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Needs Assessment Report

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					Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

                                Needs Assessment Report
                  ALCOHOL SCREENING AND BRIEF INTERVENTION
                            Montgomery County, Ohio

I. Introduction

   A. Purpose of the needs assessment:
      The purpose of the needs assessment will be to determine what the WIC program of
      Montgomery County needs to address to successfully implement the Screening and Brief
      Intervention for Alcohol Use by Pregnant Women in Montgomery County. In addition,
      alcohol treatment services will be assessed for their ability to accommodate referrals that
      result from the Screening and Brief Intervention. A met need is a required service that is
      currently being addressed through the WIC program and/or alcohol treatment service that
      can easily be incorporated into the Screening and Brief Intervention. An unmet need is a
      required service of the Screening and Brief Intervention that is not currently being
      addressed through WIC services or alcohol treatment services that will need to be changed
      or modified as needed to successfully implement the intervention.

      In addition, the needs assessment will address methods of placing the maternal alcohol
      history into the child’s medical record. The needs assessment will identify the strengths
      and weaknesses of the methods available and then determine which of these methods
      would be most effective for the WIC environment. Barriers to placing a maternal alcohol
      history into a child’s medical record will be identified and strategies will be suggested to
      overcome these barriers.

      The needs assessment will also provide information on currently existing community
      resources available in Montgomery County, Ohio to treat pregnant women assessed as
      being at risk of an alcohol-exposed pregnancy. The assessment will identify barriers that
      make it difficult for pregnant women to receive WIC services and additional alcohol
      interventions and suggest strategies that may be effective in overcoming these barriers.

   B. Goal of initiative: The goal of the Montgomery County FASD Prevention Collaborative
      is to reduce the rate of alcohol use among pregnant women in Montgomery County, Ohio.

   C. Selected service delivery system: Public Health Women, Infant and Children (WIC)
      system for services to pregnant women in Montgomery County is selected for the project.
      Public Health Dayton & Montgomery County has agreed to screen pregnant women for
      alcohol use during pregnancy at the five WIC sites in Montgomery County, Ohio. The
      WIC clinic provides nutrition related services to pregnant women. WIC clinic staff will
      screen pregnant women who receive WIC services. Women with a positive screen for
      alcohol use will receive a brief education and support intervention and referrals to
      community resources.




                                                1
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

      Through screening at the WIC clinics in Montgomery County, it is expected that referrals
      will be generated to the substance abuse treatment services of the Center for Alcohol and
      Drug Addiction Services (CADAS). CADAS provides a wide range of chemical
      dependency treatment, prevention and intervention services to help individuals and
      families respond to the devastation of addiction. Services are available for both adults and
      youth and are offered during the day and evenings to accommodate work and school
      schedules. Services for adults are provided in outpatient, intensive outpatient care and
      residential treatment settings. Placement and length of involvement are based upon the
      severity of the problems the individual is experiencing. Whatever the level of care, clients
      participate in individual and group counseling, lecture and discussion groups, family
      counseling and other services determined by the individual’s condition and needs. Highly
      experienced and trained staff guide clients through the recovery process using proven,
      effective methods. All Montgomery County residents are eligible and fees are adjusted
      based upon an ability to pay. This project hopes to identify women early in their
      pregnancy so that women will receive needed substance abuse services to promote
      positive birth outcomes. Prevention activities that increase awareness and education
      related to substance abuse that are currently in place at CADAS will continue.

      In the event that CADAS does not have the ability to accommodate the referral, the
      pregnant woman will be referred to another alcohol treatment provider in Montgomery
      County. The additional providers include:
                         1. DayMont Behavioral Health Care, Inc.
                         2. Eastway Corporation
                         3. Nova House Association, Inc.
                         4. Project C.U.R.E., Inc.
                         5. RCI/Women’s Recovery Center
                         6. Samaritan Behavioral Health, Inc.
                         7. Wright State Physicians, Inc. CAM Program

   D. Population: The target population is pregnant women receiving prenatal services from
      WIC in Montgomery County. There are approximately 7,250 births annually in
      Montgomery County. Based on local prenatal care utilization statistics, approximately
      1200 pregnant women obtain WIC services each year. The target population will be
      reached through implementation of a screening, brief intervention and referral process in
      the WIC clinic in Montgomery County, Ohio.

II. Needs Assessment Methodology
    The needs assessment is a critical component of the FASD prevention planning process for
    Montgomery County, Ohio that will include:

       1. Assessing the capability of WIC sites to incorporate the Screening and Brief
       Intervention for Alcohol Use by Pregnant Women. This will be determined by
       information gathered from service provider interviews (both WIC and CADAS) and
       existing information in the community on barriers to alcohol service in pregnant women.


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Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008


       2. Assessing the capability of WIC sites to routinely place a maternal alcohol history into
       a child’s medical record.

       3. Assessing existing community resources for FASD prevention to determine the
       community’s capability to provide prevention services to women at risk of an alcohol-
       exposed pregnancy.

       4. Conducting a Gap analysis of Met and Unmet needs regarding incorporation of the
       screening and brief intervention into WIC programs and incorporation of the maternal
       alcohol history of the mother into the child’s medical record.

A. Data Collection Sources and Methods

The needs assessment will utilize a variety of data sources to describe the needs of WIC to
incorporate the Screening and Brief Intervention for Alcohol Use by a Pregnant Woman into its
existing program. Needs Assessment data will include:

   Secondary Data
   Secondary data will provide an assessment of the barriers of pregnant women to obtaining
   WIC services, and alcohol services from alcohol treatment agencies. Data will be collected
   and reviewed from existing local data and substance abuse screening programs of pregnant
   women in the community. Available state and national data regarding barriers to obtaining
   alcohol services among pregnant women will also be utilized to assess needs.

   Primary Data – Group Interviews and Individual Interviews
   Interviews will provide an assessment of need based on the perspectives of the WIC
   providers, alcohol referral service providers, and prenatal and pediatric providers of
   Montgomery County. Interviews are expected to give valuable information on effective
   strategies and barriers to implementation of the screening and brief intervention for alcohol
   use by pregnant women and assessment of the capability of WIC to place a maternal alcohol
   history into a child’s medical record. The following groups or individuals will be
   interviewed:
   1. WIC providers of Montgomery County
   2. CADAS providers (regional alcohol treatment facility), and other licensed alcohol
   treatment facilities in Montgomery County.
   3. Prenatal care providers and/or pediatric providers in Montgomery County.

