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Local and StateAction to PreventFetal AlcoholSpectrum DisordersCalondra Tibbs - Phil PetroskyRoseMary Asman – Mary Claire Massi-Lee

Objectives Increase awareness of FASD prevention activities atlocal and state levels, specifically Ohio's Not a SingleDrop initiative and Michigan's FASD Community Grants. Learn about strategies to support education andscreening of pregnant women for exposure to alcohol. Learn how to engage communities in FASD preventionactivities through partnerships at the local and statehealth departments.

PresentersCalondra D. Tibbs, MPHNational Association of County& City Health Officials

PresentersPhil PetroskyOhio Department of Health,WIC Program

PresentersRose Mary Asman, RN, MPAMichigan Department of CommunityHealth, Division for Family andCommunity HealthMary Claire Massi-LeePublic Health, Delta andMenominee Counties,Substance Abuse Services

Overview of Fetal AlcoholSpectrum Disorders

Fetal Alcohol SpectrumDisorders (FASD) Group of conditions that occur in a person whosemother drank alcohol during pregnancy Effects may include physical problems, behavioralproblems, and difficulty with learning FASD is not a clinical diagnosis Effects can range from mild to severe

Types of FASDsFetal Alcohol Syndrome (FAS)Alcohol-Related Neurodevelopmental Disorder(ARND)Alcohol-Related Birth Defect (ARBD)

Signs, Difficulties andDisabilities by Age LevelAge LevelSigns, Difficulties, and DisabilitiesINFANTSLow birth weight; irritability; sensitivity to light, noises and touch;poor sucking; slow development; poor sleep-wake cycles; andincreased ear infections.TODDLERSPoor memory capability; hyperactivity; lack of fear; no sense ofboundaries; and a need for excessive physical contact.GRADEShort attention span; poor coordination; and difficulty with both fineSCHOOL YEARS and gross motor skills.OLDERCHILDRENTrouble keeping up with school; and low self-esteem from recognizingthat they are different from their peers.TEENAGERSPoor impulse control; cannot distinguish between public and privatebehaviors and must be reminded of concepts on a daily basis.ADULTSNeed to deal with many daily obstacles, such as affordable andappropriate housing, transportation, employment and moneyhandling.

FASD Facts Scientists believe that there are at least 3 times thenumber of FASDs as FAS An estimated 0.2 – 1.5 cases of FAS occur for every 1,000live births Each year 40,000 babies are born with an FASD FASDs are a leading preventable cause of intellectualdisabilities

FASD in Comparison

Financial Impact of FASD FASDs cost about 6 billionper year The lifetime cost of caringfor one individual withFASD is estimated to begreater than 2 million For a child with identifiedFAS, incurred health costsare 9 times higher thanfor children with an FASD

Facts aboutAlcohol Use 7.6% of pregnant women and51.5% of non-pregnant womenreported drinking alcohol in thepast 30 days 1.4% of pregnant women and15.0% of non-pregnant womenreported binge drinking in thepast 30 days The highest estimates ofreported alcohol use amongpregnant women were: Aged 35-44 years White College graduates Employed

FASD Prevention &Reduction Prevention begins with communication Ask all women of child-bearing age about alcohol useTalk about the effects of alcohol on an individual and on a fetus Brief interventions Outreach, screening, referral, and other activities that promote the health ofthe mother and the fetus Public Health Messaging No known safe amount of alcohol use during pregnancy or while trying to getpregnant FASDs are completely preventable if a woman does not drink alcohol duringpregnancy

FASD Resources The Arc http://www.thearc.org/learn-about/fasd Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/ncbddd/fasd/index.html Substance Abuse and Mental Health Services (SAMSHA) http://www.fasdcenter.samhsa.gov/

Ohio’s FASDInitiativePhil Petrosky, Parent NetworkOhio FASD Steering CommitteeOhio Department of HealthPhil.Petrosky@odh.ohio.govAugust 28, 2014

Ohio’s FASD Initiative2003 - FoundationMrs. Hope Taft, First Lady of Ohio(Emeritus), in partnership with membersof the Ohio Family and Children First(OFCF) Cabinet Council, formed the OhioFASD Steering Committee. Originalcommittee included: nine state agencies,institutes of higher education, providersand parents.

