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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

Nancy Poole with Heather Cameron, BCPOPs Executive Director, at BCAPOP Annual Conference

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.

Nancy Poole with Myles Himmelreich at BCAPOP Annual Conference.

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.

A few of our Prevention Network (pNAT) members recently spotted an online article entitled “Demonising smoking and drinking in pregnancy may lead women to do it in private, says study.” Read the online article about the study here.

This study from the University of Cardiff in Wales has confirmed what most women’s health advocates know – that judging pregnant women for behaviours that may negatively affect fetal and child health, did not cause them to stop, but instead caused them avoid public and professional scrutiny, and to use in private. Women felt judged by healthcare professionals for their smoking and poverty, which made interactions with health care providers awkward. (See journal article on the study here.)

In the research 10 low-income, pregnant women in Wales were asked to “tell their stories” including how pregnancy affects their everyday life. Although smoking was discussed extensively by the women, interviewers did not raise the topic during the interviews. As part of their stories, women described their smoking behaviours, and reactions from the public, family, friends, and health care providers.

  

Liberation: Helping Women Quit Smoking

  

Doorways to Conversation

This study underscores what we know about substance use prevention in general – shame and stigma are not solutions to helping people change use, and specifically that the judgement of health professionals is tied to not accessing the support that is needed and deserved. In that way, the professionals become part of the problem instead of the solution. Evidence has established that using non-judgmental approaches are key to supporting behaviour change. These approaches emphasise harm reduction and employ collaborative and empathic conversations that respect individuals’ self determination and understand the underlying issues of substance use problems. Further to collaborative conversations, it is critical to understand substance use, and challenges to change substance use, as related to the burdens of violence and poverty faced by women – this forces us to move beyond a focus on individual behaviour and instead to action for social justice on these conditions of women’s lives.

Collaborative Approaches for Health Care Professionals

Indigenous Approaches to FASD Prevention

Mothercraft Study: “A Focus on Relationships”

The pNAT has written extensively about the importance of non-judgmental Level 2 discussions with women and their partners about alcohol, other substance use and the determinants of health that affect use. Included here are some resources that can help practitioners to engage in those discussions with women in a way that builds connection and relationship and supports movement toward positive change in alcohol and tobacco use, and related health and social concerns. As well, practitioners can connect to local pregnancy and addictions support programs to learn what community action to address stigma and promote social justice is underway.

References

Weinberger, A. H., Platt, J., Esan, H., Galea, S., Erlich, D., & Goodwin, R. D. (2017). Cigarette Smoking is Associated with Increased Risk of Substance Use Disorder Relapse: A Nationally Representative, Prospective Longitudinal Investigation. The Journal of clinical psychiatry, 78(2), e152-e160.

See earlier posts

LINKING CANNABIS USE WITH ALCOHOL AND TOBACCO November 13, 2018
NEW RESOURCES FOR COLLABORATIVE CONVERSATIONS ON SUBSTANCE USE WITH GIRLS AND WOMEN June 18, 2018
REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED May 15, 2017
TARGETING STIGMA AND FASD IN MANITOBA June 26, 2017
ADVERSE CHILDHOOD EXPERIENCES AND ALCOHOL USE DURING PREGNANCY August 18, 2015
BRIEF INTERVENTIONS TO DECREASE ALCOHOL MISUSE IN WOMEN November 26, 2013
LET’S START A CONVERSATION ABOUT HEALTH . . . AND NOT TALK ABOUT HEALTH CARE AT ALL June 23, 2011

In developing a panel presentation at the FASD International conference in 2007, Nancy Poole highlighted why the traditional “primary, secondary, and tertiary” model used for disease prevention did not fit as well for prevention of FASD. While designing that panel together with service providers and a birth mother to a child diagnosed with FASD, it dawned on Nancy and the panelists that FASD prevention wasn’t just about alcohol or pregnancy.

