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This September 9th marks 19 years since the first International FASD Awareness Day. Building awareness is multi-faceted and, for long-time advocates of FASD prevention, it can seem that we take two steps forward and one step back.

We asked four members of our Network Action Team on FASD Prevention (pNAT) to reflect on the work they have done over the years in their community of Victoria, BC. They bring perspectives on how practice approaches, policy and research intersect to build effective FASD prevention efforts within the larger goal of supporting the health of women and families in general.

Many people, including health professionals, believe that there is a greater negative impact from opioid exposure rather than alcohol exposure. The current opioid crisis provides us with a unique opportunity for FASD prevention.
Lenora Marcellus — Associate Professor of Nursing, University of Victoria

I have had the opportunity over many years to work with Neonatal Intensive Care Unit teams related to supporting infants experiencing withdrawal from opioids. This issue has actually continued to grow related to the prescription opioid epidemic and fentanyl crisis that is impacting many communities, including here in British Columbia where the Provincial Medical Health Officer declared a public health emergency in 2016 in response to the rise in drug overdoses and deaths. What continues to surprise me in this work is how the issue of prenatal alcohol exposure rarely, if ever, comes into the conversation. Many people, including health professionals, believe that there is a greater negative impact from opioid exposure rather than alcohol exposure. The current opioid crisis provides us with a unique opportunity for FASD prevention . The strategies for supporting women during pregnancy, many developed by members of the pNAT, have been demonstrated in research to be effective, no matter the substance. I encourage you to partner with women, advocates and professionals in your community to highlight the importance of FASD prevention within the many conversations that are taking place about opioid use during pregnancy across Canada and beyond.

The proof is in – these kinds of wraparound programs that join a FASD-informed approach, with being culturally safe, trauma-informed and women-centred are successful and make a significant difference.
Amanda Seymour – Programming and Practice – Coordinator, HerWay Home

HerWay Home’s 5th Anniversary was earlier this year and I’ve been reflecting on how far the program has come since the visioning and advocacy done by community members leading to its opening in 2013. We have had the privilege of working with over 220 women and being allowed into their lives and that of their families. We have seen the impressive strides and successes the women have made and witnessed their love for and connection with their children. I’ve also reflected on how much more society needs to do. To prevent FASD along with the myriad harms from substance use and ongoing violence and trauma, we must address all the social determinants of health. Women report a positive change in their lives due to their connection with other women in the program, the support, trust and respect they receive from staff and the access to practical supports, health care and counselling. When I look forward to the next 5-10 years I would like to see programs like this one be available in many communities on Vancouver Island where I live, across BC and across Canada. The proof is in – these kinds of wraparound programs that join a FASD-informed approach, with being culturally safe, trauma-informed and women-centred are successful and make a significant difference. Women are able to reduce or abstain from substance use, improve their mental health and keep their children or see them returned to their care when they receive non-judgemental, harm reduction supports and tangible, practical help.

[We now have] … a set of Evaluation Maps to provide guidance and tools for developing, implementing and evaluating FASD-related programs (www.fasd-evaluation.ca).
Deborah Rutman – Principal and Co-Founder, Nota Bene Consulting Group & Adjunct Associate Professor, School of Social Work, University of Victoria

As a researcher and program evaluator, I feel immensely privileged to be able to learn about and report on the incredible work undertaken by staff at diverse FASD prevention programs and to hear women’s stories and experiences, including about what a tremendous difference these wrap-around programs such as HerWay Home make to women and their families. For me, one of the exciting opportunities – and one of the challenges – of evaluating FASD prevention programs is depicting the complexities associated with FASD and FASD-related programming: complexities in terms of the inter-related issues that women and families struggle with; complexities in terms of the range of services and program activities that matter to women; and complexities in terms of the myriad program outcomes that, as evaluators, it is important to document, including: women feeling safe and not judged; women having improved basic needs support, nutrition and safe housing; healthy births; reduced child welfare involvement; increased mother-child connection; abstinence/reduced or safer substance use; and women’s sense of connection and hope. Several years ago, our Nota Bene team, partnering with Nancy and with lots of input from pNAT members, developed a set of Evaluation Maps to provide guidance and tools for developing, implementing and evaluating FASD-related programs. Currently, with funding from the Public Health Agency of Canada and in partnership with eight inspiring programs across the country, our team is undertaking the Co-Creating Evidence study: a ‘first in Canada’ national evaluation of wrap-around programs that work with pregnant or recently parenting women with substance use and other complex issues. We have just completed our first round of data collection at all eight sites and we look forward to sharing our findings with NAT members – and beyond – in the coming months.

