Skip to main content

Advertisement

Log in

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

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Hoyme, H. E., et al. (2005). A practical clinical approach to diagnosis of fetal alcohol spectrum disorders: Clarification of the 1996 institute of medicine criteria. Pediatrics, 115, 39–47.

    Article  PubMed  Google Scholar 

  2. Jones, K. L., & Smith, D. W. (1973). Recognition of the fetal alcohol syndrome in early infancy. Lancet, 2, 999–1001.

    Article  PubMed  CAS  Google Scholar 

  3. May, P. A. (1995). A multiple-level, comprehensive approach to the prevention of fetal alcohol syndrome (FAS) and other alcohol-related birth defects (ARBD). The International Journal of the Addiction, 30, 1549–1602.

    CAS  Google Scholar 

  4. Viljoen, D., et al. (2002). Characteristics of mothers of children with fetal alcohol syndrome in the Western Cape Province of South Africa: A case control study. Journal of Studies on Alcohol, 63, 6–17.

    PubMed  Google Scholar 

  5. May, P. A., et al. (2004). Alcohol consumption and other maternal risk factors for fetal alcohol syndrome among three distinct samples of women before, during, and after pregnancy: The risk is relative. Seminars in Medical Genetics, 127C, 10–20.

    Article  PubMed  Google Scholar 

  6. May, P. A., et al. (2005). Maternal risk factors for fetal alcohol syndrome in the Western Cape Province of South Africa: A population-based study. American Journal of Public Health, 95, 1190–1199.

    Article  PubMed  Google Scholar 

  7. May, P. A., & Hymbaugh, K. J. (1982). A pilot project on fetal alcohol syndrome among American Indians. Alcohol Health Research World, 7, 3–9.

    Google Scholar 

  8. May, P. A., & Hymbaugh, K. J. (1989). A macro-level fetal alcohol syndrome prevention program for Native Americans and Alaska Natives: Description and evaluation. Journal of Studies on Alcohol, 50, 508–518.

    PubMed  CAS  Google Scholar 

  9. May, P. A., & Gossage, P. (2001). New data on the epidemiology of adult drinking and substance use among American Indians of the northern states: Male and female data on prevalence, patterns, and consequences. American Indian and Alaska Native Mental Health Research, 10, 1–26.

    PubMed  CAS  Google Scholar 

  10. May, P. A. (1986). Alcohol and drug misuse prevention programs for American Indians: Needs and opportunities. Journal of Studies on Alcohol, 47, 187–195.

    PubMed  CAS  Google Scholar 

  11. Mitchell, C. M., et al. (2003). Drug use among two American Indian populations: Prevalence of lifetime use and DSM-IV substance use disorders. Drug and Alcohol Dependence, 69, 29–41.

    Article  PubMed  Google Scholar 

  12. Spicer, P., et al. (2003). The prevalence of DSM-III-R alcohol dependence in two American Indian populations. Alcohol Clinical and Experimental Research, 27, 1785–1797.

    Article  Google Scholar 

  13. Dvorchak, P. A., et al. (1995). Pregnant and postpartum women in recovery: Barriers to treatment and the role of Oxford House in the continuation of care. Alcoholism Treatment Quarterly, 13, 97–107.

    Article  Google Scholar 

  14. Finkelstein, W. (1993). Treatment programming for alcohol and drug dependent women. The International Journal of the Addiction, 28, 1275–1309.

    CAS  Google Scholar 

  15. Berkowitz, G., et al. (1996). Options for recovery: Promoting success among women mandated to treatment. Journal of Psychoactive Drugs, 28, 31–38.

    PubMed  CAS  Google Scholar 

  16. Higgins, P. G., Clough, D. H., & Wallerstedt, C. (1995). Drug-taking behaviours of pregnant substance abusers in treatment. Journal of Advanced Nursing, 22, 425–432.

    Article  PubMed  CAS  Google Scholar 

  17. National Institute on Alcohol Abuse and Alcoholism. (2000). Alcohol and health: Tenth special report to Congress Washington: U.S. Department of Health and Human Services.

