FOR ADDITIONAL INFORMATION CONTACT ERICA WILSON, EAST REGION HEALTH PROMOTIONS DIRECTORErica.Wilson@tn.gov

Methods Conclusions

The referral rate of 61.8% and interviews with the inmates indicate both an interest in and need for the program.

Only 63.2% of the referrals received services and 39.7% a LARC indicating that best results are achieved when the presentation, the initial exam, and the LARC placement can occur within a 5 to 7 day period.

The average cost for an infant born drug dependent, diagnosed with NAS in 2011 was $62,973. Providing a LARC to 27 women and Depo-Provera to 9 women will greatly reduce the risk of pregnancy. If only one pregnancy is prevented for each participant, it would represent a potential savings of $2,267,028.

Results

The program was piloted in Cocke and Sevier Counties from January 1 through June 30, 2014.

Three more counties in the East Region have received training and are preparing to implement the LARC initiative. The remaining 10 counties are to receive training in October, 2014.

The Recovery Court Judge for four counties will start making NAS/LARC education at the health department a mandatory part of sentencing for both men and women with drug related charges in September, 2014.

On December 4, 2014 the East Region Medical Director and the Cocke/Sevier Health Department Director will be conducting a break-out session on the East Region’s primary prevention initiatives at the Tennessee Association of Drug Court Professionals Annual Drug Court Conference in an effort to expand the sentencing requirement to other counties.

An algorithm was developed to guide the implementation of an initiative to provide long-acting, reversible contraceptives (LARC) to jail inmates.

A presentation was developed to educate local health department staff on NAS and the importance of the primary prevention initiative.

An outreach plan with 2 educational pamphlets one on NAS and the other on LARCs was developed to use in securing the cooperation of jail officials in providing a time/place to do an educational presentation and providing transport for inmates wanting to receive a LARC.

Referral and tracking forms were developed.

An educational presentation and pamphlet were developed to inform inmates about the risk of NAS associated with using narcotics during pregnancy and how to minimize the risk of pregnancy through the use of LARCs.

Standardized clinic documentation tools were developed.

Initial Exam and LARC clinics were conducted in the health department to provide services while participants were still incarcerated.

Collaborated with UT Family Physicians to provide experience for residents to place LARCs.

An access data base was developed for reporting.

Selected two counties (Cocke and Sevier) having 25.8% of the total East Region NAS cases as pilot sites and began implementation in January, 2014.

Followed the PDCA (PLAN-DO-CHECK-ACT) continuous improvement cycle after each phase of the implementation – from securing the “buy-in” from local staff to data collection and reporting – evaluated the processes and made revisions for continuous program improvement and to ensure success as other counties begin to replicate and implement the program.

Future Directions

  Number PercentTotal Presentations 5  Total Participants 110  Total Referrals 68 61.8%Average Age of Referrals 27  Age Range of Referrals 20-45  

Referrals Receiving Some Type of Service

43 63.2%

Patient History     Drug charge 19 44.2% History of drug use 34 79.1% Child born drug-dependent 9 20.9% Child ever in state custody 6 14.0% Taking anxiety meds 1 2.3% Taking pain meds 1 2.3% Drug use during pregnancy 9 20.9% Previous FP patient 12 27.9%Current BC Method     Condoms 3 7.0% Depovera 1 2.3% IUD 1 2.3% None 34 79.1% Unknown 4 9.3%Referrals Receiving Contraceptive 36 52.9%

Contraceptive Type Provided (n=36)

   

Depo-Provera Injection 9 25.0% Mirena IUD 6 16.7% Nexplanon Implant 19 52.8% Paraguard IUD 2 5.5%Referrals Receiving LARC 27 39.7%