Members of the Prevention Network Action Team recently attended a webinar sponsored by the Children and Family Futures Program (CCFutures) in the US. During the webinar, a CFFutures representative shared how Plans of Safe Care (POSCs) were being developed to support women who are using substances during pregnancy and promote mother/child togetherness at the time of delivery.
These POSCs are being instigated by court teams, who convene multi-agency collaborations that include child welfare, substance use treatment and OAT providers, medical/health care providers and children’s services, including home visitation and peer recovery supports. The peer supports play a key role in engaging families in voluntary services prenatally or prior to child welfare involvement, helping them navigate social services systems, as well as assisting with creating and monitoring the POSC, and providing important insights into barriers experienced by the families.
This POSC approach has the benefits of forging strong and deliberate partnerships across providers and is positively informing child welfare responses to women and infants where there has been prenatal substance exposure. This work to provide organized, trauma-informed and effective care prenatally is preventing removal of children at birth and family separation overall. At the court level, it is integrating a prevention mindset by asking what it would take to maintain the child in the home and ensure that reasonable and active efforts are made to support the woman’s and family’s health. At the community level, it involves the funding of community coordinators to oversee collaboration and implementation, as well as community education and training. It means that there is coordination from pre-to postnatal care, and that continuity of services is provided. And it is reducing NICU stays and the need for pharmacological interventions.
This is an excellent example of system level change to prevent FASD, as opposed to individualizing and medicalizing the response. The leaders cite similar barriers to what has been identified in many locations and in research about system-level barriers including limited staff and system capacity, concerns about confidentiality, stigma, as well as lack of knowledge about POSCs and their benefits – yet they are addressing these. One of the sites was quoted to say that most of the efforts did not require funding, with the implication that the accomplishments can be sustained in the local systems of care. Instead of requiring significant additional funding for the POSC work they “required commitment and investment by all involved parties to systems change and improved practices – collaboratively and individually – as providers and entities working with the target population.”
The description of this fine work has echoes in the conversations we at the Prevention Network Action Team have had over the years, and when developing the Mothering and Opioids: Addressing Stigma-Acting Collaboratively resource (see the policy values diagram from that resource below). Many of us have, and continue to, advocate for and deliver components of this coordinated system level response. The webinar covered the solid evaluation evidence for this type of response in detail, but the big story is that system level can be done that effectively and safely supports women, children and families. Where there’s a will, there’s a way.
The Prevention Network Action Team (pNAT) recently had an inquiry from an ally about what research is available that informs us about the experience of mothers whose children have been diagnosed with a FASD (sometimes called “birth” mothers). While three researchers associated with the pNAT have undertaken research with mothers for their Master’s or PhD theses (Dr. Amy Salmon, Dr. Dorothy Badry and Dr. Kelly Coons-Harding) we realize that this is a significant gap in the available published research!
We have relied (and will continue to rely!) on the wisdom of mothers who have presented with us at FASD conferences, people such as Pip Williams (UK), Elizabeth Russell (AU), Lisa Lawley and Janet Christie (CA) and Kathy Mitchell (US). Their courageous and thoughtful work as addiction coaches, spokespersons and organizers of networks has contributed so much to our understanding of the issues they have faced, and to the benefits of peer support for mothers who deserve such wise and kind mentors.
In addition to the wisdom of mothers, to answer the request for information, we gathered – see the list below – the academic literature specifically about biological mothers of children with FASD, and welcome readers to send us further links. Here are a few key ideas that emerge from these articles.
Stigmatizing attitudes prevail – Mothers who have been interviewed by researchers describe societal and service provider ignorance about FASD, and harsh judgements directed to women who drink in pregnancy. This perpetuates the reluctance of women to access support. When mothers do access care for themselves and their children, they report additional unintended stigma from physicians and diagnostic teams.
Addiction and other overwhelming influences – Most often in the studies, mothers describe having a family history of alcohol problems and/or mental illness, addiction problems themselves and histories of intimate partner violence. And they note that services which are welcoming, non-judgemental and integrate support on trauma/violence, substance use/addiction and women’s/maternal health are not usually readily available.
Transformation – Some women described that having a child with FASD gave them a reason to stay sober and in effect saved them from a life of addiction and possible death. In essence, it caused a major shift to a recovery trajectory for them. A part of the transformation is empowerment related to knowing they are helping to break the generational cycle of trauma and addiction in their family. The courage and ongoing effort involved, and the external challenges encountered related to recovery, stigma and parenting a child with FASD are formidable.
