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This September 9th marks 19 years since the first International FASD Awareness Day. Building awareness is multi-faceted and, for long-time advocates of FASD prevention, it can seem that we take two steps forward and one step back.

We asked four members of our Network Action Team on FASD Prevention (pNAT) to reflect on the work they have done over the years in their community of Victoria, BC. They bring perspectives on how practice approaches, policy and research intersect to build effective FASD prevention efforts within the larger goal of supporting the health of women and families in general.

Many people, including health professionals, believe that there is a greater negative impact from opioid exposure rather than alcohol exposure. The current opioid crisis provides us with a unique opportunity for FASD prevention.
Lenora Marcellus — Associate Professor of Nursing, University of Victoria

I have had the opportunity over many years to work with Neonatal Intensive Care Unit teams related to supporting infants experiencing withdrawal from opioids. This issue has actually continued to grow related to the prescription opioid epidemic and fentanyl crisis that is impacting many communities, including here in British Columbia where the Provincial Medical Health Officer declared a public health emergency in 2016 in response to the rise in drug overdoses and deaths. What continues to surprise me in this work is how the issue of prenatal alcohol exposure rarely, if ever, comes into the conversation. Many people, including health professionals, believe that there is a greater negative impact from opioid exposure rather than alcohol exposure. The current opioid crisis provides us with a unique opportunity for FASD prevention . The strategies for supporting women during pregnancy, many developed by members of the pNAT, have been demonstrated in research to be effective, no matter the substance. I encourage you to partner with women, advocates and professionals in your community to highlight the importance of FASD prevention within the many conversations that are taking place about opioid use during pregnancy across Canada and beyond.

The proof is in – these kinds of wraparound programs that join a FASD-informed approach, with being culturally safe, trauma-informed and women-centred are successful and make a significant difference.
Amanda Seymour – Programming and Practice – Coordinator, HerWay Home

HerWay Home’s 5th Anniversary was earlier this year and I’ve been reflecting on how far the program has come since the visioning and advocacy done by community members leading to its opening in 2013. We have had the privilege of working with over 220 women and being allowed into their lives and that of their families. We have seen the impressive strides and successes the women have made and witnessed their love for and connection with their children. I’ve also reflected on how much more society needs to do. To prevent FASD along with the myriad harms from substance use and ongoing violence and trauma, we must address all the social determinants of health. Women report a positive change in their lives due to their connection with other women in the program, the support, trust and respect they receive from staff and the access to practical supports, health care and counselling. When I look forward to the next 5-10 years I would like to see programs like this one be available in many communities on Vancouver Island where I live, across BC and across Canada. The proof is in – these kinds of wraparound programs that join a FASD-informed approach, with being culturally safe, trauma-informed and women-centred are successful and make a significant difference. Women are able to reduce or abstain from substance use, improve their mental health and keep their children or see them returned to their care when they receive non-judgemental, harm reduction supports and tangible, practical help.

[We now have] … a set of Evaluation Maps to provide guidance and tools for developing, implementing and evaluating FASD-related programs (www.fasd-evaluation.ca).
Deborah Rutman – Principal and Co-Founder, Nota Bene Consulting Group & Adjunct Associate Professor, School of Social Work, University of Victoria

As a researcher and program evaluator, I feel immensely privileged to be able to learn about and report on the incredible work undertaken by staff at diverse FASD prevention programs and to hear women’s stories and experiences, including about what a tremendous difference these wrap-around programs such as HerWay Home make to women and their families. For me, one of the exciting opportunities – and one of the challenges – of evaluating FASD prevention programs is depicting the complexities associated with FASD and FASD-related programming: complexities in terms of the inter-related issues that women and families struggle with; complexities in terms of the range of services and program activities that matter to women; and complexities in terms of the myriad program outcomes that, as evaluators, it is important to document, including: women feeling safe and not judged; women having improved basic needs support, nutrition and safe housing; healthy births; reduced child welfare involvement; increased mother-child connection; abstinence/reduced or safer substance use; and women’s sense of connection and hope. Several years ago, our Nota Bene team, partnering with Nancy and with lots of input from pNAT members, developed a set of Evaluation Maps to provide guidance and tools for developing, implementing and evaluating FASD-related programs. Currently, with funding from the Public Health Agency of Canada and in partnership with eight inspiring programs across the country, our team is undertaking the Co-Creating Evidence study: a ‘first in Canada’ national evaluation of wrap-around programs that work with pregnant or recently parenting women with substance use and other complex issues. We have just completed our first round of data collection at all eight sites and we look forward to sharing our findings with NAT members – and beyond – in the coming months.