It so gratifying that for a decade now, we in Canada have been able to meet virtually in this pNAT to share ideas and identify ways to collaborate on research, practice and policy related to alcohol and FASD prevention.
Nancy Poole – Researcher and Knowledge Translation – Director, Centre of Excellence for Women’s Health

Every time International FASD Day comes around, I think both of the tremendous work people are doing on FASD prevention and how much there still is to do. I am so lucky to have colleagues like Lenora, Deborah and Amanda who are committed to FASD prevention in my own city! We get together over dinner fairly regularly to talk about how our work fits together, and how we can actively work together in various combinations to advance FASD prevention research, practice and policy. In particular, we have been able to lend lots of support to the establishment and ongoing enhancement of programming at HerWay Home. Amanda, Deborah and Lenora have also been core members in our national work on FASD prevention where we link and advance the work on research, evaluation, practice and policy through the Network Action Team on FASD Prevention (pNAT) that is funded by the CanFASD Research Network. It so gratifying that for a decade now, we in Canada have been able to meet virtually in this pNAT to share ideas and identify ways to collaborate on research, practice and policy related to alcohol and FASD prevention .

Prevention Plenary Opening: Moira Plant and Nancy Poole introduce group from Australia

In 7 years, the FASD International Conference has grown to become a truly international event with presenters from six continents and from international health organizations such as the World Health Organization. Current research on clinical topics we’ve come to expect, like prevalence, diagnosis, and neurodevelopment outcomes, were featured this year along with newer topics like biomarkers and epigenetics (See some of the video recorded conference presentations here).

It was the emphasis on prevention, and stigma that took center stage for many attendees. For the first time, there was a specialized prevention plenary – “FASD Prevention Research – State of the Evidence, and Plans for a Global Network” – developed by Nancy Poole (CanFASD; Centre of Excellence for Women’s Health) and Moira Plant (Alcohol & Health Research Unit, University of West England).  Using a model of prevention research used worldwide that Nancy first presented in a poster in 2009, researchers, advocates and birth mothers from around the world talked about where we are and where we need to go.

Watch for upcoming blogs in the next weeks for details on specific prevention presentations.

Objectives for the Prevention Plenary

The Prevention Plenary was divided into 4 areas of presentation and discussion that we will cover in a few posts in the next weeks:

  1. Community-wide FASD prevention with Indigenous communities
  2. International research on discussing alcohol with all women and their partners, and empowering professionals to have these conversations
  3. Research on reaching and engaging women and children at highest risk using approaches that are theory based, and have an equity lens
  4. Plans for international FASD prevention research infrastructure

 

For posts on past International FASD conferences, see:

The 5th International Conference on Fetal Alcohol Spectrum Disorder: Special Session on FASD Prevention, January 14, 2013

Webcasts on 4th Annual International Conference

Since 1999, FASD activists have held World FASD Awareness Day events on 09/09 to represent the nine months of pregnancy, often highlighted with a bell ringing ceremony at 9:09 am. September 9, 2016 is approaching, and this year activists want to use social media because it provides a unique and far-reaching means of building awareness.

You can help build FASD awareness by posting a message, reposting theirs, or bringing attention to their events on your own social media accounts.

