I'M MARCIA SCOTT AND WE'RE GOING TO GET STARTED WITH DR. KEN WARREN WHO'S THE CHAIR OF THE ICCFASD WHO'S GOING TO GIVE A BRIEF WELCOME. >> MARCIA, THANK YOU VERY MUCH. I'M PLEASED TO WELCOME EVERYBODY HERE TO THE 2016 GENERAL MEETING OF THE INTERAGENCY COORDINATING ON FETAL ALCOHOL SPRECTRUM DISORDERS. PLEASE TAKE NOTE. th ICCFASD WAS CREATED AT THE RECOMMENDATION OF THE U.S. CONGRESS IN THE YEAR 1996 WHICH IS EXACTLY 20 YEARS AGO SO THIS IS OUR 20th ANNIVERSARY BECAUSE WE BEGAN ALMOST IMMEDIATELY FOLLOWING THE RECOMMENDATION. IT'S BEEN VERY IMPORTANT IN THE CONTEXT OF BRINGING COORDINATION AMONG THE VARIOUS AGENCIES THAT ARE INVOLVED IN AND AWAY OF PROGRAMS ASSOCIATED WITH THE ADVERSE EFFECTS OF ALCOHOL DURING PREGNANCY AND THAT INCLUDES AT LEAST TWO OF THE INSTITUTES AT NATIONAL INSTITUTES OF HEALTH. A NUMBER OF CENTERS FROM THE -- CENTERS FOR DISEASE CONTROL. AND PREVENTION. AND THE SUBSTANCE ABUSE AND MENTAL HEALTH ADMINISTRATION. AND A NUMBER OF OTHER AGENCIES WITHIN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND BEYOND THAT WE WERE FORTUNATE ALMOST FROM THE VERY BEGINNING TO HAVE TWO AGENCIES TO HAVE TWO OTHER DEPARTMENTS JOIN US IN TERMS OF THE MEMBERSHIP AND THAT WAS THE DEPARTMENT OF JUSTICE AND THE DEPARTMENT OF EDUCATION. THE DEPARTMENT OF EDUCATION ACTIVITY HAS WANED BACK AND FORTH. AT THE CURRENT TIME THEY DID NOT HAVE A REPRESENTATIVE ON THE ICCFASD AND WE HOPE WE WOULD BE HAVING A REPRESENTATIVE FROM THE DEPARTMENT OF EDUCATION AGAIN BECAUSE EDUCATION IS EXTREMELY IMPORTANT COMPONENT OF THE ISSUES SURROUNDING THE BOTH THE IDENTIFICATION AS WELL AS THE TREATMENT OF DISORDER, THE BEHAVIORAL AND EDUCATION DEFICITS ASSOCIATED WITH ALCOHOL EXPOSURE IN PREGNANCY AND WE HOPE TO HAVE THEM BACK AGAIN AS A MEMBER SOON BUT WE'RE VERY PLEASED THAT THE DEPARTMENT OF JUSTICE THROUGH THE OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTION HAS BEEN VERY ACTIVE MEMBER FOR A VERY LONG PERIOD OF TIME AND I THINK FOR ABOUT 18 YEARS OF THE 20 YEARS OF THE EXISTENCE OF THE ICCFASD AND OF COURSE WE HAVE MANY IMPORTANT ISSUES INVOLVING THE JUSTICE SYSTEM SO WE'RE VERY PLEASED TO HAVE THEM HERE AS WELL. WITH THAT I WOULD LIKE TO END MY WELCOME AND IF WE COULD -- WE COULD GO AROUND THE TABLE AND HAVE EVERYBODY INTRODUCE THEMSELVES AND THEN I'LL TURN BASICALLY THE FLOOR BACK TO OUR EXECUTIVE DIRECTOR DR. MARCIA SCOTT. BUT LET'S GO AROUND THE ROOM AND WE'LL SEE IF THE CAMERA FOLLOWS US AROUND THE ROOM. IT LOOKS LIKE CAN IT DO IT AND WE'LL SEE IF THAT HAPPENS. AGAIN MY NAME IS KEN WARREN. I'M THE CHAIR OF THE ICCFASD. AND AT THIS POINT IN TIME A SPECIAL CONSULTANT TO THE NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM. AN INSTITUTE WHERE I SERVED AS DEPUTY DIRECTOR FOR SEVEN YEARS BUT STEPPED DOWN FROM THAT POST AND ASSUMED THE POST AS A SPECIAL CONSULT ANNUAL AND SPECIAL ADVISOR. >> I'M MARCIA SCOTT. THE PROGRAM OFFICER IN THE DIVISION OF EPIDEMIOLOGY AND RESEARCH AND SERVING AS THE EXECUTIVE SECRETARY FOR THE ICCFASD. >> GOOD MORNING. MY NAME IS LELA McKNIGHT. >> GOOD MORNING, EVERYONE. I'M DALE HAROLD. HERE AT NIAAA WHERE I SERVE AS A PROGRAM OFFICER AND PROJECT SCIENTIST ON ISSUES RELATED AND I'M THE REPRESENTATIVE FOR NIAAA AS WELL. >> GOOD MORNING. I'M A PEDIATRICIAN. WE'RE A PROGRAM AND -- AND PART OF THE JOHN HOPKINS AND MEDICINE AND I WORK AS COORDINATOR AND WORK WITH DOMESTIC VIOLENCE AND THE INTERACTION BETWEEN THE MOTHER AND CHILD INTERACTION. >> GOOD MORNING. I'M DR. LORRAINE -- THE OBSTETRICAL DIRECTOR. >> GOOD MORNING. MY NAME IS CARROLL WOLF BRAND. I'M A GUEST TODAY AND WITH THE AWESOME UNITED STATES. >> AND BECAUSE THERE IS ONLY ONE ROW BEHIND THE TABLE. BILL INTRODUCE YOURSELF AND THEN WE'LL GO FROM THERE ACROSS. >> GOOD MORNING. BILL -- PROGRAM OFFICER AT THE DIVISION OF METABOLISM AND HEALTH EFFECTS. >> OKAY. >> MY NAME IS -- ALSO WITH THE ARC OF THE UNITED STATES WORKING ON THE PROJECT. >> THANK YOU. WELCOME. >> SUSAN CARLSON AND I'M PRESIDENT OF THE MINNESOTA ORGANIZATION ON FETAL ALCOHOL SYNDROME. ALSO A MEMBER OF THE JUSTICE -- [ INAUDIBLE ] AND LOTS OF OTHER THINGS. >> RUTH RICHARDSON DIRECTOR OF PROGRAM IN MINNESOTA. >> SCOTT -- SENIOR POLICY ADVISOR --. GOOD MORNING. MADELINE REYES. [ INAUDIBLE ] ALSO THE PROJECT OFFICER FOR THE. [ INAUDIBLE ] >> KAREN LEAF FROM THE NATIONAL INSTITUTE OF CHILD AND YOUTH DEVELOPMENT FOR NIH. >> -- [ INAUDIBLE ] AND I AM THE CONTRACTING OFFICER REPRESENTATIVE FOR THE CENTER FOR CONVENTION. >> I'M SALLY ANDERSON. FROM NIAAA AND I'M THE FASD COORDINATOR FOR THE ICCFASD. >> THANK YOU VERY MUCH. I'M JUST GOING TO ASK A QUESTION. IS THERE ANYBODY ON THE PHONE THAT WOULD LIKE TO INTRODUCE THEMSELVES. WE'LL PAUSE FOR A MOMENT. I THINK I HEARD A BEEP. ANYONE THERE? OKAY. WITH THAT WHY DON'T I GO AHEAD AND I'M GOING TO TURN THE FLOOR OR THE TABLE OVER TO DR. MARCIA SCOTT. >> I'M GOING TO GIVE A BRIEF OVERVIEW OF THE ICCFASD. DR. WARREN HAS ALREADY GIVEN YOU BACKGROUND ABOUT THE ORIGIN OF THE ICCFASD AND I WANT TO REVIEW THE MISSION OF THE ICCFASD. THE COMMITTEE TO IMPROVE COMMUNICATION AND COOPERATION AND COLLABORATION AMONG FEDERAL AGENCIES THAT ADDRESS ISSUES RELATED TO PRENATAL ALCOHOL EXPOSURE. THE ICCFASD ISSUES THAT ARE IRRELEVANT TO FASD SPAN ACROSS MANY AREAS INCLUDING BASIC AND CLINICAL RESEARCH. BEST PRACTICES IN CLINICAL TREATMENT. HEALTH CARE DELIVERIES. JUSTICE REHABILITATION. EDUCATION OF CHILDREN WITH FASD AND COMPILING AND UNDERSTANDING AND ANALYZING DATA FOR PUBLIC HEALTH POLICY. THE THEME THAT THE FASD -- THE ICCFASD HAS FOCUSED ON OVER THE YEARS AND CONTINUES TO VIEW AS PRIORITIES INCLUDE PREVENTION OF DRINKING DURING