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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

PCAP quilt squareParent-Child Assistance Programs (PCAP) are one important approach to FASD prevention in a number of provinces in Canada and the U.S. These programs use a relational, women-centred, strengths-based approach, which is proven to be effective in FASD prevention [1, 2].

As a visual way to express their experiences of mentorship within Alberta’s PCAP program, women came together in workshops across the province to create individual quilt squares for a larger quilt.

The finished quilt, pictured below, captures the hope, resilience, acceptance and connection that participation in the PCAP program has brought them and their children.

revisedapril4 quilt photoIMG_7064

Described as lively, creative, interactive and dynamic, the workshops were held in Calgary, Edmonton and several rural communities; women were supported by their mentors in getting to them. The workshops built connection between women as well as long-term relationships with their children and their mentors.

Developed and researched by Dorothy Badry, Kristin Bonot and Rhonda Delorme, a full description of the project is here.This is the second quilt project from Alberta’s PCAP program; the first quilt was made by mentors (read more about that project here).

To read earlier blogs about FASD primary prevention projects in Canada follow the links below:

The Mother-Child Study

H.E.R. Pregnancy Program

The Mothering Project

HerWay Home Program

FASD Prevention in Saskatchewan

Harm Reduction and Pregnancy

1. Thanh, N.X., et al., An economic evaluation of the parent-child assistance program for preventing fetal alcohol spectrum disorder in Alberta, Canada. Adm Policy Ment Health, 2015. 42(1): p. 10-8. View article link
2. Grant, T.M., et al., Preventing alcohol and drug exposed births in Washington state: Intervention findings from three parent-child assistance program sites. The American Journal of Drug and Alcohol Abuse, 2005. 31(3): p. 471-490. View PDF

'Family Caregivers Unite! I VoiceAmerica

University of Calgary professor and Canada FASD Research Network member, Dorothy Badry, was interviewed in December 2014 on the live talk radio program Family Caregivers Unite!

The one hour episode, hosted by Dr. Gordon Atherley, focused on the topic of “Developing Services for Canadians Living with FASD.”

Dr. Badry discusses her earlier PhD work,  ‘Becoming a Birth Mother of a Child with Fetal Alcohol Syndrome’, which reviewed the lives of 8 women aged 25 to 60 who gave birth to children diagnosed with FAS. She talks about her life, career, and her experience of family caregiving for close family members with serious health conditions.

Dr. Badry, drawing upon her experiences in the social work field, also discusses types of services provided for individuals with FASD and their families. She also touches on prevention issues such as increasing rates of binge drinking in youth, the Parent-Child Assistance Program, and the role of men in supporting women.

Dr. Badry is currently the co-chair of the Education and Training Council of the Alberta FASD Cross Ministry Committee and a member of the Prairie Child Welfare Consortium.

Listen to the interview here (via streaming, in iTunes or download the MP3).

One of her recent projects has been the development of the Caregiver Curriculum on FASD on the http://www.fasdchildwelfare.ca website.

Also check out this article on how Dr. Badry’s work is influencing work in indigenous communities in Australia: Canadian fetal alcohol programs inspire Australian researcher (November 26. 2014).

'Canadian fetal alcohol programs inspire Australian researcher I

 

 

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The Parent–Child Assistance Program (PCAP) began in 1991 at the University of Washington. It is an intensive three-year one-on-one mentoring program for women at high risk of having a child born with FASD.

The primary aim of the program is to prevent future alcohol and drug exposed pregnancies by encouraging the use of effective contraceptive use, by helping women abstain from or decrease their use of alcohol and drugs and by addressing the range of factors that contribute to women’s substance use, including poverty, isolation, and lack of parenting support. The program uses a home visiting/case management approach and is based on principles of harm reduction.

The model has been  replicated and evaluated across North America and has been found to be effective in a number of ways.

A recent study conducted an economic evaluation of the PCAP program in Alberta.  Between 2008 and 2011,  366 women participated in 25 P-CAP programs across the province.

The evaluation estimated that the program prevented approximately 31 (range 20–43) cases of FASD among the 366 clients in a 3-year period which resulted in a cost-benefit of approximately $22 million.

