1
|
Stubbs T, Cannon L, Carter E, Naanai H, Okurame JC, Martiniuk ALC, Davies J, Thomas S, Bedford M, Elliott EJ, Rice LJ. Fetal alcohol spectrum disorder resources for health professionals: a scoping review. BMJ Open 2024; 14:e086999. [PMID: 39002966 PMCID: PMC11253770 DOI: 10.1136/bmjopen-2024-086999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/12/2024] [Indexed: 07/15/2024] Open
Abstract
OBJECTIVES This scoping review aimed to identify and critically appraise resources for health professionals to identify, diagnose, refer, and support individuals with fetal alcohol spectrum disorder (FASD)-including the extent to which the resources are appropriate for use in communities with First Nations Peoples. METHOD Seven peer-reviewed databases (April 2022) and 14 grey literature websites (August 2022) were searched. The reference lists of all sources that underwent full-text review were handsearched, and FASD experts were consulted for additional sources. Resources were assessed using the Appraisal of Guidelines for REsearch and Evaluation II instrument and an adapted version of the National Health and Medical Research Council FORM Framework and iCAHE Guideline Quality Checklist. RESULTS A total of 41 resources underwent data extraction and critical appraisal, as screening and/or diagnosis guidelines were excluded because they are covered in other reviews. Most were recently published or updated (n=24), developed in the USA (n=15, 36.6%) or Australia (n=12, 29.3%) and assisted with FASD patient referral or support (n=40). Most management guidelines scored 76%-100% on overall quality assessment (n=5/9) and were recommended for use in the Australian context with modifications (n=7/9). Most of the guides (n=15/22) and factsheets (n=7/10) received a 'good' overall score. Few (n=3/41) resources were explicitly designed for or with input from First Nations Australians. CONCLUSION High-quality resources are available to support health professionals providing referrals and support to individuals with FASD, including language guides. Resources should be codesigned with people living with FASD to capture and integrate their knowledge and preferences.
Collapse
Affiliation(s)
- Thomas Stubbs
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Lisa Cannon
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Emily Carter
- Marulu Unit, Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Habiba Naanai
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Josephine Chidinma Okurame
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Alexandra L C Martiniuk
- School of Public Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Office of the Chief Scientist, The George Institute for Global Health, Sydney, New South Wales, Australia
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Jadnah Davies
- Marulu Unit, Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Sue Thomas
- Marulu Unit, Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Mudge Bedford
- Marulu Unit, Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, Western Australia, Australia
- NDIS Remote Community Connector Team, Marra Worra Worra Aboriginal Cooporation, Fitzroy Crossing, Western Australia, Australia
| | - Elizabeth J Elliott
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network and Kid's Research, Westmead, Sydney, New South Wales, Australia
| | - Lauren J Rice
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Panton KR, Fitzpatrick JP, Pestell CF. An evaluation of a multi-site fetal alcohol spectrum disorder models of care project. Front Public Health 2023; 11:1195484. [PMID: 37554728 PMCID: PMC10406497 DOI: 10.3389/fpubh.2023.1195484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023] Open
Abstract
Fetal alcohol spectrum disorder (FASD) continues to be underdiagnosed in Australia, partly due to the lack of trained clinicians and diagnostic services. This project aimed to help increase FASD knowledge and diagnostic capacity across Australia. Six sites across Australia formed part of a national consortium, delivering training clinics, diagnostic clinics and community education sessions. The number of FASD diagnoses significantly increased across the project. Additionally, the number of community education sessions steadily increased across the project, with largely positive feedback. Participants attending the training clinics demonstrated increased knowledge of and confidence in FASD diagnosis. This evaluation showcases the benefits of a coordinated approach to prevention, assessment, diagnosis and training in FASD.
Collapse
Affiliation(s)
- Kirsten R. Panton
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
| | - James P. Fitzpatrick
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
- Patches Assessment Services, Subiaco, WA, Australia
| | - Carmela F. Pestell
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
3
|
McCormack JC, Chu JTW, Wilson H, Rahman J, Marsh S, Bullen C. Knowledge, attitudes, and practices towards fetal alcohol spectrum disorder in the New Zealand social and community sector: An online survey. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231172234. [PMID: 37092706 DOI: 10.1177/17446295231172234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background: Fetal Alcohol Spectrum Disorder (FASD) is a common neurodevelopmental disorder but may be underrecognized and misunderstood by people who provide health and social support services. The aim of the research is to understand the FASD knowledge, attitudes, and practices among people employed by the social and community sector in New Zealand. Methods: We conducted an online survey of people working in the New Zealand social and community sector (i.e., social workers, support workers). The survey focused on the following areas: awareness of FASD; knowledge and beliefs about FASD; the impact of FASD on professional practice; and training needs. Results: Most participants reported a basic understanding of FASD, however only 5% felt very well prepared to support someone with FASD. A large majority of participants believed that FASD diagnosis may be stigmatising for individuals or families. Conclusion: There is a need to improve training, professional development, and workplace support for social and community workers in New Zealand to support people with FASD.
Collapse
Affiliation(s)
- Jessica C McCormack
- Food Science, University of Otago, Dunedin, New Zealand
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Joanna Ting Wai Chu
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Holly Wilson
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Juma Rahman
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Samantha Marsh
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
4
|
McCormack JC, Chu JTW, Marsh S, Bullen C. Knowledge, attitudes, and practices of fetal alcohol spectrum disorder in health, justice, and education professionals: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 131:104354. [PMID: 36375286 DOI: 10.1016/j.ridd.2022.104354] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/12/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS Fetal alcohol spectrum disorder (FASD) is one of the most common forms of developmental disability, and yet, anecdotally, is poorly understood by both the public and professionals across health, justice, education, and social services. This review aims to understand the knowledge, attitudes, and practices of professionals who work across a range of sectors - specifically health, education and justice - where they may encounter people with FASD, their families and caregivers. METHOD We conducted a systematic search for research using surveys or questionnaires to address knowledge, and attitudes of professionals in health, education, and justice with regards to FASD between 1990 and 2021. Our search consisted of electronic databases (APA PsychInfo, CINAHL, EMBASE, Medline, PubMed, and PAIS Index) and grey literature sources. RESULTS Our search yielded 971 results, of which 58 were relevant. The studies surveyed professionals from health (n = 35), education (n = 10), justice (n = 8), social services (n = 1), and multiple settings (n = 4). Most studies were conducted in North America. The areas surveyed included knowledge of FASD, attitudes towards people with FASD, experience with FASD, practices towards people with FASD, and education and training needs. CONCLUSIONS Knowledge, attitudes, and practices towards FASD have been surveyed extensively in healthcare professionals over the last 30 years, but less so with those working in justice and education sectors. Findings from surveys suggest that although most professionals had some knowledge of the effects of FASD, their knowledge of the specific criteria of Fetal Alcohol Syndrome (FAS) and FASD is poor across most professional groups, including most health professionals. Our review highlights the need to provide training and information across sectors ongoing surveillance to determine where gaps in knowledge are and what resources are needed. WHAT THIS PAPER ADDS This study is the first to systematically synthesize knowledge, attitudes, and practices toward FASD across different sectors. Poor knowledge and insufficient training were common. Knowledge, attitudes, and practices about FASD have been surveyed extensively in the healthcare setting, but surveys are more limited outside of this setting. Continuous surveillance is needed to identify and respond to knowledge gaps and changes in practice.