PREGNANCY IS A PRIMARY GOAL OF THE ICCFASD IN GENERAL. WE KNOW THAT IF WOMEN DON'T DRINK DURING PREGNANCY THERE COULD BE 100% PREVENTION. SO, IT IS A CONTINUING CHALLENGE THAT WE CONTINUE TO FOCUS ON. WE'RE ALSO INTERESTED IN INTERVENING WITH CHILDREN AND FAMILIES AFFECTED BY PRENATAL ALCOHOL EXPOSURE AND IMPROVING METHODS FOR DIAGNOSIS AND IDENTIFICATION. AND INCREASING RESEARCH ON IDEOLOGY AND PATHO GENESIS AND INCREASING INFORMATION AND DISSEMINATION AND WE WILL BE DISCUSSING MANY OF THOSE ISSUES DURING THE COURSE OF MEETING TODAY. AN OVERVIEW OF THE STRUCTURE OF THE ICCFASD AS DR. WARREN INDICATED OVER THE YEARS WE HAVE HAD REPRESENTATIVES FROM THE DEPARTMENT OF EDUCATION. MANY OF THE AGENCIES THAT ARE COMPRISING THE ICCFASD ARE UNDER THE OFFICES OF DEPARTMENT OF HEALTH AND HUMAN SERVICE AND I WON'T NAME THEM ALL BUT YOU CAN SEE THEM DISPLAYED THERE. EACH OF THE REPRESENTATIVES WILL BE SPEAKING TODAY TO TALK ABOUT UPDATES ON ACTIVITIES RELATED TO FASD TODAY. SO YOU'LL BE ABLE TO HEAR THAT. AND THEN OF COURSE THE DEPARTMENT OF JUSTICE ALSO WE WILL BE TALKING ABOUT SOME OF THE JUSTICE RELATED ISSUES THAT ARE RELEVANT TO FASD. SO WITH THAT NEXT ON OUR AGENDA WE WILL BEGIN WITH UPDATES FROM MEMBER AGENCIES. SO THE FIRST PERSON WHO'S GOING TO PRESENTING ACTUALLY IS THE UPDATE FROM THE JUSTICE ISSUES WORKING GROUP BY SCOTT PESTRIDGE. AND OTHER MEMBERS OF THAT GROUP. >> THANK YOU. MASHIA. PGH GOOD MORNING. I JUST WANTED TO UPDATE EVERYONE. WE HAD A ROBUST DISCUSSION ON THE JUSTICE WORKING GROUP AND I'M GOING TO GIVE A BRIEF OVERVIEW. >> TERMS OF MAIN ISSUES THAT WE DISCUSSED YESTERDAY ONE IS A LISTENING SESSION REPORT. WE HAD IN 2013. JUNE OF 2013. THE HUGHES OF JUVENILE JUSTICE HELD A LISTENING SESSION. THAT REPORT IS FORTHCOMING. IT WAS DUE TO BE PUBLISHED IN JANUARY. HOWEVER, WE REALIZED THAT OUR EDITOR HAD NOT HAVING A SUBJECT MATTER EXPERTISE OF FASD HAD EDITORIALIZED IN SUCH A WAY THAT MADE THE LANGUAGE INCONSISTENT WITH THE FIELD AND THE WORK OF FASD. SO SALLY WILL BE WORKING OVER THE COURSE OF THE NEXT WEEKS TO PROVIDE SOME EDITS SO WE CAN ENSURE THAT THE DOCUMENT IS CONSISTENT WITH THE LANGUAGE THAT WE NEED. IN AWAY THAT IS CONSISTENT WITH THE LANGUAGE OF FASD AND I DID SAY YESTERDAY THAT WE WOULD HAVE A COUPLE MONTHS BUT I DID TALK TO OUR EDITORIAL STAFF AND ASKED IF WE COULD GET THINGS BACK BY THE END OF APRIL JUST FOR AN FYI FOR THE RECORD. ANOTHER THING THAT -- THE VAST MAJORITY OF OUR TIME YESTERDAY WAS FOCUSED ON A BENCH GUIDE. THE NATIONAL COUNCIL FOR JUVENILE AND FAMILY COURT JUDGES HAVE DEVELOPED IN ASSOCIATION WITH OUR OFFICE A FETAL ALCOHOL SPECTRUM DISORDERS IMPLICATIONS BENCH GUIDE AND THAT GUIDE RECENTLY BECAME COMPLIANT AND IS BEING DISSEMINATED AND WE SPENT A LOT OF TIME TALKING ABOUT HOW WE COULD FULLY DISSEMINATE THAT IN A WAY THAT COULD BE TO THE APPROPRIATE AUDIENCE THAT COMPRISE THE UNITED STATES. WE WANT TO MAKE SURE THAT WE'RE -- THE JUDGE SITS ON THE JUSTICE WORK GROUP. IT'S GREAT THAT WE PRESENT AT CONFERENCES AND THAT SORT OF THING BUT THAT IS NOT GETTING TO WHERE THIS BENCH GUIDE NEEDS TO BE. IT NEEDS TO BE FRONT AND CENTER AND SO WITH THAT WE TALKED ABOUT TECHNICAL ASSISTANCE THAT WE MAY BE ABLE TO BROKER IN A WAY TO MAXIMIZE THE GUIDE. I THINK RUTH MAY TALK ABOUT THE TAP AND THEN WE'LL GO TO JUDGE CARL SON IF SHE HAS ANY THOUGHTS. >> IN TERMS OF THE TAC. WE TALKED ABOUT THE NEED TO MOVE BEYOND EDUCATION AND PROVIDE CONSULTATION AND TECHNICAL ASSISTANCE FOR COURTS IN ORDER FOR THE GUIDE TO BE MOST EFFECTIVE. AND IN ADDITION TO THAT WE ALSO TALKED ABOUT THE IMPORTANCE OF USING SOME OF THE LIMITED DATA THAT WE HAVE ABOUT THESE SCREENING PROJECTS THAT WERE HIGHLIGHTED YEARS AGO TO DO A BIT OF COST ANALYSIS AS A WAY IN TO GET PEOPLE INTERESTED IN TALKING ABOUT SCREENING AND AS A WAY TO REDUCE RECIDIVISM AND ALSO TO TALK ABOUT THE COST BENEFITS AS WELL. >> I JUST WANT TO ADD I THINK THAT THE GUIDE IS GOING TO BE VERY HELPFUL FOR THE SYSTEM FOR THE COURTS AND I THINK RUTH IS CORRECT. WE NEED TO SHOW THEM WHY IT'S IMPORTANT. AND I WAS PART OF ONE OF THE GROUPS THAT DID THE SCREENING IN MINNEAPOLIS IN THE SUBURBS FUNDING THROUGH THE CENTER FOR EXCELLENCE AND ONE OF OUR OTHER MEMBERS EILEEN WAS ALSO A MEMBER OF THAT AND DID THE SCREENING SO WE HAVE SOME LIMITED DATA BUT I THINK VERY IMPORTANT DATA THAT COULD BE SHARED ACROSS VARIOUS SYSTEMS BECAUSE THE KNOWLEDGE BASE WE KNOW IS NEVER GOOD OUT THERE. IT'S BETTER THAN WHEN I GOT INVOLVED BACK IN 1997 BUT IT'S STILL NOT VERY GOOD. I'M VERY PROUD OF THE WORK THAT THE WORK GROUP HAS DONE AND WE ALSO TALKED ABOUT A LOT OF OTHER -- AREAS THAT WE COULD PARTICULARLY GET IN TO THE COURTS AND SALLIE MAE HAVE SOMETHING TO ADD -- WITH THE JUDGES -- THE NATIONAL CONFERENCE OF -- FAMILY COURT JUDGES AND IN WORKING WITH THEM. SO AND I VOLUNTEER WAY TOO MUCH. BUT I'M VERY EXCITED ABOUT THE DIRECTION THAT WE'RE GOING. >> THANK YOU. JUST TO ADD A COUPLE OF POINTS TO RUTH AND THE JUDGE'S COMMENTS. ONE OF THE THINGS THAT WE STRUGGLE WITH AND TALKED ABOUT AT FAIR LENGTH YESTERDAY WAS HOW TO TRANSLATE THE CRITICAL ELEMENTS OF FASD AND THE WORK OF FASD AMONG THE SCIENCE COMMUNITIES AND INTEGRATE THAT INTO THE JUSTICE COMMUNITY BECAUSE IT'S DIFFERENT LANGUAGE AND HOW TO ALLOW FOR A PATTERN IF YOU WILL THAT RESONATE WITH THE JUSTICE COMMUNITY. AND SO WE TALKED ABOUT EXECUTIVE SUMMARIES. THE JOURNAL OF AMERICAN JAMA WAS SUBJECTED. THERE IS AN EXECUTIVE SUMMARY REQUIRED WITH THE ARTICLES THAT IT'S KIND OF A LAYMAN'S LANGUAGE SO WE WERE THINKING HOW WE CAN ENSURE THAT THE LANGUAGE IS BEING COMMUNICATED IN A WAY THAT IS RESONATING WITH THE JUSTICE