Ontario-based Health Nexus has produced a series on Preventive FASD Education. The PowerPoint presentations are available on their website.

Accessibility of FASD supports and services was presented by Dr. Hilary K. Brown, Assistant Professor at the University of Toronto. Dr. Brown identified three major gaps in current prevention efforts identified by current research:

·      Public education campaigns have elevated awareness of FASD, but campaigns alone are not sufficient to change behaviours of women at highest risk of alcohol use in pregnancy.

·      Use of alcohol by pregnant women occurs within a complex web of other influences, including interpersonal violence, socioeconomic status, mental illness, and isolation.

·      Pregnant women facing multiple and complex issues during pregnancy often “fall through the cracks” of uncoordinated systems of care.

 

Dr. Brown notes the following implications for tailoring and accessibility to information and supports:

·      Need for a more systemic approach to FASD prevention with strong linkages amongst the multiple levels of prevention efforts, along with integrated, multidisciplinary care.

·      A trauma-informed and culturally appropriate approach to care, sensitive to histories of violence and systemic/institutional racism.

·      A holistic approach that includes improving health, income, housing and other social needs.

·      Collaborative, integrated care that includes addressing mental health and other substance use as well as alcohol use.

They offered the following recommendations which have been identified to address three significant barriers to care:

·      Distance and transportation: Mobile clinics, consultation via videoconference or text message, integration of substance use and primary care services with teleconsultation for primary care providers.

·      Lack of accommodations: Noting that people with disabilities are at elevated risk of alcohol and substance use but are more likely to experience barriers to preventive and treatment-related services, recommendations include training of program staff, provision of appropriate accommodations, and collaboration with disability organizations.

·      Language barriers: Recommendations include availability of interpreters, cultural competency for providers, and attention to other social determinants of health.

Given that 4% of Canadians have FASD, with higher rates in certain groups, and that women with FASD have higher rates of mental illness, substance use, and experiences of interpersonal violence than the general population, and are at elevated risk of pregnancy and postpartum complications, Dr. Brown notes the need for specific supports for reproductive-aged women with FASD:

·      Support persons

·      Medical and mental health needs

·      Sensory, communication, and memory needs

·      Personal safety and relationships

·      Financial, housing

·      Postpartum and parenting needs

Preventive FASD Education for Pregnancy Healthcare Providers: Reducing FASD was presented by Lisa Graves, MD CCFP (AM), FCFP, MClinSc.

Research is showing that there may be no safe lower limit for alcohol use during pregnancy, yet Dr. Graves notes that there has been no decrease in the prevalence of alcohol use during pregnancy in Canada (10%) and the prevalence of binge drinking during pregnancy (3.3%).

Noting that every prenatal visit is an opportunity for discussion about alcohol use, the recommendation for healthcare professionals is that:

·      All pregnant women should be screened for alcohol use by asking a single question to determine use (in a non-judgmental way) and then, if they consume alcohol, with a provincially/territorially approved evidence-based screening tool (e.g. AUDIT-C or T-ACE). If women consume alcohol, pattern of use should be established to screen for binge drinking.

Dr. Graves discussed the “Three A’s”:

·      Awareness raising (through discussion of risks) and assessment/identification of readiness for change.

·      Advice including provision of written materials (or web links) and discussion of strategies for reducing or eliminating problematic alcohol use

·      Assistance in the form of eliciting ideas about change strategies; supporting/enhancing readiness; goal setting to reduce or eliminate alcohol use; positive reinforcement; and/or referrals to supportive services.

They note: “Women need to be able to participate in brief interventions and treatment without undue risk of loss of child custody … policy must be aligned so that support and treatment can be encouraged by providers and accessed by women without fear”, while still giving appropriate attention to the safety of the child.

The presentation includes a strong recommendation that specialized community-based interventions be available and accessible for women with problematic drinking and related health and social concerns.

The presentation concludes with a discussion of guidelines around use of pharmacotherapy by healthcare providers before, during and following pregnancy, with safety notes around the prescription of specific drugs.

Dr. Naana Afua Jumah provided a presentation on Alcohol, Pregnancy & Society.

In their presentation, Dr. Jumah used examples of advertising and media that highlight class-based differences in societal perception of maternal alcohol use, pointing out:

·      If one is middle or upper class, especially if white, it is perceived as acceptable to drink in public with an infant (showing posters for “Moms to Wine Festival” “Babies n’Brews” events)

·      If one is poor, especially if Indigenous or a Person of Colour, then there is fear of having one’s child taken away if there is suspicion of public alcohol consumption whilst pregnant or breastfeeding one’s infant.

Recommendations:

·      Ask all reproductive age/pregnant women about alcohol use.

·      Provide a brief intervention along with screening.

·      Create space during appointments to discuss alcohol use.

·      Make specialized, community-based interventions available and accessible to women with problematic drinking and related health and social concerns.

The presentation offers suggestions for best practice during medical appointments, and some suggestions for conversation starters for talking about alcohol use in pregnancy, for example:

·      A woman discloses that she has been drinking in pregnancy: “It was brave of you to share that with me. Can we talk about this more?”

·      A woman shares that she has been drinking but cutting down: “That’s a really big step. How can I support you to reach your goal?”

·      A woman attends her appointment/session intoxicated: “I am concerned about you. Tell me about your day?”

In the fourth presentation, Caring for Each Other, Nathalie Pambrun, a Franco-Manitoban Metis midwife who has practiced in urban, rural and remote communities across Canada and internationally, and who has served as President of the Canadian Association of Midwives, talked around FASD harm reduction in Indigenous communities. They focused on decolonizing addiction, redefining the path to wellness and centering self-determination, with an emphasis on:

·      Learning in and from the community

·      Respectful relationships

·      Learning together

·      Learning on and from the land

·      Providing caring for the caregiver: awareness, support, grounding and care

Nexus also provide a number of Preconception Health resources on their “best start” website at https://resources.beststart.org/product-category/resources/preconception-health/ including:

·      Planning for Change Facilitator Guide: Workshop for First Nations Women about FASD Prevention and Skills for Change

·      Prescription Opioid Use booklet

·      Risks of Cannabis on Fertility, Pregnancy, Breastfeeding and Parenting booklet

·      Tips for Parents – Brain Development: Two sets of handouts (one for future fathers and one for future mothers) offering practical suggestions to support a baby’s brain development before conception.

·      Reproductive Life Plans: a webinar recording for service providers outlining the reproductive life plan as one strategy to improve preconception health.

·      Health Before Pregnancy: Is there a baby in your future? A bilingual website for prospective parents.

·      My Reproductive Life Plan booklet.

Men’s Information – How to Build a Healthy Baby booklet.