The Mother-Child Study: Evaluating Treatments for Substance-Using Women

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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.

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“Developing Services for Canadians Living with FASD” interview with Dorothy Badry on Family Caregivers Unite!

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University of Calgary professor and Canada FASD Research Network member, Dorothy Badry, was interviewed in December 2014 on the live talk radio program Family Caregivers Unite!

The one hour episode, hosted by Dr. Gordon Atherley, focused on the topic of “Developing Services for Canadians Living with FASD.”

Dr. Badry discusses her earlier PhD work,  ‘Becoming a Birth Mother of a Child with Fetal Alcohol Syndrome’, which reviewed the lives of 8 women aged 25 to 60 who gave birth to children diagnosed with FAS. She talks about her life, career, and her experience of family caregiving for close family members with serious health conditions.

Dr. Badry, drawing upon her experiences in the social work field, also discusses types of services provided for individuals with FASD and their families. She also touches on prevention issues such as increasing rates of binge drinking in youth, the Parent-Child Assistance Program, and the role of men in supporting women.

Dr. Badry is currently the co-chair of the Education and Training Council of the Alberta FASD Cross Ministry Committee and a member of the Prairie Child Welfare Consortium.

Listen to the interview here (via streaming, in iTunes or download the MP3).

One of her recent projects has been the development of the Caregiver Curriculum on FASD on the http://www.fasdchildwelfare.ca website.

Also check out this article on how Dr. Badry’s work is influencing work in indigenous communities in Australia: Canadian fetal alcohol programs inspire Australian researcher (November 26. 2014).

'Canadian fetal alcohol programs inspire Australian researcher I

 

 

First Nations Women’s Healing: Moving from Hardship to Resilience Photo-essay

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This photo-essay is part of The Women’s Health Research Project on FASD Prevention in First Nations Communities conducted by the Canada FASD Research Network.

The project involved 37 First Nations Women from four different communities: Piikani Nation (Alberta), Sandy Bay Nation (Manitoba), St. Mary’s First Nation (New Brunswick) and Woodstock First Nation (New Brunswick).

Photovoice is a research approach that uses photography as a tool to move towards meaningful and respectful dialogue. Women participating in the project were asked to explore the question “What does health and healing look like for you in your community?” as an entry to discussion about issues such as substance use, pregnancy, FASD, and overall health.

The photo-essay explores how health and healing for many First Nations women is based on relationships – with land, with family and friends, with community, and with culture. Preventing FASD requires attention to creating and rebuilding these relationships.

View the photo-essay here. Learn more about the Canada FASD Research Network here.

Learn more about a related project in Canada’s Northwest Territories in an earlier post: Brightening Our Home Fires: An FASD Prevention and Women’s Health Project in Canada’s Northwest Territories (May 6, 2013).

Read more about Photovoice as a research method in FASD prevention in the journal article “An exploratory study on the use of Photovoice as a method for approaching FASD prevention in the Northwest Territories” published in The First Peoples Child and Family Review here (open access).

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Free Webinar: Trauma Informed Approaches to FASD Prevention – June 12, 2014

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Over the past year, the BC Ministry of Health in collaboration with the BC Centre of Excellence for Women’s Health has been supporting educational sessions in Health Authorities across British Columbia for service providers who have the opportunity to engage with women of childbearing age on alcohol use during pregnancy and related concerns.

Service providers have included: nurses, pregnancy outreach program providers, transition housing/violence service workers, social workers, doulas, midwives, physicians, mental health workers and substance use service providers working in both Aboriginal and other communities.

Current or past experiences of trauma and violence can be a major reason why women continue to drink alcohol during pregnancy. The third webinar in this series will examine trauma-informed approaches to FASD prevention. (For more on alcohol, pregnancy and trauma-informed practice, check out this section of the Coalescing on Women and Substance use website)

Thursday, June 12, 2014
9:00 – 10:00 am (PDT)
Presenters: Nancy Poole, Cristine Urquhart, Frances Jasiura

To register, visit http://fluidsurveys.com/s/A-Learning-Series-3

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What is the role of women’s experiences of violence and trauma on alcohol use during pregnancy?

Image credit: Eric Parker, via flickr (creative commons)
Delft, Cape Town, South Africa (Image credit: Eric Parker, via flickr)

The reasons why a woman may drink alcohol during pregnancy can vary enormously. That said, research has consistently shown two strong associations with alcohol use during pregnancy: (1) women’s alcohol use before pregnancy (especially for women who drink heavily before pregnancy) and (2) past or current experiences of violence, trauma, and abuse.

The relationship between alcohol use during pregnancy and women’s experiences of violence, trauma, and abuse was recognized in early research with women who have children with FASD. For example, in a study in 2000 with 80 mothers of children with FAS,  95% of the women had been seriously sexually, physically, or emotionally abused at some point in their lives and 72% of them reported that they felt unable to reduce their alcohol use because they were in an abusive relationship.