FASD Awareness Day Share with CanFASD

Canada

This year Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD) is providing an online forum for organizations to post their initiatives on the CanFASD website. Include a description and a picture or video and they will re-post and Tweet it out to all of their followers. You can post using #FASDAwarenessDay #CanFASD and win prizes.

The Executive Director of CanFASD , Audrey McFarlane says “ CanFASD is very pleased to be able to highlight the fantastic work that the local communities are doing to raise awareness of FASD on September 9 as the local FASD service providers and caregivers are the hardworking folks that manage this work everyday.”

United States

NOFAS US has developed a FASD Awareness Day Packet for 2016 to assist organizations with planning activities for the month of September – FASD Awareness Month.

Their social media campaign includes:

  • A Twitter Chat using the hashtag #FASDMonth as well as offering tweets you can use to send out to others.
  • A one-time message commemorating FASD Awareness Day can be posted to your social media accounts using ThunderClap – a crowd-speaking platform using social media. Learn more here.
  • A campaign to create a video that will feature an inflatable globe being “passed” around the world. Click here to learn more about the campaign.

New Zealand

The University of Auckland is hosting a FASD Policy and Research Forum starting at 9 a.m. on FASD Awareness Day. Find out more here. To find more information, links, and downloads from New Zealand, visit the Fetal Alcohol Network NZ and the Ako Aotearoa learning website for the Pregnancy and Alcohol Cessation Toolkit for providers.

Australia

NOFAS Australia is encouraging people to take a pledge not drink on Sept 9 and to post it on social media as a way to spread the word about FASD.

Also on the Pregnancy Birth & Baby website, there is a call to join the Pregnant Pause Campaign for FASD Awareness Day.

United Kingdom

The FASD Trust is asking people to get involved in a number of ways – raising awareness in school using the Trust’s School Pack, writing their MP. Click here to see their efforts.

To learn more about the history of FASD Awareness Day and get more ideas for events, click on FASD Awareness Day website.

Is your group, organization, or country planning a FASD Awareness Day event? Please share them in the Comments section below.


Previous postings about FASD Awareness Day

Today is International FASD Awareness Day, September 9, 2015

Today is International FASD Awareness Day, September 9, 2014

FASD Annotated Bibliography, Part 2

2015-12-Life-of-Pix-free-stock-photos-city-distributors-newspapers-AlexisDoyenIt seems more attention is being brought to preconception health and its role in FASD prevention.  We have known about the value of preconception intervention for many years. The Project CHOICES Research Group described positive intervention results using Motivational Interviewing in 2003 [1]. Yet now attention to the preconception period seems to be “trending.”

Preconception intervention has been discussed all along (we were asking about it in a landmark study in the ‘90s[2]), but the recent actions like U.S. CDC recommendations and Yukon’s placement of pregnancy tests in bars are certainly highlighting preconception alcohol use and health behaviours. The current Annotated Bibliography of articles published on FASD prevention seems to bear this recent focus out:., there were a total of five articles on preconception efforts in the 2013 list; and in articles published in 2015, that number has doubled.

In the latest annotated list, Landeen et al. says that the “fetal origin of disease theory” provides the rationale for providing preconception interventions[3]. Johnson et al. describe the development and dissemination of the CHOICES model[4] and its successful adaptation in a variety of settings. Hanson et al. have written three articles that expand on the work they did adapting and implementing a CHOICES program with the Oglala Sioux Tribe in the U.S.[5-7]. Analyses by Hussein et al.[8], Mitra et al.[9] and Oza-Frank et al.[10] suggest that preconception interventions must be tailored if they are to be successful. McBride stresses the need for preconception counseling for men, as substance use during pregnancy is not solely a decision made by women or under their control [11].

Members of the pNAT are currently undertaking a review of the literature on preconception interventions and formulating recommendations for a national research agenda. They will present some of these recommendations at the research meeting in August at the University of Regina (See www.canfasd.ca for more info on this meeting).

