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In developing a panel presentation at the FASD International conference in 2007, Nancy Poole highlighted why the traditional “primary, secondary, and tertiary” model used for disease prevention did not fit as well for prevention of FASD. While designing that panel together with service providers and a birth mother to a child diagnosed with FASD, it dawned on Nancy and the panelists that FASD prevention wasn’t just about alcohol or pregnancy.

When asked to prepare a write-up of this emerging thinking for the Public Health Agency of Canada (PHAC), Poole assembled a group of 25 Canadian prevention specialists to collectively discuss and build the final 4 part model. It was published by PHAC in 2008 (see page 18 for the list of 25 co-developers – Full MODEL Here). The model illustrates how it is important to link mother child and community health in prevention, including continuing to support women and children past the perinatal period.

Over these last 10 years, this Canadian model has been adopted or built upon by FASD prevention specialists in Canada and a number of countries.

Figure 1: Four Levels of FASD Prevention

A recent article discussing what to do about high levels of alcohol use during pregnancy in the United Kingdom recommended the 4-level prevention model as a way to help women make informed decisions.

In Australia, Dr. James Fitzpatrick of Telethon Kids has used and built upon the multi-level model by showing how important it is to link, intervention, research and diagnosis to FASD prevention efforts (Figure 2). He has led community-based FASD prevention initiatives in remote parts of Western Australia that have significantly reduced alcohol use during pregnancy.

Figure 2: Adaptation of 4-Level Model of FASD Prevention by Dr. James Fitzpatrick, Telethon Kids, AU

Perhaps the model has influenced recent action plans regarding FASD, such as that of New Zealand. It emphasises the need for wrap-around services that pair women’s and children’s health including substance use services and treatment for pregnant and post-partum women. They also emphasize collaboration across sectors at the policy and community level.

Looking back, the 4-level prevention model was developed from the collective wisdom of researchers, service providers, policy analysts and birth mothers while implementing prevention initiatives in Canada. Further adaptations have included larger policy components that are key to prevention of alcohol problems. The development process of the model underscores how no one agency or approach can cover FASD prevention. It requires efforts in each of the levels, in ways that are mutually reinforcing.

For more on these topics, see earlier posts:

FASD PREVENTION WITH INDIGENOUS COMMUNITIES IN AUSTRALIA April 3, 2017

FASD PREVENTION CAMPAIGNS LINK TO SUPPORT January 29, 2018

BRIEF INTERVENTIONS TO DECREASE ALCOHOL MISUSE IN WOMEN November 26, 2013

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

THE MOTHERING PROJECT/MANITO IKWE KAGIIKWE IN WINNIPEG, MANITOBA May 1, 2015

INTEGRATING FASD PREVENTION AND ALCOHOL POLICY March 17, 2011

NEW ZEALAND’S NEW ACTION PLAN TO ADDRESS FASD September 17, 2016

There have been recent debates about lifting alcohol bans in Aboriginal communities in Queensland, Australia. The governments in Queensland and Northern Territories have proposed to lift “grog bans” based on the idea that Aborigines should have the same rights as all Australians, including the right to drink.

This news clip interviews indigenous academic, Marcia Langton, who says the evidence supports keeping restrictions in place. “The fact of the matter is is that all Australians are subject to alcohol restrictions in one form or another. We can’t go and buy alcohol at any time of the day or night. There are restrictions on hours. There are restrictions everywhere in Australia now on drinking in public places and specified places. So, it is not true that Aborigines are the only people who are subject to restrictions on alcohol.”

For more on the history of alcohol bans in Queensland, check out this news article Bans on alcohol spawn generation of lucky children (The Australian, October 13, 2012).

For more on local alcohol policies 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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