MSS Policy and Procedure Manual
Risk Factors and Minimal Interventions – Alcohol and Substance Use Prior to, and During Pregnancy

Screen/Assess:

• Note any pertinent history and client’s verbal and non-verbal behavior suggesting alcohol/substance use.
• Assess the client’s motivation to change substance use behavior including: frequency and type of use, client’s concern regarding use, knowledge of the effects of substance use during pregnancy and stage of change regarding abstinence.

Educate/Counsel:

• Offer health messages regarding substance use during pregnancy.
• Provide harm reduction health messages if client is unable to achieve abstinence during pregnancy.

Intervention:

• Document risk factor on care plan
• Support the client in her change process including: listening to understand her experience; problem solving together to reduce barriers to change; support and reinforce her sense of self-efficacy to make changes to achieve harm reduction or abstinence.
• Provide information and/or refer to chemical dependency resources including treatment, NA, AA, etc.
• Alert prenatal care provider of use and inform the client of this action.
• Alert CPS and hospital if use continues throughout pregnancy and inform the client of this action.
• Case conference with MSS team members.

Alcohol/substance use in the environment (partner, parent, grandparent, support person)

• Support the client in developing a safety plan for herself and her children if needed.
• Refer the client to a support program such as Al-Anon.
• Assess basic needs such as food and housing. Refer and advocate for linkages.

Surveillance - Monitor, follow-up and Ongoing Assessment:

• Observe the client and environment for signs of use at each encounter.
• Reassess the client periodically in pregnancy and post-pregnancy period for stage of change, progress and if abstinent, ability to maintain. Support problem solving and reinforcing self-efficacy through out.
• Document outcomes on the care plan, and if no changes occurred since the risk factor was identified note why.