Collapse
Affiliation(s)
- Jessica C McCormack
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand
| | - Joanna Ting Wai Chu
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand.
| | - Samantha Marsh
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand; Social and Community Health, School of Population Health, The University of Auckland, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand
| |
Collapse
|
5
|
Okurame JC, Cannon L, Carter E, Thomas S, Elliott EJ, Rice LJ. Fetal alcohol spectrum disorder resources for health professionals: a scoping review protocol. BMJ Open 2022; 12:e065327. [PMID: 36100303 PMCID: PMC9472138 DOI: 10.1136/bmjopen-2022-065327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION People with fetal alcohol spectrum disorder (FASD) encounter a range of health and allied health providers and require specialised support to ensure health services are provided safely and effectively. Not all health professionals possess the knowledge or expertise required for the identification, assessment, referral and management of FASD. Accessible resources for understanding and managing FASD can help create awareness in health professionals and ensure patients receive the correct diagnosis and timely access to the necessary supports and services. The aim of this scoping review is to identify and analyse FASD resources for health professionals. METHODS AND ANALYSIS A comprehensive search of eight databases (MEDLINE, Scopus, PsycINFO, CINAHL, PubMED, EMBASE, Web of Science and Trip Medical Database) and nine grey literature databases (FASD Hub, NOFASD Australia, National Organisation for FASD, FASD United, HealthInfoNet, Proof Alliance, Child Family Community Australia, Foundation for Alcohol Research & Education and the Australian Department of Health websites) will be conducted using three search engines including PubMed, Ovid and Google advanced search (search dates: October 2021 to May 2022). Consultations will also be carried out with international and national experts in the diagnosis/management of FASD to obtain any additional relevant published or unpublished resources. Inclusion criteria were developed to guide the selection of resources that are publicly available, primarily focused on FASD and curated for health professionals for the identification, management or referral of FASD. Critical appraisal process will be executed using the Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) tool to assess the quality of selected resources. ETHICS AND DISSEMINATION Ethical approval is not required for the scoping review. Scoping review results will be presented at relevant national and international conferences and published in peer-reviewed journals. Search results will be made available to ensure reproducibility and transparency.
Collapse
Affiliation(s)
| | - Lisa Cannon
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Emily Carter
- Marulu Unit, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Kimberley, Australia
| | - Sue Thomas
- Marulu Unit, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Kimberley, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Kids Research, The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Lauren J Rice
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Panisi C, Marini M. Dynamic and Systemic Perspective in Autism Spectrum Disorders: A Change of Gaze in Research Opens to A New Landscape of Needs and Solutions. Brain Sci 2022; 12:250. [PMID: 35204013 PMCID: PMC8870276 DOI: 10.3390/brainsci12020250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/21/2022] Open
Abstract
The first step for a harmonious bio-psycho-social framework in approaching autism spectrum disorders (ASD) is overcoming the conflict between the biological and the psychosocial perspective. Biological research can provide clues for a correct approach to clinical practice, assuming that it would lead to the conceptualization of a pathogenetic paradigm able to account for epidemiologic and clinical findings. The upward trajectory in ASD prevalence and the systemic involvement of other organs besides the brain suggest that the epigenetic paradigm is the most plausible one. The embryo-fetal period is the crucial window of opportunity for keeping neurodevelopment on the right tracks, suggesting that women's health in pregnancy should be a priority. Maladaptive molecular pathways beginning in utero, in particular, a vicious circle between the immune response, oxidative stress/mitochondrial dysfunction, and dysbiosis-impact neurodevelopment and brain functioning across the lifespan and are the basis for progressive multisystemic disorders that account for the substantial health loss and the increased mortality in ASD. Therefore, the biological complexity of ASD and its implications for health requires the enhancement of clinical skills on these topics, to achieve an effective multi-disciplinary healthcare model. Well-balanced training courses could be a promising starting point to make a change.
Collapse
Affiliation(s)
- Cristina Panisi
- Fondazione Istituto Sacra Famiglia ONLUS, Cesano Boscone, 20090 Milan, Italy
| | - Marina Marini
- Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, 40126 Bologna, Italy;
| |
Collapse
|
7
|
Pedruzzi RA, Hamilton O, Hodgson HHA, Connor E, Johnson E, Fitzpatrick J. ‘We do what we can as soon as we can’ Alcohol and Other Drug workforce perspectives on preventing and responding to prenatal alcohol exposure. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2020.1843600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rebecca A. Pedruzzi
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | | | | | - Elizabeth Connor
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
| | | | - James Fitzpatrick
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
8
|
Shelton D, Reid N, Till H, Butel F, Moritz K. Responding to fetal alcohol spectrum disorder in Australia. J Paediatr Child Health 2018; 54:1121-1126. [PMID: 30294984 DOI: 10.1111/jpc.14152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
Fetal alcohol spectrum disorder (FASD) is a significant public health issue in Australia that is poorly diagnosed, chronic and costly. FASD is a diffuse acquired brain injury secondary to prenatal alcohol exposure. The prevalence rate of FASD among the general population in Australia is currently unknown; however, an Australian study in a selected high-risk population reported some of the highest rates of FASD in the world. A common misconception among clinicians is that a child must have 'the face' of FASD to have the disorder. This is incorrect. The three sentinel facial features only occur in the minority of individuals with FASD. FASD should be considered as a 'whole body' disorder as increased susceptibility to chronic health problems suggests suboptimal in utero environments places the individual at risk of later disease. Clinicians are reluctant to consider FASD as a possible diagnosis because of the concern of inducing stigma; however, this concern is neither supported by the evidence nor patient stories. The Australian Guide to the Diagnosis of FASD is now available to assist health professionals in providing timely and accurate diagnoses, which can lead to improved outcomes via evidence-based intervention and is an important first step in future prevention.
