NACCHO Aboriginal Health and Fetal Alcohol Spectrum Disorders #FASD : Community participation is a key principle in effective health promotion

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 ” Community participation is a key principle in effective health promotion. Gurriny have used a whole-of-community approach by involving the five above mentioned target groups when designing their FASD prevention activities.

Gurriny consulted with women of childbearing age to learn about their views and attitudes towards alcohol, and assed their current knowledge about the harms associated with drinking in pregnancy. It was also important for health professionals to understand what types of alcoholic drinks women of child bearing age were consuming and how much.

For further information about the FASD Prevention and Health Promotion Resources Project please contact Bridie Kenna on 0401 815 228 or bridie.kenna@naccho.org.au

Read 17 Articles about FASD

Menzies School of Health Research have partnered with the National Aboriginal Community Controlled Health Organisation (NACCHO) and the Telethon Kids Institute (TKI) to develop a package of resources to reduce the impacts of FASD on the Aboriginal population.

FASD is a diagnostic term used for a spectrum of conditions caused by fetal alcohol exposure. Each condition and its diagnosis is based on the presentation of characteristic features which are unique to the individual and may be physical, developmental and/or neurobehavioural.

The package of resources is based on the model developed by the Ord Valley Aboriginal Health Service (OVAHS). OVAHS is an Aboriginal Community Controlled Health Service located in the far north east region of the Kimberly in Western Australia. OVAHS services Aboriginal people in the remote town of Kununurra and surrounding regions.

The package incorporates FASD education modules targeting five key groups:

  • Pregnant women using New Directions: Mothers and Babies Services (NDMBS) antenatal services, and their partners and families;
  •  Aboriginal and Torres Strait Islander women of childbearing age;
  •  Aboriginal and Torres Strait Islander grandmothers;
  •  NDMBS staff who provide antenatal care
  •  Aboriginal and Torres Strait Islander men.

To complement the package of resources, two day capacity building workshops for the 85 New Directions: Mothers and Babies Services (NDMBS) were held in Darwin, Cairns, Melbourne (TAS, VIC and SA sites combined), Perth and Sydney. The aim of the training workshops was to enable NDMBS sites to develop, implement and evaluate community-driven strategies and solutions by:

i. Increasing awareness and understanding of alcohol use during pregnancy, and FASD;

ii. Increasing awareness and understanding of existing FASD health promotion resources;

iii. Increase understanding, skills and capacity to use existing FASD health promotion resources within NDMBS, in line with their capacity, readiness and community circumstances and needs.

Staff from Gurriny Yealamucka Health Service (Gurriny) participated in the Queensland FASD training workshop in April. Since then, Gurriny have thrived in the area of FASD prevention by implementing multiple strategies within their community.

A key component of the FASD training workshop was highlighting the importance of routine screening of women about alcohol use during pregnancy. Assessment of alcohol consumption, combined with education in a supportive environment can assist women to stop or significantly reduce their alcohol use during pregnancy. A number of screening tools were introduced at the workshop including AUDIT-C (Alcohol Use Disorders Identification Test – Consumption), which Gurriny have now incorporated into their own data recording system. This tool has three short questions that estimate alcohol consumption in a standard, meaningful and non-judgemental manner.

Gurriny now places great emphasis on providing routine screening of women about their alcohol use during all stages of pregnancy and recording results in clinical records at each visit. Health professionals at Gurriny often use brief intervention and motivational interviewing techniques to guide conversations about alcohol and pregnancy.

This is of particular significance when working with pregnant women, as there are multiple opportunities through routine antenatal care to provide support through the stages of change. There is sound evidence that motivational interviewing and brief interventions can decrease alcohol and other drug use in adults. Both practices are listed in the Royal Australian College of General Practice (RACGP) guidelines as an effective strategy for positive behaviour change.

