The role of Pregnancy Outreach Programs in preventing FASD

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.

Using e-technology to support maternal-child health

The Hope Project app

With most everyone having a smartphone these days, people are using apps to support their health. There are a few apps directed to pregnant women about their substance use and mental health. Some recent efforts developed together by researchers and health providers show how these apps can be used to offer focused information and support to pregnant women.

A perinatal mental health research project in Alberta, The Hope Project, is exploring how e-technology can be used to support pregnant women with mental health concerns. Dr. Dawn Kingston and her team at the University of Calgary developed an app for screening and treating pregnant women experiencing anxiety and depression. It provides information, support, and help to women in the research study whenever they need it. The project will also look at how this intervention affects post-partum depression and the health of their children.

SmartMom Canada, was developed as part of a study from the University of British Columbia. Through text messaging, Optimal Birth BC provides women in Northern BC with prenatal education endorsed by the Society of Obstetricians and Gynaecologists of Canada (SOGC). Many of these women live in rural areas and may have limited access to prenatal care. Women who enroll in the study complete a confidential survey and then receive personalized text messages that include pregnancy tips, info on health topics, and available resources in their own community.

SmartMom Canada app

Women outside of these studies may find it challenging to find similar apps. Popular pregnancy apps do not offer much info or ideas for resources for women with mental health or substance use issues. One that has been positively evaluated is Text4baby in the U.S. The sponsors partner with national, state, and private organizations and offer local resource information in some states. Also available to Spanish speakers, an evaluation of the app can be found here.

As well, apps are being targeted to health care providers on improving the care they provide. A preconception care app available to physicians provides them with information from the National Preconception Health and Health Care Initiative and makes suggestions for responding to patient questions. Research is being done on using an app to provide motivational interviewing interventions to pregnant women who use substances.

Most apps available on smartphones are directed toward the general population and seek a large user base. Mental health apps and substance use apps that might support prevention, are not designed specifically for women, pregnant or not. And most pregnancy apps focus on fetal growth and “kick counters”, the woman’s weight and blood pressure, and checklists to get ready for a child.

So, while there is an app for everything, they may not an app for everyone. However, healthcare technology is growing at a fast pace, so hopefully we will see more apps in future that can expand FASD prevention efforts.

Related topics:

TEXT4BABY PROGRAM IN THE UNITED STATES: CAN TEXT MESSAGING BE AN EFFECTIVE ALCOHOL BRIEF INTERVENTION? February 2, 2015

HEALTHY PREGNANCY, HEALTHY BABY TEXT MESSAGING SERVICE IN TANZANIA December 17, 2013

New Curriculum for FASD Informed Practice

The College of New Caledonia (CNC) has developed a FASD-informed training curriculum to support their FASD informed guide and in response to the expressed needs of three national programs supported by the Public Health Agency of Canada (PHAC) that focus on healthy birth outcomes and healthy outcomes for children.

“Facilitating a Collaborative, Strength-based Approach to FASD Informed Practice:  Western Region BC” was developed following consultations with workers in The Community Action Program for Children (CAPC), the Canada Prenatal Nutrition Program (CPNP), and Aboriginal Head Start (AHS in BC). Workers and administrators wanted help in adjusting their practice of working with women, children and families to include FASD-informed approaches.

These trainings were delivered on-site to approximately 350 people during 2014-2016. Developed by Anne Guarasci and Barb Durban with funding from PHAC, the curriculum, in the form of PowerPoint presentations, has been refined for distribution and consists of three separate presentations each with a particular focus, but all include a primer on FASD including current diagnostic terminology.

1. “Supporting Marginalized Parents who may have FASD” — This presentation focuses on what causes FASD, how it is diagnosed, and who is at risk; the complex nature of prevention and why a holistic, relational approach is required; behavioural and cognitive cues that may indicate FASD; and, the fundamentals of an FASD-informed practice.

2. “Strategies and Structures for Supporting Marginalized Women and Families who may have FASD” — Participants explore practices and communication skills that empower and support clients and build relationships; examine individual and agency perceptions, policies and structures in order to reduce barriers to relationship and services for clients; and, develop FASD-specific communication strategies. Client “compliance” issues are re-examined within the context of brain functioning. FASD diagnostic terminology and pathways to access assessment and diagnosis are reviewed.