Collapse
Affiliation(s)
- Doug Shelton
- Community Child Health, Gold Coast Health, Gold Coast, Queensland, Australia.,Neurodevelopmental and Behavioural Paediatric Society of Australasia (https://nbpsa.org/)
| | - Natasha Reid
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Haydn Till
- Community Child Health, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Francoise Butel
- Community Child Health, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Karen Moritz
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.,School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Kingsland M, Doherty E, Anderson AE, Crooks K, Tully B, Tremain D, Tsang TW, Attia J, Wolfenden L, Dunlop AJ, Bennett N, Hunter M, Ward S, Reeves P, Symonds I, Rissel C, Azzopardi C, Searles A, Gillham K, Elliott EJ, Wiggers J. A practice change intervention to improve antenatal care addressing alcohol consumption by women during pregnancy: research protocol for a randomised stepped-wedge cluster trial. Implement Sci 2018; 13:112. [PMID: 30126437 PMCID: PMC6102816 DOI: 10.1186/s13012-018-0806-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/07/2018] [Indexed: 12/20/2022] Open
Abstract
Background Despite clinical guideline recommendations, implementation of antenatal care addressing alcohol consumption by pregnant women is limited. Implementation strategies addressing barriers to such care may be effective in increasing care provision. The aim of this study is to examine the effectiveness, cost and cost-effectiveness of a multi-strategy practice change intervention in increasing antenatal care addressing the consumption of alcohol by pregnant women. Methods The study will be a randomised, stepped-wedge controlled trial conducted in three sectors in a health district in New South Wales, Australia. Stepped implementation of a practice change intervention will be delivered to sectors in a random order to support the introduction of a model of care for addressing alcohol consumption by pregnant women. A staged process was undertaken to develop the implementation strategies, which comprise of: leadership support, local clinical practice guidelines, electronic prompts and reminders, opinion leaders, academic detailing (audit and feedback), educational meetings and educational materials, and performance monitoring. Repeated cross-sectional outcome data will be gathered weekly across all sectors for the study duration. The primary outcome measures are the proportion of antenatal appointments at ‘booking in’, 27–28 weeks gestation and 35–36 weeks gestation for which women report (1) being assessed for alcohol consumption, (2) being provided with brief advice related to alcohol consumption during pregnancy, (3) receiving relevant care for addressing alcohol consumption during pregnancy, and (4) being assessed for alcohol consumption and receiving relevant care. Data on resources expended during intervention development and implementation will be collected. The proportion of women who report consuming alcohol since knowing they were pregnant will be measured as a secondary outcome. Discussion This will be the first randomised controlled trial to evaluate the effectiveness, cost and cost-effectiveness of implementation strategies in improving antenatal care that addresses alcohol consumption by pregnant women. If positive changes in clinical practice are found, this evidence will support health service adoption of implementation strategies to support improved antenatal care for this recognised risk to the health and wellbeing of the mother and child. Trial registrations Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017).
Collapse
Affiliation(s)
- Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia. .,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
| | - Emma Doherty
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Amy E Anderson
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Kristy Crooks
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Danika Tremain
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Tracey W Tsang
- School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Adrian J Dunlop
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Nicole Bennett
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Mandy Hunter
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Sarah Ward
- Foundation for Alcohol Research and Education, Deakin, Australian Capital Territory, Australia
| | - Penny Reeves
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Chris Rissel
- School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia.,New South Wales Office of Preventive Health, Liverpool, New South Wales, Australia
| | - Carol Azzopardi
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Andrew Searles
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Elizabeth J Elliott
- School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
10
|
Passmore HM, Mutch RC, Burns S, Watkins R, Carapetis J, Hall G, Bower C. Fetal Alcohol Spectrum Disorder (FASD): Knowledge, attitudes, experiences and practices of the Western Australian youth custodial workforce. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 59:44-52. [PMID: 29996987 DOI: 10.1016/j.ijlp.2018.05.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 05/14/2018] [Accepted: 05/30/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND Fetal Alcohol Spectrum Disorder (FASD) is a condition caused by prenatal alcohol exposure and characterised by lifelong physical, behavioural and cognitive abnormalities. Primary disabilities, such as impairment in memory, attention, cognition, language, executive function, and adaptive function, can lead to young people with FASD becoming engaged with the justice system. Little is known about the extent of FASD in youth detention in Australia, or of the capacity custodial staff have to manage and support young people with FASD. In tandem with a study assessing the prevalence of FASD among youth in detention in Western Australia (WA), this study aims to establish the current knowledge, attitudes, experiences and practices regarding FASD and other neurodevelopmental impairments among youth custodial officers in order to develop training resources for this workforce. METHODS We invited youth custodial officers in the only youth detention centre in WA to participate in an online or hardcopy survey. The survey was developed following extensive consultation with the workforce and investigated their knowledge, attitudes, experiences and practices relating to FASD and other neurodevelopmental impairments. This included experience working with young people with FASD and other impairments, and attitudes towards relevant training. RESULTS 112 youth custodial officers (51% of the youth custodial workforce) completed the survey. While many respondents had heard of FASD (77%) and understood it is relevant to the justice system (74%), limited in-depth FASD knowledge existed. Many respondents were unsure or unaware that FASD is permanent brain damage (53%) and cannot be outgrown (57%). Respondents were infrequently informed if a young person in detention had a diagnosis of FASD. Almost all custodial officers indicated motivation to complete training to further understand FASD (92%) and other neurodevelopmental impairments (94%), with particular interest in the application of management strategies appropriate for affected young people. CONCLUSIONS A lack of specific knowledge, inadequate training to recognise and manage young people with neurodevelopmental impairments, and inconsistent information-sharing processes reduce the ability of the custodial workforce to care for young people with FASD and other neurodevelopmental impairments. These findings have supported the development and evaluation of training resources targeting the specific needs and requests of the WA youth custodial workforce, and this is now underway.