A recent longitudinal study looked at both of these factors, alcohol use before pregnancy and experiences of trauma, in a group of 66 pregnant women in Delft, Cape Town, South Africa. The researchers found that:

  • Similar to previous research, women’s drinking levels before pregnancy were generally predictive of drinking levels during pregnancy. Most women significantly decreased their drinking after pregnancy recognition.
  • Women who reported no trauma history seemed to drink proportionally to the levels that they did before pregnancy recognition, i.e., higher-risk drinkers continued to drink at high levels, while lower-risk drinkers maintained their low drinking levels.
  • However, women who reported a history of trauma tended to drink at higher levels, regardless of prior drinking levels and even if they were low risk drinkers beforehand

The study findings suggest that there are two groups of pregnant women that may benefit from special attention from an FASD prevention perspective: (1) women are already drinking at risky levels before pregnancy, and (2) women who report a history of trauma, regardless of how much they were drinking prior to pregnancy.

To learn more about trauma-informed approaches to FASD prevention, visit the Coalescing on Women and Substance use website and check out the section on Alcohol and Pregnancy.

To learn more about alcohol and pregnancy in South Africa, see earlier posts:

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 available here).

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.  doi:10.1186/1471-2393-14-97. (Open access – free full text available).

Skagerstrom J, Chang G, Nilsen P (2011).  Predictors of drinking during pregnancy: a systematic review. Journal of Women’s Health (Larchmt), 20(6): 901–913. (Open access – free full text available).

FASD Informed Practice for Community Based Programs

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FASD informed practice can include:

  • An awareness that FASD (diagnosed and undiagnosed) is a reality for many individuals involved with a variety of community-based programs
  • A strong theoretical and practical understanding of the traits, characteristics, barriers, and needs of those affected by FASD
  • A willingness on the part of program staff, including administration, reception, and frontline workers, to participate in ongoing FASD education and training initiatives
  • Agency policies that accommodate the unique needs of individuals living with FASD in order to create a program that works for all participants
  • A respectful and individualized approach to service delivery that recognizes individual strengths

This guide from the College of New Caledonia is designed to assist programs in providing FASD-informed services and supports. The approaches discussed were developed from evidence-based research and from the practical experience of individuals working with women and their families who may be living with FASD.

The guide includes sections on promoting dialogue about alcohol and drug use during pregnancy, contraception, trauma-informed practice, effective group facilitation, strategies for individual support, and examples of exercises that can be used in group programming.

FASD Informed Practice for Community Based Programs can be downloaded from the College of New Caledonia website here.

For more about FASD-informed work at the College of New Caledonia, see an earlier posts:

 

 

Experiences of Northern British Columbian Aboriginal Mothers Raising Adolescents With FASD

Intergenerational Patterns, Parenting, and FASD

Image Credit: Jason Drury, via flickr, http://www.flickr.com/photos/42373177@N07/10057224733/in/photostream/
Image Credit: Jason Drury, via flickr, http://www.flickr.com/photos/42373177@N07/10057224733/in/photostream/

A paper published in the Journal of Transcultural Nursing by Suzanne Johnston and Joyceen Boyle (based on Johnston’s PhD work) explores the experiences and strengths of Aboriginal mothers raising children affected by FASD.

At a practical level, this ethnographic study aims to demonstrate what it is like for mothers to raise teenagers who have FASD, what their struggles are, how they meet challenges, what is helpful, and what is not.

The paper also explores a range of issues using a postcolonial framework (for more on this, see earlier post Postcolonial Theory for Beginners, September 1, 2010). This perspective allows the study authors to explore intergenerational patterns related to parenting and FASD. The authors connect alcohol misuse during pregnancy to colonial pressures and effects that have continued to exist after seven generations.

“…the root causes are undoubtedly related to the historical and collective emotional injury Aboriginal peoples have experienced as a result of colonialism. This injury manifests itself in various behaviors, including the abuse of alcohol, which leads to FASD, among other problems. According to the [study] participants, they have ignored and suppressed the trauma associated with FASD because there has been little support for dealing with associated feelings that remain unresolved and passed down through generations.

For example, individuals pass on unhealthy ways of behaving or coping that they use to protect themselves from their pain and trauma, such as abusing alcohol or drugs; these behaviors are modeled for their children, sometimes those involved even being aware of these dynamics.” (p. 63)

The women interviewed in this study describe feelings of blame and shame and experiences of marginalization in their lives. Yet, this study clearly works towards debunking stereotypes by demonstrating the adaptability and increasing strength of Aboriginal mothers caring for adolescents with FASD.

For more on this topic, see earlier posts:

References

 Johnston, S. and Boyle, J.S. (2013). Northern British Columbian Aboriginal Mothers: Raising Adolescents With Fetal Alcohol Spectrum Disorder. Journal of Transcultural Nursing, 24(1):60-7. DOI:10.1177/1043659612452006

Johnston, M.J. (2008). Northern British Columbia Aboriginal Mothers: Raising Adolescents with Fetal Alcohol Spectrum Disorder. (Doctoral Dissertation). Retrieved from The University of Arizona – College of Nursing.

First Peoples Child & Family Review journal: Special Issue on FASD

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The First Peoples Child & Family Review is a Canadian journal dedicated to interdisciplinary research honouring the voices, perspectives and knowledges of First Peoples through research, critical analyses, stories, standpoints and media reviews.

