# Presentation: 398851

## Detroit FAS Prevention Project

- Cheryl Lauber, RN, MSN, DPA
- Michigan Department of Community Health

- Building FASD State Systems Meeting  May 2006

## Challenges of FAS Prevention in Detroit

| Challenge | Numbers | Source |
| --- | --- | --- |
| Live Births 2004:       Black                            			 White | 10,830 2,414  | Vital Records 
 |
| 52% of women drink prior to pregnancy. | 6,887 | PRAMS 2002 |
| 64.9% of black and 37.7% of white pregnancies are unintended. | 7,000 
910 | PRAMS 2002 |
| 4.4% of women drink during pregnancy. | 583 | PRAMS 2002 |

## Surveillance Process

## Substance Abuse Treatment

-  In Detroit and Wayne County 10,225 women age 14-54 were admitted to substance abuse treatment between 2000 and 2004.
-  50% listed alcohol as the primary,  secondary, or tertiary substance of abuse
-  48% had previous substance abuse    treatment episode
-  Average alcohol use: 10.33 days for 30-day
-     period prior to admission

## Demographic Profile of Women in Substance Abuse Treatment

-  66% African American, 30% White
-  53% age 30-44, 44% age 21-29
-  50% with education 12+ years
-  77% never-been married
-  74% unemployed
-  58% with 1+ dependents
-  12% pregnant at the time of admission

## Birth Registry Match

-  2,144 births to 1,680 women in
-      substance abuse treatment
-  88% born in Detroit and Wayne county
-  49% males, 51% females
-  48% matched to women who listed
-      alcohol as the substance of abuse
-  <8% reported alcohol use during
-      pregnancy in the birth certificate

## Birth Defects Registry Match

-  **562 out of 2,144 births found in MBDR**
**     ****49% matched to women who listed alcohol **
**     ****as the substance of abuse**
** ****8 out of 562 had FAS diagnostic code of 760.71 **
**     ****(3.7 – 7.8 per 1,000 births)**
** ****7 extra had the diagnostic code of 742.1 **
**     ****(7.0 – 14.5 per 1,000 births)**
** ****291 out of 562 (52%) had other maternal**
**     ****exposure affecting the fetus**

## Detroit Children with Diagnosis Code 760.71 Identified through Medicaid Files, Hospital Discharge Data and Michigan Birth Defects Registry Databases, Births in 2000 - 2004

**Detroit Children with Diagnosis Code 760.71 Identified through Medicaid Files, Hospital Discharge Data and Michigan Birth Defects Registry Databases, Births in 2000 - 2004**

## Timing of Birth for Woman Who Listed Alcohol as Substance for Treatment 

-  **On average, 3 treatment episodes per women **
**    ****(range:1-24)**
** ****16% of births occurred during SA treatment**
** ****60% of births occurred before SA treatment, **
**     ****32% within a year of treatment admission**
** ****25% of births occurred after SA treatment, 16% **
**     ****within a year of treatment discharge**

##  Birth Defects of Michigan Children and Children of Alcohol Users in Substance Abuse Treatment in Detroit for 2000-2003 

## Relative Risk of Birth Defects of Michigan Children and Children of Alcohol Users in Substance Abuse Treatment in Detroit for 2000-2003

** **

## Project CHOICES

## Project CHOICES Overview

**OUTREACH**

**SCREENING**

**RECRUITMENT**

**M.I. SESSION 1**

**REFERRALS**

**M.I. SESSION 2**

**M.I. FOLLOW-UP SESSIONS**

## Outreach Methods

- Three-panel board of information and pictures about FASD
- Realityworks® simulator doll models of infants with FAS characteristics
- PowerPoint shows for various audiences, from school children to medical providers
- Literature on FASD: brochures, booklets, fact sheets, bookmarks and posters.

## Recruitment

| 2 Mailings | Phone Calls | Clinic Flyers | Referral | One-on-One |
| --- | --- | --- | --- | --- |
| 846 | 416 | 64 | 2 | 42 |
| Total | 1370 recruitment events |  |  |  |

## Screening

| Eligible | Not Eligible | Eligible but Refused | Total Screened |
| --- | --- | --- | --- |
| 59 | 112 | 34  | 205 |

## Motivational Intervention

| Sessions Scheduled | Sessions Completed |
| --- | --- |
| 50 | 20
1st Session: 12/12/05 |

## Client Workbook 

***Michigan Personal CHOICES***
***supports you to***

***Empower yourself.***
***   ******Improve yourself.***
***     ******Reduce the Risks in Your Life.***

**Personal CHOICES**

***Client Workbook***

*Michigan Fetal Alcohol Syndrome Prevention Project*
*Detroit Department of Health and Wellness Promotion*
*1151 Taylor Street, Room 235-C*
*Detroit, Michigan  48202*
*(313) 876-4733 ph (313) 876-4658 fax*

## Self Guided Change

## Media Messages

***#1****:  If you think you have to drink to live, or feel you live to drink, this might be a problem . . . call for help at 1-800 . . *
***#2****:  Excuse me ladies, ****if**** you feel you have to take a drink *_*everyday*_* . . or . . can only have fun *_*when you drink*_* . . this ****just might**** be a problem.  Call us at 1-800 . . . *
***#3****:  If you wake up in the morning and don’t know how you made it home from the party last night, call us . .we want to help you.  Call 1-800 . . .*
***#4****:  If you think you’ve got a problem drinking . . . maybe . . . YOU DO!  Please give us a call at 1-800 STOP NOW {786-7669}.*

## Evaluation

- Process Objectives:
- Recruit and screen 1,000 women of childbearing age in the city of Detroit.
- Enroll 100 women in Personal CHOICES Intervention.
- Screen 25 women through the Self-Guided Change Intervention.

## Evaluation

- Outcome Objectives:
- Identify women drinking 8 or more drinks per week and/or 4 or more drinks in one day
- Identify women not using contraceptives
- Give FASD information to at-risk women
- Give feedback on at-risk behavior
- Give birth control information

## Linking to Services

## FAS Diagnostic Center

- Genetics Clinic – Children’s Hospital
- Outreach – “*FASt*ar”
- Diagnostic Team – Physician, Psychologist
- Case Management – Social Worker
- Evaluations
- About 40 cases per year
- 1/40 FAS; 17/40 FASD
- 30/40 in foster care, adoption, kinship care

## State Systems Building

## Michigan’s FASD System

- FASD State Coordinator – MDCH
- State Task Force – Raising awareness among state agencies to improve service delivery
- Program Advisory Group
- Community prevention grants
- Pilot screening project w/ foster care
- 6 Diagnostic Centers
- Community linking to services grants
- Local parent support groups