Taillac, C., Goler, N., Armstrong, M. A., Haley, K., & Osejo, V. (2007). The Permanente Journal, 11, 5-11.

Evidence continues to come from Kaiser Permanente to substantiate this work published a year ago that documents the success of a fully integrated service delivery approach for the treatment of substance use in pregnancy. In May 2004, the American College of Obstetricians and Gynecologists (ACOG) Committee on Ethics indicated that providers of care to pregnant women had an obligation to use universal screening questions, brief interventions, and refer to treatment to all pregnant drug-using women. The premise is that substance use is a treatable disease, like many other complications in pregnancy, and it should be addressed in a nonjudgmental manner. The challenge was how to implement this diagnosis and treatment. In the early 1990s, Kaiser Permanente began a seamless, on-site substance abuse Early Start program that went beyond the ACOG recommendations.

Nearly 39,000 women are currently screened each year, and study results indicate that rates for placental abruption, preterm labor, and stillbirth were lower for the 2,100 women in the Early Start program than for substance-using women not in the program (and the 160 who declined treatment). Cost savings for Early Start intervention mothers were $1,504 per baby. Outcomes for women in the study compared favorably with women whose initial screening revealed negative results (no drug use), particularly for women who began treatment early in pregnancy. What is the take-home message? We all know that drug use in pregnancy needs treatment, but the new standard of care based on evidence from Early Start establishes that women who receive substance use counseling with their regular prenatal care do better. One-stop shopping that provides seamless care delivery is essential.

Linda Beth Tiedje