Background:
Untreated perinatal substance abuse is associated with serious adverse maternal and neonatal outcomes. Historically many barriers have prevented pregnant women from seeking treatment. Early Start (ES) breaks new ground by sidestepping these barriers with a fully integrated service delivery model. ES is the largest HMO evidence-based prenatal substance abuse program in the United States serving all pregnant women (>39,000) seen in Kaiser Permanente Northern California (KPNC) Women's Health clinics. The innovation of the program is locating a substance-abuse counselor in each Women's Health clinic providing accessible one-to-one counseling to women at risk for alcohol, tobacco, or drug use as part of routine prenatal care offered to all patients. Patients can be followed up to one year post-partum. Therefore ES is not only an effective early intervention model but provides prevention for subsequent pregnancies by offering inter-conception intervention and education. ES exceeds the recommendations of the 2004 ACOG Committee on Ethics Opinion, and addresses 2 top priorities for Healthy People 2010 which states a national goal of increasing the percentage of pregnant women who achieve abstinence from alcohol to 94%, and to 100% from illicit drugs.

Objectives:
By the end of the presentation participants will be able to understand key components of the Early Start model, articulate the benefits of Early Start, and identify the program components that can be transferred to other organizations.

Methods:
The successful roll-out of ES among the KPNC region can be attributed to program evaluation looking at neonatal outcomes conducted in 2003. In 2006 a follow-up study evaluated program effectiveness in terms of its impact on maternal and additional neonatal outcomes. Both showed a positive effect on the health of mothers and babies.

Results:
The 2006 study results indicate that compared with substance abusing pregnant women who were untreated in Early Start, ES-treated women had significantly lower rates on outcomes such as assisted ventilation, pre-term delivery, placental abruption, and IUFD.

Conclusion and implications for practice:
Universal screening of all pregnant women with access to an integrated model of substance-abuse treatment should be the standard of care for all prenatal patients because of the significant benefits for mothers, babies, and generations to come.