   At least one group interview will be conducted of WIC providers in Montgomery County.
   These interviews are expected to generate valuable strategies for incorporating the screening
   and brief intervention into existing WIC services as well as discussing barriers to
   incorporating the intervention and methods of overcoming these barriers. Additional
   interviews will be conducted as needed.



                                                3
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

   Interviews of providers of alcohol treatment services will provide an assessment of need
   based on the perspectives of the alcohol treatment providers. Agency representatives of all
   alcohol treatment providers in Montgomery County will be invited to participate in the
   interviews either via group or individual interviews. At least 3 interviews will be conducted.

   Interviews will be conducted to obtain information from providers of prenatal care and/or
   pediatric care to gather information on ways to successfully incorporate the maternal alcohol
   history into the child’s medical record. Participants may include PHDMC, Elizabeth New
   Life Center, OBGYNs/midwives and any other prenatal or pediatric providers. At least 3
   interviews will be conducted.

   The Task Force meeting in May 2008 will be utilized to review results of the needs
   assessment and help determine the interpretation of these results. This information will be
   recorded during the meeting and will be summarized for the needs assessment.

   Key questions for the WIC provider interviewers:

    What does WIC already have in place to assist in providing the screening and brief
     intervention to clients?
    What strategies could be used to provide the screening and brief intervention to clients?
    What are the barriers in attempting to provide the screening and brief intervention to
     clients?
    How might barriers be overcome?

   Key questions for interviews of alcohol treatment services:

    Does the alcohol treatment service have the capacity to serve all referrals of the screening
     and brief intervention?
    What type of referral process is already in place that could be utilized if capacity to serve
     referrals is limited?
    What are the barriers in attempting to provide alcohol services for pregnant women who
     have had the screening and brief intervention to clients?
    How might barriers be overcome?

   Key questions for interviews of prenatal/pediatric providers:

    What strategies could be utilized to placing the maternal alcohol record into the pediatric
     medical record?
    What barriers are there in placing the maternal alcohol record into the pediatric medical
     record?
    How might barriers be overcome?




                                                4
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

Assessing Community Resources for FASD Prevention

   An inventory of resources will be developed in order to describe organizations providing
   FASD prevention services currently accessible in Montgomery County. This information
   will be used to conduct the gap analysis. The following information will be collected from
   organizations in Montgomery County that provide services to women at risk for an alcohol-
   exposed pregnancy in order to summarize resources:
        A description of the types of FASD prevention services available
        Number of pregnant clients served by age and race
        Funding levels and sources
        Accessibility of services
        Appropriateness of services
        Barriers to services

Conducting a Gap Analysis

   The gap analysis will consider all quantitative and qualitative data on service needs,
   resources, and barriers to help set priorities for the strategic planning process. Discussion
   questions to guide the gap analysis include:

Maternal Alcohol History Gap Analysis Questions
    What is the best strategy to incorporating a maternal alcohol history into a pediatric file?
    What are the gaps in terms of incorporating the maternal alcohol history into the pediatric
      file?
    Are there any specific reasons/considerations to explain these gaps?
    What are the recommendations to address these gaps?

Community Resource Gap Analysis Questions
   What does the resource inventory say about current FASD prevention efforts to reach
     women at risk for an alcohol-exposed pregnancy?
   Are there any specific reasons/considerations to explain these gaps?
   What are the recommendations to address population gaps?

Intervention Gap Analysis Questions
     What are the gaps in terms of incorporating the screening and brief intervention into
       existing WIC services?
     Are there any specific reasons/considerations to explain these gaps?
     What are the recommendations to address intervention gaps?

Alcohol Referral Services Analysis Questions
    What gaps do pregnant women have in obtaining alcohol treatment services?
    Are there any specific reasons/considerations to explain these gaps?
    What are the recommendations to address alcohol treatment center gaps?



                                                5
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008


B. Needs Assessment Questions

The major questions that the needs assessment will answer include:

      What barriers exist to incorporating the screening and brief intervention for alcohol use
       by pregnant women into existing WIC services?
      What is the best strategy to use to routinely place a maternal alcohol history from WIC
       into a child’s medical record?
      What barriers to accessing or using substance abuse services do pregnant women
       experience or perceive?
      What FASD prevention or related services are available, accessible, and appropriate for
       pregnant women?

III. Results of Needs Assessment

   A. What barriers exist to incorporate the screening and brief intervention for alcohol
      use by pregnant women into existing WIC services?

   Secondary Data
   Secondary data will provide an assessment of the barriers of pregnant women to obtaining
   WIC services

   Research conducted by Woelfel, et al. (2004) identified barriers that deter parents/caretakers
   of infants and children enrolled in WIC from taking full advantage of services provided by
   the program. Eleven barriers were identified as being a barrier sometimes or frequently by
   more than 20% of respondents. These barriers are listed in Table 1.

    Table 1. Eleven largest barriers to accessing WIC services reported by respondents
Barriers                                                        %          Total n
1. Lacking activities for the children                          42          3,115
2. Waiting room overcrowded and noisy                           36          3,160
3. Wait too long                                                48          3,156
4. Wait more than 1 hour to recertify                           27          2,888
5. Nutrition education repetitive                               33          3,042
6. Nutrition education boring                                   27          3,045
7. Stores have different policies about WIC (vendor issues)     29          3,144
8. Not getting right cereal box size (procurement issue)        41          3,139
9. Matching check amount to food in store (procurement)         23          3,139
10. Too little formula                                          38          2,941
11. Too little juice                                            27          3,083




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Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

   Additional barriers reported from 10-20% of respondents that are relevant to participants
   receiving the screening and brief intervention for alcohol use by pregnant women are listed in
   Table 2.

    Table 2. Additional barriers to accessing WIC service that may impact participants
    receiving the screening and brief intervention for alcohol
Barriers                                                        %         Total n
1. Parking                                                      19         2,760
2. Transportation                                               10         3,137
3. Waiting Room unsanitary or not clean                         11         3,156
4. Inconvenient days/hours                                      15         3,146
5. Difficulties getting off work                                15         2,725
6. Rescheduling appointment                                     10         3,122
7. Must bring infant/child (recertification)                    17         2,846
8. Too much paperwork                                           14         2,875
9. Infant/child needs blood work                                11         2,848
10. Too long                                                    14         3,044
11. Not very useful                                             15         3,052
12. Being employed makes it difficult to use WIC                13         2,289


Additional information was gathered from the National Survey of WIC Participants (2001).
Focus groups were conducted of WIC participants. Barriers to receiving WIC services included:
    Distance from home to site
    Neighborhood safety
    Transportation
    Access to parking
    Negative experiences with other social services and WIC agencies
    Time involved in obtaining WIC benefits
    Respondents thought they were not eligible

Data also indicates that nearly half (45.6%) of WIC participants reported that they missed an
appointment (no-show) at least one time.