    Google Scholar 

  18. Brindis, C., Berkowitz, G., & Clayson, Z. (1997). Options for recovery: Promoting perinatal drug and alcohol recovery, child health, and family stability. Journal of Drug Issues, 27, 607–624.

    Google Scholar 

  19. Laken, M. P., & Ager, J. W. (1996). Effects of case management on retention in prenatal substance abuse treatment. The American Journal of Drug and Alcohol Abuse, 22, 439–448.

    Article  PubMed  CAS  Google Scholar 

  20. Issel, M. L., Anderson, R. A., & Kane, D. J. (2003). Administrative characteristics of comprehensive prenatal case management programs. Public Health Nursing, 20, 349–360.

    Article  PubMed  Google Scholar 

  21. Hankin, J., McCaul, M. E., & Heussner, J. (2000). Pregnant, alcohol abusing women. Alcoholism, Clinical and Experimental Research, 24(1999), 1276–1286.

    Google Scholar 

  22. Miller, W. R., & Wilbourne, P. L. (2002). Mesa Grande: A methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction, 97, 265–277.

    Article  PubMed  Google Scholar 

  23. Masis, K. B., & May, P. A. (1991). A comprehensive local program for the prevention of fetal alcohol syndrome. Public Health Report, 106, 484–489.

    CAS  Google Scholar 

  24. Grant, T., et al. (2003). Postpartum follow-up effects of paraprofessional intervention with high-risk women who abused alcohol and drugs during pregnancy. Journal of Community Psychology, 31, 211–222.

    Article  Google Scholar 

  25. Grant, T. M., Ernst, C. C., & Streissguth, A. P. (1996). An intervention with high-risk mothers who abuse alcohol and drugs: The Seattle Advocacy Model. American Journal of Public Health, 86, 1816–1817.

    Article  PubMed  CAS  Google Scholar 

  26. Ernst, C. C., et al. (1999). Intervention with high-risk alcohol and drug-abusing mothers: II: 3-year findings from the Seattle Model of Paraprofessional Advocacy. Journal of Community Psychology, 27, 19–38.

    Article  Google Scholar 

  27. Eisen, M., et al. (2000). Evaluation of substance abuse outcomes in demonstration projects for pregnant and postpartum women and their infants: Findings from a quasi-experiment. Addiction Behavior, 25, 123–129.

    Article  CAS  Google Scholar 

  28. Struck, J. (2003). Four-state consortium: Model for program implementation and data collection. Neurotoxicology and Teratology, 25, 643–649.

    Article  PubMed  CAS  Google Scholar 

  29. Dotson, J. W, Henderson, D., & Magraw, M. (2003). A public health program for preventing fetal alcohol syndrome among women at risk in Montana. Neurotoxicology and Teratology, 25, 757–761.

    Article  CAS  Google Scholar 

  30. Loudenburg, R., & Leonardson, G. R. (2003). A multifaceted intervention strategy for reducing substance use in high-risk women. Neurotoxicology and Teratology, 25, 737–744.

    Article  PubMed  CAS  Google Scholar 

  31. Handmaker, N. S., Miller, W. R., & Manicke, M. (1999). Findings of a pilot study of motivational interviewing with pregnant drinkers. Journal of Studies on Alcohol, 60, 285–287.

    PubMed  CAS  Google Scholar 

  32. Ingersoll, K., et al. (2003). Reducing the risk of alcohol-exposed pregnancies: A study of motivational intervention in community settings. Pediatrics, 111, 1131–1135.

    PubMed  Google Scholar 

  33. Stratton, K., Howe, C., & Battaglia, F. (1996). Fetal alcohol syndrome: Diagnosis, epidemiology, prevention, treatment. Washington: National Academy Press.

    Google Scholar 

  34. Andrews, A. B. (1995). Searching for solutions to alcohol and other drug use during pregnancy. Social Work, 40, 55–64.