COMMUNITY AND TO THAT POINT AND I KNOW I BELIEVE JUDGE CARLSON WORKED ON THIS FASD BENCH GUIDE AND MASSAGING THE LANGUAGE TO ALLOW FOR GREAT COORDINATION OF THE JUDICIAL COMMUNITY. SO THAT IS SOMETHING THAT WE REALLY ARE IS -- STRIVING TOWARDS AND TO SEE IF WE CAN DO SOME QUICK BROAD BRUSH UPDATES TO RESONATE MORE CLOSELY. IN TERMS OF THE DISSEMINATION THERE IS A BIG COALITION FOR JUVENILE JUSTICE MEETING NEXT WEEK AND I AM WORKING ON -- WE'RE GOING TO WORK ON SOME LANGUAGE TODAY TO FIGURE OUT HOW WE CAN GET THAT OUT TO THE ATTENDEES IN ADVANCE OF THE SESSION OF THE CONFERENCE JUST TO MAKE THEM AWARE OF ONE, THE GUIDE. TWO, TO ENCOURAGE THEM REALLY GET INVOLVED WITH THEIR STATE ADVISORIES GROUPS AND CONNECTING THEM WITH WORK OF FASD BECAUSE WE REALIZED THEY ARE DIFFERENT DISCIPLINES BUT VERY MUCH APPLICABLE IN THE FORM OF BLOCK GRANTS THAT OUR OFFICE SUPPORTS AND COULD SUPPORT FASD WORK WITHIN THE COMMUNITY AND MAKING PEOPLE AWARE OF THE CONNECTIONS SO, THAT IS PART OF OUR WORK MOVING FORWARD AND PART OF OUR CHARGE IS FIGURING OUT HOW TO MAKE THAT CONNECTIONS. IT'S A TWO-WAY STREET. NOT ONLY CONNECTING THEM BUT CONNECTING THE REPRESENTATIVES WITH THE JUVENILE JUSTICE REPRESENTATIVES AS WELL. SO I THINK THAT IS THE BROAD BRUSH REVIEW OF WHAT WE DISCUSSED. AND I DON'T KNOW, CAROLYN, DO YOU HAVE ANYTHING YOU WANT TO ADD? >> WE WERE TALKING ABOUT LINKING RESEARCH WITH PRACTICE. HOW LONG THAT TAKES. HOW CRUCIAL THAT IS. AND THE EX I GAVE WAS THE THE ACE DATA. EVERY CHILD EXPERIENCES. THAT IS NOT NEW INFORMATION. IT IS TAKING AN AMAZINGLY LONG TIME TO ACTUALLY IMPLEMENT IT IN REAL LIFE PRACTICE. JUST SEEMS TO TAKE FOREVER. >> AND TO THAT POINT OUR ADMINISTRATOR IS A VERY BIG -- COULD COULD YOU PUT THE MIC IN FRONT OF YOU. >> OUR ADMINISTRATOR IS A VERY BIG ACE PROPONENT AND I WAS NOT AWARE THAT IT WAS LIKE A 20 PLUS-YEAR-OLD STUDY SO THAT WAS INTERESTING AND TO THE POINT THAT CAROLYN IS MAKING. BUT SO I THINK WE HAVE A LOT OF WORK TO DO AND WE SOME GREAT PRODUCTS THAT HAVE COME OUT AND THAT ARE FORTH COMING WHICH SPEAKS TO THE COMMITMENT OF THE JUSTICE COMMUNITY AROUND THIS ISSUE. SO WE'RE LOOKING FORWARD TO CONTINUE TO MOVE FORWARD AND PROMOTE THE WORK OF THIS COMMITTEE. >> OKAY. THANK YOU VERY MUCH. I WANT TO ADD A LITTLE PERSPECTIVE AS WELL. I MENTIONED YESTERDAY AT THE SUBCOMMITTEE MEETING THAT JUST LAST WEEK JUST A WEEK AGO I HAD ATTENDED THE ADOLESCENT AND ADULT FOCUS MEETING IN VANCOUVER, CANADA. ORGANIZED BY THE UNIVERSITY OF BRITISH COLUMBIA. AND A MEETING THAT BASICALLY OCCURS EVERY TWO YEARS WITH THE FOCUS ON ADOLESCENCE AND ADULTS AND MEETS EVERY OTHER YEAR HAVING A RESEARCH FOCUS BUT IT BRINGS TOGETHER A VERY BIG AND VERY BROAD AUDIENCE OF PEOPLE AT ALL LEVELS AND INCLUDES INDIVIDUALS WHO ARE DIRECTLY -- HAVE FETAL ALCOHOL SPECTRUM DISORDERS AND ALSO HAS PARENTS AND SOCIAL WORKERS AND CLINICIANS AND IT HAS LAWYERS. IT HAS JUDGES. AND IT HAS RESEARCHERS AND IN GENERAL BY THE WAY A FEW LEGISLATORS AS WELL. SO IT DOES ATTRACT A VERY BROAD AUDIENCE. BUT I WANT TO HIGHLIGHT IS THAT THERE WAS A PREMEETING THAT WAS HELD THE DAY BEFORE THE MEETING. WHICH HAD A NUMBER OF SESSIONS AND ONE WAS SPECIFICALLY RELATED TO FASD AND THE JUDICIAL SYSTEM WITH A MAJOR FOCUS ON CANADA SINCE THE MEETING WAS PRIMARILY ORGANIZED IN CANADA. AND MOST OF THE ATTENDEES WERE FROM CANADA. BUT -- I ATTENDED A SESSION THAT WAS THERE -- AT -- ON THE JUDICIAL SYSTEM AND BASICALLY IT WAS THE CENTERS WERE TWO INDIVIDUALS THAT RAN THE ENTIRE SESSION THAT LASTED TWO AND A HALF, THREE AND A HALF HOURS. THEY WERE BOTH FORENSIC PSYCHOLOGIST. FORENSIC PSYCHOLOGIST WHO SERVED THE COURT SYSTEM IN I BELIEVE AT LEAST ONE OF THEM WAS FROM ONTARIO AND THE OTHER ONE I DON'T REMEMBER -- I THINK IT MAY HAVE BEEN SUCH A PROVINCE OF SASKATCHEWAN. BUT I WAS EXTREMELY IMPRESSED AT AMOUNT OF WORK THAT IS BEING DONE WITHIN THE COURT SYSTEM BY PEOPLE WHO HAVE DEGREES IN FORENSIC PSYCHOLOGY IN TERMS OF HELPING THE COURTS ADJUDICATE CASES INVOLVING INDIVIDUALS WHO HAVE FASD. SCOTT I'M GOING TO TURN IT BACK TO YOU TO ASK AND TO JUDGE CARLSON. DO WE HAVE ANYTHING THAT IS PARALLEL TO THAT IN THE UNITED STATES? GOING ON THAT WE'RE AWARE OF. I REALIZE WE DON'T HAVE A VERY ORGANIZED SYSTEM THAT ONE STATE OR ONE COURT MAY NOT KNOW WHAT ANOTHER COURT OR ANOTHER STATE IS DOING BUT HAVE WE HAD EXPERIENCE IN THAT? >> YOU'RE TALKING SPECIFIC TO FASD WORK? I'M NOT AWARE. BUT THE JUDGE WILL LIKELY HAVE MORE INSIGHT. >> CANADA IS WAY AHEAD OF US ON THIS. BUT YOU'VE GOT THE FORENSIC TEAM UP IN SEATTLE. AND THEY DO A LOT OF DEATH PENALTY CASES AND I KNOW IT'S OUR GOAL IN MINNESOTA TO SOMEHOW GET A MODEL LIKE THAT THAT WILL WORK WITH THE COURTS BECAUSE A FORENSIC PSYCHOLOGIST LOOKS AT WHAT IS GOING ON WITH THE BRAIN BUT THEN HOW THAT INTERFACES WITH THE LEGAL SYSTEM AND THAT IS THE PLACE WHERE IT SHOULD BE. SO I'M NOT AWARE -- RUTH. >> I THINK -- I THINK SAN DIEGO IS ALSO LOOKING AT TRYING TO PULL TOGETHER FORENSIC TEAMS AS WELL. >> OKAY. THANK YOU VERY. AND I THINK THAT WOULD BE A VERY, VERY IMPORTANT GOAL. AND I CAN SHARE THE NAMES WITH ANYONE HERE ONCE I GO THROUGH MY NOTES AND ONCE AGAIN PULL THE NAMES OF THE INDIVIDUALS WHO ACTUALLY MADE THE PRESENTATIONS BECAUSE I WAS VERY, VERY IMPRESSED WITH THE WORK THAT THEY DID. THEY WERE VERY ARTICULATE INDIVIDUALS. ANYONE WHO CAN GO ON -- ON THIS PARTICULAR SUGGEST FOR OVER THREE HOURS IS CERTAINLY ARTICULATE AND I THINK THERE WAS A LOT TO BE LEARNED FROM IT. AND AGAIN THE MORE WE PARTNER WITH OTHER COUNTRIES AND IN PARTICULAR CANADA BECAUSE THEY ARE SOMEWHAT AHEAD I BELIEF IN A NUMBER OF THE ASPECTS OF DEALING IN FASD