• perinatal drug testing;
  • universal screening;
  • newborns;
  • alcohol;
  • illicit drugs;
  • substance abuse

Paper Presentation

  1. Top of page
  2. Paper Presentation

Purpose for the Program

Children of mothers who abuse substances are more likely to suffer substantiated harm, enter foster care and have more negative child protection outcomes. The effects of fetal alcohol syndrome and spectrum disorders are well documented in the literature; studies attest to developmental delays, intellectual disabilities, attention disorders, and psychopathologies during the child's lifetime. Data also exist on the ill effects of maternal illicit drug use; for example, heroin has been shown to easily cross the placenta and quickly presents in fetal tissue. Identifying perinatal substance abuse increases positive outcomes for newborns and their families. Many professionals believe that early identification plays a critical role in preventing future abuse and neglect.

Proposed Change

Implementation of an effective substance abuse screening tool.

Implementation, Outcomes, and Evaluation

A multidisciplinary taskforce was formed, including community experts, to research, create, and implement a universal screening tool. The taskforce overcame obstacles, including initial resistance from nurses to give the screening survey. Physician resistance existed on the use of alcohol during pregnancy—some felt it was acceptable despite recommendations of the National Center on Birth Defects and Developmental Disabilities. The taskforce created a training program for nurses, held educational sessions for physicians and created program materials, including a patient brochure on substance use for physicians to handout during discussions with patients.

The screening tool is roughly based on the 4Ps that surveys the expectant mother's use of substances in regards to Parents, Partner, Past, and Pregnancy. The tool also includes questions that support evidence from the literature and questions that determine counseling referrals and substance usage requirements for state records.

The screening tool has resulted in increased positive screens, increased testing of fetus meconium and patient urine, and increased referrals for care and support. Community agencies partner with hospital staff through onsite meetings with families that determine the best discharge plan for the newborn. Resources for addressing substance abuse problems are also provided. The multidisciplinary taskforce meets continually to discuss future enhancements of this successful tool and program.

Implications for Nursing Practice

Nurses were trained in motivational interviewing techniques that convey empathy, listening, and objectivity. They were provided a universal script to give to all patients, regardless of their perceived risk of using. This eliminated subjectivity, made nurses more comfortable and increased surveying.