CDC Update:

Current Advances in FASD Prevention and Intervention

FASDsoutheast Train the Trainer Program

November 16, 2012

National Center on Birth Defects and Developmental Disabilities

Fetal Alcohol Syndrome Prevention Team

Elizabeth P. Dang, MPHFAS Prevention Team

Prevention Research BranchDivision of Birth Defects and Developmental Disabilities

What’s new?

Data Prevention Intervention Health promotion/education

Alcohol Use and Binge Drinking among Women of Childbearing Age - United

States, 2006-2010

7.6% of pregnant women and 51% of nonpregnantwomen reported drinking alcohol in the past 30 days

Among pregnant women, the highest estimatesof use were among those who were: Aged 35-44 years (14.3%) White (8.3%) College graduates (10.0%) Employed (9.6%)

1.4% of pregnant women and 15.0% of nonpregnant womenreported binge drinking in the past 30 days

Among pregnant and nonpregnant binge drinkers: Average frequency: ~ 3 times per month Average intensity: ~ 6 drinks per occasion

Current Prevention Activities

Alcohol SBI Alcohol SBI implementation guides Implementation of alcohol SBI through

FASD Regional Training Centers CityMatCH Practice Collaborative BRFSS module on alcohol SBI Alcohol SBI stakeholder meeting

CHOICES implementation & dissemination

Alcohol SBI Implementation Guides

Primary Care Adapted from SBI for Unhealthy Alcohol Use: A Step-by-

Step Implementation Guide for Trauma Centers To be piloted/evaluated through FASD Regional Training

Centers

Ob-gyn settings Through ACOG contract

Pediatric settings serving adolescents Exploring with AAP

Alcohol SBI Implementation Guide for Primary Care

Provides practical, step-by-step process that primary care settings can use to implement alcohol SBI

American College of Obstetricians and Gynecologists

2010-2011: Worked with ACOG to: Assess the 2006 FASD Prevention Toolkit

Resulted in new resources for women’s health care providers

New website: www.womenandalcohol.org Resources include:

• Pocket card• Cell phone app on screening/brief intervention• ACOG Committee Opinion on At Risk Alcohol

Use Tips for working with women who

drink….and more

SBI Implementation Guide for Ob-gyn Settings

ACOG developing alcohol SBI implementation guide for ob-gyn settings

Piloted in 3 settings in New York: Omni Women’s Health Group - Buffalo Segundo Ruiz Belvis Diagnostic & Treatment

Center - Bronx Albany Medical Center – Albany

Using newly developed materials

FASD Regional Training Centers (RTCs)

New cycle funded in 2011 to continue core training activities but with a new emphasison alcohol SBI 5 RTCs were funded

Move beyond training to implementation of alcohol SBI in primary care systems

3 of the RTCs recently awarded supplemental funding for implementation of alcohol SBI (2012-2014)

FASD RTCs: SBI implementation projects

Southeast FASD RTC (Tennessee) 2 Meharry Medical College Family Medicine Clinics

(FMCs)• Skyline and Meharry FMCs

Frontier FASD RTC (Nevada) University Health System, University of Nevada School

of Medicine• Women’s Health Care Center (Las Vegas)• Family Medical Center, Student Health Center,

Student Outreach Center (Reno)

Arctic FASD RTC (Alaska) Planned Parenthood of the Great Northwest

• Anchorage Health Center• Soldotna Health Center

FASD RTCs : SBI implementation projects (cont’d)

Incorporate alcohol SBI into day-to-day clinical practice

Identify barriers and facilitators to implementation

Identify methods to overcome/create solutions to barriers

Evaluate uptake of alcohol SBI in the implementation sites

Evaluate the primary care SBI implementation guide

CityMatCH Practice Collaborative Project

Pilot a practice collaborative model to address alcohol and other substance use among women of reproductive age Increase awareness and education among providers

about risks/effects Enhance capacity of providers to deliver SBI or refer to

services

Six Practice Collaborative Teams Sites in FL, OR, CO, MD, CA, OH Team plans and/or activities currently underway Plan to share Practice Collaborative lessons learned

Alcohol SBI BRFSS Module

Drafted optional module for 2014 BRFSS

Completed 3 rounds of cognitive testing

Questions include: If a doctor/HC professional asked about alcohol use If you were asked how much you drink (in general and

per occasion) If you were offered advice about what’s harmful/risky If you were advised to reduce your drinking

Insights from the Demand Side: Making the Case for Alcohol Screening

and Brief Intervention (SBI)

Convened Planning Team CDC, ACOG, NOFAS, several consultants

August 14, 2012 in Atlanta GA Meeting Purposes:

Better understand how best to “make the case” for alcohol SBI

Identify which organizations would support implementation of a new policy/health program advancing alcohol SBI within primary care settings and find out what they would need

Is a public-private partnership the right approach? Next steps for ongoing dialogue about how to advance

alcohol SBI

Insights from the Demand Side

Employers

Insurers

Business Groups

Academia

Federal Partners

Other organizations

Meeting Agenda

Introduction & Welcome

Brief Presentations:- What’s the problem?- What is alcohol SBI anyway?- What are the economic costs? - Alcohol SBI as a prevention priority

Group Discussions:- Did this information adequately make the case? - Is a public-private partnership a good way to advance alcohol SBI implementation?- Next steps

