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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.

 

2nd in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 1

“Evidence for multi-faceted, culturally relevant, community-led approaches” – Dr. James Fitzpatrick, Head, and Kaashifah Bruce, Program Manager of Telethon Kids Institute’s FASD Research; June Councillor, CEO of Wirraka Maya Aboriginal Health Services; Anne Russell, Russell Family Fetal Alcohol Disorders Association

Making FASD History newsletter

The “Make FASD History in the Pilbara” program in Western Australia is the result of community-led and culturally relevant efforts within Indigenous communities dealing with the effects of long-term colonization and FASD. It was developed in collaboration and partnership with communities in the Fitzroy Valley and provides strategies and programs to assess and diagnose FASD, as well as to provide health, educational, and management supports to mothers and children.

James Fitzpatrick described earlier successes that underpin this program – like the Lilliwan prevalence project, the PATCHES program to diagnose FASD, and the Marlu Strategy for prevention and intervention (See Video). Dr. Fitzpatrick was nominated in 2016 for the WA Australian of the Year award for his work on FASD.

June Councillor explained the role of the “’Warajanga Marnti Warrarnja” Project – translation Together We Walk This Country – in the strategy and its long-term approach. She featured a video of the project in her remarks. View the program launch Video here.

Kaashifah Bruce presented evaluation results of using this multi-pronged approach that show an increase in: 1) awareness of FASD and the harms caused by drinking in pregnancy; 2) intentions to NOT drink during future pregnancies; and, 3) intentions to help pregnant women not to drink. The encouraging results suggest that this community-led, multi-strategy approach can serve as a blueprint for success in other Aboriginal communities.

LtoR: June Councillor, Anne Russell, Kaashifah Bruce, and James Kirkpatrick

 

Finally, Anne Russell provided a lived-experience viewpoint with examples of how stigma and stereotyping impede prevention efforts. By describing her own as well as other women’s experiences, she underscored how important it is to avoid stereotypes about women and drinking, and to talk with women and communities about what they need and what is important to them.

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

Alcohol Think Again Campaign in Western Australia (June 19, 2012)

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

FASD Campaign from Kimberley and Pilbara Regions of Western Australia (October 22, 2012)

FASD Prevention in Australia’s Ord Valley (October 13, 2011)

Targeting Health Professionals in Western Australia (February 9, 2011)

Getting Fathers Involved (January 4, 2011)

More Activism from Australia (October 19, 2011)

Yajilarra: the story of the women of Fitzroy Crossing (October 15, 2010)

FASD Initiatives in Western Australia (September 15, 2010)

The World Health Organization’s regional office for Europe has published Prevention of harm caused by alcohol exposure in pregnancy: Rapid review and case studies from Member States.

who-coverIn this report it is stated that Europe has the highest level of alcohol consumption in the world, and that the gender gap in drinking, and in binge drinking, among young people has narrowed.

Looking over the past decade, the report features a review of 29 research studies and details current FASD prevention efforts of Finland, Germany, Lithuania, Luxembourg, Norway, Poland, Slovenia and Sweden. Studies included in the report were based on Recommendation 2 of the WHO Guidelines for the identification and management of substance use and substance use disorder in pregnancy, which calls for prevention of alcohol consumption in the general population of pregnant women through brief interventions. Consequently, the review excluded studies of alcohol-dependent women.

For women who may become pregnant, interventions related to both risky drinking and contraception were reviewed, such as CHOICES, EARLY and BALANCE.

For pregnant women, interventions to abstain from or reduce alcohol use, or to raise awareness were reviewed. Two of the studies with pregnant women included their partners and showed positive results regarding women reducing their drinking and partners supporting non-drinking.

Case studies of prevention efforts from the 8 profiled countries describe national awareness campaigns; screening and specialized treatment in clinical practice guidelines; national strategy/policy planning and implementation; and post-partum support including for those affected by FASD.   The report features a table that illustrates country-specific levels of FASD awareness, which can assist in developing focused strategies.