AND THE -- I THINK IT'S GOING TO BE A BENEFIT BOTH FOR THEM AS WELL AS FOR US TO INTERFACE MORE ON THESE TYPES OF ISSUES. I NOTICED THAT WE WERE JOINED BY A NUMBER OF INDIVIDUALS WHO HAVE NOW -- JOINED THE TABLE. SO I WAS WONDERING IF WE CAN HAVE -- GO AROUND AGAIN AND HAVE THE INDIVIDUALS WHO DID NOT INTRODUCE THEMSELVES BEFORE GO AHEAD AND INTRODUCE THEMSELVES. IF YOU INTRODUCE YOURSELF LIKE I DID YOU KNOW YOU DID -- SO LET'S GO AHEAD AND SHARE -- LET'S START WITH YOU. >> I'M SHARE LYNN FROM THE NATIONAL INSTITUTE ON DRUG ABUSE AND I WILL BE MODERATING THE SESSION WITH SOME OF THE. [ INAUDIBLE ] SPECIFIC WITH FASD. >> I'M LAUREN JANISON. I'M AN ASSOCIATION PROFESSOR AT JOHN'S HOPKIN'S UNIVERSITY. THANK YOU. >> GOOD MORNING. I'M DEIRDRE ROACH. -- >> GOOD MORNING. I'M -- AN ON CITY TWIGS AND GYNECOLOGIST -- MY PRIMARY PLACE OF WORK IS IN PUBLIC HEALTH IN LOCAL BEHAVIORAL HEALTH SYSTEM, BALTIMORE. -- I'M A MID-WIFE. >> SHARON. I'M A SOCIAL SCIENCE RESEARCH ANALYST FOR THE ADMINISTRATION OF CHILDREN AND FAMILIES AND ONE MY PRIMARY INTEREST IS CHILDREN IN THE CHILD WELFARE SYSTEM PARTICULARLY IN FOSTER CARE AND AS THIS TOPIC RELATES TO THEM. >> AND I THINK EVERYBODY ELSE HAS INTRODUCED THEMSELVES. MARCIA WOULD YOU LIKE TO GET US INTO THE NEXT PHASE OF THE MEETING. >> NEXT WE HAVE REPORTS OF ACTIVITIES FROM ICCFASD AGENCIES. SO WE'RE GOING TO START WITH -- -- COOPER FROM SAMHSA. >> FORGIVE ME BUT I'M GETTING OVER LARYNGITIS SO MY VOICE IS NOT WHAT IT USUALLY IS BUT ANYHOW. WELCOME EVERYBODY AND THANK YOU. I'M FROM SAMHSA AND THIS PROGRAM HAS BEEN IN -- SINCE 2004 AND NEXT FRIDAY ON APRIL 21st BECAUSE I WAS DEFUNDED -- SO THIS IS THE LAST YEAR. WE HAVE FIVE YEARS. ONE BASE YEAR AND FOUR OPTION YEARS AND WE'RE IN OPTION YEAR TWO BUT WE WILL NOT -- EXERCISE OPTION YEAR THREE BECAUSE IT'S BEEN DEFUNDED BY CONGRESS BUT I'M TOLD TO CONTINUE MY ROLE EVEN THOUGH THERE IS NO DIRECT FUNDING FOR THESE ACTIVITIES AT SAMHSA ANY LONGER. THERE IS AN FASD STATE COORDINATOR THAT WE WERE DOING AS WELL AND I'M STILL DOING THAT. USING SAMHSA RESOURCES TO BRING COORDINATORS TOGETHER AND THAT WILL CONTINUE AND SALLY JUST GAVE ME A NOTE THAT SAID SHE WANTS THE COORDINATORS AND THAT WILL WORK OUT. I JUST HANDED OUT THIS DOCUMENT TO EVERYBODY. AND I'LL GO OVER BRIEFLY SOME OF THE THINGS THAT WE'VE DONE RECENTLY. AND FROM THE TECHNICAL ASSISTANT YOU CAN SEE THAT WE DID -- ALL OF THE INFORMATION ON THE RESOURCE STORM I'M NOT GOING TO READ EVERY ONE OF THOSE. WE DID A LOT OF TA AND I ALSO WANT TO POINT OUT THAT THE ORIGINAL FUNDING FOR THE PROGRAM WAS $9.8 MILLION A YEAR. AND THEN IT WENT TO IN 2013 -- IT WENT TO $8.326 MILLION AND THEN HALFWAY THROUGH THAT FUNDING YEAR IT WAS REDUCED TO $1 MILLION AND I ACTUALLY ENDED UP WITH $960,000 SO IT WENT FROM 9.8 TO $960 DURING COURSE OF THE PROGRAM. -- THIS IS WHAT WAS DONE WITH THE $960,000. WE WERE FUNDING SOME PROVIDERS IN THE FIELD TO SEE WHAT WE COULD DO WITH PROJECT CHOICES AND PKAT AND SCREENING AND PREVENTION AND WE HAD TO DISCONTINUE THOSE. WE DISSEMINATED THE MONEY OUT TO THE PROVIDERS AND WE HAD TO PULL ALL OF THOSE BACK BECAUSE WE ONLY HAD ONE MILLION. SO, THAT IS THE BACKGROUND SO THE REASON I'M TELLING YOU THIS IS BECAUSE THE CONCENTRATION OF THE CONTRACT PROGRAM HAS BEEN THE WEBSITE. THAT IS THE ONLY VOICE WE HAVE OR HAD AND SO EVERYTHING WENT THROUGH THAT AND THEN THE STATE COORDINATOR SAID WE CONTINUED WITH -- IT WAS NOT PART OF THE NEW CONTRACT WHEN IT WAS REDUCED. THAT TASK WAS TAKEN OUT BUT I DECIDED IT WAS SO IMPORTANT THAT I CONTINUED ON MY OWN BECAUSE WE HAVE ACCESS TO A CALL IN NUMBER. SO WE'RE DOING THAT AND THEY WERE VERY COOPERATIVE. SO INFORMATION COLLECTION AND ANALYSIS. DAILY RESULTS THAT STARTED LAST YEAR. APRIL 22nd AND THEN WE HAVE TECHNICAL ASSISTANCE IN YEAR TWO. AGAIN THE -- RECEIVED THE INFORMATION RESOURCE CENTER WAS ACTIVE DURING THAT TIME THERE AND WHAT WE REALIZED WAS THAT WE WE WERE NOT DOING ALL OF THE THINGS THAT WE WERE DOING BEFORE THE ANNUAL BUILDING FASD -- CONFERENCE THAT WAS HELD ONCE A YEAR WAS ABOUT 286,000 PERSONS ATTENDING SO ALL WE COULD DO WAS MAKE THE STATE-OF-THE-ART INFORMATION AVAILABLE ON THE WEBSITE. AND THE INFORMATION RESOURCE CENTER WHAT WAS UNIQUE IS YOU COULD CALL IN AND TALK TO SOMEBODY AND GET SOME IN-DEPTH INFORMATION ON ANY TOPIC THAT YOU WANTED. TO LOOK AT -- SO MOVING ON -- TO THE WEBSITE, WE CREATED SOMETHING CALLED ASK THE EXPERT AND THAT IS ON PAGE 3 THERE. AND IT WAS VERY POPULAR WE DID INTERVIEWS WITH PEOPLE LIKE KATHY MITCHELL FOR EXAMPLE AND WE ALSO DID A TECHNICAL ASSISTANCE DISSEMINATION. WE HAD A TIP THAT WAS DONE IN 2013 AND WE ALSO CAME ONE SOME NEW TIPS FOR WOMEN, TIPS FOR MEN AND TIPS FOR PROVIDERS. AS WELL. AND WE CONTINUE THE HEALTHY BABY HEALTHY LIFE PERSPECTIVE IN ADDRESSING AND THE WEBINAR WAS DONE. THE NETWORK -- I FOUGHT TO HAVE THAT REMAIN IN THE CONTRACT AND IT WAS BUT WE DIDN'T HAVE THE MONEY TO TRAVEL FOR THEM TO SPEAK OR CON SCENE AS THEY WERE DOING IN THE PAST SO THE EXTENT WAS THAT WE DID SOME INFORMATION . IF YOU LOOK ON PAGE 4 YOU SEE THE STAKEHOLDER GROUPS THAT WE REACHED OUT TO. AND WITHIN SAMHSA WE REACHED OUT TO THE TRANSFER CENTERS AND WE DID SOME WORK WITH THEM AND IT PROVES TO BE VERY SUCCESSFUL BECAUSE OBVIOUSLY -- [ INAUDIBLE ] BUT THEY WERE NOT AWARE OF THAT -- SOME OF THE WOMEN THEY WERE TREATING. COULD HAVE FASD AND WHEN WE TOLD THEM THIS COULD HAPPEN THEY ADMITTED IT WAS POSSIBLE BUT YET DID NOT ASK FOR TRAINING FOR ANYBODY TO GO AHEAD AND USE THE KNOWLEDGE THAT WE WANTED TO SHARE WITH THEM IN THEIR DIAGNOSIS AND SCREENING SO THAT EFFORT DID NOT GO THROUGH BUT EXTERNALLY