The Prevalence of FASD in a Maritime First Nation

Community

The Prevalence of FASD in a Maritime First Nation

Community

Principal Researcher:

Lori Vitale Cox PH.D

Principal Researcher:

Lori Vitale Cox PH.D

Background Background

Is FASD a Serious Health Issue in Canada?

Still No Normative National Data Incidence U.S. FAS 1-3 per 1000 (1997)

FASD 9-10 per 1000 (2001)

Is FASD a Serious Health Issue in Canada?

Still No Normative National Data Incidence U.S. FAS 1-3 per 1000 (1997)

FASD 9-10 per 1000 (2001)

Prevalence Studies in Canadian First Nation Communities

Prevalence Studies in Canadian First Nation Communities

Northern BC FN 190/1000

Robinson et al 1987

Northern Manitoba FN 95/1000

Chudley et al 1997

No Prevalence Studies in First Nations Communities in Maritime Region of Canada

Northern BC FN 190/1000

Robinson et al 1987

Northern Manitoba FN 95/1000

Chudley et al 1997

No Prevalence Studies in First Nations Communities in Maritime Region of Canada

Is FASD Health Issue in FN Communities in Maritimes?Is FASD Health Issue in FN Communities in Maritimes?

Present Study Based on Data Collected in an Anonymous Aboriginal Community in the Maritime Region of Eastern Canada

From January 1998 Until June of 1999 Elementary School Population Grades 1-8

N=187

Present Study Based on Data Collected in an Anonymous Aboriginal Community in the Maritime Region of Eastern Canada

From January 1998 Until June of 1999 Elementary School Population Grades 1-8

N=187

IntroductionIntroduction Community-2500 People, 750 Families,

50% School Age or Younger Band Operated Elementary School K-4 to

Grade 8 267 children in Community School 187 children Grade 1-Grade 8

Community-2500 People, 750 Families, 50% School Age or Younger

Band Operated Elementary School K-4 to Grade 8

267 children in Community School 187 children Grade 1-Grade 8

School Population 1997-8School Population 1997-8

Grade Number of Children N=187 Grade 1 27 Grade 2 28 Grade 3 22 Grade 4 29 Grade 5 32 Grade 6 17 Grade 7 19 Grade 8 13

Grade Number of Children N=187 Grade 1 27 Grade 2 28 Grade 3 22 Grade 4 29 Grade 5 32 Grade 6 17 Grade 7 19 Grade 8 13

School and Community ProblemsSchool and Community Problems

Community Leaders Concerned With High Rates of Youth Suicide

Concerned With Severe Behavior and Learning Problems of Youth in and Out of School-high Rates Delinquency, Alcohol and Inhalant Use, School Attrition (75%)

Community Leaders Concerned With High Rates of Youth Suicide

Concerned With Severe Behavior and Learning Problems of Youth in and Out of School-high Rates Delinquency, Alcohol and Inhalant Use, School Attrition (75%)

1997-8 Community Meetings1997-8 Community Meetings

Working Committee Formed Decision To Undertake Needs Assessment

Research

Working Committee Formed Decision To Undertake Needs Assessment

Research

Objective of ResearchObjective of Research

To Determine Un-Met Needs-Physical, Social, Emotional, Interfering With Learning Suspicion FASD or Other Conditions Might Be

Contributing Factors

To Provide Basis for Appropriate Intervention Design

To Determine Funding Requirements

To Determine Un-Met Needs-Physical, Social, Emotional, Interfering With Learning Suspicion FASD or Other Conditions Might Be

Contributing Factors

To Provide Basis for Appropriate Intervention Design

To Determine Funding Requirements

Parents Perceptions of ProblemsParents Perceptions of Problems1998 Survey of Parents of School Children 75

surveys handed out, 56 returned-21% of School Families, 75% Response Rate

Question: What % of Children Had Problems related to Alcohol Use in the Community--FAS, Family Violence, Neglect, Sexual and Physical Abuse

Response: 71% of Children Had Problems Related Family Alcohol Use

1998 Survey of Parents of School Children 75 surveys handed out, 56 returned-21% of School Families, 75% Response Rate

Question: What % of Children Had Problems related to Alcohol Use in the Community--FAS, Family Violence, Neglect, Sexual and Physical Abuse