Primary Data

One group interview was conducted by the WIC director. The interview included nine WIC
employees. In addition, individual interviews were conducted of the WIC director and the
supervisor of the WIC director.

Results from group and individual interviews:
There was a significant amount of overlap in answers from various interviewees. Responses
from interviewees that were similar were combined to avoid repetition.


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Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008


1. Barriers to providing the screening and brief intervention to clients included:
    Time, nutritionists are busy.
    The participant’s willingness to give honest answers and to consider changing a behavior.
    The intervention requires WIC employees to be a social worker or therapist, jobs that
       they are not trained to do.
    Follow up on the referral/feedback as to participant’s progress
    No shows for follow up appointments
    Recall gaps
    Clients will not understand what is considered a drink

2. Are there specific reasons/considerations to explain these barriers/gaps?
    WIC is a screening and assessment program, not a treatment program
    Human nature is variable and cannot be easily predicted
    Each individual has a unique set of circumstances

3. How might these barriers be overcome?
    Improve the counseling skills of the WIC staff
    Skip some of the nutrition talks if time is an issue
    Use materials from the “Not a Single Drop” program and update clinic materials that are
      faded and older
    Have a pleasant environment for the women filling out the workbook/paint the walls/put
      up posters in nice frames
    Have participants fill out the workbook while their coupons are being printed as this
      gives her a reason to stay

4. What does WIC already have in place to assist in providing the screening and brief
intervention to clients?
     An environment with posted materials and pamphlets that explain the dangers of
       alcohol/drug use during pregnancy
     Private offices to discuss sensitive information with participants
     Paperwork at intake that will easily incorporate additional alcohol screening questions
     An appointment system that allows for screening and brief interventions to occur at the
       initial appointment
     A referral form that is already ready or could be easily modified to meet the needs of the
       screening and brief intervention project
     Pregnant women who are screened positive for alcohol consumption are considered high
       risk and are automatically brought back for an additional appointment.

B. What is the best strategy to use to routinely place a maternal alcohol history from WIC
into a child’s medical record?




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Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

Interviews were conducted with 13 individuals. Six of the interviewees were WIC employees.
The other seven interviews were from various prenatal providers in Montgomery County
including nurses, an obstetrician, pediatricians, and midwives.

Results from the interview questions:
There was a significant amount of overlap in answers from various interviewees. Responses
from interviewees that were similar were combined to avoid repetition.

1. What are strategies to place the maternal alcohol history from WIC into a child’s medical
record?
     Place a question on the newborn history about in utero exposure to alcohol
     Find a way to ensure the Prenatal Risk Assessment forms on all Medicaid pregnancies
        can in be connected to the newborn entering the Medicaid system
     Send out a form from WIC to the pediatrician after the child is born
     A copy of all prenatal records is currently sent from the provider’s offices to the hospital
        at delivery. Risk factors identified should be transferred to the baby’s chart. Alcohol use
        is asked at prenatal appointments and thus should be listed in the medical chart as a risk
        factor.
     At an infant’s WIC certification the maternal records should be pulled and sent to the
        location of the child’s medical chart

2. What barriers are there to placing the maternal alcohol history from WIC into a child’s
medical record?
    HIPAA
    Inability of the mother to give an honest answer
           o Fear of having her child taken from her
           o Not wanting to admit to alcohol use on paper
    Poor wording on forms and variations of what constitutes alcohol use or abuse during
      pregnancy
    If a patient indicates they used alcohol early in the pregnancy, but stopped drinking when
      they found out they were pregnant, the exposure is overlooked and not recorded
    Mothers may not give consent to have her alcohol history placed into the child’s medical
      record
    The time it takes to complete the task--pulling files, making copies, and preparing for
      mailing.
    Some parents/caregivers have no pediatric home for their child
    The willingness of pediatrician providers to receiving and placing the information into
      the pediatric file.
    The money it will cost to send the maternal alcohol history to pediatricians

3. What are some reasons for these barriers?
   a. Inability of the mother to give an honest answer
            Mothers have a lack of trust of the “system”


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Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

             Mothers are concerned the information could be used against them in the future
             The mother is concerned someone will take the baby from them
             Mothers do not want to admit they are doing something that could hurt their child
             Mother is in denial of having a problem with alcohol
             Some women do not believe there is sufficient proof that alcohol causes damage
              to an unborn child
   b. The time it takes to complete the task--pulling files, making copies, and preparing
      for mailing.
           There are time constraints already existing and to add another task would be
              challenging
   c. The willingness of pediatrician providers to receiving and placing the information into the
      pediatric file.
           The time it takes to place the maternal alcohol history into the pediatric file
           Lack of a financial incentive for pediatric offices to place the maternal alcohol
              history into the pediatric file
           FASD is not easy or profitable to treat

4. How might the barriers of placing the maternal alcohol history into the pediatric file be
overcome?
    The maternal alcohol history should be asked at the time of delivery to update
      information
    Pamphlets, advertisement and educational programs on FAS should be marketed toward
      the public, physicians, and the medical community
    More research is needed on the effects of alcohol on unborn babies
    Develop a standard for clarification of what alcohol use or abuse is during pregnancy
    Explain to mothers why the information is needed/important to the infant’s health when
      trying to obtain consent
    Notify pediatricians prior to implementation of the screening and brief intervention for
      alcohol use in pregnant women of the importance of the maternal alcohol history
    Encourage mothers to have a medical home for their infant
    Assure confidentiality of the maternal alcohol history from WIC to the pediatrician
    Faxing the maternal alcohol history may be an option to save money on postage
    Place a “confidential” stamp on the letters containing the maternal alcohol history.
      Pediatricians are more likely to open it and read it when this happens
    Keep the cover letter with the maternal alcohol history short and to the point. A wordy
      letter will not be read and the information will then be less likely to be transferred to the
      child’s medical chart.

C. What barriers to accessing or using substance abuse services do pregnant women
experience or perceive?




                                                 10
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

   Secondary Data
   Secondary data will provide an assessment of the barriers of pregnant women to obtaining or
   using substance abuse services.

