Improving screening for alcohol use during pregnancy: the Massachusetts ASAP program

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Addiction Medicine

Background:

• Prenatal care settings offer a crucial opportunity to address alcohol and drug use in pregnant individuals.
• Universal screening and brief interventions (SBIs) are recommended for identifying and managing substance use during pregnancy.

Purpose of the Study:

• To encourage prenatal care staff in diverse settings to implement universal screening for alcohol and drug use risk.
• To facilitate the delivery of brief interventions and appropriate referrals during routine prenatal visits.

Main Methods:

• The ASAP Project involved staff engagement, training on screening tools and brief interventions, and development of site-specific protocols.
• Utilized self-administered questionnaires and a clinical decision tree for identifying and managing substance use.
• Included community resource identification and ongoing technical assistance across 16 diverse clinical sites.

Main Results:

• Training was provided to 118 staff on screening tools and 175 on brief interventions.
• Achieved 95% screening rates for alcohol use among pregnant women.
• 77% of women screening positive for risk factors received a brief intervention during their visit.

Conclusions:

• Screening and brief interventions for alcohol use are effectively delivered by prenatal staff within routine visits.
• Integration into existing office systems, physician-led training, accessible resources, and ongoing support are key to successful implementation.
• The study highlights the feasibility of universal screening for any alcohol use, not just at-risk use, in prenatal care.