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Brief Interventions

Indigenous Mothering


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:





September 1, 2010

HerWay Home in Victoria, BC is organizing a community conference and networking event for September 29, 2014.

HerWay Home is a child-focused, women-centred, family-oriented drop-in and outreach program for pregnant women and new moms with substance use challenges and their children (learn more in the video above).

When: Monday September 29, 2014

Where:  DaVinci Centre, 195 Bay Street, Victoria

Time:  09:00 – 4:00

Cost: Free to those attendees from Vancouver Island. A minimal charge of $50 to attendees from off the island.

This one-day workshop will provide participants with the opportunity to learn more about the issue of substance use during pregnancy and early parenting and hear from interdisciplinary service providers working in Victoria and other communities in integrated maternity care programs.

Speakers will include program participants, Betty Poag (public health nurse, Vancouver Island Health), Ron Abrahams (Sheway and Fir Square), Nancy Poole (BC Centre of Excellence for Women’s Health), Yvette Ringhamcowan  (Island Health Cultural Safety Facilitator) and more!

View the conference brochure here.

Program and Registration Information now available

Living Well home page

The Living Well: FASD and Mental Health conference will be held November 5-7, 2014 in Winnipeg, Manitoba. The conference is an initiative of the Canada Northwest FASD Partnership Conference and hosted by Healthy Child Manitoba.

The Living Well: FASD and Mental Health conference will delve into the interconnection between mental health and Fetal Alcohol Spectrum Disorder spanning the areas of prevention, intervention, support, evaluation and research. This multidisciplinary event will cover topics such as how individuals with FASD and mental health concerns can be better understood and supported, how caregivers can support their mental health and how mental health concerns influence FASD prevention work.

Keynote Presentations include:

  • Dan Dubovsky — Working with Individuals Living with FASD and Mental Health Concerns: Best and Promising Practices
  • Nancy Poole — Working with Pregnant Women with Mental Health and Substance Use Concerns: Best and Promising Practices
  • Dr. Ana Hanlon-Dearman — FASD Diagnosis: Mental Health Considerations
  • Dr. Mansfield Mela — FASD and Mental Health Disorders: Exclusive or Mosaic?
  • Brenda Knight — Responding to the Complex Issues of Families Living with FASD
  • Momenta and the FASD Family Network — Feeling Success: The Camp Experience

Some of the workshops included in the program are:

  • FASD Assessments: From the Clinic to the Court Room — Jonathan Rudin and Panel
  • Evaluation: What’s All the Fuss About? — Jacquie Pei and Panel
  • We’ve Only Just Begun: Advances in FASD Prevention — Nancy Poole and Colleen Dell

Visit the conference website here. View the full program here.

Learning Series Flyer 3c

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.

Current or past experiences of trauma and violence can be a major reason why women continue to drink alcohol during pregnancy. The third webinar in this series will examine trauma-informed approaches to FASD prevention. (For more on alcohol, pregnancy and trauma-informed practice, check out this section of the Coalescing on Women and Substance use website)

Thursday, June 12, 2014
9:00 – 10:00 am (PDT)
Presenters: Nancy Poole, Cristine Urquhart, Frances Jasiura

To register, visit



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.

Pages from 93611 BCWA Booklet proof


The First Peoples Child & Family Review is a Canadian journal dedicated to interdisciplinary research honouring the voices, perspectives and knowledges of First Peoples through research, critical analyses, stories, standpoints and media reviews.

The Fall 2013 issue focuses specifically on FASD. Dorothy Badry and Tara Hanson describe the importance of this focus in the introduction:

“This special edition of The First Peoples Child & Family Review explores the social issue of Fetal Alcohol Spectrum Disorder (FASD) from the perspectives, experiences and needs of Aboriginal peoples. It recognizes that the context of FASD in Aboriginal communities is unique, and cannot be properly acknowledged or addressed through generalized studies and services.

As the articles in this edition illustrate, the issue and experience of Aboriginal peoples and FASD must be understood within the context of colonization and its intergenerational impacts. Without this critical lens, research findings and service recommendations may be inappropriate to Aboriginal families or communities. Mainstream programs developed from a Euro-Western perspective may conflict with Aboriginal worldviews.

The articles in this edition portray the human experience of struggles with alcohol, the role of history and trauma in adverse life outcomes as well as the existence of socioeconomic disparities. Experiences with child welfare and legal systems are chronicled, disruptions, difficulties and repercussive impacts of secondary disabilities. Along with the adversities, however, are powerful themes of hope, healing, promising practices, capabilities, and strength found through caring relationships.” (p. 5)

Several articles focus on FASD prevention and tackle topics such as developing community programs for pregnant and early parenting women who use alcohol and other substances that operate from an Indigenous knowledge framework, FASD prevention with women who have FASD themselves, and insights from workers in a home visitation program for women with a history of alcohol and drug abuse.