Response: 71% of Children Had Problems Related Family Alcohol Use

MethodMethod

Active Case Finding or Ascertainment Method Used

Children Selected for Assessment Through an Active Screening Process Identify Those That Were More Likely Than

Others in the Sample Population to Be Affected

Active Case Finding or Ascertainment Method Used

Children Selected for Assessment Through an Active Screening Process Identify Those That Were More Likely Than

Others in the Sample Population to Be Affected

MethodMethod

Four Procedures Used to Identify Children1. Screening

§ Medicine Wheel Screening Tool

2. Educational Psychology Assessment3. Medicine Wheel Developmental History

§ In-depth Interview With Primary Caretaker

4. Medical Examination-Diagnosis

Four Procedures Used to Identify Children1. Screening

§ Medicine Wheel Screening Tool

2. Educational Psychology Assessment3. Medicine Wheel Developmental History

§ In-depth Interview With Primary Caretaker

4. Medical Examination-Diagnosis

Medicine Wheel Screening ToolMedicine Wheel Screening Tool

Index was handed out to each of the 22 classroom teachers

Teacher Perception of Level of Children’s Particular Needs in 4 Domains

Cognitive-Academic, Neurobehavioral Social-Family Problems, Conduct Problems Emotional Physical

Index was handed out to each of the 22 classroom teachers

Teacher Perception of Level of Children’s Particular Needs in 4 Domains

Cognitive-Academic, Neurobehavioral Social-Family Problems, Conduct Problems Emotional Physical

Medicine Wheel Screening ToolMedicine Wheel Screening Tool

Problems=120=64% Multiple Severe Problems=65=35% Multiple Severe Cognitive/Behavioral

Problems=55=29% Average=46=25% Above Average=21=11%

Problems=120=64% Multiple Severe Problems=65=35% Multiple Severe Cognitive/Behavioral

Problems=55=29% Average=46=25% Above Average=21=11%

Ed-Psychology AssessmentEd-Psychology AssessmentBattery of Tests

PPVT, WISC, Raven’s Matrices, Bender-Gestalt, Goodenaugh, WRAT, CBCL-T, Conners PRS/TRS, Vineland Adaptive Behavior Scales

Neuro-behavior/Functioning- Memory, Auditory and Visual Language,Verbal and Non-Verbal Abstract reasoning, Attention, Focus, Concentration, Social Communication,, General Cognitive Ability, Perceptual Organization, Visual Motor Skills, Information Processing

Battery of TestsPPVT, WISC, Raven’s Matrices, Bender-Gestalt, Goodenaugh, WRAT, CBCL-T, Conners PRS/TRS, Vineland Adaptive Behavior Scales

Neuro-behavior/Functioning- Memory, Auditory and Visual Language,Verbal and Non-Verbal Abstract reasoning, Attention, Focus, Concentration, Social Communication,, General Cognitive Ability, Perceptual Organization, Visual Motor Skills, Information Processing

Medicine Wheel Developmental History Medicine Wheel Developmental History Semi-structured Interview Tool Full History of the Children in Terms of the

Physical, Social, Emotional and Mental-Developmental Domains

Mother’s Details of Pre-peri-post Natal Periods.

Specific Questions About the Use of Alcohol and Drugs Including Nicotine.

Semi-structured Interview Tool Full History of the Children in Terms of the

Physical, Social, Emotional and Mental-Developmental Domains

Mother’s Details of Pre-peri-post Natal Periods.

Specific Questions About the Use of Alcohol and Drugs Including Nicotine.

Medical Examination-DiagnosisMedical Examination-Diagnosis 2 Diagnostic Clinics-June 1998- May 1999. Dr. Mike Dickinson, Pediatrician Consent Forms Signed by the Parents CHN Nurses Check Ht, Wt, Vision,

Hearing Researcher Prepared Psycho-educational

and Developmental Assessment Including Medical, Social, Pregnancy History

2 Diagnostic Clinics-June 1998- May 1999. Dr. Mike Dickinson, Pediatrician Consent Forms Signed by the Parents CHN Nurses Check Ht, Wt, Vision,

Hearing Researcher Prepared Psycho-educational

and Developmental Assessment Including Medical, Social, Pregnancy History

Diagnostic ClinicsDiagnostic Clinics

Measured Palpebral Fissures, Head Circumference, Evaluated Philtrum-Upper Lip

Checked for Other Minor Anomalies-Flattening of the Maxillary Area, Palmar Creases Etc

FAS Diagnosed If Clear Evidence of Growth Retardation, Small Palpebral Fissure Length, Changes in the Phyltrum/thin Upper Lip, Confirmation of Exposure to Alcohol During Gestation , and Brain Dysfunction in Terms of Developmental Delays, Intellectual Impairment, or Neuro-behavioral Abnormalities.

