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

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.

Impact Evaluation Findings from Project Choices in Manitoba

Project CHOICES is a program in Winnipeg, Manitoba, that works with girls and women of any age who are not currently pregnant, drink alcohol, and are sexually active. The goal of the program is to reduce the risk of an alcohol-exposed pregnancy through choosing healthy behaviours around alcohol and birth control use.

This infographic summarizes changes for participants three months after completing the program.

Project CHOICES is based on motivational interviewing which is a counseling approach that is respectful, non-judgmental and client-centred. Motivational interviewing allows health care providers and clients to explore possible areas of change, discuss strategies that make sense for the client and their life circumstances, and provides encouragement and support.

The program considers three different routes to reducing the risk of an alcohol-exposed pregnancy: (1) reducing alcohol use (2) using effective contraception (3) reducing alcohol use and using effective contraception.

Learn more about the evaluation from Healthy Child Manitoba. Check out the program website to learn more about the program, how to make a referral, and for resources on alcohol, pregnancy and birth control.

The Prevention Conversation Project – Free Webcast on January 21, 2015 (Alberta FASD Learning Series)

The Alberta FASD Learning Series helps individuals with FASD and their caregivers to learn more about FASD and how to support a person with FASD. The webcast and videoconference educational sessions cover a broad range of topics that target both urban and rural audiences.

On January 21, 2015 (9-11am), the topic in the series will be The Prevention Conversation Project. The aim of this project is to support open and non-judgemental conversations with women and their support systems about alcohol and pregnancy.

For registration information and more information about the learning series, visit the Alberta FASD website here.

Learn more about The Prevention Conversation on the Edmonton and area Fetal Alcohol Network Society website here.

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.

Native American Motivational Interviewing: Weaving Native American and Western Practices

Manual for Counselors in Native American Communities

Motivational Interviewing was developed by William R. Miller, PhD and Stephen Rollnick, PhD. It is a client-centred counselling approach that seeks to enhance an individual’s capacity to change.

It was originally developed as an approach for addressing problem drinking, but has been shown to effective in addressing change in a range of substance use and health-related areas. Motivational interviewing is often a key approach in many FASD prevention interventions.

Native American Motivational Interviewing: Weaving Native American and Western Practices is a resource that focuses on using motivational interviewing with Native American clients struggling with alcohol abuse or dependence. It can also be helpful for anyone who is just learning to use motivational interviewing approaches and is designed for counselors of any ethnic background.

The manual can be downloaded from the Motivational Interviewing website here or the Center on Alcoholism, Substance Abuse and Addictions website here.

For more on motivational interviewing, see an earlier post: Brief Interventions to Decrease Alcohol Misuse in Women  (November 26, 2013).

 

Free Webinar: Updated resources on women and alcohol: Applying research to practice – May 8, 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.

The second in this series of webinars will introduce a newly updated resource by the BC government and discuss the latest research on women and alcohol, including issues such  stroke, heart disease and cancer.

Thursday, May 8 , 2014
9:00 – 10:00 am (PDT)
Presenters: Nancy Poole, Tasnim Nathoo, Teresa Chiesa, Cristine Urquhart, Frances Jasiura

To register, visit http://fluidsurveys.com/s/A-Learning-Series-2/

 

Free Webinar: Preventing Alcohol-Exposed Pregnancies with Women who May Have FASD Themselves – March 28 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.

Starting this week, a series of webinars will be offered to follow-up on key ideas introduced in the training sessions as well as new issues and topics. The first webinar is on working with women who have FASD themselves.

Friday, March 28 , 2014
9:00 – 10:00 am (PST)
Presenters: Anne Guarasci, Rita Marshall, Deborah Rutman, Hanna Scrivens, Arlene White

To register, please go to: http://fluidsurveys.com/s/A_Learning_Series/

 

Handbook for Aboriginal Alcohol and Drug Work from Australia

“The Handbook for Aboriginal Alcohol and Drug Work is a practical tool written for Aboriginal drug and alcohol workers, mental health workers and others working in this field. It offers a detailed look at alcohol and drug work from clinical, through to prevention, early intervention and harm reduction. This handbook is also likely to help people working to improve policy and those advocating for change.

The idea for it came from workers all over Australia. They told us that they needed an easy to use handbook that can help them respond to the range of alcohol and drug issues they face every day. They also told us that such a book needs to take into account the complex challenges facing workers when helping clients, their families and, sometimes, whole communities.”

This plain language, evidence-based guide was created in partnership between the University of Sydney and Aboriginal and non-Aboriginal agencies and health professionals. Four of the six editors are Aboriginal.

It covers alcohol and drug use as well as a whole range of other issues, including child protection notifications, legal issues, working with clients without housing, mental health and polydrug use, and community-wide approaches.

Chapter 2 focuses on alcohol and Chapter 16 focuses on Special situations, settings, and groups, including pregnancy, breastfeeding and early childhood. It discusses the use of brief intervention and counselling approaches in the context of alcohol and pregnancy. It also has sections covering Neonatal Abstinence Syndrome, Alcohol use in pregnancy and Foetal Alcohol Spectrum Disorders.

The handbook was first distributed to alcohol and drug professionals from around Australia at the National Indigenous Drug and Alcohol Conference in Western Australia in June 2012.

The project started in 2010 with a grant from the Foundation for Alcohol Research and Education (FARE) and continued with the support of the NSW Ministry of Health.

The handbook is available online.

Alcohol Screening, Brief Intervention and Referral: Helping Patients Reduce Alcohol-related Risks and Harms resource

Alcohol Screening, Brief Intervention and Referral: Helping Patients Reduce Alcohol-related Risks and Harms is a resource for Canadian family physicians, nurse practitioners and other healthcare professionals developed by the College of Family Physicians of Canada and the Canadian Centre on Substance Abuse.

The online resource, available in both English and French, uses a three-step alcohol screening, brief intervention, and referral process. The resource section includes information on seven sub-populations, including women, alcohol and pregnancy, and alcohol and breastfeeding.

Research evidence supports screening and brief interventions for alcohol misuse as efficacious and cost-effective in a variety of settings.

There are a range of screening tools out there (see posts listed below for more); this resource incorporates Canada’s Low-Risk Alcohol Drinking Guidelines which were released in November 2011.

For more on screening in primary care settings, see previous posts:

• FASD Prevention in Sweden (June 4, 2012)
• “No Alcohol, No Risk” Film for Midwives (May 22, 2012)
• Women and alcohol resources from the American College of Obstetricians and Gynecologists (ACOG) (March 29, 2012)
• Addiction Toolkit: Alcohol Use in Pregnancy (September 26, 2011)
• Targeting Health Professionals in Western Australia (February 9, 2011)
• Ask, Advise, Assist – new guide for health professionals published by New Zealand Ministry of Health (September 15, 2010)
• SOGC releases new clinical guidelines on alcohol use and pregnancy (August 12, 2010)