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Green CR, Harding KD, Unsworth K, Kaminsky K, Roberts N, Nagpal TS, Cook JL. Reporting on Health Care and Social Service Provider Approaches to Promoting Alcohol Abstinence During Pregnancy. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:422-433. [PMID: 38713493 DOI: 10.1080/19371918.2024.2323136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Despite the known detrimental health effects of alcohol use during pregnancy, there are still health care (HCP) and social service providers (SSP) who do not promote complete abstinence. The purpose of this study was to explore the current practices of HCPs and SSPs when discussing alcohol use during pregnancy, and to understand their rationale for their specific recommendations. An online survey was completed by 1123 HCPs (n = 588) and SSPs (n = 535) that asked them to identify their approach to discussing alcohol and pregnancy. Participants had the option to further explain their current recommendations regarding alcohol use during pregnancy in an open-ended format. Open-ended responses were analyzed using a content analysis approach (n = 156). The majority of respondents recommend abstinence (83.9% of HCPs, n = 493; 78.4% of SSPs, n = 419), while 9.8% of HCPs (n = 57) and 2.2% of SSPs (n = 12) responded that low levels of consumption may be acceptable. HCPs may recommend low levels of consumption based on other international guidelines, limited evidence to suggest that one unit of alcohol is harmful, and as a harm reduction strategy. SSPs stated that they refer clients to HCPs for recommendations related to alcohol consumption, and that they prefer to provide information based on public health guidelines. This exploratory work may inform the development of resources to support HCPs and SSPs to recommend abstinence from alcohol throughout gestation.
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Affiliation(s)
- Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
| | - Kelly D Harding
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
- Psychology Department, Laurentian University, Sudbury, ON, Canada
| | - Kathy Unsworth
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
| | - Kyla Kaminsky
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
| | | | - Taniya S Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada
- The Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC Canada
- The University of Ottawa, Ottawa, ON, Canada
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Kerimofski KL, Panton KR, Pestell CF. Australian psychologists' knowledge, confidence, and practices in fetal alcohol spectrum disorder diagnostic assessment. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:653-666. [PMID: 38316430 DOI: 10.1111/acer.15275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a neurodevelopmental disorder caused by prenatal alcohol exposure (PAE). There are many documented barriers to FASD diagnostic assessment, including a limited number of trained clinicians. This study aimed to establish baseline levels of Australian psychologists' knowledge and practices in FASD assessment to develop training and improve future diagnostic capacity. METHODS An online survey was completed by 106 Australian psychologists. The survey elicited respondents' demographics, knowledge about FASD, confidence in various aspects of assessment and perceived future training needs. RESULTS Respondents reported a broad understanding of the FASD diagnostic term and potential harm of prenatal alcohol exposure (PAE). However, most respondents were not confident in their ability to conduct the psychometric assessments that provide a diagnostic assessment of FASD or ask about PAE. There was a significant positive correlation between the number of correct knowledge items and the psychologists' confidence in conducting FASD assessments. The clinical neuropsychologists demonstrated significantly greater knowledge and confidence in applying FASD diagnostic criteria and assessing PAE than school, clinical, and other psychologists. Most psychologists were more confident in their ability to apply the diagnostic criteria for other neurodevelopmental disorders. CONCLUSIONS Recognition of FASD is growing in Australia, however, further work is required to improve clinicians' understanding of and confidence in completing FASD assessments. Most participants indicated a preference for online training to learn more about FASD assessment.
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Affiliation(s)
- Katherine L Kerimofski
- School of Psychological Science, University of Western Australia (WA), Crawley, Western Australia, Australia
| | - Kirsten R Panton
- School of Psychological Science, University of Western Australia (WA), Crawley, Western Australia, Australia
| | - Carmela F Pestell
- School of Psychological Science, University of Western Australia (WA), Crawley, Western Australia, Australia
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Dahl B, Johannessen A, Bondas T. Opening Pandora's box: A meta-ethnography about alcohol use in pregnancy from midwives' and other healthcare providers' perspectives. Eur J Midwifery 2023; 7:14. [PMID: 37405231 PMCID: PMC10316433 DOI: 10.18332/ejm/166189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/28/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION Alcohol consumption has increased in recent years, including among women of childbearing age. A woman's alcohol intake during pregnancy is linked to complications and injuries in the newborn, and the risk of the child being harmed by the mother's alcohol use increases in proportion to the amount of alcohol she consumes. This meta-ethnography aims to explore midwives' and other healthcare providers' experiences of screening pregnant women for alcohol use in pregnancy and counselling them on the subject. METHODS A systematic literature search in CINAHL, Maternity & Infant Care, MEDLINE, and Scopus was conducted in August 2021 and updated in January 2023. The CASP checklist was used to assess the included articles and meta-ethnography was used to synthesize the data. RESULTS Fourteen qualitative studies were included. In the synthesis, we use the metaphor of Pandora's box to deepen our understanding of the topic. We found that some healthcare providers tiptoe around the box, not wanting to face the consequences and responsibilities of asking women about their alcohol use. Others refuse or are reluctant to open the box because they lack knowledge about screening and counselling. Some eventually open the box, understanding the importance of establishing a trusting relationship to address alcohol use and seeing the need for knowledge and screening tools. CONCLUSIONS Healthcare education has the important task of ensuring that healthcare personnel have sufficient evidence-based knowledge about alcohol use in pregnancy. In the future, a health-promoting, tailored approach offering women in pre-pregnancy and early pregnancy sufficient evidence-based information should be implemented.
