Indiana Prenatal Substance Use

Prevention Program

Terrell W. Zollinger, DrPHEvaluation Consultant

Healthy Women, Healthy Hoosiers Conference

October 7, 2011

Robert M. Saywell, Jr, PhD, MPH◦ Health Economist

Jennifer Burba, BS◦ Data Manager

PSUPP team◦ State Director◦ Site Directors

Colleagues…

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

Outline

Mission of PSUPP:

To prevent birth defects, low birth weight deliveries, premature births, and other adverse outcomes associated with substance use during pregnancy

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

History of PSUPP

Location of PSUPP Sites

Floyd

Lake Porter

LaPorte St.Joseph

Elkhart LaGrange Steuben

Newton

Jasper

Starke

MarshallKosciusko

Noble DeKalb

Pulaski FultonWhitley Allen

Benton

White CassMiami Wabas

hHuntington

WellsAdams

Carroll

Howard

Grant

Blackford

JayWarren

Tippecanoe

ClintonTipton Madison Delawar

e RandolphFountain Mont

gomery Boone Hamilton

Vermillion

Parke

PutnamHendricks Marion Hancock

Henry

Wayne

Vigo

Clay

Johnson

MorganShelby

Rush

Fayette Union

Sullivan Greene

Monroe

Owen

Brown Bartholomew

DecaturFranklin

Knox

Daviess Martin

LawrenceJackson

Jennings

RipleyDearborn

Gibson

PikeDubois

Orange

Washington Scott

Jefferson Switzerland

Ohio

Crawford

Harrison

Clark

PoseyWarrick Spencer

Perry

Vander-burgh

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

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

Staff

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

Services Provided

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

Evaluation Methods/Processes

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

Data Flow

Results

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

2010 Screenings/Clients

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

Reduction Rates

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%

Changes in Knowledge/Attitudes

51.4% of smokers indicated that the information provided by PSUPP helped them cut down or quit

70.3% of alcohol users indicated that the information provided by PSUPP helped them cut down or quit

80.5% of drug users indicated that the information provided by PSUPP helped them cut down or quit

Satisfaction with PSUPP

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

Return on Investment

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

Objectives Met

Next Steps

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

Future Focus of PSUPP

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)

FY 2012 PSUPP Goals

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

Evaluation Focus

Questions???