Identifying and responding to fetal alcohol spectrum disorder in child and family health: Lessons from an exploratory mixed methods study.

INTRODUCTION: Developmental outcomes for children and young people with fetal alcohol spectrum disorder (FASD) are optimised if their needs are identified early. Yet, health workers miss vital opportunities to identify and respond to FASD due to a lack of support, knowledge and skills. METHODS: Through surveys and interviews, our study investigated what child and family health workers in an Australian metropolitan local health district understand, already do and want to learn about FASD. RESULTS: The study provided evidence of low FASD knowledge and confidence and a lack of referral options with some workers 'patching together' care planning in a 'referral black hole'. Qualitative data provided insight into how skilled clinicians engage families in FASD assessment and negotiate gaps in clinical knowledge. DISCUSSION AND CONCLUSIONS: Health workers in this study requested high-quality training and the development of FASD practice guidelines to improve role clarity and clinical impact when working with FASD populations.

Acute alcohol intoxication and alcohol expectancy effects on women's memory for consensual and non-consensual sexual activity.

Objective: To test whether acute alcohol intoxication and alcohol expectancy affects how accurately women remember consensual and non-consensual sexual activity that occurred during an interactive hypothetical dating scenario. Design: A balanced placebo randomized study that varied alcohol dose (mean Breath Alcohol Content; BrAC = 0.06%) and alcohol expectancy prior to participants encoding a hypothetical interactive rape scenario was implemented. Participants could elect to consent to sexual activity with a male partner in the hypothetical scenario. If they stopped consenting, non-consensual sexual intercourse (i.e., rape) was described. Seven days later, participants' memory for consensual and non-consensual sexual activity in the scenario was tested. Main outcome measures: Memory accuracy, confidence, and feelings of intoxication. Results: A total of 90 females (M age = 20.5, SD = 2.2) were tested regarding their memory accuracy for the consensual and non-consensual sexual activities in the scenario. A multi-level logistic regression predicting memory accuracy for the perpetrator's behaviors during the rape indicated no effect of alcohol intoxication. However, a main effect of alcohol expectancy was found, whereby participants who expected to consume alcohol, compared to those who did not, recalled the perpetrator's behaviors during the rape more accurately. A second regression predicting memory accuracy for consensual sexual activity found no main effects for alcohol intoxication or alcohol expectancy. Participants recalled consensual sexual activity with a high degree of accuracy. Calibration analyses indicated that accuracy increased with confidence level, regardless of intoxication level or alcohol expectancy condition, but that women tended to be overconfident in general. Conclusion: This study provides an important test of how accurately women remember consensual and non-consensual sexual activities. The accuracy of this information is important for forensic medical examinations and police investigations following an allegation of sexual assault. Increased memory accuracy was found for offence details when participants expected to consume alcohol, suggesting there may be important differences in attentional processes (e.g., hypervigilance) depending on whether threat is present. Further research is necessary to investigate memory for sexual violence in real-world settings and to test methods for ascertaining the most complete and reliable accounts.