WE HAVE A LOT OF CONTACTS WITH A LOT OF DIFFERENT AGENCIES. AND ON THE LAST PAGE -- THE OUTREACH PRODUCT ON PAGE 6 THE VERY BACK -- YOU CAN SEE WHAT WE DID. THE WEBINAR -- HOW TO HAVE A HEALTHY BABY SERIES. MANY GOOD THINGS THAT WE CONTINUE TO DO. AND PEOPLE DID ASK WELL WHAT WOULD HAPPEN NOW WITH THE CENTER CLOSING AND WHAT WE'RE DOING IS WE'RE INVENTORYING THE PRODUCTS AND WORKING WITH THE OFFICE AT SAMHSA TO SEE WHAT COULD BE HOUSED ON THE WEBSITE. NOT AS SIMPLE AS YOU THINK. WHEN THE PROGRAM ENDS -- THERE IS ONLY SO MUCH YOU CAN PUT ON THE SITE SO WE'RE DOING THAT SO THAT THE INFORMATION IS STILL POSTED THERE AND FIGHTING FOR A LINK THAT IF YOU PUT FASD IN -- THE SCREEN WILL COME UP ANDTq TO THE SECTION. SO WE CAN GET MORE MONEY AGAIN. THANK YOU. >> I HAVE A QUESTION. YOU'VE LOT OF OUTSIDE STAKEHOLDER GROUPS. BECAUSE YOU'VE DONE A LOT WITH A LITTLE. IT'S OBVIOUS BECAUSE YOU FOUGHT FOR THAT AND BEEN ABLE TO LEVERAGE QUITE A BIT. AND SO OUTSIDE OF SAM SAY -- -- HOW MANY CAN BE ABSORBED. SINCE THESE ARE PUBLIC DOCUMENTS AND RESOURCES HOW MUCH OF THAT CAN THEY TAKE ON? GIVEN THAT MAYBE KNOWING THAT -- AND ALSO OVER TIME THINGS WILL GET ARCHIVED BUT THEY MAY GET OLD. HOW MUCH OF -- WITH THE LIMITED FUNDING THAT DETAKE ON BUT AT LEAST BUILD UPON THE BASE. >> AND THINK WE HAD THAT CONVERSATION THE LAST TIME WE WERE HERE. I REMEMBER SALLY -- SPEAKING TO YOU. WE STARTED WITH NO FAST AND I WAS TOLD BECAUSE THE INFORMATION WAS GRANTED BY SAMHSA THAT THEY COULD NOT HOUSE OUR INFORMATION. >> TO BE ABLE TO LINK TO IT IF IT'S ON THE WEBSITE. >> YEAH. AND SO THAT WAS THE LIMITATIONS BECAUSE THE PROGRAM WAS DEFUNDED. THAT WAS ONE OF THE FEW THINGS THAT WE FACED THAT WE COULD NOT DO THAT ANY LONGER SO. >> WELL GOOD LUCK. THE ARCHIVE COULD BE LINKED BECAUSE YOU'VE DONE QUITE A BIT. >> BUT NOT EVERYTHING CAN BE AVAILABLE. A LOT OF TRAINING MATERIALS WILL BE AVAILABLE. TOOLS FOR SUCCESS THAT WAS UPDATE. >> ON YOU TUBE OR WHATEVER. PUB DISSEMINATION THAT DON'T REQUIRE SAMHSA TO MAINTAIN IT. BECAUSE THAT IS ANOTHER ISSUE. SO PEOPLE WILL KNOW WHEN IT WAS PUT UP THERE. >> IT BECOMES OBSOLETE. SO THAT IS -- PRETTY MUCH WHERE WE ARE RIGHT NOW. >> I DID REACH OUT RECENTLY TO THE ASSOCIATION OF SUBSTANCE ABUSE LIBRARIANS WHO HAVE LARGE -- HAS A LARGE ARCHIVAL COLLECTION OF LITERATURE RELATED TO ALCOHOL AND OTHER SUBSTANCES OF ABUSE. THAT IS AVAILABLE ON-LINE. AND WE'RE INVESTIGATING THE PROBABILITY THAT THEY WILL BE ABLE TO TAKE SOME OF THE DOCUMENTS. THAT SAMHSA IS UNABLE TO GET ON THE WEBSITE. >> I WANT TO JUST MAKE A COMMENT HERE TOO. BECAUSE ONE OF THE THINGS THAT I FIND WHEN WE'RE TALKING ABOUT CHILDREN IN FOSTER CARE OR IN THE CHILD WELFARE SYSTEM IN GENERAL IS THAT THERE IS A LOT OF EMPHASIS AND A LOT OF INTEREST RIGHT NOW IN OTHER KINDS OF DRUGS. PEOPLE ARE VERY INTERESTED IN THE OPIATES AND THERE IS A LOT OF STIRRING UP ON THAT TOPIC BUT AND I UNDERSTAND. I FEEL LIKE SOME KIND OF A BAD PERSON IF I STAND THERE AND SAY WELL YOU KNOW ALCOHOL IS REALLY IMPORTANT. AND THE THING IS THESE LITTLE BABIES THAT ARE BORN -- ADDICTED TO THESE SUBSTANCES THEY ARE SHAKING. AND THEY ARE IN TERRIBLE SHAPE AND THEY ARE IN PAIN. AND SO I UNDERSTAND ALL OF THAT. BUT THERE IS A MUCH BETTER CHANCE THAT THEY ARE GOING TO GET OVER THAT. THEY ARE NOT GOING TO GET OVER FETAL ALCOHOL. THEY ARE NOT GOING TO GET OVER THAT. THEY ARE GOING TO HAVE THE PROBLEM FOR THE REST OF THEIR LIVES. AND I THINK RIGHT NOW THERE IS A HUGE AMOUNT OF EMPHASIS IN CONGRESS ON THIS BUT I -- I'M TRYING TO FIND SOME KIND OF A BALANCE WHEN I TALK WITH PEOPLE AT MY OFFICE AND IF I GO TO CONFERENCES -- ON THAT TOPIC AND I HOPE THAT EVEN IN THE CHILD WELFARE FIELD AND I AM GOING TO STOP IN A SECOND HERE BUT I FIND THAT WHAT PEOPLE ARE INTERESTED IN IS WHEN IS THE PARENT GOING TO STOP ABUSING EITHER DRUGS OR ALCOHOL? THEY ARE NOT TALKING ABOUT WHAT THE BIOLOGICAL EFFECT IS ON THE CHILD. THEIR MAIN INTEREST IS TO GET THEM TO STOP ABUSING THE DRUGS OR ALCOHOL SO THAT THEY CAN BECOME BETTER PARENTS. THAT IS A VERY DIFFERENT QUESTION FROM WHAT BIOLOGICALLY HAPPENS TO THE CHILD. SO ANY WAY THAT IS MY SPIEL. >> I'M FINDING OUT THAT WITHIN SAMHSA BECAUSE OF FASD HAS BEEN SOMETHING ACTUALLY -- THIS PROGRAM COULD BE IN -- [ INAUDIBLE ] WAS ABLE GET IT IN CCAP WITH THE PREVENTION AND EVERYBODY SAID IT'S TREATMENT SO WHY IS IT THERE BUT IT'S PREVENTING REOCCURRENCES OF ALCOHOL -- PREGNANCY WHICH IS DIFFICULT TO EXPLAIN TO PEOPLE BUT WHAT WAS ALARMING TO ME IS THAT THE CONVERSATION AROUND THE PROGRAM GOING AWAY AND -- AND THERE IS EMPHASIS ON NAS NOW SO THOSE BABIES WILL BE TAKING CARE OF AND BACK TO YOUR POINT THEY DON'T UNDERSTAND THAT FASD -- THERE IS NO CURE AND THAT THE OUTCOME FOR FETUS EXPOSED TO SUBSTANCES IS MUCH DIFFERENT THAN ALCOHOL. THEY THINK THE EMPHASIS ON HEROIN ADDICTION BY CONGRESS AND NAS IS ACTUALLY KIND OF FILLING THE VOID OF WHAT WE WERE DOING WITH THIS PROGRAM HERE. >> CAN I JUMP IN AND SAY I THINK A USEFUL MESSAGE IN THIS SITUATION IS TO CONTINUE TO REMIND FOLKS THAT YES OPIATES ARE A SERIOUS ISSUE AND PEOPLE WHO USE OPIATES DRINK AS WELL. IT ALWAYS HAPPENS. AND SECONDLY TO GO BACK TO THE ISSUE OF SCIENCE AND TO PRACTICE IS TO PREMIND FOLKS THAT FETUSES HAVE A DIFFERENTIAL SENSITIVITY TO ALCOHOL. ONE MAY BE MORE SENSITIVE THAN ANOTHER. SO IT'S A TOTALLY GRAY AREA AND I'M A PURIST BUT THE ONLY SAFE THING IS NO ALCOHOL AT ALL. THERE IS -- NO WAY TO PUT IT ANY OTHER WAY. >> JUST WANT TO SAY FROM A PRACTICAL ASPECT -- I DID DO CHILD PROTECTION AND YOU'RE ABSOLUTELY RIGHT. DRUGS ALWAYS TRUMP ALCOHOL. AND WHEN I WOULD DO WHAT THEY CALL A HOLD HEARING THERE