NOFAS Integrates FASD Prevention Efforts in Community Health Centers
NOFAS recently kicked-off a new and exciting Quality Improvement Project. It will test procedures for screening women for alcohol use in Community Health Centers (CHCs) to prevent FASD.
Primary care is usually the first point of entry into health care and approximately 4 million women of childbearing age receive primary health care services at CHCs. This makes the CHCs an extremely effective setting to implement projects aimed at identifying and intervening with this population. The pre and inter-conceptional periods are known to be the most critical time to prevent alcohol exposed pregnancies due to women’s delayed recognition of pregnancy and the high rates of unplanned pregnancies so the project will focus on all women of childbearing age, not just those who are pregnant.
Unfortunately, women's risky drinking is under recognized in primary care settings. Routine screening for alcohol use in women of childbearing age can help identify those women who drink at risk levels and enable healthcare professionals to educate them about FASD and/or intervene before the woman becomes pregnant. Most, if not all, CHCs already screen for alcohol use. However, there are no standard procedures for who they screen, how often, how they screen, and what they tell people who screen positive. The Quality Improvement model helps practices establish procedures based on evidence based practices, and then test their implementation.
The process involves a team effort to work through “who does what, where, when, and how.” Since health care practices vary significantly in the number of providers, clients, services provided, setting etc., each one needs to assemble a team and work out, for example, when a client gets alcohol screening (during regular check ups, pregnancy test results, 1st prenatal visit, etc), who does the screening (physician, nurse), what screening instrument will be used, etc. Teams typically consist of physicians, nurses, social workers, front office/intake staff, and IT staff.
The project is being carried out in six community health centers:
- Detroit Family Health Connections in Detroit, MI
- PCC Community Wellness Center in Oak Park, IL
- Erie Family Health Center (Westown) in Chicago, IL
- Near North Health Center (Winfield Moody) in Chicago, IL
- Aaron E Henry Community Health Services in Clarksdale, MS
- GA Carmichael Family Health Services in Canton, MS
Our project utilizes evidenced based practices from two seminal publications—NIAAA’s Helping Patients Who Drink Too Much: A Clinician’s Guide and CDC’s Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis.
We are testing the integration of the AUDIT or AUDIT C screening tool (you can view the instrument online at: http://www.nofas.org/healthcare/AUDIT.aspx) and brief interventions using the “Advise and Assist” model. A non-pregnant woman would be advised, “You are drinking more than is medically safe and I strongly recommend that you cut down or quit.” Pregnant women would be advised, “Drinking during pregnancy can cause your baby to have lifelong problems with health, learning, and behavior. There is no known safe time, amount, or type of alcohol during pregnancy. If you stop drinking you have a better chance of having a healthy baby.” Then appropriate referrals would be made. Women will also receive patient education materials on FASD.
Each month, the CHC teams conduct chart reviews to determine what percentages of their patients have: 1) documented alcohol screening using the AUDIT or AUDIT-C; 2) received brief advice to cut down/discontinue for non pregnant women or discontinue use for pregnant women; 3) received educational materials; and 4) received counseling or a referral to alcohol/substance abuse treatment. The project will also look at the financial impact of instituting these protocols. This is critical since most states do not provide Medicaid reimbursement for alcohol screening or brief intervention in primary care settings.
The first training session was held on June 12-14 in Bethesda, MD. NOFAS recruited experts in the fields of FASD, alcohol screening and brief intervention, clinical quality improvement, business case, and measurement, to speak at the meeting. NOFAS also brought in state level FASD contacts—Barbara Wybrecht from MI and Beejee Dickson from MS to establish relationships and referral networks with the participating CHCs in their respective states.
Many of the CHC staff remarked that although they were aware of the dangers of binge and chronic heavy drinking during pregnancy, they were not aware that low to moderate alcohol use could also produce health, emotional, and cognitive problems. At the end of the training, teams established a plan to carry out the project, utilizing the "who, what, where, etc." questions mentioned above.
