Centre of Excellence for Women’s Health: Dialogue to Action on Discussing Alcohol with Women Project

With funding from the Public Health Agency of Canada and the FASD National Strategic Project Fund, the Dialogue in Action project is bringing a range of resources to support those working with women in the preconception period and during pregnancy.

The resources stress the valuable role played by service providers across a range of health care and social services settings in addressing the potential harms of substance use and improving overall health. The resources focus on the ‘brief interventions’ model: “brief interventions are collaborative conversations between an individual and a health care or social service provider about a health issue such as substance use, mental wellness, contraception, or experiences of violence and trauma. Brief interventions may be formal or informal, structured or unstructured, short or long, a one-time event, or a series of conversations over a period of time”.

Dialogue to Action Project Resources include:

Doorways to Conversation: Brief Intervention on Substance Use with Girls and Women
English version

Section 1: includes an introduction to the Dialogue + Action: Women and Substance Use project and the context for brief substance use interventions in Canada.
Section 2: discusses opportunities and barriers to brief interventions by profession, the relevance of different practice approaches and models of care, and factors that can contribute to the success of brief interventions.
Section 3: describes approaches for working with girls and women in contexts ranging from primary care to sexual health services to anti-violence services. It includes 50 ideas for starting conversations with girls and women about substance use that can be adapted to the roles of various service providers, available resources and time, and the concerns and interests of girls and women. Sections that include ideas for brief intervention are marked with a red tab.
Section 4: examines system-level policies and practices that can limit or enhance the effectiveness of brief interventions at the clinical level, including child welfare reporting practices, perinatal data collection, and the use of biological screening.
Section 5: summarizes current and promising approaches to brief interventions with girls and women in the preconception and perinatal period.
The Appendix: includes four fact sheets on the health effects of alcohol, tobacco, cannabis, and prescription opioids for women.

50 Brief Intervention Ideas for Dialogue, Skill Building, and Empowerment
English version

This resource, extracted from the larger document above, focuses on brief intervention on substance use with girls and women in the preconception and perinatal period. Whilst the conversation starters can be used in various situations, they are grouped here under the headings of Primary Care; Preconception Care; Prenatal Care; Sexual Health; Anti-Violence Services; Girls and Young Women; and Women and their Partners. The fifty issues addressed are:

Primary Care: Alcohol, tobacco, and breast cancer
Primary Care: Alcohol, depression, and antidepressants
Primary Care: Alcohol and sleep
Primary Care: Alcohol and heart health
Primary Care: Tobacco and anxiety
Primary Care: Tobacco and bone health
Primary Care: Medical cannabis and women’s health
Primary Care: Alcohol, prescription opioids, and prescription sedatives
Primary Care: Substance use and asthma
Primary Care: Substance use and nutrition
Preconception Care: Healthy eating
Preconception Care: Substance use and fertility
Preconception Care: Alcohol and pregnancy planning
Preconception Care: Quit smoking with a partner
Prenatal Care: Tobacco and harm reduction during pregnancy
Prenatal Care: Cannabis and ‘morning sickness’
Prenatal Care: Polysubstance use and harm reduction during pregnancy
Prenatal Care: Quitting tobacco and postpartum relapse prevention
Prenatal Care: Prescription opioids and breastfeeding
Prenatal Care: Alcohol and breastfeeding
Prenatal Care: Cannabis and second-hand smoke
Prenatal Care: Cannabis and safe storage
Sexual Health: Alcohol use, vomiting and oral contraception
Sexual Health: Substance use and fertility
Sexual Health: Substance use and birth control counselling
Sexual Health: HIV and tobacco
Sexual Health: Hormonal birth control and tobacco
Sexual Health: Mental wellness
Sexual Health: Consent, sexual activity and substance use
Anti-Violence Services: Transition and healing
Anti-Violence Services: Support compassion and self-care
Anti-Violence Services: Support different paths to healing and recovery
Anti-Violence Services: Substance use and mothering
Anti-violence Services: Advocacy and system navigation
Anti-violence Services: Support understanding of the links between substance use and experiences of violence
Girls and Young Women: Low risk drinking guidelines
Girls and Young Women: Driving and safety
Girls and Young Women: Substance use and sexual assault
Girls and Young Women: Substance use, disordered eating, and weight concerns
Girls and Young Women: Personal values about substance use
Girls and Young Women: Health effects for young women
Girls and Young Women: Talking to family
Girls and Young Women: Mixing alcohol and caffeine
Girls and Young Women: Recognizing the signs of alcohol poisoning
Women and their Partners: Share health information
Women and their Partners: Finding common health goals
Women and their Partners: Help plan for fun
Women and their Partners: Preconception self-assessment (for men)
Women and their Partners: Pregnant pause
Women and their Partners: Getting ready for parenthood

Resource List for Project Regional Meetings: The Resource List includes:

