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Each year since 2013, researchers associated with the Prevention Network Action Team (pNAT) of the CanFASD Research Network search the academic literature for articles related to prevention of fetal alcohol spectrum disorder (FASD). Articles are reviewed for relevancy, identified by topic and country, and the findings briefly summarized. For this year’s Annotated Bibliography of Articles Published in 2017, a total of 113 articles were identified from 17 countries. Countries with highest number of published articles were USA, (51 articles) Canada (26 articles), Australia (10 articles).

Findings are organized using a four-level prevention framework used by the pNAT to describe the wide range of work that comprises FASD prevention (see panel at left for more information). This year a record 32 articles pertained to Level 2 which involves discussion of alcohol use with all women of childbearing age and their partners/support systems. Articles pertaining to Prevalence of alcohol use in pregnancy, Influences on women’s drinking, and Preconception interventions were also well represented.

The annual literature search is intended to update those involved in FASD prevention in Canada, to inform their practice and policy work with current evidence. The members of the pNAT also have the opportunity to discuss the implications for their work of the findings of selected articles, in monthly web meetings.

Find earlier Annotated Bibliographies below and on the CanFASD Prevention page under “Bibliographies”.


FASD Prevention: An Annotated Bibliography of articles published in 2016

FASD Prevention: An Annotated Bibliography of articles published in 2015

FASD Prevention: An Annotated Bibliography of articles published in 2014

FASD Prevention: An Annotated Bibliography of articles published in 2013

A lot of progress has been made on effective FASD awareness and prevention strategies. Early efforts often used disrespectful tactics like unsettling pictures of women slugging down alcohol from a bottle while pregnant with a caption such as “Baby or the Bottle.” Those approaches have largely been abandoned. But one overly simple statement still pops up. And that is, “FASD is 100% Preventable.”

That statement is misleading because it suggests that FASD prevention is unidimensional and linked only to alcohol consumption. But alcohol use during pregnancy is linked to the social determinants of health, and its effects can be exacerbated by food insecurity, trauma, poverty and multi-substance use. It also suggests that stopping drinking is a simple choice. It puts the onus on the individual woman to make that choice and contributes to shame if they do not stop before they become pregnant. But in reality, there are many influences on women’s alcohol use, and real challenges to quitting before you know you are pregnant. Indeed, almost half of pregnancies are unplanned, so it is very challenging to be alcohol free before a pregnancy is confirmed.

In the case of other substances like tobacco or prescription painkillers, the public discourse extends beyond the individual user to corporate responsibilities, physicians and health authorities to provide harm reduction and treatment programs, and of governments to provide regulation and enforcement and policies that work toward social equity.

If we extend this perspective to alcohol use during pregnancy, we must speak about the responsibilities of the alcohol industry for targeting girls and women of childbearing age, and of health providers for providing comprehensive education and brief support during the preconception and prenatal periods. We must also consider the responsibilities of health services for providing integrated treatment programs for pregnant and parenting women; and of governments for ensuring gender equity and preventing violence against women.

Theoretically, stopping alcohol use in pregnancy, or ideally, before, sounds simple – just do it. But it takes a lot of individuals and sectors to do their part to make it realizable.  Simplifying it to statements like “FASD is 100% preventable” is not the best approach.

These previous blogs illustrate the full context of FASD and prevention approaches.

HOUSING IS KEY COMPONENT TO WOMEN’S RECOVERY, August 19, 2017

TARGETING STIGMA AND FASD IN MANITOBA, June 26, 2017

HEAVY DRINKING AMONG WOMEN: NORMALISING, MORALISING AND THE FACTS, Jan 24, 2017

FASD IS A PUBLIC SAFETY AND JUSTICE PRIORITY FOR ABORIGINAL GROUPS, October 23, 2016

HOW DO PARTNERS AFFECT WOMEN’S ALCOHOL USE DURING PREGNANCY? August 11, 2014

 

 

Brief Interventions

Indigenous Mothering

Welness

Community Action

Reconciliation & Healing

Five new booklets on Indigenous Approaches to FASD Prevention have just been published. They were developed  following the Dialogue to Action on Prevention of FASD meeting in May 2017, and reflect the 8 tenets of the Consensus Statement created by participants for enacting the Truth and Reconciliation Commission of Canada Call-to-Action #33:

“We call upon the federal, provincial, and territorial governments to recognize as a high priority the need to address and prevent Fetal Alcohol Spectrum Disorder (FASD), and to develop, in collaboration with Aboriginal people, FASD preventive programs that can be delivered in a culturally appropriate manner.” – Truth and Reconciliation Commission of Canada

The booklets were written by Tasnim Nathoo and Nancy Poole of the Centre of Excellence for Women’s Health in collaboration with the Thunderbird Partnership Foundation, and Canada FASD Research Network. Topics include: Brief Interventions with Girls and Women, Mothering, Wellness, Community Action, and Reconciliation and Healing. Printed booklets are being shared with those who attended the meeting in May and with Indigenous communities who may find them helpful as they plan FASD prevention efforts. Links to PDF versions are included in this blog.