In keeping with our understanding of multiple forms of evidence, we are interested in knowing what you are seeing and hearing about preconception interventions on alcohol. Has preconception intervention been a part of your practice for a while? Who is funded to provide it in your location? What has worked, and how has it worked, in your experience?

For further reading on preconception interventions, see earlier postings:

Alcohol and FASD: It’s not just about women, June 6, 2016
FASD Prevention needs to begin before pregnancy: Findings from the US National Survey on Family Growth, May 20, 2015
Global Trends in Unintended Pregnancy: Implications for FASD Prevention, October 13, 2014
Impact Evaluation of the Healthy, Empowered and Resilient (H.E.R.) Pregnancy Program in Edmonton, Alberta, February 7, 2014
FASD Prevention in Nova Scotia, April 25, 2013
The Sacred Journey – new resource for service providers who work with First Nations families, August 1, 2012
FASD Prevention in Russia, February 15, 2012
New book: Fetal Alcohol Spectrum Disorder: Management and Policy Perspectives of FASD, Jan 6, 2011


REFERENCES/SUGGESTED READING

  1. Reducing the risk of alcohol-exposed pregnancies: A study of a motivational intervention in community settings. Pediatrics, 2003. 111(Supplement 1): p. 1131-1135.
  2. Astley, S.J., et al., Fetal Alcohol Syndrome primary prevention through FAS Diagnosis II, A comprehensive profile of 80 birth mothers of children with FAS Alcohol and Alcoholism, 2000. 35(5): p. 509-519.
  3. Landeen, L.B., R. Bogue, and M. Schuneman, Preconception and prenatal care–useful tools for providers of women’s health. South Dakota Medicine: The Journal Of The South Dakota State Medical Association, 2015. Spec No: p. 36-43.
  4. Johnson, S.K., M.M. Velasquez, and K. von Sternberg, CHOICES: An empirically supported intervention for preventing alcohol-exposed pregnancy in community settings. Research on Social Work Practice, 2015. 25(4): p. 488-492.
  5. Hanson, J.D., K. Ingersoll, and S. Pourier, Development and implementation of choices group to reduce drinking, improve contraception, and prevent alcohol-exposed pregnancies in American Indian women. Journal of Substance Abuse Treatment, 2015.
  6. Hanson, J. and J. Jensen, Importance of Social Support in Preventing Alcohol-Exposed Pregnancies with American Indian Communities. Journal of Community Health, 2015. 40(1): p. 138-146 9p.
  7. Hanson, J.D. and S. Pourier, The Oglala Sioux Tribe CHOICES Program: Modifying an Existing Alcohol-Exposed Pregnancy Intervention for Use in an American Indian Community. International Journal Of Environmental Research And Public Health, 2015. 13(1).
  8. Hussein, N., J. Kai, and N. Qureshi, The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review. The European Journal Of General Practice, 2015: p. 1-11.
  9. Mitra, M., et al., Disparities in adverse preconception risk factors between women with and without disabilities. Maternal and Child Health Journal, 2015.
  10. Oza-Frank, R., et al., Provision of specific preconception care messages and associated maternal health behaviors before and during pregnancy. American Journal of Obstetrics & Gynecology, 2015. 212(3): p. 372.e1-372.e8.
  11. McBride, N., Paternal involvement in alcohol exposure during pre-conception and pregnancy. Australian Nursing & Midwifery Journal, 2015. 22(10): p. 51-51.

 

Each year, researchers with the Prevention Network Action Team (pNAT) of CanFASD Research Network conduct an international literature review of academic articles published on FASD prevention. Rose Schmidt and Nancy Poole of BC Centre of Excellence for Women’s Health looked at articles published between January and December 2015 and compiled a comprehensive bibliography of 88 FASD prevention-related articles – an increase of 25 articles from last year. With this review, those working on FASD prevention will be able to update themselves on the most current evidence and tailor policy and practice accordingly.

