Strategies for Community Mobilization around Fetal Alcohol

Spectrum Disorder

An Experience from Rural Ontario

Marilyn Lemon R.N. BSc.N. PHN Grey Bruce Health Unit&

Jennifer Sells Program Manager CAPC/CPNPBruce Grey Children’s Services

Introduction Over the past four years there have been a number of

community capacity building strategies focusing on FASD in our rural area of Grey and Bruce Counties.

Mainly rural 1 urban center with 20,000 Similar size as PEI

Background

1999 FAS-World launched an international FAS campaign focusing on prevention with the theme month being September- the date of the campaign launch - Sept.9th ,1999

“The 9th month, 9th day and 9th hour to be the moment of reflection when people all over the world show support for women not to drink alcohol through their entire 9

months of pregnancy” (FAS-

World, 1999)

Starting Point - Partnership

All FASD strategies have occurred through interagency partnerships

There have been 2 lead agencies and an interagency committee that have been responsible for coordinating and initiating all FASD activities

Lead agencies , BGCS Brighter Futures (CAPC/ CPNP), and Public Health

Interagency Reproductive Health Committee members include First Nations, Child Protection, Social Services, etc.

Inter-collaboration

When agency partnership exists it enables the community to lend itself to inter-collaboration

Awareness alone requires a multiple of interested people willing to give time and financial support

Partners need to see the benefits of participating and the strength in partnership

Proposals for funding are done in partnership Strengthens community capacity to respond to issues Set’s strategic direction

Plan with Partnership

Health Canada offered funding in 2001 through “CPNP Dollars”

A joint proposal was developed by Bruce Grey Brighter Futures and Public Health

This was a key strategy because the initiative began with a partner focus and seed funding

Both agencies have a large number of contacts and high profile in the community

The proposal requested funding to support FASD awareness & education session

The Benefits of a Framework

Using a framework as a tool or guide for action focuses on a coordinated effort to address the complexities of FASD and provide communities with opportunities for:

-Education -Support -Treatment (Health Canada, FASD, A Framework For Action,

2003)

FASD A Framework for Action

Five Goals: Increase Public & Professional Awareness &

Understanding of FASD & the Impact of Alcohol use during Pregnancy

Develop & Increase Capacity Create Effective National Screening Diagnostic &

Data Reporting Tools & Approaches Expand the Knowledge Base & Facilitate Information

Exchange Increase Commitment & Support for Action on FASD

(Health Canada, FASD, A Framework for Action, 2003)

Increase Public & Professional Awareness & Understanding

In our community the first step involved raising awareness and education for the community to learn more about FASD and develop responsibility that FASD is a community based issue. “Increase Public and Professional awareness and understanding of FASD and the impact of Alcohol use during pregnancy” 1st of 5 goals (Health Canada FASD, A Framework

for Action, 2003)

All FASD strategies and initiatives support Goal 5 “Increase Commitment & Support for Action” (Health Canada, FASD, A Framework for Action, 2003)

Increasing Awareness & EducationPoints to be addressed

Points addressed at the training session: What is it that I am here to learn about? (Define the

question and the focus) How is this affecting our community?(Key points, local

issues, and statistics) Why should I be interested?(Personalize it) What can I do? (How to take action) What will be the benefits/outcomes for our community?

(Impact on community)

Awareness & Education Invite Key Stakeholders

Utilize existing mailing lists to invite: Key Health and Social Service Providers Parents (birth, adoptive and foster) Physicians Board of Education (teachers, principals, etc) Police and Correctional Services Substance Abuse Prevention Programs First Nations in local area and other significant cultural

group(s) Local Politicians Faith Communities

Awareness & Education Survey the Participants

Initially: Sept. 2002 Offered “free” breakfast & seminar about FASD Survey participants about their: -Interest in FASD -Knowledge on the topic -Further involvement -Contact information Survey results indicated next steps would include

connecting with interested individuals to discuss FASD community needs

Survey repeated at subsequent meetings received feedback from participants about their needs/interests

Continued...Public & Professional Awareness

March, 2002 Interagency Reproductive Health Committee hosted a

2nd. FASD education workshop featuring Donna Debolt,- Lethbridge, Alberta (Health Can. funding supported this)

Workshop educated community professionals & nonprofessionals about FASD primary & secondary disabilities, guidelines & interventions for families, & case management

Over 130 people attended FASD educational workshop

Continued… Public & Professional Awareness

Survey & evaluation feedback suggested the community wanted involvement with strategies around FASD support, education, and further awareness

An example of the high energy and commitment came from a participant at the workshop on the evaluation….

