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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

Best Start Resource Centre in Ontario has published a new guide to help facilitators deliver FASD workshops for First Nations women (Download guide). Using culture as its foundation, the guide focuses on promoting health. It also integrates FASD-informed and trauma-informed approaches. It is set up so that facilitators do not have to be an expert on the subject of FASD. The guide provides detailed background information, instructions and resources so that facilitators can fully prepare themselves for delivering the workshops.

planning-for-change-picture

Topics covered in the training guide include:

  • Preparing for the Workshop – covers information like bringing the workshop to communities where there is a concern about the stigma attached to FASD, planning for participant learning differences, as well as handling logistical details.
  • Facilitating the Workshop – includes welcoming activities, giving background about healthy pregnancy, identifying and building on personal strengths, making a plan for health, and drawing on community for support and self care.
  • Resources, Services and Appendices – provided are weblinks to further information and videos; services for pregnancy, parenting, substance use and FASD; participant handouts, and consent forms.

Best Start Resource Centre is well known for its resources for service providers who work with diverse women and families on preconception health, prenatal health and child development.

For more on related topics, see earlier posts:

FASD is a public safety and justice priority for Aboriginal groups, October 23, 2016

Experiences of Northern British Columbian Aboriginal Mothers Raising Adolescents With FASD, January 20, 2014

Pimotisiwin: A Good Path for Pregnant and Parenting Aboriginal Teens, August 26, 2013

“You are not alone. Support is available.” Alcohol and pregnancy campaign designed by and for Aboriginal women in Manitoba, April 10, 2013

Handbook for Aboriginal Alcohol and Drug Work from Australia, January 9, 2013

The Sacred Journey – new resource for service providers who work with First Nations families, August 1, 2012

Aboriginal Comic Book for Pregnant Women and New Moms, May 1, 2012

Pregnancy and Alcohol Brochure for Aboriginal Families, January 30, 2012

Aboriginal midwifery and Poverty & Pregnancy in Aboriginal Communities, August 17, 2011

For the last four years, HerWay Home in Victoria, BC, has been providing outreach, medical and social services to pregnant and parenting women with difficult lives in a one-stop supportive environment. On June 23 from 9:00-10:00 a.m. PST, there will be a free webinar to share the results of a first-phase evaluation of HerWay.

Deborah Rutman and Carol Hubberstey of Nota Bene Consulting, and Nancy Poole of BC Centre of Excellence for Women’s Health will discuss lessons learned and promising practices, and lead a discussion on working with pregnant and parenting women affected by substance use, violence and mental health issues. With its child-focused, women-centred and family focused approach, HerWay Home encourages positive parenting and healthy outcomes for children and women.

Click here for more information and register by June 20th at http://fluidsurveys.com/surveys/bccewh/herway-home-evaluation-webinar/

To learn more about HerWay home and similar programs, see these previous postings:

 

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The American Academy of Pediatrics (AAP)—via its Program to Enhance the Health and Development of Infants and Children—is offering a series of four 30-minute educational webinars focused on raising awareness of primary care clinicians regarding the diagnosis and treatment for children with Fetal Alcohol Spectrum Disorders (FASDs). The first webinar also addresses common media misconceptions about alcohol use during pregnancy.

Myths, Media and the Medical Home

Faculty: Renee Turchi, MD, MPH, FAAP

The myths, media and the medical home session will highlight common media misconceptions about alcohol use during pregnancy, provide a clinical overview of fetal alcohol spectrum disorders, and most importantly discuss the role of medical home providers in identifying and managing children with FASDs.

Date/Time: July 16, 2014 at 3 pm ET (30 minutes)
Register: https://www3.gotomeeting.com/register/384023014

Detection, Discovery and Diagnosis

 Faculty: Yasmin Senturias, MD, FAAP

The detection, discovery and diagnosis session will delineate the signs and symptoms that may indicate prenatal alcohol exposure and a possible condition along the continuum of FASDs. An algorithm for evaluation of FASDs will be introduced and discussed as a tool for diagnosis and referral in primary care. Information about various diagnostic tools will also be shared.

Date/Time: July 28, 2014 at 3 pm ET (30 minutes)
Register: https://www3.gotomeeting.com/register/513539294

Roles, Referrals and Reimbursement

 Faculty: David Wargowski, MD

The roles, referrals and reimbursement session will provide primary care clinicians with the tools they need to work with families and children who have or may have an FASDs. Dr Wargowski will identify the appropriate professionals needed to build an FASD team and discuss options for community based resources for referral and treatment. Billing, coding and reimbursement will also be discussed.

Date/Time: August 13, 2014 at 3 pm ET (30 minutes)
Register: https://www3.gotomeeting.com/register/187514118

Communication, Care Coordination and Co-management

Faculty: Phillip John Matthias, MD, FAAP and Ira Chasnoff, MD

The communication, care coordination and co-management session will confirm the importance of a medical home and its role in working with patients and families. Drs Matthias and Chasnoff will review the development of comprehensive care plans and present several case studies to demonstrate different approaches to care coordination and co-management.

Date/Time: August 27, 2014 at 3 pm ET (30 minutes)
Register: https://www3.gotomeeting.com/register/500923542

For more information about the webinars, visit the American Academy of Pediatrics website here.