       Any discussion of the barriers of treatment for alcohol-dependent women must start with
   the understanding that substance abuse in women is a complex problem surrounded by
   multiple individual, interpersonal, familial, and social issues that require many levels of
   intervention and treatment. There are many barriers facing women wishing to receive
   alcohol treatment. This literature review will not attempt to cover every barrier to alcohol
   treatment services for women, but will give an overview of the barriers facing women with
   examples. A general summary of barriers of women receiving alcohol treatment has been
   adapted from Beckman, 1994 and is presented in Table 3.

   Table 3. Barriers to Alcohol Treatment for Women
   Internal Barriers
                  Denial of alcohol problem
                  Fear of stigmatization
                  Concern about leaving or losing children
                  Guilt and shame
   External Barriers
                  Interpersonal barriers
                  Opposition by family and friends
                  Social/societal costs of treatment
   Structural Barriers

      Examples of internal barriers to alcohol treatment for women are presented in Table 3. In
   addition, there are many other internal risk factors that have been recognized in women as a
   potential barrier to alcohol treatment services. Additional examples include having a
   negative emotional state such as depression, and having a histories of victimization, either
   physical or sexual.

       External barriers often play a significant role in the prevention of alcohol treatment
   services. Women abusing alcohol often live in families and/or communities that are either
   unable or unwilling to provide the support they need to access and engage in alcohol
   treatment programs (Gordon, 2007). Without this support many women will not enter an
   alcohol treatment program. In addition, women are concerned of what their employers,
   health care providers, friends and families will think about them. Women are more likely
   than men to encounter disapproval from friends and family regarding their participation in
   alcohol treatment programs (Beckman, 1994). The isolation from friends and co-workers that
   might happen from disclosure of alcohol abuse problems may discourage some women from
   seeking treatment.

      Examples of structural barriers to alcohol treatment for women include the many types of
   program barriers. It is commonly believed that traditional alcoholism treatment programs


                                              11
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

   have been structured to meet the needs of men rather than women (Schober and Annis,
   1996). Alcohol treatment services geared toward women are more likely to emphasize a
   woman’s concerns and treatment needs, offer compatibility with a woman’s style and
   orientation, and assess the woman’s role expectations and experiences in society. Additional
   program characteristics that may present barriers to participating in alcohol treatment
   services include (Jarvis, 1992):
             long waiting lists
             failure to provide a consistent therapist
             stringent abstinence requirements rather than treatment goals aimed at
                moderation
             low morale and poor therapeutic commitment by staff
             placement of addiction services in a stigmatizing psychiatric setting.

   Program characteristics that promote alcohol treatment services of women (Schober and
   Annis, 1996) include treatment services that provide:
           Childcare or treatment for children
           Medical and nutritional care
           Sexual abuse counseling

   Primary Data
   Primary data will provide an assessment of the barriers of pregnant women to obtaining or
   using substance abuse services from interviews. Primary data consisted of 7 interviews of
   individuals working at an alcohol treatment facility. There was a significant amount of
   overlap in answers from various interviewees. Responses from interviewees that were
   similar were combined to avoid repetition.

   1. What barriers in services exist for pregnant women obtaining alcohol treatment services?
          Identification of pregnant women in need of alcohol treatment services
          Women-only services are limited in the Montgomery County area
          There are inadequate or inconsistent interim services prior to a residential
             treatment
          No programs are targeted towards pregnant women
          Gaps are experienced in linking the client with a treatment provider
          There are waiting lists to residential treatment facilities
          There is a need for a program with a family approach to treatment
          Transportation for the pregnant woman to the alcohol treatment facility
          Childcare for the pregnant women with existing children
          Loss of employment if the woman enters alcohol treatment services
          Separation from families in a residential program

   2. What are the recommendations to address alcohol treatment center gaps in service for
   pregnant women?



                                              12
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

             Develop a specific program design for pregnant women with chemical use
              problems
             Appointments with referrals should be made before the patient leaves the office
             Marketing FAS to doctors offices, community health clinics, prenatal clinics,
              daycare centers, preschools, and other areas frequented by pregnant women
             Have a specific freestanding alcohol or drug provider serve pregnant women
             Agencies need enough dedicated personnel for dedicated tasks to insure the
              pregnant women receives the services she needs
             Increase the number of alcohol treatment programs that include services for
              existing children
             Prescreen pregnant women for barriers to service so these may be addressed
             Provide education sessions to pregnant mothers and families to prepare the family
              for separation and treatment stay
             Provide planned discussions and advocacy with the client and the client’s
              employer about leave options while engaged in treatment
             Provide bus passes or taxicab fares so pregnant women can receive the treatment
              they need

   3. Does your alcohol treatment service have the capacity to provide assistance to additional
   referrals that may come through this intervention project?
            Pregnant women are a priority in Montgomery County and are required to have an
               appointment scheduled within 48 hour of the referral
            Absolutely
            Yes, but residential capacity is limited
            Unknown


D. What FASD prevention or related services are available, accessible, and appropriate for
pregnant women?

                   ALCOHOL AND DRUG ADDICTION SERVICES
                          Montgomery County, Ohio


ADOLESCENT WELLNESS CENTER
    141 West Third Street
    Dayton, OH 45402
    222-WELL (9355)
    8:00 a.m. – 4:30 p.m. (Monday – Friday) Office Hours
    2:00 p.m. – 4:00 p.m. (Mondays and Thursdays) Appointment Times
    9:00 a.m. – 10:30 a.m. (Tuesdays, Wednesdays, and Fridays) Appointments Only
    11:00 a.m.– 12:30 p.m. (Monday – Friday) Walk-In Hours / First Come, First Served
    Basis / Only Serve 10 Patients Per Day


                                              13
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008


Offers primary medical care services to adolescents, ages 10-21. Services include
immunizations, physicals, vision and hearing screenings, podiatry screenings, and prescriptions
for contraceptives, HIV and STD testing, and treatment for acute, repetitive and chronic
illnesses. Also offers mental health counseling (assessment, diagnosis and treatment) and social
services (case management, treatment, and referrals). Pregnancy, STD, and HIV testing as well
as contraceptive care can be done without parent consent. All other medical visits require parent
consent for patients less than 18 years of age. Has both appointment and walk-in services.

FASD prevention services: Social work and counseling is available for teens, including
referrals for alcohol treatment services

Number of pregnant clients served: Pregnant women teens are served, numbers unknown

Funding levels and sources: The Adolescent Wellness Center is part of Public Health Dayton
& Montgomery County

Accessibility of services: Youths 12-19

Appropriateness of services: These services are helpful in the prevention of FASD in
adolescents.

