Preventing substance exposed pregnancies across the life course: A collaborative approach in baltimore city

Tobacco smoke—including maternal exposure to secondhand smoke during pregnancy—accounts for 10 – 12% of prematurity, low birth weight, and fetal death (DHHS 2004). B'more for Healthy Babies, Baltimore's citywide strategy to improve birth outcomes, identified substance abuse as one of 11 high-impact areas that adversely affects birth outcomes. In 2011, the Baltimore City Health Department and Baltimore Substance Abuse Systems formed a collaborative on preventing substance exposed pregnancies (PSEP). The PSEP Collaborative consists of city agencies, treatment programs, medical systems, and academic institutions who had never worked together before. The Collaborative developed a strategic vision; reviewed the literature; examined existing programs, resources, and policies; assessed feasibility and impact of interventions; and wrote a strategic plan. The vision of the PSEP Collaborative is for all women in Baltimore City to have healthy, substance-free pregnancies. The PSEP strategy applies a life course model that intervenes on four levels: policy, provider systems, community, and individual. Key objectives include integrating substance Screening Brief Intervention Referral to Treatment (SBIRT) into family planning clinics and OB practices; preventing unplanned pregnancy among substance-abusing women through access to contraception and reproductive counseling at substance treatment facilities; preventing secondhand household exposure to tobacco smoke during pregnancy and the infant's first year of life; and addressing gaps in data collection for PSEP strategies. This work brought together non-traditional partners to develop a cross-sector strategy. The process used demonstrates how a cross-agency public/private collaborative can define a problem and develop a joint strategy.