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First Steps PLUS: Yakima First Steps Mobilization Project for Pregnant Substance Abusers 

An Interim Evaluation Report

Executive Summary

The Yakima First Steps Mobilization Project for Pregnant Substance Abusers, known as First Steps PLUS (FS PLUS), is a demonstration project which began providing services in July 1993 and is funded by the Health Care Financing Administration under cooperative agreement No. 11-C-06108/0-02.

This project seeks to improve the health outcomes of pregnant substance-abusing women and their infants by enhancing existing perinatal services provided through Washington's First Steps Maternity Care Program and by integrating and coordinating maternity care services with comprehensive substance abuse intervention services.

Key project objectives are to mobilize the community, especially medical practitioners, to the complex medical health, social, and educational needs of low income, pregnant, substance-abusing women and to complete the continuum of care in the treatment of chemical dependency.

First Steps PLUS Project Components

Major accomplishments of the FS PLUS program during its first two and one-half years of operation are described in this report:

• improved coordination and linkages between maternity care providers and chemical dependency treatment providers, especially via outreach, mobile assessment workers, and maternity case managers;

• implementation of a medical stabilization protocol in a free-standing residential treatment facility (Sundown M Ranch) as an alternative to hospital-based intensive inpatient treatment programs for chemical-using pregnant women (CUP). For women admitted to this facility for primary chemical dependency treatment (N=122),

1. treatment completion rates increased from 57% for women admitted July-December 1993 to 78% for women admitted July-December 1995;
2. the proportion whose first residential admission was in the prenatal period increased from 56% for women admitted July-December 1993 to 76% for admissions during July-December 1994;
3. the average stay at Sundown M Ranch was 18.9 days at an average cost of $120 per day compared to an average stay of 19.5 days for women in CUP programs at an average cost of $256 per day; and
4. only one woman has been discharged for medical reasons.

• county-wide implementation of a screening tool to assess risk of substance abuse.

1. A total of 7,362 screening forms were completed during the first 2.5 years of the project in Yakima County;
2. About 10 percent (191 / 1944) of the women screened were identified as At Risk. If scarce outreach resources were focused only on the At Risk group, nearly 80 percent (55 / 69) of the diagnosed substance abusers would have been targeted, while reducing the proportion of women without a diagnosis who would be followed to approximately 7 percent (136 / 1875).
3. Women identified as At Risk on the screening form are more likely to have an adverse birth outcome than those not so identified. At Risk women were 5.5 times more likely to deliver very prematurely, and 2.6 times more likely to have a low birthweight baby than women who are not identified as At Risk.

Conclusions: This project has demonstrated key methods for improving coordination and linkages between maternity care and chemical dependency treatment providers, increasing the range of treatment options for pregnant substance abusers, and augmenting the content of treatment for chemical dependency among pregnant women. First Steps PLUS has increased access to both medical care and chemical dependency treatment for substance-abusing pregnant women and has changed the standard of care for these high risk women in Yakima County.

 

  

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Modified: Thursday November 17 2005

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