What’s up with This Toolkit? Understanding Prenatal Alcohol Exposure through a Social Work Lens

Background/Introduction

Prenatal substance exposure (PSE) and alcohol exposure (PAE) can result in adverse birth outcomes as well as short- and long-term behavioral, developmental, cognitive, and physical effects (Kocherlakota, 2014). Moreover, children with PAE impacts may experience greater neurodevelopmental issues than those exposed to other substances in the news such as cocaine or opioids and can make parenting a child affected by PAE difficult—potentially increasing the risk of maltreatment. These harmful effects, if not identified and treated early, can be significant and long lasting. This federally funded project developed a toolkit to be used in social work practice to facilitate the identification and care of children with PSE. The primary aim of this study is to investigate the relevancy, applicability, and perceived usefulness of the toolkit in social work practice.

Methods

This project utilized a quasi-experimental design with a nonprobability sampling approach. The sample was comprised of four sites (N=28) and included two child welfare agencies within two individual states (i.e., 4 agencies total). Data was collected in three waves and was inclusive of information in three outcome areas: reaction, knowledge, and transfer to practice with two survey administrations (pre- and post). Bivariate and multivariate analyses were conducted by examining associations among the utility and affective reactions of participants, as well as the attitudes and usefulness of the materials. Ordinal logistic regression was used to examine whether participant job role, background with substance use, and work experience characteristics predicted attitudes and usefulness of materials.

Results

The collective variables fit the model well (-2LL=4785.97, X2=479.82, df=20, p<.000) with both Pearson and Deviance Goodness-of-Fit test being non-significant. The paired t-test results for the knowledge scale addressing affective and utility reactions, which identified the extent of how participants recognized the signs of PAE and how they engaged families affected by PAE, were statistically significant with a mean difference of

-3.39 (95% CI, -4.05 to -2.72), t(219)= -10.03, p>.05. Non-significant results were found on both the attitudes scale and the reactions scale with a mean score difference of -0.045 (95% CI,-0.52 to 0.43), t (219) = -0.187, p>.05. The role transfer to practice scale, which measured the degree to which a participant used the toolkit material in practice 6-8 weeks after the training, had a non-significant mean difference of -.131 (95% CI, -0.70 to 0.44), t (219) = -0.449, p>.05.

Bivariate results revealed a statistically significant increase in participant-reported knowledge of PAE from pre to post-test with mean difference of -1.068 (95% CI: -2.135 to -0.001), t (196) = - 1.97 (.541), p .05.

Conclusions

Survey results showed that through exposure and interaction with the toolkit, child welfare professionals had more awareness and knowledge of PAE. Overall, results show the toolkit increased awareness of PAE among frontline child welfare workers and increased confidence in identifying the signs of PAE. However, findings suggests that the child welfare system would require significant structural shifts to implement the changes to integrate PAE knowledge and practices to support families within the child welfare.