Adapting to motherhood and becoming advocates – The journey of becoming a mother, addressing an addiction problem, and raising a child with a disability is a very special path. Often mothers noted that they shifted gears to be the best advocate they can be for their child, and to become advocates on the issue to help other women by increasing awareness of FASD, and of how mothers can and do make adaptations and become advocates.
Studies about the perspectives of mothers who have given birth to a child with FASD
Badry, D.E. (2008), “Becoming a birth mother of a child with fetal alcohol syndrome”. Dissertation
Stewart, M., Lawley, L., Tambout, R., & Johnson, A. (2018). Listening in a Settler State: (Birth) Mothers as Paraprofessionals in a Response to FASD. In D. Badry, H. Montgomery, D. Kikulwe, M. Bennett, & D. Fuchs (Eds.), Imagining Child Welfare in the Spirit of Reconciliation: Voices from the Prairies (pp. 117-138): University of Regina Press.
Salmon, J. (2008). FASD: New Zealand Birth Mothers’ Experiences. Canadian Journal of Clinical Pharmacology, 15(2), e191-213.
Thomas, R., & Mukherjee, R. (2019). Exploring the experiences of birth mothers whose children have been diagnosed with fetal alcohol spectrum disorders: a qualitative study. Advances in Dual Diagnosis, 12(1/2), 27-35. doi:10.1108/ADD-10-2018-0014
Studies about mothers of children with FASD (birth, foster, adoptive), societal attitudes and research engagement
Salmon, A. (2007). Walking the talk: how participatory interview methods can democratize research. Qual Health Res, 17(7), 982-993. doi:10.1177/1049732307305250
Coons, K. D., Watson, S. L., Schinke, R. J., & Yantzi, N. M. (2016). Adaptation in families raising children with fetal alcohol spectrum disorder. Part I: What has helped. Journal of Intellectual & Developmental Disability, 41(2), 150-165. doi:10.3109/13668250.2016.1156659
Corrigan, P. W., Lara, J. L., Shah, B. B., Mitchell, K. T., Simmes, D., & Jones, K. L. (2017). The Public Stigma of Birth Mothers of Children with Fetal Alcohol Spectrum Disorders. Alcohol Clin Exp Res, 41(6), 1166-1173. doi:10.1111/acer.13381
Shahram, S. Z., Bottorff, J. L., Kurtz, D. L., Oelke, N. D., Thomas, V., & Spittal, P. M. (2017). Understanding the Life Histories of Pregnant-Involved Young Aboriginal Women with Substance Use Experiences in Three Canadian Cities. Qual Health Res, 27(2), 249-259. doi:10.1177/1049732316657812
Harm reduction and health promotion for women and their partners before conception are key to FASD prevention . Providing health information and supports during the preconception period provides an opportunity for men and women to actively plan for a healthy pregnancy and learn strategies such as healthy nutrition, supplementation, and reducing alcohol and other substance use . Such education and support can contribute greatly to optimizing health and preventing FASD .
Around the world, there are examples of unique approaches to preventing alcohol exposed pregnancies. Some interventions are geared towards women and men separately, and others are gender synchronized, creating complimentary programs for men, women, boys, and girls. Interventions may also include both members of a couple and include training for healthcare professionals.
Websites, such as Healthy Families BC and the Society of Obstetricians and Gynaecologists of Canada have pages offer information about alcohol use during pregnancy and clear and concise steps to consider before becoming pregnant. The recent ThinkFASD website sponsored by the CanFASD Research Network offers advice both for couples who are consciously planning a pregnancy, and those who are drinking and having unprotected sex. Other websites are interactive, such as Alberta Health Services’ Ready or Not, which allows a woman to click through different resources and prompts based on whether or not she feels ready to become pregnant. Don’t Know? Don’t Drink is a creative campaign in New Zealand, which posts fun, engaging graphics and videos to their social media platforms with messages about using contraception and supporting friends to not drink if there’s a chance they might be pregnant. The campaign caters to younger girls and encourages finding a “Pretestie Bestie”, a friend who supports you and your decision making before getting a pregnancy test, as a strategy of FASD prevention.
Interventions in the preconception period are not limited to women. Paternal drinking can impact men’s safety, sperm health, fetal/infant health, and women’s ability to reduce their alcohol use . Various programs have been geared towards men’s education about contraception options, reproductive health, and how to support partners in their efforts to reduce drinking before and during pregnancy. Project Alpha is an American collaboration aimed at educating boys age 12 to 15 about fatherhood, contraception, healthy relationships, and sexuality.
