Interventions in Fetal Alcohol Spectrum Disorders: An International Perspective
Journal: European Journal of Medical Genetics Authors: Christie Petrenko and Michelle Alto http://www.sciencedirect.com/science/article/pii/S1769721216303937
This article takes a unique perspective on the matter of FASD interventions by highlighting cultural barriers that can affect the implementation of FASD programming in the global context. The authors presented the following table listing numerous challenges for researchers and stakeholders to consider:
Retrieved from: Interventions in fetal alcohol spectrum disorders: An international perspective (2017). European Journal of Medical Genetics, 60, 79-91. doi: 10.1016/j.ejmg.2016.10.005. Copyright 2016 by Elsevier.
Addressing Cultural Barriers
The authors suggest that researchers should include cultural liaisons on their teams to mitigate the cultural barriers to implementation. Cultural liaisons, also known as purveyors, would assess and help to develop site readiness for implementation. Much like educational professionals would contribute to the implementation of a school-based intervention, purveyors ensure systems are prepared and hospitable for the intervention, which increases feasibility. Purveyors seek buy-in, commitment to, and understanding of the intervention from stakeholders, which promotes sustainability of the intervention.
Other cultural considerations include:
- Group or individual format
- School, clinic, or home setting
- Transportation to the program
- Type of interventionist required and level of expertise necessary
- Gender of interventionist
- Frequency and duration – consider the demand on families and interventionists
- Adaptability of the intervention
Recognizing that information about the availability of evidence-based interventions is critical, Ms. Elspeth Ross (administrator of FASD Canadian News) contacted Dr. Petrenko for more information about accessing the interventions outlined in the article. Dr. Petrenko provided access information about 10 of the 24 interventions, stating that the remaining may not have published training materials or offerings at this time. Ms. Ross then reached out to us to share Dr. Petrenko’s response so others can benefit from this information. We’ll be taking an in depth look at these (and other) interventions and sharing practical tips based on the various studies and findings. What intervention would you like us to profile first? Let us know in the comments! First, where to find founding information on 10 interventions, from Dr. Petrenko:
Parent-Child Assistance Program: http://depts.washington.edu/pcapuw/
- Provides women with alcohol and substance use problems support connecting to community resources, coordinating services, and ensuring a safe environment for mother and child.
- Developed in Seattle, WA
- Website includes information on how to get trained on using this program
- P-CAP has been adapted for mothers with FASD.
- The Coaching Families and Step-by-Step programs offered by Catholic Social Services in Edmonton, Alberta are loosely based on the P-CAP model. Both described here: https://www.cssalberta.ca/Our-Ministries/Fetal-Alcohol-Spectrum-Disorder-Support
- Alberta P-CAP CouncilBreaking the Cycle: http://www.mothercraft.ca/index.php?q=ei-btc
- Focuses on the parent-child relationship with substance-abusing mothers and their young children by offering a comprehensive and coordinated range of services.
- Developed in Toronto, Ontario.
- Website includes contact information.Parent Training Workshops: http://www.emory.edu/msacd/index.html
- Educates families about FASD, information on effective behaviour management strategies, and advocacy tools.
- Developed in Atlanta, GA by Claire Coles and Julie Kable – contact developers for more information.Families Moving Forward Program: http://depts.washington.edu/fmffasd/
- Modifies specific parenting attitudes and responses toward child problem behavior to reduce child problem behavior and improve family functioning.
- Developed in Seattle, WA.
- Training available to providers (described on website); quarterly trainings available or can be set up with providers on-site.
- Providers have been training in some locations in US and Canada.
- Actively being disseminated in community; seeking interested providers.
- Note: I am one of the trainers for this program.Pay Attention Program: https://www.lapublishing.com/pay-attention/
- Focuses on improving visual and auditory attention through graded activities.
- Commercially available for providers to purchase.
- Teaches children affective and metacognitive control strategies using a computer game and behavioral training.
- Currently under study in Atlanta, GA.Alert Program for Self-Regulation: https://www.alertprogram.com/
- Targets self-regulation skills through sensory integration and cognitive processing activities organized in 3 successive stages.
- Commercially available.
- Materials available for parents, teachers, and providers.
- Online training available.
- The Parents and Children Together (PACT) program based on Alert was completed in Chicago, IL. A description of the project is here: http://www.childrensresearchtriangle.org/previous-grant-funded-projects/
- A classroom version of Alert is currently being tested in several Aboriginal communities in Australia.Fire and Street Safety Training: http://www.do2learn.com/aboutus/aboutus.html
- Trains children in 4 concrete safety skills for fire safety or street safety using a video game. An animated dog teaches child skills in small incremental steps and restricts incorrect or dangerous movements.
- Developed in Atlanta, GA in partnership with do2learn.com
- Not sure if games are still available, but other resources available currently at do2learn.Good Buddies:
- Emphasizes friendship skills. Tailored to the neurodevelopmental needs of children with FASD. Caregiver group focuses on how to support children’s friendships and social skills.
- Developed at UCLA.
- Adapted from the Child Friendship Skills program: https://www.semel.ucla.edu/socialskills
- Fred Frankel also has a book for families discussing how to support many of the skills taught in CFT.
- CFT is also listed in SAMHSA’s registry of evidence-based. programs: http://nrepp.samhsa.gov/ProgramProfile.aspx?id=13#hide4 and information on getting training in the program is provided.
- The Lagueson et al., 2007 article (cited in our review) describes how CFT was adapted for FASD.Math Interactive Learning Experience (MILE): http://www.emory.edu/msacd/Research/MILE.html
- Includes individualized tutoring for the child, parent instruction and “at-home” activities to support generalization of skills, parent workshops, and case management and consultation as needed to support the child’s readiness to learn.
- Developed and tested in Atlanta, GA.
- Has been studied in schools in Edmonton, Alberta.
- Training and materials are available (see details in link above).
Many thanks to Dr. Petrenko for compiling this information and to Ms. Ross for forwarding to us. There have also been studies on the following interventions that we can review in later posts. Again, let us know what you’d like to see more of!
- Computerized Progressive Attention Training: Uses computerized training on four tasks in combination with coaching in metacognitive strategies and support.
- Parent Child Interaction Therapy: Focuses on improving the parent-child relationship, increasing appropriate social skills, reducing problem behaviour, and creating a positive discipline program.
- Rehearsal Training: Teaches children rehearsal strategies to improve working memory.
- Cognitive Control Therapy: Reorganizes cognitive controls and maladaptive strategies that undermine classroom performance. Teaches children how to think and engage in self-observation and self-regulation.
- Parents and Children Together: Incorporates components of the Alert Program for Self-Regulation and treatment strategies from the traumatic brain injury literature.
- Kids’ Club: Facilitates the development of social skills while addressing sensory needs, providing structure and consistency, having a low child-adult ratio, and involving caregivers.
- Literacy and Language Training: Focuses on language therapy, phonological awareness, and literacy training.
- Project Step-Up: Focuses on preventing or reduces alcohol and substance abuse.in teens with FASD. Provides alcohol education, and teaches coping skills and adaptive responses to alcohol-related social pressure.
- Nutrition and medication: choline supplementation, ADHD medication, neuroleptics