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Screening and Intervention Programs

Great Plains Tribal Chairmen's Health Board (formerly Aberdeen Area Tribal Chairmen's Health Board) (Healthy Start)

Intervention Type

FASD Prevention Subcontractors
(Brief Intervention)

Project Contact Information

Great Plains Tribal Chairmen's Health Board (formerly Aberdeen Area Tribal Chairmen's Health Board) (Healthy Start)
Barbara 'Bobbie' Jacobs, MSW, MA, FASD Project Coordinator
1770 Rand Road
Rapid City, SD 57702
Phone: 605-721-1922, ext. 137
Fax: 605-721-1932
E-mail: bobbie.jacobs@gptchb.org

Project Summary Statement

The goal of this initiative is to obtain agreement to abstain from alcohol use from pregnant American Indian (AI) women in Northern Plains American Indian (NPAI) communities within 13 Aberdeen Area reservations. The evidence-based Screening and Brief Intervention is integrated into the existing Northern Plains Healthy Start (NPHS) program, which provides health and targeted case management to pregnant and post-partum women. As a part of the Great Plains Tribal Chairmen’s Health Board (GPTCHB), the NPHS mission is to address infant mortality and reduce health disparities of American Indian women and young children among its target population. The FASD Prevention Project supports the agency goal of improved pregnancy outcomes.

The prevalence of alcohol use and abuse in the Native American culture presents a challenge that the NPHS prenatal clients have themselves identified. The need for loving support and encouragement from their families and friends not to drink while they are pregnant is paramount; within the existing culture, however, such support may not be readily available. Availability of referral sites for alcohol abuse and treatment for adolescents is particularly limited on the reservations. This initiative provides several different process objectives for the population.

Case Managers screen pregnant clients for alcohol use during the intake process for Healthy Start in order to serve 90% of women who receive Healthy Start services. If screened positive, the Case Manager will provide the Brief Intervention at intake to serve 85% of women who screen positive for alcohol use. They will then provide referrals for formal alcohol treatment to 100% of women who report more than occasional use of alcohol on the initial screening or who continue to use alcohol regularly on follow-up assessments. Process objectives also exist for sustaining and enhancing the initiative and service delivery system.

The Project Coordinator convenes the Task Force to continue to monitor program process and brainstorm ideas for program and system improvement. The Coordinator also provides SBI refresher courses during site visits which take place at least twice a year. With the help of the Data Coordinator data is collected on 100% of clients screened.

Sustainability for the projects future is always kept in mind. The current plan for future sustainability is the recruitment of different types of counselors to establish a third party billing system which will generate revenue to keep sites functioning and ensure that the SBI continues in the Healthy Start system.

The project is designed to meet certain projected results. These results include 65% of NPHS pregnant clients who screen positive for alcohol use and receiving the Brief Intervention agreeing to abstain from alcohol use. 30% of these women would abstain from using alcohol within one month of receiving the Screening and Brief Intervention. The last result focused on is that 50% of NPHS pregnant clients receiving the Screening and Brief Intervention abstain from alcohol.

The target audience for this initiative is all pregnant women who present to enroll in Healthy Start. Enrollment in Healthy Start is available to all women who are pregnant or parenting and have one or more health or social risk factors; there are no income criteria.

Incorporating the Screening and Brief Intervention into the NPHS intake session takes place easily. New policies and procedures for integrating brief interventions into NPHS program continue to be planned and developed. Set up and management of the database has been furnished with help from Northrop Grumman advisors. The charge to the Task Force is to assist in planning, implementing and evaluating the integration and sustainability of alcohol screening, brief intervention, and referrals to treatment within the Northern Plains Healthy Start (NPHS) programs serving the Northern Plains American Indian communities. The Task Force also assists with the development of policies and procedures to implement the preventive intervention.

Each site is a different community. The successes and challenges, however, are relatively similar. If one site is experiencing a phenomenon, the rest of the sites may have something similar happen in their work, although they may describe it differently. While some sites experience challenges in meeting their targets due to staff turnover or in having sufficient referral resources for their clients, these are the commonly understood challenges of reservations that cover wide areas and have limited medical care services and low-paying, high stress jobs that are typical of most reservations. It is important to understand that challenges and problems may not be systemic, but cultural, and is addressed as such.

For example, the importance of word of mouth and reputation have a deeper and more powerful impact than most mainstream advertisement, marketing, and outreach. In looking at this initiative, it is focused on a truly unique population and culture; sites despite their differences have more similarities than differences. An understanding of these issues must be at the forefront of services and program analysis.

The program has been very accepted among people in the communities as well as with staff providing the SBI. Staff have been very receptive to the program due to the lack of alcohol related services. Some of the different communities served have little to no services, or the closest place a client could be seen is 100 miles away. Healthy Start staff have a very good reputation in each of the communities they work and live in. Trust is already established so clients are willing to discuss their use or lack of use. The SBI is instrumental for providing services for alcohol use where it is literally the only service available.