MenCare+ empowers men to be active and positive participants in their own health as well as the health of their partners and children. It has been implemented in Brazil, Indonesia, Rwanda, and South Africa and has been shown to reduce intimate partner violence in its participants, which is an important contributing factor to women’s substance use during pregnancy . In addition to programming for men, MenCare also offers workshops and training for healthcare professionals on engaging men in maternal and child health.
The internet has been a preferred source of information when it comes to preconception  and for couples who know they want to have children, web-based interventions are helpful tools. The UK’s Smarter Pregnancy program helps couples build a profile through an online health assessment and then offers evidence-based recommendations based on their profile. A similar approach is taken by HealthyMoms and HealthyDads complimentary websites, which were created after asking expectant moms and dads what information and supports they need to prepare for parenthood.
Culturally safe and non-judgemental interventions have been shown to be effective in reducing the risk of alcohol exposed pregnancies . In the US, CHOICES and Amor Y Salud are interventions geared towards Indigenous and Latinx communities. CHOICES educates non-pregnant at-risk women about contraceptive options and uses motivational interviewing to support women to reduce drinking. Amor Y Salud, available through the Oregon Health Authority Website, offers a radionovela that follows a young couple as they learn how to optimize their health and prepare for future children. In Canada, Best Start’s website has a page for Indigenous prenatal health with information and resources that integrates Indigenous knowledge with Western health information. They also provide resources, such as Planning for Change, to support healthcare providers in educating their patients about FASD and supporting them in making meaningful changes.
The variety of preconception education and support approaches illustrates opportunities for incorporating these initiatives across the various levels of reproductive health. Childbearing years span four decades for women and are longer for men, and interventions have and can continue to focus on those that are planning or not yet planning a pregnancy, as well as for those in the period before a pregnancy is confirmed. When such preconception and early pregnancy supports are well incorporated throughout the healthcare system, this key component of FASD prevention can be realized.
1. Network Action Team on FASD Prevention. (2010). Consensus on 10 fundamental components of FASD prevention from a women’s health determinants perspective. Canada Northwest FASD Research Network.
3. Webb, Shelby, and Diane Foley. “An Introduction to the Optimal Health Model for Family Planning Clinicians.” National Clinical Training Center for Family Planning, 17 Feb. 2020, http://www.ctcfp.org/optimal-health-podcast/.
4. McBride, N. and S. Johnson, Fathers’ role in alcohol-exposed pregnancies: Systematic review of human studies. American Journal of Preventive Medicine, 2016
5. Alhusen JL, Ray E, Sharps P, Bullock L. Intimate partner violence during pregnancy: maternal and neonatal outcomes. J Womens Health (Larchmt). 2015 Jan;24(1):100-6. doi: 10.1089/jwh.2014.4872. Epub 2014 Sep 29. PMID: 25265285; PMCID: PMC4361157.
6. Da Costa D, Zelkowitz P, Bailey K, Cruz R, Bernard JC, Dasgupta K, Lowensteyn I, Khalifé S. Results of a Needs Assessment to Guide the Development of a Website to Enhance Emotional Wellness and Healthy Behaviors During Pregnancy. J Perinat Educ. 2015;24(4):213-24. doi: 10.1891/1058-1243.24.4.213. PMID: 26834443; PMCID: PMC4718007.
7. Hanson, J., & Pourier, S. (2015). The Oglala Sioux Tribe CHOICES Program: Modifying an Existing Alcohol-Exposed Pregnancy Intervention for Use in an American Indian Community. International Journal of Environmental Research and Public Health, 13(1), 1. doi:10.3390/ijerph13010001
Building trusting and supportive relationships is foundational to women feeling safe and confident enough to take on the challenges of reducing substance use, addressing trauma, and parenting. As such, the relational approach addresses a core aspect of women’s health, stimulating a ripple effect that can enact change and growth in the lives of women at risk of having children with FASD.
Breaking the Cycle (BTC) has been delivering services using a relational lens since 1997 and have found that relationships facilitate healing and change for mothers, children, and the mother-child dyad through improving self-efficacy, instilling purpose, and increasing engagement in services2. The program emphasizes relationships of many types, including those among staff, between women and their children, staff and women, and the organization and service partners.
