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Women-centred “one-stop” program soon to open in Victoria, BC
Image via flickr (http://flic.kr/p/5wabYM)
The Times Colonist published an article today profiling the Herway Home program in Victoria, BC (Vulnerable mothers and babies to get vital help, May 20, 2012).
HerWay Home is a ‘one-stop access’ program for women in the perinatal period who use substances. After four years of planning by over 30 government and community agencies, advocates and experts, HerWay Home will be opening its doors in later summer/early fall of 2012. Services will include prenatal care, a drop-in centre, short-term stabilization housing, drug and alcohol counselling, and parenting support.
The article includes an interview with NAT member, Lenora Marcellus, Assistant Professor in the School of Nursing at the University of Victoria.
Read the news release “Healthy Babies & Women the Focus of New Community Program” from the Vancouver Island Health Authority here (May 17, 2012).
Other similar “one-stop shop” models in Canada include Breaking the Cycle in Toronto, Sheway in Vancouver’s Downtown Eastside, the Maxxine Wright Community Health Centre in Surrey, and Streetworks’ Supports for Homeless Pregnant Women in Edmonton.
For more on this program model, see previous posts:
- FASD Prevention and Social Determinants of Women’s Health: Assessing the Evidence (March 5, 2012)
- “New Choices” for pregnant and parenting women with addictions (January 9, 2012)
- Streetworks’ Supports for Homeless Pregnant Women project (September 15, 2011)
- Clinical Webcast on Breaking the Cycle Program: September 20, 2011 (August 2, 2011)
- Setting the Record Straight on Motherhood and Drug Use (April 28, 2011)
New comic book address the issue of alcohol and pregnancy in the context of overall wellness
The Healthy Aboriginal Network (HAN) released a new comic book on maternal child health today called It Takes a Village.
It Takes a Village is about Lara, a young mom-to-be that is visited by Danis, also a young mom. Danis teaches Lara the importance of eating healthy foods, avoiding alcohol, breastfeeding, keeping dad involved and bonding with her baby. The story was focus group tested online with health professionals and in-person with young, Aboriginal moms.
The Healthy Aboriginal Network is a non-profit that creates comic books on health and social issues for youth. As previously mentioned on the blog, they also have a comic about living with FASD called Drawing Hope which is a collection of five stories. Drawing Hope has also been made into a DVD using the voices of youth living with FASD. You can take a peek at one of the stories, Enough Silence, on YouTube.
You can find a 30 page preview of It Takes a Village as well as information about how to order copies on the HAN website.
Pilot study results suggest that meconium screening may not deliver on its promise
Meconium, the first stools of a newborn baby, can be tested following birth. Amongst other things, it can tell us about prenatal exposure to alcohol.
While it is a far from perfect test (e.g., it only tells us about alcohol use in the second and third trimesters of pregnancy, it is subject to false positives, and a positive test does not equal a diagnosis of FASD), it is believed by some that if meconium testing was to be routinely implemented that it would help with early diagnosis of FASD which would then in turn help with addressing some of the negative consequences of FASD later in life such as difficulties at school or problems with the law. (Meconium testing does not prevent FASD or help to reverse biological effects of alcohol consumption during pregnancy).
A recent study published in the journal Alcohol explores whether women would willingly participate in a neonatal screening program which involves meconium testing. The pilot screening project was conducted in a high-risk obstetric unit in a regional Ontario hospital.
First, the researchers conducted anonymous testing where mothers agreed to have meconium collected from their baby as long as the test results were not connected to individuals. Then, in order to compare, a second group of mothers were asked to participate in an open screening program. The results were significantly different in terms of participation and the rates of a positive test for alcohol exposure.
The participation rate in the screening program was significantly lower than when testing was conducted anonymously (78% vs. 95%) and the positivity rate was 3% in contrast to 30% observed under anonymous conditions. The researchers conclude that the majority of mothers who consumed alcohol during pregnancy refused to participate in a screening program.
The researchers comment on how these outcomes are likely due to embarrassment, guilt, and fears of stigma and child apprehension. One of the suggested ways of resolving this is to eliminate the need for maternal consent to the test. This is an extremely murky ethical area and not likely one to build trust between health care providers and women giving birth (I mean, how would you like it for a random nurse or doctor conducted tests on your child without you knowing about it? Is that really in the “best interests of a child”?).