Selected Academic articles on Brief Intervention
Trauma and Gender Informed Web resources that address the 4 substances (listed in alphabetical order), including a variety of resources on women’s health and substance use; alcohol and pregnancy; creating a welcoming environment; developing an indigenous approach to FASD prevention; opioid use and overdose in women; quitting smoking; perinatal substance use and ways to improve pregnancy care; planning for change; risks of cannabis on fertility, pregnancy, breastfeeding and parenting; women, girls and prescription medication.
Selected resources organized by professional group (as inspiration for profession-specific action):
- Midwifery
- Public Health Nursing
- Primary Care Physicians
- Violence Prevention
- Pregnancy Outreach
- Sexual Health
- Substance Use
- Indigenous-Specific

Women and Substances Information Sheets

Women and Alcohol English version French version
Women and Tobacco English version French version
Women and Prescription Opioids English version French version
Women and Cannabis English version French version

Indigenous Approaches to FASD Prevention: Brief Interventions with Girls and Women

This booklet, one of five publications highlighting how FASD prevention is understood and practiced in Indigenous traditional culture produced through a collaboration of The Centre of Excellence for Women’s Health, the Thunderbird Partnership Foundation, and the Canada FASD Research Network, provides a brief introduction to ways of working with Indigenous girls and women to address alcohol, pregnancy, and other related concerns. The booklet is intended as a starting place for individuals, organization, and communities who are interested in learning how they can be involved in supporting FASD p0revention in Indigenous communities in ways that are respectful of history, culturally aligned, and supportive of Indigenous self-determination and cultural resurgence.

Webinar—Dialogue + Action: Women and Substance Use
Recording View Slides

This webinar was presented on June 4, 2018, by Nancy Poole and Lindsay Wolfson. The webinar summarizes key findings from the Dialogue + Action project, shares promising approaches to brief intervention and support, encourages critical thinking about how we can improved our capacity to discuss substance use with girls, women, and their support networks, and introduces two resources to support practice.
The project fits within the four-part FASD Prevention Model:
- Level 1: Broad awareness building and health promotion efforts
- Level 2: Discussion of alcohol use and related risks with all women of childbearing years and their support networks
- Level 3: Specialized, holistic support of pregnant women with alcohol and other health/social problems
- Level 4: Postpartum support for new mothers and support for child assessment and development
The project endorses the belief that “our responses need to incorporate the complexity of influences on problematic substance use by girls and women”. It incorporates the Principles for Practice and Policy Perinatal Substance Use:
- Women (or patient or person) Centred: Respect women’s context, pressures, and goals when delivering care. Support self-determination, choices and empowerment.
- Harm Reduction: Support girls and women to address immediate health and social goal, and consider their options for change in substance use.
- Cultural Safety and Humility: Build respectful and reciprocal relationships that acknowledge differences and create safe ways to interact.
- Trauma Informed: Recognize that substance us may be related to past and current experiences of violence and trauma. Create safety and collaboration.
The webinar discusses what the project means by brief interventions:
- Collaborative conversations between an individual and a health or social service provider about issues such as substance use, mental wellness, contraception, experiences of violence or trauma, which can be informal, structured or unstructured. They can be one-time conversations or a series of conversations over a period of time, initiated by a range of health and social service providers.
The webinar notes a range of opportunities:
- Education and training can help overcome many of the common barriers to brief interventions. The presenters note that training on motivational interviewing and brief interventions has increased knowledge and use of screening and brief interventions, increased confidence in providing health education, and increased knowledge for referral.
- The presenters comment that being explicit about consent, confidentiality and privacy can reduce concerns that brief interventions will impact relationship with patients/clients.
- Web-based and mobile resources are proving effective in disseminating consistent prenatal health messages and have increased knowledge on substance use, preconception and perinatal health:
  - Virtual screening and/or brief interventions can help overcome limited service provider time.
  - Online and test-message interventions can reach women in rural and remote locations.
  - Electronic screening increases anonymity, which can reduce stigma and judgement.
The webinar slides include Practice Approaches: Self-Assessment Questions and examples of use in Primary Care, Sexual Health, Anti-Violence, Young Girls and Women, and Indigenous Girls and Women work.
The presenters conclude with a note that: “There remains much to be done with child welfare systems to ensure that women are not afraid to access prenatal care for fear of losing custody of their children, and that providers are clear about what constitutes a duty to report.” They see promising steps to improve cross-sectoral work and promising interest in integrating these principles and practices in clinical professional guidelines and training. They see a focus work area as being national improvement of approaches to how we ask, record, analyze and share data on perinatal substance use.

Webinar—The Role of Anti-violence Workers in Providing Brief Support on Substance Use (March 8, 2018). This webinar was presented by Nancy Poole, Director of the Centre of Excellence for Women’s Health and Prevention Lead for Can FASD Research Network, along with panelist Kathryn Mettler (KM Training and Consulting), Melody Rose (Executive Director Maplegate House for Women, Elliot Lake, Ontario) and Pakka Liu (Training Coordinator, BC Society of Transition Houses). This webinar looks at research on the connections between substance use and gender-based violence and the use of the brief support model by Anti-Violence Workers in existing programs.
Recording View Slides

Jessica CampbellJuly 20, 2018