Breaking the Cycle Compendium Volume 2 – Healing Through Relationships compiles research conducted between 2008 and 2018, and the evidence shows that the relational approach offers opportunities to model relationships based on equality, empowerment, and respect, and that having strong relationships with service providers can have more impact on women’s health than the services themselves. Additionally, emphasizing interagency and intra-agency relationships and collaborations better positions a program to meet the needs of the women and children receiving services3. Through this approach, the BTC program has been successful in preventing FASD and has also positively increased confidence in parenting and mother-child bonds.
In focusing interventions and preventative efforts on building belonging and connection, existing and future programs can better address root causes of women’s substance use. It is from here that we can stimulate a ripple effect to make positive changes in the psychological, emotional, and physical health of mothers and their children.
Developing specialized, culturally safe, and holistic support for pregnant women is an important strategy in preventing FASD . In Labrador, Thea Penashue and June Fry of the Innu Roundtable Secretariat are bringing Innu midwifery and parenting back to Sheshatshiu and Mushuau Innu First Nations through two initiatives.
Centering Pregnancy was introduced in Sheshatshiu in 2018 to increase access to and use of primary prenatal care. The project was born from dialogues between the Innu Round Table Secretariat, Innu Health Directors, the Regional Health Board, physicians, and public health nurses. Centering Pregnancy is a group pregnancy outreach program where women can access prenatal group education, health assessments, and social support. The program promotes relationship-building by allowing participants to bring supports with them to the group sessions and encouraging discussion and bonding between women within the program. Expectant mothers have autonomy and control in their care in addition to support from a health care worker .
The Innu Midwifery Project aims to reintroduce traditional midwifery to Sheshatshiu and Natuashish, drawing on Innu Elders’ knowledge of Innu birthing practices. The project is being done in collaboration with Gisela Becker, the Chief Midwife for Newfoundland and Labrador, to support the training Innu midwives using a culturally-specific, hands-on, individually paced learning approach. Reintroducing midwifery to the Innu First Nations will result in Innu children being born on Innu lands, fostering a greater connection to the land and culture, continuation of cultural practices and culturally safe care, and empowering women in the context of their pregnancy.
These initiatives create a safer environment for Innu women to discuss their health. Based in and driven by the communities and culture, these programs are centered around women, their families, and the communities .
Thea Penashue, the Community Wellness Systems Navigator at the Innu Round Table Secretariat, delivered her second child in a tshuap, a traditional Innu tent, in September. She hopes that, through the Midwifery project and Centering Pregnancy program, more Innu women will be able to give birth in a tshuap, connecting to their land, culture, and sense of self as Innu people, in the company of their loved ones .
Two updated resources are available about alcohol and breastfeeding: a research update from CanFASD Alcohol and Breastfeeding and a brochure from Best Start Mixing Alcohol and Breastfeeding. They both illustrate how little research there is available, and how public health messaging directed to new mothers has changed over time.
The public health message currently offered to mothers is that it is safest not to drink alcohol when breastfeeding and if one chooses to drink, to avoid drinking near the time of breastfeeding, so that infants are exposed to the very least amount of alcohol. Some recent studies about alcohol use when breastfeeding have not found negative effects for infants – and instead, have found that low level drinking during breastfeeding was not associated with shorter breastfeeding duration or adverse outcomes in infants up to 12 months of age. These adverse outcomes included effects on infant feeding and sleeping behaviour, as well as developmental outcomes .
Yet, infants cannot metabolize alcohol in the same way as adults, and exposure to alcohol places them at risk of potential alcohol-related harm, in the short, if not long term. As a result, the weight of decision-making about breastfeeding and drinking alcohol rests on women. What is low level drinking, and how can one assess the many confounding factors related to alcohol’s effects – sex, genetics, nutrition, use of other substances, etc.? All of these issues are in play for their own, and their infant’s health.
Similarly, in light of cannabis legalization, more attention has been placed on the impact of cannabis use on breastfeeding. As with alcohol, initial public health messaging focussed on the studies that showed risk. But, a recent review of the literature led by Dr. Alice Ordean of St Joseph’s Health Centre in Toronto, found only two articles that addressed the impact of postpartum cannabis use by lactating women that provided developmental outcomes for infants . That review found some evidence regarding health risks of post-natal exposure to cannabis, but the authors noted that further research is needed to determine the impact of cannabis exposure via breastmilk on infant neurodevelopmental outcomes beyond the first year of life. They concluded that given the conflicting evidence on outcomes from exposure to cannabis in breast milk, women are advised that it is safest to abstain from cannabis use during lactation and to reduce consumption and plan timing for least exposure, if abstinence is not possible.