Collapse
Affiliation(s)
- Hayley M Passmore
- Telethon Kids Institute, The University of Western Australia, Perth, Australia; School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia.
| | - Raewyn C Mutch
- Telethon Kids Institute, The University of Western Australia, Perth, Australia; School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia; Child and Adolescent Health Service, Department of Health Western Australia, Perth, Australia
| | - Sharyn Burns
- School of Public Health, Curtin University, Perth, Australia
| | - Rochelle Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia; Perth Children's Hospital, Perth, Australia
| | - Guy Hall
- School of Law, Murdoch University, Perth, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| |
Collapse
|
11
|
Williams HM, Percival NA, Hewlett NC, Cassady RBJ, Silburn SR. Online scan of FASD prevention and health promotion resources for Aboriginal and Torres Strait Islander communities. Health Promot J Austr 2018; 29:31-38. [PMID: 29700936 DOI: 10.1002/hpja.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 10/03/2017] [Indexed: 11/07/2022] Open
Abstract
ISSUE ADDRESSED Foetal Alcohol Spectrum Disorder (FASD) includes a range of life-long impairments caused by alcohol exposure in utero. Health professionals are vital to preventing FASD but many are hesitant to discuss FASD with clients due to their need for additional resources to aid the conversation. This scan sought to identify the scope and gaps in publicly available FASD prevention and health promotion resources, and assess their cultural appropriateness for use among five key groups of Indigenous Australian people including: (i) pregnant women, (ii) women of childbearing age, (iii) grandmothers and aunties, (iv) men, and (v) health professionals. METHODS Relevant resources published 1995-2017 were identified through the Australian Indigenous HealthInfoNet, FASD organisation websites, grey literature, Google searches, and field experts. Results were screened by inclusion and cultural appropriateness criteria developed and piloted by the research team, and further screened by health professionals attending FASD training workshops. RESULTS 115 of the 2146 identified resources were eligible. Relevant resources were found for all five key groups; however, no resources were specifically designed for men, grandmothers or aunties. CONCLUSIONS A range of high-quality, culturally appropriate resources were identified, however, health professionals attending the training workshops were not aware of their availability. Further resource development is suggested for men, grandmothers and aunties. SO WHAT?: Prioritisation of active dissemination and implementation strategies is suggested to increase awareness and use of future resource developments. The inclusion of a resource trial among health professionals is a recommended strategy to increase awareness and use of newly developed resources.
Collapse
Affiliation(s)
- Hayley M Williams
- Centre for Children's Burns and Trauma Research, University of Queensland, Child Health Research Centre, South Brisbane, QLD, Australia.,Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Spring Hill, QLD, Australia
| | - Nikki A Percival
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Nicole C Hewlett
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Spring Hill, QLD, Australia
| | - Rahni B J Cassady
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Spring Hill, QLD, Australia
| | - Sven R Silburn
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Spring Hill, QLD, Australia
| |
Collapse
|
12
|
Halliday JL, Muggli E, Lewis S, Elliott EJ, Amor DJ, O'Leary C, Donath S, Forster D, Nagle C, Craig JM, Anderson PJ. Alcohol consumption in a general antenatal population and child neurodevelopment at 2 years. J Epidemiol Community Health 2017; 71:990-998. [PMID: 28839077 DOI: 10.1136/jech-2017-209165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/05/2017] [Accepted: 08/09/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) is a community health problem with up to 50% of pregnant women drinking alcohol. The relationship between low or sporadic binge PAE and adverse child outcomes is not clear. This study examines the association between PAE in the general antenatal population and child neurodevelopment at 2 years, accounting for relevant contributing factors. METHODS This prospective population-based cohort recruited 1570 pregnant women, providing sociodemographic, psychological and lifestyle information and alcohol use for five time periods. PAE categories were 'low', 'moderate/high', 'binge', in trimester 1 or throughout pregnancy. Measures of cognitive, language and motor development (Bayley Scales of Infant and Toddler Development) were available for 554 children, while measures of sensory processing (Infant/Toddler Sensory Profile) and social-emotional development (Brief Infant Toddler Social Emotional Assessment) were available for 948. RESULTS A positive association in univariate analysis with low-level PAE throughout pregnancy and cognition (β=4.1, 95% CI -0.02 to 8.22, p=0.05) was attenuated by adjusting for environmental/social deprivation risk factors (β=3.06 (-1.19 to 7.30), p=0.16). Early binge drinking, plus continued PAE at lower levels, was associated with the child being more likely to score low in sensation avoidance (adjusted OR 1.88 (1.03 to 3.41), p=0.04). CONCLUSION Early binge exposure, followed by lower-level PAE, demonstrated an increase in sensation-avoiding behaviour. There were, however, no significant associations between PAE and neurodevelopment following adjustment for important confounders and modifiers. Follow-up is paramount to investigate subtle or later onset problems.
Collapse
Affiliation(s)
- Jane L Halliday
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Evelyne Muggli
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon Lewis
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth J Elliott
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Paediatrics and Child Health, Children's Hospital Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Amor
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Colleen O'Leary
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Susan Donath
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Della Forster
- School of Nursing and Midwifery, Judith Lumley Centre, SHE College, La Trobe University, Melbourne, Victoria, Australia.,Midwifery and Maternity Services Research Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Cate Nagle
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia.,Women's and Children's Division, Western Health, St Albans, Victoria, Australia
| | - Jeffrey M Craig
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter J Anderson
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| |
Collapse
|
13
|
Fitzpatrick JP, Pestell CF. Neuropsychological Aspects of Prevention and Intervention for Fetal Alcohol Spectrum Disorders in Australia. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2016. [DOI: 10.1007/s40817-016-0018-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
14
|
Lucas BR, Latimer J, Fitzpatrick JP, Doney R, Watkins RE, Tsang TW, Jirikowic T, Carmichael Olson H, Oscar J, Carter M, Elliott EJ. Soft neurological signs and prenatal alcohol exposure: a population-based study in remote Australia. Dev Med Child Neurol 2016; 58:861-7. [PMID: 26991727 DOI: 10.1111/dmcn.13071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/29/2022]
Abstract
AIM To identify soft neurological signs (SNS) in a population-based study of children living in remote Aboriginal communities in the Fitzroy Valley, Western Australia, born between 2002 and 2003 and explore the relationship between SNS, prenatal alcohol exposure (PAE), and fetal alcohol spectrum disorders (FASD). METHOD The presence of SNS was assessed using the Quick Neurological Screening Test, 2nd edition (QNST-2), which has a total maximum score of 140. Higher scores indicated more SNS. 'Severe discrepancy' was defined as scores less than or equal to the fifth centile while 'moderate discrepancy' represented scores from the sixth to the 24th centile. Children were assigned FASD diagnoses using modified Canadian FASD diagnostic guidelines. RESULTS A total of 108 of 134 (80.6%) eligible children (mean age 8y 9mo, SD=6mo, 53% male) were assessed. The median QNST-2 Total Score for all participants was within the normal category (19.0, range 4-66). However, the median QNST-2 Total Score was higher in children with than without (1) PAE (r=0.2, p=0.045) and (2) FASD (r=0.3, p=0.004). Half (8/16) of children scoring 'moderate discrepancy' and all (2/2) children scoring 'severe discrepancy' had at least three domains of central nervous system impairment. INTERPRETATION SNS were more common in children with PAE or FASD, consistent with the known neurotoxic effect of PAE. The QNST-2 is a useful screen for subtle neurological dysfunction indicating the need for more comprehensive assessment in children with PAE or FASD.
