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CDC Update:
Current Advances in FASD Prevention and Intervention
FASDsoutheast Train the Trainer Program
November 16, 2012
National Center on Birth Defects and Developmental Disabilities
Fetal Alcohol Syndrome Prevention Team
Elizabeth P. Dang, MPHFAS Prevention Team
Prevention Research BranchDivision of Birth Defects and Developmental Disabilities
Alcohol Use and Binge Drinking among Women of Childbearing Age - United
States, 2006-2010
7.6% of pregnant women and 51% of nonpregnantwomen reported drinking alcohol in the past 30 days
Among pregnant women, the highest estimatesof use were among those who were: Aged 35-44 years (14.3%) White (8.3%) College graduates (10.0%) Employed (9.6%)
1.4% of pregnant women and 15.0% of nonpregnant womenreported binge drinking in the past 30 days
Among pregnant and nonpregnant binge drinkers: Average frequency: ~ 3 times per month Average intensity: ~ 6 drinks per occasion
Current Prevention Activities
Alcohol SBI Alcohol SBI implementation guides Implementation of alcohol SBI through
FASD Regional Training Centers CityMatCH Practice Collaborative BRFSS module on alcohol SBI Alcohol SBI stakeholder meeting
CHOICES implementation & dissemination
Alcohol SBI Implementation Guides
Primary Care Adapted from SBI for Unhealthy Alcohol Use: A Step-by-
Step Implementation Guide for Trauma Centers To be piloted/evaluated through FASD Regional Training
Centers
Ob-gyn settings Through ACOG contract
Pediatric settings serving adolescents Exploring with AAP
Alcohol SBI Implementation Guide for Primary Care
Provides practical, step-by-step process that primary care settings can use to implement alcohol SBI
American College of Obstetricians and Gynecologists
2010-2011: Worked with ACOG to: Assess the 2006 FASD Prevention Toolkit
Resulted in new resources for women’s health care providers
New website: www.womenandalcohol.org Resources include:
• Pocket card• Cell phone app on screening/brief intervention• ACOG Committee Opinion on At Risk Alcohol
Use Tips for working with women who
drink….and more
SBI Implementation Guide for Ob-gyn Settings
ACOG developing alcohol SBI implementation guide for ob-gyn settings
Piloted in 3 settings in New York: Omni Women’s Health Group - Buffalo Segundo Ruiz Belvis Diagnostic & Treatment
Center - Bronx Albany Medical Center – Albany
Using newly developed materials
FASD Regional Training Centers (RTCs)
New cycle funded in 2011 to continue core training activities but with a new emphasison alcohol SBI 5 RTCs were funded
Move beyond training to implementation of alcohol SBI in primary care systems
3 of the RTCs recently awarded supplemental funding for implementation of alcohol SBI (2012-2014)
FASD RTCs: SBI implementation projects
Southeast FASD RTC (Tennessee) 2 Meharry Medical College Family Medicine Clinics
(FMCs)• Skyline and Meharry FMCs
Frontier FASD RTC (Nevada) University Health System, University of Nevada School
of Medicine• Women’s Health Care Center (Las Vegas)• Family Medical Center, Student Health Center,
Student Outreach Center (Reno)
Arctic FASD RTC (Alaska) Planned Parenthood of the Great Northwest
• Anchorage Health Center• Soldotna Health Center
FASD RTCs : SBI implementation projects (cont’d)
Incorporate alcohol SBI into day-to-day clinical practice
Identify barriers and facilitators to implementation
Identify methods to overcome/create solutions to barriers
Evaluate uptake of alcohol SBI in the implementation sites
Evaluate the primary care SBI implementation guide
CityMatCH Practice Collaborative Project
Pilot a practice collaborative model to address alcohol and other substance use among women of reproductive age Increase awareness and education among providers
about risks/effects Enhance capacity of providers to deliver SBI or refer to
services
Six Practice Collaborative Teams Sites in FL, OR, CO, MD, CA, OH Team plans and/or activities currently underway Plan to share Practice Collaborative lessons learned
Alcohol SBI BRFSS Module
Drafted optional module for 2014 BRFSS
Completed 3 rounds of cognitive testing
Questions include: If a doctor/HC professional asked about alcohol use If you were asked how much you drink (in general and
per occasion) If you were offered advice about what’s harmful/risky If you were advised to reduce your drinking
Insights from the Demand Side: Making the Case for Alcohol Screening
and Brief Intervention (SBI)
Convened Planning Team CDC, ACOG, NOFAS, several consultants
August 14, 2012 in Atlanta GA Meeting Purposes:
Better understand how best to “make the case” for alcohol SBI
Identify which organizations would support implementation of a new policy/health program advancing alcohol SBI within primary care settings and find out what they would need
Is a public-private partnership the right approach? Next steps for ongoing dialogue about how to advance
alcohol SBI
Insights from the Demand Side
Employers
Insurers
Business Groups
Academia
Federal Partners
Other organizations
Meeting Agenda
Introduction & Welcome
Brief Presentations:- What’s the problem?- What is alcohol SBI anyway?- What are the economic costs? - Alcohol SBI as a prevention priority
Group Discussions:- Did this information adequately make the case? - Is a public-private partnership a good way to advance alcohol SBI implementation?- Next steps
Questions from meeting observersFeedback from federal partners
Key Themes
Awareness about risky drinking
Integration/bundling of services
Better data needed
Not just physicians/electronic SBI
Demonstration projects (provider/insurer/business)
Engage professional groups
Coordinated efforts
Potential Next Steps
Explore issues around communication/messaging
Address data issues
Support SBI demonstration projects from the insurer/business perspective
Increase engagement of professional groups
Strengthen federal linkages related to SBI
Insights from the Demand Side
CHOICES: Now available!