Measured Palpebral Fissures, Head Circumference, Evaluated Philtrum-Upper Lip

Checked for Other Minor Anomalies-Flattening of the Maxillary Area, Palmar Creases Etc

FAS Diagnosed If Clear Evidence of Growth Retardation, Small Palpebral Fissure Length, Changes in the Phyltrum/thin Upper Lip, Confirmation of Exposure to Alcohol During Gestation , and Brain Dysfunction in Terms of Developmental Delays, Intellectual Impairment, or Neuro-behavioral Abnormalities.

Diagnostic ClinicsDiagnostic Clinics

FAE (PFAS) When Disclosure of Alcohol Consumption As Well As Evidence of One or Two of the Physical Anomalies And/or Growth Retardation Together With the CNS Dysfunction.

ARND As Recommended by the IOM for Children Exposed to Alcohol in Utero and With Clear Evidence of Brain Dysfunction Not Caused by History or Genetics

FAE (PFAS) When Disclosure of Alcohol Consumption As Well As Evidence of One or Two of the Physical Anomalies And/or Growth Retardation Together With the CNS Dysfunction.

ARND As Recommended by the IOM for Children Exposed to Alcohol in Utero and With Clear Evidence of Brain Dysfunction Not Caused by History or Genetics

Results-Diagnosable Medical Conditions

Results-Diagnosable Medical Conditions

Diagnosis FAS (PFAS) ARND AD/HD ASD* Downs Tourettes Sub-Total

Alcohol

Totals

Children diagnosed 1998

5 11 2 4 1 1 18 24

Children diagnosed 1999

2 6 10 6 1 18 25

Totals 7 17 12 10 1 1 1 36 49 *Autism Spectrum Disorder

Diagnosis FAS (PFAS) ARND AD/HD ASD* Downs Tourettes Sub-Total

Alcohol

Totals

Children diagnosed 1998

5 11 2 4 1 1 18 24

Children diagnosed 1999

2 6 10 6 1 18 25

Totals 7 17 12 10 1 1 1 36 49 *Autism Spectrum Disorder

Prevalence Rates of FASDPrevalence Rates of FASD

FAS= 3.74% 37/1000

PFAS= 9.09% 90/1000

ARND= 6.42% 64/1000

TOTAL FASD 19.25% 193/1000

FAS= 3.74% 37/1000

PFAS= 9.09% 90/1000

ARND= 6.42% 64/1000

TOTAL FASD 19.25% 193/1000

DiscussionDiscussion

All of the mothers who disclosed alcohol use also smoked nicotine cigarettes

All of the mothers in the sample drank in a binge pattern-most during the first trimester before they knew they were pregnant

Most could not remember the details of their drinking in terms of quantities: ‘I drank a Friday and Saturday night…6-12 beer a night.. no more than a 24…enough to feel good’

All of the mothers who disclosed alcohol use also smoked nicotine cigarettes

All of the mothers in the sample drank in a binge pattern-most during the first trimester before they knew they were pregnant

Most could not remember the details of their drinking in terms of quantities: ‘I drank a Friday and Saturday night…6-12 beer a night.. no more than a 24…enough to feel good’

DiscussionDiscussionActual Prevalence Rates Likely Higher 19-20% 3/10 Children Diagnosed As AD/HD Had

Confirmed Exposure to Alcohol in Utero Boy AD/HD Fraternal Twin Girl Diagnosed ARND

2/10 Exposed to Cannabis 5/10 Had Unconfirmed Alcohol Exposure

• Disclosure Continues to Be Difficult for Mothers Because Social Implications for Themselves If Children Found to Have an Alcohol Related Disability.

Actual Prevalence Rates Likely Higher 19-20% 3/10 Children Diagnosed As AD/HD Had

Confirmed Exposure to Alcohol in Utero Boy AD/HD Fraternal Twin Girl Diagnosed ARND

2/10 Exposed to Cannabis 5/10 Had Unconfirmed Alcohol Exposure

• Disclosure Continues to Be Difficult for Mothers Because Social Implications for Themselves If Children Found to Have an Alcohol Related Disability.

