive no-cost or low-cost
- 	health care
- Referrals to other FAS-PACE interventions

**Notes:**
Or referral to community or Personal Choices/skills/support

## Group Choices

- FASD Education
- Self-assessment of
-    drinking and
-    contraceptive use
- Goal Setting

## Personal Choices/new theme “Party Wise”

- 2 visits/2 phone calls
- Assist in self-assessment, provide feedback and set goals around drinking and contraception use

## Personal Skills

- 3-6 months
- Ongoing sessions to develop skills needed to achieve goals around alcohol and contraceptive use

**Notes:**
Attitude, Knowledge, skill, situational support

## Personal Support

- Up to 3 years
- Long term case management for pregnant clients or those with a significant alcohol abuse history

## Evaluation 

**Data collection consists of retrieving process and outcome-level information from program participants at **
**	****baseline, three months and six months after intervention **

**Follow-up data collection efforts will consist of phone interviews for women participating in Personal CHOICES and in-person interviews for Personal SKILLS and Personal SUPPORT participants. **

## Evaluation - Process

- Number of childbearing aged women screened
- Number who screened positive for risk of an alcohol-	exposed pregnancy
- Number offered the intervention, number who 	refused/accepted
- Number receiving other services in connection with 	intervention (e.g., family planning, drug and alcohol 	treatment services, mental health services)
- Number/type of sessions program participant received
- Race, ethnicity, income level of participants

## Evaluation -Outcome

- The impact of intervention on the woman’s knowledge and attitudes about alcohol use during pregnancy or when at risk for pregnancy
- Changes in the amount and pattern of alcohol before and after the intervention
- Risk for an alcohol-exposed pregnancy – contraceptive use
- Types of services used from other community service agencies to support and maintain behavior change
- Women’s report of services they needed but were unavailable or 	inaccessible to them
- Increased self efficacy
- Improved life health domains