But it also doesn’t get at the whole issue of how some mothers, regardless of whether they drank alcohol or not during pregnancy, may not be interested in this particular application of technology which is intent on scrutinizing their every move, especially when there is no evidence of spectacular outcomes from the test (FASD is, at present, incurable). In this pilot study, there was one positive case identified by the screening. This led to the identification of motor development delays at 6 months and referrals for further assessment – but it’s not even clear if these delays were related to prenatal alcohol exposure or other factors.
For more on meconium screening, see earlier posts:
- Testing for Fetal Exposure to Alcohol (November 15, 2011)
- The Ethics of Meconium Screening (October 3, 2011)
- Thinking About Meconium Screening (September 28, 2010)
References
Zelner, I., Shor, S., Lynn, H., Roukema, H., Lum, L., Eisinga, K., Koren, G. (2012). Neonatal screening for prenatal alcohol exposure: Assessment of voluntary maternal participation in an open meconium screening program. Alcohol, 1-8. Epub 22 March 2012. doi:10.1016/j.alcohol.2011.09.029
Zelner, I., Shor, S., Lynn, H., Roukema, H., Lum, L., Eisinga, K., Koren, G. (2012). Clinical use of meconium fatty acid ethyl esters for identifying children at risk for alcohol-related disabilities: the first reported case. Journal of Population Therapeutics and Clinical Pharmacology, 19(1):e26-31. (Free full-text)
Banff River. Image by Nav A., via flickr
This year’s Banff International Conference on Behavioural Science is on “Fetal Alcohol Spectrum Disorder: Challenges in Practice, Research and Policy.” The conference is being held March 18-21, 2012 and prevention will be one of the key areas of focus.
NAT members Dorothy Badry (University of Calgary) and Amy Salmon (Sheway, Vancouver) will be presenting on Monday afternoon on FASD Prevention and Social Determinants of Women’s Health: Assessing the Evidence and again on Wednesday afternoon on Community-based Approaches to FASD Prevention: Examples from Front-Line Practice. Their workshops will cover issues such as:
- What is the current state of evidence for FASD prevention efforts addressing social determinants of women’s health?
- How do social determinants of health increase or mitigate risk for FASD in alcohol-exposed pregnancies?
- How to address practical challenges to implementing evidence-based approaches to FASD prevention education and programming at the community level
- An introduction to three different programs: the Sheway Project in Vancouver’s Downtown Eastside; the Brightening Our Homefires Project in four Dene and Inuit communities in the Northwest Territories; and birth mother mentoring and advocacy programs in southern Alberta.
If you’re interested in learning more about the work that Dorothy and Amy are involved with, I’ve listed some resources and links below.
Learn more
Bell, K., McNaughton, D., and Salmon, A. (2009). Medicine, morality and mothering: public health discourses on foetal alcohol exposure, smoking around children and childhood overnutrition. Critical Public Health, 19(2).DOI: 10.1080/09581590802385664
Brochure: SHEWAY: A Community Project for Women and Children
FASD Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective. (2010). 10 Fundamental components of FASD prevention from a women’s health determinants perspective.
FASD Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective . (2009). Taking a relational approach: the importance of timely and supportive connections for women.
Marshall, S.K., Charles, G., Hare, J., Ponzetti, J.J., and Stokl, M. (2005). Sheway’s services for substance using pregnant and parenting women: evaluating the outcomes for infants. Canadian Journal of Community Mental Health, 24(1): 19-33.
Poole, Nancy. (2000). Evaluation report of the Sheway Project for high-risk pregnant and parenting women. Vancouver: British Columbia Centre of Excellence for Women’s Health.
Rasmussen, C., Kully-Martens, K., Denys, K., Badry, D., Henneveld, D., Wyper, K., Grant, T. (2010). The Effectiveness of a Community-Based Intervention Program for Women At-Risk for Giving Birth to a Child with Fetal Alcohol Spectrum Disorder (FASD). Community Mental Health Journal, DOI: 10.1007/s10597-010-9342-0.
Salmon, A. and Clarren, S.K. (2011). Developing effective, culturally appropriate avenues to FASD diagnosis and prevention in northern Canada. International Journal of Circumpolar Health, published online 29.08.2011. PMID: 21878184. Download the free full-text here.
Salmon, A. (2010). “Strength and support: A women’s perspective.” In Jonsson, E., Dennett, L., Littlejohn, G., Fetal Alcohol Spectrum Disorder (FASD): Across the Lifespan: Proceedings from an IHE Consensus Development Conference 2009. Videos of the full conference can viewed here. Hard copies of the book can be ordered from the Institute of Health Economics or downloaded as a PDF.