Barriers to services: A potential barrier might be that professionally trained addiction
counselors are not involved.


AL-ANON / ALATEEN FAMILY GROUPS
     P.O. Box 282
     Dayton, OH 45401
     427-5439
     8:00 a.m. – 9:00 p.m.
     24-hour answering service

Offers a self-help recovery program for families and friends of alcoholics, whether or not the
alcoholic seeks help or recognizes the existence of a drinking problem. Members give and
receive comfort and understanding through a mutual exchange of experiences, strength, and
hope. Anonymity is maintained.


ALCOHOLICS ANONYMOUS
    120 West Second Street, #211
    Dayton, OH 45402
    222-2211
    9:00 a.m. – 4:00 p.m. (Monday – Friday)


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Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008


Alcoholics provide mutual support for one another, fellowship, and information provided
through meetings attended as often as needed. Interpreter service available for hearing impaired
individuals during the meeting.

FASD prevention services: The services consist primarily of support group meetings.
Participants share information and support to assist in the cessation of alcohol use.

Number of pregnant clients served: Pregnant women are served, but the numbers cannot be
determined.

Funding levels and sources: AA is self-supported. Donations (which are optional) are made by
participants at meetings.

Accessibility of services: There are approximately 350 weekly meetings in the Dayton area. In
addition, participants often connect with a sponsor within the group who may be available for
support outside of meetings. The meetings are open to anyone who expresses a desire to stop
drinking.

Appropriateness of services: These services appear to be helpful in the prevention of FASD.

Barriers to services: A potential barrier might be that professionally trained counselors are not
typically involved.


CENTER FOR ALCOHOLISM & DRUG ADDICTION SERVICES (CADAS)
    One Elizabeth Place
    Southeast, 3rd Floor
    Dayton, OH 45408
    461-5223
    Outpatient: 8:00 a.m. – 9:00 p.m. (Monday – Thursday)
    8:00 a.m. – 4:30 p.m. (Fridays)
    224-4646 (Residential 24 hours/day)

Offers residential chemical dependency treatment services for adult males and females. Highly
structured 30-bed program that provides individual and group counseling, education, and skill
building. Average length of stay is 28 days. Assessment and referral generally must be done
through CrisisCare.
Provides a substance abuse prevention program for pre-school children and their parents.
Provides outpatient treatment, which consists of two group sessions that total five hours of group
treatment interventions plus individual counseling sessions. The program also offers a more
intensive outpatient treatment, which consists of three groups per week for a total of nine hours
of group treatment three times per week plus individual counseling sessions. Both services can


                                                15
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

last up to 16 weeks. For clients that have completed the residential treatment sessions can attend
the one group per week plus individual counseling sessions that are offered for an additional 12
weeks. Potential clients must have a substance abuse or dependency diagnosis for chemical
dependency treatment. Assessment and referral generally must be done through CrisisCare (224-
4646).

FASD prevention services: Services include non-intensive outpatient, intensive outpatient, and
non-medical residential. Group sessions and individual counseling are available.

Number of pregnant clients served: The exact number is not available.

Funding levels and sources: This agency is part of Public Health Dayton & Montgomery
County

Accessibility of services: Pregnant women who are using alcohol are considered high priority
and must be seen within 2 days of referral. All referrals are made through Crisiscare.

Appropriateness of services: The services provided by CADAS should be considered highly
appropriate for prevention of FASD.

Barriers to services: No appointments can be made without a Crisiscare referral and
assessment.


CRISISCARE
     601 North Edwin C. Moses Boulevard
     Dayton, OH 45408
     224-4646
     24 hours/day

Offers 24-hour crisis and assessment services to persons with mental health or drug and alcohol
needs. Services include a telephone crisis intervention hotline, emergency walk-in care, pre-
hospital screening, crisis counseling, emergency psychiatric care/medication, alcohol/drug
assessments, and severely mentally disabled assessments. Fees are based on a sliding scale.

FASD prevention services: Crisis Care serves as an assessment and referral service as well as
offering a crisis telephone line and other emergency care.

Number of pregnant clients served: Unknown.

Funding levels and sources: Medicaid and private insurance are accepted. Those with no
insurance are also eligible for services. Fees are on a sliding scale.

Accessibility of services: Crisiscare provides 24-hour service.



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Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008


Appropriateness of services: These services are appropriate especially in relation to obtaining
referrals for CADAS.

Barriers to services: None.


DAY-MONT BEHAVIORAL HEALTH CARE
        1520 Germantown Street
        Dayton, OH 45408
        222-8111
        Hours vary depending on program
        Fees are based on a sliding scale.
Offers a program that educates participants on the effects of cocaine on prenatal conditions.
Participants must be residents of an area public housing and be a female between the ages of 10
to 14 years to be eligible for this program.
Offers outpatient counseling for substance abuse problems, including intensive rehabilitative
therapy and support groups. Also includes programs specifically geared towards adolescents,
minorities, and women. Also provides outreach prevention services for senior citizens
(education and referrals for seniors and training for families and professionals).
Offers groups for the following needs: a women's issues group for battered women, women's
severity group for women who are or have been substance abusers, and a parenting group
offering practical guidance in meeting the challenge of raising children.
FASD prevention services: Day-Mont offers integrated programs for consumers dealing with
combined psychiatric and substance abuse problems. Children and Adolescent services provide
high-quality therapeutic counseling, consultative, educational and supportive services to both
children and their families who experience behavioral, mental or emotional and/or substance
abuse issues related to their everyday living. Qualified clinicians provide a variety of services to
assist women with developing a life free from substance abuse, and regain custody of their
children.

Number of pregnant clients served: Unknown.

Funding levels and sources: Unknown

Accessibility of services: Clients are eligible for fee subsidies to cover the cost of services. The
amount of the fee subsidy is based on family size and gross monthly income. Also includes
programs specifically geared towards adolescents, minorities, and women.

Appropriateness of services: These services are appropriate for pregnant women

Barriers to services: None.


                                                 17
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008


EASTWAY CORPORATION
    1110 Webster Street
    Dayton OH,
    (937) 463-2955
    www.eastway.org/site.html

Eastway’s treatment philosophy is based upon a Recovery Model – teaching people the life skills
they need to take care of themselves, and thus, afford them the opportunity to be a fulfilled and
productive person.