WOULD BE WOMEN THAT COME IN WITH SEVEN OR EIGHT CHILDREN ALL HAD BEEN IMPACTED. SO IT'S A HUGE PROBLEM BY ALCOHOL. AND A LOT OF THE PETITIONS WOULD -- IF THEY FOUND DRUG USE THAT WOULD GO IN THE PETITION. THERE WOULD NOT BE AN INQUIRY AS TO THE USE OF ALCOHOL. AND SO IN MACHINE THE ONE THING THAT WE'RE TRYING TO WORK ON THAT BUT ONE THING THAT WE'RE TRYING TO DO IS TO PROVIDE EDUCATION FOR THOSE -- FAMILIES THAT ARE -- THAT HAVE FOSTER CARE CHILDREN THAT THEY GET EDUCATION ON FASD SO WE'RE NIPPING AT IT AND I TALKED TO OUR COMMISSIONER OF HUMAN SERVICES ABOUT THE IMPORTANCE OF FASD IN SCREENING AND SHE SAID WELL IT'S HEROIN AND THEY ALL HAVE THIS THING ABOUT THE DRUGS SO I THINK IT'S -- A MAJOR ISSUE. >> BUT I THINK THAT AT LEAST WITHIN THE GOVERNMENT IT'S OUR RESPONSIBILITY TO LET PEOPLE KNOW THAT MOST OF THE WOMEN BEING SCREENED OR DIAGNOSED WILL ALSO BE USING ALCOHOL BUT ONCE THE PROGRAM IS FUNDED AND THE INSTRUMENT DOES NOT INCLUDE THIS IT'S OUT THERE AND IT'S DONE. SO UNDERSTANDING THE CONVERSATION AND. [ INAUDIBLE ] AND THAT DOES NOT ALWAYS TAKE PLACE. >> PROVIDERS -- SCREEN. THE QUESTION IS WHERE ARE THE SERVICE? AND SECONDLY, I DON'T KNOW. I REMEMBER THE OLD DAYS WENT MARCH DIMES WAS FOCUSING ON LOW BIRTH WEIGHT AND NOW FOCUSING PRETERM BIRTH. ONE QUICK AND EASY THING IS FOR PROVIDERS TO GIVE PATIENTS A PRESCRIPTION FOR ABSTINENCE OR EVEN EARLIER WHEN THEY ARE PICKING UP THEIR BIRTH CONTROL. A PRESCRIPTION FOR ABSTINENCE AND TALK TO THEM ABOUT IT BUT IT'S NOT GOING TO HAPPEN UNTIL SCHOOLS AND MEDICINE AND ADVOCACY ORGANIZATIONS FOCUS IT ON. IT SEEMS SIMPLE AND STUPID EVEN BUT IF THOSE KINDS OF THINGS ARE FOCUSED ON THEY MIGHT HAPPEN. >> THANK YOU. WE'RE GOING TO MOVE ON TO OUR NEXT PRESENTER. DR. -- >> THANK YOU, MARCIA. I'M GOING TO TALK FOR THE NEXT 15 MINUTES I HOPE. I SOMETIMES LOSE TRACK OF TIME. >> THE FOCUS IS WHERE WE OVERSEE IN THIS AREA. OKAY. SO WE'VE HAD A CHANGE OF LEADERSHIP HERE OVER THE PAST SEVERAL YEARS. AND IN 2014 DR. GEORGE KOOB BECAME OUR DIRECTOR AND HE REMAINS SO AND EARLY IN HIS REIGN AS THE DIRECTOR HE GENERATED THIS LIST OF WHERE WE WANT TO BE. THESE ARE THINGS THAT WE WANT TO FOCUS ON AND MAKE PROGRESS IN. AND THE POINT I'M GOING TO MAKE HERE IS THAT FASD IS WELL REPRESENTED AMONG THESE NUMBER FOUR IMPLEMENTATION OF EFFECTIVE STRATEGIES OF DRINKING DURING PREGNANCIES AND NUMBER SIX. EFFECTIVENESS OF TREATMENTS. WE'RE MOVING FORWARD IN THESE AREAS AND AND I WANT TO TALK ABOUT -- STEP BACK FROM THE SPECIFICS OF GRANTS EXCEPT TO SAY THAT WE TRIED TO FUND -- A SPRECTRUM OF AREAS OF RESEARCH THAT ARE RELEVANT TO FASD. BUT ALSO TO GIVE YOU A SENSE THAT WE HAVE A VERY STABLE PORTFOLIO THAT TURNS OVER. GRANTS DON'T LAST FOREVER. THEY COME AND GO AND REPLACED BY NEW GRANTS BUT ON THE AGGREGATE WE HAVE A STABLE PICTURE WHEN IT COMES TO THE FASD PORTFOLIO. AND I DON'T WANT TO OVERWHELMED ANYONE WITH A BUNCH OF NUMBERS BUT HERE THEY ARE. YOU CAN SEE THAT WE ENDURE IT'S LIKE A ROLLER COASTER RIDE WITH OUR BUDGET. THERE IS A SEQUESTER. THERE IS AN ERROR AND -- SO WE'VE GOT UPS AND DOWNS HERE BUT NEVERTHELESS WE HAVE MANAGED A PRETTY STABLE FASD GRANT PORTFOLIO AND YOU CAN SEE HERE THAT WE CARRY ABOUT 100 GRANTS ON AVERAGE ACROSS THE YEARS. AND THAT REPRESENTS ABOUT 8-9% OF OUR OVER OWL BUDGET THAT WE HAVE AVAILABLE FOR TRAINING AND RESEARCH PURPOSES. AND YOU CAN SEE THAT STABILITY HAS REALLY BEEN THERE FOR THE BETTER PART OF A DECADE NOW. AND WE DON'T EXPECT THAT TO CHANGE. I WANT TO INTRODUCE YOU TO SOME NEW GRANTS THAT WE INITIATED IN FISCAL YEAR 2015 THE MOST RECENT COMPLETE YEAR THAT WE HAVE SO WE'LL RUN THROUGH AT A HIGH LEVEL THE NEXT THREE SLIDES. AND I'M JUST PROVIDING THE NAME, THE PI AND TYPE OF MECHANISM. UP FRONT I'VE CLUSTERED MECHANISMS THAT ARE INVOLVED IN TRAINING ONE SCIENTISTS AND PEOPLE ON THE VERGE OF STARTING THEIR CAREER IN SCIENCE SO WE'RE SUPPORTING THE NEXT GENERATION OF RESEARCHERS. I'M ALSO SHOWING YOU THESE LITTLE CODES HERE AND YOU CAN DECIPHER THEM WITH THE LEGEND BUT I'M TRYING TO SHOW YOU IF YOU SEE A DIVERSITY OF COLOR BOXES HERE. WE'RE COVERING MANY OF THE BASIS HERE AND YOU'LL SEE ON THE NEXT SLIDE OR TWO THAT WHILE WE DON'T HAVE A LOT OF PREVENTION GRANTS WE DO HAVE SOME. AND NOW WE'RE GETTING INTO DEVELOPMENTAL GRANTS. THESE GIVE INVESTIGATORS THE OPPORTUNITY TO TEST OUT SOME EXCITING NEW IDEAS AND THEY GET TWO YEARS TO DECIDE IF IT'S GOING TO PAN OUT OR NOT. AND OFTEN TIMES IF THEY DO AND THEY LEAD TO LONGER RUNNING RESEARCH PROJECTS. AND SO THIS IS THE THIRD OF THE THREE SLIDES. AND WE'LL JUST LEAVE IT AT THAT. SO THIS IS -- THE COLLECTION OF NEW GRANTS IN THAT PARTICULAR FISCAL YEAR. AND IT'S FAIRLY TYPICAL -- I'LL MENTION A NOTEWORTHY -- GRANT THAT WAS AWARDED IN THE PRIOR YEAR. AND IT GAVE RISE TO THE NEW MEXICO ALCOHOL RESEARCH CENTER AND WHAT IS IMPORTANT HERE FOR YOU TO KNOW IS THAT THIS CENTER AMONG -- HALF A DOZEN OR SO THAT WE SUPPORT THIS ONE IS DEDICATED SPECIFICALLY TO FASD RESEARCH. TO UNDERSTAND HOW FETAL ALCOHOL EXPOSURE -- BRAIN DAMAGE TO IMPROVE FASD DIAGNOSIS, TO EFFECTIVE THERAPEUTIC INTERVENTION. SO THIS IS GOING TO BE AN EXCITING PROGRAM TO FOLLOW OVER THE COMING YEARS. THIS IS NOT TO BE READ. THIS IS A LAUNDRY LIST OF FUNDING OPPORTUNITY ANNOUNCEMENTS THAT WE HAVE THAT ARE ACTIVE -- ON AND THESE PARTICULAR ONES ALL HAVE LANGUAGE IN THEM ABOUT ALCOHOL EXPOSED FETUS SO THESE ARE -- SIGNAL TO THE COMMUNITY THAT ANY ONE OF THESE PROGRAMS THAT WE'RE TRYING TO DEVELOP ARE -- POSSIBLY UP THERE. FOR DOING FASD RESEARCH. THESE TWO IN PARTICULAR ARE VERY -- CLEARLY RELATED TO FASD. -- THE EFFECTS OF ALCOHOL EXPOSURE -- AND