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Stimulating Systems Change for Fetal Alcohol Spectrum Disorder (FASD)

Stimulating Systems Change for Fetal Alcohol Spectrum Disorder (FASD) Canadian Public Health Association Conference June 2, 2008. Stimulating Systems Change for Fetal alcohol spectrum disorder (FASD)?. Overview of Presentation What is FASD? Why be concerned about FASD? Vision/Goal

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Stimulating Systems Change for Fetal Alcohol Spectrum Disorder (FASD)

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  1. Stimulating Systems Change for Fetal Alcohol Spectrum Disorder (FASD) Canadian Public Health Association Conference June 2, 2008

  2. Stimulating Systems Change for Fetal alcohol spectrum disorder (FASD)? Overview of Presentation • What is FASD? • Why be concerned about FASD? • Vision/Goal • Steps necessary to achieve the goal • Interventions • Impact

  3. What is fetal alcohol spectrum disorder (FASD)? • FASD is a general term that describes the range of disabilities that may affect a person if the birth mother drank alcohol while pregnant • Possible diagnoses • Fetal Alcohol Syndrome (FAS) • Partial FAS (pFAS) • Alcohol-related Neuro-developmental disorders (ARND) • Alcohol-related Birth defects (ARBD)

  4. What is fetal alcohol spectrum disorder (FASD)? • Impact of alcohol varies with • Timing during the pregnancy • Amount consumed • Frequency of consumption • Pattern in which it is consumed • Health status of pregnant woman • Genetic background of pregnant woman • Alcohol crosses the placenta but fetus can’t metabolize it • Collects in the amniotic fluid and maternal and infant blood • Impacts cell differentiation, migration and growth

  5. What is fetal alcohol spectrum disorder (FASD)? Source: Childbirth Graphics

  6. Why be concerned about FASD? • FASD is a serious public health, social and economic issue in Canada • Leading cause of congenital brain injury and developmental disability • Estimated incidence is 1% • More than affected 3000 babies born annually • Over 300,000 people living with FASD in Canada • Economic cost over $24,000 annually per person aged 0 to 21 (total of over $571 million annually) • Social costs are high (17% of children in-care, Manitoba) • Health costs are high

  7. Who is at-risk? • All women who consume alcohol, are sexually active and do not use reliable contraception • Most women stop once they know they are pregnant • 13.9% of women reported drinking during their pregnancy (CCHS) • Study of infant meconium showed 3.7% drank significant amounts during the last trimester

  8. What are the problems? • No Canadian incidence and prevalence data • No consistent advice to pregnant women from health care providers (40% health care providers discuss risk of alcohol use during pregnancy) • Lack of confirmed maternal alcohol consumption • Lack of consistent prevention activities • Lack of consistent diagnosis • Lack of diagnostic capacity

  9. What is the vision? • Future alcohol affected births are prevented • Outcomes are improved for those already affected • Canadian incidence, prevalence and cost data will be available

  10. Common Data Collection & Reporting Consistent Advice & Intervention Consistent Diagnosis Early Identification & Diagnosis Training Effective Screening & Counselling Common Diagnostic Tools Confirmed Maternal Alcohol Use Consistent Screening Counselling & Recording Guidelines for Screening & Counselling Women & Data Recording Diagnostic Guides Prevent FASD Improve Outcomes Canadian Incidence Data

  11. What has been done? • Facilitate development of Canadian diagnostic guidelines (CMAJ March 2005) • Survey of health care provider knowledge, attitudes and practices (2004) • Facilitate consensus re: screening pregnant women and data recording (2007) • Facilitate training of trainers for health care providers (2007) • Facilitate refinement and revision of diagnostic guidelines (2008)

  12. FASD Initiative Prevention Intervention Pan-Canadian Identification / Screening Screening Tools Province / Territory Region Municipality Prevention Screening SOGC, PRIMA, MD-CME a Community Neighbourhood Family Evidence Base for Decision Making / Knowledge Exchange Diagnosis Revisions, Training, Tools Person Intervention / Management Incidence / Prevalence / Cost Evaluation

  13. FASD Initiative Policy, Program & Practice Development Building the evidence base for decisions • Who needs to make decisions? • What types of decisions are needed? • What information do we need? • At what level? • Whom do we need to convince? • What do we need to do next?

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