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  • Letter to the Editor
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Commentary: screening as a tool for engagement

Journal of Perinatology volume 26, page 261 (2006)Cite this article

We wish to thank Dr Hendree E Jones for her thoughtful commentary1 regarding our article, ‘The 4P's Plus© Screen for Substance Use in Pregnancy: Clinical Application and Outcomes.’2 Because the article focused on data generated through the use of the 4P's Plus© to screen for alcohol, tobacco and illicit drug use in pregnancy, there was nothing presented regarding the practical, public health goals served by the use of the screening instrument. In the best of circumstances, the 4P's Plus© is utilized in the context of a much larger integrated system of screening, assessment, referral and treatment – the SART system.3 Prior to implementing screening in any community, we establish guidelines and policies that allow for conducting a field assessment4 in the prenatal care setting on any woman who screens ‘positive’. The screen identifies women who are at risk for substance use; the field assessment identifies women who actually are continuing to use alcohol, tobacco or illicit drugs during their pregnancy and require further intervention. Although quantity and frequency of substance use would be interesting, busy obstetric practices do not have the time for that depth of investigation. In addition, these factors are of little importance in the screening process; the job of the primary care provider is to identify women at risk so that they can be referred for further interventions. The screening and field assessment, which occur in the prenatal care site, are easy, fast (less than 5?min) and are used to link the woman to a single community-based referral mechanism through which the woman accesses treatment. In this context, the 4P's Plus© screen takes its place as the trigger event for a coordinated response to perinatal substance use. In practice, we work with communities to establish a full process of which screening and assessment are just an initial component.

In her commentary, Dr Jones also touched on some important issues, which we would like to amplify. First, Dr Jones correctly observes how fear of criminal prosecution or the involvement of child welfare services can create an environment that impedes accurate self-report. We have found that to be exactly the case. In particular, the current wave of methamphetamine use has prompted some judges, prosecutors, child welfare advocates and others to promote policies that bring the heavy hammer of the law into play. As health-care practitioners, we must drive community approaches away from such punitive approaches. Second, Dr Jones sees opportunity in screening non-pregnant women of childbearing age. We could not agree more. Pre- and inter-conceptual prevention and education efforts hold tremendous potential value. Despite this, these efforts are under-funded as Dr Jones emphasizes in her final comment.

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References

  1. Jones HE . The challenges of screening for substance use in pregnant women: commentary on the 4P's Plus© tool. J Perinatol 2005; 25: 365–367.

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  1. Children's Research Triangle, Chicago, IL, USA

    I J Chasnoff & R McGourty

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  1. I J Chasnoff
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  2. R McGourty
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Correspondence to I J Chasnoff.

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Chasnoff, I., McGourty, R. Commentary: screening as a tool for engagement. J Perinatol 26, 261 (2006). https://doi.org/10.1038/sj.jp.7211484

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