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Many women who have FASD are able to benefit from tailored support on substance use problems. Audrey McFarlane, Executive Director of Lakeland Centre for FASD in Cold Lake AB recently shared strategies for working on FASD prevention with women who have FASD themselves. One of the LCFASD programs, the 2nd Floor Women’s Recovery Centre, provides residential treatment exclusively to women. She explained how programs can better support women who have FASD.

Challenges

Because of the possible neuro-behavioural and physical health issues associated with FASD, working with women living with FASD may pose particular challenges for the service provider due to:

  • Limited understanding of how their body works and how or why to use birth control;
  • Limited understanding of how to get housing, money and to keep themselves safe;
  • Physical health issues, such as diabetes, STDs, vision, hearing and dental;
  • Limited ability to envision the future;
  • Inability to link actions to consequences, which makes them more likely to be connected to the justice system and to have many children not in their care with multiple partners.

Strategies

McFarlane says that these and other challenges mean it often takes longer to see the benefits of supports. Yet, there are a number of strategies that have proven successful.

  • Take a family alcohol history and ask each woman, specifically, if she has a diagnosis of FASD. Woman will tell you if they do, but are often not even asked.
  • Make suggestions in key areas where they can agree or disagree rather than using client-generated approaches.
  • Prioritize building a relationship so that the woman will come back for support as needed. Reframe returning to treatment as a positive, not a negative.
  • Expect to spend more time on basic life skills and necessities. She may not have connection to family or social services. This means treatment needs to be longer.
  • Approaches that work best include solution-focused counselling, physical activities, positive touch, relaxation, and connections that develop a sense of belonging, like volunteering and cultural practices.

Resources

Here are a number of resources on trauma-informed and FASD-informed approaches for working with women living with FASD.

FASD Informed

2 Reports on Substance Using Women with FASD and FASD Prevention: Voices of Women and Perspectives of Providers, prepared by Deborah Rudman

Evaluation of FASD Prevention and FASD Support Programs website

FASD Informed Approach by Mary Mueller, RN, Waterloo Region Public Health and Emergency Services

FASD Informed Practice for Community Based Programs, College of New Caledonia

Working with Women Who May Have FASD Themselves – Webinar View SlidesRecording

Trauma Informed

Pregnancy, Alcohol, and Trauma-informed Practice, The Prevention Conversation

Trauma-informed Approaches to FASD Prevention – Webinar View SlidesRecording

Trauma-Informed Practice Resource List, Centre of Excellence for Women’s Health

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For more on this topic, see earlier posts:

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

NEW CURRICULUM FOR FASD INFORMED PRACTICE, August 1, 2016

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

FACT SHEET ON SUPPORTING WOMEN WITH FASD IN RESIDENTIAL SUBSTANCE ABUSE TREATMENT, April 22, 2013

TRAUMA MATTERS: GUIDELINES FOR TRAUMA‐INFORMED PRACTICES IN WOMEN’S SUBSTANCE USE SERVICES, April 17, 2013

 

ACEs_Original

Adverse childhood experiences (ACEs) is a term that describes potentially traumatic events that can have lasting negative effects on health and well-being. Research has shown a clear connection between ACEs on alcohol use and misuse in adults.

An emerging area of research also suggests that a history of childhood stressors, such as physical, sexual, and emotional abuse, may influence alcohol use among pregnant women.

In a recent study, researchers used data from the 2010 Nevada Behavioral Risk Factor Surveillance System to learn more about this relationship. They found a dose–response relationship between ACEs and alcohol use during pregnancy that remained even after controlling for pre-pregnancy drinking and other known factors that influence drinking during pregnancy.

This study contributes to a growing body of research demonstrating that factors affecting alcohol use during pregnancy begin long before pregnancy.

It also suggests the importance of initiatives and movements such as ‘trauma-informed’ practice and their application to FASD prevention. Learn more about trauma-informed practice, alcohol, and pregnancy use on the Coalescing on Women and Substance use website.