DiscussionDiscussion Also Canadian Standard Norms for Birth Weight and

Head Size Significantly Lower Than in Aboriginal Communities

Implications for Diagnosis of FAS Because Growth Retardation Is Key Area in Diagnosis

May Be More Children in Sample Population With FAS Than Reported-these Children Would Have Been Inaccurately Classified PFAS

Health Center Data Indicates Drinking and Drugging Still A Problem During Pregnancy 20-30%

Also Canadian Standard Norms for Birth Weight and Head Size Significantly Lower Than in Aboriginal Communities

Implications for Diagnosis of FAS Because Growth Retardation Is Key Area in Diagnosis

May Be More Children in Sample Population With FAS Than Reported-these Children Would Have Been Inaccurately Classified PFAS

Health Center Data Indicates Drinking and Drugging Still A Problem During Pregnancy 20-30%

ConclusionConclusion

Unexpected High Prevalence FASD This high rate cannot be generalized to the larger

population Results challenge research assumption Abel(1994) He estimated worldwide incidence anywhere from

.19/1000 (1987) to 1.2/1000 (1994)-recent estimate less than 1/1000 (1999)--based on a number of prospective epidemiological studies of obstetric hospital populations worldwide

Unexpected High Prevalence FASD This high rate cannot be generalized to the larger

population Results challenge research assumption Abel(1994) He estimated worldwide incidence anywhere from

.19/1000 (1987) to 1.2/1000 (1994)-recent estimate less than 1/1000 (1999)--based on a number of prospective epidemiological studies of obstetric hospital populations worldwide

Abel’s Incidence DataAbel’s Incidence Data

Abel Assumes FAS Readily Recognized and Diagnosed in Hospitals at Birth or Soon After

He States ‘there is little evidence to support (the) assumption (that) FAS is underdiagnosed…. as a result of increased awareness of FAS among health care professionals, the possibility of FAS going unrecognized shortly after live birth seems unlikely.’ (1994)

Abel Assumes FAS Readily Recognized and Diagnosed in Hospitals at Birth or Soon After

He States ‘there is little evidence to support (the) assumption (that) FAS is underdiagnosed…. as a result of increased awareness of FAS among health care professionals, the possibility of FAS going unrecognized shortly after live birth seems unlikely.’ (1994)

Incidence ResearchIncidence Research

The Fallacy of This Argument Is Obvious From the High Number of Undiagnosed Individuals in Research Studies Such As This

For Instance Byrd (2004) Looks at Medical Records Population of 3,080,904 in US Correction System--only 1 Diagnosed Case of FASD

Incidence Should Be From 1540-28,036 Even Using Conservative Estimates Such As Abel’s

One Could Argue This Population Too Old to Be Identified at Birth

The Fallacy of This Argument Is Obvious From the High Number of Undiagnosed Individuals in Research Studies Such As This

For Instance Byrd (2004) Looks at Medical Records Population of 3,080,904 in US Correction System--only 1 Diagnosed Case of FASD

Incidence Should Be From 1540-28,036 Even Using Conservative Estimates Such As Abel’s

One Could Argue This Population Too Old to Be Identified at Birth

FASD Still Invisible To Many Health Professionals

FASD Still Invisible To Many Health Professionals

Present study Children Born In Late 1980’s 1990’s

All Were Born at Large Regional Hospital Center-Less Than Hour Away By Car On Good Road

Mothers Received Pre-Natal Services Many At Hospital

Not One of These Cases Diagnosed At Birth, Shortly After, Or For Years Until This Study

Present study Children Born In Late 1980’s 1990’s

All Were Born at Large Regional Hospital Center-Less Than Hour Away By Car On Good Road

Mothers Received Pre-Natal Services Many At Hospital

Not One of These Cases Diagnosed At Birth, Shortly After, Or For Years Until This Study