When asked to prepare a write-up of this emerging thinking for the Public Health Agency of Canada (PHAC), Poole assembled a group of 25 Canadian prevention specialists to collectively discuss and build the final 4 part model. It was published by PHAC in 2008 (see page 18 for the list of 25 co-developers – Full MODEL Here). The model illustrates how it is important to link mother child and community health in prevention, including continuing to support women and children past the perinatal period.

Over these last 10 years, this Canadian model has been adopted or built upon by FASD prevention specialists in Canada and a number of countries.

Figure 1: Four Levels of FASD Prevention

A recent article discussing what to do about high levels of alcohol use during pregnancy in the United Kingdom recommended the 4-level prevention model as a way to help women make informed decisions.

In Australia, Dr. James Fitzpatrick of Telethon Kids has used and built upon the multi-level model by showing how important it is to link, intervention, research and diagnosis to FASD prevention efforts (Figure 2). He has led community-based FASD prevention initiatives in remote parts of Western Australia that have significantly reduced alcohol use during pregnancy.

Figure 2: Adaptation of 4-Level Model of FASD Prevention by Dr. James Fitzpatrick, Telethon Kids, AU

Perhaps the model has influenced recent action plans regarding FASD, such as that of New Zealand. It emphasises the need for wrap-around services that pair women’s and children’s health including substance use services and treatment for pregnant and post-partum women. They also emphasize collaboration across sectors at the policy and community level.

Looking back, the 4-level prevention model was developed from the collective wisdom of researchers, service providers, policy analysts and birth mothers while implementing prevention initiatives in Canada. Further adaptations have included larger policy components that are key to prevention of alcohol problems. The development process of the model underscores how no one agency or approach can cover FASD prevention. It requires efforts in each of the levels, in ways that are mutually reinforcing.

For more on these topics, see earlier posts:

FASD PREVENTION WITH INDIGENOUS COMMUNITIES IN AUSTRALIA April 3, 2017

FASD PREVENTION CAMPAIGNS LINK TO SUPPORT January 29, 2018

BRIEF INTERVENTIONS TO DECREASE ALCOHOL MISUSE IN WOMEN November 26, 2013

HOLISTIC AND SPECIALIZED SUPPORT FOR PREGNANT WOMEN: LEVEL 3 PREVENTION November 21, 2016

THE MOTHERING PROJECT/MANITO IKWE KAGIIKWE IN WINNIPEG, MANITOBA May 1, 2015

INTEGRATING FASD PREVENTION AND ALCOHOL POLICY March 17, 2011

NEW ZEALAND’S NEW ACTION PLAN TO ADDRESS FASD September 17, 2016

Because alcohol and tobacco have long been legal substances, there is a lot of evidence about their use during the preconception, pregnancy and perinatal periods. With the legalization of cannabis in Canada, new research on cannabis use may begin to fill the existing evidence gaps and better define its risks.

Because of its illegal status, women may have been reluctant to report using cannabis during pregnancy unless it was being used medically, and research ethics may have prohibited its study. Consequently, much of what we know about cannabis use in pregnancy has come from data gathered during studies on alcohol and tobacco. That is why it now makes sense to link the work of all three substances.

For instance, research shows that women who use cannabis during pregnancy are more likely to smoke cigarettes and use alcohol.1 As well, co-use of tobacco and cannabis is associated small head circumference and may increase other birth defects (cardio, musculoskeletal, and gastrointestinal) compared to no-use and single-use groups.2 This finding of association should be interpreted with some caution based on the number of limitations of the study. Still, it does underscore the need for more robust research in order to understand the association.

Researching all three substances allows for understanding the “clustering of risks” and the interactions between those risks in a way that targeting individual substances cannot do.3 By looking at the clustering of risk as described by researchers, holistic prevention efforts can target social determinants of health that affect poly-substance use.

Linking the findings on the three substances allows researchers to parse out the differences among those who use substances in pregnancy, and the clusters of risk for the substances they use. That will help to further prevention efforts in messaging, discussing substance use with women and their partners, and supporting women with holistic and safe approaches.