POTENTIALLY BEING A MECHANISM THAT FETAL ALCOHOL EFFECTS CAN BE PASSED FROM GENERATION TO GENERATION. AND -- THIS IS A SUMMARY OF ONE OF OUR FIRST INTO DEVELOPING TREATMENT FOR FASD AND YOU CAN SEE THROUGH THIS RFA THAT WE HAD AN APPLICATION COME IN ON COLEEN -- ONE THAT WAS MORE USING TABLETS AND GAMES TO TRAIN CHILDREN THAT ARE AFFECTED TO IMPROVE THEIR SELF-CONTROL. ONE THAT CAME OUT OF A GROUP OF PEOPLE THAT ARE PHYSICAL THERAPIST AND THEY -- EXAMINE -- POTENTIAL SENSORY MOTOR TRAINING TO IMPROVE BALANCE AND ENGAGEMENT IN CHILDREN. AND THEN ANOTHER ONE WITH TODDLERS -- TO IMPROVE THEIR SELF-REGULATION SO ALL OF THESE GRANTS HAVE RUN THE COURSE. WE GAVE THEM TWO YEARS AND IF THEY MET THEIR MILESTONE WE GAVE THEM THREE MORE YEARS OF FUNDING. ALL WITH THE EXCEPTION OF ONE OF THESE THAT HAVE GENERATED SOME PUBLICATIONS TO LOOK AT WITH PROMISING RESULTS. I'M GOING TO MOVE AHEAD ON THE CHOLINE PROGRAM. THE JACOBSON PROJECT WHICH USES -- AND ADMINISTERS COLEEN TO PREGNANT WOMEN. -- SO I WANTED -- IN THE REMAINING FEW MINUTES I WANT TO INFORM YOU OF SOME OF THE BIG COMMITMENTS IN CONSORTIUM THAT FOCUS ON FASD. AND ONE OF THEM IS THE COLLABORATIVE INITIATIVE. CIFASD. SOME MAJOR THEMES THAT HAVE BEEN FOLLOWED IN THE CURRENT PHASE OF CIFASD. STRUCTURAL AND FUNCTIONAL BRAIN IMAGING. LOOKING AT REGIONS OF THE BRAIN THAT ARE ALTERED BY ALCOHOL EXPOSURE AND HOW THESE THINGS ARE ASSOCIATED WITH NEURAL BEHAVIORAL PROBLEMS. AND THEY'VE MADE A LOT OF INTERESTING PROGRESS IN THAT AREA. 3D FACIAL IMAGING. THAT IS WHAT THIS PICTURE REFERS TO. THEY'VE GOT A WORLD EXPERT RUNNING THIS PROGRAM AND 3D IMAGE ANALYSIS AND COMPUTERJ COMPUTATIONAL METHODS -- HE CAN FAS IN CHARACTERIZE PARTIALEJPD EXPOSED INDIVIDUALS APART FROM CONTROLS. THESE ARE DONE IN VERY RELATIVELY NONDIVERSE POPULACES BUT THEY ARE DOING GENETICS TO LOOK AT THAT RACIAL DIMENSION AND RUNNING THESE COME FEW TEASES AND HOPEFULLY A TOOL WILL BE DEVELOPED TO BE USED IN A PEDIATRICIAN'S OFFICE. THERE IS A GENETIC COMPONENT ALSO USING ZEBRA FISH AND I'LL TELL YOU WHAT THIS SHOWS IS THAT THE PROTECTIVE EFFECTS OF THIS PARTICULAR GENE ON THE FACIAL STRUCTURES AND THE EFFECTS THAT ALCOHOL CAN WREAK HAVOC ON IN THESE ZEBRA FISH SO THROUGH THESE EFFORTS WE HOPE TO FIND GENES THAT ARE RELEVANT TO HUMAN FASD SUBJECTS AND THAT THEY MAY GUIDE US TO -- RISK -- WHEELS. OR OTHERS THAT MAY BE PROTECTIVE SO THERE MIGHT BE A FUTURE HERE WITH PERSONALIZED MEDICINE TO SEE WHAT THE GENO TYPES OF THESE KIDS ARE EVEN BEFORE THEY ARE BORN TO KNOW WHICH KIDS MIGHT HAVE TO BE LOOKED AT OR GET THE PROTECTIVE EFFECTS. SO I DON'T WANT TO GO TOO FAR INTO THIS BECAUSE KAREN MIGHT BE ABLE TO TOUCH ON IT. NOD YES OR NO. SO OKAY. WE'VE PARTNERED IN A NUMBER OF WAYS AND ONE IS THIS VERY LONG-STANDING LONG RUNNING LARGE -- COLLECTION OF 12,000 PREGNANT WOMEN IN TWO DIFFERENT GEOGRAPHIC REGIONS AROUND THE WORLD BUT THE IDEA IS TO SEE DOES ALCOHOL PROMOTE SIDS OR STILLBIRTHS? AND THIS TEAM HAS GOT ANOTHER YEAR, YEAR AND A HALF TO GET THEIR FINDINGS GOING AND THEY ARE STARTING TO PUBLISH NOW. AND IF THAT TIME FRAME WE'RE GOING TO LEARN QUITE A BIT HERE. AND THIS IS IN COLLABORATION -- WITH THE DISORDER GROUP. WE ALSO HAVE A CONSORTIUM THAT IS TRYING TO ACCURATELY ASSESS PREVALENCE OF -- FASD AND THEY ARE ONGOING IN A VARIETY OF COMMUNITIES ACROSS THE UNITED STATES. THIS IS -- -- ANOTHER NEW INITIATIVE AT NIH -- THIS IS TO GENERATE -- A RICH GENOMIC SEQUENCE REPOSITORY TO LOOK AT BIRTH DEFECTS AND CHILDHOOD CANCERS RIGHT NOW BUT THIS SHOULD BE AN ONGOING PROJECT WHERE DIFFERENT DISORDERS CAN BE INTERFACED WITH THE GENOMIC RESOURCES BEING DEVELOPED WITH THIS PROGRAM. THIS IS A BIG PROGRAM. REPURPOSEING THE NATIONAL CHILDREN'S STUDY FUNDS THAT WERE DIRECTLY APPROPRIATED BY CONGRESS TO THE TUNE OF $170 MILLION A YEAR AND CONGRESS SEEMS TO BE WILLING TO PERPETUATE THIS SO THIS NEW PROGRAM -- ECHO PROGRAM WHICH EMPHASIZES AND THEY ARE GOING TO LEVERAGE EXISTING COHORTS AND THIS IS GOING TO BE A BIG PROGRAM. THE INITIAL ROUND OF GRANTS ARE DUE ON TAX DAY. WHICH IS RIGHT AROUND THE CORNER SO KEEP THAT ON YOUR RADAR SCREEN AND IT'S GOING TO BE A BIG LONG RUNNING PROGRAM AND WE'LL SEE A ROLE FOR LOOKING AT FASD AND ALCOHOL EXPOSED INDIVIDUALS. THAT IS ALL I'VE GOT. I HOPE I DIDN'T RUN OVER TOO BADLY. >> THANK YOU FOR YOUR ATTENTION. >> QUESTIONS FOR DALE. >> THANK YOU. >> I'LL JUST ASK ONE QUESTION. AS WE BECOME MORE AWARE OF THE EFFECT THAT'S THIS IS ONE OF THE POTENTIAL MECHANISMS OR A REAL MECHANISM THAT WE'RE SEEING AND THE FACT THAT YOU GET #B,w MULTI-GENERATIONAL EFFECTS FROM EPPIE GENETIC CHANGES -- WHAT ARE YOUR THOUGHTS IN TERMS OF LOOKING -- STARTING TO LOOK AT THE OFFSPRING OF INDIVIDUALS WHO HAVE FAS TO SEE IF SOME OF THESE EFFECTS ARE LONG LASTING. >> THAT'S AN AREA OF INTENSIVE INVESTIGATION NOT ONLY IN THE ALCOHOL FIELD. DR. BILL EXPERT. WE HAVE INVESTIGATORS -- DEPOC BEING ONE OF THEM WHO AHAS GENERATED EVIDENCE THAT ALCOHOL ALTERS EPPIE GENOMESf:::::: PERPETUATED IN THE ABSENCE OFUz–?