Many people continue to mistakenly believe that FASD is primarily an Indigenous issue (this is definitely not the case – FASD is an issue wherever women drink alcohol during pregnancy). It is true, though, that many Indigenous communities have been working to address FASD and related social concerns for longer than many non-Indigenous communities – this special issue highlights some of the leadership and innovation that many communities have taken in the past few years.

View the table of contents and download free full-text for all the articles here.


Video on Legal Issues and FASD Prevention now available

Legal Measures to Prevent FASD

In September 2013, the Institute of Health Economics (IHE) held the first-ever Consensus Development Conference on Legal Issues of FASD in Edmonton, Alberta.

The three-day conference examined issues such as:

  • What are the implications of FASD for the legal system?
  • Is there a need for enhanced efforts to identify people with FASD and how can these efforts be achieved?
  • How can the criminal justice system respond more effectively to those with FASD?
  • How can family courts and the family/child welfare legal system address the specific needs of people with FASD?
  • What are the best practices for guardianship, trusteeship and social support in a legal context?
  • What legal measures are there in different jurisdictions to contribute to the prevention of FASD and what are the ethical and economic implications of these measures?

Nancy Poole, Director of Research and Knowledge Translation at the British Columbia Centre of Excellence for Women’s Health and FASD Prevention Team Lead with the Canada FASD Research Network, gave a fantastic 30 minute presentation called “Legal measures to contribute to prevention of FASD, effectiveness and ethical issues. Some of the issues that she addresses are:

  • Alcohol and pregnancy warning labels
  • Measures to ban selling or serving alcohol to pregnant women
  • Interventions targeted at pregnant women with addictions
  • Measures related to contraception, and
  • Compulsory testing of pregnant women for alcohol

Some of the issues discussed following the presentation included the importance of alcohol brief interventions by health care providers, involving men in FASD prevention, subsidizing long-acting contraception, targeted vs. universal interventions, the relationship between women’s empowerment and successful FASD prevention, and the broader context of alcohol consumption in society.


Some of the themes from this presentation can be found in the Consensus Statement developed following the conference.

The 2013 Consensus Statement on Legal Issues of Fetal Alcohol Spectrum Disorder (FASD) was produced by a distinguished jury led by the Honourable Ian Binnie, former Justice of the Supreme Court of Canada, and includes a range of recommendations calling for changes to the way people with FASD are dealt with by the legal system in Canada. Recommendations related to FASD prevention (p. 35) included:

59. Develop a comprehensive FASD prevention strategy for Canada.

60. Develop gender-specific programs and create opportunities for women and men to discuss with their health care provider relationship issues, child care, and alcohol consumption.

61. Prevention programs should focus on those areas in which positive effects have been demonstrated. In particular, it may be worthwhile to examine interventions involving the mother-child unit. Such approaches might help reduce the likelihood of subsequent children with FASD after a child is found to suffer from an intellectual impairment or neurological disorder such as FASD.

62. Develop evidence-based mandatory training programs for front-line workers on how to talk to women in a secure, non-threatening fashion about the underlying causes of alcohol consumption

Videos from the entire conference are available for viewing on the IHE website here.

FASD prevention can be approached from many levels. For example, Poole (2008) discusses four levels of FASD prevention:

Level 1 – Broad awareness building, health promotion efforts, and public policy
Level 2 – Brief Counselling with Girls and Women of Childbearing Age
Level 3 – Specialized Prenatal Support
Level 4 – Postpartum Support

Levels of FASD Prevention_Poole 2008

Level 2 focuses on ensuring girls and women of childbearing years have the opportunity for safe discussion about reproductive health, contraception, pregnancy, alcohol use, and related issues, with their support networks and healthcare providers.

Overall, research evidence supports screening and brief interventions for alcohol misuse as efficacious and cost-effective in a variety of settings. While there are many variations in “brief intervention” approaches, most are grounded in social-cognitive theory and commonly incorporate elements of motivational interviewing. Brief interventions often provide feedback on alcohol use (e.g., is it considered “risky”?), information on the effects and possible consequences of alcohol use, and discussion of possible strategies to moderate or reduce alcohol use.

A recent systematic review by Gebara et al (2013) specifically examines brief interventions to reduce at-risk drinking in women, including studies related to alcohol use during pregnancy. They found that many types of brief interventions could be effective for women, e.g., face-to-face or by computer or telephone, and resulted in changes in both in the number of days of consumption and in the number of doses, or both.

For more on this topic, see earlier posts:


Gebara, C., Bhona, F., Ronzani, T., Lourenço, L. and Noto, A. (2013). Brief intervention and decrease of alcohol consumption among women: a systematic review. Substance Abuse Treatment, Prevention, and Policy, 8: 31  doi:10.1186/1747-597X-8-31

Poole, N. (2008). Fetal Alcohol Spectrum Disorder (FASD) Prevention: Canadian Perspectives. Ottawa, ON: Public Health Agency of Canada

IJCH cover

The International Journal of Circumpolar Health is a multidisciplinary journal that specializes in Arctic and Antarctic health issues, with a particular interest in the health of indigenous peoples.