3. “FASD Prevention” — Using a FASD-informed approach as described in CNC guides (1,2) and the work of Deb Rutman (3), this training builds on the 4 levels of prevention of FASD in Canada (4): awareness and health promotion; brief counseling with women and girls of childbearing age; specialized prenatal support; and postpartum support.  How FASD-informed and trauma-informed approaches overlap is explored along with many strategies for working with women, including those who may have FASD, such as building relationships and reducing barriers through reflective practice, Motivational Interviewing, harm reduction, and individualized services.

The FASD-informed practice training curricula is intended for training of program coordinators and administrators, new frontline workers and seasoned workers who may benefit from a refresher. A year-long evaluation of the training was conducted by Deborah Rutman, and the results will be available for presentation in this blog space, in the next few months.

For more about FASD-informed work, see earlier posts:

• Women with FASD, Substance Use, and FASD Prevention (March 7, 2011)
• Supporting Women with FASD who are Pregnant or Parenting(January 17, 2012)
• FASD Informed Practice for Community Based Programs (March 27, 2014)

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REFERENCES/SUGGESTED READING

1. Guarasci, Anne (2013). FASD Informed Practice for Community Based Programs. Burns Lake, BC: College of New Caledonia – Lakes District Campus.
2. Guarasci, Anne (2011). Empowering Front-Line Staff and Families Through a Collection of Lived Experiences: Supporting Women Who Have Fetal Alcohol Spectrum Disorder (FASD) Behaviours and Characteristics and/or Other Related Disabilities. Burns Lake, BC: College of New Caledonia – Lake District Campus.
3. Rutman, D. (2011). Substance using women with FASD and FASD prevention: Voices of women with FASD: Promising approaches in substance use treatment and care for women with FASD. Victoria, BC: University of Victoria.
4. Poole, Nancy A. (2008). Fetal Alcohol Spectrum Disorder (FASD) Prevention: Canadian Perspectives. Public Health Agency of Canada: Ottawa, ON.

 

Webinar June 23 – Working with Pregnant and Parenting Women: Learnings from HerWay Home

Webinar Recording and Slides Here

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 20^th at http://fluidsurveys.com/surveys/bccewh/herway-home-evaluation-webinar/

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

• Harm Reduction and Pregnancy: Community-Based Approaches to Prenatal Substance Use In Western Canada, February 26, 2015
• Herway Home Conference and Networking Day – September 29, 2014 – Registration Information, August 18, 2014
• New Maternal and Infant Health Interventions on the Canadian Best Practices Portal, August 1, 2013
• Herway Home Program for Pregnant Women and New Mothers In Victoria, BC, February 12, 2013
• Herway Home ‘One-Stop Access’ Program in Victoria Set to Open, May 20, 2012
• Alberta’s Pcap Women’s Quilt: “Creating A Bond . . . Building A Relationship”, April 22, 2016
• Evaluation of FASD Prevention Programs in Saskatchewan, November 3, 2014
• Supporting Pregnant and Parenting Women Who Use Substances: What Communities Are Doing To Help, October 1, 2012
• Women-Centred Approaches to FASD Prevention, October 13, 2010

 

BC Association of Pregnancy Outreach Programs Conference 2015

The BC Association of Pregnancy Outreach Programs (BCAPOP) is made up of Pregnancy Outreach Programs from across British Columbia.

Pregnancy Outreach Programs provide free prenatal and early parenting support to women who experience health or lifestyle challenges during pregnancy, birth and the transition to parenting. The BCAPOP supports POPs in their work to enhance maternal and infant health for the long-term benefit of communities. Many of the programs work with women who are at high risk of having a child with FASD.

The 19th Annual BCAPOP Conference and Annual General Meeting will be held October 27-29, 2015 in Richmond, BC. The theme of this year’s conference is “Embracing Diversity and Celebrating Inclusion.” Keynote speakers include Diane Malbin who will be talking about “FASD — Normalizing Discomfort and Creating Comfort” and Jessica Ball who will discuss “Ensuring Cultural Safety in Services for Indigenous Children and Families.”

Learn more about the conference here.

Alcohol and Pregnancy: Warning Signage Information Kit for Local Governments from British Columbia

The government of British Columbia recently released Alcohol and Pregnancy: Warning Signage Information Kit for Local Governments in British Columbia.

Over the past decade, several B.C. municipalities have passed bylaws under the Community Charter Act requiring alcohol retailers to post point-of-sale FASD warning or prevention signs.

