Where there’s a will, there’s a way. US system-level action to institute Plans of Safe Care

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.

Source: Page 42, Mothering and Opioids Toolkit

September – A Month Dedicated to Raising Awareness of FASD and its Prevention

In September each year, efforts are made to raise public awareness of FASD as a disability and of FASD prevention.  Here we describe some of the great work that is being done.

Awareness of FASD as a disability – It is important to build awareness of the disability and how to support people living with FASD. This year, a report entitled Excluded: Increasing Understanding, Support and Inclusion for Children with FASD and their Families was developed by the Office of the BC Representative for Youth, with the involvement of people living with FASD. It provides a clear description of the effects of FASD and its challenges for individuals. It also looks at the challenges and gaps in support in educational, health, justice and other systems, and makes recommendations for addressing these gaps and challenges. Another resource of note about provision of support over the lifespan is Towards Healthy Outcomes for Individuals with FASD by the CanFASD Research Network in collaboration with the University of Alberta.

Awareness about alcohol use in pregnancy via educational materials and messaging – Every province and territory in Canada is working to some degree on FASD prevention awareness through informational materials, posters or social media posts. The Saskatchewan Prevention Institute (SPI) does a remarkable job of advocating for “changing the conversation” via an informational website and posters with modern images and encouraging messages. Click here for more information. SPI is consciously working to prevent stigma and uses this approach with the language and images in their prevention messaging, which are described in guidelines created by the CanFASD Research Network. Also within this year, the BC government updated and expanded their public Health File about FASD prevention. Click here for more information.

Alcohol policy initiatives – Warning labels have been found to play a small but important part in raising awareness about not drinking in pregnancy. In the past year The Foundation for Alcohol Research and Education (FARE) in Australia led a successful campaign for mandatory, visible pregnancy health warnings on all alcohol products in Australia and New Zealand. It is worth reading about how they achieved this, through broad inclusion of 4,000 people from 180 organizations, including people with lived experience, as well as health advocates, researchers, politicians, Indigenous leaders and many others: https://fare.org.au/labelling-campaign/. There are many other aspects of alcohol policy that deserve attention as part of FASD prevention, and the CanFASD Network Action Team on FASD Prevention (pNAT) is pleased to have participants who are interested in actively working towards improved alcohol policy over the coming year.

Community development – Another approach to raising awareness of the disability and its prevention is though involving families, organizations and communities in collective health promotion action. While the pandemic has thwarted most face- to- face community action, the Able2 group in Ontario is organizing a community walk to raise awareness on September 11th in Ottawa. For more information see: https://kitchissippi.com/2021/08/04/able2-on-upcoming-fasd-awareness-walk-pandemic-fundraising/

Promoting connection, respect and awareness is always a win!

“Learning to Understand”

When we first formed the Prevention Network Action Team over a decade ago, we insisted on calling it the Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective.  We did not want FASD prevention to have a sole focus on stopping or reducing alcohol use but instead to have a wider focus on the need for changing systemic as well as personal and interpersonal influences on women’s alcohol use.  One such systemic influence is women’s experience of trauma and violence.

Understanding the impact of trauma and violence on women and gender diverse people’s lives has never been more important as we in Canada read and absorb the findings of Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls in Canada. We are called upon to understand and act against systemic processes such as racism, sexism and misogyny, and structural oppression related to ongoing and widespread violence against women, social and economic marginalization of Indigenous women, and the multigenerational effects of horrific colonial and patriarchal practices.

The MMIWG report sets out seven principles for change that inform the 231 Calls for Justice needing action across federal, provincial, territorial and Indigenous governments, industries, institutions, health care, child welfare, correctional services, and policing.  Some of these principles we have often discussed and promoted in our work on FASD prevention. They include:

  1. A focus on substantive equality and human and Indigenous rights
  2. A decolonizing approach
  3. The inclusion of families and survivors
  4. Self-determined and Indigenous-led solutions and services
  5. Recognition of distinctions (i.e., the diversity of Indigenous peoples)
  6. Cultural safety
  7. A trauma-informed approach

In addition to the Calls for Justice, several action plans have been created in order to enact change. The Native Women’s Association of Canada has committed to taking leadership and action to end the violence and genocide, and to the full implementation of an Action Plan they have developed for: ending the violence including all forms of race-and gender-based violence, and upholding dignity and justice for Indigenous women, girls and gender-diverse people in Canada. There are many opportunities within their Action Plan where we who are working on FASD prevention can work together on key actions they have identified.  Here are three examples:

  • Continue ongoing health, policy, research, training and programs to support Indigenous-led health initiatives (page 22)
  • Create and implement awareness building campaigns that will educate the public about MMIWG and the issues and roots of violence (page 38)
  • Monitor media stories and track inaccurate portrayal of Indigenous women (page 41), so that portrayals that perpetuate negative stereotypes of Indigenous women are challenged/stopped and the “curious silence” (page 388 of the MMIWG report) of the media in covering the lives of Indigenous women is addressed.

National and regional Inuit organizations have also developed an action plan. The National Inuit Action Plan was developed by a 10-member Working Group, co-chaired by Inuit Tapiriit Kanatami (ITK) and Pauktuutit Inuit Women of Canada. The National Inuit Action Plan also identifies a wide range of areas where concrete, timely and measurable positive changes need to be made for Inuit women, girls and 2SLGBTQQIA+ people to achieve substantive equality. The image from page 6 of that report illustrates the breadth of the work that needs to be done, how we in FASD prevention can align our actions.

Harriet Visitor, an Indigenous educator and niece of Chanie Wendak, used the expression “learning to understand” on the radio this past week. She describes this as different than simply learning, it involves unlearning, not turning a blind eye, and acting. In the case of missing and murdered Indigenous women and girls, it involves supporting decolonization and revitalization of Indigenous culture and doing everything in our power to ensure the future is one where Indigenous women can thrive as leaders, teachers and healers, and be acknowledged and honoured for their expertise, agency and wisdom.

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