Evolution of Project CHOICES: Adaptations in research and practice

While the four-session Project CHOICES model to prevent alcohol-exposed pregnancy in high risk preconception women has been efficacious, briefer versions were desired for new populations and for practical translation into public health practice. The time commitment of four sessions and the demand for specialized counselors trained in Motivational Interviewing was prohibitive of widespread use among many health care providers in primary care settings. Project BALANCE, is a one-session intervention project tailored to college women. Based on its success, Project EARLY, an even briefer one-session study was developed for women of child bearing age at increased risk for AEP and is currently underway. Additionally, CDC funded seven states via Departments of Health to modify the CHOICES model, retaining fidelity but creating specialized projects tailored to specific risk populations and feasibility issues in each state (Colorado, North and South Dakota, Michigan, Minnesota, Missouri, Oregon and Wisconsin). States adapted CHOICES for individual prevention services or created a community-level intervention using a combination of CHOICES elements and guided-self change methodology or both. This presentation will include a brief overview of the CHOICES intervention, adaptations for the research projects BALANCE and EARLY including outcomes, and modifications for public health practice made by the states. Logistical, policy, and fidelity challenges and successes of transferring the original CHOICES model to public health practice in seven states with differing populations at risk including women who are Native American, African American, Hispanic and Caucasian of various socioeconomic and education levels will be described.