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Video on Legal Issues and FASD Prevention now available
In September 2013, the Institute of Health Economics (IHE) held the first-ever Consensus Development Conference on Legal Issues of FASD in Edmonton, Alberta.
The three-day conference examined issues such as:
- What are the implications of FASD for the legal system?
- Is there a need for enhanced efforts to identify people with FASD and how can these efforts be achieved?
- How can the criminal justice system respond more effectively to those with FASD?
- How can family courts and the family/child welfare legal system address the specific needs of people with FASD?
- What are the best practices for guardianship, trusteeship and social support in a legal context?
- What legal measures are there in different jurisdictions to contribute to the prevention of FASD and what are the ethical and economic implications of these measures?
Nancy Poole, Director of Research and Knowledge Translation at the British Columbia Centre of Excellence for Women’s Health and FASD Prevention Team Lead with the Canada FASD Research Network, gave a fantastic 30 minute presentation called “Legal measures to contribute to prevention of FASD, effectiveness and ethical issues.“ Some of the issues that she addresses are:
- Alcohol and pregnancy warning labels
- Measures to ban selling or serving alcohol to pregnant women
- Interventions targeted at pregnant women with addictions
- Measures related to contraception, and
- Compulsory testing of pregnant women for alcohol
Some of the issues discussed following the presentation included the importance of alcohol brief interventions by health care providers, involving men in FASD prevention, subsidizing long-acting contraception, targeted vs. universal interventions, the relationship between women’s empowerment and successful FASD prevention, and the broader context of alcohol consumption in society.
Some of the themes from this presentation can be found in the Consensus Statement developed following the conference.
The 2013 Consensus Statement on Legal Issues of Fetal Alcohol Spectrum Disorder (FASD) was produced by a distinguished jury led by the Honourable Ian Binnie, former Justice of the Supreme Court of Canada, and includes a range of recommendations calling for changes to the way people with FASD are dealt with by the legal system in Canada. Recommendations related to FASD prevention (p. 35) included:
59. Develop a comprehensive FASD prevention strategy for Canada.
60. Develop gender-specific programs and create opportunities for women and men to discuss with their health care provider relationship issues, child care, and alcohol consumption.
61. Prevention programs should focus on those areas in which positive effects have been demonstrated. In particular, it may be worthwhile to examine interventions involving the mother-child unit. Such approaches might help reduce the likelihood of subsequent children with FASD after a child is found to suffer from an intellectual impairment or neurological disorder such as FASD.
62. Develop evidence-based mandatory training programs for front-line workers on how to talk to women in a secure, non-threatening fashion about the underlying causes of alcohol consumption
FASD prevention can be approached from many levels. For example, Poole (2008) discusses four levels of FASD prevention:
Level 1 - Broad awareness building, health promotion efforts, and public policy
Level 2 – Brief Counselling with Girls and Women of Childbearing Age
Level 3 – Specialized Prenatal Support
Level 4 – Postpartum Support
Level 2 focuses on ensuring girls and women of childbearing years have the opportunity for safe discussion about reproductive health, contraception, pregnancy, alcohol use, and related issues, with their support networks and healthcare providers.
Overall, research evidence supports screening and brief interventions for alcohol misuse as efficacious and cost-effective in a variety of settings. While there are many variations in “brief intervention” approaches, most are grounded in social-cognitive theory and commonly incorporate elements of motivational interviewing. Brief interventions often provide feedback on alcohol use (e.g., is it considered “risky”?), information on the effects and possible consequences of alcohol use, and discussion of possible strategies to moderate or reduce alcohol use.
A recent systematic review by Gebara et al (2013) specifically examines brief interventions to reduce at-risk drinking in women, including studies related to alcohol use during pregnancy. They found that many types of brief interventions could be effective for women, e.g., face-to-face or by computer or telephone, and resulted in changes in both in the number of days of consumption and in the number of doses, or both.
For more on this topic, see earlier posts:
- The Essentials of …. Women and Problematic Substance Use (August 19, 2013)
- Alcohol Screening, Brief Intervention and Referral: Helping Patients Reduce Alcohol-related Risks and Harms resource (December 17, 2012)
- FASD Prevention in Sweden (June 4, 2012)
- Handbook for Aboriginal Alcohol and Drug Work from Australia (January 9, 2012)
- College Binge Drinking and FASD Prevention (February 28, 2011)
Gebara, C., Bhona, F., Ronzani, T., Lourenço, L. and Noto, A. (2013). Brief intervention and decrease of alcohol consumption among women: a systematic review. Substance Abuse Treatment, Prevention, and Policy, 8: 31 doi:10.1186/1747-597X-8-31
Poole, N. (2008). Fetal Alcohol Spectrum Disorder (FASD) Prevention: Canadian Perspectives. Ottawa, ON: Public Health Agency of Canada
Nancy Poole and Lorraine Greaves have a short commentary in the March/April issue of the Canadian Journal of Public Health on the Healthy Choices in Pregnancy Program developed in British Columbia as part of the ActNow Initiative that led up to the Olympics in 2010. The article is an interesting case study on building support for FASD prevention work at the level of government and looking at system-level strategies for increasing awareness of FASD.
