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Nationwide Primary Prevention of FAS
Nationwide effort to develop and disseminate FAS prevention materials to a wide range of audiences.
This is a nationwide fetal alcohol syndrome (FAS) primary prevention project employing public education and training of trainers who would then train local interventionists to target Native American and Alaska Native school children, prenatal women, and community groups. Educational materials included pamphlets, slide shows, movies, and discussions. Trainings varied from 30- to 60-minute sessions for school-age children. Prenatal and community group trainings varied from 30-minute to 6-hour sessions, including multiple media exposures.
Outcomes
Variable increases in retention of knowledge about FAS.
This intervention appears to be effective for some Tribes. Pilot findings included statistically significant increases in and retention of FAS knowledge at 2– to 4–month follow-ups. However, results varied by location. Changes appeared substantial for some Tribes; other Tribes did not experience much change in knowledge.
Costs
Start-up costs to develop materials and training interventionists would be high, but ongoing costs would be lower.
Start-up costs are high with a large volume of print and electronic materials created and disseminated, plus travel and training costs. The intervention requires FAS specialists; trainers need certification to train several community members from various areas to reach the entire community. This would be costly. Maintenance would depend on retention of trained personnel and the cost of materials.
Cultural Engagment
Materials were developed for specific Tribal groups.
Prevention materials were developed with specific Tribal groups in mind (e.g., use of Tribe-specific illustrations, different cultural versions of pamphlets and posters). Some materials were translated into Navajo. Preference was given to local interventionists, and some group sessions were conducted in Navajo language.
Participants
Child, Adolescent, Young Adult, Adult; Native; Female, Male
Setting
Community Wide, Clinical/Healthcare, Reservation, Rural, School
Delivery
Multi-level
Students, community health personnel, community groups in a variety of community settings.
The early part of this prevention program focused on clinical and community-level activities in the southwestern United States. These activities included individual and group training of clinicians and community members as well as delivery of prevention intervention to at-risk moms and the broader community. The latter part of the program ramped up training activities to cover all Indian Health Services (IHS) service areas (urban and rural). This latter series of interventions was delivered in prenatal clinics, schools, and community settings.
Participants included groups of elementary and secondary school students, women in their first pregnancy, and members of the community. No specific details are provided on the age range of community people or whether non-Natives were included. The study suggests that materials were developed for both males and females.
Staffing Needs
Advanced Degree (post BA) Professional, Certified Professional, Community Leader, Educator
Fetal alcohol syndrome (FAS) experts provided training to local community professionals on delivering intervention.
FAS experts provided the first level of training. Local community members were then trained. Drawn from many backgrounds, most trainers were professionals, such as teachers, nurses, counselors, mental health professionals, physicians, and health educators.
Research Design
Pre-/post-intervention data
Developmental stage of research
Early Stage due to inconsistent efficacy.
Feasibility and acceptability were demonstrated in multiple locations. However, there was evidence of inconsistent results at an early stage of development.
Potential
This “train the trainer” model to develop and disseminate an alcohol prevention intervention can be promising.
The "train the trainer" model has been employed in Tribal communities. However, buy-in by clinicians, leadership, and community members is needed for the full potential to be realized. This particular intervention was a good model of how to train trainers to disseminate information across multiple groups. "Train the trainer" appears to be a feasible model and can be adapted to specific community needs. Results suggest it can be effective.
References
May PA, Hymbaugh KJ. A macro-level fetal alcohol syndrome prevention program for Native Americans and Alaska Natives: Description and evaluation. J Stud Alcohol. 1989;50(6):508-518. http://www.ncbi.nlm.nih.gov/pubmed/2586104. https://doi.org/10.15288/jsa.1989.50.508.
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