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Affiliation(s)
- Bente Dahl
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Aud Johannessen
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Terese Bondas
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Curran WC, Danbrook MC. Hearing the voice of child welfare social workers: planning safe care for a child with or suspected of having fetal alcohol spectrum disorders (FASDs). ADVANCES IN DUAL DIAGNOSIS 2023. [DOI: 10.1108/add-04-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Purpose
In the early 1970s, clinical evidence emerged documenting causal links between prenatal alcohol exposure (PAE) and children’s behaviors as observed by child welfare social workers (CWSWs). Unfortunately, fetal alcohol spectrum disorders (FASD) remain on the margins of public health priorities. The purpose of this study was to elicit the views of child welfare social workers when responding to case of or suspected FASD.
Design/methodology/approach
A sample (N = 18) of CWSWs, allied health professionals and foster parents were interviewed.
Findings
Findings indicate that social workers struggle with their statutory duty to plan safe care for children with or suspected of having FASD. Emergent themes include struggling with advocacy, professional devaluation and lack of procedural guidance.
Practical implications
Social workers need a clear pathway and FASD knowledge to guide their interventions and enhance their capacity to advocate for affected children.
Originality/value
An abundance of research documents the direct effect of PAE on physical, cognitive and behavioral outcomes. However, few studies focus on the critical interface of children with an FASD entering public care and the social workers responsible for planning their safe care. This study sought to document social workers’ response to this vulnerable cohort of children.
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Fletcher T, Mullan B, Finlay-Jones A. Perceptions of two different alcohol use behaviours in pregnancy: an application of the prototype/willingness model. Health Psychol Behav Med 2022; 10:1071-1085. [PMID: 36388869 PMCID: PMC9645282 DOI: 10.1080/21642850.2022.2143362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: This study explored whether exposure to either an ‘ambiguous consumption’ prototype (no amount of alcohol specified) or a ‘small consumption’ prototype (‘small’ amount of alcohol specified) had an impact on prototype perceptions of, and willingness to use, small amounts of alcohol during pregnancy. Method: Participants were 140 women living in the UK, aged 20–45 years old, of whom 92% had previously been, or intended to become, pregnant. Participants completed measures to assess how favourably they viewed alcohol use in pregnancy, how similar they felt to those who would use alcohol in pregnancy and how responsible they perceived those who would use alcohol in pregnancy to be. Participant’s own willingness to use small amounts of alcohol during pregnancy was also assessed. Results: Having at least one child was positively correlated with being willing to accept an alcoholic drink while pregnant for those exposed to the ‘ambiguous consumption’ prototype only. Although perceptions of favourability, similarity and responsibility were consistently higher for those exposed to a ‘small consumption’ condition, there were no differences in willingness to drink according to exposure. Conclusion: This research suggests that women’s perceptions of those who drink alcohol while pregnant differ according to the amount of alcohol that they perceive as typical. This may have implications for how alcohol use in pregnancy is portrayed in public health messaging, particularly regarding the level of acceptance that may be associated with low to moderate alcohol use.
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Affiliation(s)
- Tess Fletcher
- FASD Research Australia Centre for Research Excellence, Telethon Kids Institute, Nedlands, Australia
- Enable Institute, Curtin University, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
| | | | - Amy Finlay-Jones
- FASD Research Australia Centre for Research Excellence, Telethon Kids Institute, Nedlands, Australia
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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.
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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
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Green CR, Kaminsky KJ, Tough S, Roberts N, Nagpal TS, Cook JL. Perspectives of Canadian Health Care Providers on Fetal Alcohol Spectrum Disorder: Has Anything Changed in 15 years? A Brief Report. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:1086-1089. [PMID: 33581349 DOI: 10.1016/j.jogc.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Abstract
Initiatives have been implemented to provide training to health care providers (HCPs) on the adverse health outcomes associated with alcohol use during pregnancy, including the risk of fetal alcohol spectrum disorder (FASD). The purpose of this exploratory study was to compare two cross-sectional data sets of HCP perspectives over 15 years. In 2002 and 2017, two samples of HCPs received a survey on FASD. The findings from these surveys may inform the development of ongoing educational initiatives to help HCPs with screening for alcohol use during pregnancy and early diagnosis and prevention of FASD.
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Affiliation(s)
- Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Kyla J Kaminsky
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Suzanne Tough
- Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Nicole Roberts
- Better Outcomes Registry & Network (BORN) Ontario, Centre for Practice-Changing Research, Ottawa, ON
| | - Taniya S Nagpal
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Jocelynn L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON.
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Burd L, Popova S. Fetal Alcohol Spectrum Disorders: Fixing Our Aim to Aim for the Fix. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3978. [PMID: 31635265 PMCID: PMC6843765 DOI: 10.3390/ijerph16203978] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/12/2019] [Indexed: 11/20/2022]
Abstract
We, as editors of this special issue on Fetal Alcohol Spectrum Disorders (FASD), are proud to present eleven papers [...].
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Affiliation(s)
- Larry Burd
- North Dakota Fetal Alcohol Syndrome Center, Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Pediatric Therapy Services, Altru Health System, Grand Forks, ND 58202, USA.
| | - Svetlana Popova
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, (CAMH), Toronto, ON M6J 1H4, Canada.
- Epidemiology Division, Office of Global Public Health Education & Training, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada.
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON M5S 1A1, Canada.
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