It so gratifying that for a decade now, we in Canada have been able to meet virtually in this pNAT to share ideas and identify ways to collaborate on research, practice and policy related to alcohol and FASD prevention.
Nancy Poole – Researcher and Knowledge Translation – Director, Centre of Excellence for Women’s Health

Every time International FASD Day comes around, I think both of the tremendous work people are doing on FASD prevention and how much there still is to do. I am so lucky to have colleagues like Lenora, Deborah and Amanda who are committed to FASD prevention in my own city! We get together over dinner fairly regularly to talk about how our work fits together, and how we can actively work together in various combinations to advance FASD prevention research, practice and policy. In particular, we have been able to lend lots of support to the establishment and ongoing enhancement of programming at HerWay Home. Amanda, Deborah and Lenora have also been core members in our national work on FASD prevention where we link and advance the work on research, evaluation, practice and policy through the Network Action Team on FASD Prevention (pNAT) that is funded by the CanFASD Research Network. It so gratifying that for a decade now, we in Canada have been able to meet virtually in this pNAT to share ideas and identify ways to collaborate on research, practice and policy related to alcohol and FASD prevention .

A newly published book entitled Mothers, Addiction and Recovery underscores the value of focusing on maternal identity and meaning for supporting women with children through addiction and recovery. By bringing together the voices of women with lived experiences, as well as program practitioners, policy makers, and researchers from across Canada, the editors illustrate the gendered nature of addictions (including gambling, food and smartphones) and the value of harm reduction and holistic approaches to healing and recovery.

Members of this Prevention Network Action Team contributed articles to the book. In “Mothering and Mentoring: The PCAP Women’s Quilt”, Dorothy Badry, Kristin Bonot, and Rhonda Nelson describe the quilt project undertaken by mentors and program participants from the Parent Child Assistance Program (PCAP) project in Alberta. Named “Woven Together”, the quilt is a visual expression of the powerful relationship ties that the women and mentors created together. As well, the article offers a historical perspective on FASD and FASD prevention efforts.

In a chapter entitled “Beyond Abstinence: Harm Reduction during Pregnancy and Early Parenting” Lenora Marcellus, Nancy Poole, and Natalie Hemsing reflect on the historical concern around substance use during pregnancy and how important it is, now, to bring a gendered and harm reduction orientation to our responses. They conclude that, regardless of the substances used, harm reduction approaches address the complex life circumstances of women, such as culture, trauma, connection to children, and practical socio-economic realities. They describe emerging and established programs that use harm-reduction and trauma-informed approaches in order to provide tailored systems of care that are non-punitive, responsive and effective for women and families. Many of these programs have been featured in this blog (see below).

This book is published by Demeter Press and features many other articles that address the experience of mothering within the context of addictions. Although the voices of women with lived experiences are included in part, the editors, Wendy E. Peterson, Laura Lynn Armstrong, and Michelle A. Foulkes, regretfully acknowledge that the book is missing the unique perspectives of Indigenous women.

For related information, see these earlier posts:

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

TARGETING STIGMA AND FASD IN MANITOBA June 26, 2017

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

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

ALBERTA’S PCAP WOMEN’S QUILT: “CREATING A BOND . . . BUILDING A RELATIONSHIP” April 22, 2016

WEBINAR JUNE 23 – WORKING WITH PREGNANT AND PARENTING WOMEN: LEARNINGS FROM HERWAY HOME June 16, 2016

HARM REDUCTION AND PREGNANCY: COMMUNITY-BASED APPROACHES TO PRENATAL SUBSTANCE USE IN WESTERN CANADA February 26, 2015

THE MOTHER-CHILD STUDY: EVALUATING TREATMENTS FOR SUBSTANCE-USING WOMEN March 18, 2015

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

FASD PREVENTION AND SOCIAL DETERMINANTS OF WOMEN’S HEALTH: ASSESSING THE EVIDENCE March 5, 2012

 

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

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 http://fluidsurveys.com/s/A-Learning-Series-3

5_preganancy

Webinar2-UpdatedResources_May82014

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

FPCFR

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.

vimeo_com_76911578

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:

References

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

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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