References

1. Ko, J.Y., Tong, V.T., Bombard, J.M., Hayes, D.K., Davy, J., & Perham-Hester, K.A. (2018). Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: A population-based study. Drug and alcohol dependence, 187, 72-78.
2. Coleman-Cowger, V.H., Oga, E.A., Peters, E.N., & Mark, K. (2018). Prevalence and associated birth outcomes of co-use of Cannabis and tobacco cigarettes during pregnancy. Neurotoxicology and teratology, 68, 84-90.
3. Passey, Megan E. et al. (2014). Tobacco, alcohol and cannabis use during pregnancy: Clustering of risks. Drug & Alcohol Dependence, Volume 134, 44–50. https://www.sciencedirect.com/science/article/pii/S0376871613003700#bib0185

For more on these topics, see earlier posts:

DISCUSSING ALCOHOL USE WITH WOMEN – DOES THE SBIR MODEL NEED REARRANGING? October 4, 2017
ALCOHOL, COCAINE, MARIJUANA, AND CIGARETTE USE DURING PREGNANCY: LOOKING AT RELATIVE HARMS March 17, 2014

A newly published book entitled Mothers, Addiction and Recovery underscores the value of focusing on maternal identity and meaning for supporting women with children through addiction and recovery. By bringing together the voices of women with lived experiences, as well as program practitioners, policy makers, and researchers from across Canada, the editors illustrate the gendered nature of addictions (including gambling, food and smartphones) and the value of harm reduction and holistic approaches to healing and recovery.

Members of this Prevention Network Action Team contributed articles to the book. In “Mothering and Mentoring: The PCAP Women’s Quilt”, Dorothy Badry, Kristin Bonot, and Rhonda Nelson describe the quilt project undertaken by mentors and program participants from the Parent Child Assistance Program (PCAP) project in Alberta. Named “Woven Together”, the quilt is a visual expression of the powerful relationship ties that the women and mentors created together. As well, the article offers a historical perspective on FASD and FASD prevention efforts.

In a chapter entitled “Beyond Abstinence: Harm Reduction during Pregnancy and Early Parenting” Lenora Marcellus, Nancy Poole, and Natalie Hemsing reflect on the historical concern around substance use during pregnancy and how important it is, now, to bring a gendered and harm reduction orientation to our responses. They conclude that, regardless of the substances used, harm reduction approaches address the complex life circumstances of women, such as culture, trauma, connection to children, and practical socio-economic realities. They describe emerging and established programs that use harm-reduction and trauma-informed approaches in order to provide tailored systems of care that are non-punitive, responsive and effective for women and families. Many of these programs have been featured in this blog (see below).

This book is published by Demeter Press and features many other articles that address the experience of mothering within the context of addictions. Although the voices of women with lived experiences are included in part, the editors, Wendy E. Peterson, Laura Lynn Armstrong, and Michelle A. Foulkes, regretfully acknowledge that the book is missing the unique perspectives of Indigenous women.

For related information, see these earlier posts:

REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED May 15, 2017

TARGETING STIGMA AND FASD IN MANITOBA June 26, 2017

HOUSING IS KEY COMPONENT TO WOMEN’S RECOVERY August 19, 2017

DEVELOPING AN INDIGENOUS APPROACH TO FASD PREVENTION IN BC’S FRASER SALISH REGION December 11, 2017

ALBERTA’S PCAP WOMEN’S QUILT: “CREATING A BOND . . . BUILDING A RELATIONSHIP” April 22, 2016

WEBINAR JUNE 23 – WORKING WITH PREGNANT AND PARENTING WOMEN: LEARNINGS FROM HERWAY HOME June 16, 2016

HARM REDUCTION AND PREGNANCY: COMMUNITY-BASED APPROACHES TO PRENATAL SUBSTANCE USE IN WESTERN CANADA February 26, 2015

THE MOTHER-CHILD STUDY: EVALUATING TREATMENTS FOR SUBSTANCE-USING WOMEN March 18, 2015

THE MOTHERING PROJECT/MANITO IKWE KAGIIKWE IN WINNIPEG, MANITOBA May 1, 2015

FASD PREVENTION AND SOCIAL DETERMINANTS OF WOMEN’S HEALTH: ASSESSING THE EVIDENCE March 5, 2012

Research has shown that everyone has a role to play in preventing FASD and that positive messaging is most effective for promoting awareness and discussion of alcohol use during pregnancy. Understanding positive messaging can help avoid the unintended negative consequences we have seen from previous efforts. Prevention-positive principles include:

