Developing an Indigenous Approach to FASD Prevention in BC’s Fraser Salish Region

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


Alberta Parent-Child Assistance Program Quilt

PCAP quilt

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 first PCAP programs in Alberta started in 1999 (two in Edmonton and one in Lethbridge). In 2013, there were over 20 programs across the province that provided PCAP services.


In 2013, the Alberta PCAP Council collaborated with the ACCERT Lab and Dr. Jacquie Pei from the University of Alberta on a qualitative research project to collect the experiences of PCAP mentors. This quilting project explored the experiences of 46 women and men working in FASD prevention programs across the province.

Each participant created a square that depicted the experience of working in a PCAP program. The final quilt is comprised of 55 unique squares, each one telling one part of the story of individuals and families affected by FASD and the work of PCAP mentors to help prevent FASD.

Read more about the making of the quilt in the Alberta FASD Cross-Ministry Committee’s 2011/2012 Annual Report  and in this article:

Job, J. M., Poth, C., Pei, J., Wyper, K., O’Riordan, T., and Taylor, L. (2014). Combining visual methods with focus groups: An innovative approach for capturing the multifaceted and complex work experiences of Fetal Alcohol Spectrum Disorder prevention specialists. The International Journal of Alcohol and Drug Research, 3(1), 71-80. (Open Access)

The quilt is “on tour” – find out where you can see the quilt by following the Alberta PCAP Council Facebook page.


Learn more about the Alberta PCAP programs here.

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


Tracing the History of FASD in Alberta

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).

Cultural Safety and FASD Prevention

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.



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.

Webcast: Working with women who have addictions issues, Alberta Parent-Child Assistance Program (PCAP), October 24, 2012, 9-11 am

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.”