FASD The Course > Module 5: FASD Prevention > 8. Selective Prevention Strategies Page 1
Module 5: FASD Prevention
Selective Prevention Strategies
Researchers have identified age, socioeconomic status, spousal characteristics,
and other risk factors for FASD. This
information can help suggest women for selective and indicated prevention strategies.
The first challenge in implementing such prevention strategies is to identify women
at increased risk of having children with an FASD. Drinking during pregnancy puts
a child at risk for having an FASD. Helping women not drink during pregnancy is
the key to prevention. Screening at
primary and prenatal care clinics can help.
Alcohol screening questionnaires have been developed to screen for alcohol use,
at-risk drinking, and alcoholism. Studies have shown that some screening tools can
be effective. In one study3,
the T-ACE4 questionnaire was more effective than assessments
by health care staff in identifying pregnant women who drink. The T-ACE is one of
several commonly used screening tools.
Once a pregnant woman says she is drinking, brief structured interventions to help
her stop drinking should be provided. Ask about her drinking and clearly advise
her to stop. Discuss her drinking and her willingness to stop, and ask for her agreement
to end her alcohol use by a specific time. Provide assistance or ideas to help her.
Arrange referrals for more assistance, if needed, and followup with her. Repeat
the discussion and intervention at future encounters.
A woman is more likely to talk about her drinking when she does not have a motive
to hide it. For this reason, it is important to be nonjudgmental, friendly, helpful,
and nonthreatening. Tell her the information will be kept confidential. A woman
may not be willing to talk about her drinking at one visit but may at another. As
such, routinely ask about alcohol use. Ask about when she drinks beer, wine, or
liquor; how often and how much; and if she has drank four or more drinks at one
Most women stop drinking once they learn they are pregnant. But many women drink
before they are aware of their pregnancy. To prevent this, women need to use effective
contraception and stop drinking when they are trying to become pregnant. Screening
all women of childbearing age for alcohol use and intervening can help prevent FASD.
Steps in the process include:
- Asking about alcohol use
- Advising appropriate action—stop drinking if pregnant
- Asking for agreement to take specific actions
- Assisting in taking the actions
- Arranging for followup, monitoring progress, and repeating the intervention
An example of screening and encouraging change is motivational interviewing.
Motivational interviewing is based on change theory. It involves helping people make decisions for themselves
along the stages of change.5
Stages of readiness for change (read from bottom to top)