It is estimated that over half of all pregnancies in Australia are unplanned and many Australian women are unknowingly consuming alcohol during pregnancy. Providing women of childbearing age with reliable information about the risks of alcohol consumption during pregnancy and the importance of contraception use if they are not planning a pregnancy are essential strategies in preventing FASD. Staff at Gurriny have pre-conception discussions about healthy pregnancies and FASD prevention with women who cease contraception use and may be planning a pregnancy. Women are provided with reliable information in a supportive environment to help them make informed decisions.

Knowledge transfer strategies are a key component to ensure new information is shared and retained within the service and community. Members from Gurriny’s Child and Maternal Health team have shared the package of resources and new skills gained at the workshop with a number of their colleagues, both clinical and administrative. They have also shared the new information with relevant health professionals from external organisations, including the local hospital. This assists in developing a more consistent approach to FASD prevention and maximises available resources in the community. Gurriny have made links with other health and community services within the Yarrabah community to develop a coordinated, strategic approach to FASD prevention.

Community participation is a key principle in effective health promotion. Gurriny have used a whole-of-community approach by involving the five abovementioned target groups when designing their FASD prevention activities.

Gurriny consulted with women of childbearing age to learn about their views and attitudes towards alcohol, and assed their current knowledge about the harms associated with drinking in pregnancy. It was also important for health professionals to understand what types of alcoholic drinks women of child bearing age were consuming and how much.

Based on the findings, laminated cards were developed which show the number of standard drinks in each serving according to the National Health and Medical Research Council (NHMRC) alcohol guidelines. These cards are used in both one-on-one and group based education sessions. There is no safe level of alcohol consumption at any stage of pregnancy; this message is emphasised at all opportunities with women of childbearing age.

Raising community awareness is a key strategy in successful health promotion. Gurriny have a strong presence in the Yarrabah community and often attend health and community events to raise awareness of the harms associated with drinking in pregnancy and FASD.

Health staff make use of any opportunity to raise awareness, share information and prompt people to think about making positive changes to their own drinking behaviour, or support others to do so.

Additional awareness raising strategies include showing FASD prevention DVD’s on iPad’s in clinic waiting rooms, demonstrating the concept of the invisible nature of FASD disability by using demonstration FASD dolls in education sessions, and having posters about healthy pregnancies and FASD prevention in clear view throughout the clinic.

Health promotion is most effective when multiple strategies are used which target not only the individual, but the community at large. It is evident Gurriny Yealamucka Health Service is using this approach in order to reach the best possible health outcomes for women, children and families.

For further information about the FASD Prevention and Health Promotion Resources Project please contact Bridie Kenna on 0401 815 228 or bridie.kenna@naccho.org.au

 

NACCHO Aboriginal Health and #FASD : Record Indigenous incarceration #justjustice rates could be avoided with early clinical assessment: experts

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 “Australia’s prison population recently reached a record 33,791 with 27 per cent of those identifying as Aboriginal or Torres Strait Islanders

Leading experts in Fetal Alcohol Spectrum Disorder (FASD) believe Australia’s record rates of Indigenous incarceration could be dramatically reduced if children were clinically assessed when their troubled behaviour first emerged in the classroom or at home.

In one form or another, Federal, State and Territory Governments have been inquiring into Indigenous prison rates since the 1987 leaving behind a long list of mostly-ignored recommendations “

As reported by Russell Skelton ABC

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NACCHO partnered with the Menzies School of Health Research and the Telethon Kids Institute (TKI) to develop and implement health promotion resources and interventions to prevent and reduce the impacts of Fetal Alcohol Spectrum Disorders (FASD) on Aboriginal and Torres Strait Islander families and young children.