Collapse
Affiliation(s)
- Barbara R Lucas
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - James P Fitzpatrick
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Robyn Doney
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Rochelle E Watkins
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Tracey W Tsang
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Tracy Jirikowic
- Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Heather Carmichael Olson
- Seattle Children's Research Institute and University of Washington School of Medicine, Seattle, WA, USA
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, WA, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, WA, Australia
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, The Children's Hospital at Westmead, Clinical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
15
|
Passmore HM, Giglia R, Watkins RE, Mutch RC, Marriott R, Pestell C, Zubrick SR, Rainsford C, Walker N, Fitzpatrick JP, Freeman J, Kippin N, Safe B, Bower C. Study protocol for screening and diagnosis of fetal alcohol spectrum disorders (FASD) among young people sentenced to detention in Western Australia. BMJ Open 2016; 6:e012184. [PMID: 27334884 PMCID: PMC4932283 DOI: 10.1136/bmjopen-2016-012184] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/01/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Prenatal alcohol exposure can cause lifelong disability, including physical, cognitive and behavioural deficits, known as fetal alcohol spectrum disorders (FASD). Among individuals with FASD, engagement with justice services is common. Little is known about the prevalence of FASD among young people engaged with the Australian justice system. This study aims to establish FASD prevalence among sentenced young people in detention in Western Australia (WA), and use the findings to develop a screening tool for use among young people entering detention. Translation of these results will guide the management and support of young people in detention and will have significant implications on the lives of young people with FASD and the future of Australian youth justice services. METHODS AND ANALYSIS Any sentenced young person in WA aged 10-17 years 11 months is eligible to participate. Young people are assessed for FASD by a multidisciplinary team. Standardised assessment tools refined for the Australian context are used, acknowledging the language and social complexities involved. Australian diagnostic guidelines for FASD will be applied. Information is obtained from young people, responsible adults, teachers and custodial officers. Individualised results and management plans for each young person are communicated to the young person and responsible adult. Prevalence of FASD will be reported and multivariate methods used to identify variables most predictive of FASD and to optimise the predictive value of screening. ETHICS AND DISSEMINATION Approvals have been granted by the WA Aboriginal Health Ethics Committee, University of WA Human Research Ethics Committee, Department of Corrective Services, and Department for Child Protection and Family Support. Anonymised findings will be disseminated through peer-reviewed manuscripts, presentations and the media. Extensive consultation with stakeholders (including government agencies, detention centre staff, community service providers, the young people and their families or carers) will be ongoing until findings are disseminated and translated.
Collapse
Affiliation(s)
- Hayley M Passmore
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Roslyn Giglia
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- National Health and Medical Research Council Centre of Research Excellence “Reducing the Effects of Antenatal Alcohol on Child Health”, Perth, Western Australia, Australia
| | - Rochelle E Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- National Health and Medical Research Council Centre of Research Excellence “Reducing the Effects of Antenatal Alcohol on Child Health”, Perth, Western Australia, Australia
| | - Raewyn C Mutch
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia
- National Health and Medical Research Council Centre of Research Excellence “Reducing the Effects of Antenatal Alcohol on Child Health”, Perth, Western Australia, Australia
- Department of Health Western Australia, Child and Adolescent Health Service, Perth, Australia
| | - Rhonda Marriott
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia
| | - Carmela Pestell
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Psychology, The University of Western Australia, Perth, Western Australia, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- National Health and Medical Research Council Centre of Research Excellence “Reducing the Effects of Antenatal Alcohol on Child Health”, Perth, Western Australia, Australia
- Faculty of Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Candice Rainsford
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Noni Walker
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - James P Fitzpatrick
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- National Health and Medical Research Council Centre of Research Excellence “Reducing the Effects of Antenatal Alcohol on Child Health”, Perth, Western Australia, Australia
| | - Jacinta Freeman
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Natalie Kippin
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Bernadette Safe
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- National Health and Medical Research Council Centre of Research Excellence “Reducing the Effects of Antenatal Alcohol on Child Health”, Perth, Western Australia, Australia
- Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
16
|
Dietrich T, Rundle-Thiele S, Schuster L, Connor JP. A systematic literature review of alcohol education programmes in middle and high school settings (2000-2014). HEALTH EDUCATION 2016. [DOI: 10.1108/he-03-2014-0042] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Social marketing benchmark criteria were used to understand the extent to which single-substance alcohol education programmes targeting adolescents in middle and high school settings sought to change behaviour, utilised theory, included audience research and applied the market segmentation process. The paper aims to discuss these issues.
Design/methodology/approach
– A systematic literature review retrieved a total of 1,495 identified articles; 565 duplicates were removed. The remaining 930 articles were then screened. Articles detailing formative research or programmes targeting multiple substances, parents, families and/or communities, as well as elementary schools and universities were excluded. A total of 31 articles, encompassing 16 qualifying programmes, were selected for detailed evaluation.
Findings
– The majority of alcohol education programmes were developed on the basis of theory and achieved short- and medium-term behavioural effects. Importantly, most programmes were universal and did not apply the full market segmentation process. Limited audience research in the form of student involvement in programme design was identified.
Research limitations/implications
– This systematic literature review focused on single-substance alcohol education programmes targeted at middle and high school student populations, retrieving studies back to the year 2000.