Dr. Alabed from Detroit Community Health Connections at the June Training Session
June Training Session
CHC teams are now in the process of conducting screenings, brief interventions, and referral services and will submit data monthly through the end of August, 2006. NOFAS recently submitted an application to HRSA to secure funding to continue the project for a second year. In year two, we would expand on what we are currently doing to include testing clinical interventions to identify FASD in CHC patients.
NOFAS is very excited to be working on this groundbreaking project. If successful, the model could be incorporated in the 979 CHCs nationwide. This means that we can help prevent FASD and spread the FASD message to over 6 million people who utilize CHCs. Also, the quality improvement model is sustainable since it involves changing documents and procedures (client intake forms, health records, provider protocols) and fully integrating them into the practice. Even as staff turnover occurs, the procedures will still be followed. This could go far in helping to prevent FASD and improve the lives of those affected by FASD. For more information on this project, please contact Annie Acosta at acosta@nofas.org
2006 NOFAS Annual Leadership Awards and Benefit
Senator Murkowski and former Senator Tom Daschle co-hosted the NOFAS Annual Leadership Awards Benefit on June 7th in Washington, D.C. U.S. Senator Byron Dorgan and U.S. Surgeon General Vice Admiral Richard Carmona received NOFAS Leadership Awards.
Senator Dorgan was recognized for his public service in support of women, children and families with special needs in North Dakota and across the country. Former Senator Tom Daschle praised Dorgan for working to prevent Fetal Alcohol Spectrum Disorders (FASD) among North Dakota tribes and for steadfastly standing with him as they fought to increase attention and investment for FASD for twenty years in the United States Senate.
Vice Admiral Richard Carmona was honored for his 2005 message to the American public about Alcohol and Pregnancy. His advisory emphasized that there is no known safe level of alcohol consumption during pregnancy, and that women should completely abstain from alcohol when they are pregnant or if they could be pregnant, due to the risk of birth defects.
“Senator Dorgan is a leader in the United States Senate for North Dakotans and all Americans, said NOFAS president Tom Donaldson. He added, “NOFAS and FASD families nationwide are thrilled to honor his dedication to the health and well-being of our nation’s women and children.”
Dr. Faye Calhoun, the recently retired deputy director of the National Institute on Alcohol Abuse and Alcoholism, Dr. Sterling Clarren, a pioneer in the field of FASD research, and Cheri Scott, a co-founder of Stone Soup Group an Alaska organization providing services to families living with developmental disabilities, were each presented with a NOFAS Excellence Award.
Third Annual Hill Day
NOFAS organized the Third Annual FASD Hill Day on June 7, 2006. Nearly one hundred delegates from across the country met with over 65 Senate and House members and their staff, in an effort to educate Congress about Fetal Alcohol Spectrum Disorders. Jennifer Goudy, a parent of two adolescent boys with FASD remarked, “I’ve been part of this Hill Day since it first began in 2004. The event has grown significantly and as a result, each year we are impacting families and making strides in FASD awareness, prevention, and treatment.” This year, NOFAS Hill Day delegates represented over 15 states and 30 congressional districts from across the country. NOFAS Vice President and Spokesperson, Kathy Mitchell stated, “We have had several successes on Capitol Hill as a result of this event. Already in 2006, we have added 3 new members to the Congressional Caucus on FASD and 2 new co-sponsors to the House and Senate FASD Bills.” For more details on Hill Day and how to become part of it next year, please contact Nav Dayanand at Dayanand@nofas.org.
NOFAS Mourns the Loss of Carol Echternach
Carol Echternach, one of the first directors of CalFAS, the NOFAS affiliate in California, passed away on July 7, 2006. Carol was a passionate advocate with a great understanding of FASD and secondary disabilities. Her knowledge of Eastern European adoptions and related issues was a passion she spent many hours with. She blessed her life with her husband Dennis, son Johnathon and three daughters Lana, Mia and Anya, as well as many family and friends. CalFAS member Amber Kesterson remarked that we've lost a great advocate, a dear friend and a beautiful smile.
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