Initiative Empowers Social Workers in Preventing Substance-Exposed Pregnancies

Foundation

By Paul R. Pace

Recognizing the crucial role social workers play in addressing prenatal substance exposure, which is associated with poor maternal and fetal health outcomes, NASW and the NASW Foundation have partnered with the Health Behavior Research and Training Institute (HBRT) at the University of Texas at Austin’s Steve Hicks School of Social Work to participate in the Fetal Alcohol Spectrum Disorder (FASD) National Partner Network.

The initiative, funded by the Centers for Disease Control and Prevention, includes numerous national health workforce organizations and is one example of how NASW and the NASW Foundation support a wide range of educational, research and training initiatives.

Social workers are leading providers of mental and behavioral health care, and are positioned to help prevent FASDs and other adverse health effects from prenatal substance exposure. One effective strategy is the use of screening, brief intervention, and referral to treatment (SBIRT)—a proven public health approach.

Clients begin by completing a brief screening to identify risky substance use. This is followed by a structured conversation with a trained health professional and, when necessary, a referral to appropriate treatment services. The entire process is designed to take less than 10 minutes, which is important in busy practice settings.

This model empowers social workers to intervene universally and early, supporting healthier outcomes for individuals and families. The CDC initiative is the only one of its kind that includes social work at the center of substance use prevention practice—along with family medicine, obstetrics-gynecology, pediatrics, nursing, and medical assisting.

Despite the strong evidence supporting its effectiveness with a broad range of population subgroups, SBIRT remains underused, researchers note. A recent study found that although 80% of pregnant women were asked about recent alcohol use at their last health care visit, just 16% who reported current drinking were advised to stop or reduce drinking. These findings highlight the opportunity for social workers to integrate alcohol SBIRT into routine practice to help prevent alcohol use during pregnancy.

Researchers and clinicians from HBRT include Mary Velasquez, PhD, the grant’s principal investigator, professor and director of HBRT; and Kirk von Sternberg, PhD, co-principal investigator, professor, and co-director of HBRT. With backgrounds in behavioral sciences and social work, they’ve spent more than 30 years developing evidence-based strategies to reduce risky substance use, especially in vulnerable populations.

“Our work really began to pivot when the CDC called for proposals to prevent FASDs in 2014,” Velasquez said. “That’s when we developed the ‘CHOICES’ intervention, which we tested in jails, treatment centers, and primary care clinics. It proved highly effective.”

CHOICES is an internationally recognized series of evidence-based programs for use with women at risk for alcohol- and other substance-exposed pregnancies. From there, the collaboration expanded. The CDC initially focused on engaging physician, nurse and pediatrician professional associations. But von Sternberg saw an untapped opportunity.

“I asked them, ‘What about universities? What about social workers?’” he recalled. “Social workers are uniquely positioned for this kind of preventive work—they build trust, they meet clients where they are, and they can have these sensitive conversations in ways other professionals sometimes can’t.”

The idea helped spark the participation of UT Austin and NASW in the CDC initiative, aimed at engaging social workers in preventing substance-exposed pregnancies, including training in SBIRT, which is grounded in respect for client autonomy.

“We’re not here to tell clients what to do,” Velasquez said. “Instead, we train social workers in how to have thoughtful, empathetic conversations about substance use and pregnancy risk.”

These conversations are essential, even when a woman isn’t pregnant. “We work with women of childbearing age who may not be using contraception effectively,” von Sternberg explained. “They may not realize they’re pregnant until several weeks in—and by then, exposure to alcohol or drugs may have already occurred.”

Another key component of the initiative has been outreach and education through a wide variety of channels to social workers.

Diana Ling, MA, senior program manager at HBRT, noted, “We’ve exhibited at NASW conferences, published in “Social Work Speaks,” and contributed regularly to podcasts, webinars and blog posts.”

NASW’s communications channels have proven essential in amplifying the message, including campaigns around events like FASD Awareness Month, Women’s Health Week, and National Alcohol Screening Day.

“We’re reaching social workers nationally,” said Anna Mangum, MSW, MPH, senior health strategist at HBRT. “It’s exciting to see how receptive they are. They understand the value, and they want to learn more.”

A survey by the team of more than 2,000 social workers identified both the importance of SBIRT and areas for growth. While 71% of respondents said they worked in settings where SBIRT was used, many still lacked confidence in applying the techniques. “They knew it was important, but they didn’t feel fully trained,” Ling said. “That’s exactly why this initiative matters. It bridges the gap between knowledge and practice.”

To support this effort, the team has invited NASW members to join the Partner Network and earn complimentary continuing education credit by learning about SBIRT and substance-exposed pregnancy through virtual trainings and self-study options such as reading NASW Intersections in Practice articles.

The team plans to do a follow-up survey to measure progress and refine training methods. Meanwhile, they continue to expand social work participation in the Partner Network and improve educational content for social workers across diverse practice areas. Velasquez, Ling and Mangum presented their work during a symposium at NASW’s national conference in June, where attendees received hands-on training in SBIRT and had the opportunity to join the Partner Network.

It’s been 10 years, and we’re still going strong,” Velasquez said. “We’ve learned that with the right tools and support, social workers can continue to be powerful agents of change and leaders in this space. They just needed to be invited to the table.”

Learn more at naswfoundation.org./our -work/special-projects.