For more on related topics, see earlier blogs:

DANISH CAMPAIGN SUGGESTS THAT EVERYONE “STICK A CORK IN IT” ON OCTOBER 11TH, October 11, 2012

SPECIALIZED TREATMENT AND CARE FOR PREGNANT WOMEN WITH SUBSTANCE ABUSE PROBLEMS AND THEIR CHILDREN IN HAGA, GOTHENBURG, SWEDEN, November 15, 2012

WORLD HEALTH ORGANIZATION RELEASES THE FIRST EVIDENCE-BASED GLOBAL GUIDELINES TO PREVENT AND TREAT SUBSTANCE USE BY PREGNANT WOMEN, April 28, 2014

GLOBAL STATUS REPORT ON ALCOHOL AND HEALTH 2014 – WORLD HEALTH ORGANIZATION, July 24, 2014

PLANNING AND IMPLEMENTING SCREENING AND BRIEF INTERVENTION FOR RISKY ALCOHOL USE: A STEP-BY-STEP GUIDE FOR PRIMARY CARE PRACTICES FROM THE CDC, August 4, 2014

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

thunder-bay-report-coverAs part of the work of the Family Health Program, the Thunder Bay District Health Unit has published results from a research project on best practices to preventing alcohol-exposed pregnancy. Alongside reviewing literature, they looked at practices both in their health unit and among local community programs and services, and at provincial public health standards.

Seven over-arching themes were identified for a multi-pronged approach to preventing FASD:

1.  Population Health Surveillance
2. Public Awareness
3. Public Programs
4. Education for Health Care and Social Service Providers
5. Screening and Intervention by Health Care and Social Services Providers
6. Partnerships
7. Policy/Government Directives (1)

The report targets gaps to be addressed within each of these themes. As an example, within “Public Programs” there is a call to expand or develop programming that is culturally based and that includes women’s partners, and within “Education” to replace generalized training and education with approaches that target specific provider needs.

The authors caution readers not to “dilute the alcohol and pregnancy focus” when incorporating recommendations into existing service structures, and stress that additional research and evidence of programming, policy, and partnerships is needed.

Download the full report here to read more about their research methods, findings and recommendations, and to explore linkages with the Ontario Public Health Standards for reproductive health.


REFERENCES
  1. Thunder Bay District Health Unit, Family Health Program. (2016). Effective interventions and strategies to prevent alcohol-exposed pregnancies. Thunder Bay, ON.

whydrink

With International FASD Awareness Day just around the corner (on September 9th), many organizations and communities are getting ready by developing awareness materials and planning activities ranging from pancake breakfasts to seminars and training for health professionals to social media activities.

In the past decade, awareness about FASD has increased and in many communities the majority of women are aware that alcohol consumption can cause harm during pregnancy. However, new research and ongoing media coverage and continues to raise questions about whether any alcohol use during pregnancy is okay or whether risk remains the same throughout pregnancy. And many people know very little about FASD in general.

In addition to addressing this type of ambiguity, there are a number of other types of messages that have been shown to be helpful, informative and supportive. Depending on who your audience is (see the infographic above about some different audiences you could consider), some of the other issues to consider in developing FASD prevention messages include:

  • Make sure that messages are balanced and informative. Indistinct or ambiguous messages about the risks of alcohol use during pregnancy should be avoided. Messages like “Think before you drink” or “Alcohol can harm your unborn baby” can be perceived as threatening without helping women place risk into context.
  • Avoid focusing on encouraging women to stop drinking for their baby or suggesting that women who don’t stop drinking are uncaring or irresponsible. This includes messages like “When you drink during pregnancy so does your baby” or messages written on top of pregnant bellies saying “Hey, I’m in here!”  Lessons from the tobacco and pregnancy field indicate that these messages are not effective and can be perceived as shaming and blaming women who are unable to stop drinking during pregnancy due to problems with alcohol dependence.
  • The message that “Fetal alcohol spectrum disorder is 100% preventable” is controversial as alcohol use often happens before a woman recognizes that she is pregnant or can be tied to other serious health and social issues such as poverty and experiences of violence.
  • Don’t forget that preventing pregnancy by supporting accessible and safe contraception is an excellent FASD prevention strategy – it’s not always necessary to focus on alcohol use. For example, a message could say something like “Alcohol and pregnancy don’t mix. If you drink alcohol and are sexually active, make sure you use effective contraception.

bcldb_sr_fasd_brochure_Page_2

Here are a few resources for starting to think about effective messaging and communication.