NACCHO Report 1 of 4 :Prevent and reduce the impacts of Fetal Alcohol Spectrum Disorders (FASD)

Key points:

  • Experts say Indigenous incarceration rates could be reduced with early behavioural assessment
  • Fetal Alcohol Spectrum Disorder (FASD) affects many of those incarcerated
  • People with FASD are often unable to instruct a lawyer, understand court procedures and even the decisions handed down when convicted

The facts about FASD

  • FASD covers a range of conditions that can occur in children whose mothers drink during pregnancy
  • Conditions vary from mild to severe
  • The effects can include learning difficulties, behavourial problems, growth defects and facial abnormalities
  • The Australian Drug Foundation believes the condition is “significantly under-reported” in Australia
  • National Health and Medical Research Council guidelines say not drinking at all all during pregnancy is the safest option

A major issue in recent months:

  • Last month the Northern Territory’s adult prison population hit an alarming 15-year high. According to Corrections Commissioner Mark Payne 958 people are being held — almost half aboriginal and Torres Strait Islanders. He expects half will reoffend within two years of being released.
  • A report by Amnesty International Australia found, and ABC Fact Check confirmed, that incarceration rates for Indigenous children were 24 times higher than they were for non-Indigenous children.In WA the rate is 76 per 10,000, in the US, where rates of black incarceration are regarded as the highest in the western world, it is 52.
  • Attorney-General George Brandis and the Indigenous Affairs Minister Nigel Scullion announced the Federal Government have commissioned the Australian Law Reform Commission to investigate factors behind the over representation of Indigenous Australians in prison and to recommend reforms to “ameliorate the national tragedy”.
  • The appointment of a Royal Commission to investigate brutal treatment and years of detainee abuse at Darwin’s Don Dale Youth detention facility.The move followed detailed allegations of mistreatment by the ABC’s Four Corner program.

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The #JustJustice book is was launched  at Gleebooks in Sydney yesterday by Professor Tom Calma AO, and NACCHO readers are invited to download the 242-page e-version

The Federal Government must make good on its promise to listen to, and work with, Aboriginal and Torres Strait Islander people, including engaging with the solutions put forward in the forthcoming #JustJustice essay collection.

The book includes more than 90 articles on solutions to protect the rights of Australia’s First Peoples.

The experts said parents, teachers and health workers were often well aware of unacceptable behaviour in young people — both Indigenous and non-Indigenous — long before they appeared before the courts.

Around 70 per cent of young people in the juvenile justice system are Aboriginal, and research shows rates of the disorder amongst Aboriginal communities are significantly higher than non-Aboriginal communities.

Elizabeth Elliot, professor of Paediatrics and Child Health a Sydney University, said: “What we need is screening tool so teachers and health workers can assess a child’s executive functions and red flag cognitive impairments early on before they encounter the justice system.”

Paediatrician and clinical research fellow at Perth’s Telethon Kids Institute Dr Raewyn Mutch agreed, saying there was a growing need to identify serious behavioural issues associated with FASD and other developmental disorders such as autism so affected children can be better managed.

Fetal Alcohol Spectrum Disorder, known as FASD, occurs in the children whose mothers consumed alcohol during pregnancy.

Symptoms include lifelong physical, mental, behavioural and learning difficulties. It can cause severe intellectual impairment, learning and memory disorders, high-risk and violent behaviour.

Professor Elliott said reform in Australia had been “glacial” compared with Canada and the United States, as authorities have been slow to acknowledge the extent of the problem.

“In Canada it is estimated that 60 per cent of kids in the juvenile justice system are FASD, it is a huge number,” she said.

“We don’t need another inquiry into the justice system, we need governments to act on the evidence before them from past inquiries,

Professor Elliott was the paediatric specialist involved the ground-breaking Lililwan study initiated by Aboriginal women. The study that found that one in five Indigenous children living in WA Fitzroy River Valley had FASD. Although still teenagers, many were before the juvenile justice.

“For children suffering from FASD, it’s like having the umpire removed from an AFL match, they have difficulties deciding best choices or understanding cause and effect,” Dr Mutch said.

“A person with FASD may have cognitive impairment, language difficulties as severe as being illiterate.”

Professor Elliott, a widely acknowledged authority on FASD, said offenders — non-Indigenous and Indigenous — with fetal alcohol brain damage were often incapable of changing their behaviour and learning from mistakes.

“These are young people who can be easily led, are incapable of understanding the consequences of their actions, have difficulty understanding the boundaries for acceptable behaviour. They can confess to crimes they did not commit.”