The website also includes a section with prevention resources for pediatricians. Two of the ways that pediatricians can be involved in FASD prevention is through brief interventions with women in their practice who may have consumed alcohol during a previous pregnancy and with youth in their practice who are sexually active and/or consuming alcohol.

 

advise mothers on subsequent pregnancies and (2) advise adolescents about the risks of drinking alcohol during pregnancy. – See more at: http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/Prevention-Education-and-Counseling.aspx#sthash.HNyEiIMF.dpuf

what-men-can-do-_final-feb-2014_Page_1

Because FASD prevention initiatives often focus on alcohol and pregnancy, people often have questions about how men can get involved.

Researchers and service providers who are part of the Canada FASD Research Network have created a two-page information sheet with some suggestions for men who want to make a difference.

For more on men and FASD prevention, see earlier posts:

Image credit: Malcolm Browne, via flickr

Image credit: Malcolm Browne, via flickr

A recent study by Colleen O’Leary and colleagues in Western Australia explored trends in alcohol-use disorders in pregnant women between 1985 and 2006.

Rather than focusing on the prevalence of FASD in children, the researchers chose to focus on mothers of children with a diagnosis of FASD and determine whether these mothers had their alcohol use formally recognized by health care providers or whether they received health services to address alcohol misuse. They also examined alcohol-related diagnoses (e.g., heavy alcohol consumption) to gain a sense of whether alcohol use and misuse was being addressed by health care providers before, after, and during pregnancy.

This population-based cohort study using linked, longitudinal, health, mental health, and drug and alcohol data sets. Overall, 5839 non-Aboriginal mothers and 2583 Aboriginal gave birth between 1985 and 2006 who had an alcohol-related diagnosis recorded on one or more of the hospital morbidity, mental health outpatients, or drug and alcohol data sets. This group of women was compared with another group of women without an alcohol-related diagnosis and who were matched on maternal age, year of birth of offspring, and Aboriginal status.

The researchers found a substantial increase in the proportion of births with an alcohol diagnosis recorded during pregnancy across the 22 years for all mothers. For both non-Aboriginal and Aboriginal mothers, around 80% of the pregnancy alcohol diagnoses were recorded for births occurring from 1995 to 2006.

This trend may be related to changes in knowledge and awareness regarding the effects of alcohol use during pregnancy. In 2001, alcohol and pregnancy was included for the first time in the Australian national policy agenda. This resulted in considerable debate and, in 2009, guidelines regarding alcohol use during pregnancy shifted to promote abstinence.

One of the most interesting findings from this study was that the majority (70%) of mothers who had a child diagnosed with FAS did not have an alcohol diagnosis recorded during pregnancy. While there are a wide range of possible reasons for this (e.g., health care providers not routinely discussing alcohol use with women, women not feeling comfortable disclosing their alcohol use, general perception that alcohol use is not a major concern), it does suggest that there are many pregnant women who are not receiving support and information regarding their alcohol use and are not being referred to other services and supports. This raises questions about the different ways that health care providers, program planners, and policy analysts can be working to create a more responsive and supportive system to women with alcohol misuse concerns.

For more on FASD prevention in Western Australia, see earlier posts:

 References

Alati, T. (2013). In Western Australia, 70% of mothers of babies with fetal alcohol syndrome did not have an alcohol-related diagnosis recorded during pregnancy. Evidence-based Nursing. doi: 10.1136/eb-2013-101456

O’Leary, C., Halliday, J., Bartu, A., D’Antoine, H., and Bower, C. (2013). Alcohol-use disorders during and within 1 year of pregnancy: a population-based cohort study 1985–2006. BJOG, 120: 744–53.

Handbook Cover

“The Handbook for Aboriginal Alcohol and Drug Work is a practical tool written for Aboriginal drug and alcohol workers, mental health workers and others working in this field. It offers a detailed look at alcohol and drug work from clinical, through to prevention, early intervention and harm reduction. This handbook is also likely to help people working to improve policy and those advocating for change.

The idea for it came from workers all over Australia. They told us that they needed an easy to use handbook that can help them respond to the range of alcohol and drug issues they face every day. They also told us that such a book needs to take into account the complex challenges facing workers when helping clients, their families and, sometimes, whole communities.”

This plain language, evidence-based guide was created in partnership between the University of Sydney and Aboriginal and non-Aboriginal agencies and health professionals. Four of the six editors are Aboriginal.

It covers alcohol and drug use as well as a whole range of other issues, including child protection notifications, legal issues, working with clients without housing, mental health and polydrug use, and community-wide approaches.

Chapter 2 focuses on alcohol and Chapter 16 focuses on Special situations, settings, and groups, including pregnancy, breastfeeding and early childhood. It discusses the use of brief intervention and counselling approaches in the context of alcohol and pregnancy. It also has sections covering Neonatal Abstinence Syndrome, Alcohol use in pregnancy and Foetal Alcohol Spectrum Disorders.

The handbook was first distributed to alcohol and drug professionals from around Australia at the National Indigenous Drug and Alcohol Conference in Western Australia in June 2012.

The project started in 2010 with a grant from the Foundation for Alcohol Research and Education (FARE) and continued with the support of the NSW Ministry of Health.

The handbook is available online.

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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