Grounded in research, the booklets prioritize Indigenous knowledge for implementing culturally-safe, cross-disciplinary, cross-organizational, and collaborative approaches to FASD prevention. As well, each booklet offers discussion questions that shift the lens from a primary focus on alcohol use during pregnancy, to a holistic focus that aligns with Indigenous values and worldviews to support change and transformation in all systems of care.

The Truth and Reconciliation Commission of Canada (TRC) provided a process for discovering the harms and injustices that Aboriginal people experienced as part of the Indian Residential School system with an aim to build a lasting and respectful foundation of reconciliation across Canada. TRC findings were released in 2015 along with 94 Calls-To-Action (CTA), including CTA #33, which focuses on FASD prevention.

 

See earlier posts on these topics:

DEVELOPING AN INDIGENOUS APPROACH TO FASD PREVENTION IN BC’S FRASER SALISH REGION December 11, 2017

INNU COMMUNITY FASD PREVENTION IN LABRADOR October 27, 2017

FASD PREVENTION WITH INDIGENOUS COMMUNITIES IN AUSTRALIA April 3, 2017

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

POSTCOLONIAL THEORY FOR BEGINNERS
September 1, 2010

Using animal models, scientists at Northwestern University in Chicago were able to reverse learning and memory deficits resulting from exposure to alcohol in utero. The scientists administered thyroxine (a hormone that is reduced in pregnant women who drink and in infants with fetal alcohol spectrum disorder) or metformin (an insulin sensitizing drug that lowers blood sugar levels, which is higher in alcoholics) to rat pups exposed to alcohol in utero, in the 10 days immediately after they were born.  Based on these findings, they will conduct a clinical trial with pregnant women in South Africa.

Dr. Eva Redei, one of the scientists involved in the study believes that such options are necessary for women with alcohol use disorders, or those who drink before they know they are pregnant. In a recent newspaper interview, Dr. James Reynolds at Queen’s University in Canada said he doubts that this will be a cure for FASD, but that studies like this one could give us more clues as to how alcohol affects development.

Other important voices are community-based prenatal program providers and mothers of children with FASD who see that medical interventions, should they be found to be effective, are likely to be only a part of the picture, and that a range of prevention efforts will always be needed.

Whether or not learning and memory deficits can be reversed through hormonal and insulin interventions in the future, there are many other health deficits resulting from alcohol-exposed pregnancies that remain and that may not respond to this treatment (https://www.sciencedaily.com/releases/2016/01/160106091842.htm ).

Consequently, even if this new clinical trial shows positive outcomes, FASD prevention efforts that support women’s decision making about alcohol use, and prevention efforts that influence the social determinants of women’s health will still be needed.

You can read more here:

https://www.eurekalert.org/pub_releases/2017-07/nu-rfa071717.php

 

The First Nations Health Authority (FNHA) in British Columbia is exploring a partnership approach to developing a community-based FASD prevention strategy in the Fraser Salish region.

Inspired by the Marulu Strategy in the Fitzroy Valley of Western Australia and the work of other Indigenous communities in Canada, the FNHA Community Wellness Support team brought together individuals and organizations working in health care, child welfare, early childhood development, community wellness and other related areas for a one-day meeting on December 1, 2017. The meeting was held on the on the traditional territory of the Musqueam people.

The meeting began with an opening prayer and welcome from a Musqueam Elder. In the morning, participants learned about the successful Family Empowerment Team in the Stó:lō Nation (the Stó:lō traditional territory extends from Yale to Langley, BC). The program is based on the Parent Child Assistance Program (PCAP) model developed by Therese Grant at the University of Washington in 1991 which has been shown to an effective approach to preventing FASD.

The Family Empowerment Team has built upon the PCAP model to develop a holistic and culturally relevant approach to FASD prevention in the Stó:lō Nation. Meeting attendees had the unique opportunity to hear from a woman who has participated in the program and to hear how the program has supported her and her family to reach her goals.