The bulk of the articles have come from the U.S., Canada and Australia, the United Kingdom and South Africa, in that order. The articles are organized under the four-level prevention framework created by the pNAT, as well as including articles related to FASD prevalence, influences, issues of preconception, indigenous women and young women. Fourteen articles were assigned to more than one topic category.

A look at “prevalence”

The topic category with the most articles was prevalence, followed in order by brief intervention with girls and women of childbearing age (Level 2), and influences. Preconception, raising awareness (Level 1), and specialized prenatal report (Level 3) also had a significant number of articles. We will highlight these topics individually in this blog over time in order to focus on key components of FASD prevention.

There were 26 articles having to do with prevalence rates as compared to seven articles in that category in 2014. They relate to specific location, U.S., Canada, Uganda, Norway and Tanzania, for instance, as well as pregnancy intentions, characteristics of women at risk for alcohol-exposed pregnancy, women’s understanding of risk factors during pregnancy, rates of binge drinking, adverse childhood experiences, and use of both alcohol and tobacco during pregnancy.

Some of the more compelling findings include:

  • new data from Canada shows that 27% of pregnancies are unintended – useful in that previous data on unintended pregnancies has been from the U.S. only [1];
  • smoking currently or in the past increased the likelihood of consuming alcohol during pregnancy [2];
  • experiences of abuse and violence are associated with higher levels of drinking during pregnancy[3], as well as higher education levels and older maternal age [4-9];
  • a “dose response” relationship was found to exist between adverse childhood experiences and drinking during pregnancy[3], and;
  • smoking during pregnancy was the most consistent predictor of drinking during pregnancy[10] .

Preconception behaviors as they relate to prevalence of alcohol-exposed pregnancies, in general, has become more of a focus in prevention efforts, and will be further discussed in upcoming blog posts on this bibliography.

For more information on FASD Prevention and Prevalence, see these earlier posts:


REFERENCES
  1. Oulman, E., et al., Prevalence and predictors of unintended pregnancy among women: an analysis of the Canadian Maternity Experiences Survey. BMC Pregnancy & Childbirth, 2015. 15: p. 1-8.
  2. Lange, S., et al., Alcohol use, smoking and their co-occurrence during pregnancy among Canadian women, 2003 to 2011/12. Addictive Behaviors, 2015. 50: p. 102-109.
  3. Frankenberger, D.J., K. Clements-Nolle, and W. Yang, The association between adverse childhood experiences and alcohol use during pregnancy in a representative sample of adult women. Women’s Health Issues, 2015. 25(6): p. 688-695.
  4. English, L., et al., Prevalence of Ethanol Use Among Pregnant Women in Southwestern Uganda. Journal Of Obstetrics And Gynaecology Canada: JOGC = Journal D’obstétrique Et Gynécologie Du Canada: JOGC, 2015. 37(10): p. 901-902.
  5. González-Mesa, E., et al., High levels of alcohol consumption in pregnant women from a touristic area of Southern Spain. Journal of Obstetrics & Gynaecology, 2015. 35(8): p. 821-824.
  6. Dunney, C., K. Muldoon, and D.J. Murphy, Alcohol consumption in pregnancy and its implications for breastfeeding. British Journal of Midwifery, 2015. 23(2): p. 126-134.
  7. Kingsbury, A.M., et al., Women’s frequency of alcohol consumption prior to pregnancy and at their pregnancy-booking visit 2001–2006: A cohort study. Women & Birth, 2015. 28(2): p. 160-165 6p.
  8. Kitsantas, P., K.F. Gaffney, and H. Wu, Identifying high-risk subgroups for alcohol consumption among younger and older pregnant women. Journal of Perinatal Medicine, 2015. 43(1): p. 43-52 10p.
  9. Lanting, C.I., et al., Prevalence and pattern of alcohol consumption during pregnancy in the Netherlands. BMC Public Health, 2015. 15(1): p. 1-5.
  10. O’Keeffe, L.M., et al., Prevalence and predictors of alcohol use during pregnancy: findings from international multicentre cohort studies. BMJ Open, 2015. 5(7): p. e006323-e006323.

