Commentary: screening as a tool for engagement

Abstract

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.