DC WIC POLICY & PROCEDURE MANUAL

Policy 8.020 1 | P a g e Title: Substance Use Screening and Referral Category: Certification CFR Reference: 7 CFR 246.7(a) 7 CFR 246.7(n)(2) Policy Number: 8.020 Effective Date: September 1st 2021 Revised Date: April 30th, 2024

POLICY STATEMENT: In accordance with 7 CFR 246.7(a), 7 CFR 246.7(n)(2), and 7 CFR 246.11(a)(3) the Local Agency must ensure: 1. Local Agency Resource List - A listing of local resources for drug and other harmful substance abuse counseling and treatment is maintained and made available for distribution to all pregnant, postpartum, and breastfeeding women and to parents or caretakers of infants and children in the DC WIC program, as required by Public Health Law 101-147. 2. Screening - Drug and other harmful substance abuse screening is performed at certification as part of the nutritional assessment for all pregnant, postpartum, and breastfeeding women and to parents or caretakers of infants and children. 3. Brief Intervention (Education) and Referral - Education on the harmful effects of drug and other harmful substances is provided at certification, and if needed, a referral is made to the participant or to the parent or caregiver of an infant or child. Education needs to be provided once per certification. 4. Documentation - The CPA/CPPA documents the education and referral (if provided) in the participant’s record in the MIS (see DC WIC policy 2.006 Nutrition Education Documentation). PROCEDURE Substance Abuse Screening Substance abuse screening must be performed at certification for all pregnant, postpartum, and breastfeeding participants and to parents or caretakers to infant and child participants as part of the nutrition assessment. The CPA/CPPA should ensure privacy and conduct the screening process in a nonjudgemental manner. Screening questions can include: 1. Have you ever had difficulties in your life because of alcohol, smoking, or other drug use, including unprescribed medications? 2. Do you have any concerns about the use of drug, alcohol, or other harmful substances for yourself or someone who spends a significant amount of time with you and/or your child? If the participant or parent or caretaker of an infant or child participant responds “no” to either screening question above, then general substance use education must be provided (see below). If the participant or parent or caretaker of an infant or child participant responds “yes” to either screening question above, then the CPA/CPPA must further evaluate if any nutritional risk codes should be applied to the participant (see DC WIC Nutrition Risk Manual) and provide tailored substance use education (see below).

DC WIC POLICY & PROCEDURE MANUAL

Policy 8.020 2 | P a g e Substance Use Brief Intervention (Education) and Referral All participants and caretakers must receive brief intervention education on the harmful effects of substance use at the time of certification. Depending on the response provided by the participant or caretaker above, the CPA/CPPA must provide one of the following forms of education: 1. General education – if the participant or caretaker responds “no” to the substance use screening questions and/or if the participant does not appear to need tailored substance use education. The CPA/CPPA may perform the following: a. Provide brief education related to the dangers of substance use. Staff may reference the “Give Your Baby a Healthy Start” handout or the “Substance Use: Risk to You and Your Family” handout created by DC WIC (handouts are available on www.dcwic.org). b. Provide the local agency listing of substance use resources. Staff may describe how to access resources online. 2. Tailored Education – if the participant or caretaker responds “yes” to the substance use screening questions and/or if a substance use related nutrition risk code has been identified for the participant. The CPA/CPPA should discuss the answers provided to the substance use screening questions and the potential substance abuse problem. The CPA/CPPA should provide the brief intervention in a positive framing, such as below:

Accentuate the Positive and Avoid the Negative (Source – FNS Substance Use Prevention Guide) Positive Negative If you stop drinking now, you have a better chance of having a healthy baby. Your drinking has already damaged your baby. Your concern for your baby will help you be a good mother. If you really loved your baby, you would not drink so much. You will feel better when you are sober and so will your child. Continued drinking will ruin your health and prevent your child from developing normally.

Substance Use Referral The information collected from the substance use screening and nutrition assessment must be used as the basis of providing a general or tailored substance use referral to the participant: • Informal (general) – the referral can be considered general if the participant receives general education related to substance use and its harmful effects. • Semi-formal (tailored) – the referral can be considered semi-formal if the participant responds “yes” to the substance use screening questions and the CPA/CPPA works with the participant to identify specific resources that may best address the substance use concern. A tailored referral must be documented in the “I” portion of the TGIF note. • Formal (tailored and action-based) – the referral can be considered formal if the participant responds “yes” to the substance use screening questions and the CPA/CPPA initiates contact

DC WIC POLICY & PROCEDURE MANUAL

Policy 8.020 3 | P a g e with an assessment, counseling, treatment, legal, or any substance use-related agency on behalf of the participant. This type of referral is generally considered outside the normal practice for WIC staff and requires a Release of Information form to be signed by the participant or Authorized Representative in accordance with DC WIC policy 12.019 Confidentiality. • No referral – there may be cases where no referral is made for the participant at the time of certification such as if the participant or caretaker denies the request for a referral to substance use services. A referral denial must be documented in the “I” portion of the TGIF note for the participant in accordance with DC WIC policy 2.005 Nutrition Education Overview. Documentation The CPA/CPPA must ensure that the brief intervention (education) and referral (if applicable) are documented in the participant’s record at the time of certification as follows: • The education provided (either general or tailored) must be documented in the “I” portion of the TGIF note for the participant at the time of certification. • If a referral is provided, it must be documented under the “Referrals” tab of participant’s record in the MIS. o If the referral is a tailored (i.e. formal) referral, this information must be documented in the “I” portion of the TGIF note. o If the participant or caretaker refuses a referral for substance use, this must be documented in the “I” portion of the TGIF note. REFERENCES 7 CFR 246.7(a) 7 CFR 246.7(n)(2) 7 CFR 246.11(a)(3) DC WIC policy 2.005 Nutrition Education Overview, 2.006 Nutrition Education Documentation, 12.019 Confidentiality ATTACHMENTS & FORMS Substance Use Prevention Guide (USDA – WIC) Substance Use Screen / Educate / Refer Cheat Sheet DC WIC Nutrition Risk Manual