Adult Recovery                       Family & Youth Intervention
Counseling                           counseling
case management                      psychiatry
psychiatry                           education
dual diagnosis                       residential treatment
housing
employment

FASD prevention services: This is an outpatient program that provides education, parenting
classes, nutritional support, and counseling for alcohol abuse. Aftercare and follow up services
are also available.

Number of pregnant clients served: Unknown

Funding levels and sources: nonprofit organization

Accessibility of services: Special groups include—Adolescents and persons with co-occurring
mental and substance abuse disorders. Self payment, Medicaid, Medicare, Private health
insurance, a sliding fee scale (fee is based on income and other factors) and payment assistance
is available

Appropriateness of services: Appropriate for both adults and teens for FASD services

Barriers to services: None.


NOVA HOUSE
    732 Beckman Street
    Dayton, OH 45410
    253-1680
    24 hours/day and vary depending on the program
    Fees are based on a sliding scale and depend on the program




                                               18
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

Offers residential, drug-free, treatment using the therapeutic community model. Three to nine
month program based on individual needs. Program includes counseling, vocational
rehabilitation, and activities therapy. Also offers a dual diagnosis residential treatment program
adapted to the needs of substance abusing mentally ill persons.
Offers drug dependency evaluation, drug-free counseling, urine surveillance, psychological
testing and evaluation, and counseling (individual, group, and family) regarding chemical abuse
and related issues.

FASD prevention services: This is an outpatient and a residential program that provides
education, parenting classes, nutritional support, and counseling for alcohol abuse. Aftercare and
follow up services are also available.

Number of pregnant clients served: Approximately 55 within the last year.

Funding levels and sources: This agency is funded through ADAMHS (Alcohol and Drug
Abuse and Mental Health Services). Private insurance is also accepted.

Accessibility of services: There is no waiting list for the residential program. There are
facilities for women with children under 5 to bring their children with them.

Appropriateness of services: Nova House services are appropriate in the prevention of FASD.
They have a program specifically designed for pregnant and post partum women.

Barriers to services: None.


PROJECT CURE
     1800 North James H. McGee Boulevard
     Dayton, OH 45427
     262-3500
     8:00 a.m. – 5:00 p.m. (Monday – Friday)
     Fees vary depending on the program

Drug Abuse Hotline - Provides a program which establishes immediate phone contact between
people who abuse drugs of any kind or are at risk of abuse, and individuals trained to provide
telephone assistance with the objective of diffusing the immediate crisis ensuring the individuals
safety and providing information about alternatives to drug use.
Methadone Detoxification - Utilizes controlled dosages of methadone in order to support the
efforts of abusers to abstain from the use of heroin. Drug use is monitored by urine surveillance.
Also refers abusers for further medical and psychosocial treatment. Must be referred by a
physician or a Crisis Care worker.




                                                19
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

Outpatient Drug Rehab Counseling - Offers outpatient treatment for drug abusers and addicts.
Support services include counseling and referrals for social services. Must be referred by a
physician or a Crisis Care worker.
Residential Drug & Narcotic Abuse Treatment - Offers residential treatment and rehabilitation
for drug users and addicts. Services include: secondary prevention program for former drug
users, supportive services (counseling and referrals for social services), emergency drug care
treatment, and referrals to hospitals or physicians. Must be referred by a physician or a Crisis
Care worker.
Alcoholic Anonymous - Offers an Alcoholics Anonymous support group. Meetings are held
7:00 p.m. to 8:30 p.m. on Mondays and Fridays. Call for location and more information.
Cocaine Anonymous - Offers a 12-step discussion group for persons addicted to cocaine and
other mind-altering substances. Open meetings are held 7:30 p.m. to 9:00 p.m. on Wednesdays
and Saturdays. There is also a closed meeting from 7:30 p.m. to 9:00 p.m. on Fridays. Call for
locations and information.

FASD prevention services: This is an outpatient and residential program that provides
education, and counseling for alcohol and drug abuse as well as nutritional counseling, and
referrals for other services such as vocational.

Number of pregnant clients served: unknown

Funding levels and sources: ODADSAS, The Alcohol, Drug, Addiction and Mental Health Services
Board for Montgomery County (ADAMHS Board)

Accessibility of services: Clients are assessed a nominal fee on a sliding fee scale based on their
ability to pay

Appropriateness of services: Services are appropriate in the prevention of FASD.

Barriers to services: None.


UNIFIED HEALTH SOLUTIONS
     184 Salem Avenue
     Dayton, OH 45406
     220-6600
     8:30 a.m. – 5:00 p.m. (Monday – Friday)
     Times for community programs vary depending on location

Offers a program for young parents (ages 21 and younger), which is designed to empower them
to make healthy drug-free choices for themselves and their children. Activities are offered
weekly at a number of community sites throughout Montgomery County. These weekly



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Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

meetings provide a format for young parents to get to know other young parents. They also offer
focused discussion sessions that deal with issues, such as parenting, anger control, relationships,
and family empowerment activities. Call 220-6641 for more information.

FASD prevention services: First Step provides prevention and education enrichment for
students in grades k-12 including alcohol and drug consequences

Number of pregnant clients served: unknown

Funding levels and sources: Many different community and state sources

Accessibility of services:

Appropriateness of services: Services are appropriate in the prevention of FASD.

Barriers to services: None.


URBAN MINORITY ALCOHOL & DRUG ADDICTION OUTREACH PROGRAM
(UMADAOP)
       One Elizabeth Place
       Four West Pavillion, Suite 400
       Dayton, OH 45408
       461-5223
       8:00 a.m. – 4:30 p.m. (Monday – Friday)
Provides culturally specific alcohol and drug abuse outreach, including education and training.
Also makes referrals for substance abuse treatment.

FASD prevention services: Prevention services strategies include Information Dissemination,
Education, Alternatives, Problem Identification and Referral, Community Based Process and
Environmental Strategies outlined by the Center for Substance Abuse Prevention (CSAP). In
addition, a program is in place to provide relapse prevention and re-socialization services to
African-American men and women who had been recently released from an Ohio Rehabilitation
and Correctional institution.

Number of pregnant clients served: unknown

Funding levels and sources: ODADAS Ohio Department of Drug and Drug Addiction Services

Accessibility of services: Provides culturally appropriate prevention services to African-
American and Hispanic/Latino American communities

Appropriateness of services: Services are appropriate in the prevention of FASD.




