Intergovernmental committee on Drugs working party on Fetal Alcohol Spectrum Disorders
Fetal Alcohol Spectrum Disorders in Australia: An Update
8.5 Barriers to Change
Various factors operate as barriers to professional practice and systems change and the introduction of innovations and new approaches. The levels at which these barriers work include the following:
- Healthcare system – resources, policies
- Political environment – ideology
- Social environment – disadvantaged groups*
- Education environment - curricula
- Practice environment – time, resources, organisational structure
- Practitioners – knowledge, beliefs and attitudes
- Patient/client – demands, perceptions.
minimum, they include prevention, early intervention, early identification and remediation.
8.5.1. Prevention:There is considerable work that needs to be undertaken of a preventive nature, especially given the changing patterns of drinking among young women. Changing cultural norms about drinking is an important preventive strategy for FASD. Such strategies must be cognisant of the extended period of adolescence-adultescence that young people now experience and all the attended behaviours and risks associated with it. Little attention has been directed to the pre-pregnancy period as an opportunity for prevention, and similarly greater preventive attention is required in early pregnancy for all women in relation to basic information about alcohol and its risks in pregnancy. This requires a whole of community response including the schools, parents and the media.
8.5.2. Early Intervention:All pregnant women require basic information about alcohol use, but more importantly all pregnant women should be appropriately assessed for their drinking levels and patterns using standardised assessment tools by trained and skilled health professionals. Data should be recorded in standard formats that can be readily shared among health professionals. Women drinking at risky levels should receive appropriate counselling and support. Staff and services involved in the above need to have adequate knowledge and skills and the systems need to be in place for the necessary screens and assessments to be undertaken.
8.5.3. Early Identification:The early identification of FASD at the time of birth or soon after is important and involves obstetric and postnatal care staff. The application of standardised assessment and screening procedures embedded within normal medical care systems is essential.
8.5.4. Remediation:Once a diagnosis is made the long term ongoing support of a range of different health and human workers and organisations is required. This support extends well beyond the health care system to the wider child protection services and education system. The latter have been largely neglected as key players in this area until relatively recently. Important issues in terms of empathic care and support for the parents, and the mothers in particular, is paramount.
*In the context of FASD particular attention needs to be paid to the support and resources required by Indigenous workers or workers with Indigenous clients.