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Maternal and Child Health Journal

, Volume 12, Issue 6, pp 747–759 | Cite as

Enhanced Case Management to Prevent Fetal Alcohol Spectrum Disorders in Northern Plains Communities

  • Philip A. MayEmail author
  • Joseph H. Miller
  • Karen A. Goodhart
  • Olivia R. Maestas
  • David Buckley
  • Phyllis M. Trujillo
  • J. Phillip Gossage
Article

Abstract

Women proven to be extremely high risk for drinking during pregnancy were provided case management (CM) enhanced with strategies derived from motivational interviewing (MI) as a part of a comprehensive Fetal Alcohol Syndrome (FAS) epidemiology and prevention program in four American Indian communities in Northern Plains states. Data on the first women enrolled (n = 131) revealed that they have extreme issues with alcohol abuse to overcome. Sixty-five percent of these women have experienced extensive alcohol use within their immediate family. At intake, 24% of CM clients reported binge drinking one or more days in the preceding week. Heavy drinking resulted in estimated blood alcohol concentrations (BAC) as high as .576 using the BACCUS methodology. Project staff has attempted to actively engage each of these women in CM. Clients have been in CM an average of 17.2 months (SD = 16.6). The mean number of significant contacts (face-to-face or telephone MI sessions) was 19. Thirty-one percent of the women entered some type of formal alcohol or drug treatment while in CM. Data were collected at 6 month intervals from 6 to 72 months after enrollment. Consumption of alcohol, as measured by both quantity and frequency measures, was reduced at 6 months. Thirty-eight percent of enrolled women reported complete abstinence from alcohol use at 6 months, and the number of binges while drinking in CM declined significantly from 15 at baseline to 4.3 at 6 months. However, mean peak BACs for the heavy drinking sessions were still problematic for those who continued to drink. They ranged from .234 to .275 from baseline to 12 month follow-up, but the total number of binges was reduced substantially at 12 months as well. Furthermore, the most important outcomes are the status of the children born while in CM. One hundred and forty nine pregnancies have occurred among these women, and 76% of those pregnancies have resulted in normal deliveries, and only two children born in CM are suspected of having some form of severe FASD. At 6, 12, 18, and 24 month follow-up milestones, 70% of the women who were not currently pregnant were protected from having a child with FAS by not drinking, using birth control, or both. Other measures of CM success include enrolling in school, regaining custody of children, completing substance abuse treatment, probation from the criminal justice system, substantial periods of abstinence, enrolling in programs to improve life skills, and employment.

Keywords

Fetal Alcohol Spectrum Disorders (FASD) Fetal Alcohol Syndrome (FAS) Prevention Case management Pregnancy Alcohol abuse American Indians Native Americans 

Notes

Acknowledgements

The project has been funded by the National Institute on Alcohol Abuse and Alcoholism, (NIAAA) under grants R01 AA9440, R01-UO1 AA11685. There are multiple constituents that have collaborated closely and well with the project including: the tribal councils and health officials of the four Plains tribes, the Indian Health Service, and the public health officials of the State of Montana in particular. Our special thanks to Deborah Henderson, R. N., Sara DeCoteau, B. S., Julia Doney, Paul Dauphinais, Ph.D., and the tribal councils and health committees of the participating communities. At NIAAA tireless advocacy for the prevention of FAS has been ongoing over the years from Jan Howard, Ph.D., Faye Calhoun, D.P.A., Kenneth Warren, Ph.D., Enoch Gordis, M.D., Marcia Scott, Ph.D., and T.-K. Li, M.D. Without their support for the tribal communities of the Plains and the research team they have funded, this project would not exist. The Fetal Alcohol Syndrome Epidemiology Research (FASER) prevention field team who has been involved in Case Management and all other areas of FASD prevention is: Irene Lake, Rose Maestas, the late Joan Alvord, Lorinda Beck, Mary White Country, Karen Goodhart, Mabel Bad Moccasin-Granados, Rene Fasthorse, Renee Parker, Whitney Renville, and Jill Plumage. UNM-based FASER team members include: Phyllis Trujillo, Wendy Kalberg, Jerome Romero, Alfredo Aragon, P. W. Kodituwakku, Jason Blankenship, Marita Brooks, Kathy Deeshchii’nii, and Diana Baumgardner. We thank Chandra Stellavato for assistance with data entry and quality assurance.

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Philip A. May
    • 1
    Email author
  • Joseph H. Miller
    • 1
  • Karen A. Goodhart
    • 2
  • Olivia R. Maestas
    • 2
  • David Buckley
    • 1
  • Phyllis M. Trujillo
    • 1
  • J. Phillip Gossage
    • 1
  1. 1.Center on Alcoholism, Substance Abuse and Addictions (CASAA)The University of New MexicoAlbuquerqueUSA
  2. 2.FASER Project, Center on Alcoholism, Substance Abuse and Addictions (CASAA)The University of New MexicoAlbuquerqueUSA

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