Questions from meeting observersFeedback from federal partners

Key Themes

Awareness about risky drinking

Integration/bundling of services

Better data needed

Not just physicians/electronic SBI

Demonstration projects (provider/insurer/business)

Engage professional groups

Coordinated efforts

Potential Next Steps

Explore issues around communication/messaging

Address data issues

Support SBI demonstration projects from the insurer/business perspective

Increase engagement of professional groups

Strengthen federal linkages related to SBI

Insights from the Demand Side

CHOICES: Now available!

www.cdc.gov/fasd “Free Materials” link

Counselor Manual Client Workbook Assessment Tools Training Curriculum Training videos Web page (TBA)

CHOICES Implementation Efforts

Sexually Transmitted Diseases (STD) clinics Baltimore City Health Department CO Department of Health & Environment/Denver Health

Family Planning/Community Health Centers AltaMed Corporation in LA (3 clinics) New York Health and Hospital Corporation in NYC (4

clinics)

Oglala Sioux Tribe in South Dakota

Choices Plus (Choices + smoking cessation) University of Texas at Austin

Recent Intervention Activities

Interventions for Children with FASDs Intervening with Youth and Young Adults

with FASDs Collaboration with ACF

Intervention Materials/Training available at:

Mile: Marcus Autism Centerhttp://marcus.org

PACT:Children’s Research Trianglehttp://childstudy.org

Good BuddiesU. of California, Los Angeleshttp://http://www.semel.ucla.edu/fas/

Families Moving ForwardChildren’s Hospital, Seattle http://depts.washington.edu/fmffasd

Example of Intervention Materials: Families Moving Forward Program

BEFORE AFTER

Example of Intervention Materials:Parents and Children Together (PACT)

Intervening with Youth and Young Adults with FASDs

Purpose: to support innovative research of interventions for youth and young adults (aged 12-25 years) with FASDs Randomized control design (at least 50 per group)

Funded: UCLA and Saint Louis University UCLA – targets alcohol misuse/abuse SLU – targets externalizing behaviors & life skills

Studies wrapping up

Collaboration with Administration for Children & Families

Analysis of datasets to determine prevalence of FASDs and DDs in foster/adoptive care

Develop/disseminate ACF Informational Memorandum regarding FASDs and LTSAE to foster/adoptive and child welfare agencies and regions

Research into identifying children with FASDs and DDs in foster/adoptive care

Systematic ongoing dissemination of LTSAE and FASD information

Health Promotion and Education

American Academy of Pediatrics

CDC is working with AAP on a variety of activities: Professional education materials to inform pediatricians

about prevention, identification, and treatment of children with FASDs

Visiting Professorship Program – connection with FASD Regional Training Centers (5 AAP chapters in 2011)

FASD Risk Communication Workshop – July 2012 Information dissemination to members through AAP

OnCall, AAP SmartBriefs, and AAP News

Enhanced Resources for FASD Prevention and Intervention through National Networking, Education, &

Dissemination

Four-year cooperative agreement (2010-2014) with NOFAS: Enhance/expand the NOFAS National & State Resource

Directory Engage/enhance affiliate and stakeholder networks Enhance/expand the NOFAS Information Clearinghouse

and disseminate resources/materials Conduct media outreach New in 2013:

• Develop plan to engage American Indian communities re: dissemination of CHOICES• Promote evidence-based interventions for children with FASDs

FASD Regional Training Centers (RTCs)

Purpose: to educate medical and allied health students and practitioners in the prevention, identification, and treatment of FASDs

Previous Cycle of RTCs (2008-2011) In 2008, awarded 5 cooperative agreements Conducted 724 trainings/events Reached 7,140 students/residents and 10,631

health care professionals New funding cycle (2011-2014)

5 cooperative agreements Continue core training activities 3 RTCs recently funded to implement SBI in primary care

system

Washington

Montana

Oregon

Nevada

California

Utah

Arizona

New Mexico

Colorado

Idaho

Wyoming

North Dakota

South Dakota

Minnesota

IowaNebraska

Kansas

TexasFlorida

Mississippi

Louisiana

Alabama

Georgia

South Carolina

North Carolina

Virginia

Maine

New York

Michigan

Wisconsin

Oklahoma

Missouri

Arkansas

Tennessee

Kentucky

IllinoisIndiana

Michigan

Ohio

West Virginia

DC

Maryland

Delaware

New Jersey

Vermont

Rhode Island

Connecticut

New Hampshire

Massachusetts

Alaska

Hawaii

Pennsylvania

FASD Regional Training Centers 2011-2014

Arctic RTC, Univ of Alaska AnchorageMidwestern RTC, Saint Louis Univ

Great Lakes RTC, Univ of Wisconsin

Southeastern RTC, Meharry Medical College

Frontier RTC, Univ of Nevada Reno

Messages & Materials for Women on Alcohol Use in Pregnancy

Conducted formative research to explore women’s knowledge and beliefs about alcohol use and pregnancy 20 focus groups with women of childbearing age, March

2010 Manuscript in press at American Journal of Health

Education Inform development of new CDC materials

on alcohol use in pregnancy and FASDs Developed and tested concepts/messages/materials for

women of childbearing age Focus groups occurred recently (June 2012)

Next Steps Translate findings into new messages/materials

Recently Tested….

Multimedia & Tools

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Questions?www.cdc.gov/fasd

Thank you!edang@cdc.gov

National Center on Birth Defects and Developmental Disabilities

Fetal Alcohol Syndrome Prevention Team