For more on the Parent-Child Assistance Program in Canada, see earlier posts:

References

Rasmussen, C., Kully-Martens, K., Denys, K., et al. (2012). The effectiveness of a community-based intervention program for women at-risk for giving birth to a child with fetal alcohol spectrum disorder (FASD). Community Mental Health Journal, 48, 12–21.

Thanh, N.X., Jonsson, E., Moffat, J., Dennett, L., Chuck, A.W., and Birchard, S. (2014).  An Economic Evaluation of the Parent-Child Assistance Program for Preventing Fetal Alcohol Spectrum Disorder in Alberta, Canada. Administration and Policy in Mental Health and Mental Health Services Research.

 

 

 

FASDposterLtr72

The Alberta Gaming and Liquor Commission (AGLC) has a new FASD poster campaign. The AGLC  website reports that the poster will be distributed through liquor stores, healthcare delivery sites, and key provincial stakeholders and describes the poster like this:

“The poster is bold and impactful as it was created to be eye-catching and to grab consumer attention. The message does not place blame nor create an unsupportive environment, but is a visual representation of the fact that choices related to alcohol and pregnancy do matter and can have severe consequences.”

While the poster is not intended to be unsupportive, it is reminiscent of smoking in pregnancy campaigns of the early 1980s. (For more on this issue, see earlier posts here and here). What do you think? Who is the intended audience and what is the poster trying to accomplish?

The Alberta Gaming and Liquor Commission is a member of the FASD Cross Ministry Committee. The FASD-CMC works in co-operation with provincial and community organizations and regional groups to provide a comprehensive and co-ordinated provincial response to FASD.

Denise Milne, Senior Manager in Alberta Health Services and lead of the Provincial FASD Initiative, recently gave an update on FASD prevention activities in Alberta which you can view here.

Denise mentions the development of an FASD Awareness and Prevention Council through the FASD Cross Ministry Committee. She also reports on evaluation findings from Alberta’s 24 mentoring programs (7 are First Nations) based on the Parent–Child Assistance Program (PCAP) (learn more about the PCAP model here). These programs work with about 250 women who are at-risk of having a child with FASD. Evaluation findings show that the program is effective in decreasing rates of welfare use and increasing employment and use of birth control.

For more on FASD prevention in Alberta, see earlier posts:

Ever wonder why some programs get funded and others don’t? Or why certain messages about FASD catch the public’s interest and other urgent issues are ignored?

History and politics are at the heart of the answers to these questions. I just read Irene Shankar‘s 2011 PhD dissertation Discourses of Fetal Alcohol Spectrum Disorder in Alberta where Shankar examines how FASD emerged and become recognized as a public health concern in Alberta in the late 1980s and early 1990s.

Her research draws upon interviews, archival research, and a review of policy and FASD program documents.

She reveals that FASD came to public attention in Alberta through the efforts of two social workers employed by the Ministry of Children and Youth Services. These two social workers worked with children in government care and they both noticed that some children were particularly hard to care for and, as a result, had a myriad of broken fostercare placements. They went looking for answers at a time when little was understood about FASD. As a result, in Alberta, FASD emerged and came to public attention as an issue of child health and welfare.

“They [elected officials and the public] make more noise about affected kids [than they do about adults] and …the reason that people got [all] excited about … this issue is because we saw hurt children. If it would have started with awareness of birth mothers, we would be nowhere. But we saw hurt children and we thought, ‘that’s bad, what can we do?’ ” (Interview quote, p. 72)

Shankar takes a look at how early understandings of FASD led to the development of certain programs and approaches to addressing FASD. (Some of the programs she discusses include First Steps, Coaching Families, and Step by Step.) She highlights how issues such as the invisibility of adults with FASD, the allocation of responsibility for FASD to women of reproductive age, and the racialization of FASD are remnants of the historical and socio-political discussions that brought FASD to public attention.

You can download Irene Shankar’s 2011 PhD dissertation Discourses of Fetal Alcohol Spectrum Disorder in Alberta from the University of Alberta here.

You can learn more about current government-funded FASD programs and services in Alberta by visiting the Fetal Alcohol Spectrum Disorder Cross Ministry Committee website (the FASD-CMC is comprised of nine provincial government ministries).

The term “cultural safety” is popping up in all sorts of fields these days, ranging from law to education to social policy. It’s also a term connected with a growing number of FASD support programs, such as the Alberta Parent-Child Assistance Program (PCAP) and the FASD Key Worker and Parent Support Program in British Columbia, which include cultural safety as part of the program framework.

