Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Prenatal alcohol exposure is one of the leading preventable causes of birth defects, mental retardation, and neurodevelopmental disorders. Fetal alcohol spectrum disorder (FASD) is a recently coined term used to describe the spectrum of outcomes related to prenatal exposure to alcohol ranging from behavioral disorders to the growth restriction, neurodevelopmental abnormalities, and facial dysmorphology of full-blown fetal alcohol syndrome. Fetal alcohol syndrome and FASD are significant and costly medical and societal problems. Project CHOICES tested the feasibility and impact of motivational counseling in reducing drinking and/or increasing effective contraception in women at risk for an alcohol-exposed pregnancy in six community settings. In addition to presenting the outcomes from this study, this paper presentation will describe the rationale for treatment; the use of motivational interviewing for a dual-focused approach to behavior change; the development of the Project CHOICES intervention; development of the study protocol and treatment manual; and selection, training, supervision, and monitoring of study counselors. Methods: This multi-site single-arm study was conducted in 6 settings in 3 large cities. Study settings included primary care, university-hospital based obstetrical/gynecology practices, an urban jail, a set of substance abuse treatment settings, and a media-recruited sample. There were 2,384 women screened for eligibility; 230 were eligible based on their alcohol use and lack of contraception. Of the eligible women, 190 consented and were enrolled, and 143 (75.3%) completed the 6-month follow-up. The intervention consisted of 4 manual-guided motivational counseling sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. Outcome measures include intervention completion rates, alcohol use (frequency, quantity and binging), contraceptive use and effectiveness, and risk for alcohol-exposed pregnancy. Results: Among women who completed the six-month follow-up, 68.5% were no longer at risk of an alcohol-exposed pregnancy; 12.6% of women who completed the program reduced drinking only; 23.1% used effective contraception only; and 32.9% reported both. Results were consistent across the 6 diverse high-risk settings. Implications for practice or policy: This study provides evidence that providing 4 sessions of motivational interviewing plus a contraception counseling session is feasible, and strongly suggests that this multidisciplinary intervention can decrease the risk of alcohol-exposed pregnancy in women in high-risk settings.