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PERINATAL RISK ASSESSMENT FOR SUBSTANCE USE - Free downloadable form to assist health care providers in assessing a preg

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Missouri Department of Health & Senior Services Gov. Eric Greitens Home » Healthy Living » Wellness & Prevention » Tobacco Use » Alcohol, Tobacco, and Other Drug Prevention & Awareness

Resources Educational tools: INFANT MANIKINS - Lifelike manikins representing Caucasian and African American infants with Fetal Alcohol Syndrome, prenatal drug exposure, and normal characteristics are available at no cost through 29 community placement sites statewide for use in educational outreach. They are ideal for teaching classes, and come with a kit of instructions. For information regarding how to borrow the manikins, contact us. CHAPTER 191.725-191.745, RSMo., views substance abuse during pregnancy as a disease and focuses on getting women into a system of care. It mandates assessment and counseling of all pregnant women regarding the effects of substance abuse in pregnancy, identifying pregnant women who are chemically dependent and providing priority for treatment and service coordination, addressing education needs of health care providers, and assessing the extent of prenatal substance abuse in Missouri. PERINATAL RISK ASSESSMENT FOR SUBSTANCE USE - Free downloadable form to assist health care providers in assessing a pregnant woman’s use of alcohol, tobacco and drugs. To view and/or download this form, link to MCFH-4. ACKNOWLEDGEMENT OF COUNSELING – Free downloadable form for documentation that a pregnant woman has received counseling about the dangers of prenatal alcohol, tobacco and drug use. To view and/or download this form, link to MCFH-3. This is also available in Spanish. To view and/or download this form, link to MCFH3S.

Toll-free numbers: MISSOURI DEPARTMENT OF MENTAL HEALTH, DIVISION OF ALCOHOL AND DRUG ABUSE – Referral to a treatment center. 800-575-7480. MISSOURI TOBACCO QUITLINE - A toll-free, proactive telephone smoking cessation counseling quitline. 800-QUITNOW (800-784-8669). Any Missourian who uses tobacco and would like assistance with quitting will be provided, without charge, at least one counseling session and self-help materials. Missouri physicians can also call for free medical consultation on tobacco dependence treatment, as well as explanation of available quitline counseling services. For additional information, visit: Smoking and Tobacco. NATIONAL DOMESTIC VIOLENCE HOTLINE – 800-799-SAFE (800-799-7233) TEL-LINK – Missouri’s information and referral telephone line for maternal, child and family health services. 800-TEL-LINK or (800-835-5465). TERATOGEN INFORMATION SERVICES – A toll-free number with information about the effects of exposure to substances or diseases that may influence the development of an unborn baby. 866-626-6847.

Websites: ACOG's Behavioral Health-Drinking and Reproductive Health Tool Kit Patient Handouts Drinking and Reproductive Health Before You Get Pregnant Contracts If You're Pregnant If You Are Not Planning to Get Pregnant Is Someone Special Having a Baby My Plan for Alcohol My Plan for Birth Control Clinician Tools - Drinking and Reproductive Health Additional Screening and Intervention Tools Assess Readiness to Change Standard-Sized Drink Equivalents Card Strategies for Change Drinking and Reproductive Health CME Evaluation Form LINKS to more resources on smoking Arc of the United States Centers for Disease Control and Prevention www.cdc.gov/NCBDDD/fasd/widget/getWidget.html www.cdc.gov/ncbddd/fasd March of Dimes Missouri Department of Mental Health National Organization on Fetal Alcohol Syndrome (NOFAS)

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