Upcoming workshops in northern BC
If you’re at all interested in the latest findings from neuroscience on mental health and brain development and what you can do in practice to support at-risk infants (including infants with FASD), then you’d probably love to attend a 1 day workshop with Evelyn Wotherspooon.
There are three workshop dates:
- February 27, 2012 – Fort St. John
- February 29, 2012 – Terrace
- March 2, 2012 – Prince George
The workshops are free and intended primarily for therapists, support workers, key workers, social workers, teachers, teacher aides, childcare workers, infant development workers, public health nurses, and Aboriginal service providers. View the workshop poster with registration details here.
If you can’t attend the workshops, Evelyn Wotherspoon has a website chock full of resources – online lectures, news articles, information sheets – covering issues ranging from child protection and family law to trauma and caregiving.
Resource from the College of New Caledonia
Image via www.cnc.bc.ca
Women who have FASD are considered to be a high risk group for having an alcohol-exposed pregnancy. (For more on this issue, see an earlier post Women with FASD, Substance Use, and FASD Prevention, March 7, 2011).
NAT member Anne Guarasci and colleagues at the College of New Caledonia have developed a resource for front-line workers who work with women who have FASD or FASD behaviours and characteristics. The resource uses stories and examples collected primarily from outreach workers, group facilitators and caregivers in BC’s northern interior region.
The resource was developed as a result of recommendations from Canada Prenatal Nutrition Program, Community Action Plan for Children and Aboriginal Headstart Program frontline workers and coordinators for a resource to help bring clarity to the issue of FASD and provide suggestions for practical strategies and supports. These programs target families with children from 0 to 6 years of age who are considered to be at risk. Many program participants struggle with poverty, unemployment, unstable living conditions, violence and substance misuse and may have difficulty with relationships and parenting.
In addition to the use of individual stories to explore issues for these pregnant and parenting women, there’s a section on facilitating prenatal and parenting groups for participants who may have FASD.
You can download the resource here or from the College of New Caledonia website. You can learn more about the community FASD prevention program Healthier Babies Brighter Futures here and about the College’s FASD programs here.
Reference:
Guarasci, A. (2011). Empowering Front-Line Staff and Families Through a Collection of Lived Experiences: Supporting women who have FASD behaviours and characteristics and/or other related disabilities. College of New Caledonia: Lakes District Region.
Image via www.cnc.bc.ca
Integrated treatment programs for women and their children
The New Choices program in Hamilton, Ontario has been in the media recently as it will be losing its major source of funding at the end of March. (See Addiction treatment ‘lifeline’ losing major funding, January 5 2012).
The New Choices program is an example of a “one-stop shopping” model for women with substance use issues who are pregnant and/or parenting young children. The program components include addiction groups and counselling, nutrition counselling and skill development, parenting education, peer support, and an enriched children’s program.
In addition, it provides linkages with prenatal services, a family physician, a perinatal home visiting program, and other services as needed. The program is not set in terms of a specific structure or length of time which allows services to be tailored to meet the needs of individual women. Attendance at New Choices ranges from 1 to 12 months, with the average length of involvement being 4 months. Sometimes clients will be involved for a few months, leave, and then return to the program at a later date.
Other similar “one-stop shop” models in Canada include Breaking the Cycle in Toronto, Sheway in Vancouver’s Downtown Eastside, the Maxxine Wright Community Health Centre in Surrey, and Streetworks’ Supports for Homeless Pregnant Women in Edmonton.
Many of these programs have been designed to address barriers to accessing prenatal services that exist for many women who use substances. These include: fear of losing custody of children; fear of forced treatment or criminal prosecution; lack of treatment readiness; coexisting mental illness; guilt, denial and/or embarrassment regarding their substance use; and lack of transportation and/or child care.
Other systems-level issues often create barriers to care such as negative attitudes of health care providers towards pregnant women who use substances and the traditional separation of prenatal care and substance abuse treatment.
Further reading: Integrated Treatment Approaches for Pregnant and Parenting Women with Substance Use Issues
Cailleaux, M. and Dechief, L. “I’ve found my voice”: Wraparound as a Promising Strength-based Team Process for High-risk Pregnant and Early Parenting Women. Surrey, BC: Atira Women’s Resource Society
Leslie, M., DeMarchi, G., Motz, M. (2007). Breaking the Cycle: An Essay in Three Voices. In Boyd, S.C. and Marcellus, L. (Eds). With Child: Substance Use During Pregnancy: A Woman-Centred Approach. Peterborough: Fernwood Publishing. pp. 91-104.
