Why we are recommending this best practice
Strategies for implementation
- Educate staff on how to administer a validated screening tool and the importance of screening universally in order to reduce implicit bias.
- Initial screening for risk takes little time and can be done at many points within care. Validated screening tools include the NIDA quick screen, 4Ps Plus, and the CRAFFT (for women younger than 21 years old). See full list of validated screening tools in the Resources section of this Best Practice.
- Screening should be performed at intake of prenatal care to identify needs as early as possible and at regular intervals thereafter.
- If screening is positive, use a validated verbal assessment tool to identify the presence and severity of an actual SUD. Ideally, this assessment should immediately follow a positive screen. Examples include, but are not limited to, AUDIT-C (alcohol specific), ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test), and DAST-10 (drug use). For descriptions of these and other validated tools, refer to the AIM Opioid Screening Tools in the Resources section of this Best Practice.
- Intervention for a positive screening should include a brief intervention and referral to appropriate treatment using resources within your setting and community. Determining severity of disease is critical in referring to the correct level of care (refer to Best Practice #2).
- Screen all women for coerced sex and the possibility of human trafficking. An Adult Human Trafficking Screening Tool has been created by the US Department of Health and Human Services. Please also see a commentary from The Journal of Ethics in the References section of this Best Practice.
- Inquire about polysubstance use. If smoking tobacco or drinking alcohol, provide brief intervention and referral to services. Encourage cessation and refer to cessation services to decrease risk for a variety of adverse pregnancy outcomes and to decrease severity of NAS. If drinking alcohol, counsel the patient that there is no known safe amount of alcohol during pregnancy. Inform patient/family that alcohol is the leading known cause of birth defects.
- AIM Opioid Screening Tools.
- SAMHSA-HRSA Center for Integrated Health Solutions.
- Council on Patient Safety Women’s Health Care Safety Bundle for Obstetric Care for Women with Opioid Use Disorder.
- Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants. SAMHSA.
- Adult Human Trafficking Screening Tool and Guide.
- Accuracy of Three Screening Tools for Prenatal Substance Use
- ACOG Postpartum Toolkit (see screening tools in Table 1 of the Substance Use Disorder section of this toolkit)
- ACOG Committee Opinion No 711: Opioid Use and Opioid Use Disorder in Pregnancy. Obstet Gynecol. 2017;130: e81-94.
- Chasnoff IJ, Mcgourty RF, Bailey GW, et al. The 4Ps Plus© Screen for Substance Use in Pregnancy: Clinical Application and Outcomes. Journal of Perinatology. 2005;25(6):368-374. doi:10.1038/sj.jp.7211266.
- Yonkers KA, Gotman N, Kershaw T, Forray A, Howell HB, Rounsaville BJ. Screening for Prenatal Substance Use. Obstet Gynecol. 2010;116(4):827-833. doi:10.1097/aog.0b013e3181ed8290.
- Wood SP. Trafficked. AMA Journal of Ethics. 2018;20(12). doi:10.1001/amajethics.2018.1212. https://journalofethics.ama-assn.org/article/trafficked/2018-12.