                                                21
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

Barriers to services: None


US DEPARTMENT OF VETERAN AFFAIRS MEDICAL CENTER
     4100 West Third Street
     Dayton, OH 45428
     268-6511
     8:00 a.m. – 4:00 p.m. (Monday – Friday)

Provides residential treatment for veterans with chronic medical and/or psychiatric diagnoses.
Length of stay is negotiable. The treatment plan is tailored to help individuals function as
independently as possible. Call 268-6511, ext. 2860 for more information. Must be an
honorably discharged veteran.
Provides individual counseling, substance abuse counseling, and assists veterans with adjustment
problems. Assists veterans in obtaining jobs, securing housing, and re-adjusting to being in the
workforce and the community.
FASD prevention services: Offers outpatient and 28-day inpatient treatment for substance
abuse, including follow-up outpatient care. Also offers support services for families of abusers,
informational workshops for families and friends, couples, groups, individual, and marital
counseling.

Number of pregnant clients served: Numbers unknown

Funding levels and sources: Federal

Accessibility of services: Women veterans

Appropriateness of services: Very appropriate if accessible

Barriers to services: None.


WOMEN’S RECOVERY CENTER
   515 Martin Drive
   Xenia, OH 45385
   (937) 372-4477
   24 hours/day
   Fees are based on third party sliding scale

Provides non-medical chemical dependency treatment in a residential setting for women.
Program length is based on need (approximately 30-90 days). Substance abuse counseling
education and case management are provided.



                                                22
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

FASD prevention services: Residential long-term treatment (more than 30 days), Outpatient,
Partial hospitalization/day treatment

Number of pregnant clients served: Numbers unknown

Funding levels and sources: unknown

Accessibility of services: Services for women. Self-payment, Medicaid, and Private health
insurance

Appropriateness of services: Includes residential beds for client’s children, appropriate for
FASD services

Barriers to services: None.


IV. Implications and Recommendations
   The Task Force meeting in May 2008 was utilized to review results of the needs assessment
   and to help determine the implication and recommendations from the results.

   A. What barriers exist to incorporate the screening and brief intervention for alcohol
      use by pregnant women into existing WIC services?

   1. Implications

   Barriers exist to implementing the screening and brief intervention for alcohol use by
   pregnant women for both participants of the WIC program and by WIC employees. This
   section will interpret the results of the needs assessment for both WIC participants and WIC
   employees.

        a. WIC participants
        Studying barriers faced by current WIC participants provides a basis for understanding
   reasons that may cause them to discontinue receiving WIC services. Findings from the
   literature review are informative in two ways. One, to find barriers that WIC participants
   have difficulty with and two, to identify those barriers that pose little or no difficulties in
   participation. An example of a barrier that poses no difficulty is that while social support and
   stigma against receiving aid may be reasons why eligible individuals do not access the
   program, they do not appear to be deterrents for continued WIC participation.
        Results from the literature found that waiting too long was the most frequently reported
   barrier to using services (Woelfel et al. 2004). This is particularly relevant to the screening
   and brief intervention for alcohol use by pregnant women because women receiving the
   screening and brief intervention will have an additional 15-20 minutes added to their
   appointment. Long waiting times may contribute to creating an environment at WIC that is
   noisy and crowded, which was also listed as a leading barrier to accessing WIC services.


                                               23
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

   This in turn could be responsible for another leading barrier to accessing WIC services, that
   there is nothing for children to do while at WIC.
        Other key findings from the literature on barriers to accessing WIC services included
   barriers on receiving both WIC checks and procurement of food. The literature demonstrates
   that parent/caretakers who fail to use all their WIC checks report significantly more barriers
   than those who used all their checks (Rosenberg et al. 2003). In addition, waiting was
   associated with the greatest number of participants who failed to use WIC checks, and
   waiting more than ½ and hour to pick up checks was related to an increased number of
   reported barriers (Woelfel et al. 2004).

       b. WIC employees
       The overall impression given by WIC employees at the interviews indicated that the
   screening and brief intervention for alcohol use by pregnant women would not be difficult to
   implement. WIC employees indicated that WIC has an environment and policies that
   positively contribute to implementing the screening and brief intervention for alcohol use by
   pregnant women. Examples of this included a referral form that could easily be modified,
   intake paperwork that could readily include alcohol screening questions, private offices, and
   existing policies that have a pregnant woman who is drinking alcohol become listed as a high
   risk participant.
       However, interviews with WIC employees also indicated several barriers. The barrier
   that was mentioned the most frequently was time. WIC employees indicated that everyone is
   very busy, and finding time to conduct a screening and brief intervention could be
   challenging if there are many interviews to conduct.
       An additional barrier that WIC employees were concerned with included the WIC
   participant’s willingness to give honest answers and to consider changing their behavior.
   This ties in with another barrier WIC employees expressed, that the screening and brief
   intervention was asking them to become a social worker or therapist, neither of which they
   have training in. One comment from a nutritionist was that WIC is a screening and
   assessment program, not a treatment program, and other nutritionists agreed that they were
   uncomfortable playing a role they were not trained for. WIC employees felt that improving
   the WIC environment may make participants feel more willing to give honest answers. This
   would include such improvements as painting the walls in a warm color, replacing faded
   posters and updating outdated materials.
       Other barriers listed from WIC employees included recall gaps from participants,
   participants not understanding what a drink is, no shows for follow up appointments, and
   concern that WIC would not receive feedback from referrals.

   2. Recommendations

   This section will present recommendations for how to overcome barriers associated with
   implementing the screening and brief intervention for alcohol use by pregnant women for
   both WIC participants and WIC employees.
      a. WIC participants



                                               24
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

       Strategies need to be developed to reduce waiting time for WIC participants. Hopefully
   by decreasing waiting time, other barriers such as noisy and crowded waiting rooms and a
   lack of activities for children could be decreased as well. In addition, decreasing waiting
   time should increase the number of participants who receive their food money.

        b. WIC employees
        As with the WIC participants, the biggest barrier indicated by WIC employees was time.
   The recommendation from this needs assessment would be to strategize ways to reduce the
   additional time it would take to give the screening and brief intervention for alcohol use by
   pregnant women. Suggestions were given from WIC employees on how to overcome this
   barrier. One suggestion to reduce time was to skip some of the nutrition talks once a women
   is identified as being at risk for drinking. Another suggestion was to have participants
   complete the intervention workbook while their coupons were printing.
        Another barrier indicated by WIC participants was their unease at providing an
   intervention that was considered social work or therapy. A recommendation from this needs
   assessment would be to provide training to WIC employees to improve their counseling
   skills.
        A final recommendation from this needs assessment is to improve the environment at
   WIC. Suggestions of how to do this were mentioned in the implications section.

B. What is the best strategy to use to routinely place a maternal alcohol history from WIC
into a child’s medical record?

   1. Implications

   There are several ways that a maternal alcohol history could be placed into a child’s medical
   file. This section will interpret the results of the needs assessment and determine what the
   best strategy is for placing the WIC maternal alcohol history into the child’s medical file.

               The results from the interviews initiated a long discussion at the task force about
       the most appropriate way to incorporate the maternal alcohol history into the pediatric
       files. Of the various strategies that were listed in the results, the two that seemed the
       most feasible were:
           a. Sending out a form from WIC to the pediatrician after the child is born
           b. A copy of all prenatal records is currently sent from the providers offices to the
              hospital at delivery. Risk factors identified should be transferred to the baby’s
              chart. Alcohol use is asked at prenatal appointments and thus should be listed in
              the medical chart as a risk factor.

               Both methods theoretically should place the maternal alcohol history into the
       medical record of the child, and both methods have barriers associated with them. The
       barriers were discussed at length during the task force meeting. The main barriers
       associated with sending out a form from WIC included time, money, and the pediatrician
       office not placing the file in the child’s medical record after they have received it. The


                                                25
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

       barriers associated with the prenatal risk factors in the prenatal file being transferred to
       the medical file of the child were more complex. One theme mentioned many times in
       the task force meeting was the variability of prenatal providers to assess alcohol
       consumption in prenatal patients. Each prenatal provider determines this independently,
       and the methods vary considerably from not asking alcohol usage questions at all, to
       asking at every appointment. Also, the variability of what constitutes “use” and “abuse”
       of alcohol is subjective.
               In order to retain the fidelity of the project, the most direct and consistent way of
       placing the maternal alcohol history into the child’s medical file, would be to have WIC
       send a form of the maternal alcohol history to the pediatrician office after the child is
       born. Recommendations to overcoming barriers will focus on this method of placing the
       maternal alcohol history into the child’s medical file.

   2. Recommendations

               The recommendation on the best strategy to incorporate the maternal alcohol
       history into the child’s medical file is to have WIC send a copy of the maternal alcohol
       history to the pediatrician after the child is born. In order to overcome some of the
       barriers associated with this strategy, the following recommendations are made:
                   1. Mothers should be encouraged during pregnancy to have a medical home
                       for their child.
                   2. The mother should be asked to sign a consent form to avoid HIPAA
                       violations.
                   3. The letter to the pediatrician containing the maternal alcohol history
                       should be stamped CONFIDENTIAL to both protect the patient’s privacy
                       and to encourage the physician’s office to open and read the document.
                   4. The information sent to the physician’s office should be kept as minimal
                       as possible.
                   5. Strategies to saving time for WIC employees should be explored.

C. What barriers to accessing or using substance abuse services do pregnant women
experience or perceive?

   1. Implications

        The secondary review of the literature revealed that there are many obstacles for women
receiving alcohol treatment services. The Task Force had a lengthy discussion about the results
from the interviews and disagreed with some of the barriers to alcohol treatment services listed.
For example, several interviewees noted gaps in services to women. The Task Force disagreed
with this, and the information gathered from the Resource Inventory supports this conclusion.
Montgomery County has a variety of services that provide women-only treatment services. A
notable gap, however, is that there are no treatment services exclusively for pregnant women.
        Additional barriers to alcohol treatment services were discussed. The Task Force agreed
that childcare, transportation and loss of employment were barriers in Montgomery County.


                                                26
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

Many suggestions to addressing these barriers were suggested, but will need to be addressed on
the specific needs of the pregnant woman needing services.
        The overwhelming response from the interviews and Task Force meeting on treatment
capacity was that Montgomery County does have the capacity to respond to pregnant women
who need alcohol treatment services. Montgomery County is fortunate that pregnant women are
treated as high priority for alcohol treatment services. This means that a pregnant woman is
required to have an appointment with an alcohol treatment facility within 48 hours of the referral.
There is however, a barrier to residential treatment. The waiting list for residential treatment is
approximately 30 days for the average person needing alcohol treatment services. Since
pregnant women are given priority that waiting time should be significantly less, and until the
residential treatment is available the pregnant woman could begin outpatient treatments
immediately for the interim.

   2. Recommendations

        Many barriers to alcohol treatment services exist for pregnant women. It is impossible to
address all of these barriers. Recommendations for reducing alcohol treatment barriers based on
this needs assessment are:
            1. Assess alcohol treatment service barriers for each pregnant woman at WIC who
                needs these services. This assessment can then be used to help refer a woman to
                the most appropriate alcohol treatment service for her specific needs.
            2. Refer the pregnant woman to women-specific alcohol treatment programs
                whenever possible

D. What FASD prevention or related services are available, accessible, and appropriate
for pregnant women?

   1. Implications
               The data from the resource inventory indicates that there is a large selection and
       variety of alcohol treatment services in Montgomery County, Ohio and the surrounding
       area. In addition, specialized treatment approaches to minority groups are available.
       Examples of specialized treatment approaches include alcohol treatment programs
       specialized towards women, minorities, adolescents, and veterans.

   2. Recommendations

              A recommendation from the overview of the resource inventory of alcohol
       services in Montgomery County, Ohio is to use the resource inventory in the
       development of the referral system for pregnant women at WIC who demonstrate the
       need for additional alcohol services other than the screening and brief intervention.
       Treatment programs specialized towards specific demographic groups should be utilized
       when appropriate.




                                                27
Public Health Dayton & Montgomery County
Task 2. Design and conduct a needs assessment and submit a written report
Deliverable 2. A report on the findings from the needs assessment
Submitted to Northrop Grumman on May 20, 2008

   References

   Beckman, LJ. Treatment needs of women with alcohol problems. Alcohol Health and
   Research World. 1994;18:206-211.

   Finkelstein, N. Treatment issues for alcohol- and drug-dependent pregnant and parenting
   women. Health Soc Work. 1994; 19:7-15.

   Gordon, S. Barriers to Treatment for Women. Am J Drug Alcohol Abuse. 2007; 29(1):19-
   53.

   Jarvis, T.J. Implications of gender for alcohol treatment research: A quantitative and
   qualitative review. British Journal of Addiction. 1992. 87; 1249-1261.

   Rosenberg, TJ, JK Alperen, MA Chiassom. Why do WIC participants fail to pick up their
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