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Comprehensive Program for High-Risk Women
A comprehensive fetal alcohol syndrome (FAS)/fetal alcohol effects (FAE) prevention program that included individualized treatment and support.
The Tuba City FAS Prevention Project was a comprehensive prevention program that, while including some fetal alcohol syndrome (FAS) prevention education and screening in prenatal clinics, focused on prevention among Native American women to reduce fetal alcohol effects and FAS. After screening, women at high risk for an alcohol-exposed pregnancy were referred for intensive prevention services to avoid prenatal alcohol exposure. These services included case management, counseling, personal support, social services, and medical services, such as alcohol treatment and contraception.
Outcomes
At follow-up, most participants were abstinent or drinking less; and 31% maintained a high-risk level of drinking.
Of 48 women referred, 39 became participants, and follow-up data were collected for 32. Approximately one-third of participants were drinking as heavily at follow-up as they were before the intervention. More than 50% were abstinent from drinking at follow-up, and 12.5% reported drinking reduction. A large percentage were still not using contraception. Clients referred during pregnancy were more likely to accept help. The program achieved high acceptability ratings.
Costs
This comprehensive, multi-layered program may require substantial funding to initiate and maintain.
Overall costs could be high because of the need for a dysmorphologist, staff training, and effort to prepare materials and presentations. Maintenance costs also seem high because they would include, for example, funding for detox and alcohol treatments, FAS diagnostic clinic staff, and clinic rooms. It is unclear what level of training or what degree of involvement is necessary for staff.
Cultural Engagment
No specific cultural engagement was described, but materials and interactions were provided in Navajo language.
The Navajo language was used in recruitment materials and by the Navajo interventionists. There is no mention of Hopi adaptations. The incorporation of natural helpers assisted in bridging the gap between mainstream and Navajo culture. There appear to have been multi-year partnerships with the Tribal community.
Participants
Adolescent, Young Adult, Adult; Native; Female
Setting
Clinical/Healthcare, Reservation
Delivery
Individual
Women at high risk for an alcohol-exposed pregnancy on Navajo and Hopi reservations.
The intervention was conducted at the Tuba City Service Unit, serving women living on Navajo and Hopi reservations in Arizona. The primary focus of this program was individual women at high risk for an alcohol-exposed pregnancy. The program maintained contact with 39 of 48 referred women (ages 16 to 41 years) and measured healthy birth outcomes.
Staffing Needs
Not Specified
Trusted community members, local service providers, and a university-based dysmorphologist (a pediatrician who focuses on the causes, treatment, and prevention of birth defects).
Trusted community residents made up the majority of the staff, but their credentials and backgrounds were not specified. A dysmorphologist (most likely someone at M.D. or Ph.D. level) was employed to diagnose FAS in infants born to the participants during the program.
Research Design
Pre-/post-intervention data
Developmental stage of research
The program assessed drinking before and up to 18 months after the intervention as well as birth status of the newborns. Pre-test data were unclear, but post-test data describe self-reported drinking.
Potential
Feasibility is demonstrated but there is insufficient detail to determine efficacy and transportability.
This program demonstrates feasibility. It is an ambitious prevention program because it includes trainings, recruitment efforts, brief and longer interventions with pregnant and potentially pregnant women, and assessments of newborns. There was moderate retention and a suggestion of reduced drinking. However, insufficient detail is provided to fully assess the scope, cost, or promise of the program.
References
Masis KB, May PA. A comprehensive local program for the prevention of fetal alcohol syndrome. Public Health Rep. 1991;106(5):484-489. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1580308.
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