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Memorial Hospital of South Bend (WIC)
FASD Prevention Subcontractors
(Brief Intervention - Funded in 2008 and 2012*)
*Projects funded in 2012 were unable to complete their programs due to funding cuts after the first year.
Project Contact Information
Memorial Hospital of South Bend (WIC)
Jamie Reinebold, MSW, FACES Program Director
325 North Lafayette Boulevard
South Bend, IN 46601
Project Summary Statement
Memorial Hospital’s Foundations for Alcohol Cessation; Education and Support (FACES) program was instituted on August 1, 2008. FACES is an FASD prevention program designed to screen pregnant women for alcohol use and, if indicated, provide a brief intervention, thereby reducing the number of infants born exposed to alcohol in utero.
Objective: The outcome objective for Year 2 was identified as the following: 85% of pregnant women who had received the brief intervention would cease using alcohol within 30 days. It was estimated that 236 women would screen positive and be eligible for the brief intervention with 200 women reporting abstinence 30 days post intervention
Method: Pregnant women seeking services at two WIC clinics located in St. Joseph County, Indiana are eligible to participate in the FACES program. St. Joseph County Health Department data compiled for the year 2009 states 4,582 infants were born to mothers residing in the county (St. Joseph County Health Department, 2009). The WIC program served 1,419 pregnant women between July 21, 2009 and July 31, 2010. These numbers indicate a large portion of the county’s infants were born into WIC eligible households (incomes equal to or below 185% of federal poverty guidelines). This also confirms the FACES program is able to connect with a large portion of the pregnant population of the county.
Women participating in WIC services are accustomed to receiving education regarding healthy choices through non-judgmental interactions with clinic staff. WIC policy mandates all pregnant WIC participants be interviewed and educated about the dangers of alcohol use during pregnancy. Prior to the establishment of the FACES SBI program, WIC nutritionists were required to ask clients two questions regarding their alcohol history (previous three months). With the institution of the FACES program, six quantity and frequency questions were substituted.
The six FACES screening questions specifically ask clients to relate not only recent alcohol use history but more specifically to identify alcohol use within the past 30 days. All clients are asked to sign a Release of Information form as well as an Institutional Review Board Agreement to Participate form prior to screening. At the conclusion of the interview with the nutritionist, the FACES educator then completes a T-ACE screen with the participating client. A self-report screening tool designed for use in the OB/Gyne setting, the T-ACE is especially sensitive to at-risk drinking among pregnant women (Morse, Gehshan and Hutchings, 1997). The T-ACE is comprised of a tolerance question and inquiries designed to identify women who may have lifetime issues with alcohol abuse or addiction.
The completed screens are then scored by the FACES educator. Pregnant women who report any alcohol use in the past 30 days and/or those who score a two or greater on the T-ACE are considered eligible for the brief intervention. The FACES educator receives a verbal confirmation from the client of an agreement to participate and then facilitates the brief intervention. The brief intervention takes approximately fifteen minutes to complete. It is comprised of an educational portion outlining the risk to the fetus. The brief intervention also directs the client to identify risky situations where she might feel compelled to use alcohol, optional behaviors to resist risk-filled situations and asks that the participant verbalize her drinking goals for the next 30 days.
Clients who have completed the initial brief intervention are contacted by phone approximately every 30 days until gestational week thirty-six. At these monthly follow-ups, clients are asked if they have had any alcohol since first speaking with a FACES educator and if they have had any alcohol in the past 30 days. If a participant states they have had alcohol in the past thirty days, they receive a review of the brief intervention and are again asked to set a goal for alcohol use in the next 30 days. At the 36 week follow-up, clients are asked to sign a release of information form allowing the FACES program to send the prenatal alcohol use history of the participant to the medical provider of the infant. Clients are contacted again in the period of 60 days following their estimated due date.
If the client agrees to have the records released, the records are sent after the postpartum contact has been completed. All clients who express low confidence in remaining abstinent from alcohol in the 30 days following intervention, who use alcohol within the 30 days between follow-up contacts, or who self-refer meet the criteria for referral for treatment. Requests for treatment are referred to the Perinatal Exposure Prevention Project (PEPP) located in the county. PEPP’s Referral Specialist contacts the client and, if the client agrees, conducts further assessment of her need for treatment and ongoing services. Clients are then referred to one of six designated treatment centers for pregnant women in St. Joseph County. Both PEPP and FACES remain in contact with women referred for treatment throughout the remainder of their pregnancy.