The Fall 2013 issue focuses specifically on FASD. Dorothy Badry and Tara Hanson describe the importance of this focus in the introduction:

“This special edition of The First Peoples Child & Family Review explores the social issue of Fetal Alcohol Spectrum Disorder (FASD) from the perspectives, experiences and needs of Aboriginal peoples. It recognizes that the context of FASD in Aboriginal communities is unique, and cannot be properly acknowledged or addressed through generalized studies and services.

As the articles in this edition illustrate, the issue and experience of Aboriginal peoples and FASD must be understood within the context of colonization and its intergenerational impacts. Without this critical lens, research findings and service recommendations may be inappropriate to Aboriginal families or communities. Mainstream programs developed from a Euro-Western perspective may conflict with Aboriginal worldviews.

The articles in this edition portray the human experience of struggles with alcohol, the role of history and trauma in adverse life outcomes as well as the existence of socioeconomic disparities. Experiences with child welfare and legal systems are chronicled, disruptions, difficulties and repercussive impacts of secondary disabilities. Along with the adversities, however, are powerful themes of hope, healing, promising practices, capabilities, and strength found through caring relationships.” (p. 5)

Several articles focus on FASD prevention and tackle topics such as developing community programs for pregnant and early parenting women who use alcohol and other substances that operate from an Indigenous knowledge framework, FASD prevention with women who have FASD themselves, and insights from workers in a home visitation program for women with a history of alcohol and drug abuse.

Many people continue to mistakenly believe that FASD is primarily an Indigenous issue (this is definitely not the case – FASD is an issue wherever women drink alcohol during pregnancy). It is true, though, that many Indigenous communities have been working to address FASD and related social concerns for longer than many non-Indigenous communities – this special issue highlights some of the leadership and innovation that many communities have taken in the past few years.

View the table of contents and download free full-text for all the articles here.

 

The Essentials of …. Women and Problematic Substance Use

'Canadian Network of Substance Abuse and Allied Professionals'

The Canadian Network of Substance Abuse and Allied Professionals has a series of resources or “toolkits” for professionals.

The latest toolkit is on “The Essentials of … Women and Problematic Substance Use” which is a four page overview of the unique aspects of women and substance use and implications for allied professionals. The toolkit was written by Colleen Ann Dell from the University of Saskatchewan. (You can also check out a previous post on work she has done related to Aboriginal women and healing from illicit substance use here).

Other resources that might be of interest include:

Women’s health and FASD prevention in a special issue of the International Journal of Circumpolar Health

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The International Journal of Circumpolar Health is a multidisciplinary journal that specializes in Arctic and Antarctic health issues, with a particular interest in the health of indigenous peoples.

The journal has just published a special supplement (Supplement 1, 2013) which includes 100 full length papers, 90 extended abstracts and nearly 100 short abstracts from the 15th International Congress on Circumpolar Health held in August 2012.

This issue has a number of full length and brief papers related to FASD, women’s addictions, and indigenous health. Here are some of the papers you might be interested in taking a look at:

Perceptions of needs regarding FASD across the province of British Columbia, Canada – Anne George, Cindy Hardy, Erica Clark (p. 91)

This study describes the perceived needs for services for people affected by FASD in rural and urban British Columbia.

Prenatal alcohol exposure among Alaska Native/American Indian infants – Burhan A. Khan, Renee F. Robinson, Julia J. Smith, Denise A. Dillard (p. 147)

A survey which found that rates of prenatal alcohol use are primarily limited to pre-conception and the 1st trimester, with a dramatic decrease in the 2nd and 3rd trimesters.

An examination of the social determinants of health as factors related to health, healing and prevention of foetal alcohol spectrum disorder in a northern context – the Brightening Our Home Fires Project, Northwest Territories, Canada – Dorothy Badry, Aileen Wight Felske (p. 169)

An exploratory study of the issue of the prevention of FASD from a women’s health perspective in the Northwest Territories of Canada.

Resituating the ethical gaze: government morality and the local worlds of impoverished Indigenous women – Caroline L. Tait (p. 200)

Drawing from a project documenting 100 life histories of Indigenous women with addictions and who have involvement with the child welfare system, as children or adults, this paper explores the influence of government policies and programs in Canada on recovery and healing.

Coordinating foetal alcohol syndrome interventions in Alaska – Kris Broom, Wendy Getchell, Chantelle Hardy, Garrett Hartley and Jessica Olson (p. 241)

A review of current Alaska FAS policies and interventions.

The healing constellation: a framework for understanding and treating trauma in Alaska Native women – Wendy H. Arundale (p. 243)

Connecting theory, research, and treatment approaches, a look at indigenous women’s substance use in relation to mental health, intergenerational trauma and other factors.

Community-driven alcohol policy and foetal alcohol spectrum disorder prevention: implications for Canada’s North? – Nancy Poole, Tasnim Nathoo and Arlene Hache (p. 250)

An exploration of the potentially important role of alcohol policy in northern communities in influencing alcohol use in pregnancy and risk of FASD.

The full publication is freely available for download here.

For more on FASD prevention in northern regions, see earlier posts: