Beginnings History
Background: Responding to the issues facing children and families in San Luis Obispo County, a team was organized in April 2003 to develop a strategic plan for promoting the early identification and treatment of women using drugs or alcohol during pregnancy.
The team consisted of representatives from the County's various agencies, as well as community-based professionals in obstetrics, pediatrics, early childhood education, hospital administration, mental health, substance abuse treatment, and child protection. As a result of that planning effort, in 2004, pregnant women enrolled in prenatal care throughout San Luis Obispo County were screened with the 4P's Plusİ, a screening instrument designed to identify those women at highest risk for using alcohol, tobacco, and illegal drugs.
Eighteen of twenty-one obstetric providers in the County integrated the screen into routine prenatal care. Those women with a positive screen underwent a more thorough assessment for substance use through a follow-up structured clinical interview conducted at the same prenatal visit.
There are approximately 2,600 deliveries per year in San Luis Obispo County. Of these, 1,305 women were screened at their first prenatal visit in 2004. Among these women, 18% were smoking cigarettes in early pregnancy before they knew they were pregnant, 35% were drinking alcohol, and 11% were using both cigarettes and alcohol. Overall, 42% of the women had a positive screen; that is, they were using alcohol and/or tobacco during the early pregnancy.
The screening and assessment process in San Luis Obispo County found alcohol to be the major substance of abuse. This has tremendous implications for children being born here, since even small amounts of alcohol can affect fetal brain development and affect long term behavior, learning and mental health.
Development of Children's Assessment Center
As a result of the emerging information and the documented numbers of children being born exposed to alcohol and illicit drugs during the prenatal period, a second group of community professionals met in September 2004 to examine issues of risk for children in San Luis Obispo County.
The core strategy was determined to be the development of a comprehensive Early Childhood Assessment and Treatment Center, anchored by universal screening of children birth to five years of age throughout the county. As a next step, this team of professionals worked with their consultants, Dr. Ira Chasnoff and Dr. Richard McGourty of the National Training Institute in Chicago, to develop a plan for community-wide outreach, comprehensive screening, follow up assessment, and universal access to treatment services.
A Model of Care was developed based on the successful work of Dr. Ira Chasnoff and the Child Study Center in Chicago, Ill. Since 1990, the Child Study Center has been providing quality evaluation, treatment planning, and therapeutic services for children and adolescents and their families. Their primary focus is to improve the quality of life for all children with special needs or children at risk for developmental, behavioral, psychological, or educational problems.
Children's Research Triangle has been in the forefront of many issues related to maternal substance abuse in pregnancy, the outcomes of children prenatally exposed to drugs, and the child welfare implications of substance abuse in families. Through closely working with Dr. Chasnoff, the team is modeling San Luis Obispo's Children's Assessment Center after that of the center in Chicago. Our Model of Care integrates systems of health and behavioral health to ensure access to appropriate early intervention services for children from birth through five years of age in San Luis Obispo County.