“It was worth driving through a snowstorm to be

here” (Participant at FASD Workshop)

Education leads to Commitment & Support

Since 2002 there have been 4 Education/Training Events

Donna Debolt (Sept. 02) spoke to community professionals/nonprofessional and Board of Education Staff

Allan Mountford (Oct. 03) teaches children in the school system with violent behaviour and specializes in the behaviour of the child with FASD and interventions

Marilyn Debassige (Feb. 04)- FASD through the Eyes of a Child- an Aboriginal approach to children with FASD

Allan Mountford (Aug. 04) focus- educators working with children with FASD in school setting

Awareness

Awareness Campaigns included posters, pens, fact cards

Provincial Campaign -May 2004 posters, pamphlets, tent cards, trans-ads etc. (Provincially funded)

Target groups faith communities, health/social service providers, protection services, educators, families & caregivers for children with FASD

Restaurant Sticker Campaign (2002) in partnership, targeting licensed establishments with a no alcohol during pregnancy sticker to put in their menu in alcohol section

Develop & Increase Capacity

September, 2002:Developed: FASD Community Mobilization Committee: Joint Initiative

(Brighter Futures-CPNP/CAPC & Public Health) Invited:

- All past workshop participants who indicated interest in becoming involved - Key service providers (child protection, police, social services, etc.) - Chris Margetson -Executive Director FASAT Guelph, Ont. - District Health Council

Develop & Increase Capacity

Community Mobilization:Meeting agenda: District Health Council - Chaired Guest from FASAT- Shared her expertise Brainstormed community needs around FASD focused

on 3 areas (Community, Family, Child/Youth) Narrowed our focus to 2 attainable objectives for the

community 1. FASD Support Group Development 2. FASD Resource Lending Library **see handouts in package**

FASD Support & Resources

FASD Support Group: Native Friendship Centre - hosted the Support Group Evening meetings - once a month Public Health - houses the mailing list

FASD Resources: Lending Library - partnered - Ontario Early Years Centre

library -accessible, day & evening hours Proposal - funding for resources - through FOCUS

Substance Abuse Prevention Program and CPNP funding

*These initiatives expanded knowledge & facilitated information exchange (Goal 4, Health Canada, FASD, A Framework for Action, 2003)

Create Effective Screening Diagnostic &Data Reporting Tools & Approaches

Strategies to Improve Community Capacity for Screening & Diagnosis of FASD

Physician Training using a standard tool to diagnose FASD

Facilitated by Dr. Gideon Koren Executive Director-Motherisk-Hospital for Sick Children, Toronto, Ont.

10 Physicians, 12 Psychologists received training Physicians received 3 MAIN PRO C Medical credits upon

completion of the training Hosted by Interagency Reproductive Health Committee Medical Officer of Health as the lead

Continued…Tools and Approaches

Meconium Testing for In-Utero Exposure to Alcohol:Grey-Bruce Study: Conducted by Masters of Toxicology

Student, University of Toronto

A sample of a minimum of 1 gram of meconium is collected in a clean container, kept refrigerated and within 48 hrs. transported to The Hospital for Sick Children in Toronto Motherisk Lab for Drug Exposure. If it will take more than 48hr. to transport sample it can be frozen and transported on dry ice

The lab extracts the alcohol esters (fatty acid ethyl esters) from the meconium and analyzed using a gas chromatographic method

Meconium Study

Meconium starts to form in 2nd trimester therefore the test provides information about alcohol use during 2nd & 3rd trimester

Significant correlation to # of drinks during pregnancy & FAEE in meconium

FASD meconium study provides evidenced-based research to determine prevalence of alcohol consumption by pregnant women in Grey-Bruce

Data-base will provide current results for our community that link directly to FASD strategies

Keys to Success Obtain seed funding Recruit motivational speakers Link with other areas with expertise and resources Increase awareness and resources through information

campaigns Provide training for local physicians to assist with

diagnosis Survey participants at educational events Know mandates local agencies have so you partner

appropriately Create committee to develop community capacity

Indicators of Success

Sustainable Activities: -Community Mobilization Committee -Support Group -Lending Library Interagency Involvement: -Interagency Committee - Local Agencies committed to FASD sustainable activities ie. hosting Support Group, housing and marketing resources, providing education and training opportunities locally

Thank you

All the best to you in your Communities

as you develop capacity building &

mobilization strategies targeting FASD.

Contact Information

Marilyn Lemon, Grey Bruce Health Unit, 920 1st Ave West, Owen Sound, Ontario N4K 4K5

mlemon@bmts.com 1-519-376-9420

Jennifer Sells, Bruce Grey Children’s Services, 845 2nd Ave East

Owen Sound, Ontario N4K 2H2 bfowensound@bmts.com 1-519-371-4773