Case Management to Prevent Fetal Alcohol Spectrum Disorder

Study in South Africa shows that case management can be effective for women at highest risk of having a child with FASD

Stellenbosch University in South Africa was one of the institutions involved in a new study on case management and FASD prevention. Image via http://www.sun.ac.za

The most recent issue of the International Journal of Alcohol and Drug Research is a collection on  articles that focuses on FASD. The articles include pieces by Canada FASD Research Network members Jacqueline Pei, Dorothy Badry, and Aileen Feske. (View the Table of Contents here; all articles are available for free download).

In this special issue, there is a very interesting study by Philip May and colleagues who looked at the use of case management to prevent FASD. Their research took place in a South African community with a subculture of heavy, regular, weekend, recreational drinking and high documented rates of FASD and with women who were at high risk of drinking heavily throughout their pregnancy (e.g., because they had previously given birth to a child diagnosed with FASD or had drunk heavily during a previous pregnancy).

They provided 41 women with 18 months of case management support by a social worker or nurse. Through case management, women received education, coaching, and support with accessing inner strengths and external resources to reduce their alcohol use and address a range of other life issues.

At the beginning of the study:

• 87.8% of the women were pregnant
• Most women had previous alcohol-exposed pregnancies
• 67.5% reported that most or all of their friends drank alcohol, and
• 50.0% reported stressful lives

The researchers used a number of different tools to track changes in drinking practices, including AUDIT scores, average alcohol consumption, and estimated peak BAC measures, at 6, 12, and 18 months after starting the study.

They found that case management was particularly effective with pregnant women in reducing alcohol consumption. And while alcohol levels remained at lower levels than when they started the study, many women resumed previous drinking practices after pregnancy. This suggests that case management can be effective during critical periods, but other initiatives (e.g., changing the culture of drinking) are likely required to support women in making lasting changes.

Overall, this study is part of a growing body of literature supporting the use of case-management approaches for women at highest risk of having a child with FASD.

For more on FASD prevention in South Africa, see previous posts:

• FASD Prevention in South Africa (January 12, 2011)
• More on FASD Prevention in South Africa (June 8, 2011)
• Mentor Mother Home Visiting Program in South Africa (October 6, 2011)

References

Grant, T., Streissguth, A., & Ernst, C. (2002). Benefits and challenges of paraprofessional advocacy with mothers who abuse alcohol and drugs and their children. Zero to Three, 23, 14–20. Free full-text available here.

May, P.A., Marais, A., Gossage, J.P., Barnard, R., Joubert, et al. (2013). Case management reduces drinking during pregnancy among high-risk women. The International Journal of Alcohol and Drug Research. ISSN: 1925-7066. Free full-text available here.

May, P. A., Miller, J. H., Goodhart, K. A., Maestas, O. R., Buckley,  et al. (2008). Enhanced case management to prevent fetal alcohol spectrum disorders in northern plains communities. Maternal and Child Health Journal, 12, 747–759.