  • Using non-exploitative imagery. Prevention campaigns are replacing lone naked-belly images with those that emphasize the mother-child dyad within a supportive network.
  • Respectful messaging that encourages women to access help if they need it rather than fear-based or blaming messaging like “if you loved your baby, you wouldn’t drink.”
  • Linking to where information and help is available.
  • Not describing FASD as “100% preventable” as this may lead women to think that the system of care won’t welcome them if they have already consumed alcohol in pregnancy.

Here are some recent examples of prevention-positive efforts from across Canada.

Yukon

The Yukon FASD Interagency Advisory Committee is taking a prevention-positive approach with their “Alcohol-free is supportive” campaign. It consists of posters in English and French, ads in the local theatres, online ads, and a radio ad as featured on CKRW. Below is an example of one poster with plans for others in the coming months. Partners in this project are the Yukon Government, Fetal Alcohol Syndrome Society of the Yukon (FASSY), and Child Development Centre.

Alberta

Women can sign up to do a “Dry 9” and receive a t-shirt and emails of support during their pregnancy. The Dry 9 movement encourages others to support women who decide not to drink any alcohol during their pregnancy. Short videos on topics such as the “Persistent Friend”, “Co-Parent to Be”, and the “Previous Generation” can be shared with others. The Alberta Gaming and Liquor Commission launched the Dry 9 movement last December as part of DrinkSense.

Saskatchewan

The Saskatchewan Prevention Institute focused on positive partner support in their “This is why I supported her not to drink” campaign. The information card is available as a poster and there are also versions in Dene and Cree. Learn more about partner influence and support on their “How To Help” page http://skprevention.ca/how-to-help/

Saskatchewan Prevention Institute http://skprevention.ca/

Québec

Health professionals in Québec City will use printable pamphlets to have discussions with women and their partners about alcohol and pregnancy. Besides information on alcohol and FASD, the pamphlets, published with the help of Public Heath Agency of Canada, describe fetal development, and resources and support. Link to brochures and posters can be found on the Dispensaire Diététique de Montréal site.

Montreal Diet Dispensary and the Public Health Agency of Canada

Ontario

Having discussions about alcohol and birth control with all women of childbearing age and their partners has proven to be an effective FASD prevention strategy. This FASD ONE prevention poster aims to encourage health and social service providers to have discussions and to support a universal screening approach.

FASD ONE

For previous posts about other prevention campaigns, see:

ARE SHOCK TACTICS EFFECTIVE? March 22, 2011

SHOULD AWARENESS CAMPAIGNS BE FEAR-BASED OR SUPPORT-BASED? April 20, 2011

STRONG SPIRIT STRONG FUTURE CAMPAIGN IN WESTERN AUSTRALIA December 19, 2013

ALCOHOL AND PREGNANCY CAMPAIGN FROM NUNAVUT, CANADA September 23, 2014

ONTARIO ALCOHOL AND PREGNANCY AWARENESS CAMPAIGN DRAWS MIXED REACTIONS September 16, 2014

“SWAP THE PUB FOR YOUR BUB” – PREGNANT PAUSE CAMPAIGN LAUNCHES IN CANBERRA August 21, 2014

FASD AWARENESS CAMPAIGNS: CREATING EFFECTIVE MESSAGES July 14, 2014

“WOMEN WANT TO KNOW” CAMPAIGN FOR HEALTH PROFESSIONALS FROM AUSTRALIA July 9, 2014

RETHINK YOUR DRINKING CAMPAIGN FROM SOUTHWESTERN ONTARIO January 13, 2014

The First Nations Health Authority (FNHA) in British Columbia is exploring a partnership approach to developing a community-based FASD prevention strategy in the Fraser Salish region.