So, what is cultural safety? Cultural safety is still a relatively new term in the Canadian context, but it first evolved out of nursing practice in New Zealand with regards to health care for Maori people. It was suggested that in order to provide quality care for people from different ethnicities and cultures that nurses needed to provide care within the cultural values and norms of the patient.

In Canada, the concept is often used to describe an approach to healthcare that recognizes the conditions that Aboriginal people experience today as a result of a history of colonization, residential schools, and other practices of cultural and social assimilation. This has resulted in a lack of trust and understanding between health care providers and patients and power imbalances that affect care and treatment. Culturally unsafe practices can be considered “any actions that diminish, demean, or disempower the cultural identity and well-being of an individual.”

Cultural safety can be a tool for understanding relationships between health care providers and patients, for analyzing organizational practices, and developing policies that support healing and self-determination.

When cultural safety does not exist, we see issues like the reluctance of individuals to visit mainstream health facilities even when services are needed (and a subsequent discussion by programmers about the “low utilization” of available services by Aboriginal people), inappropriate discussions about the “non-compliance” of individuals with referrals and recommendations, and feelings of fear, disrespect and alienation.

When we apply cultural safety to FASD prevention, we start to recognize things like how:

  • FASD is a medical diagnostic label based on a Western bio-medical model; FASD prevention interventions are based on this same bio-medical model of care
  • FASD continues to be described in mainstream media as a problem primarily in Aboriginal communities
  • Discussions of FASD often build on the historical ‘deficit’ view of Aboriginal people and, in particular, of Aboriginal women as ‘deficit’ mothers
  • The solutions to preventing FASD still continue to focus on addressing alcohol use during pregnancy and do not recognize the historical relationships between colonization, trauma, and alcohol use
  • FASD prevention frequently views alcohol use in pregnancy as an act by an individual women that must be targeted with various interventions (e.g., awareness campaigns and screening by health care providers) and ignores strategies that focus on families and communities (e.g., policies to redress residential schools or addictions programs that include a cultural component on intergenerational trauma)

There’s a growing number of resources on cultural safety available on-line. You can take a look at the resources below as well as the National Aboriginal Health Organization website and the National Native Addictions Partnership Foundation website.

 

References

Brascoupe, S. (2009). Cultural Safety:  Exploring the Applicability of the Concept of Cultural Safety to Aboriginal Health and Community Wellness.  The Journal of Aboriginal Health.  Ottawa: National Aboriginal Health Organization. Download free full-text here.

FASD Network Action Team on FASD Prevention from a Women’s Health Determinants Perspective. (2010). 10 Fundamental components of FASD prevention from a women’s health determinants perspective.

Gerlach, Alison J. (2012). A critical reflection on the concept of cultural safety. Canadian Journal of Occupational Therapy, 79(3): 151-158.

Indigenous Physicians Association of Canada and The Association of Faculties of Medicine of Canada.  (2009). First Nations, Inuit, Metis Health Core Competencies: A Curriculum Framework for Undergraduate Medical Education.

National Aboriginal Health Organization. (2008).  Cultural Competency and Safety: A Guide for Health Care Administrators, Providers and Educators. Ottawa, ON.

Tait, Caroline L. (2008) Ethical Programming Towards a Community-Centered Approach to Mental Health and Addiction Programming in Aboriginal communities. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 6(1), 29-60. Download free full-text from here.

Alberta FASD Learning Series 2012-2013 announced

For the past couple of years, the government of Alberta and partners have offered free online educational opportunities on FASD. The topics for 2012-2013 have just been announced.

The lectures are broadcast via live webcast (or you can attend in-person in Edmonton) and participants have the opportunity to interact with the presenter during a facilitated Q&A period.

If you’re interested in FASD  prevention, be sure to check out the webcast on October 24th on “Working with women who have addictions issues – Alberta Parent-Child Assistance Program (PCAP)“. (Learn more about PCAP in previous posts here and here).

You can also view previous sessions in the archives here, including talks on “What do we mean by trauma-informed care?“, “Understanding Substance Use Problems and Addictions in Women as Key to FASD Prevention,” and “Talking with Women about Alcohol and Pregnancy.”

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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