1. A Pregnant Woman Never Drinks Alone. Visit zeroexposure.org The Zero Exposure Project Presented by Lisa Colen, MHA ZEP Director

2. The vision of ZEP Hillsborough County will be a community where every child is born substance free and lives in a family that promotes healthy growth and development.

3. Why do we need ZEP? According to 2003 National Survey on Drug Use and Health: -4.3 % of pregnant women aged 15 to 44 used illicit drugs during the last month. -4.1% reported binge alcohol use(5+) -18% reported smoking cigarettes

4. Why do we need ZEP? In 2004, Hillsborough County had 15, 414 births to mothers aged 15-44. By NSDUH survey prediction: –663 used illicit drugs –632 would have binged on alcohol –2775 would have smoked cigarettes

5. Another type of need According to risk behavior survey results, the woman most likely to be a social drinker before and during pregnancy is 35+, white, college educated, professionally employed and married.

6. Goals of Zero Exposure Raise community awareness about the impact of substance use during pregnancy in order to improve positive birth outcomes.

7. Goals of Zero Exposure Pregnant women who are identified early in pregnancy as substance users are linked with appropriate education, services and treatment in order to improve positive birth outcomes.

8. Goals of Zero Exposure Incorporate evaluation component in all areas of screening, campaign and outreach in order to enhance continuous quality improvement of the project.

9. Partners of ZEP The Children’s Board of Hillsborough County Hillsborough Kids, Inc. Central Hillsborough Healthy Start DACCO Healthy Start Coalition of Hillsborough County Healthy Families Hillsborough Department of Children and Families Tampa Bay Women’s Care St. Joseph’s Women’s Hospital Hillsborough County Health Department Humana Health Plans Central Behavioral Health Network Child Abuse Council Operation PAR

10. Partners in Funding Children’s Board of Hillsborough County, Inc. –Three Year Funding –Focus on public awareness and education –Improved birth outcomes as a goal for community DACCO –CBR/Two years –Provide 4 liaisons for screening, assessment and referral –Evaluation

11. Community Coordinator Oversees liaison activities Builds community partnerships Builds relationships with universities, schools and hospitals Acts as resource for jail and TOPWA (Targeted Outreach to Pregnant Women at Risk) Stays current on treatment options Oversees evaluation of program Seeks additional funding Advocates on all relevant legislative issues

12. Community Committees PartnershipResource EducationEvaluation

13. Committee Reporting Partnership ResourceEducationEvaluation

14. Education Committee Comprehensive literature Presentations/Provide Speakers Insurance Referrals for providers Physician Spokesperson Screening tool training Healthy Pregnancy Class Private Provider Focus Groups/Outreach

15. Media and Messages Prevention messages aimed at youth Public Service Announcement To date, media aimed at 35+ social drinker Messages aimed at support network Website Phoneline Newspaper

16. Website information www.zeroexposure.org Community can contribute Interactive/download materials National and local information Several phases

17. Website Statistics Numbers for July-October, 2005 –2,202 Visits to website –39,758 “hits” on the site –Visitors spent an average of 9.5 minutes on the site Why is this important?

18. Community Alcohol Survey How much can a pregnant woman drink?

19. Community Survey Should places that sell alcoholic beverages be required to post warnings to pregnant women?

20. Community Outreach Statewide conference Trainings statewide for other communities Coordinate and conduct monthly community committee meetings

21. Resource Committee Networking Multiple disciplines Case Management Feedback and reporting Referrals

22. Jail Outreach Providing education to all pregnant women in jail (avg. 40/day) Healthy Start Passports to all women Relationships for referral Liaison working with women Participation in community referrals Approved new position for discharge planning

23. Resource Committee Projects Documentary Jail Outreach and Education Networking Event in February 2006 Transportation Medication Issues Communication Referral process for substance abuse treatment and prenatal care

24. Evaluation Committee Screening tools Data Collection Acts as a consultant to all projects Develops impact studies/tools

25. Screening tools 4 P’s Plus TWEAK T-Ace

26. 4 P’s Plus Questions Parents -Did either of your parents have any problems with drugs or alcohol? Partner -Does your partner have any problems with drugs or alcohol? -Is your partner’s temper ever a problem for you? Past -Have you ever drunk beer/wine/liquor? Pregnancy -In the month before you knew you were pregnant, how many cigarettes did you smoke? -In the month before you knew you were pregnant, how much beer/wine/liquor did you drink?

27. Results to date of 4 P’s Parents? 18% yes Partner? 2.4% yes Partner’s temper? 1% Ever drink? 93.5% yes Smoke month before? 12.1% Drink month before? 37% *total of 1231 screened women

28. Challenges to date Multiple providers as partners Evaluation Validity of 4 P’s Plus Screening administration (interview vs. self- assessment) Community Resources Private Referrals No solid numbers on substance exposed newborns Comprehensive range of needs from social drinker to illicit drug addicted mom Sensitive topic that is easily avoided and hidden

29. Successes of ZEP to Date New partnerships with substance treatment agencies Increased awareness community wide Private OB relationships Statewide interest in campaign Substance exposed newborn issues/FAW referrals Jail initiative with new position Media interest Dependency drug court School system support

30. What is next for ZEP? Saturate community with prevention messages and expand target group Develop messages aimed at partners and support systems Include Interconceptional mesages Focus on younger audiences with prenatal messages Finalize decision on screening tools and utilization Statewide trainings for other communities Continued training for all ZEP members Expand number of pilot sites of private OB offices Engage Pediatric community Increase attention on smoking and smoking cessation Advocate for mandatory messages at points of sale for alcohol Seek future funding Evaluate impact on community attitudes

31. How can I get involved? Join a committee Contribute to the website Network, network, network Email suggestions, contacts or any relevant information Attend trainings and events

32. Contact information www.zeroexposure.org Phone line 877-233-5656 Lisa Colen, Project Director Lcolen@hstart.org 813-233-2800, ext. 133

33. Screening to date Partner have problems with drugs or alcohol?

34. Screening Results In the month prior to pregnancy, did you smoke cigarettes?

35. Screening Results In the month before, did you drink alcohol?

36. Screening Results How many days in the last month, did you drink alcohol?