Ohio’s FASD InitiativeOhio FASD Steering Committee State Agency Membership Ohio Department of AgingOhio Department of Alcohol and Drug Addiction Services merged into OhioDepartment of Mental Health and Addiction Services (July 2013)Ohio Department of EducationOhio Department of HealthOhio Department of Job and Family ServicesOhio Department of Medicaid (Launched July 2013)Ohio Department of Mental Health merged into Ohio Department of MentalHealth and Addiction Services (July 2013)Ohio Department of Developmental DisabilitiesOhio Department of Rehabilitation and CorrectionsOhio Department of Youth Services

Ohio’s FASD InitiativeOhio FASD Steering Committee AdvocacyMembership 7 Parents/CaregiversOhio Center for Autism and Low IncidenceOhio Family and Children First CouncilDouble ARC – Toledo, OhioMontgomery County ADAMHS BoardAkron Children’s Hospital Regional Genetics CenterLorain County General Health DistrictFirst Step Home (Women’s Center)Cincinnati Children’s Medical Center

Ohio’s FASD Initiative On Sept. 9, 2004, the FASD Steering Committeeheld a Town Hall Meeting to increase awareness ofthe challenges faced by Ohio’s children andfamilies. This testimony and a needs assessment conductedin 2005 with The Ohio State University’s Center forLearning Excellence, using the Partnerships forSuccess Strategic Planning Process, led to a courseof action based on key findings.

Ohio’s FASD InitiativeStrategic Planning Findings Many professionals who provide services to children andfamilies in Ohio are ill-prepared to address FASD. Children are often diagnosed with several mental andphysical health disorders that can lead to a variety ofuncoordinated services. New and existing servicesshould be designed and coordinated to screen for FASD.

Ohio’s FASD InitiativeStrategic Planning Findings With the exception of a few areas of the state, servicesavailable to individuals affected by FASD areinadequate. There are few services available for parents, fosterparents and other caregivers, who play key roles inpromoting the welfare of children affected by FASD.

Ohio’s FASD InitiativeStrategic Planning Findings Efforts should be undertaken to establish formalrecognition of FASD. Policies should be developed andadopted that define how FASD is addressed ineducational settings. Ohio-specific FASD prevalence data should be collectedon a continuing basis.

Ohio’s FASD InitiativeSteering Committee MissionTo establish efficiency in state systemsresource allocation, coordination ofservices and augmentation of availableresources to address Fetal AlcoholSpectrum Disorders(FASD)

Ohio’s FASD InitiativeThe Strategic Plan Has Five Goals1. Increase the availability of services for those alreadyaffected by FASD and for parents and other caregivers;2. Increase awareness regarding the risks associated withalcohol use during pregnancy;3. Provide FASD-specific education and training foragencies, organizations and professionals who provideservices to children and families with or at risk of FASD;

Ohio’s FASD InitiativeThe Strategic Plan Has Five Goals4. Adopt appropriate FASD screening tools and protocolsand increase access to screening; and5. Create and implement a data tracking system to trackFASD risk factors, prevalence, and incidence in Ohio,and measure progress toward reaching the other fourgoals.

