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Competency 4: Prevention

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Comprehensive FASD Prevention Programs

A review of more than 160 articles described treatment programs designed to reduce fetal alcohol exposure in alcohol- and drug-dependent women.19 The review suggested that programs that provide comprehensive and coordinated treatment attract more pregnant women into care and are more effective. A number of sources suggested that the most effective treatment approach combines social, cognitive-behavioral, medical, and referral services. The review also notes that many consider an active case manager essential to coordinate services.

An example of a successful case management program for women at risk of giving birth to a child with an FASD is the Parent-Child Assistance Program (P-CAP) in Seattle, which began in 1991 and has been replicated in other communities. P-CAP is an intensive home visitation model for mothers at highest risk.

As part of P-CAP, paraprofessional advocates are paired with clients for 3 years after the birth of a baby prenatally exposed to alcohol or drugs. They help link clients with community services. The advocates are extensively trained and closely supervised and have a maximum caseload of 15. Program results include fewer children born affected by alcohol and drugs, fewer foster care placements, and less family dependence on welfare. Other positive outcomes are an increase in family planning and child well-being.20,21

Some communities have mandated court-ordered or involuntary participation in alcohol treatment for heavily drinking pregnant women. These programs have stimulated legal and ethical debates concerning the comparative rights of the pregnant woman, the fetus, and society.22 Although some positive findings exist,23,24 the effectiveness of this approach has not been determined.

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