Originality/value
– The results of this systematic literature review indicate that application of the social marketing benchmark criteria of market segmentation and audience research may represent an avenue for further extending alcohol education programme effectiveness in middle and high school settings.
Collapse
|
17
|
“If you can have one glass of wine now and then, why are you denying that to a woman with no evidence”: Knowledge and practices of health professionals concerning alcohol consumption during pregnancy. Women Birth 2015; 28:329-35. [DOI: 10.1016/j.wombi.2015.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 11/22/2022]
|
18
|
Mutch RC, Watkins R, Bower C. Fetal alcohol spectrum disorders: notifications to the Western Australian Register of Developmental Anomalies. J Paediatr Child Health 2015; 51:433-6. [PMID: 25412883 DOI: 10.1111/jpc.12746] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 11/29/2022]
Abstract
AIM There is increasing attention on fetal alcohol spectrum disorders (FASD) in Australia, but there are limited data on their birth prevalence. Our aim was to report on the birth prevalence of FASD in Western Australia. METHODS Data on notified cases of FASD born in Western Australia 1980-2010 were identified from the Western Australian Register of Developmental Anomalies. Tabulated denominator data were obtained from the Midwives Notification System. Prevalence rates per 1000 births were calculated by demographic variables. Prevalence ratios (PRs) and 95% confidence intervals (CIs) of Aboriginal compared with non-Aboriginal prevalence rates were calculated. PRs were also calculated to compare rates for births 2000-2010 with 1980-1989. RESULTS Two hundred ten cases of FASDs were identified: a birth prevalence of 0.26/1000 births (95% CI 0.23-0.30). The majority of cases reported were Aboriginal (89.5%), a rate of 4.08/1000, compared with 0.03/1000 in notified non-Aboriginal cases, giving a PR of 139 (95% CI 89-215). The prevalence of FASD in 2000-2010 was over twice that in 1980-1989 for both Aboriginal (PR 2.37; CI 1.60-3.51) and non-Aboriginal (PR 2.13; CI 0.68-6.69) children. CONCLUSIONS There has been a twofold increase in FASD notifications in Western Australia over the last 30 years. Population surveillance data such as these are valuable in advocating for and monitoring the effectiveness of preventive activities and diagnostic and management services.
Collapse
Affiliation(s)
- Raewyn C Mutch
- Paediatric and Adolescent Medicine/Refugee Health, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | | | | |
Collapse
|
19
|
Payne JM, Watkins RE, Jones HM, Reibel T, Mutch R, Wilkins A, Whitlock J, Bower C. Midwives' knowledge, attitudes and practice about alcohol exposure and the risk of fetal alcohol spectrum disorder. BMC Pregnancy Childbirth 2014; 14:377. [PMID: 25366388 PMCID: PMC4228156 DOI: 10.1186/s12884-014-0377-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/17/2014] [Indexed: 01/26/2023] Open
Abstract
Background Midwives are an influential profession and a key group in informing women about alcohol consumption in pregnancy and its consequences. There are no current quantitative Australian data on midwives’ knowledge, attitudes and practice in relation to alcohol consumption during pregnancy and Fetal Alcohol Spectrum Disorder. We aimed to reduce this knowledge gap by understanding midwives’ perceptions of their practice in addressing alcohol consumption during pregnancy. Methods This cross-sectional study was conducted at 19 maternity sites across the seven health regions of country Western Australia. A questionnaire was designed following review of the literature and other relevant surveys. Midwifery managers of the maternity sites distributed questionnaires to all midwives working in their line of management. A total of 334 midwives were invited to participate in the research and (n = 245, 73.4%) of these were eligible. Results The response fraction was (n = 166, 67.8%). Nearly all (n = 151, 93.2%) midwives asked pregnant women about their alcohol consumption during pregnancy and (n = 164, 99.4%) offered advice about alcohol consumption in accordance with the Australian Alcohol Guideline, which states “For women who are pregnant or planning a pregnancy, not drinking is the safest option”. Nearly two thirds (n = 104, 64.2%) of the midwives informed pregnant women about the effects of alcohol consumption in pregnancy, they did not always use the recommended AUDIT screening tool (n = 66, 47.5%) to assess alcohol consumption during pregnancy, nor conduct brief intervention when indicated (n = 107, 70.4%). Most midwives endorsed professional development about screening tools (n = 145, 93.5%), brief intervention (n = 144, 92.9%), and alcohol consumption during pregnancy and FASD (n = 144, 92.9%). Conclusion Nearly all midwives in this study asked and advised about alcohol consumption in pregnancy and around two thirds provided information about the effects of alcohol in pregnancy. Our findings support the need for further professional development for midwives on screening and brief intervention. Policy should support midwives’ practice to screen for alcohol consumption in pregnancy and offer brief intervention when indicated.
Collapse
|
20
|
Watkins RE, Elliott EJ, Wilkins A, Latimer J, Halliday J, Fitzpatrick JP, Mutch RC, O'Leary CM, Burns L, McKenzie A, Jones HM, Payne JM, D'Antoine H, Miers S, Russell E, Hayes L, Carter M, Bower C. Fetal alcohol spectrum disorder: development of consensus referral criteria for specialist diagnostic assessment in Australia. BMC Pediatr 2014; 14:178. [PMID: 25005425 PMCID: PMC4123492 DOI: 10.1186/1471-2431-14-178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is known to be under-recognised in Australia. The use of standard methods to identify when to refer individuals who may have FASD for specialist assessment could help improve the identification of this disorder. The purpose of this study was to develop referral criteria for use in Australia. METHOD An online survey about FASD screening and diagnosis in Australia, which included 23 statements describing criteria for referral for fetal alcohol syndrome (FAS) and FASD based on published recommendations for referral in North America, was sent to 139 health professionals who had expertise or involvement in FASD screening or diagnosis. Survey findings and published criteria for referral were subsequently reviewed by a panel of 14 investigators at a consensus development workshop where criteria for referral were developed. RESULTS Among the 139 health professionals who were sent the survey, 103 (74%) responded, and 90 (65%) responded to the statements on criteria for referral. Over 80% of respondents agreed that referral for specialist evaluation should occur when there is evidence of significant prenatal alcohol exposure, defined as 7 or more standard drinks per week and at least 3 standard drinks on any one day, and more than 70% agreed with 13 of the 16 statements that described criteria for referral other than prenatal alcohol exposure. Workshop participants recommended five independent criteria for referral: confirmed significant prenatal alcohol exposure; microcephaly and confirmed prenatal alcohol exposure; 2 or more significant central nervous system (CNS) abnormalities and confirmed prenatal alcohol exposure; 3 characteristic FAS facial anomalies; and 1 characteristic FAS facial anomaly, growth deficit and 1 or more CNS abnormalities. CONCLUSION Referral criteria recommended for use in Australia are similar to those recommended in North America. There is a need to develop resources to raise awareness of these criteria among health professionals and evaluate their feasibility, acceptability and capacity to improve the identification of FASD in Australia.