www.cdc.gov/fasd “Free Materials” link
Counselor Manual Client Workbook Assessment Tools Training Curriculum Training videos Web page (TBA)
CHOICES Implementation Efforts
Sexually Transmitted Diseases (STD) clinics Baltimore City Health Department CO Department of Health & Environment/Denver Health
Family Planning/Community Health Centers AltaMed Corporation in LA (3 clinics) New York Health and Hospital Corporation in NYC (4
clinics)
Oglala Sioux Tribe in South Dakota
Choices Plus (Choices + smoking cessation) University of Texas at Austin
Recent Intervention Activities
Interventions for Children with FASDs Intervening with Youth and Young Adults
with FASDs Collaboration with ACF
Intervention Materials/Training available at:
Mile: Marcus Autism Centerhttp://marcus.org
PACT:Children’s Research Trianglehttp://childstudy.org
Good BuddiesU. of California, Los Angeleshttp://http://www.semel.ucla.edu/fas/
Families Moving ForwardChildren’s Hospital, Seattle http://depts.washington.edu/fmffasd
Intervening with Youth and Young Adults with FASDs
Purpose: to support innovative research of interventions for youth and young adults (aged 12-25 years) with FASDs Randomized control design (at least 50 per group)
Funded: UCLA and Saint Louis University UCLA – targets alcohol misuse/abuse SLU – targets externalizing behaviors & life skills
Studies wrapping up
Collaboration with Administration for Children & Families
Analysis of datasets to determine prevalence of FASDs and DDs in foster/adoptive care
Develop/disseminate ACF Informational Memorandum regarding FASDs and LTSAE to foster/adoptive and child welfare agencies and regions
Research into identifying children with FASDs and DDs in foster/adoptive care
Systematic ongoing dissemination of LTSAE and FASD information
American Academy of Pediatrics
CDC is working with AAP on a variety of activities: Professional education materials to inform pediatricians
about prevention, identification, and treatment of children with FASDs
Visiting Professorship Program – connection with FASD Regional Training Centers (5 AAP chapters in 2011)
FASD Risk Communication Workshop – July 2012 Information dissemination to members through AAP
OnCall, AAP SmartBriefs, and AAP News
Enhanced Resources for FASD Prevention and Intervention through National Networking, Education, &
Dissemination
Four-year cooperative agreement (2010-2014) with NOFAS: Enhance/expand the NOFAS National & State Resource
Directory Engage/enhance affiliate and stakeholder networks Enhance/expand the NOFAS Information Clearinghouse
and disseminate resources/materials Conduct media outreach New in 2013:
• Develop plan to engage American Indian communities re: dissemination of CHOICES• Promote evidence-based interventions for children with FASDs
FASD Regional Training Centers (RTCs)
Purpose: to educate medical and allied health students and practitioners in the prevention, identification, and treatment of FASDs
Previous Cycle of RTCs (2008-2011) In 2008, awarded 5 cooperative agreements Conducted 724 trainings/events Reached 7,140 students/residents and 10,631
health care professionals New funding cycle (2011-2014)
5 cooperative agreements Continue core training activities 3 RTCs recently funded to implement SBI in primary care
system
Washington
Montana
Oregon
Nevada
California
Utah
Arizona
New Mexico
Colorado
Idaho
Wyoming
North Dakota
South Dakota
Minnesota
IowaNebraska
Kansas
TexasFlorida
Mississippi
Louisiana
Alabama
Georgia
South Carolina
North Carolina
Virginia
Maine
New York
Michigan
Wisconsin
Oklahoma
Missouri
Arkansas
Tennessee
Kentucky
IllinoisIndiana
Michigan
Ohio
West Virginia
DC
Maryland
Delaware
New Jersey
Vermont
Rhode Island
Connecticut
New Hampshire
Massachusetts
Alaska
Hawaii
Pennsylvania
FASD Regional Training Centers 2011-2014
Arctic RTC, Univ of Alaska AnchorageMidwestern RTC, Saint Louis Univ
Great Lakes RTC, Univ of Wisconsin
Southeastern RTC, Meharry Medical College
Frontier RTC, Univ of Nevada Reno
Messages & Materials for Women on Alcohol Use in Pregnancy
Conducted formative research to explore women’s knowledge and beliefs about alcohol use and pregnancy 20 focus groups with women of childbearing age, March
2010 Manuscript in press at American Journal of Health
Education Inform development of new CDC materials
on alcohol use in pregnancy and FASDs Developed and tested concepts/messages/materials for
women of childbearing age Focus groups occurred recently (June 2012)
Next Steps Translate findings into new messages/materials
For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Questions?www.cdc.gov/fasd
Thank [email protected]
National Center on Birth Defects and Developmental Disabilities
Fetal Alcohol Syndrome Prevention Team