Brief Intervention

Brief intervention strategies were integrated into the screening process in 2000. Grounded in motivational interviewing techniques, “I Am Concerned...” is an interactive, multisensory psychoeducational approach that takes about five minutes and is administered to all women who are found through the screening process to be using alcohol, tobacco, or illicit drugs. In San Bernardino County, California, over a period of three years, close to 20,000 women were screened with the 4P’s Plus© and those women with a positive screen underwent the brief intervention in the prenatal care provider’s office. A follow-up study demonstrated that among those women receiving prenatal care in offices that used the 4P’s Plus© and “I Am Concerned...”, there was a decrease in the low birth weight rate of 18%, a statistically significant drop as compared to the increase in low birth weight rate of 1% among women whose physicians did not use the 4P’s Plus©. Similar findings emerged in a study in Solano County, California. It was estimated that use of the 4P’s Plus© and “I Am concerned...” as a universal screening and brief intervention strategy saved the county $1.8 million in costs related to low birth weight infants over a two-year period.7

Finally, the 4P’s Plus© is a successful prevention strategy. Among six California counties who implemented universal screening of pregnant women for substance use, the rate of substance use in pregnancy has decreased an average of 27%. This is a statistically greater decrease in rates compared to rates of substance use in pregnancy in California and in the U.S. as a whole, both of which have demonstrated no changes in rates of substance use in pregnancy over the same period of time. From focus groups with providers and patients, it appears that administration of the 4P’s Plus© in the target pregnancy impacts a woman’s use of substances in subsequent pregnancies.