What has changed in our public health messaging? As well as repeating the sound advice that it is safest not to use these substances when breastfeeding, practical harm reduction advice is also offered. In the case of alcohol, women are advised to plan ahead to consume alcohol immediately after, and not before, breastfeeding, so that infants are exposed to the very least amount of alcohol. In the case of cannabis, women are advised to avoid breastfeeding within 1 hour of inhaled use to reduce exposure to highest concentration of cannabis in breast milk.
In addition to what is known and not known about the effects of exposure to substances when breastfeeding, there are many other reasons women may need to think critically about their alcohol and cannabis use as new mothers. These include relational attachment, fatigue, risk of exposure to 2nd and 3rd hand smoke for infants and children, and role modelling healthy behaviour. With limited evidence, the benefits and drawbacks of low level alcohol and/or cannabis use will continue to be forefront for breastfeeding mothers.
Tay, R.Y., et al., Alcohol consumption by breastfeeding mothers: Frequency, correlates, and infant outcomes. Drug and Alcohol Review, 2017. 36: p. 667-676.
Ordean, A. and G. Kim, Cannabis Use During Lactation: Literature Review and Clinical Recommendations. Journal of Obstetrics and Gynaecology Canada, epub January 25, 2020.
As we continue to connect our work in Canada on FASD prevention, via the Prevention Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective (pNAT), new priorities for action emerge. These are five priorities that this virtual community identified for the coming year.
Collaboration across fields provides an important opportunity to support mothers, children, and women who may be at risk of using substances during pregnancy. Resources, such as Mothering and Opioids: Addressing Stigma – Acting Collaboratively, highlight opportunities for collaboration across fields to foster advocacy, streamline service delivery and referrals, and offer systems navigation.
Indigenous approaches to FASD prevention
There are an increasing number of wholistic FASD prevention and wellness programs that are incorporating culture and language, traditional knowledge, and land-based programming, while responding to the needs of families and communities. Programs such as Circle of Life in Terrace, Xyólhmettsel Syémyem (Family Empowerment Team) in Chilliwack and others highlighted in the recent booklet, Revitalizing Culture and Healing: Indigenous Approaches to FASD Prevention, bring attention to the importance of community-led, community-driven FASD prevention and wellness programs.
Trauma-informed practice and policy development are essential components in responding to each level of the four-part prevention model. Trauma-informed services recognize the interconnections of trauma, mental health, and substance use and the role that substance use may have in coping with past or current violence or trauma. When discussing alcohol and other substance use, trauma-informed approaches will promote building relationships, building upon individuals’ strengths, and offering choice and collaboration in service provision.
There has been an increasing focus on reducing stigma that mothers and women who use substances during pregnancy experience. By reducing stigma, pregnant women and mothers will be able to better access necessary supports and servicces that support stigma reduction. The recent issue paper from the Canada FASD Research Network on mothers’ experience of stigma through a multi-level model offers recommendations and recommended resources for service providers, health systems planners, and policymakers.
Keeping families together
More attention is being brought to service delivery models that have the goal of keeping families together. These programs, which range from co-located multi-service programming to mentor and peer support models increase women’s access to prenatal care, health care, social support, advocacy, and childcare. PNAT members from programs such as the Parent-Child Assistance Program, Sheway in Vancouver, HerWayHome in Victoria, H.E.R. Pregnancy Program in Edmonton, Manito Ikwe Kagiikwe (the Mothering Project) in Winnipeg, and Mothercraft (Breaking the Cycle) in Toronto are helping us understand how this goal can be achieved in community contexts.
Pregnancy Outreach Programs (POPs) in British Columbia incorporate FASD prevention efforts in their community-based programming. While these programs do not necessarily advertise themselves as providing FASD prevention, their open, non-stigmatizing, and non-judgemental nature make them successful in offering brief support on a range of issues, including alcohol and other substance use.
There are over 70 local pregnancy outreach programs available across the province, including a number of programs that are funded through the Canada Prenatal Nutrition Programs (CPNP). These outreach programs provide support to high-risk pregnant women who are interested in accessing free and voluntary prenatal information and perinatal support services.
Originally, these programs were developed to improve the nutritional status of high-risk pregnant women who typically don’t access such information and services. They offer a variety of supports, often unique to the community that they serve. Some offer daytime support groups for parents and caregivers. Others offer nighttime events where participants get together for arts, crafts, and mocktails. Among other things, these programs provide women with free access to nutrition and health counselling; peer support groups; physical needs (i.e. food vouchers & prenatal vitamins); referrals to counselling services; supports to address issues with alcohol and/or substance use; and supports and resources to help care for their newborns. The diversity in what is offered and their dedication to meeting women where they’re currently at in their life is what makes these programs so effective.
