shannon e. whaley, phd director of research and ... saves lives...shannon e. whaley, phd director of...
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Shannon E. Whaley, PhD Director of Research and Evaluation PHFE WIC Program, Los Angeles Samar McGregor, MPH, RD Senior Nutritionist PHFE WIC Program, Los Angeles
• Major Problems: • Small size • Mental retardation • Deformed face • Heart problems
• Other Problems: • Eating and sleeping • Hyperactivity • Attention • Language development • Memory • Learning • Hearing and vision
• WIC serves 50% of all infants born in the US. • In Los Angeles County, WIC serves 69% of all births. • WIC has great potential to reduce prenatal alcohol exposure
in this country.
• The question is: HOW? • Alcohol use is a sensitive topic, social desirability is a concern. • Many staff report feeling uncomfortable talking to clients about
alcohol use. • Approach matters. Asking “Do you drink?” will invariably be
answered with a resounding “no”.
Helping Pregnant WomenHave Healthier Babies
Are you pregnant?Are you pregnant?
Is this your f irst WIC Is this your f irst WIC visit for this pregnancy?visit for this pregnancy?
Ask us about joining Ask us about joining Project CARE.Project CARE.
Helping Pregnant WomenHave Healthier Babies
Are you pregnant?Are you pregnant?
Is this your f irst WIC Is this your f irst WIC visit for this pregnancy?visit for this pregnancy?
Ask us about joining Ask us about joining Project CARE.Project CARE.
Collaboration between PHFE WIC and UCLA Co-Principal Investigators: Shannon E. Whaley and Mary J. O’Connor
• Improve detection of alcohol use during pregnancy by improving screening techniques in the WIC setting.
• Evaluate the impact of brief intervention on the drinking behavior of pregnant WIC participants.
55 PHFE-WIC Sites
12 Project CARE Sites (Improved Screening)
6 Assessment Only Sites
(Improved Screening)
6 Brief Intervention Sites
(Improved Screening + Intervention)
43 Remaining Sites (WIC standard
screening)
• Use a self-report questionnaire
• Ask alcohol questions after nutrition questions
• Start by asking about the period of time prior to pregnancy recognition
• Ask about binge episodes
• Short, manualized intervention targeted at a specific behavior.
• Participant-centered. • Conducted by a health
professional, but not necessarily one who has extensive training in the topic.
• Needed only once or a few times to be effective.
• Easy to use.
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Detection Rates: Project CARE Sites vs. Control Sites
CARE Sites Control Sites C115
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Drinks per occasion
Assessment Only 4 nonviable infants 17.78 in 1000
Brief Intervention 1 nonviable infant 4.4 in 1000
O’Connor & Whaley (2007). Brief Intervention reduces drinking during pregnancy. American Journal of Public Health, 97, 252-258.
• Project CARE became part of the evidence base for reducing prenatal alcohol use.
• Trained staff in six states to use the Project CARE materials. • Trained staff from Healthy Start and WIC
• Funded by SAMHSA through the Northrop FASD Center for Excellence
• Conducted trainings across California • 33 Local Agency WIC Programs • Funded by one-time special project funds to CA WIC
Alcohol Screening and Brief Intervention Training • Welcome, Introductions and Warm-Up - Welcome, Overview of the In-service and goals of the project • Why are we here? - History of the project and results of the original research • Experience with women and alcohol use - Sharing of experiences talking to women about alcohol use • Screening - Presentation about using screening tools • Modeling an Intervention Encounter- Role play of a Brief Intervention Encounter • Reviewing Brief Intervention Manual - Review all sections of the Manual, section by section • Troubleshooting - Discuss potential areas of concern • Practicing the Brief Intervention - Practice conducting a Brief Intervention Encounter, in groups with observation • Closing and Evaluation -
The workbook provides guidance through the goal setting process.
“What are one or two things you are taking away from today that you will try using with your participants?”
How to handle a difficult client will
always be challenging – thanks for the
examples of what to say.
I feel more comfortable with the approach to talk to women thanks to the wonderful tool you
gave us: “WIC Project CARE”
This is a positive approach when
working with participants - very non-judgmental.
• Northrop Grumman’s FASD Center for Excellence is currently evaluating outcomes from the expansion to 6 states.
• Implementation is underway at the CA WIC agencies that were trained.
• Improved screening techniques in the WIC setting increase detection of alcohol use.
• Brief intervention appears to result in a greater reduction in drinking scores following one intervention and is maintained throughout pregnancy.
• Brief intervention impacts infant outcomes. • WIC staff reported feeling prepared to help their pregnant
clients address their drinking. • The low-cost, well tested brief intervention materials can serve
as a model for state and nationwide prevention of fetal alcohol spectrum disorder in a community based setting.
• State and local WIC providers should standardize prenatal questionnaires to include an evidence-based screening tool for alcohol use, and they should use brief intervention techniques to counsel and refer pregnant women who report using alcohol.
• Congress should continue to fully fund screening and referrals for alcohol and drug use as a core WIC Nutrition Services and Administrations (NSA) function.
• To support USDA Food and Nutrition Services’ (FNS) mission and help meet WIC regulations, FNS is updating and replacing the substance abuse materials that were last developed and presented in January 1990.
• Goal: Develop resource materials for use by WIC professionals and participants that reflect current evidence-based practices and epidemiological trends.
• JMH Education Marketing, Inc. (JMH), in partnership with JumpStart Healthcare Communication Consultants, LLC (JumpStart) has been funded to do this work and are looking closely at integrating brief intervention materials into the resource guides for WIC programs nationwide.
