Vision, Research, Innovation, and Influence: Early Start's 15-Year Journey from Pilot Project to Regional Program

Abstract

Early Start1 is a nationally recognized program designed and implemented in the Kaiser Permanente Northern California (KPNC) Region for early intervention and treatment of substance abuse in pregnant women. Begun in 1990 as a pilot program with Institutional Review Board approval, Early Start is now implemented in more than 90% of KPNC prenatal clinics. In this way arose the key component of Early Start: making available a licensed substance abuse specialist in the Obstetrics and Gynecology Department for women to see in conjunction with their routine prenatal visits. Development of the Early Start Program mirrors earlier, more traditional, and holistic ways of caring for women's health. The pioneers of Early Start faced the difficult task of convincing their colleagues and garnering funding to provide innovative specialty care for a marginalized, stigmatized group of women: those who are at risk for using alcohol, tobacco, and other drugs during pregnancy. The visionaries observed that most pregnant woman who were referred from prenatal care to external substance abuse programs for treatment did not seek services. The innovation of Early Start was that it embraced an approach used by the earliest of medicine women—the “wise women” or shamans—who made themselves directly accessible to women. In this way arose the key component of Early Start: making available a licensed substance abuse specialist in the Obstetrics and Gynecology Department for women to see in conjunction with their routine prenatal visits. This model of accessibility provided a welcoming environment that reduced barriers, fear, and stigma and empowered women through listening, building relationships, and supporting them in their personal wisdom, strength, and self-determination toward reclaiming their own health. This vision and innovation form only part of the story. The founders of Early Start were required to use influence and advocacy to legitimize their vision and to procure sufficient funding to study the benefits of this unique model. The founders were met with many challenges, opposition, and predictions of failure. Fifteen years later, the program serves more than 25,000 women each year and exists in almost every prenatal clinic in KPNC. As in the traditional “medicine wheel” of many native cultures, four strong elements have worked together in a fluid circle of reciprocity to bring the Early Start program to its full maturity: vision, innovation, influence, and research. The Early Start journey is a microcosm of the journey taken by women to reclaim their health choices and to fulfill their long-standing desire to receive balanced, personalized, evidenced-based care from practitioners who understand women's unique needs.