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Revitalizing Culture and Healing: Indigenous Approaches to FASD Prevention is a new resource developed by program providers and experts in Indigenous women’s health and researchers from the Centre of Excellence for Women’s Health, in partnership  with the First Nations Health Authority in BC. The resource includes a beautiful and FASD preventionthoughtful introduction by Marilyn Van Bibber and highlights seven community led and culture driven programs. Each program successfully integrates culture, language, and healing into their program in order to improve the health and wellness of women, children, their families, and their communities. Marilyn is well known for her development of the first resource on Indigenous approaches to FASD prevention in Canada, entitled It Takes a Community published in 1996.

The programs highlighted in this resource use the traditional holistic view of health and wellness that encourages balance between mental, physical, emotional, and spiritual health. They incorporate culture and language, coordinate basic needs, and address women, their families, and their communities’ unique and complex needs by promoting healing through language, ceremony, traditional knowledge, land-based programming, involvement of Elders, and more.

The driving principles that contribute to the success of these programs is that they are community led, culture driven, strengths-based, and provide wraparound support that address broad social and structural factors that impact individuals’ and their families’ lives across the lifespan.

Program planners and service providers can learn from the lessons shared from these programs and integrate the following 4 considerations that support healthy beginnings:

  1. Use Non-Stigmatizing Language

Service providers and healthcare professionals should use strengths based language that promotes wellbeing, creates safe spaces for women and girls to discuss their substance use, and helps women and girls build confidence and ask for support. Providers should shift towards using person-first language in their practices, where clients are identified as a person rather than by their health condition or behaviours. Some examples my include shifting from language “addicts” to “women who use alcohol” and from “she admitted to drinking alcohol during pregnancy” to “she reported drinking during pregnancy.”

For more information on the strengths-based language, the Canadian Centre on Substance Use and Addiction and Canada FASD Research Network have released language guides to support the use of non-stigmatizing language when discussing substance use and FASD.

  1. Identify Existing Community Strengths and Programming

Meeting with existing services to see how they are, or could be, a part of wellness and FASD prevention initiatives is an important strategy in identifying community strengths and linkages that can better support healthy beginnings and healthy families. Identifying these strengths and linkages can better support current or existing program planners in developing a realistic goal for program delivery in your community.

  1. Connecting with those who have Walked the Path Before Us

The programs featured in this booklet enact approaches that have been successful at implementing community led, and culture based approaches to improving the health of women, their families, and their communities. The lessons and approaches in these programs demonstrate what decolonized approaches to FASD prevention can look like.

  1. Identifying Potential Funding Partners

Building relationships with potential funders is an important step towards developing or supporting community-based prevention programs. The breadth of these programs – in addressing a multitude of needs – demonstrate the varied funding that can support families. Given how the programs enact evidence informed and wise practices, it is important that stable and long term support is provided to ensure the programs’ ongoing responsivity and development.

For more information on the seven highlighted programs, four critical considerations, and to review the eight reflection questions on how to support healthy beginnings in your community, see the booklet, Revitalizing Culture and Healing: Indigenous Approaches to FASD Prevention.

One year ago, the Centre of Excellence for Women’s Health released Doorways to Conversation: Brief Intervention on Substance Use with Girls and Women. Since then, there has been a growing interest in expanding work on brief interventions and FASD prevention, to be inclusive of multiple substances and multiple health issues for women, their families and communities.

Here are four innovative ways that brief discussion about alcohol and other substance use is being expanded:

In Sexual Health

Sexual health clinicians are well positioned to deliver brief substance use interventions due to their open, non-judgmental and harm reduction-oriented model of practice. Sexual health providers are able to discuss substance use together with contraceptive use and/or sexually transmitted and blood borne infections [1, 2]. Conversations about substances, sex, and safety can support a woman’s decisions and confidence for change towards improving health in whatever area fits for her.

Linking Discussion of Multiple Substances

Cannabis legalization provides a ‘window of opportunity’ to engage in discussions about alcohol, tobacco, and cannabis use in pregnancy. Discussing what we know and don’t know about cannabis use in pregnancy can now be linked to open conversations about alcohol and other substance use in pregnancy.

Understanding the Link to Adverse Childhood Experiences (ACEs)

Research on ACEs shows how a history of childhood stressors, including physical, sexual, and emotional abuse, may influence alcohol use among adults including pregnant women [3]. Adopting a trauma-informed approach in conversations about alcohol use in pregnancy supports women who experienced childhood adversity with safety, choices, collaboration, self compassion and skills for change.