 

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From the FASDay website:

“The first FAS Day began on September 9, 1999 in Auckland, New Zealand, where “Minute of Reflection” bells rang at 9:09 a.m., at Mt Albert Methodist church. Then it moved to Adelaide, Australia, and then to South Africa, where at 9:09 a.m., Cape Town volunteers gathered to hear the War Memorial Carillon that rang when Nelson Mandela was released from prison.

Volunteers in Italy, Germany and Sweden held events – and then FASDay crossed the Atlantic.  There were events in every time zone across Canada and the U.S., including ringing of carillons in Toronto, Niagara Falls, Hastings, NE, and Austin & San Antonio, Texas. The westernmost activity was the community breakfast on the tiny island of Kitkatla, B.C., near the Queen Charlotte Islands, where the village bell rang at 9:09 a.m. followed by prayers in the native tongue by village elders.”

Events to increase awareness about FASD are happening all over the world today and throughout September. Find out what’s happening in your community.

The image above is from a poster and brochure developed by the British Columbia Liquor Distribution Branch. (Each of Canada’s 13 provinces and territories has a liquor board or commission that oversees the control, distribution and sale of beverage alcohol in its jurisdiction. Many boards run FASD Awareness campaigns in the month of September as part of their social responsibility initiatives).

Here are a few other resources on FASD developed by members of the Canada FASD Research Network that you might want to share with others.

What Men Can Do

KNOW FASD

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Pages from First-Nations-Women’s-Healing-Photoessay-web

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The Canada FASD Research Network has developed a series of “issue papers” that provide a 2-3 page overview of a range of issues related to FASD based on the latest research.

Some of the prevention-related topics include:

Other topics related to FASD more generally include:

These issue papers can be a great way to catch up on recent research or to get a quick overview of an area of work you’re not as familiar with. All the issue papers can be downloaded from the Canada FASD Research Network website.

 

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The Intervention Network Action Team (iNAT) of the Canada FASD Research Network focuses on research and knowledge translation in FASD interventions.

Check out the team’s 14th newsletter here and visit the FASD Intervention blog here. This newsletter includes interviews with folks working on the Caribbean Quest intervention program that aims to improve attention and working memory as well as information about the Strongest Families Research program.

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Yes, that’s right, the Girls, Women, Alcohol, and Pregnancy blog is 4 years old today!

Thank you to everyone who reads our blog for your continuing support. There were over 40,000 visits from you lovely people from all over the world (as you can see in the map below).

Year 4 map

Just in case you’re interested, here are the top 10 most viewed posts since July 2013.

  1. Postcolonial Theory for Beginners
  2. Films from the Lililwan Project: Tristan and Marulu
  3. Pregnancy and Alcohol Brochure for Aboriginal Families
  4. Streetworks’ Supports for Homeless Pregnant Women project
  5. “Alcohol? Know Your Limit” campaign from Germany
  6. Alcohol Think Again Campaign in Western Australia
  7. Do concerns about alcohol use during pregnancy lead women to consider having an abortion?
  8. FASD Prevention in South Africa
  9. FASD Prevention in France
  10. Psychological distress and maternal drinking: exploring the context of risk for FASD

Here are some of my favorite posts for the year (based on newsworthiness, interest, and other unquantifiable factors).

  1. Honouring Our Strengths: Culture as Intervention in Addictions Treatment (June 5, 2014)
  2. How Men Can Help Prevent FASD (March 11, 2014)
  3. Impact Evaluation of the Healthy, Empowered and Resilient (H.E.R.) Pregnancy Program in Edmonton, Alberta (February 7, 2014)
  4. Cancer and Alcohol: Canada’s Low Risk Drinking Guidelines (January 27, 2014)
  5. Advice for Journalists Reporting on FASD (November 18, 2013)

This blog is an initiative of the Canada FASD Research Network. Learn more about our activities by visiting our website.

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:

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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