Dr Mutch said not only FASD affected individuals ended up in the justice system, but children with developmental difficulties and also children traumatised by conflict and abuse.

She is involved in landmark study of young offenders in WA’s Banksia Hill Detention Centre to establish the prevalence of FASD and other neurological disorders. The study is likely to revolutionise strategies for handling juveniles with “neurodevelopmental” issues.

The study will establish the first authoritative estimate in Australia of FASD among young people in detention. It involves a two day multi-disciplined clinical assessment of children with the hope of developing a screening tool for application among all young people entering the juvenile justice system.

“Children in the juvenile justice system have ended up there for a variety of reasons, many of these kids have learning and memory problems,” Dr Mutch said.

“They may also have speech and language problems. Not all are FASD affected, but all I would predict have experienced severe trauma.”

A ‘national tragedy’

A Productivity Commission report into Indigenous disadvantage released last week confirmed rates of incarceration had failed to drop despite a string of reports, inquiries and recommendations dating back to 1987 Deaths in Custody Royal Commission.

Dr Mutch said children were being excluded from society because their behaviour.

“The central question is what are the factors that caused them to be like that and how best to rehabilitate them,” she said.

Both Professor Elliott and Dr Mutch believe screening and clinical assessments in childhood would identify cognitive problems, enable early treatment and result in profound improvements in troublesome behaviours.

This would have an impact on child protection placements including foster care and the management of group homes where evidence has emerged of inappropriate placements and poor supervision.

Offenders with FASD are easily led, coerced by their peers. They can be incapable of providing a record of events, names of associates and often confabulate even to the extent of making false confessions.

They are often unable to instruct a lawyer, understand court procedures and even the decisions handed down when convicted.

In one form or another, Federal, State and Territory Governments have been inquiring into Indigenous prison rates since the 1987 leaving behind a long list of mostly-ignored recommendations.

The Senate is also inquiring into the indefinite detention of people with cognitive impairments — a central issue when it comes to explaining the “national tragedy”.

The Telethon Kids Institute noted in a submission to Senate inquiry into the indefinite detention of people with cognitive and psychiatric impairment that diagnosis of FASD has been limited by a lack of knowledge and until recently an absence of accepted national diagnostic framework.

Australia’s prison population recently reached a record 33,791 with 27 per cent of those identifying as Aboriginal or Torres Strait Islanders.

 

NACCHO #FASDAwarenessDay Aboriginal Health : AMA calls for #FASD to be recognised as a disability

FASD

” FASD has a significant impact on education, criminal justice, and child protection services in Australia, and yet has not been included by the Government on the list of recognised disabilities.

“FASD is associated with a range of birth defects including hyperactivity, lack of focus and poor concentration, delayed development, heart and kidney problems, and below average height and weight development,”

“The average life expectancy of a patient with FASD is just 34 years. FASD is extremely costly to our health, education, and justice systems, yet is potentially preventable.

AMA President, Dr Michael Gannon

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“High rates of alcohol consumption have been reported in both the Aboriginal and non-Aboriginal population.

Aboriginal women are more likely than non-Aboriginal women to consume alcohol in pregnancy at harmful levels. Australian research indicates that maternal alcohol use is a significant risk factor for stillbirths, infant mortality and intellectual disability in children, particularly in the Aboriginal population.”

NACCHO Newspaper Report

The AMA is calling for Fetal Alcohol Syndrome Disorder (FASD) to be included on the list of recognised disabilities, so that families can have access to much-needed support services.

Ahead of World Fetal Alcohol Syndrome Disorder (FASD) Awareness Day on 9 September, the AMA today released its new Position Statement on Fetal Alcohol Spectrum Disorder – (FASD) 2016.

FASD is a diagnostic term used to describe the range of permanent, severe neurodevelopmental impairments that may occur as a result of maternal alcohol consumption.

Globally, FASD is thought to be the leading cause of preventable birth defects and intellectual disability. World FASD Awareness Day aims to raise awareness about the dangers of drinking during pregnancy and the plight of individuals and families who struggle with FASD.

