Fostering FASD Research Capacity in Under-served, Under-represented Communities

1. Fostering FASD Research Capacity in Under-served, Under-represented Communities 5th Annual FACE Research Roundtable September 9, 2004 Saskatoon, SK Christine A. Loock & Paul Masotti, presenters Other Team Members: M. Anne George, Michel Morton, Jennifer Ranford, Marilyn Van Bibber, Michael Fleming, Stuart M. Macleod

2. Community Methods - Developing Brief Alcohol Interventions for Aboriginal Mothers(CIHR Project Title) Healthy Communities, Mothers and Children - “HCMC” (Working Project Title)

3. Research on the Adaptation of a Brief Alcohol Intervention to Prevent FAS: A Community-based Participatory Research Project Poster Presentation Handout Research Society On Alcoholism (RSA) Annual Meeting June 2004 Vancouver BC, M. Anne George, Paul Masotti, Christine A. Loock,Michel Morton, Jennifer Ranford, Marilyn Van Bibber, Michael Fleming, Stuart M. Macleod

4. Overview Background: This is a project aimed at understanding methods development in the area of FASD prevention. Purposes: • (1) To support women in their community-based efforts to prevent FASD. • (2) To understand the processes involved in communities developing prevention interventions.

5. Overview Deliverables: • FASD interventions developed in a collaborative effort between four Aboriginal communities and university- based researchers; • Model for participatory, community-based research and intervention development.

6. HCMC Research “Team” Partner Communities (Community-Based Researchers) • Ontario Urban • Ontario Rural • British Columbia Urban • British Columbia Rural University-Based Researchers • McMaster University – Paul Masotti, Jennifer Ranford • Lakehead University – Michel Morton • University of British Columbia – Stuart MacLeod, Anne George, Christine Loock, Marilyn Van Bibber • University of Wisconsin – Mike Fleming

7. RESEARCH QUESTIONS • What is an appropriate model for communities interested in developing and implementing culturally appropriate brief alcohol interventions for aboriginal women identified as at-risk in the post-partum period? • What are the characteristics of culturally appropriate brief alcohol interventions for women living in urban and rural areas? • What instruments may be used to screen and measure intervention effectiveness?

8. DRINKING DURING PREGNANCY: A POPULATION-BASED ASSESSMENT OF IDENTIFYING RISK Armstrong, RW, Loock, C.A., George, M.A.,Lalonde, C.E., Lupton, N.M, and Robinson, G.C.

9. RESULTS • The actual rate of surveillance for the population over the one-year study period was 47.0% (1721/3659). • 13.4% of the women scored HR ( “High Risk”) and 36.6 as IR (“Intermediate Risk”). • 52.2% of the women scored 2 or greater (the original T-ACE cut-off for at risk!). Subjects were categorized as being at Low Risk (LR: scores of 0 or 1), Intermediate Risk (IR: score of 2), and High Risk (HR: scores of 3-5).

10. Purpose of Target Population: Postpartum Women • Some evidence that women who are at highest risk for alcohol use during pregnancy are least likely to seek medical care early in pregnancy. • FASD is associated with increased age and parity.

11. Purpose of Target Population: Postpartum WomenAdvantages • Identification: at-risk mothers can be identified through birth events. • Timing: intervention takes place prior to next pregnancy (before injury to the fetus). • Effective allocation of resources. • Women may be more receptive to assessing drinking.

12. METHODS The project consists of three methodological phases: • developing the intervention & instruments through a process of listening and learning from local community people; • implementing and evaluating the interventions; and • documenting the process, thereby providing model for communities interested in developing and implementing culturally appropriate brief alcohol interventions.

13. Phase I – Developing the Interventions CRF & WG CAC University Based Researchers Community Research Facilitator (CRF) Workgroup (WG) Community Advisory Committee (CAC)

14. RESULTS TO DATE • There is a progressive shift from university-based researchers’ input to a reciprocal learning process between university and community-based researchers. • A dialogue in the community has been created around support for women. This includes a broader discussion on alcohol and prevention, and on conducting research in aboriginal communities. In some communities, a readiness for this dialogue has been enhanced by the practical example in working on this project.

15. Phase I – Developing the Interventions Ontario Urban Rural British Columbia Urban Rural CRF & WG CRF & WG CRF & WG CRF & WG CAC CAC CAC CAC University Based Researchers Combined & Research TeamCommunity Research Facilitators Model *Meetings funded by FNIHB N. A. P. C.* National Advisory Partnership Committee

16. RESULTS TO DATE • Each of the communities has adapted the process for developing a post-partum brief alcohol intervention. • Each of the communities has developed their own working process. • In at least one of the sites, working on this project has led to an interest in participating in, or designing, other community-based research projects.

17. ANTICIPATED RESULTS AND IMPLICATIONS It is our hypothesis that: • Four models to address the needs of postpartum women will be developed, each uniquely appropriate for the specific community. Some may adapt the existing model (Fleming & Manwell, 1999; Fleming et al, 2000), others will develop an entirely new intervention. • Participation in this research better prepares each community partner to advance their own research agenda, regardless of the topic.