In the afternoon, members of Alberta’s Parent-Child Assistance Program Council shared their experiences of working with and supporting over 30 PCAP programs in Alberta and how different agencies, groups, and government departments have collaborated in developing a 10-year provincial strategy to address FASD.


For more on these topics, see these earlier posts:

Alberta Parent-Child Assistance Program Quilt, December 8, 2014

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

FASD Mentoring Programs in Canada, December 7, 2011

 

For International FASD Awareness Day on September 9th, the CanFASD Research Network, through its Prevention Network Action Team (pNAT) and the Centre of Excellence for Women’s Health, developed this infographic on what we know about alcohol use and preventing FASD. You can download a PDF version here.

CanFASD focuses on all aspects of FASD that impact women, individuals, caregivers, and service providers through its network action teams, each with a different focus – prevention, intervention, research, and policy and service providers. These teams aim to put forth knowledge in a way that is useful to communities and organizations in Canada in developing effective programs and policies.

You can search hashtags #FASDay2017 #CanFASD on Twitter to see examples of what others in Canada, or visit some of our pNAT partners using the links on the left side of this blog.

 

negative-space-macbook-graphs-chartsWhen you sign up for online alerts regarding new FASD research, a lot of research articles come your way. Some offer hope like the recent article on a possible future treatment for newborns diagnosed with FASD (see Common drugs reverse signs of fetal alcohol syndrome in rats). But most are headlines about newly identified risks associated with alcohol-exposed pregnancies.

For instance, these four recent headlines:

Drinking alcohol during pregnancy could have transgenerational effects

Prenatal exposure to alcohol increases likelihood of addiction later in life

Any alcohol consumption during pregnancy affects craniofacial development

Foetus absorbs mother’s alcohol and nicotine intake in just 2 hours

From a scientific research standpoint, it’s important to fully understand effects of alcohol -exposed pregnancies. But, from a prevention point of view, does it add anything to our efforts to know one more reason drinking alcohol during pregnancy is risky? Does it lessen the stigma these women face? Would one more identified risk be the thing a woman needed to hear in order to stop drinking in her pregnancy or while trying to become pregnant?

Obviously, the full picture of effects is important, and this kind of medical and scientific research should continue. At the same itme, it would be helpful to see more headlines on what has been discovered around prevention – focusing on programs that support the mother child dyad, efforts to reduce stigma, and implementation of trauma-informed and FASD-informed practices and policies.

How about five headlines like these?

Relational treatment programs reduce risk of alcohol-exposed pregnancies and FASD

Connection to culture is key to prevention for many women

Changes in alcohol policy contribute to reduction of violence against women and incidence of alcohol-exposed pregnancies

Secure housing contributes to reduction in alcohol-exposed pregnancies

Women who can safely discuss alcohol with their health provider are  more likely to stop risky drinking

This real headline deserves more coverage: “ If we want to save lives, control alcohol. ”

We have lots of information of the risks of alcohol-exposed pregnancies. The work now is about prevention and we will work to bring you those “headlines.”


For more information on these topics, see these previous posts:

REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED May 15, 2017

THUNDER BAY’S FAMILY HEALTH PROGRAM PUBLISHES RESEARCH REPORT FOR PREVENTING ALCOHOL-EXPOSED PREGNANCY October 4, 2016

THE WORK OF THE NETWORK ACTION TEAM ON FASD PREVENTION FROM A WOMEN’S HEALTH DETERMINANTS PERSPECTIVE (CANFASD RESEARCH NETWORK) April 11, 2016

