An Overview of CDC’s FASD Resources You Can Use

An Overview of CDC’s FASD
Prevention & Intervention Efforts:
Resources You Can Use
FASD: Best Practices in the Last Frontier
Anchorage, Alaska
May 23, 2013
Claire M. Marchetta, MPH
Nancy Cheal, MS, PhD
Elizabeth P. Dang, MPH
National Center on Birth Defects and Developmental Disabilities
Fetal Alcohol Syndrome Prevention Team
What ’s new?
Prevention and Intervention
Health promotion/education
National fertility survey for the US
 Women 18-44 years old
NCBDDD is a supporting agency of the National Survey of
Family Growth and serves as one of its funders
The collaboration with the NSFG Team (National Center for
Health Statistics—NCHS) gives NCBDDD an opportunity to
assess AEP risk among U.S. women of childbearing age
Questions are based off of BRFSS core alcohol questions
Currently being collected
Development of new question module
 2014 BRFSS
Questions focus on alcohol screening and brief
If a doctor/HC professional asked about alcohol use
If you were asked how much you drink (in general/per occasion)
If you were offered advice about what’s harmful/risky
If you were advised to reduce your drinking
Public use data
 By state
 Aggregated to represent the US population
Alcohol Use and Binge Drinking among Women of
Childbearing Age - United States, 2006-2010
7.6% of pregnant women and 51% of nonpregnant
women reported drinking alcohol in the past 30 days
Among pregnant women, the highest estimates
of 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 women
reported 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
Vital Signs: Binge Drinking Among Women and
High School Girls — United States, 2011
Among w om en ≥18 years
Among high school girls
Prevalence:12.5% (1 in 8)
Frequency: 3.2 episodes/month
Intensity: 5.7 drinks on occasion
Prevalence: 20% (1 in 5)
Who is most likely to binge drink?
Women aged 18-34 years and high school girls
Whites and Hispanics
Women with household incomes about $75,000
FASNet II Surveillance
3 funded sites (2009-2015)
 Western New York
 Metropolitan Denver
 Arizona
Records based system
 Hospital
 Medical
 FASD diagnostic clinics
Point prevalence (2010)
Ages 7-9 years of age
 Prevalence estimates anticipated 2014
Prevention Status Report: Excessive Alcohol Use
10 important health topics
JULY: Healthcare-associated Infections, Tobacco Use
AUGUST: Prescription Drug Overdose, Food Safety
SEPTEMBER: Heart Disease and Stroke
OCTOBER: Excessive Alcohol Use; HIV; Motor Vehicle Injuries;
Nutrition, Physical Activity, and Obesity; Teen Pregnancy
The Public Health Problem
Policy and Practice Solutions
Status of Policy and Practice Solutions, by state
 Rating: Green, Yellow, Red
Indicator definitions
Prevention & Intervention
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
CHOICES: Expanding Availabilit y of Resources
 “Free Materials” link
Counselor Manual
Client Workbook
Assessment Tools
Training Curriculum
Training videos
Web page (TBD)
ToT curriculum
Making (and Understanding) the Case
for Alcohol Screening
and Brief Intervention (SBI)
Initial “Demand” meeting on 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
Key Themes
Potential Next Steps
Awareness about risky drinking
Explore issues around
Integration/bundling of services
Address data issues
Better data needed
Not just physicians/electronic
Demonstration projects
Engage professional groups
Coordinated efforts
Support SBI demonstration
projects from the
insurer/business perspective
Increase engagement of
professional groups
Strengthen federal linkages
related to SBI
Alcohol Screening and Brief Intervention:
Practice Implications
Work with Providers
 October 29, 2012 meeting with SAMHSA’s
SBIRT Residency Program Representatives
Work with RTCs
 Funded pilot projects
Develop Implementation Guides
Alcohol SBI Implementation Guides
Primary Care
 Adapted from SBI for Unhealthy Alcohol Use: A Step-by-Step
Implementation Guide for Trauma Centers
 Currently being piloted/evaluated through FASD Regional Training
Ob-gyn settings
 Through ACOG contract