Ohio’s FASD InitiativeFASD Parent Network The Ohio FASD Parent Network is a workgroup of the SteeringCommittee. Their mission is to increase FASD awareness andprovide information and resources to families and caregivers aswell as organizations serving individuals affected by FASD. The parent network has held meetings in five Ohio regions forinput from families about their experiences with FASD. Feedback isprovided to the Steering Committee to help shape Ohio goals andpriorities Three parent network families participated in an FASD trainingvideo for educators entitled: In Their Own Words

Ohio’s FASD InitiativeOn August 16, 2005, the 1st Ohio FASD Conference washeld with expert featured speakers: Dr. Larry Burd, Dr.Susan Astley, Ira Chasnoff, and Kathleen Mitchell. About 350 families, health & human serviceprofessionals, & teachers participated

Ohio’s FASD InitiativeOhio's FASD Web Sitehttps://notasingledrop.mh.state.oh.us/Launched in April 2006, the site includes featured linksfor: definition of FASD, information on Ohio’s FASDinitiative, evidenced-based practices, screening anddiagnosis, living with FASD, and resources including Ohio’sMarketing Toolkit and FASD Generalist Training PowerPoint

Ohio’s FASD Initiative

Ohio’s FASD InitiativeApril 2006 – FASD AwarenessThe Ohio FASD universal marketing campaign kicked offwith public service announcements airing on WBNS 10TV,Ohio News Network, Mix 97.1FM and Ohio News NetworkRadio.Advertisements also ran in Columbus Parentmagazine and its sister publications throughoutthe state.

Ohio’s FASD InitiativeSeptember is FASD Awareness Month in OhioIn 2011, the Governor’s Resolution on FASD Preventionand Awareness Month was presented at an FASDcelebration of accomplishments in the Ohio StatehouseAtrium in Columbus.First Lady of Ohio, Karen Kasich, presented theGovernor’s Resolution to the Ohio FASD SteeringCommittee.

Ohio’s FASD InitiativeSeptember is FASD Awareness Month in OhioA letter for Maternal and Child Health Careprograms is provided with information to assistwith FASD awareness month efforts; the letterincludes attachments such as: Governor’s FASD Month DesignationFASD Awareness Day Suggestions SheetFASD Fill-in Press ReleaseFASD Fill-in Letter to Elected OfficialsOhio FASD Facts Sheet

Ohio’s FASD InitiativeOhio FASD Fast Facts Sheet

Ohio’s FASD InitiativeOhio FASD Awareness ActivitiesIn 2010, provided FASD Training for Parents and Providersin NW and SW Ohio Regions, & FASD Generalist Training inNE RegionIn 2013, provided FASDDiagnostic Capacity Trainingfor health care practitioners inSE & Central Ohio Regions

Ohio’s FASD InitiativeAdditional Ohio FASD Prevention EffortsASBI stands for Alcohol Screening Brief Intervention. It is a process modeled after California Women, Infants, andChildren’s program (WIC), which screens all pregnant WICparticipants for alcohol use, provides brief interventions toall who screen positive, follows those receiving briefinterventions during pregnancy, and refers them totreatment services. The goal is to educate pregnant women about the dangers ofdrinking alcohol while pregnant and, in turn, positivelyinfluence their decision about reducing or completelyceasing drinking.

Ohio’s FASD InitiativeAdditional Ohio FASD Prevention EffortsResults from Montgomery County, Ohio WIC pilot ASBIproject indicated that:o five percent of the pregnant women screened positive,o 97 percent abstained from further alcohol use after an initialbrief intervention, ando 99 percent abstained after two brief interventions.

Ohio’s FASD InitiativeAdditional Ohio FASD Prevention EffortsOhio WIC and the Montgomery County WIC program developed fourAlcohol Screening and Brief Intervention training modules for OhioWIC projects and other programs’ use.Modules are on the OhioTrain website: Course number 1044743ASBI process materials are available on the Ohio WIC website wic1.aspxClick on ASBI and scroll down to links for:o ASBI Screening and Scoring Toolso WIC Project CARE Health and Behavior Workbooko ASBI Follow-up Visit Questionso What is a Standard Drink

Ohio’s FASD InitiativeAdditional Ohio FASD Prevention EffortsAs of April 7, 2014 650 Ohio WIC employees had been trained on the ASBIprocess. There were 5,160 Ohio WIC participants that had beenscreened, and 564 brief interventions were given.