Outcomes and needs of health and education professionals following fetal alcohol spectrum disorder-specific training.

AIM: Understanding professionals' views and needs can help advance service provision and improve future training opportunities, Therefore, the current study examined the experiences of Australian and New Zealand professionals who have attended fetal alcohol spectrum disorder (FASD)-specific training and the impact of this training on their current practices. METHODS: A total of 52 health and education professionals from Australia and New Zealand completed an online survey that asked about their training experiences; changes in practice following training; their experiences implementing assessments in their workplace; and, for Australian professionals, their experiences of using the recently released Australian Guide to FASD diagnosis. RESULTS: Respondents described a range of perceived practice changes following training attendance. These included increases in: asking about alcohol use during pregnancy; providing referrals for assessments; providing assessments and consultation with other professionals regarding FASD diagnosis. Qualitative findings also demonstrated themes of increased knowledge, awareness and/or confidence about providing neurodevelopmental assessments and FASD diagnosis following training. CONCLUSIONS: This is the first study to document training and practice experiences of Australian and New Zealand professionals in relation to FASD. Overall, training efforts were well received by professionals and were effective in changing professionals' self-reported practice. Future investment in FASD-specific training initiatives and increased resources to enable neurodevelopmental assessments for all complex presentations, including FASD, is warranted.

Fetal alcohol spectrum disorders.

Alcohol readily crosses the placenta and may disrupt fetal development. Harm from prenatal alcohol exposure (PAE) is determined by the dose, pattern, timing and duration of exposure, fetal and maternal genetics, maternal nutrition, concurrent substance use, and epigenetic responses. A safe dose of alcohol use during pregnancy has not been established. PAE can cause fetal alcohol spectrum disorders (FASD), which are characterized by neurodevelopmental impairment with or without facial dysmorphology, congenital anomalies and poor growth. FASD are a leading preventable cause of birth defects and developmental disability. The prevalence of FASD in 76 countries is >1% and is high in individuals living in out-of-home care or engaged in justice and mental health systems. The social and economic effects of FASD are profound, but the diagnosis is often missed or delayed and receives little public recognition. Future research should be informed by people living with FASD and be guided by cultural context, seek consensus on diagnostic criteria and evidence-based treatments, and describe the pathophysiology and lifelong effects of FASD. Imperatives include reducing stigma, equitable access to services, improved quality of life for people with FASD and FASD prevention in future generations.

Pakeha/Palangi positionality: disentangling power and paralysis.

Significant health inequities in Aotearoa present compelling evidence that responsibilities under Te Tiriti o Waitangi have not been upheld. The aim of this paper is to present our experiences as Pakeha/Palangi working in Maori and Pasifika health in Aotearoa. We are interested in what prevents the upholding of responsibilities by tangata Tiriti and in how, as tangata Tiriti, we can do better. In this paper we explore responsibilities of tangata Tiriti by describing the context and evaluating power, paralysis, and positionality. "Power" is identified as a key factor continuing to perpetuate colonisation and systemic racism. "Paralysis" occurs due to individual racism, apathy, guilt and/or a fear of doing wrong. "Positionality" is an internal and external process that involves consciousness of biases, perspectives, values, privileges, beliefs, superiority and identities. Finally, we point to tools of engagement with the aim of serving and creating space for self-determination for Maori and Pasifika peoples.

Describing the experience of Indigenous peoples with prenatal alcohol exposure and FASD: a global review of the literature to inform a Kaupapa Maori study into the experiences of Maori with FASD.

AIM: This paper reports the findings of a literature review in answer to the research question: "What are the strengths and weaknesses of the existing research into the experience of prenatal alcohol exposure and Foetal Alcohol Spectrum Disorder in Indigenous communities?" METHOD: MEDLINE (Ovid), psychINFO, CINAHL Plus and Web of Science, EMBASE, Informit databases were searched using key words to identify relevant literature. Given the anticipated scarcity of research relevant to our study, no geographic or chronologic limitations were placed on the searches. Studies which were solely descriptive were excluded, but reviews were included. The data analysis was informed by a Kaupapa Maori positioning and the 'CONSIDER' statement on reporting of health research involving Indigenous people. RESULTS: Thirty-four papers met the inclusion criteria. Four main categories of papers were found: protocols/methods development, evaluation of interventions to reduce alcohol-exposed pregnancy, research seeking to understand alcohol use in pregnancy and interventions to improve the experience of people with FASD and their families. Indigenous peoples of Australia, Canada and North America were the participants of the papers found in this review, with only one research study found from Aotearoa New Zealand. CONCLUSION: The existing literature on FASD in Indigenous communities internationally is heavily skewed towards the development and evaluation of interventions to reduce alcohol-exposed pregnancies. There is also a focus on studies which aim to understand and describe the variables which lead to alcohol use among Indigenous communities, and the relationship with alcohol use in the perinatal period. In the last ten years, a number of protocols/methods development for FASD-related interventions in Indigenous communities have been published. There is one published study from Aotearoa in the scientific literature into the experience of Maori with FASD.