Collapse
Affiliation(s)
- Rochelle E Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Astley SJ. Invited commentary on Australian fetal alcohol spectrum disorder diagnostic guidelines. BMC Pediatr 2014; 14:85. [PMID: 24685275 PMCID: PMC3994222 DOI: 10.1186/1471-2431-14-85] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 03/27/2014] [Indexed: 11/28/2022] Open
Abstract
The publication of Australian fetal alcohol spectrum disorder (FASD) diagnostic guidelines marks an important step forward in Australia’s efforts to prevent FASD. But do we need yet another set of FASD guidelines? At the 5th International FASD Conference, the ever growing number of FASD diagnostic guidelines was identified as a core area of concern by leaders in FASD worldwide. All agreed we need to strive to adopt a single set of guidelines. It is essential that FASD diagnosis advance to incorporate new knowledge and technology. But to date, the field of FASD has seen multiple sets of guidelines published that do not address the important question-How is the performance of these new guidelines superior to the performance of existing guidelines to warrant/justify their introduction into the medical literature? The Australian guidelines include FAS, PFAS and Neurodevelopmental Disorder-Alcohol Exposed (ND-AE). This latter group includes individuals with severe CNS abnormalities without the physical features of FAS. This is the group the 4-Digit-Code calls Static-Encephalopathy-Alcohol-Exposed (SE-AE). The criteria for FAS, PFAS, and ND-AE (or what the 4-Digit-Code calls SE-AE) are identical between the Australian and 4-Digit-Code guidelines with the exception of one very small, but very consequential difference in facial criteria for PFAS. The 4-Digit-Code requires a Rank 3 FAS facial phenotype for PFAS (J Popul Ther Clin Pharmacol20(3):e416–e467, 2013); the Australian guidelines relax the criteria to include the Rank 2 FAS facial phenotype. This relaxation of the criteria renders the facial phenotype NOT specific to prenatal alcohol exposure as confirmed in published empirical studies. If the facial phenotype is not specific to (caused only by) prenatal alcohol exposure one can no longer validly call the outcome PFAS. When one makes a diagnosis of FAS (full or partial), one is stating explicitly that the individual has a syndrome caused by prenatal alcohol exposure. One is also stating explicitly that the biological mother drank alcohol during pregnancy and, as a result, harmed her child. These are bold conclusions to draw and are not without medical, ethical, and even legal consequences. So the question remains-Why go against the published empirical evidence and relax the PFAS facial criteria into the normal range?
Collapse
Affiliation(s)
- Susan J Astley
- FAS Diagnostic & Prevention Network, Center on Human Development and Disability, University of Washington, Box 357920, Seattle, WA 98195-7920, USA.
| |
Collapse
|
22
|
Bakhshi S, While AE. Health professionals' alcohol-related professional practices and the relationship between their personal alcohol attitudes and behavior and professional practices: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 11:218-48. [PMID: 24366045 PMCID: PMC3924442 DOI: 10.3390/ijerph110100218] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/05/2013] [Accepted: 12/09/2013] [Indexed: 12/12/2022]
Abstract
Health professionals' personal health behaviors have been found to be associated with their practices with patients in areas such as smoking, physical activity and weight management, but little is known in relation to alcohol use. This review has two related strands and aims to: (1) examine health professionals' alcohol-related health promotion practices; and (2) explore the relationship between health professionals' personal alcohol attitudes and behaviors, and their professional alcohol-related health promotion practices. A comprehensive literature search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, British Nursing Index, Web of Science, Scopus and Science Direct (2007-2013) identified 26 studies that met the inclusion criteria for Strand 1, out of which six were analyzed for Strand 2. The findings indicate that health professionals use a range of methods to aid patients who are high-risk alcohol users. Positive associations were reported between health professionals' alcohol-related health promotion activities and their personal attitudes towards alcohol (n = 2), and their personal alcohol use (n = 2). The findings have some important implications for professional education. Future research should focus on conducting well-designed studies with larger samples to enable us to draw firm conclusions and develop the evidence base.
Collapse
Affiliation(s)
- Savita Bakhshi
- Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | | |
Collapse
|
23
|
Watkins RE, Elliott EJ, Wilkins A, Mutch RC, Fitzpatrick JP, Payne JM, O'Leary CM, Jones HM, Latimer J, Hayes L, Halliday J, D'Antoine H, Miers S, Russell E, Burns L, McKenzie A, Peadon E, Carter M, Bower C. Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia. BMC Pediatr 2013; 13:156. [PMID: 24083778 PMCID: PMC3849849 DOI: 10.1186/1471-2431-13-156] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal alcohol spectrum disorders (FASD) are underdiagnosed in Australia, and health professionals have endorsed the need for national guidelines for diagnosis. The aim of this study was to develop consensus recommendations for the diagnosis of FASD in Australia. METHODS A panel of 13 health professionals, researchers, and consumer and community representatives with relevant expertise attended a 2-day consensus development workshop to review evidence on the screening and diagnosis of FASD obtained from a systematic literature review, a national survey of health professionals and community group discussions. The nominal group technique and facilitated discussion were used to review the evidence on screening and diagnosis, and to develop consensus recommendations for the diagnosis of FASD in Australia. RESULTS The use of population-based screening for FASD was not recommended. However, there was consensus support for the development of standard criteria for referral for specialist diagnostic assessment. Participants developed consensus recommendations for diagnostic categories, criteria and assessment methods, based on the adaption of elements from both the University of Washington 4-Digit Diagnostic Code and the Canadian guidelines for FASD diagnosis. Panel members also recommended the development of resources to: facilitate consistency in referral and diagnostic practices, including comprehensive clinical guidelines and assessment instruments; and to support individuals undergoing assessment and their parents or carers. CONCLUSIONS These consensus recommendations provide a foundation for the development of guidelines and other resources to promote consistency in the diagnosis of FASD in Australia. Guidelines for diagnosis will require review and evaluation in the Australian context prior to national implementation as well as periodic review to incorporate new knowledge.