Advancing Indigenous Wellness Approaches

Holistic, relational, community-based, and culture-led FASD prevention initiatives are key to wellness for pregnant women in Indigenous communities [4]. These interventions address the broad social and structural determinants of health that are associated with substance use and respond to the Truth and Reconciliation Commission Call to Action #33.

References

  1. Lane, J., et al., Nurse-provided screening and brief intervention for risky alcohol consumption by sexual health clinic patients. Sexually Transmitted Infections, 2008. 84(7): p. 524-527.
  2. Crawford, M.J., et al., The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR). Health Technology Assessment, 2014. 18(8): p. 1-48.
  3. Frankenberger, D.J., K. Clements-Nolle, and W. Yang, The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women. Women’s Health Issues, 2015. 25(6): p. 688 – 695.
  4. Wolfson, L., et al., Collaborative Action on Fetal Alcohol Spectrum Disorder Prevention: Principles for Enacting the Truth and Reconciliation Commission Call to Action #33. International Journal Of Environmental Research And Public Health, 2019. 16(9).

 

FASD Conference 2

Marsha Wilson, Nancy Poole and Dorothy Badry at the 7th National Biennial Conference on Adolescents and Adults with Fetal Alcohol Spectrum Disorder (FASD). Session E3: Developments in Prevention of FASD – The Work of the Can FASD Prevention Network Action Team

At the 7th National Biennial Conference on Adolescents and Adults with FASD in Vancouver on April 9, 2016, Nancy Poole and Dorothy Badry described the work of CanFASD’s Prevention Network Action Team (pNAT).  They provided examples of the pNAT’s work on:

  1. Network building – Sharing expertise and skills through a network of researchers, policy analysts, clinicians, community-based service providers and advocates dedicated to FASD prevention
  2. Research – Building multidisciplinary research teams, developing research proposals, and conducting research
  3. Collaborative knowledge exchange – Developing and implementing strategies for moving “research into action” such as through workshops, curricula development for health and social service professionals, and policy analysis
  4. Influencing policy and service provision  Guiding service and policy improvements with governments and communities

Given the conference focus on adolescents and adults with FASD, the 2011 research led by pNAT member Deborah Rutman on prevention with girls and women with FASD and substance use problems was highlighted.   Treatment and support with girls and women who live with FASD is one of the least researched areas of FASD prevention.

A list of FASD prevention resource materials developed by pNAT members was provided. Reports and infographics that summarize research, and thereby support research-to-practice and -policy are included below.

LINKS

7th National Biennial Conference on Adolescents and Adults with FASD

Research on prevention with girls and women with FASD

CanFASD  – description of the pNAT

FASD Prevention Resources Spring 2016

FASD Resources

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The Canadian Association of Pediatric Health Centres is hosting a free webinar on International FASD Day, September 9th, 2015.

Award-winning journalist and author, Ann Dowsett Johnston will discuss dismantling stigma and how to address an alcogenic culture that blames and shames the FASD community.

Dr. Dorothy Badry and Dr. Deb Goodman will discuss a practical set of tools and resources that will be useful to healthcare practitioners and caregivers. The Caregiver Curriculum on FASD and the website www.fasdchildwelfare.ca were developed in response to an identified need for training on FASD that was accessible and available to caregivers supporting individuals with this lifelong disability on a day to day basis.

The webinar will be held on September 9th from 11:00am-12:30pm EST. Click here for more information and to register.

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Developed by the Saskatchewan Prevention Institute, the FASD Training Package for Post-Secondary Instructors is a resource  for post-secondary instructors and professors.

The focus of the resource is on understanding and preventing FASD. It can be used to provide information and education about Fetal Alcohol Spectrum Disorder (FASD) to students enrolled in professional programs leading to a career working with women of child bearing age.

Examples of programs include that this resource might be helpful for include: health care, education, justice, addictions, psychology, social work, and other community services’ programs (e.g., Early Childhood Education, Disability Support Worker, and Correctional Studies.)

The teaching package contains 11 modules with references. These modules provide evidence-based information on topics such as “What is FASD”, “Alcohol, Women, and Pregnancy”, “Prevention of FASD”, and “Primary and Secondary Disabilities”.