FASD ISSUE PAPERS FROM THE CANADA FASD RESEARCH NETWORK PROVIDE A QUICK OVERVIEW OF RECENT RESEARCH December 1, 2014

SUPPORTING PREGNANT WOMEN WHO USE ALCOHOL OR OTHER DRUGS: A GUIDE FOR PRIMARY HEALTH CARE PROFESSIONALS MAY 15, 2016

FREE WEBINAR: UPDATED RESOURCES ON WOMEN AND ALCOHOL: APPLYING RESEARCH TO PRACTICE – MAY 8, 2014 April 21, 2014

FASD PREVENTION RESEARCH AND KNOWLEDGE TRANSLATION: DEVELOPING A PAN-CANADIAN AGENDA WORKSHOP January 29, 2014

FASD INFORMED PRACTICE FOR COMMUNITY BASED PROGRAMS March 27, 2014

RESEARCH MAKES LINKS BETWEEN GENDER, ETHNICITY, CHILDHOOD ABUSE AND ALCOHOL USE April 2, 2013

TRAUMA MATTERS: GUIDELINES FOR TRAUMA‐INFORMED PRACTICES IN WOMEN’S SUBSTANCE USE SERVICES April 17, 2013

4th in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 3

“Research on Reaching and Engaging Women and Children using Approaches that are Theory Based, and have an Equity Lens” – Janet Christie, Addiction Recovery Coach, Canada; Anne Russell of the Russell Family Fetal Alcohol Disorders, Australia; Pippa Williams of UK and European Mothers Network-FASD; Margaret Leslie and Dr. Mary Motz of the Mothercraft/Breaking the Cycle, Canada

L to R: Janet Christie, Anne Russell, Pippa Williams, Margaret Leslie, Dr. Mary Motz with Dr. Nancy Poole, Prevention Plenary Co-Lead

One of the highlights of the first Plenary on Prevention at the 2017 International Conference on FASD, was the presentation on supporting women and families dealing with issues of alcohol and FASD.

Janet Christie, Anne Russell and Pippa Williams are three birth mothers who have created supports for women and families dealing with issues of alcohol or FASD. Their experiences have informed and are reflected in many reports and studies: that no woman intends to harm her child; that there are multiple and complex issues that affect women at risk for alcohol-exposed pregnancies; and, that fragmented and inflexible services make it difficult for women and families to get help.

Stigma is one of the biggest barriers affecting access to services. Addiction is still viewed by many as a moral failing rather than a public health issue. Meanwhile the alcohol industry normalizes and glamourizes drinking to women through targeted marketing campaigns. Women are often met with judgement and blame, and fear losing their children if they seek help for an addiction. As well, mothers whose children have FASD need support in dealing with their feelings of guilt and with parenting their children. Often women have complex and intersecting issues, including FASD, that affect their ability to accept support. While these three mothers/advocates are from different countries, they all identify these same issues, and call for programs with wrap-around services to support women and their families.

Margaret Leslie and Dr. Mary Motz then described such a program – Breaking the Cycle in Toronto and its mother-child study “Focus on Relationships”. Based upon well-researched attachment theory, the program focuses on the mother-child dyad during the pre- and post-partum period and on building trust, safety and relational capacity. Relationships extend to staff and service providers. Program efforts to develop collaborative relationships between child welfare, addiction recovery and mental health service agencies have successfully created an integrated and flexible program with the goal of supporting the whole family.

 

For more on these topics, see earlier posts:

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
Why Would She Drink? Winnipeg Free Press Articles Explore Drinking during Pregnancy, April 4, 2011

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

dorothy-awardDorothy Badry was honoured by the Premier’s Council on the Status of Persons with Disabilities for Alberta on December 2nd. Dorothy has been a long-time advocate, researcher and educator on the impact of FASD (and a dedicated member of the Prevention Network Action Team). Her work has contributed to FASD being recognized as a disability. For families and individuals affected by FASD, that recognition has made a huge difference.

In a University of Calgary article written about her, she describes FASD as an health “outcome” – a key shift from early stigmatizing assessments. This allows for a relational approach that includes women, children, families, and communities and for inclusive and multi-level prevention/intervention strategies.

An original member of the Canada FASD Research Network, we have benefited from Dorothy’s active participation and counsel. She has been featured in some of our previous blogs for her work at with University of Calgary, Alberta province, and several FASD-related programs. We are happy to feature her once again for this well-deserved honour. Congratulations, Dorothy Badry.

For related blogs, see previous postings:

“Developing Services for Canadians Living with FASD” interview with Dorothy Badry on Family Caregivers Unite! January 5, 2015

Alberta’s PCAP Women’s Quilt: “Creating a bond . . . Building a relationship” April 22, 2016

The work of the Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective (CanFASD Research Network) April 11, 2016

Webinar: “Caregiving, FASD, and Alcohol: Caring about FASD Prevention” – September 9, 2015 August 25, 2015

First Peoples Child & Family Review journal: Special Issue on FASD December 9,

Case Management to Prevent Fetal Alcohol Spectrum Disorder September 20, 2013

Women’s health and FASD prevention in a special issue of the International Journal of Circumpolar Health August 6, 2013

Brightening Our Home Fires: An FASD Prevention and Women’s Health Project in Canada’s Northwest Territories May 6, 2013

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

Look for us at the 5th National Biennial Conference on Adolescents and Adults with FASD (April 18-21, 2012) April 9, 2012

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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