Low Incidence Estimates Low Incidence Estimates

Abel’s low incidence estimates depend upon data that may not be at all reliable

Physicians still un-trained--unfamiliar with FASD Diagnosis

FASD Multi-Disciplinary Diagnostic Teams Scarce

Diagnosis of most of the spectrum of FASD is difficult at birth

Abel’s low incidence estimates depend upon data that may not be at all reliable

Physicians still un-trained--unfamiliar with FASD Diagnosis

FASD Multi-Disciplinary Diagnostic Teams Scarce

Diagnosis of most of the spectrum of FASD is difficult at birth

Good Incidence Data EssentialGood Incidence Data Essential

Based On Low Incidence Estimates Armstrong (1998) and Abel and Armstrong (1999) Conclude Concerns With FASD Are Socially Constructed ‘Panic’and Moral Crusade That Has More to Do With Getting Research Funds Than Scientific Findings

This Is Dangerous For Prevention--We Need Good Incidence Data ASAP

Based On Low Incidence Estimates Armstrong (1998) and Abel and Armstrong (1999) Conclude Concerns With FASD Are Socially Constructed ‘Panic’and Moral Crusade That Has More to Do With Getting Research Funds Than Scientific Findings

This Is Dangerous For Prevention--We Need Good Incidence Data ASAP

If FASD Were Not Under Diagnosed the Individuals in Prevalence Studies Would Have Been Diagnosed

This Study Also Indicates a Problem With Our Diagnosis of This Disability for the General Population Who Are Also Receiving Services at This Hospital Center-Using Conservative Incidence 9-10/1000 8-10,000 People-NB FASD

Most Undiagnosed-Still No Hospital Multidisciplinary Diagnostic Team In Maritimes

Proper Diagnosis of Fetal Alcohol Spectrum Disorders Is Not Accessible in Much of Eastern Canada

If FASD Were Not Under Diagnosed the Individuals in Prevalence Studies Would Have Been Diagnosed

This Study Also Indicates a Problem With Our Diagnosis of This Disability for the General Population Who Are Also Receiving Services at This Hospital Center-Using Conservative Incidence 9-10/1000 8-10,000 People-NB FASD

Most Undiagnosed-Still No Hospital Multidisciplinary Diagnostic Team In Maritimes

Proper Diagnosis of Fetal Alcohol Spectrum Disorders Is Not Accessible in Much of Eastern Canada

FASD Is Not Just an Aboriginal Problem Problem Anywhere That Women of Childbearing

Age Drink--one of the Groups at Highest Risk for the Disability Are Young University Women

High Prevalence Rates in Study Can Not Be Generalized to Larger Population but They Point up Serious Flaw in Medical Health Delivery System in Region in Terms of FASD Diagnosis, Prevention Intervention Services

Flaw That Has Serious Consequences for Individuals Who Suffer Disability, for Families+ Communities

FASD Is Not Just an Aboriginal Problem Problem Anywhere That Women of Childbearing

Age Drink--one of the Groups at Highest Risk for the Disability Are Young University Women

High Prevalence Rates in Study Can Not Be Generalized to Larger Population but They Point up Serious Flaw in Medical Health Delivery System in Region in Terms of FASD Diagnosis, Prevention Intervention Services

Flaw That Has Serious Consequences for Individuals Who Suffer Disability, for Families+ Communities

Individuals With FASD Perceived as Being Problems

Instead of Being Perceived of As Having A Problem

Individuals With FASD Perceived as Being Problems

Instead of Being Perceived of As Having A Problem

Secondary ProblemsSecondary Problems

90% Individuals Develop Secondary Problems-Disabilities--School Problems, Mental Health Disorders, Trouble With the Law, Addictions, Etc

90% Individuals Develop Secondary Problems-Disabilities--School Problems, Mental Health Disorders, Trouble With the Law, Addictions, Etc

Spiralling Problems-RCMP Stats

RCMP Stats Maritime First Nation Community

Comparison Community

Year 1998 1999 1998 1999Sex Assault 19 14 3 4

Assault 237 220 32 40

Property Damage 117 117 9 10

Spousal Assault 18 40 2 4

Total Mental Health Act

110 107 9 5

Suicide/Attempted Suicide

56 100 5 3

Spiralling ProblemsSpiralling Problems

Is FASD Fuelling this Spiral? Keeping People From Achieving Health

and Well-Being. What Can We Do To Change This?

Is FASD Fuelling this Spiral? Keeping People From Achieving Health

and Well-Being. What Can We Do To Change This?