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.

In the afternoon, members of Alberta’s Parent-Child Assistance Program Council shared their experiences of working with and supporting over 30 PCAP programs in Alberta and how different agencies, groups, and government departments have collaborated in developing a 10-year provincial strategy to address FASD.


For more on these topics, see these earlier posts:

Alberta Parent-Child Assistance Program Quilt, December 8, 2014

Films from the Lililwan Project: Tristan and Marulu, May 9, 2012

FASD Mentoring Programs in Canada, December 7, 2011

 

Sheway is well-known in Canada for its success in providing wrap-around services for pregnant and newly parenting women who are dealing with complex personal and social circumstances. It is trauma-informed, women-centred, culturally responsive and uses a harm reduction approach with a focus on connection with self and others. Women and their children can remain in the program up to 18 months post-partum. Last December, Lenora Marcellus, University of Victoria, and Sheway published findings to their study on how women make the transition from Sheway to living on their own – Supporting Families at Sheway and Beyond. Additionally, Dr. Marcellus has published a journal article:

Marcellus, L. (2017). A grounded theory of mothering in the early years for women recovering from substance use. Journal of Family Nursing. E-print ahead of press. 

In order to learn what elements of a positive transition could be identified and built upon, they followed 18 women for 3 years after leaving Sheway. These women faced multiple obstacles in this transition process with the overarching theme being “holding it together.” Their daily efforts are explored in these 3 ways:

Download Sheway Report

Restoring Self: gaining recovery and taking care of self, reconnecting with self and others, and rebuilding trust and credibility.

Centering Family: parenting their children, preserving a routine, dealing with partners, and handling custody issues.

Creating  Home: “chasing housing”, having to take whatever housing is available even if inadequate, and maintaining not only a physical space but a feeling of home for the family

While acknowledging the value for pregnancy and postpartum support as most often provided in maternity programs, their findings underscore that secure housing is a key component to a successful transition for women and their families. Yet, although housing is important to the overall health of women and their families, the choices they must make often result in a double bind. For example, women often are faced with choosing between affordable housing that is far from supports versus more expensive housing that is near supports. Some women must choose between staying in an unsafe relationship or losing housing. As well, some women must accept inadequate housing because of their substance use history, which serves to undermine their recovery and their maintaining custody of their children.

“Poor housing was identified by women as a potential trigger to relapse in their recovery.” – [1] p. 39

Complete findings are detailed within the report and recommendations are framed within the Levels of Prevention model developed by this prevention network.  Among the research team recommendations is to extend the time women can stay in the program in order to solidify recovery, supports and resources. As well, they stress that housing needs to be a core component of intensive, integrated maternity programs.


For more on these topics, see earlier posts:

HOLISTIC AND SPECIALIZED SUPPORT FOR PREGNANT WOMEN: LEVEL 3 PREVENTION, November 21, 2016
THE MOTHER-CHILD STUDY: EVALUATING TREATMENTS FOR SUBSTANCE-USING WOMEN, MARCH 18, 2015
SUPPORTING PREGNANT AND PARENTING WOMEN WHO USE SUBSTANCES: WHAT COMMUNITIES ARE DOING TO HELP, OCTOBER 1, 2012
HERWAY HOME ‘ONE-STOP ACCESS’ PROGRAM IN VICTORIA SET TO OPEN, MAY 20, 2012
“NEW CHOICES” FOR PREGNANT AND PARENTING WOMEN WITH ADDICTIONS, JANUARY 9, 2012
TORONTO CENTRE FOR SUBSTANCE USE IN PREGNANCY (T-CUP), DECEMBER 19, 2011
CLINICAL WEBCAST ON BREAKING THE CYCLE PROGRAM: SEPTEMBER 20, 2011, AUGUST 2, 2011

