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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.

Screening

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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.

T-ACE screening tool

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 time.

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

Motivational Interviewing

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)

Stages of readiness for change

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