Pediatric settings serving adolescents
 Exploring with AAP
Advancing Alcohol SBI & CHOICES in
American Indian and Alaska Native Populations
through Training & Technical Assistance
Focus is on building capacity in 2 organizations to provide
Training and TA to clinics serving AI/AN clients
Clinics will offer CHOICES and alcohol SBI
Each funded organization will work with 3 primary care
Clinics will screen all men and women and provide
appropriate intervention
Intervention Activities for Children & Youth
Interventions for Children with FASDs
Intervening with Youth and Young Adults with FASDs
Collaboration with ACF
Interventions for Children with FASDs
Emory University
Children’s Research Triangle
Good Buddies
U. of California, Los Angeles
Families Moving Forward
Children’s Hospital, Seattle
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
Identification of national datasets that may facilitate determining
the burden of FASDs and DDs in foster/adoptive care settings
Capitalize on ACF informational channels to disseminate
information on FASDs and LTSAE to foster/adoptive and child
welfare agencies and regions
Assistance with electronic version (and subsequent validation of )
the Survey of Wellbeing in Young Children (SWYC), a public use
(i.e., no cost) developmental screener. Working to include
questions on prenatal exposures.
Health Promotion and Education
FASD Regional Training Centers (RTCs)
Purpose: to educate medical and allied health students and
practitioners in the prevention, identification, and treatment of FASDs
Current funding cycle (2011-2014)
 5 cooperative agreements
 Core training activities
 3 RTCs implementing alcohol SBI in primary
care systems
Data Collection
 2008-2011
• Conducted 724 trainings/events
• Reached 7,140 students/residents and 10,631 health care professionals
 Knowledge, comfort, self-efficacy, practice behaviors
FASD Regional Training Centers,
North Dakota
South Dakota
New York
Rhode Island
New Jersey
North Carolina
New Mexico
Arctic RTC, Univ of Alaska Anchorage
Midwestern RTC, Univ of Missouri
Great Lakes RTC, Univ of Wisconsin
Southeastern RTC, Meharry Medical College
Frontier RTC, Univ of Nevada Reno
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 & Patient Care Center (Las Vegas)
• Family Medical Center, Student Health Center,
Student Outreach Center (Reno)
Arctic FASD RTC (Alaska)
 State of Alaska, Section of Public Health Nursing
• Fairbanks
• Ketchikan
• Mat-Su/Wasilla
FASD RTCs : SBI implementation projects (cont ’d)
Incorporate alcohol SBI into day-to-day clinical
Identify barriers and facilitators to implementation
Identify methods to overcome/create solutions to
Evaluate uptake of alcohol SBI in the
implementation sites
Evaluate the primary care SBI implementation
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
 PediaLink online training course
 AAP FASD Toolkit –
 Visiting Professorship Program – connection with FASD Regional
Training Centers (5 AAP chapters in 2013)
 FASD Risk Communication Workshop / Joint Call to Action
 Information dissemination to members through AAP OnCall,
AAP SmartBriefs, and AAP News
 ARND work group
 Alcohol SBI for adolescents work group
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:
 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
NOFAS Clearinghouse & Media Center
Four-year cooperative agreement (2010-2014) with
 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 AI/AN
communities re: dissemination of CHOICES
• Promote evidence-based interventions for
children with FASDs
Messages & Materials for Women:
Alcohol Use in Pregnancy
Conducted formative research to explore women’s
knowledge and beliefs about alcohol use and
 20 focus groups
 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
 8 focus groups
Next Steps
 Finalizing new messages/materials
Recently Tested….
Multimedia & Tools
Thank you!
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected]
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.
National Center on Birth Defects and Developmental Disabilities
Fetal Alcohol Syndrome Prevention Team