  1. Marcellus, L., Supporting families at Sheway and beyond: Self, recovery, family home. 2016, Sheway: Vancouver, BC.

 

4th in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 3

“Research on Reaching and Engaging Women and Children using Approaches that are Theory Based, and have an Equity Lens” – Janet Christie, Addiction Recovery Coach, Canada; Anne Russell of the Russell Family Fetal Alcohol Disorders, Australia; Pippa Williams of UK and European Mothers Network-FASD; Margaret Leslie and Dr. Mary Motz of the Mothercraft/Breaking the Cycle, Canada

L to R: Janet Christie, Anne Russell, Pippa Williams, Margaret Leslie, Dr. Mary Motz with Dr. Nancy Poole, Prevention Plenary Co-Lead

One of the highlights of the first Plenary on Prevention at the 2017 International Conference on FASD, was the presentation on supporting women and families dealing with issues of alcohol and FASD.

Janet Christie, Anne Russell and Pippa Williams are three birth mothers who have created supports for women and families dealing with issues of alcohol or FASD. Their experiences have informed and are reflected in many reports and studies: that no woman intends to harm her child; that there are multiple and complex issues that affect women at risk for alcohol-exposed pregnancies; and, that fragmented and inflexible services make it difficult for women and families to get help.

Stigma is one of the biggest barriers affecting access to services. Addiction is still viewed by many as a moral failing rather than a public health issue. Meanwhile the alcohol industry normalizes and glamourizes drinking to women through targeted marketing campaigns. Women are often met with judgement and blame, and fear losing their children if they seek help for an addiction. As well, mothers whose children have FASD need support in dealing with their feelings of guilt and with parenting their children. Often women have complex and intersecting issues, including FASD, that affect their ability to accept support. While these three mothers/advocates are from different countries, they all identify these same issues, and call for programs with wrap-around services to support women and their families.

Margaret Leslie and Dr. Mary Motz then described such a program – Breaking the Cycle in Toronto and its mother-child study “Focus on Relationships”. Based upon well-researched attachment theory, the program focuses on the mother-child dyad during the pre- and post-partum period and on building trust, safety and relational capacity. Relationships extend to staff and service providers. Program efforts to develop collaborative relationships between child welfare, addiction recovery and mental health service agencies have successfully created an integrated and flexible program with the goal of supporting the whole family.

 

For more on these topics, see earlier posts:

The Mother-Child Study: Evaluating Treatments for Substance-Using Women, March 18, 2015
Supporting Pregnant and Parenting Women Who Use Substances: What Communities are Doing to Help, October 1, 2012
Herway Home ‘One-Stop Access’ Program in Victoria Set to Open, May 20, 2012
“New Choices” for Pregnant and Parenting Women with Addictions, January 9, 2012
Toronto Centre for Substance Use in Pregnancy (T-CUP), December 19, 2011
Clinical Webcast on Breaking the Cycle Program: September 20, 2011, August 2, 2011
Why Would She Drink? Winnipeg Free Press Articles Explore Drinking during Pregnancy, April 4, 2011

3rd in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 2

“International Research on Discussing Alcohol with Women and Their Partners, and Empowering Professionals to Have These Conversations”: Tatiana Balachova, PhD, Associate Professor, University of Oklahoma Health Sciences Center & Prevent FAS Research Group; Jocelynn Cook, Chief Scientific Officer for The Society of Obstetricians and Gynaecologists; Lisa Schölin, Consultant at WHO Regional Office for Europe – Alcohol, Illicit Drugs and Prison Health; Leana Oliver, CEO of FARR; Cheryl Tan, Health Scientist CDC

Research shows that building awareness and offering brief interventions can help women reduce alcohol-exposed pregnancies. For a variety of reasons, not all providers feel comfortable or confident in giving information or asking about alcohol use, and they may not be sure it makes a difference in preventing alcohol-exposed pregnancies. Consequently, researchers from around the world presented their findings at the 7th International FASD Conference Prevention Plenary. They discussed whether or not brief interventions work, and if they do, then which strategies work best.

