Background:
A comprehensive study of infant deaths, conducted as part of Boston's Infant Mortality Review concluded that some of the largest gaps in women's health services occurred in the failure to identify and address women's life circumstances and behavioral risks in their ongoing health care. Based on the evidence in the area of infant mortality and preterm delivery, researchers and health policy experts are increasingly looking beyond the narrow window of pregnancy to consider risks and stresses over mothers' lives as a major contributor to the large and thus far fairly intractable racial disparities in low birthweight and infant mortality for Black women.

Objectives:
1. Develop a brief face to face behvior risk screening instrument for preconceptional and other women of reproductive age;
2. Implement the new system for women of reproductive age seeking primary care at two community health centers;
3.Work with the Massachusetts Dept. of PH to provide training and other forms of technical assistance to providers at health centers throughout the state.

Methods:
A Screening Working Group made up of 5 behavioral health and screening experts had primary responsibility for development of the PSAP screening tool ; six focus groups were held; a Project Advisory Committee met quarterly to review data and program experience; two community health centers piloted the tool.

Results:
Baseline rates of identifying women at risk prior to implementation of the PSAP screening process: depression 12% compared to 23% using our tool; substance use 3% versus 26%, and domestic violence 2% versus 14% using the PSAP tool.

Conclusion and implications for practice:
The PSAP tool is a brief, effective, and easy to use system for screening women of reproductive age in the preconception period for behavioral risks. It has proven to be a successful model to reach women from diverse backgrounds with behavioral risks in primary care.