The Tri-County Community Action Agency offers a broad spectrum of comprehensive services to those in need including, but not limited to, their Health Center (Primary Care, Behavioral Health, Dental), Head Start and Child Care, Elder Care Services, Fuel Assistance, and Food Pantry. Their Health Center includes a fully-embedded Integrated Behavioral Health (IBH) team made up of IBH clinicians, an SBIRT Community Health Worker, Psychiatric Nurse Practitioner, and support staff. All patients seen at the Health Center who are 12 years old and up are screened for substance use (SU) regularly and at time of follow-up if prior screens were positive - including prenatal patients.
With 1 in 10 pregnant women reporting alcohol use, and with opioid use disorder among pregnant women rising more than 4 times from 1999 to 2014, it became apparent to Tri-County providers that the tool being utilized to assess SU (the CADE-AID) was not specific or sensitive enough to be effective - particularly for women and the prenatal population. It was then decided by the Medical Director and IBH Director that the Health Center would begin using the National Institute on Drug Abuse (NIDA) Quick Screen followed by the Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test (DAST) It was also decided to increase the frequency of screening - shifting from screening at the initial prenatal appointment and post-partum appointment to instead screening at initial prenatal appointment, at 10, 20 and 30-week appointments, and at post-partum appointments.
If a patient is to screen positive at any screening, the medical assistant notifies an IBH team member to conduct a warm hand-off. The BH clinician or the SBIRT Community Health Worker then meet with the patient prior to the medical provider's visit. Screens are reviewed, and the appropriate level of intervention is arranged and provided. SBIRT materials, as well as motivational interviewing, are utilized to gauge the patient's interest in change, and if a patient is interested in change, resources are provided.
Since implementing this screening tool and frequency schedule, Tri-County Community Action Agency has seen positive changes in screening rates - 90 percent at 10-week screenings, 74 percent at 20-week screenings, and 100 percent at 30-week screenings. Over time, they strive to increase their screening rate at 20 weeks, as well as to improve Medical-Assisted Treatment service delivery, continue to train and educate staff, and to onboard a fellow specializing in prenatal health and substance use disorder.
*All information in this write up, including statistics, is from the SBIRT-OB Pilot Presentation on August 15.
NIDA Quick Screen Citation: National Institute on Drug Abuse. The NIDA Quick Screen. Retrieved from https://www.drugabuse.gov/publications/resource-guide-screening-drug-use...