Point-of-sale prevention messages can be helpful in:

1. Influencing knowledge and levels of awareness, changing attitudes and beliefs, and (with sufficient exposure) reducing risk behaviours;
2. Encouraging information seeking;
3. Conveying information about how to make positive change;
4. Indicating where to receive support and services; and
5. Encouraging people who already know the facts.

This new resource provides city councils with information about the rationale for point-of-purchase FASD warning and prevention sign bylaws and discusses the form and types of messages that can be effective, including
examples of recommended messages designed to help prevent/reduce drinking in pregnancy and promote health among women of childbearing ages.

While intended for a local audience, the information about effective messaging as well as issues such as visibility, recall, and comprehension of signs will be helpful for anyone involved in developing FASD awareness materials. Appendix 3 is especially valuable with a discussion of alcohol and pregnancy messages for women at different levels of risk.

The resource can be downloaded from the BC government website.

Women and Alcohol Resources from British Columbia

Earlier this year, the British Columbia government released a revised version of Women and Alcohol: A Women’s Health Resource.

This 12-page resource “was written by women for women, to provide useful information about alcohol and to help women make healthy and well-informed choices about alcohol use.”

It has six sections:

1. Low Risk Drinking
2. Health Risks of Drinking
3. Individual Responses to Alcohol
4. Considerations for Women
5. Supporting Someone Close to You
6. Resources

The update includes information on Canada’s Low Risk Drinking Guidelines (released in 2011) and recent research on the relationship between alcohol and cancer as well as other chronic diseases. Pregnancy and breastfeeding are discussed in the section on “Considerations for Women.”

The resource complements the Problem Drinking Guidelines and Protocols released by the BC Ministry of Health in 2013 for physicians. Physicians are encouraged to conduct brief interventions related to alcohol use and are able to bill for their time using specific diagnostic codes for this purpose.

Also available from the BC government is the International FASD Awareness Day Toolkit and the Pregnancy and Alcohol info sheet from HealthLink, an online directory of health information.

The Liquor Distribution Branch (one of two branches of government in British Columbia responsible for the beverage alcohol industry) has developed educational materials about the risks of alcohol use during pregnancy, including brochures and posters which are available to health care workers throughout the province.

In September (FASD month), BC Liquor Stores feature signage and brochures in stores to help raise awareness with the tagline “We believe that healthy mothers and babies need everyone’s support. Remember: alcohol and pregnancy don’t mix.”

 

 

Save the Date for the Herway Home Community Conference – September 29, 2014

HerWay Home in Victoria, BC is organizing a community conference and networking event for September 29, 2014.

HerWay Home is a child-focused, women-centred, family-oriented drop-in and outreach program for pregnant women and new moms with substance use challenges and their children.

When: Monday September 29, 2014

Where:  DaVinci Centre, 195 Bay Street, Victoria

Time:  09:00 – 4:00

Cost: Free to those attendees from Vancouver Island. A minimal charge of $50 to attendees from off the island.

Who should attend: HWH works with women who are pregnant or early parenting and also affected by substance use, mental health issues, violence, and trauma. This conference will be of interest to those working with women or in settings that are more focused on working with the baby (such as the NICU, foster care etc.),  along with those working on the social determinants of health such as housing, poverty, food security.

Registration information will be available in August. For more information or if you have any questions please contact HerWay Home at  Herwayhome@viha.ca

For more information about HerWay Home, see earlier posts:

• HerWay Home Program for Pregnant Women and New Mothers in Victoria, BC (February 12, 2013)
• Supporting Pregnant and Parenting Women Who Use Substances: What Communities are Doing to Help (October 1, 2012)

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

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

Empowering Conversations to Prevent Alcohol Exposed Pregnancies: Extended Learning Webinars

The BC Ministry of Health and the BC Centre of Excellence for Women’s Health (BCCEWH)  has been offering one-day face-to-face training sessions on motivational interviewing and FASD prevention across British Columbia.

As part of this initiative, they have also been offering a series of webinars (open to all, not just those who attended the training) to continue the learning in an on-line setting.

The slides and the presentation recordings from the first two webinars have now been posted on the BCCEWH website here.

The first webinar discussed working with women who may themselves have FASD and the second webinar introduced a series of new resources on women and alcohol and provide examples on how to incorporate these resources into your work with women.

The second webinar focused on a recently updated resource Women and Alcohol: A Women’s Health Resource which can be downloaded from the BC Ministry of Health website here.

A third webinar will be held in mid-June.