Thunder Bay’s Family Health Program publishes research report for preventing alcohol-exposed pregnancy

As 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.

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REFERENCES

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

FASD Awareness Day 2016: Focus on Social Media

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.

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.

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Previous postings about FASD Awareness Day

Today is International FASD Awareness Day, September 9, 2015

Today is International FASD Awareness Day, September 9, 2014

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.

 

Preconception Interventions – Trending or Mainstream?

FASD Annotated Bibliography, Part 2

It 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].

2015 FASD Prevention Bibliography

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

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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.

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

 

Alberta’s PCAP Women’s Quilt: “Creating a bond . . . Building a relationship”

Parent-Child Assistance Programs (PCAP) are one important approach to FASD prevention in a number of provinces in Canada and the U.S. These programs use a relational, women-centred, strengths-based approach, which is proven to be effective in FASD prevention [1, 2].

As a visual way to express their experiences of mentorship within Alberta’s PCAP program, women came together in workshops across the province to create individual quilt squares for a larger quilt.

The finished quilt, pictured below, captures the hope, resilience, acceptance and connection that participation in the PCAP program has brought them and their children.

Described as lively, creative, interactive and dynamic, the workshops were held in Calgary, Edmonton and several rural communities; women were supported by their mentors in getting to them. The workshops built connection between women as well as long-term relationships with their children and their mentors.

Developed and researched by Dorothy Badry, Kristin Bonot and Rhonda Delorme, a full description of the project is here.This is the second quilt project from Alberta’s PCAP program; the first quilt was made by mentors (read more about that project here).

To read earlier blogs about FASD primary prevention projects in Canada follow the links below:

The Mother-Child Study

H.E.R. Pregnancy Program

The Mothering Project

HerWay Home Program

FASD Prevention in Saskatchewan

Harm Reduction and Pregnancy

1. Thanh, N.X., et al., An economic evaluation of the parent-child assistance program for preventing fetal alcohol spectrum disorder in Alberta, Canada. Adm Policy Ment Health, 2015. 42(1): p. 10-8. View article link
2. Grant, T.M., et al., Preventing alcohol and drug exposed births in Washington state: Intervention findings from three parent-child assistance program sites. The American Journal of Drug and Alcohol Abuse, 2005. 31(3): p. 471-490. View PDF

Today is International FASD Awareness Day

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.

Webinar: “Caregiving, FASD, and Alcohol: Caring about FASD Prevention” – September 9, 2015

The Canadian Association of Pediatric Health Centres is hosting a free webinar on International FASD Day, September 9th, 2015.

Award-winning journalist and author, Ann Dowsett Johnston will discuss dismantling stigma and how to address an alcogenic culture that blames and shames the FASD community.

Dr. Dorothy Badry and Dr. Deb Goodman will discuss a practical set of tools and resources that will be useful to healthcare practitioners and caregivers. The Caregiver Curriculum on FASD and the website www.fasdchildwelfare.ca were developed in response to an identified need for training on FASD that was accessible and available to caregivers supporting individuals with this lifelong disability on a day to day basis.

The webinar will be held on September 9th from 11:00am-12:30pm EST. Click here for more information and to register.

Smoking and Alcohol Use During Pregnancy: Findings from the Canadian Community Health Survey

Overall, alcohol and tobacco are the most commonly used drugs during pregnancy in Canada. They are also the two drugs that can be the most harmful to a fetus during pregnancy and in the long-term for babies that are exposed.

New research, using data from the Canadian Community Health Survey (2003-2012), takes a closer look at this relationship. Internationally, research has shown that women who smoke are also more likely to drink and vice versa. (One study by Cannon et al showed that 74% of mothers who had a child with FASD also smoked during their pregnancy).

The researchers looked at a national sample of 22,962 women who had given birth in the previous five years. They found that the overall prevalence of smoking during pregnancy in this group of women was 14.3% (of the women who smoked, 52.5% smoked daily and 47.5% smoked occasionally). The prevalence was the lowest in British Columbia at 9.0% and the highest in the territories (Yukon, Northwest Territories, and Nunavut combined) at 39.9%.

They found that:

• Women who smoked during pregnancy were more likely to be younger, single, white/non-immigrants, and have a lower income.
• Women who smoked during pregnancy were more likely to drink while pregnant. Women who were daily or occasional smokers during pregnancy were 2.54 and 2.71, respectively, times more likely to have consumed alcohol during pregnancy as compared to non-smokers.
• Women who had a lifetime history of smoking, but who did not smoke during pregnancy, were also more likely to have consumed alcohol during pregnancy.
• Binge drinking was the only factor that had a relationship to whether women used alcohol, smoked or used both during pregnancy.

These findings suggest the importance of public health interventions that address alcohol use and smoking together both before and during pregnancy.

References

Bailey, B.A., McCook, JG., Hodge, A. and McGrady, L. (2012). Infant birth outcomes among substance using women: why quitting smoking during pregnancy is just as important as quitting harder drugs. Matern Child Health J, 16:414–422.

Cannon, M.J., Dominique, Y., O’Leary, L.A., Sniezek, J.E., & Floyd, R.L. (2012). Characteristics and behaviors of mothers who have a child with fetal alcohol syndrome. Neurotoxicology and Teratology, 34: 90–95.

Janisse, J.J., Bailey, B.A., Ager, J., and Sokol, R.J. (2014). Alcohol, Tobacco, Cocaine, and Marijuana Use: Relative Contributions to Preterm Delivery and Fetal Growth Restriction. Substance Abuse, 35(1): 60-67, DOI: 10.1080/08897077.2013.804483

Lange, S., Probst, C., Quere, M., Rehm, J., Popova, S. (2015). Alcohol use, smoking and their co-occurrence during pregnancy among Canadian women, 2003 to 2011/12. Addictive Behaviors, 50: 102–109.

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

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.

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.