Diagnosis Means Responsibility Diagnosis Means Responsibility

Wellness Objectives-Diagnosis, Intervention, Prevention Wellness Objectives-Diagnosis, Intervention, Prevention Prevent Secondary Problems--Provide

Interventions and Support at School and Home

Prevent Further Incidence Provide Regular Diagnostic Services

Prevent Secondary Problems--Provide Interventions and Support at School and Home

Prevent Further Incidence Provide Regular Diagnostic Services

Protective FactorsProtective Factors

Early Diagnosis Stable Home Life Supportive Interventions School

Early Diagnosis Stable Home Life Supportive Interventions School

School Initiative School Initiative Implemented-1998-9 Elementary School Educational Funding From INAC-Indian and

Northern Affairs Change Outcome by Providing Supportive School

Environment For Youth With FASD and Other Developmental Disorders

To Develop Children’s Gifts as Well as Their Academic Skills

To Create A Culturally Sensitive Model of Intervention

Implemented-1998-9 Elementary School Educational Funding From INAC-Indian and

Northern Affairs Change Outcome by Providing Supportive School

Environment For Youth With FASD and Other Developmental Disorders

To Develop Children’s Gifts as Well as Their Academic Skills

To Create A Culturally Sensitive Model of Intervention

Medicine Wheel Approach-1998-2006 Medicine Wheel Approach-1998-2006

Hot Lunch Program Small Class Size 12-15 Children

Children With FASD and Other Conditions Mainstreamed

Individual Support Space +Time From 1/2 Hour To 1/2 Day

Resource Room Program Developmental Playroom Mi’qmaw Cultural Program

Hot Lunch Program Small Class Size 12-15 Children

Children With FASD and Other Conditions Mainstreamed

Individual Support Space +Time From 1/2 Hour To 1/2 Day

Resource Room Program Developmental Playroom Mi’qmaw Cultural Program

Medicine Wheel Approach-1998-2006Medicine Wheel Approach-1998-2006

Teacher Assistants In Some Classes Literacy Initiative Speech Therapy Program Youth-At-Risk Program Youth Mentors-Mother Mentors Guitar, Drumming, Dancing Behaviour Mentors Traditional Health And Wellness Initiative

Teacher Assistants In Some Classes Literacy Initiative Speech Therapy Program Youth-At-Risk Program Youth Mentors-Mother Mentors Guitar, Drumming, Dancing Behaviour Mentors Traditional Health And Wellness Initiative

Intervention Makes a Difference

Can You Tell Which of These Children Has Special Needs ?

Friends Friends

Interventions Help Everyone Interventions Help Everyone End of 1996-7 School Year Before Interventions

80% Students Grades 1-3 Read Below Grade Level End of 1999-2006 School Years After

70- 90% of Students Grades 1-3 Read On or Above Grade Level

Children in This Band School Now Perform On Par On Provincial Exams

External Evaluation Now Rates The School Average or Above Average In All Areas

Children With FASD Now Attending and Graduating HS

End of 1996-7 School Year Before Interventions 80% Students Grades 1-3 Read Below Grade Level

End of 1999-2006 School Years After 70- 90% of Students Grades 1-3 Read On or Above Grade

Level Children in This Band School Now Perform On Par On

Provincial Exams External Evaluation Now Rates The School Average or

Above Average In All Areas Children With FASD Now Attending and Graduating

HS

Nogomag Healing Lodge ProjectNogomag Healing Lodge Project

Began Spring 2002 Funding From Youth Justice,

Homelessness Initiative And AHRDEducational Alternative for Youth-at-Risk and

Their Mothers with History of: Pre-natal Exposure to Alcohol School Problems Trouble with the Law

Began Spring 2002 Funding From Youth Justice,

Homelessness Initiative And AHRDEducational Alternative for Youth-at-Risk and

Their Mothers with History of: Pre-natal Exposure to Alcohol School Problems Trouble with the Law

NogemagNogemag Mi’Maq Concept Means ‘All My Relations’

Restore Relationship and Connections Connections To Self, Family, Community Connection To Elders--Regeneration of Community,

Family Culture Through Supportive Daily Ritual Like Talking Circles,

Sweats, Smudging Baisis of Medicine Wheel Approach Is

Relationship of Individual To Whole System

Mi’Maq Concept Means ‘All My Relations’Restore Relationship and Connections Connections To Self, Family, Community Connection To Elders--Regeneration of Community,

