Screening and Assessment

In this section, you’ll find guidance on the importance of training staff to screen and assess for both pregnancy and opioid use. Identifying pregnant individuals with OUD at intake is essential to getting them into care timely.

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Key Points

HOW 

  • Train all intake staff on procedures for screening for pregnancy and opioid use disorder. See MOMCARE Screening content.
  • Train staff to identify when a pregnant patient is unwell at intake so the patient can be expedited to care or get hospital clearance before admittance to jail.
  • Add pregnancy and OUD screening and assessment procedures to the jail policy including guidelines for retesting if necessary and re-training at a set period.
  • Implement compliance checks to make sure standardized screening and assessment are consistent across shifts and personnel.

WHY

  • To provide MOUD (also referred to as MAT) and supportive services to pregnant patients in custody, jails must first have a systematic way of screening and assessing for pregnancy and opioid use at intake.
  • Ensuring that all staff members are adequately trained in screening and assessment methods will help ensure that pregnancy and opioid use are immediately identified and patients receive the care they need.

KEEP IN MIND 

  • Women may not be aware that they are pregnant. If negative, pregnancy tests should be repeated in 1-2 weeks if the patient believes there is a chance of pregnancy or if there are other clinical indications (i.e. late menstrual cycle) that the patient may be pregnant. See MOMCARE Screening Pregnancy.
  • Some people may be reluctant to share their most recent time of drug use due to fear of legal consequences. Pregnant individuals who use substances may also be hesitant to share that they are using to due fear of involvement with child welfare and stigma and judgment. Jail staff must use their judgment and be as conservative as possible when determining the risk of withdrawal for pregnant individuals. Jail staff should use patient-centered, non-judgmental language and communicate your goal is to get them appropriate treatment. See MOMCARE Screening OUD.
  • Some jail staff may be responsible for screening for pregnancy and OUD but do not have a professional medical background. Staff must be adequately trained so that comprehensive screening is performed consistently.

Deeper Dive

HOW

Action Items

  1. Train all intake staff on procedures for screening for pregnancy and opioid use disorder. See MOMCARE Screening content.
  2. Train staff to identify when a pregnant patient is unwell at intake so the patient can be expedited to care or get hospital clearance before admittance to jail.
  3. Add pregnancy and OUD screening and assessment procedures to the jail policy including guidelines for retesting if necessary and re-training at a set period.
  4. Implement compliance checks to make sure standardized screening and assessment are consistent across shifts and personnel.

If there is a possibility that a staff member may perform intake processing, even if unlikely, then they should be trained on screening and assessment measures for pregnancy and opioid use.

We do NOT recommend urine drug tests to screen for drug use in pregnancy; national guidelines also support screening with questions, not urine. Urine tests are not always accurate, and in some settings can take a while for results to return.

We provide further guidance on using validated screening tools and other methods to screen for both pregnancy and OUD, see MOMCARE Screening OUD and Screening Pregnancy. We also provide suggested language staff can use for patient interactions.

We suggest using the BJA Management Withdrawal Guidelines to determine if someone is showing signs of being “unwell.”

“Unwell” means that someone has observed signs and symptoms that are obvious to a layperson that they are physically or psychologically sick, including signs of self-reported intoxication or substance withdrawal (see BJA Withdrawal Management Guidelines, p. 5, for more about “unwell”). For a pregnant person, this also includes signs or symptoms of urgent maternal warning signs, like bleeding, pelvic pain, severe headache, contractions, and other symptoms.

WHY

To provide MOUD and supportive services to pregnant patients in custody, jails must first have a systematic way of screening and assessing for pregnancy and opioid use at intake. This involves using evidence-based screening measures and questions to identify folks who use opioids. Training for screening and assessment is important because different staff with varying backgrounds may perform this task. Sometimes it may be someone from the medical team, other times it can be an intake coordinator or custody officer. Ensuring that all staff members are adequately trained in screening and assessment methods will help ensure that pregnancy and opioid use are immediately identified and patients receive the care they need.

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