Implementation of choices: An evidence based motivational intervention program to prevent alcohol exposed pregnancies (AEP) among women attending ambulatory care family planning clinics at municipal hospitals in New York City

Fetal Alcohol Spectrum Disorders are the number one completely preventable birth defect in the US, affecting as many as 1 in 750 births. Current CDC data indicate binge drinking among women is most prevalent among those aged 18–24 years (24.2%) and 25–34 years (19.9%), putting them at high risk for AEPs. CHOICES, a two-session motivational interview program developed by the CDC, has been demonstrated to prevent AEPs by assisting women wanting to lower their drinking levels and/or to ensure effective contraception. Eligibility is based on three criteria: within the three months prior to the interview, the patient must have been 1) sexually active with a man, 2) not using contraception or using it ineffectively, and 3) drinking at high risk levels defined as more than 3 standard drinks in a session or more than 7 drinks in a week. The New York City Health and Hospitals Corporation (the safety net, municipal hospital system for the City of New York) has been funded by the CDC for a 4 year grant to evaluate implementation processes and outcomes at three of its Title X family planning clinics. The process of implementing prevention efforts within the hospitals' family planning clinics and enhancing preconception care required use of staff education, media, identification of stakeholders in clinical and administrative camps, multiple tiered interdisciplinary meetings, analysis of administrative and provider systems, monitoring patient reaction, and great staff flexibility. To date 271 women have been identified as at risk for an AEP.