In 2003, the Canadian province of British Columbia won the bid to host the 2010 Winter Olympic and Paralympic Games. The government of the day saw this achievement as a window of opportunity to establish a health promotion legacy.
In 2005, the BC government launched ActNowBC, a intersectoral initiative that integrated activities across government with civil society initiatives to achieve five health promotion targets by 2010. Among its several components and streams, ActNow had a focus on the reduction of alcohol (and tobacco) use during pregnancy called Healthy Choices in Pregnancy (HCIP).
The Healthy Choices in Pregnancy initiative took a unique approach to addressing alcohol use during pregnancy by focusing on helping healthcare and social service practitioners to change the ways in which they engage with women. Rather than focusing on the development and dissemination of information about the risks of alcohol use in pregnancy targeted at women directly, the program aimed its resources at providers.
This approach was intended to relieve the burden of change from individuals and allowed women—who are often highly stigmatized for drinking and smoking when pregnant—to experience health care and social service systems as welcoming and helpful.
Collaboration across a range of groups, professions and services was encouraged. Researchers, health system planners, service providers, policy-makers, and women themselves worked collaboratively on the initiative. In shifting from individual to systemic change, the program created a shift in attitude and focus from blaming individual women for drinking during pregnancy, to creating systemic change and action based on effective and supportive approaches to reducing alcohol use during pregnancy.
Poole, N. and Greaves, L. (2013). Alcohol Use During Pregnancy in Canada: How Policy Moments Can Create Opportunities for Promoting Women’s Health. Canadian Journal of Public Health, 104(2): e170-e172.
The 5th International Conference on Fetal Alcohol Spectrum Disorder is being held February 27 – March 2, 2013 in Vancouver, BC, Canada.
If you’re attending the conference, you might be interested in a new evening session that has just been announced.
Shining a Light on Canada’s Multi-layered Approach on FASD Prevention
Thursday, February 28 (5:30 – 8:30pm at The Westin Bayshore)
FASD prevention involves much more than providing information about the risks of alcohol use in pregnancy. Over the past two decades, Canada has developed a multi-layered approach to FASD prevention. This session will use current examples of FASD-related policies, programs, and initiatives from across Canada.
After providing an overview of the different levels of FASD prevention, the session will highlight the perspectives and work of individuals working in a range of contexts, including government, university and community-based research, program development and service provision, community advocacy, municipal and provincial alcohol policy development.
The session will include highlights from individuals working across Canada, opportunities for networking and dialogue, and group exercises to stimulate reflection and integration of key ideas and principles. Learn more about registering for the session here.
As well, members of the Canada FASD Research Network will be presenting on prevention-related work throughout the conference.
Wednesday, February 27, 2013
Who Drinks Alcohol during Pregnancy? How Results from a Universal Screening Program can Inform Policy and Practice (Ana Hanlon-Dearman and Holly Gammon)
Patterns of Alcohol Use Among Women of Childbearing Years in Canada: Implications for FASD Prevention (Gerald Thomas and Nancy Poole)
Alcohol and Drug Abuse Treatment Among Women Who Have FASD (Therese M Grant, Dan Dubovsky, Nancy L Whitney)
Thursday, February 28, 2013
Evaluating Community-based FASD Prevention and FASD Support Programs Phase Two: Promising Approaches, Frameworks and Resources (Deborah Rutman, Nancy Poole, Carol Hubberstey, Sharon Hume, Marilyn van Bibber)
Friday, March 1, 2013
The Politics of Alcohol and Pregnancy Campaigns (Nancy Poole and Tasnim Nathoo)
Brightening Our Home Fires: The Application of Photovoice as a Means of Community Engagement in FASD Prevention (Dorothy E Badry, Arlene Hache, Amy Salmon, Aileen Wight Felske)
Session F4 (A4 repeated)
Alcohol and Drug Abuse Treatment Among Women Who Have FASD (Therese M Grant, Dan Dubovsky, Nancy L Whitney)
Webcasts and presentations from the 4th International Conference on Fetal Alcohol Spectrum Disorder are available on-line. You can also take a look at earlier posts:
- Webcasts from 4th International Conference on FASD available (April 26, 2011)
- Public Presentation at the 4th International FASD Conference (February 21, 2011)
- Look for us at the 4th International Conference on FASD, March 2-5, 2011 (January 10, 2011)