The AKPQC partners with the State of Alaska’s Substance-Exposed Newborns Initiative (SENI) to promote high quality universal verbal prenatal/postpartum screening with appropriate follow up: which is a recommended, evidence-based practice. SENI was developed in response to the overwhelming acknowledgment that the health care system can and must improve our care of pregnant and parenting people with substance use issues. Identification of those who are experiencing risks for harmful substance use during their pregnancy is a crucial step in their care.

American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, SAMHSA, along with multiple other organizations agree that:

1. Screening for substance use should be a part of routine prenatal care.

2. Universal verbal screening with a validated tool is the preferred method for initial screening.

3. Screening based on risk factors will result in missed cases and perpetuate bias.

4. Urine toxicology testing is not recommended for screening because it does not rule out sporadic substance use and does not detect many substances.

The SENI program supports health care providers to implement and maintain perinatal substance use screening in 3 main ways:

• Provides on-line and in-person Screening, Brief Intervention, and Referral to Treatment (SBIRT) trainings. SBIRT gives staff the tools and confidence to universally screen as well as offer timely intervention to improve patient outcomes.

• Pays the licensing costs for clinical facilities who choose to use the 4P’s Plus©, a screening instrument for tobacco, alcohol, marijuana, and other drugs. 4P’s Plus© also engages patients about intimate partner violence and depression/anxiety and is specifically validated for use during pregnancy.

• Tracks screening rates for participating facilities in conjunction with the AKPQC

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If your facility or practice is interested in receiving information about screenings, staff training in SBIRT, and how SENI can support you, please email seni@alaska.gov.

History of SENI
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In 2016, the Alaska Department of Health and Social Services (DHSS) Divisions of Behavioral (DBH) and Public Health (DPH), Office of Substance Misuse and Addiction Prevention (OSMAP), and hospitals in Anchorage, Fairbanks, Juneau, and Palmer launched a project to screen childbearing people being admitted for childbirth for harmful substances, domestic violence, depression, and desire for subsequent pregnancy. The goal of the project was to support clinicians to provide evidence-based care for pregnant women and their infants.  By early 2017, the project evolved into the Alaska Prenatal Screening Program (APSP) as Alaska’s Governor issued a disaster declaration for Alaska’s opioid epidemic. By July 2019, the APSP had screened 2,298 childbearing people.  Later that year the program re-branded and became the Substance Exposed Newborns Initiative (SENI).
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In January 2020, the AKPQC began supporting SENI with a goal to include recommendations and resources for infant toxicology testing, optimizing non-pharmacologic management, standards for pharmacologic management, as well as Plans of Safe Care and full spectrum community support services for infants and families with substance exposure.

In 2020-2022 the Covid-19 pandemic impacted the capacity of clinical staff while also contributing to increased levels of mental/behavioral health issues including substance use issues. SENI, with the support of the AKPQC, developed on-line SBIRT training due to challenges with in-person trainings.

In 2023 the AKPQC initiated the Substance Affected Pregnancy Initiative, engaging facilities to implement additional best practices, including screening, in the care of pregnant people with substance use disorder and newborns exposed to substances. SENI continues to support the SBIRT model for screening and reach out to outpatient clinics to implement screening as early as possible during pregnancy.