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Module 5: FASD Prevention

Indicated Prevention for Women at Risk

Indicated prevention targets women at high risk of having a child with an FASD:

  • Women with alcohol problems
  • Women who already have children with an FASD
  • Women with alcohol problems who do not use effective contraception
  • Women with an FASD

Indicated strategies include:

  • Identification of risk factors
  • Identification of an FASD in women
  • Intensive case management
  • Programs that combine alcohol interventions with promotion of contraceptive use, such as Project CHOICES
  • "Aftercare" programs for women who have given birth to children with an FASD7,8

Researchers have not yet determined the effectiveness of some of these approaches, but they are being studied. Some women may have an FASD themselves and may not respond to various prevention approaches. They may lack the cognitive ability to process or retain the information needed for the approach to work.

The Institute of Medicine1 recommends that any health care provider who encounters a woman who is abusing alcohol consider:

  • Brief intervention therapy
  • Counseling regarding the risks of prenatal alcohol exposure
  • Referral to more formal alcohol abuse treatment

For women who continue to use alcohol during pregnancy, comprehensive clinical treatment programs may be necessary. These programs generally include medical and obstetric care, as well as alcohol and other drug abuse services. Alcohol and drug abuse services may involve:

Doctor providing consultation to pregnant woman
  • Individual or group counseling, such as brief interventions, cognitive-behavioral therapy, mentoring, and therapeutic communities
  • Family therapy
  • Referral to self-help groups, such as Alcoholics Anonymous Exit Disclaimer Graphic
  • Parenting skills training
  • Case management
  • Information on the effects and risks of alcohol consumption

A review of more than 160 articles examined treatment programs designed to reduce fetal alcohol exposure in alcohol- and drug-dependent women.9 The review suggested that programs that provide comprehensive and coordinated treatment attract more pregnant women into care and are more effective.9 A number of sources indicated that the most effective treatment approach combine social, cognitive-behavioral, medical, and referral services. The review also notes that many consider an active case manager essential to coordinate services.9

Case management program logo

An example of a successful case management program for women at risk of giving birth to a child with an FASD is the Parent-Child Assistance Program (P-CAP) in Seattle, which began in 1991 and has been replicated in other communities. P-CAP is an intensive home visitation model for the mothers at highest risk.

As part of P-CAP, paraprofessional advocates are paired with clients for 3 years after the birth of a baby prenatally exposed to alcohol or drugs. One of the program's goals is to prevent subsequent alcohol exposed pregnancies. Advocates help link clients with community services. They are extensively trained, closely supervised, and have a maximum caseload of 15. Program results include fewer children born affected by alcohol and drugs, fewer foster care placements, and less family dependence on welfare. Other positive outcomes are an increase in family planning and child well-being.10,11

Some communities have mandated court-ordered or involuntary participation in alcohol treatment for heavily drinking pregnant women. These programs have stimulated legal and ethical debates concerning the comparative rights of the pregnant woman, the fetus, and society.12,13 Although some positive findings exist,14,15 the effectiveness of this approach has not been determined.

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