Research shows that a helpful way to encourage disclosure about alcohol consumption during pregnancy is by using a conversational approach. Approaches that are non-confrontational, women-centred, and recognize the social pressure that women may be experiencing are effective at opening “doorways to conversation.” These approaches allow providers to build relationships with their participants, creating a safe space to discuss risks of alcohol and other substance use, and related challenges women face during their pregnancy. In providing a safe and non-judgemental environment that is based on building trust and relationships with women, the practice model of POPs providers fits with this best practice.
Facilitating understanding of FASD and brief support in POPs
The British Columbia Association of Pregnancy Outreach Programs (BCAPOP) is the provincial association for all of the pregnancy outreach programs (POP). Through their work, they provide a platform through which skills, supports, resources, expertise, and information can be shared. Their recent resource, BC Pregnancy Outreach Program Handbook Supplement on Perinatal Substance Use includes information on how to support women and girls facing substance use concerns in a trauma-informed way. The content of this resource is being shared for free through in-person training throughout BC to over one hundred outreach workers by November 2019. BCAPOP also offered a workshop led by Myles Himmelreich at their recent annual conference in Richmond BC, to support understanding by POP workers of the realities of living with FASD.
The important role of social service providers in delivering effective brief interventions on alcohol and substance use, should not be ignored or underestimated. Outreach programs, including CPNP programs, offer a space that provides unconditional supports and resources for women, regardless of where they are at in their health or recovery journeys. We should look to the practice approaches modeled by these programs to find additional ways to meet community needs for action on FASD prevention and build programs that respond to the unique needs of each woman and each community.
Inspired by the Marulu Strategy in the Fitzroy Valley of Western Australia and the work of other Indigenous communities in Canada, the FNHA Community Wellness Support team brought together individuals and organizations working in health care, child welfare, early childhood development, community wellness and other related areas for a one-day meeting on December 1, 2017. The meeting was held on the on the traditional territory of the Musqueam people.
The meeting began with an opening prayer and welcome from a Musqueam Elder. In the morning, participants learned about the successful Family Empowerment Team in the Stó:lō Nation (the Stó:lō traditional territory extends from Yale to Langley, BC). The program is based on the Parent Child Assistance Program (PCAP) model developed by Therese Grant at the University of Washington in 1991 which has been shown to an effective approach to preventing FASD.
The Family Empowerment Team has built upon the PCAP model to develop a holistic and culturally relevant approach to FASD prevention in the Stó:lō Nation. Meeting attendees had the unique opportunity to hear from a woman who has participated in the program and to hear how the program has supported her and her family to reach her goals.
Many women who have FASD are able to benefit from tailored support on substance use problems. Audrey McFarlane, Executive Director of Lakeland Centre for FASD in Cold Lake AB recently shared strategies for working on FASD prevention with women who have FASD themselves. One of the LCFASD programs, the 2nd Floor Women’s Recovery Centre, provides residential treatment exclusively to women. She explained how programs can better support women who have FASD.
Because of the possible neuro-behavioural and physical health issues associated with FASD, working with women living with FASD may pose particular challenges for the service provider due to:
Limited understanding of how their body works and how or why to use birth control;
Limited understanding of how to get housing, money and to keep themselves safe;
Physical health issues, such as diabetes, STDs, vision, hearing and dental;
Limited ability to envision the future;
Inability to link actions to consequences, which makes them more likely to be connected to the justice system and to have many children not in their care with multiple partners.
McFarlane says that these and other challenges mean it often takes longer to see the benefits of supports. Yet, there are a number of strategies that have proven successful.
Take a family alcohol history and ask each woman, specifically, if she has a diagnosis of FASD. Woman will tell you if they do, but are often not even asked.
Make suggestions in key areas where they can agree or disagree rather than using client-generated approaches.
Prioritize building a relationship so that the woman will come back for support as needed. Reframe returning to treatment as a positive, not a negative.
Expect to spend more time on basic life skills and necessities. She may not have connection to family or social services. This means treatment needs to be longer.
Approaches that work best include solution-focused counselling, physical activities, positive touch, relaxation, and connections that develop a sense of belonging, like volunteering and cultural practices.
Here are a number of resources on trauma-informed and FASD-informed approaches for working with women living with FASD.