The journal has just published a special supplement (Supplement 1, 2013) which includes 100 full length papers, 90 extended abstracts and nearly 100 short abstracts from the 15th International Congress on Circumpolar Health held in August 2012.

This issue has a number of full length and brief papers related to FASD, women’s addictions, and indigenous health. Here are some of the papers you might be interested in taking a look at:

Perceptions of needs regarding FASD across the province of British Columbia, Canada – Anne George, Cindy Hardy, Erica Clark (p. 91)

This study describes the perceived needs for services for people affected by FASD in rural and urban British Columbia.

Prenatal alcohol exposure among Alaska Native/American Indian infants – Burhan A. Khan, Renee F. Robinson, Julia J. Smith, Denise A. Dillard (p. 147)

A survey which found that rates of prenatal alcohol use are primarily limited to pre-conception and the 1st trimester, with a dramatic decrease in the 2nd and 3rd trimesters.

An examination of the social determinants of health as factors related to health, healing and prevention of foetal alcohol spectrum disorder in a northern context – the Brightening Our Home Fires Project, Northwest Territories, Canada – Dorothy Badry, Aileen Wight Felske (p. 169)

An exploratory study of the issue of the prevention of FASD from a women’s health perspective in the Northwest Territories of Canada.

Resituating the ethical gaze: government morality and the local worlds of impoverished Indigenous women – Caroline L. Tait (p. 200)

Drawing from a project documenting 100 life histories of Indigenous women with addictions and who have involvement with the child welfare system, as children or adults, this paper explores the influence of government policies and programs in Canada on recovery and healing.

Coordinating foetal alcohol syndrome interventions in Alaska – Kris Broom, Wendy Getchell, Chantelle Hardy, Garrett Hartley and Jessica Olson (p. 241)

A review of current Alaska FAS policies and interventions.

The healing constellation: a framework for understanding and treating trauma in Alaska Native women – Wendy H. Arundale (p. 243)

Connecting theory, research, and treatment approaches, a look at indigenous women’s substance use in relation to mental health, intergenerational trauma and other factors.

Community-driven alcohol policy and foetal alcohol spectrum disorder prevention: implications for Canada’s North? – Nancy Poole, Tasnim Nathoo and Arlene Hache (p. 250)

An exploration of the potentially important role of alcohol policy in northern communities in influencing alcohol use in pregnancy and risk of FASD.

The full publication is freely available for download here.

For more on FASD prevention in northern regions, see earlier posts:

A resource developed as part of the Healthy Choices in Pregnancy initiative.

A resource developed as part of the Healthy Choices in Pregnancy initiative.

Nancy Poole and Lorraine Greaves have a short commentary in the March/April issue of the Canadian Journal of Public Health on the Healthy Choices in Pregnancy Program developed in British Columbia as part of the ActNow Initiative that led up to the Olympics in 2010. The article is an interesting case study on building support for FASD prevention work at the level of government and looking at system-level strategies for increasing awareness of FASD.

In 2003, the Canadian province of British Columbia won the bid to host the 2010 Winter Olympic and Paralympic Games. The government of the day saw this achievement as a window of opportunity to establish a health promotion legacy.

In 2005, the BC government launched ActNowBC, a intersectoral initiative that integrated activities across government with civil society initiatives to achieve five health promotion targets by 2010. Among its several components and streams, ActNow had a focus on the reduction of alcohol (and tobacco) use during pregnancy called Healthy Choices in Pregnancy (HCIP).


The Healthy Choices in Pregnancy initiative took a unique approach to addressing alcohol use during pregnancy by focusing on helping healthcare and social service practitioners to change the ways in which they engage with women. Rather than focusing on the development and dissemination of information about the risks of alcohol use in pregnancy targeted at women directly, the program aimed its resources at providers.

This approach was intended to relieve the burden of change from individuals and allowed women—who are often highly stigmatized for drinking and smoking when pregnant—to experience health care and social service systems as welcoming and helpful.

Collaboration across a range of groups, professions and services was encouraged. Researchers, health system planners, service providers, policy-makers, and women themselves worked collaboratively on the initiative. In shifting from individual to systemic change, the program created a shift in attitude and focus from blaming individual women for drinking during pregnancy, to creating systemic change and action based on effective and supportive approaches to reducing alcohol use during pregnancy.


Poole, N. and Greaves, L. (2013). Alcohol Use During Pregnancy in Canada: How Policy Moments Can Create Opportunities for Promoting Women’s Health. Canadian Journal of Public Health, 104(2): e170-e172.

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD