empowering significant others to prevent fetal alcohol spectrum disorders (fasd) samhsa’s...

Empowering Significant Others to Prevent

Fetal Alcohol Spectrum Disorders (FASD)

SAMHSA’sPartnership to Prevent FASDFASD Center for Excellencefor Materials Development

Memi Miscally, M.P.H.Rebecca M. Buchanan, Ph.D.

Scott Crosse, Ph.D.Gwyndolyn Ensley, M.Ed.Giovonna Miller, M.P.H.

November 17, 2003

Learning Objectives

1. Articulate at least 3 reasons why significant others should be empowered to support women in abstaining from alcoholconsumption

2. List at least 5 factors that influence significant others’ decisions to support women

3. Identify at least 2 ways for providers to help empower significant others to support women

Research Methods

• Literature review (medicine, public health, social science)

• Focus groups in four pilot sites – Women:

• 97 participants in 11 groups• 33% White, 30% Hispanic/Latino,

24% Black/African American, 13% Other

– Significant others: • 141 participants in 16 groups• 49% Black/African American, 23% White,

23% Hispanic/Latino, 5% Other

Overview of the Partnershipto Prevent FASD

Background

• Funder SAMHSA/CSAP

• Period July 2001-June 2004

• Resources Funds from CSAP Contributions from partnerships in 4 pilot communities

• Final Task Share community-based model

Pilot Communities and Coordinators

Erie County, NYErie County Council for the

Prevention of Alcohol and Substance Abuse

Sumter County, SCThe Prevention Center, SCADA

East Baton Rouge Parish, LACapital Area Human

Services DistrictDoña Ana County, NM

Ben Archer Health Center

Strategies

Initiate and sustain FASD prevention activities

Local Partnerships

Increase perceptions

of risk

Encourage women to abstain

from alcohol

Significant Others

Increase perceptions

of risk

Abstain from alcohol

Preconceptional/Pregnant Women

Advise women and significant

others

Providers

Definition of Providers

Pilot CommunityCoordinator

PromotorasHealth Educator

OB/GYN

Wellness Coordinator

Social Worker

Why Significant Others?

Personally Connect with Women

Significant Others Have Opportunities for Discussion

• They live with or spend time with her at home

• They accompany her to restaurants, bars, parties, etc.

• They accompany her to prenatal visits

• They are “there for her”

Significant Others Are Committed

to Supporting Women“I would go the whole 9 yards.”

Significant Others Influence Women’s Alcohol

Consumption During Preconception/Pregnancy

To Drink

Take part in social settings where women drink alcohol

Approve of women’s alcohol consumption

Not To Drink

Disapprove of women’s alcohol consumption

Help women find non-alcoholic options

Talk women through cravings

Please note “women” is used as an abbreviation for preconceptional/pregnant women to save space on this slide.

How Do Significant Others

Decide Whether or Notto Advise Women

ConcerningDrinking During

Pregnancy?

Consider the Challenges

Barriers to Initiating a Conversation

• Not aware of the pregnancy

• Concern over other issues– Unexpected pregnancy– Financial status

• Perceive advice as unwanted

Low Perceived Likelihood of Relevance

• “Not me”

• Rather, people who know women who are:– Alcoholics, heavy drinkers– Teens– Non-white, low income, single women

Perceptions of Women’sDrinking Behaviors

• Social– At home, with fathers-to-be who drink– Out, with others who drink

• Moderate– “Sip” or 1-2 drinks– Occasionally– Not during 1st-2nd trimester– Beer, wine, wine cooler, “mild” mixed drink (not

hard liquor)

Skepticism

• Women can drink alcohol and give birth to healthy babies

• Women can abstain from alcohol use and give to unhealthy babies

Low Perceived Self-Efficacy

• What do I say to her?– How much alcohol harms the baby?– What are the specific consequences of

drinking alcohol during pregnancy?

• How do I tell when she needs support?

• Will I actually make a difference?

Negative Consequences

• Denial

• Anger

• Loss of a friend

Consider the Facilitators

Positive Consequences

• Healthy babies

• Influence in bearing and raising children– Children are the future

• Personal fulfillment

Sources of Support

• Parents/grandparents (esp. mothers/grandmothers)

• Couples

• Friends

• Neighbors

• Providers

How Can Providers Empower Significant

Others?

Advise Significant Others1. Help disseminate materials

– Hang up posters– Write newsletter articles

2. Counsel – One-on-one conversation– Support group– Class– Workshop

3. Reinforce the positive

4. Leave behind booklets, rack cards

5. Develop a referral system

6. Ensure relevancy

Questions