Key Stakeholder Priorities for the Review and Update of the Australian Guide to Diagnosis of Fetal Alcohol Spectrum Disorder: A Qualitative Descriptive Study.

Since the 2016 release of the Australian Guide to the Diagnosis of Fetal Alcohol Spectrum Disorder (FASD), considerable progress has been made in the identification and diagnosis of the disorder. As part of a larger process to review and update the Guide, the aim of this study was to identify review priorities from a broad range of stakeholders involved in the assessment and diagnosis of FASD. Sixty-two stakeholders, including healthcare practitioners, researchers, other specialists, individuals with cultural expertise, lived experience and consumer representatives completed an online survey asking them to describe up to five priorities for the review of the Australian Guide to the Diagnosis of FASD. A total of 267 priorities were described. Content analysis of responses revealed priority areas relating to diagnostic criteria (n = 82, 30.7%), guideline content (n = 91, 34.1%), guideline dissemination (n = 15, 5.6%) and guideline implementation (n = 63, 23.6%). Other considerations included prevention and screening of FASD (n = 16, 6%). Engaging stakeholders in setting priorities will ensure the revised Australian Guide can be as relevant and meaningful as possible for the primary end-users and that it meets the needs of individuals with lived experience who will be most affected by the diagnosis.

Evidence for the Effectiveness and Acceptability of e-SBI or e-SBIRT in the Management of Alcohol and Illicit Substance Use in Pregnant and Post-partum Women.

Alcohol and illicit psychoactive drug use during pregnancy have increased worldwide, putting women and their children's health and development at risk. Multiple drug use, comorbid psychiatric disorders, sexual and physical abuse are common in women who use alcohol and drugs during pregnancy. The effects on the mother include poor reproductive and life-long health, legal, family, and social problems. Additionally, the exposed child is at increased risk of long-term physical health, mental health, and developmental problems. The stigma associated with substance use during pregnancy and some clinicians' reticence to inquire about substance use means many women are not receiving adequate prenatal, substance abuse, and mental health care. Evidence for mHealth apps to provide health care for pregnant and post-partum women reveal the usability and effectiveness of these apps to reduce gestational weight gain, improve nutrition, promote smoking cessation and manage gestational diabetes mellitus, and treat depression and anxiety. Emerging evidence suggests mHealth technology using a public health approach of electronic screening, brief intervention, or referral to treatment (e-SBIRT) for substance use or abuse can overcome the typical barriers preventing women from receiving treatment for alcohol and drug use during pregnancy. This brief intervention delivered through a mobile device may be equally effective as SBIRT delivered by a health care professional in preventing maternal drug use, minimizing the effects to the exposed child, and providing a pathway to therapeutic options for a substance use disorder. However, larger studies in more diverse settings with women who have co-morbid mental illness and a constellation of social risk factors that are frequently associated with substance use disorders are needed.

[Formula: see text] Cognitive and social/emotional influences on adaptive functioning in children with FASD: Clinical and cultural considerations.

Fetal Alcohol Spectrum Disorder (FASD) is one of the leading causes of intellectual disability and learning difficulties around the world. Children with FASD often have extremely low adaptive behavior due to the severity of brain impairment, however there is limited understanding as to the important predictors of adaptive behavior. In a study of 39 children with FASD and 29 comparison children, we found that social cognition (specifically recognizing emotions) was the only significant independent predictor of teacher-rated adaptive functioning even after including IQ, executive functioning, and adverse childhood experiences into the model. In this current study, Maori (Indigenous people of Aotearoa New Zealand) were overrepresented; therefore, the research was supported by a strong partnership with Te Wahanga Hauora Maori (Maori Health Service). Aotearoa New Zealand's colonized history is recognized and findings are discussed with regard to both the psychological literature and a Te Ao Maori worldview.