“The AMA welcomes the efforts of the Government, particularly the Commonwealth Action Plan, through which the Australian Guide to the Diagnosis of FASD was developed, but more must be done.

“The current Commonwealth Action Plan expires in 2017 and the lack of recognition of FASD on the Department of Social Services disability list leaves families without access to much-needed disability support services.

“The AMA urges the Government to continue to provide support for the important preventive and aftercare work being undertaken, and to include FASD on the list of recognised disabilities.”

Dr Gannon said that no safe level of fetal alcohol exposure to alcohol has been identified.

“The AMA believes that the safest option for women who are pregnant or planning a pregnancy is to completely abstain from alcohol consumption,” Dr Gannon said.

“The message is simple and safe – no alcohol during pregnancy.

“The AMA encourages partners, friends, and loved ones to support pregnant women in their choice not to drink,” Dr Gannon said.

The AMA Position Statement on Fetal Alcohol Spectrum Disorder – (FASD)

2016 is available at https://ama.com.au/position-statement/fetal-alcohol-spectrum-disorder-fasd-2016.

Background

  • We do not currently know the true extent of FASD in the Australian community, largely due to the complexity of the diagnostic process.
  • Data from comparable countries suggests FASD may affect roughly between 2 per cent and 5 per cent of the population.
  • Overseas research suggests that individuals with FASD are 19 times more likely to come into contact with the criminal justice system than their peers.
  • In Canada, this is estimated to cost the Juvenile Justice System $17.5 million CND and the adult custodial system $356.2 million CND annually
  • No safe level of fetal alcohol exposure has been identified.
  • The safest option for women who are pregnant or planning a pregnancy is to completely abstain from alcohol consumption.
  • FASD2                                    More Info www.nofasd.org.au

NACCHO Aboriginal Health News Alert :One in five kids in remote communities has FASD -Fetal Alcohol Spectrum Disorder

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One in five kids in remote communities has fetal alcohol spectrum disorder. Picture: Croakey

“Children in remote communities are suffering from disabilities caused by their mothers drinking at a rate drama­tically higher than previously report­ed, with one in five affect­ed by fetal alcohol­ spectrum dis­orders, accordi­ng to a new report.

The published rate from the only Australian population study in Western Australia’s Fitzroy Valley­ is one in eight, but that was a conser­vative figure.”

Report in today Australian   SEE 2nd Story BELOW

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“High rates of alcohol consumption have been reported in both the Aboriginal and non-Aboriginal population. Aboriginal women are more likely than non-Aboriginal women to consume alcohol in pregnancy at harmful levels. Australian research indicates that maternal alcohol use is a significant risk factor for stillbirths, infant mortality and intellectual disability in children, particularly in the Aboriginal population.”

Report in this weeks NACCHO Aboriginal Health News DOWNLOAD HERE

Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term used for a spectrum of conditions caused by fetal alcohol exposure. Each condition and its diagnosis is based on the presentation of characteristic features which are unique to the individual and may be physical, developmental and/or neurobehavioral.

Health professionals asking and advising all women of child bearing age about the consequences of alcohol consumption in pregnancy is an essential strategy in preventing FASD.

Based on this evidence, NACCHO in partnership with Menzies School of Health Research and the Telethon Kids Institute have developed and implemented a flexible, modular package of FASD Prevention and Health Promotion Resources (FPHPR) to reduce the impacts of FASD on the Aboriginal and Torres Strait Islander population. The package has been designed for the 85 New Directions: Mothers and Babies Services (NDMBS) across the country which are made up of Aboriginal Community Controlled Health Services (ACCHO’s), State and Territory Government bodies and Primary Health Networks (PHN’s).

The package of resources is based on the model developed by the Ord Valley Aboriginal Health Service (OVAHS) which includes FASD education modules targeting five key groups:

  • Pregnant women who are using NDMB antenatal services, and their partners and families;
  • Aboriginal and Torres Strait Islander women of childbearing age;
  • Aboriginal and Torres Strait Islander grandmothers;
  • NDMBS staff; and
  • Aboriginal and Torres Strait Islander men.