A downloadable PowerPoint with teaching notes is ready for use in class. Both the PowerPoint and written modules contain case studies, activities, and discussion questions that may be used with any group.

Download the package from the Saskatchewan Prevention Institute’s website.

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ACEs_Original

Adverse childhood experiences (ACEs) is a term that describes potentially traumatic events that can have lasting negative effects on health and well-being. Research has shown a clear connection between ACEs on alcohol use and misuse in adults.

An emerging area of research also suggests that a history of childhood stressors, such as physical, sexual, and emotional abuse, may influence alcohol use among pregnant women.

In a recent study, researchers used data from the 2010 Nevada Behavioral Risk Factor Surveillance System to learn more about this relationship. They found a dose–response relationship between ACEs and alcohol use during pregnancy that remained even after controlling for pre-pregnancy drinking and other known factors that influence drinking during pregnancy.

This study contributes to a growing body of research demonstrating that factors affecting alcohol use during pregnancy begin long before pregnancy.

It also suggests the importance of initiatives and movements such as ‘trauma-informed’ practice and their application to FASD prevention. Learn more about trauma-informed practice, alcohol, and pregnancy use on the Coalescing on Women and Substance use website.

For more on this topic, see earlier blog posts:

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References

Astley, S.J., et al. (2000). Fetal Alcohol Syndrome (FAS) primary prevention through FAS Diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol and Alcoholism,  35(5): p. 509-519. [Free full text]

Choi, K.W., Abler, L.A., Watt, M.H., Eaton, L.A., Kalichman, S.C., Skinner, D., Pieterse, D., and Sikkema, K.J. (2014) Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences. BMC Pregnancy and Childbirth, 14: 97. [Free full text]

Chung, E. K., Nurmohamed, L., Mathew, L., Elo, I. T., Coyne, J. C., & Culhane, J. F. (2010). Risky health behaviors among mothers-to-be: The impact of adverse childhood experiences. Academic Pediatrics, 10(4): 245–251. [Free full text]

Frankenberger, D.J., Clements-Nolle, K., Yang, W. (2015). The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women. Women’s Health Issues (epub ahead of print). [Abstract]

Nelson, D. B., Uscher-Pines, L., Staples, S. R., & Ann Grisso, J. (2010). Childhood violence and behavioral effects among urban pregnant women. Journal of Women’s Health, 19(6): 1177–1183. [Abstract]

Skagerstrom, J., Chang, G., & Nilsen, P. (2011). Predictors of drinking during pregnancy: A systematic review. Journal of Women’s Health, 20(6):901–913. [Free full text]

Edmonton inner-city program - Aboriginal - CBC'

The Healthy, Empowered and Resilient (H.E.R.) Pregnancy Program in Edmonton, Alberta uses professional staff and peer support workers to reach at-risk pregnant and parenting women in inner city Edmonton. The program, developed by Streetworks, supports street-involved women to access healthcare services before and throughout their pregnancy and address issues such as addiction, poverty and family violence.

CBC News featured the H.E.R. Pregnancy Program last week in the article “Pregnant aboriginal women find ‘world of difference’ in Edmonton inner-city program” (July 27, 2015). Nikki Wiart interviewed staff and clients of the program and learned about the importance of outreach, peer support, and the impact of early engagement with services on pregnancy and parenting outcomes.

90% of the program’s clients are Aboriginal while 50% of the staff is Aboriginal. Morgan Chalifoux, a pregnancy support worker, with the program describes how her personal experiences as a teen mother and living on the streets can make a difference: “”Honestly, if I wasn’t aboriginal, if I didn’t have the experience, if I didn’t use when I was on the street, if I didn’t understand what it was like to have my son threatened to be taken away from me … I wouldn’t be able to have the success that I have now with the clients.”

The program uses a harm reduction approach to addressing alcohol and other substance use during pregnancy. An evaluation of the program found that:

  • 76% of 139 pregnant women who connected with the program reported substance use, typically alcohol (32%), marijuana, and other drugs
  • While connected with the program, women reported elimination of use (40%), safer use (37%), and reduction of substance use (26%) at least once during their pregnancy with the program

The Alberta government has committed to funding the program for another three years as well as developing similar programs in Red Deer and Calgary.

