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New in 2010, NOFAS will collaborate with Federal agencies and select American Indian tribes and healthcare delivery sites serving American Indian populations in California to prevent Fetal Alcohol Spectrum Disorders (FASD).
The primary purpose of the project is to prevent all adverse outcomes of alcohol exposure during pregnancy. Prevention of FASD requires identifying the women who are at risk prior to pregnancy and then providing them with effective risk-reduction interventions. It also requires a multidisciplinary clinical framework familiar with FASD, addiction medicine, alcohol screening instruments, and motivational intervention, and one that has an accessible referral network. The NOFAS project differs from other approaches to reducing alcohol-exposed pregnancies because it targets high-risk women before they become pregnant and seeks to permanently assimilate project concepts throughout the clinical structure, thereby sustaining the intended disease prevention and cost benefits.
The project objectives are to 1) increase from <20% to >80% the percentage of clinical staff with knowledge about FASD and alcohol screening and intervention, 2) increase from <10% to >80% the percentage of women of childbearing age that are screened for alcohol use disorders, 3) increase from <35% to >90% the percentage of women with positive screens that receive an intervention, 4) increase from <60% to >95% the percentage of women recommended for alcohol rehabilitative treatment services that are given a referral for services, 5) increase from <5% to >50% the number of offspring of women with positive alcohol screens that are screened for FASD, and 6) refer >80% of individuals that screen positive for FASD for a formal diagnosis.
In order to achieve these objectives, project activities will consist of:
- Formative research within area clinical networks serving the target audience, including an environmental scan of existing screening and data collection methods, as well as an evaluation of participating sites’ capacity, services provided, referral networks and other measures;
- Development of culturally appropriate FASD prevention messages and materials;
- Implementation and assessment of both in-service and web-based training for clinical and administrative staff a select project locations;
- Implementation and assessment of select screening and brief intervention models;
- Implementation and assessment of select screening instruments;
- Implementation and assessment of both practitioner-administered and computer-assisted screening formats such as eCHECKUP TO GO, an alcohol assessment tool that provides the user with important information about alcohol and health;
- Technical assistance, including development of referral networks for all project partners and clinical sites;
- Data collection and evaluation;
- Incentives for participation and achievement of performance measures.
The project will be complemented by an existing state-of-the-art web-based interactive training program and computer assisted screening technology that will reduce practitioner training and project travel costs. NOFAS plans to continue its partnership with ScienceMedia to develop and implement two additional web-based training components, and to explore the use of computer-assisted screening tools modeled after the San Diego State University Research Foundation technology, eCHECKUP TO GO. Web-based assessment, as represented by WIC clients, has been demonstrated to be both feasible and reliable. Accredited web-based training and the use of electronic screening technology will significantly enhance the cost effectiveness of practitioner education and patient screening and ensure uniform application across clinical settings.
The project will be launched at 4-6 Indian Health Service (IHS) clinical sites. The twelve IHS Area Offices include alcohol screening and FASD prevention in appropriate female patients as a separate clinical Government Performance and Results Act (GPRA) measure. In FY 2009, although the IHS system nationally met the GPRA target for alcohol screening, the California Area fell short of the goal and finished 11th among the 12 Area Offices for this measure. NOFAS and its partners plan to launch this initiative at clinics within the Riverside San Bernardino County Indian Health (RSB) system since it has the largest user population, serving over 13,000 registered Indian patients in FY 2009, among the 31 health programs or clinical systems in the California Area IHS, and because together RSB clinics finished 28th among the 31 clinical systems in the California Area for alcohol screening and FASD prevention.
The NOFAS project is the initial effort to boost the alcohol screening figures among California tribes. A growing demand by FASD families for services and an increasing recognition among health officials and multidisciplinary care systems to the significance of the issue has created a public and private imperative to eradicating and treating the nation’s leading know cause of intellectual disabilities and birth defects. The highly successful NOFAS screening, intervention and referral model has been demonstrated during a four-year implementation in 35 Community Health Center clinical sites in 8 states as among the most cost-effective, practical and reliable programs to reduce alcohol exposed pregnancies and identify Fetal Alcohol Syndrome. By securing a range of partnerships and investment for the project, NOFAS will ensure the continued progress toward the promise of FASD prevention, and fulfill its mission to meet the needs of families living with the disorder.
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