Poole, Nancy. (2000). Evaluation report of the Sheway Project for high-risk pregnant and parenting women. Vancouver: British Columbia Centre of Excellence for Women’s Health.
Racine, N., Motz, M., Leslie, M. and Pepler, D. (2009). Breaking the Cycle Pregnancy Outreach Program: Reaching out to improve the health and well-being of pregnant substance involved mothers. Journal of the Association for Research on Mothering, 11 (1): 279-290. (Free full-text here).
Sword, W., Jack, S., Niccols, A., Milligan, K., Henderson, J., and Thabane, L. (2009). Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes. Harm Reduction Journal, 6:32. doi:10.1186/1477-7517-6-32. (Free full-text through PMC)
Sword, W., Niccols, A., and Fan, A. (2004). “New Choices” for women with addictions: perceptions of program participants. BMC Public Health, 4:10. PMCID: 420243. doi: 10.1186/1471-2458-4-10. (Free full-textthrough PMC)
Evaluating the role of mentoring programs in FASD prevention
FASD is an issue that spans across all populations. However, some women who use alcohol in high-risk ways during pregnancy have a history of complex background factors, including trauma, childhood abuse, mental illness, violence, and poverty. For this population, traditional strategies for addressing alcohol use are of limited effectiveness.
One approach to working with women struggling with high-risk substance use has been the development of intensive mentorship support services to women considered most at risk of having a child with FASD. (For examples of these mentoring programs, see earlier posts on Alberta’s First Steps Program and the Mentor Mother Home Visiting Program in South Africa and Saskatchewan’s KidsFirst Program).
Many of these programs are modelled on the Parent–Child Assistance Program (PCAP), which began in 1991 at the University of Washington. This program has been shown to be effective in preventing the births of children with FASD.
A group of researchers from Canada FASD Research Network (NAT 4) is focusing on the research and evaluation of Parent Child Assistance Programs (PCAP), or other mentoring support programs, that provide intensive mentorship support services to women considered most at risk to have a child with FASD. They are interested in better understanding the role these programs play in the prevention of FASD, how the programs are structured, what successes they achieve, what challenges they face, and what gaps exist.
At the moment, mentor-based intervention programs are unevenly distributed across the country. The provinces of Manitoba and Alberta have led the way in starting PCAPs and other kinds of mentoring programs, with British Columbia,
Saskatchewan, and First Nations communities throughout the north having created some programs that have close similarities to the original PCAP model.
- In Manitoba, the mentoring programs, called InSight, are funded by the provincial government. They began in 1998 with two sites in Winnipeg (the Nor’West Co-op Community Health Centre and the Aboriginal Health and Wellness Centre) and a rural site in the community of Norway House. By 2009, the program had six sites, 16 mentors and served up to 240 women. In 2010, there were seven sites, including one program that serves only Aboriginal women. Learn more about InSight here.
- In Alberta, urban PCAP programs were started in December 1999 in Edmonton and Lethbridge, followed soon after by a site in Calgary. There are now 21 PCAP or PCAP-like mentoring programs operating in Alberta under a variety of names such as First Steps, Step by Step, Open Arms, Parent-Child Advocate Program, Mothers to Be Mentorship Program, Coaching Families, and Youth with FASD Mentorship Program. Learn more about these programs here.
- On-reserve Aboriginal communities in Canada have developed numerous approaches to addressing FASD in their communities, many of which include a mentoring component. For example, in Saskatchewan, the Northern Inter-Tribal Health Authority began its “Strengthening the Circle” project in 2003 which now operates at four sites. In BC, the Inter-Tribal Health Authority runs the SOAR Mentoring Program. In Alberta, the Blood Tribe Department of Health offers the First Steps for Healthy Babies program.
Click here to learn more about the Network Action Team on the Evaluation of FASD Mentoring Programs, including links to their quarterly newsletter, a poster presentation from the 4th International Conference on FASD, and a report for 2010-2011 which summarizes their first year of work.
(In case you’re wondering about how many Network Action Teams (NAT) there are in the Canada FASD Research Network, the answer is 5. The NATs are:
NAT 1 – Research in Diagnostic Issues
NAT 2 – Intervention on FASD
NAT 3 – Evaluating FASD-Specific Public Health and Education Materials
NAT 4 – Evaluation of FASD Mentoring Programs
NAT 5 – Prevention from a Women’s Health Determinants Perspective
This blog is an initiative of NAT 5).