Family Culture Through Supportive Daily Ritual Like Talking Circles,

Sweats, Smudging Baisis of Medicine Wheel Approach Is

Relationship of Individual To Whole System

4 R’s Of FASD Educational Interventions4 R’s Of FASD Educational Interventions

Relationship Respect Brain Differences

Routine/Ritual Repetition

Nogomag Healing Lodge Nogomag Healing Lodge

Outside Evaluation After Two Years of Intervention: All Youth Involved Stayed Out Of Trouble 4 Of 5 School Age Youth (13-15) Were Back In Regular

School--3 Full Time, 1 Part Time. 4 Older Youth-17-21 Doing GED--Working 3 Birth Mothers In Skill-Training At Lodge-Doing GED-2

Have Their Youth With FASD Back From Foster Care, 1 Hired As Permanent Staff At School

Youth Crime Rate In Community Decreased By Approximately 40% Since Implementation of 1998 Educational Interventions

Outside Evaluation After Two Years of Intervention: All Youth Involved Stayed Out Of Trouble 4 Of 5 School Age Youth (13-15) Were Back In Regular

School--3 Full Time, 1 Part Time. 4 Older Youth-17-21 Doing GED--Working 3 Birth Mothers In Skill-Training At Lodge-Doing GED-2

Have Their Youth With FASD Back From Foster Care, 1 Hired As Permanent Staff At School

Youth Crime Rate In Community Decreased By Approximately 40% Since Implementation of 1998 Educational Interventions

What We LearnedWhat We Learned

‘If You’ve Told (Someone) A Thousand Times And He Still Doesn’t Understand Then It is Not (He) Who Is The Slow Learner’

Walter Barbee

‘If You’ve Told (Someone) A Thousand Times And He Still Doesn’t Understand Then It is Not (He) Who Is The Slow Learner’

Walter Barbee

Other Developments-ResearchOther Developments-Research

Development of Medicine Wheel Tools and Model To Replicate In First Nation Communities and Small Community Schools-Crime Prevention Funding

Movie To Demonstrate Model Provincial Judges Training Survey Research of Judges and Crowns

Perceptions and Needs-2006 Survey of Health Professionals in Atlantic

Aboriginal Communities-2000/ 2007 Follow-up

Development of Medicine Wheel Tools and Model To Replicate In First Nation Communities and Small Community Schools-Crime Prevention Funding

Movie To Demonstrate Model Provincial Judges Training Survey Research of Judges and Crowns

Perceptions and Needs-2006 Survey of Health Professionals in Atlantic

Aboriginal Communities-2000/ 2007 Follow-up

Eastern Door Diagnostic CenterEastern Door Diagnostic Center

Multidisciplinary Diagnostic Team for FASD and Other Developmental Conditions

First Diagnostic Team in Maritimes Training Cold Lake Alberta + Ted Rosalas First 2 Diagnosis In Spring of 2006 Family Support Worker After Diagnosis-6 Months Offering Pre-natal Out-Reach-High Risk Moms Developing Medicine Wheel Difference Game

Cards For Mentoring Program

Multidisciplinary Diagnostic Team for FASD and Other Developmental Conditions

First Diagnostic Team in Maritimes Training Cold Lake Alberta + Ted Rosalas First 2 Diagnosis In Spring of 2006 Family Support Worker After Diagnosis-6 Months Offering Pre-natal Out-Reach-High Risk Moms Developing Medicine Wheel Difference Game

Cards For Mentoring Program

FASD Prevention NeededFASD Prevention Needed

30% of Children In Study Sample Were Related Recent Data From Health Center Indicates

Continuing High Rates of Alcohol and Drug Use Especially During Early Pregnancy

Need Funding For Mentoring Program For Birth Mother’s of Children With FASD Of Child-Bearing Age Social Workers-Family Workers Not Attached To

Child Protection Services

30% of Children In Study Sample Were Related Recent Data From Health Center Indicates

Continuing High Rates of Alcohol and Drug Use Especially During Early Pregnancy

Need Funding For Mentoring Program For Birth Mother’s of Children With FASD Of Child-Bearing Age Social Workers-Family Workers Not Attached To

Child Protection Services

Every Person Is A Gift To Us From Creator

Each Of Them Has A Purpose

We Can Help We Can Help Them Find Them Find

That Purpose That Purpose By Believing By Believing

In In ThemThem

EndEnd

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