Russian study picRussia – Positive Messaging Improves Knowledge and Action

Tatiana Balachova, PhD, and her research group conducted a 3-part study to develop, implement, and test a prevention program in Russia. They found that women in Russia most trusted their OB/GYN physicians, so they developed FASD educational materials and trained physicians to deliver prevention information in two face-to-face structured interventions. FASD brochures using positive messages and images improved women’s knowledge of FASD and reduced risk for alcohol-exposed pregnancies. As well, they found that women who received the intervention reduced their frequency of alcohol use – most quitting – during in pregnancy.

JOGC picCanada – Care/Service Provider Education is key

Jocelynn Cook, Chief Scientific Officer for The Society of Obstetricians and Gynaecologists of Canada (SOGC) detailed the Vision 2020 strategies: advocacy, quality of care, education, and growing stronger. These strategies underpin their goals for care providers to focus on preconception as well as pregnancy, and deliver consistent messaging. In line with these goals. Alcohol Use and Pregnancy Consensus Clinical Guidelines that were first published by the SOGC in August 2010 were updated in 2016. The guidelines highlight the value of brief interventions and will be supported in the coming year with online education and training that recognizes “red flags” and provide best practices for supporting women’s health and engagement in discussions on potentially stigmatizing topics such as alcohol use.

who-coverWorld Health Organization – Prevalence Rates Inform Strategy

Lisa Schӧlin, consultant with the World Health Organization’s European office, described the data from Europe on alcohol consumption and drinking during pregnancy. The most recent prevalence data shows that Europe has the highest consumption rate of alcohol per capita of anywhere else in the world. As well, at 25.2%, it has the highest rate of alcohol consumption during pregnancy and the highest rate of FAS (37.4 per 10,000). These data were published in a review of the evidence and case studies illustrating good practices and areas of European action called “Prevention of harm caused by alcohol exposure in pregnancy” – you can view or download here.

FARR picSouth Africa – Short Messages Can Build Awareness

Leana Oliver, CEO of Foundation for Alcohol Related Research (FARR), explained how FARR builds upon existing health services by providing prenatal support, pregnancy planning and teaching of coping strategies to women through their programmes. Their “Do you have 3 Minutes?” campaign has been successful in building awareness within communities and in supporting prevention programmes (learn more here). As well, the FARR Training Academy offers accredited trainings and continued professional development on FASD to professionals, providers and educators. Research projects and FARR publications detail what has been learned such as the benefits of motivational interviewing and the need for preconception care and planning.

CDC picU.S. – Promoting Universal Screening and Brief Intervention

Cheryl Tan, Health Scientist, Centers for Disease Control and Prevention reviewed FASD activities currently underway. Surveillance of alcohol consumption by women of reproductive age is ongoing alongside efforts by the CDC to promote universal screening and brief interventions (aSBI) of adults 18+ years. She noted the wide discrepancy between how often providers say they conduct SBI (85%) and how often patients say they receive it (25%). As well, as a partner of the Collaborative of Alcohol-free Pregnancy, the CDC is helping to change healthcare practice through high-impact projects: 1) implement interprofessional model for prevention of AEP; 2) provide evidence for aSBI to insurers in the US; and, 3) reduce stigma associated with drinking during pregnancy.

For more these topics see earlier posts:

First-ever FASD Prevention Plenary at the 7th International Conference on FASD, March 22, 2017
WHO Europe: Prevention of harm caused by alcohol exposure in pregnancy, December 22, 2016
“Supporting pregnant women who use alcohol or other drugs: A guide for primary health care professionals”, May 15, 2016
How do partners affect women’s alcohol use during pregnancy?, August 11, 2014
Empowering Conversations to Prevent Alcohol Exposed Pregnancies: Extended Learning Webinars, May 8, 2014
The Prevention Conversation Project – Free Webcast on January 21, 2015 (Alberta FASD Learning Series), December 15, 2014
Alcohol and Pregnancy campaign from Norway, December 12, 2011
FASD Prevention in Russia, February 15, 2012

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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