1. Addressing Perinatal Substance Use, Intimate Partner Violence & Mood Disorder Screening in a CPSP Setting Using a Collective Impact Model

2. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH CityMatCH What is CityMatCH? How your program might benefit? http://www.citymatch.org/

3. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH CityMatCH Practice Collaborative to Prevent Substance Exposed Pregnancies Funded by CDC - National Center on Birth Defects and Developmental Disabilities Increase awareness of risks among health care providers Increase capacity to deliver screening & brief intervention services to women of reproductive age Six Teams: Baltimore, Dayton, Tampa, Denver, Portland, Sonoma

4. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH

5. Sonoma County Selected 3 Strategies 1.Screening & brief intervention of women seeking reproductive health services at 4 clinical sites 2. Decrease unintended pregnancy among women at high risk for continued use 3. Development of a community plan to address prescription drug misuse among women of reproductive age

6. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Adverse Childhood Experiences Context is key to successfully addressing perinatal substance us, IPV & mood disorder http://www.cdc.gov/violenceprevention/acestudy/ http://www.acesconnection.com/

7. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH

8. Collective Impact Public Health as the backbone organization in the collective impact process http://www.fsg.org/OurApproach/CollectiveImpact.aspx http://www.ssireview.org/articles/entry/collective_impact

9. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Collective impact provide a structure for cross-sector leaders to forge a common agenda for solving a specific social problem

10. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH

12. Plan-Do-Study-Act Process matters – buy-in from team essential to success http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx https://innovations.ahrq.gov/qualitytools/plan-do-study-act-pdsa-cycle

13. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Bundling Evidence Based Tools Preventing missed screening opportunities http://www.citymatch.org/sites/default/files/documents/boo kpages/PESP%20final%20report.pdf http://www.citymatch.org/sites/default/files/documents/boo kpages/PESP%20final%20report.pdf

14. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Women screened  for risky ETOH - 59% experienced DV/SA Physically abused women - >7x risk of ETOH in pregnancy Women with IPV - 20-38% have symptoms of depression Teens in physically abusive relationships - 3-5x  risk of pregnancy Source: Family Violence Prevention Fund Substance Use Depressive Disorders Intimate Partner Violence

15. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Local Pilot Results 70% of women screened  for 1 or more areas  20%  ETOH - one third were < 21 yrs  20%  depressive disorder 6%  intimate partner violence 18%  marijuana 42% of non-pregnant women reported using either tobacco or marijuana < ¼ providers assessed birth control 15

16. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Learnings Marijuana, prevalence of IPV, and access to services for mood disorder http://www.cdph.ca.gov/DATA/SURVEYS/Pages/default.aspx http://www.cdph.ca.gov/data/surveys/MIHA/Pages/Maternalan dInfantHealthAssessment(MIHA)survey.aspx

17. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH 24,874 women - over a 7 year period of time …

18. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH The U.S. Surgeon General reported that smoking during pregnancy is responsible for 10% of all perinatal deaths. National Partnership to Help Pregnant Smokers Quit Tobacco

19. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Partners Matter! http://www.naccho.org/topics/environmental/pullingtogether/sectiontwo.cfm

20. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Sustainability Fit within CPSP! Billable opportunities – demonstrated need for behavioral health staff! http://www.cdph.ca.gov/programs/NutiritionandPhysicalActi vity/Pages/MO-NUPA-SystemsandEnvironmentalChange.aspx http://www.cdph.ca.gov/programs/NutiritionandPhysicalActi vity/Pages/MO-NUPA-SystemsandEnvironmentalChange.aspx

21. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Leveraging Data Leverage data to drive program change and resources http://www.cdph.ca.gov/data/pages/default.aspx

22. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Pregnant women in Sonoma County don’t smoke & drink … right?

23. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH

25. FAS and the Brain A B C MRI of the corpus callosum of A. a 14-year-old with a normal corpus callosum; B. a 12-year-old with FAS and a thin corpus callosum; C. a 14-year-old with FAS and agenesis (absence due to abnormal development) of the corpus callosum. Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.

26. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH

27. Ongoing … Printing, quality assurance …

28. SONOMA COUNTY DEPARTMENT OF HEALTH SERVICES PUBLIC HEALTH Thank You! Next …. SBIRT Implementation ….