For more on the H.E.R. Pregnancy Program, see earlier posts:

cbc mothering project

Manito Ikwe Kagiikwe (The Mothering Project), located at Mount Carmel Clinic in Winnipeg’s North End, provides prenatal care, parenting and child development support, group programming, advocacy, and addiction support for vulnerable pregnant women and new mothers.

CBC News interviewed Stephanie Wesley and Margaret Bryans about the program earlier this week. Bryans, a nurse and program manager at Manito Ikwe Kagiikwe, discusses the successes of the program since it first opened two years ago. The article focuses on the importance of supportive relationships and the value of a ‘focus on kindness’: “Women who are pregnant, who are using drugs and alcohol are one of the most stigmatized groups in our community.” (The Mothering Project aims to break cycle of addiction, CBC News, April 28, 2015).

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The program is a wonderful example of a integrated and holistic pregnancy program for women with addiction and related concerns. The program is based on principles of harm reduction. (Learn more about harm reduction and similar programs in this booklet, Harm Reduction and Pregnancy: Community-based Approaches to Prenatal Substance Use in Western Canada).

Since the program opened two years ago, 49 women have participated. Early evaluation findings show that, at the beginning of the program, 100% of women were actively using substances, 97% had never completed a substance use treatment program and 56% did not have a prenatal health care provider. Over the course of the program, 36% stopped using alcohol and drugs, 47% reduced their use, 39% attended an addiction treatment facility and 100% accessed prenatal care. Over half of mothers have been able to take their babies home with them from the hospital. Check out the infographic below for more.

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fasd prev entry The Encyclopedia on Early Childhood Development is produced by the Centre of Excellence for Early Childhood Development (CEECD) and the Strategic Knowledge Cluster on Early Child Development (SKC-ECD). This online Encyclopedia is intended for service providers, service planners, policy makers and parents and provides evidence-based information on 51 topics on early childhood development from conception to age 5. It includes easy-to-understand articles on FASD prevention and related topics. The encyclopedia is translated into French, Spanish, Portuguese and is expected to be translated into Russian. homepage Entries related to FASD include:

  • Early Intervention for Children with Fetal Alcohol Spectrum Disorders
  • Prevention of Fetal Alcohol Spectrum Disorders
  • Fetal Alcohol Spectrum Disorders and Nutrition
  • Supporting Parents of Children with Fetal Alcohol Spectrum Disorders and Young Children with Significant Prenatal Alcohol Exposure

The Encyclopedia includes two information sheets for parents on alcohol use during pregnancy (one for a general audience and one for Aboriginal parents) that are available in English, French, and Portuguese. parents - alc preg parents - alc preg abor french

Cover Mother-Child-Study_Report_2014

Mothercraft’s Breaking the Cycle (BTC) in Toronto is one of Canada’s first prevention and early intervention programs for pregnant women and mothers who are substance-involved and their young children.

The program’s goal is to reduce risk and enhance the development of substance-exposed children by addressing maternal substance use problems and the mother-child relationship.

Historically, treatments for substance use tended to minimize gender roles and, in particular, mothering relationships. Contemporary integrated treatments for substance use often emphasize gender-specific issues within the treatment setting, such as trauma (historical and/or present, including domestic violence), depression and other mental health concerns, and adoption of harm reduction goals with respect to substance use. Contemporary integrated treatments have also evolved to acknowledge the importance of the mothering role for women.

Profile of BTC families

This evaluation report described the findings of the Mother-Child Study. The study evaluated and compared the Breaking the Cycle program model of relationship-focused service delivery and its effects on mothers and children with a group of similar women who received a more standard contemporary integrated treatment for substance use issues.

The findings of the Mother-Child Study highlight the critical role of relational-focused interventions in supporting change for substance-involved mothers and their children.

Program features that made a difference for women’s outcomes included:

  • Supporting women to learn about relationships in a number of different ways
  • Making the focus on relationships an integral part of substance use treatment
  • Recognizing that increased relationship capacity with their children enriches the lives of women

Program features that made a difference for children’s outcomes included:

  • Providing integrated early intervention programs
  • Providing comprehensive, multimethod assessments
  • Prioritizing early intervention services which support the mother-child relationship

Importantly, the study found that children, even those exposed to substances during pregnancy, do better when mothers have relationship-focused intervention

Read the report, take a look at summary fact sheets and learn more about the Breaking the Cycle program at www.mothercraft.ca.

fact sheet 9

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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