    PubMed  CAS  Google Scholar 

  35. Siegel, H., & Rapp, B. (1996). Case management and substance abuse treatment. New York: Springer.

    Google Scholar 

  36. Miller, W. R., & Rollnick, S. (1991). Motivational interviewing. New York: Guilford Press.

    Google Scholar 

  37. Miller, W. R., & Rollnick, S. (2002). Motivational interviewing (2nd ed.). New York: Guilford Press.

    Google Scholar 

  38. Azrin, H. H. (1976). Improvements in the community reinforcement approach. Behavior Research and Therapy, 14, 339–348.

    Article  CAS  Google Scholar 

  39. Meyers, R. J., & Smith, J. E. (1995). Clinical guide to alcohol treatment: The community reinforcement approach. New York: Guilford Press.

    Google Scholar 

  40. Babor, T. F., et al. (1992). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care. Geneva: World Health Organization.

    Google Scholar 

  41. Saunders, J. B., et al. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on early detection of persons with harmful alcohol consumption–II. Addiction, 88, 791–804.

    Article  PubMed  CAS  Google Scholar 

  42. Miller, W. R., Tonigan, J. S., & Longabaugh, R. (1995). The drinker inventory of consequences (DrinC). Washington, DC, NIAAA. Project Match Monograph Series.

  43. Miller, W. R., & Tonigan, J. S. (1996). Assessing drinkers’ motivation for change: The stages of change readiness and treatment eagerness scale. Psychology of Addictive Behaviors, 10, 81–89.

    Article  Google Scholar 

  44. Maier, S. E., & West, J. R. (2001). Drinking patterns and alcohol-related birth defects. Alcohol Research & Health, 25, 168–174.

    CAS  Google Scholar 

  45. West, J. R., & Goodlett, C. R. (1990). Teratogenic effects of alcohol on brain development. Annals of Medicine, 22, 319–325.

    Article  PubMed  CAS  Google Scholar 

  46. Jacobson, J. L., & Jacobson, S. W. (1994). Prenatal alcohol exposure and neurobehavioral development”. Where is the threshold? Journal of Studies on Alcohol, 18, 30–36.

    Google Scholar 

  47. Streissguth, A. P., Barr, H. M., & Sampson, P. D. (1990). Moderate prenatal alcohol exposure: Effects on child IQ and learning problems at age 7½ years. Alcoholism, Clinical and Experimental Research, 14, 662–669.

    Article  PubMed  CAS  Google Scholar 

  48. Streissguth, A. P., et al. (1994). Maternal drinking during pregnancy: Attention and short-term memory in 14 year-old offspring—a longitudinal prospective study. Alcoholism, Clinical and Experimental Research, 18, 202–218.

    Article  PubMed  CAS  Google Scholar 

  49. Jacobson, J. L., et al. (1993). Teratogenic effects of alcohol on infant development. Alcoholism, Clinical and Experimental Research, 17, 174–183.

    Article  PubMed  CAS  Google Scholar 

  50. Hanson, J. W., Streissguth, A. P., & Smith, D. W. (1978). The effects of moderate alcohol consumption during pregnancy on fetal growth and morphogenesis. Journal of Pediatrics, 92, 457–460.

    Article  PubMed  CAS  Google Scholar 

  51. Markham, M. R., Miller, W. R., & Arciniega, L. (1993). BaCCus 2.01: Computer software for quantifying alcohol consumption. Behavior Research, Methods, Instruments, & Computers, 25, 420–421.

    Google Scholar 

  52. Dean, A. G., et al. (1994). Epi info version 6: A word processing, data base, and statistics program for epidemiology on microcomputers. Centers for Disease Control and Prevention, Atlanta, Georgia.

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Philip A. May.

Rights and permissions

Reprints and permissions

About this article

Cite this article

May, P.A., Miller, J.H., Goodhart, K.A. et al. Enhanced Case Management to Prevent Fetal Alcohol Spectrum Disorders in Northern Plains Communities. Matern Child Health J 12, 747–759 (2008). https://doi.org/10.1007/s10995-007-0304-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-007-0304-2

Keywords

Navigation