For more on this topic, see earlier blog posts:

5_preganancy

References

Astley, S.J., et al. (2000). Fetal Alcohol Syndrome (FAS) primary prevention through FAS Diagnosis: II. A comprehensive profile of 80 birth mothers of children with FAS. Alcohol and Alcoholism,  35(5): p. 509-519. [Free full text]

Choi, K.W., Abler, L.A., Watt, M.H., Eaton, L.A., Kalichman, S.C., Skinner, D., Pieterse, D., and Sikkema, K.J. (2014) Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences. BMC Pregnancy and Childbirth, 14: 97. [Free full text]

Chung, E. K., Nurmohamed, L., Mathew, L., Elo, I. T., Coyne, J. C., & Culhane, J. F. (2010). Risky health behaviors among mothers-to-be: The impact of adverse childhood experiences. Academic Pediatrics, 10(4): 245–251. [Free full text]

Frankenberger, D.J., Clements-Nolle, K., Yang, W. (2015). The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women. Women’s Health Issues (epub ahead of print). [Abstract]

Nelson, D. B., Uscher-Pines, L., Staples, S. R., & Ann Grisso, J. (2010). Childhood violence and behavioral effects among urban pregnant women. Journal of Women’s Health, 19(6): 1177–1183. [Abstract]

Skagerstrom, J., Chang, G., & Nilsen, P. (2011). Predictors of drinking during pregnancy: A systematic review. Journal of Women’s Health, 20(6):901–913. [Free full text]

FASDInformedPracticeFinalVersionSeptember9-2013_pdf

FASD informed practice can include:

  • An awareness that FASD (diagnosed and undiagnosed) is a reality for many individuals involved with a variety of community-based programs
  • A strong theoretical and practical understanding of the traits, characteristics, barriers, and needs of those affected by FASD
  • A willingness on the part of program staff, including administration, reception, and frontline workers, to participate in ongoing FASD education and training initiatives
  • Agency policies that accommodate the unique needs of individuals living with FASD in order to create a program that works for all participants
  • A respectful and individualized approach to service delivery that recognizes individual strengths

This guide from the College of New Caledonia is designed to assist programs in providing FASD-informed services and supports. The approaches discussed were developed from evidence-based research and from the practical experience of individuals working with women and their families who may be living with FASD.

The guide includes sections on promoting dialogue about alcohol and drug use during pregnancy, contraception, trauma-informed practice, effective group facilitation, strategies for individual support, and examples of exercises that can be used in group programming.

FASD Informed Practice for Community Based Programs can be downloaded from the College of New Caledonia website here.

For more about FASD-informed work at the College of New Caledonia, see an earlier posts:

 

 

Pages from trauma-matters-final

Over the past several years, the impacts of trauma and the interrelationships between trauma and women’s substance use have been well-identified by both research and clinical practice.

Recently, the Ontario Drug Treatment Funding Program Trauma and Substance Use project team released guidelines to support organizations that provide substance use treatment services for women. The guidelines are intended to help service providers understand the interconnections of trauma and substance use and to provide improved care for substance-involved women who have experienced trauma.

The guidelines identify six core principles for trauma‐informed practice: acknowledgment, safety, trustworthiness, choice and control, relational/collaborative approaches, and strengths-based empowerment.

The guidelines also take a look at trauma and its connection to mothering and family relationships. The authors comment:

“Substance-involved women who have experienced trauma may also be mothers, or be pregnant. Many have needs related to their mothering role when they seek help with their substance use concerns. For
these women, concerns about their children and their role as mothers can play a critical part in their recovery and be a powerful catalyst for change.

Hard data on substance use, mothering, and pregnancy are somewhat limited because many mothers fear negative or punitive consequences if they disclose their substance use concerns; however, research
indicates that up to 70% of women who attend substance use programs have children.

Although there are sensitive and caring mother-centered programs in Canada, “there are vast gaps in the availability and accessibility of these services, depending on the required level of care, parenting status,
and the severity of health and social problems.” “(p. 87)

Trauma Matters: Guidelines for trauma‐informed practices in women’s substance use services can be downloaded here as well as from the Jean Tweed Centre, the Evidence Exchange Network, and the Ontario Federation of Community Mental Health and Addiction Programs.

For more on women’s substance use and trauma, see Trauma-informed care for women in Canada (July 11, 2011).

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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