Video: Prevention of FASD: What do we know? Are we doing it?

This video looks at recent evidence on what works to prevent FASD. Policy and practice implications of this evidence are also discussed.

About this video

Production Date: September 26, 2013
Length: 1 hour, 48 minutes
Presenter: Nancy Poole
Download slide notes for this video (PDF, 6 pages)

Nancy is the Director of Research and Knowledge Translation for the BC Centre of Excellence for Women’s Health and the Provincial Research Consultant on Women and Substance Use Issues for BC Women’s Hospital. She is also the Network Action Team Lead on FASD Prevention for the CanFASD Research Network.

Nancy is well-known for her collaborative work on FASD prevention research, training and policy initiatives with governments and organizations on local, provincial, national and international levels. She has edited 2 books: ‘Becoming Trauma Informed’ (2012) and ‘Highs and Lows: Canadian Perspectives on Women and Substance Use’ (2007), both published by the Centre for Addiction and Mental Health in Ontario.

Debra Organ is a single parent with 18 years’ experience of raising a FASD child. She is a passionate and vocal advocate in all areas of FASD and has strong desire to ensure that all barriers be set aside to nurture Charlene’s success and happiness.

Outcomes

This video will help you understand:

  • recent evidence about what works to prevent FASD
  • the implications of the evidence for policy and practice
  • how programs are incorporating the current findings and producing more evidence

Content

  1. How has our understanding of FASD prevention changed over time? (5:26)
  2. Prevention Level 1: Awareness campaigns (10:49)
  3. Prevention Level 2: Identification and brief intervention (19:05)
  4. Prevention Level 3: Specialized support (37:28)
  5. Prevention Level 4: Parent-Child Assistance Program (57:40)
  6. Supportive alcohol policy (1:22:18)
  7. Conclusion (1:25:47)

How has our understanding of FASD prevention changed over time?

We used to think that it was as simple as not drinking alcohol during pregnancy. However, we now know that a number of the following factors are associated with alcohol use in pregnancy:

  • experience of interpersonal violence
  • depression
  • psychological distress
  • smoking
  • nutrition
  • ethno cultural status
  • aboriginal status, colonization
  • eating disorders
  • pregnancy intention
  • illicit substance use
  • pre-pregnancy drinking
  • attitudes toward drinking in pregnancy
  • awareness that one is pregnant
  • perception that small amounts of alcohol do not matter
  • rurality
  • partner type, sexual assertiveness
  • access to prenatal care
  • disadvantaged and stressed about money
  • lack of social support
  • sleeping problems

We now have a better understanding of the social, political, and economic factors that influence risk of having a child with FASD. We are shifting the focus and responsibility for FASD prevention away from individual women.

We now have a broader understanding of the ‘target’ of our interventions which includes:

  • pregnant women
  • women of childbearing age
  • women who have given birth to a child with FASD
  • partners
  • foster and adopted parents
  • service providers working in health and social service settings
  • policy makers/governments
  • researchers
  • citizens
  • communities
  • this shift results a new model of FASD prevention, which has four mutually reinforcing levels of prevention

Level 1: Awareness campaigns

  • development of health education materials (pamphlets, posters, alcohol warning labels)
  • awareness campaigns influence levels of awareness about prenatal alcohol exposure
  • they encourage information-seeking
  • they indicate what services are available and how to access them
  • the hope is to change behaviour
  • provides low risk drinking guidelines
  • makes available materials for facilitators of girls’ empowerment groups

Warning labels:

  • most effective when it’s easy for consumers to comply with warnings
  • pregnant women who are already light drinkers are influenced by warning messages about birth defects
  • but there’s no significant effect for heavy drinkers
  • we tend to become habituated to warning labels after years of exposure

Level 2: Identification and brief intervention

  • aimed at all women of childbearing years, their partners and support networks
  • health professionals who provide healthcare to women of childbearing age are positioned to deliver important information about health risks of alcohol, tobacco and other drugs
  • evidence shows that screening and brief interventions for alcohol misuse are successful and cost-effective in a variety of settings
  • there is evidence for the efficacy of a wide range of tools and interventions such as:
    • drink size and ‘alcohol literacy’
    • routine screening for all women
    • screening for polydrug use (such as alcohol and tobacco)
    • tools such as CAGE questionnaire, T-ACE (PDF, 1 page), TWEAK (PDF, 3 pages), TLFB (PDF, 5 pages)
    • web-and computer-based screening
    • telephone screening
    • medical school training
    • continuing education for health professionals

Challenges:

  • barriers for health and social service providers
  • resources needed
  • such as follow-up referral services and billing codes
  • women’s perspectives on screening
  • for example: aversion to admitting drug use and fear of legal consequences

Dual-focus model:

Preconception interventions:

  • Canada is lacking preconception initiatives
  • such as the ‘Show Your Love’ campaign in the USA
  • Motivational Interviewing (MI) techniques are successful
  • MI elicits ideas from women and youth about their ideas for change

Level 3: Specialized supports

  • we cannot take away the substance use before we address a range of other issues
  • development of specialized holistic support of pregnant woman with substance use problems and other health and social problems is crucial
  • in urban settings this support is often provided through combination of outreach and ‘one stop’ drop-in services
  • provided in smaller communities through a network of community-based services
  • it’s a challenge to connect everyone, to agree and to create a ‘net’ of support
  • multidisciplinary approaches are necessary, such as:
    • women’s health
    • prenatal, addictions
    • maternity care, housing
    • education and child health and welfare
  • the goal is to ‘wrap’ care around the mother-child unit

Specialized maternity care

  • care centres on the mother-child unit
  • shift from expectation that mothers adapt to existing systems to reorganization of providers
  • continuity of care between community and hospital
  • work to support child protection and enhance mothering capacity
  • respectful environment is key

Level 4: Parent-Child Assistance Program

Post-partum support for new mothers and their children helps to prevent the mother from having another child with FASD. This support also helps the mother create the best possible outcomes for her child.

Parent-Child Assistance Program (PCAP)

  • intensive 3-year one-on-one mentoring program for women who have given birth to a baby exposed to prenatal alcohol
  • addresses history of complex background factors, including:
    • trauma
    • childhood abuse
    • mental illness
    • violence
    • poverty
    • FASD
  • aim of the program is to prevent future alcohol and drug exposed births among high-risk mothers who have already delivered at least one exposed child

Supportive alcohol policy

We know that the more a behaviour increases in a population, the greater the number of individuals who will experience difficulties as a result of this behaviour.

Overall alcohol policy is vital to the success of FASD prevention, and can include:

  • marketing and advertising
  • screening, brief intervention and referrals
  • warning labels and signs
  • minimum pricing
  • community or municipal-driven alcohol policy

Conclusion

  • action at all levels is important
  • anyone person only works at one level, and no group or agency can be responsible for all levels
  • we all have a role to play in the whole: how do you link to other levels?
  • what is your role in supporting a woman?

Resources

Created:
Modified: 2015-09-09
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