  1. Keys to a Successful Alcohol and Pregnancy Communication Campaign – While over a decade old, this 2003 resource from the Best Start Resource Centre in Ontario remains an excellent guide to getting started with thinking through key issues related to alcohol and pregnancy awareness campaigns. Includes facts, tips, ideas, and examples. The Centre also has a range of resources for health professionals and general audiences related to alcohol, pregnancy, and breastfeeding, including Mocktails for Moms and printer-ready handouts in English, French, Arabic, Cree, Ojibway, Hindi, Punjabi, Tamil, Urdu, Simplified Chinese, Spanish and Tagalog
  2. FASD PosterMaker app -This app was designed for health professionals working in Aboriginal and Torres Strait Islander health care settings across Australia so that they can create their own locally relevant and culturally appropriate resources on Fetal Alcohol Spectrum Disorders (FASD).
  3. BC Ministry of Health International FASD Awareness Day Toolkit – Includes planning tools, sample press releases, and FAQs
  4. Alcohol, Pregnancy and Prevention of Fetal Alcohol Spectrum Disorder: What Men Can do to Help – There are a number of ways to engage men in FASD prevention activities. This two-page fact sheet has a dozen suggestions to start thinking about how to create messages and campaigns that view FASD prevention as a shared responsibility.

For more discussion on best practices and controversies related to messaging, see earlier posts:

The Women Want to Know project encourages health professionals to routinely discuss alcohol and pregnancy with women and to provide advice that is consistent with the National Health and Medical Research Council’s Australian Guidelines to Reduce Health Risks from Drinking Alcohol. This is the first national campaign targeted at health professionals since the Alcohol Guidelines were last updated in 2009.

A survey of 300 health professionals conducted prior to the project  found that one in five health professionals had not heard of the Guidelines and more than two in five (45%) were aware of the Guidelines but not familiar with the content.

The guidelines state that  ‘Maternal alcohol consumption can harm the developing fetus or breastfeeding baby’ and ‘For woman who are pregnant or planning a pregnancy, not drinking is the safest option’ and ‘For women who are breastfeeding, not drinking is the safest option’.

Research has also shown that 97 per cent of Australian women want to be asked about alcohol use during pregnancy.

wwtk
The Women Want to Know project was developed by the Foundation for Alcohol Research and Education (FARE) in collaboration with leading health professional bodies across Australia and is supported by funding from the Australian Government Department of Health.

There are two main components to the project: (1) resources to support health professionals in discussing alcohol use and pregnancy with women, and (2) accredited training.

Resources from the Women Want to Know project include:

In addition three online e-Learning courses with Continuing Professional Development accreditation are available for health professionals through the:

Read the press release from the Foundation for Alcohol Research and Education here. Learn more about the project and recently developed resources here.

HealthPro_Page_1

Program and Registration Information now available

Living Well home page

The Living Well: FASD and Mental Health conference will be held November 5-7, 2014 in Winnipeg, Manitoba. The conference is an initiative of the Canada Northwest FASD Partnership Conference and hosted by Healthy Child Manitoba.

The Living Well: FASD and Mental Health conference will delve into the interconnection between mental health and Fetal Alcohol Spectrum Disorder spanning the areas of prevention, intervention, support, evaluation and research. This multidisciplinary event will cover topics such as how individuals with FASD and mental health concerns can be better understood and supported, how caregivers can support their mental health and how mental health concerns influence FASD prevention work.

Keynote Presentations include:

  • Dan Dubovsky — Working with Individuals Living with FASD and Mental Health Concerns: Best and Promising Practices
  • Nancy Poole — Working with Pregnant Women with Mental Health and Substance Use Concerns: Best and Promising Practices
  • Dr. Ana Hanlon-Dearman — FASD Diagnosis: Mental Health Considerations
  • Dr. Mansfield Mela — FASD and Mental Health Disorders: Exclusive or Mosaic?
  • Brenda Knight — Responding to the Complex Issues of Families Living with FASD
  • Momenta and the FASD Family Network — Feeling Success: The Camp Experience

Some of the workshops included in the program are:

  • FASD Assessments: From the Clinic to the Court Room — Jonathan Rudin and Panel
  • Evaluation: What’s All the Fuss About? — Jacquie Pei and Panel
  • We’ve Only Just Begun: Advances in FASD Prevention — Nancy Poole and Colleen Dell

Visit the conference website here. View the full program here.

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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