To compliment the package of resources, 2 day capacity building workshops for NDMBS staff are currently being implemented across the country. The aim of the workshops is to enable health professionals to develop, implement and evaluate community driven strategies to reduce the impact of FASD in Aboriginal and Torres Strait Islander communities.

Addressing other health behaviours such as tobacco smoking and other drug use in pregnancy is also covered as part of the training. The interactive workshops focus on a broad range of skill development, ranging from community engagement strategies to one on one brief intervention and motivational interviewing techniques. Participants are also introduced to a range of screening tools to assess drinking alcohol, tobacco smoking and other drug use in pregnancy and how to use them effectively. The importance of data collection, continuous quality improvement (CQI) and monitoring and evaluation is also covered.

FASD

The first workshop was recently held in Darwin with great success. Participants gained valuable knowledge on the issue of FASD and the importance of developing practical, whole of community approaches to prevent it. The project team will now move to Queensland in April to deliver the second workshop followed by other States and Territories across the country.

For further information about the FASD Prevention and Health Promotion Resources Project please contact Bridie Kenna on (02) 6246 9310 or bridie.kenna@naccho.org.au

Mums’ excessive drinking linked to suicides in remote communities

NACCHO Note : this was the Australians headline

Children in remote communities are suffering from disabilities caused by their mothers drinking at a rate drama­tically higher than previously report­ed, with one in five affect­ed by fetal alcohol­ spectrum dis­orders, accordi­ng to a new report.

The published rate from the only Australian population study in Western Australia’s Fitzroy Valley­ is one in eight, but that was a conser­vative figure.”

In a report to the $22 billion ­National Disability Insurance Scheme agency, its authors say the real figure is 20 per cent.

James Fitz­patrick, the lead author­ of that study, says the collection of disorders — character­ised by the loss of decisio­n-making abilities and impuls­e control — are one of the most critical, preventable public health challenges and “absolute­ly” linked to a suicide epidemic that has ravaged far-flung communities.

“Children … in the remote communities in which I work have higher rates of anxiety and ­depression, higher rates of ­suicidal thoughts and a lot of ­people with FASD have drug and alcohol ­dependency problems,” Dr Fitzpatrick told The Australian. “This is the perfect storm for somebody to take their own life. Cognitive impairment of any cause is linked to momentary lapses in impulse control after a seemingly innocuous ­immediate insult. This is preventable, the result­ of social malaise and our destruct­ive relationship with ­alco­hol. It creates lifelong brain damage that then becomes an issue for health, disability servic­es, education, child protection and the criminal justice system.”

FASD is a spectrum of neuro-cognitive disorders caused by exposur­e to alcohol in the womb.

A diagnosis is made when three or more “structural or functional” brain domains — including memory, cognition and learning, ­behaviour, speech and language, and executive functions — are knocked out. For decades, little was known about it and the prevalence in Australia was hidden, a fact that prompted the NDIS agency to ask experts whether the impairmen­t should be considered a disability and whether it ­responded to ­treatment.

The answers, detailed in a ­report handed to the agency late last year but not publicly released, are: yes and yes.

Dr Fitzpatrick said FASD bore a resemblance to autism­, another con­dition with which the NDIS has been grappling, in that if it could be treated early with intensive therapy, severe longer-term problems could be ameliorated or avoided.

The report handed to the NDIS agency says “intensive, individu­alised behavioural treatment to improve cognitive skills” — the best of which cost about $50,000 a year per person — are “likely to be useful in FASD interventi­ons”.

“Some of the hallmarks of FASD are severe attention and behavioural problems, the maj­ority of those with FASD also have a diagnosis of ADHD,” Dr Fitzpatrick said. “The group of skills known as executive functions, they affect the brain’s ability to co-ordinate cognitive functions. Without (these) it is like trying to navigate your way around Melbourne with a map of Sydney.”

As they grow, children with the condition have a greater tendency to get caught up in crime, unable to factor in the consequences of their behaviour.