Image: SOAR mentoring program brochure, Intertribal Health
Updated resource for parents and caregivers of babies who have been prenatally exposed to alcohol or other drugs
Check out the 3rd edition of Baby Steps: caring for babies with prenatal substance exposure. The newest edition was revised by Charlotte Nelson, Radhika Bhagat, Kate Browning, and Leslie Mills and was a collaboration of the BC Ministry of Children and Family Development, Vancouver Coastal Health, and Vancouver Aboriginal Child & Family Services Society.
The 92-page handbook is for parents and caregivers of babies who have been prenatally exposed to alcohol or other drugs. It includes information about the daily care of babies aged birth to 12 months who may have been exposed to substances in the womb. Information in the resource was gathered from various sources, including parents, caregivers, professionals and published books and articles. It includes stories from both a birth mom and foster parent. As well, it takes a “no shame, no blame” view of substance use and pregnancy:
“Alcohol and substance misuse is a complex issue. Women who misuse substances often struggle with poverty, homelessness, mental illness, violence, trauma, ill health, and have often experienced abuse and a lack of support and protection from an early age. Women from all social and economic groups may use substances while pregnant. However, women who are poor or visible minorities are more likely to be identified when using substances while pregnant.”
This handbook evolved out of the Safe Babies program developed in Victoria, BC in 1998 by NAT member and UVic professor, Lenora Marcellus, in partnership with Capital Regional Health and the Ministry for Children and Families. The program was introduced in response to a recognized need for highly-skilled caregivers who could be trained specifically in meeting the special needs of substance-exposed infants. The program has since spread across the province. You can learn more about the Safe Babies program in the Vancouver area in this powerpoint presentation.
Further Reading: Academic articles by Lenora Marcellus on perinatal substance use
Marcellus, L. and Nelson, C. (2011). Pilot project to provincial program: Sustaining Safe Babies. Canadian Nurse, 107(9): 28-31. (Free full-text here).
Marcellus, L. (2010). Supporting resilience in foster families: A model for program design that supports recruitment, retention and satisfaction of foster families who care for infants with prenatal substance exposure. Child Welfare, 89(1), 7-29.
Marcellus, L. (2008). (Ad)ministering love: Foster families caring for infants with prenatal substance exposure. Qualitative Health Research, 18(9), 1220-1230.
Marcellus, L. (2007). Neonatal Abstinence Syndrome: Reconstructing the evidence. Neonatal Network, 26(1), 33-40.
Marcellus, L. (2005). The ethics of relation: Moral tension for the public health nurse working with child protection clients. Journal of Advanced Nursing, 51(4), 414-420.
Marcellus, L. (2004). Feminist ethics must inform practice: Interventions with perinatal substance users. Health Care for Women International, 25(8), 730-742.
Marcellus, L. (2004). Foster parents who care for infants with prenatal drug exposure: Support during transition from NICU to home. Neonatal Network, 23(6), 33-42.
Marcellus, L. (2004). Developmental evaluation of the Safe Babies Project: Application of the COECA model. Issues in Comprehensive Pediatric Nursing, 27(2), 107-119.
Marcellus, L. (2000). The Safe Babies project. Canadian Nurse, 96(10), 22-26.
Dirk Hanson’s article Alcoholism’s Gender Gap is Closing Fast (November 4, 2011) over at The Fix was my first introduction to the work of Harvard Psychiatry Professor Shelly F. Greenfield.
Hanson comments on the closing gender gap in alcohol problems. (I discussed this “convergence” in youth a couple of weeks ago – see the post Gender Convergence in Youth Binge Drinking, October 20, 2011). In the early 1980s, the ratio of men to women with alcohol use problems in the United States was 5:1; by the early 1990s, this ratio was 2.5:1.
One of Greenfield’s areas of research is gender differences in substance disorders. She comments: “the disease of alcohol dependence proceeds on a faster course in women, requiring medical treatment four years sooner, on average, than for male problem drinkers.” And, as most readers of this blog are aware, addiction treatment strategies developed for men do not work equally well for women.
Recently, she and her colleagues developed a treatment manual with a focus on issues specific to women. They found that their women-only pilot study of the manual was as effective as as a typical, mixed-gender, 12-week treatment program. Interestingly, they found that after six months, women from the all-female group continued to improve, whereas women in the mixed group were likely to have relapsed. Greenfield comments that a woman-focused women-only program “isn’t important for all women, but will be really essential” for some.
Read the interview in Harvard Magazine here.