Collapse
Affiliation(s)
- Rochelle E Watkins
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, P,O, Box 855, West Perth, WA 6872, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Watkins RE, Elliott EJ, Halliday J, O’Leary CM, D’Antoine H, Russell E, Hayes L, Peadon E, Wilkins A, Jones HM, McKenzie A, Miers S, Burns L, Mutch RC, Payne JM, Fitzpatrick JP, Carter M, Latimer J, Bower C. A modified Delphi study of screening for fetal alcohol spectrum disorders in Australia. BMC Pediatr 2013; 13:13. [PMID: 23347677 PMCID: PMC3583688 DOI: 10.1186/1471-2431-13-13] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 01/21/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is little reliable information on the prevalence of fetal alcohol spectrum disorders (FASD) in Australia and no coordinated national approach to facilitate case detection. The aim of this study was to identify health professionals' perceptions about screening for FASD in Australia. METHOD A modified Delphi process was used to assess perceptions of the need for, and the process of, screening for FASD in Australia. We recruited a panel of 130 Australian health professionals with experience or expertise in FASD screening or diagnosis. A systematic review of the literature was used to develop Likert statements on screening coverage, components and assessment methods which were administered using an online survey over two survey rounds. RESULTS Of the panel members surveyed, 95 (73%) responded to the questions on screening in the first survey round and, of these, 81 (85%) responded to the second round. Following two rounds there was consensus agreement on the need for targeted screening at birth (76%) and in childhood (84%). Participants did not reach consensus agreement on the need for universal screening at birth (55%) or in childhood (40%). Support for targeted screening was linked to perceived constraints on service provision and the need to examine the performance, costs and benefits of screening.For targeted screening of high risk groups, we found highest agreement for siblings of known cases of FASD (96%) and children of mothers attending alcohol treatment services (93%). Participants agreed that screening for FASD primarily requires assessment of prenatal alcohol exposure at birth (86%) and in childhood (88%), and that a checklist is needed to identify the components of screening and criteria for referral at birth (84%) and in childhood (90%). CONCLUSIONS There is an agreed need for targeted but not universal screening for FASD in Australia, and sufficient consensus among health professionals to warrant development and evaluation of standardised methods for targeted screening and referral in the Australian context. Participants emphasised the need for locally-appropriate, evidence-based approaches to facilitate case detection, and the importance of ensuring that screening and referral programs are supported by adequate diagnostic and management capacity.
Collapse
Affiliation(s)
- Rochelle E Watkins
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
- The Children’s Hospital at Westmead, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Jane Halliday
- Public Health Genetics, Genetic Disorders, Murdoch Childrens Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Colleen M O’Leary
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
- Centre for Population Health Research, Curtin University, Perth, Australia
| | - Heather D’Antoine
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Elizabeth Russell
- Russell Family Fetal Alcohol Disorders Association, Cairns, Australia
| | - Lorian Hayes
- Centre for Chronic Disease, School of Medicine, University of Queensland, Brisbane, Australia
| | - Elizabeth Peadon
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
- The Children’s Hospital at Westmead, Sydney, Australia
| | - Amanda Wilkins
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
- Child and Adolescent Health Service, Department of Health Western Australia, Perth, Australia
| | - Heather M Jones
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Anne McKenzie
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Sue Miers
- National Organisation for Fetal Alcohol Syndrome and Related Disorders, Adelaide, Australia
| | - Lucinda Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Raewyn C Mutch
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
- Child and Adolescent Health Service, Department of Health Western Australia, Perth, Australia
| | - Janet M Payne
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - James P Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - Jane Latimer
- The George Institute for Global Health, Sydney, Australia
| | - Carol Bower
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
| |
Collapse
|
25
|
Sulik KK, O’Leary-Moore SK, Charness ME, Riley EP. ‘Better safe than sorry’- better for whom? BJOG 2012. [DOI: 10.1111/j.1471-0528.2012.03497.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
26
|
Health professionals' perceptions about the adoption of existing guidelines for the diagnosis of fetal alcohol spectrum disorders in Australia. BMC Pediatr 2012; 12:69. [PMID: 22697051 PMCID: PMC3416706 DOI: 10.1186/1471-2431-12-69] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 06/14/2012] [Indexed: 11/10/2022] Open
Abstract
Background Despite the availability of five guidelines for the diagnosis of fetal alcohol spectrum disorders (FASD), there is no national endorsement for their use in diagnosis in Australia. In this study we aimed to describe health professionals’ perceptions about the adoption of existing guidelines for the diagnosis of FASD in Australia and identify implications for the development of national guidelines. Methods We surveyed 130 Australian and 9 international health professionals with expertise or involvement in the screening or diagnosis of FASD. An online questionnaire was used to evaluate participants’ familiarity with and use of five existing diagnostic guidelines for FASD, and to assess their perceptions about the adoption of these guidelines in Australia. Results Of the 139 participants surveyed, 84 Australian and 8 international health professionals (66.2%) responded to the questions on existing diagnostic guidelines. Participants most frequently reported using the University of Washington 4-Digit Diagnostic Code (27.2%) and the Canadian guidelines (18.5%) for diagnosis. These two guidelines were also most frequently recommended for adoption in Australia: 32.5% of the 40 participants who were familiar with the University of Washington 4-Digit Diagnostic Code recommended adoption of this guideline in Australia, and 30.8% of the 26 participants who were familiar with the Canadian guidelines recommended adoption of this guideline in Australia. However, for the majority of guidelines examined, most participants were unsure whether they should be adopted in Australia. The adoption of existing guidelines in Australia was perceived to be limited by: their lack of evidence base, including the appropriateness of established reference standards for the Australian population; their complexity; the need for training and support to use the guidelines; and the lack of an interdisciplinary and interagency model to support service delivery in Australia. Conclusions Participants indicated some support for the adoption of the University of Washington or Canadian guidelines for FASD diagnosis; however, concerns were raised about the adoption of these diagnostic guidelines in their current form. Australian diagnostic guidelines will require evaluation to establish their validity in the Australian context, and a comprehensive implementation model is needed to facilitate improved diagnostic capacity in Australia.
Collapse
|