–?uH— ZNO +6@ FURTHER ALCOHOL. THIS IS WHERE WE ARE GETTING THE FEASIBILITY AND THE IMPLEMENT INFORMATION THAT WE'LL NEED TO MOVE FORWARD. IT MIGHT BE SOMETHING THAT WE NEED TO SET IN MOTION AND HAVE IN PLACE. THANK YOU. NEXT WE HAVE DR. CAROLYN -- -- >> MY NAME IS KAREN LEE. AND IT'S MY PRIVILEGE TO BE ABLE TO SPEAK WITH YOU TODAY ABOUT FASD RELATED ACTIVITIES. OKAY. SO AS DR. HERELD JUST MENTIONED THE PRENATAL ALCOHOL AND STILL PATTED -- STILL BIRTH -- THE PAST NETWORK WAS ESTABLISHED IN 2003 AS A PARTNERSHIP. THE NATIONAL INSTITUTE ON DEFINITENESS AND OTHER DISORDERS JOINED IN 2009. THE NETWORK IS DESIGNED TO LINK STUDIES TO INVESTIGATE THE ROLE OF PRENATAL ALCOHOL EXPOSER IN SIDS AND STILLBIRTH AND HOW THEY ARE RELATED. THE MAIN STUDY IS THE SAFE PASSAGE STUDY WHICH IS THE FIRST PROSPECTIVE -- STUDY OF THE RELATIONSHIP IN THE HUMAN FETUS AND INFANT AND THE STUDY SEEKS TO ENROLL 12,000 WOMEN IN THE U.S. AND AFRICA THE NEXT STUDY IS MEASURE THE EFFECTS OF PRENATAL ALCOHOL EXPOSURE ON -- METHYLATION. METH LACKS. WITH DETAILED EXPOSURE INFORMATION -- THIS WORK WILL SERVE AS A FOUNDATION FOR A LARGE SCALE STUDY ON THE INTERPLAY OF EXPOSURE OF METHYLATION AND CHILD HEALTH OUTCOMES. THE NEXT STUDY IS MECHANISMS OF CONTEXT CONDITIONING IN THE DEVELOPING RAT. WHICH WE'LL USE A VARIANT OF -- CONDITIONING TO EXAMINE NORMAL AND ABNORMAL DEVELOPMENT OF SPATIAL INFORMATION PROCESSING. IT EXPLORES THE ROLE IN NORMALLY DEVELOPING RATS AND IN ROADANT MODELS OF FASD: -- AS I MENTIONED I'M THE DIRECTOR OF THE HEALTH BEHAVIOR AND -- THE BEHAVIORAL OF PEDIATRICS. I WANT TO TELL YOU A LITTLE BIT ABOUT OTHER GRANTS IN MY PORTFOLIO THAT ARE RELATED TO RISK REDUCTION. SO HERE WE HAVE A COUPLE OF GRANTS TO INFLUENCE -- -- AND HERE ARE A FEW GRANTS THAT WE HAVE. LOOKING AT NICOTINE SOME OF WHICH IS FUNDED BY FDA. AND IN MY POLL I -- TO APPLY THESE TECHNOLOGIES TO UNDERSTAND AND MONITOR IN REALTIME WHAT CENTRAL DEVELOPMENT AND FUNCTION AND TO DEVELOP AND EVALUATE NONINVASIVE MARKERS AND TO UNDERSTAND THE CONTRIBUTIONS OF WHAT CENTRAL DEVELOPMENT AND TO DEVELOP -- SO THE MEETING IS TAKING PLACE TODAY AT NIH. WE ALSO HAVE -- AN FOA RELATED TO THIS PROJECT. IT HAS BEEN EXTENDED TO THE END OF JUNE AND I'VE INCLUDED CONTACT INFORMATION HERE. >> QUESTIONS FOR KAREN? >> I CAN'T RESIST. ALWAYS ASKING THIS QUESTION. THE PAST STUDY -- -- HAS A WEALTH OF PLACENTAS FROM THE POPULATION. THAT WAS IN THE STUDY POPULATION AND IF I REMEMBER CORRECTLY EVERY PLACENTA -- IS THE WORD FOR THE ALMOST 12,000 INDIVIDUALS -- THE -- ARE THERE ANY THOUGHTS OF ENGAGING THE USE OF THAT RESOURCE IN THIS NEW EFFORT INVOLVING -- ADVANCE AND UNDERSTANDING OF THE PLACENTA AND PLACENTA FUNCTION? >> I CAN FIND OUT FOR YOU. >> OKAY. >> THANK YOU, KAREN. THAT ACTUALLY PUTS US A LITTLE BIT AHEAD OF SCHEDULE. WE'LL TAKE A 15 MINUTE BREAK AND BE BACK -- AT ABOUT 10:00. AND WE WILL PROCEED WITH THE REST OF THE AGENDA. THANK YOU. >> WE'RE CONTINUING SOME OF THE THEMES OF OUR LAST MEETING WHERE WE WERE EXPLORING I WOULD SAY SOME OF THE SCIENCE THAT LOOKS "AT ISSUES" OF POLYDRUG USE. I'M CHERYL BOYCE AND I'M GOING TO BE MODERATING THIS SESSION SO WE'RE PLEASED THAT WE HAVE THREE PRESENTATIONS TODAY THAT REALLY WILL I THINK GENERATE SOME INTERESTING DISCUSS. AND THE FIRST TALK WE HAVE IS BY LORRAINE MILIO AND SHE IS AT JOHNS HOPKINS BAYVIEW. >> THANK YOU. >> THANK YOU FOR INVITING ME TO SPEAK TODAY. YOU'RE FAMILIAR WITH THE ALCOHOL -- IT'S VERY DIFFERENT THAN THE DEFINITION THAT'S WE USE FOR OPIATE AND OTHER SUBSTANCE ABUSE DEFINITE NEWSES IN PREGNANCY SO WE START OUT WITH LOOKING AT RISK DRINKING FOR WOMEN MORE THAN THREE DRINKS A DAY AND SEVEN A WEEK AND BING DRINKING IS ALCOHOL CON CONCENTRATIONS TO .08 AS MORE AS DEFINED BY THE NIH. THIS IS USUALLY FOUR OR MORE DRINKS WITHIN TWO HOURS AND THEN YOU HAVE ALCOHOL DEPEND ANNES. HOWEVER 90% OF ABUSE IS NOT ASSOCIATED WITH DEPENDENCE AND IT'S VERY DIFFERENT FROM TREATING OPIATE ABUSE DURING PREGNANCY. AND ALCOHOL ABUSE CAN LAST FOR DECADES WITHOUT PROGRESSING TO DEPENDENCE. I ACTUALLY HAD A PATIENT A COUPLE OF DAYS AGO WAS TELLING ME THAT SHE WAS DRINKING SOMETHING LIKE 100 OUNCES OF ALCOHOL A DAY AND SHE WAS TALKING ABOUT RISKY AND BASICALLY SAID -- BUT I DIDN'T DRINK FOR THE LAST THREE OR FOUR DAYS. SO IT'S A DIFFERENT PATTERN THAN WE SEE WITH OPIATES. SO IN PREGNANCY THERE IS NO MINIMUM AMOUNT WHICH IS CONSIDERED SAFE IN PREGNANCY. AND THE AMERICAN CONGRESS OF OBGYN HAS TAKEN THIS POSITION FOR YEARS. HOWEVER, YOU HAVE THE ISSUE WHERE ABOUT HALF OR 50 PERCENT OF PREGNANCIES IN THE U.S. ARE UNPLANNED AND UP TO 80% IN THE SUBSTANCE ABUSE DISORDER -- UNPLANNED PREGNANCY SO THEREFORE PREPREGNANCY ALCOHOL ABUSE MAY EXIST WELL INTO THE FIRST AND EVEN INTO THE SECOND TRIMESTER UNTIL THE PREGNANCY IS DEGREES AND AMONG SOME PATIENTS PREGNANCY MAY NOT BE DIAGNOSED UNTIL EVEN LATER. SO IN PREGNANCY INTO THE 1970s THERE WAS A PERVASIVE BELIEF THAT DRINKING ALCOHOL ACTUALLY POSED NO RISK FOR THE FETUS OR THE MOTHER AND I ACTUALLY REMEMBER ALCOHOL WAS ACTUALLY USED TO TREAT PRETERM LABOR WELL INTO THE 1980s. AND I REMEMBER THE -- AS A RESIDENT SOME OF THE ATTENDINGS TELLING PATIENTS WHO TODAY TRAVEL BACK TO THE HOSPITAL BECAUSE OF PRETERM LABOR TO SIP A BOTTLE OF WINE SLOWLY WHILE TRAVELING THE TWO HOURS BACK TO THE HOSPITAL. SO REALLY LACK OF AWARENESS UNTIL IN TO THE '80s. SO WHY SHOULD WE CARE? SO THE EPIDEMIOLOGY OF ADDICTION IN THE U.S. AS YOU ALL WELL KNOW THE LIFETIME PREVALENCE IS BY 12.5% BUT HIGHEST IN THE 18-29-YEAR-OLD AGE GROUP WHICH IS THE AGE GROUP WHERE YOU HAVE PEEK PREGNANCY. AND MORE THAN 10% -- REPORT SOME ALCOHOL USE IN PREGNANCY AND 1.6% WAS FREQUENT USE. COMPARED WITH LIFETIME PREVALENCE WITHDRAWING DEPENDENCE BEING 2.6% AND WROUGHT DEPENDENCE IT'S 7.7%. SO DEFINITELY HIGHER INCIDENCE FOR ALCOHOL USE IN PREGNANCY AND YET NOT THE SAME NUMBER OF RESOURCES OR CERTAINLY CONCERN ABOUT IT. ON THE PART OF THE OB COMMUNITY. THERE ARE DIFFERENCE THAT'S WE SEE IN SUB DANZA BOOS IN WOMEN THAT ALSO IMPACT PREGNANCY WOMAN HAVE A MORE RAPID TRANSITION FROM INITIAL ALCOHOL ABUSE TO DEPENDENCE AND WHERE IT INTERACTS ALSO WITH SUBSTANCE ABUSE -- DISORDERS AND IN GENERAL THEY HAVE MORE INTERPERSONAL DIFFICULTIES. CLINICAL DEPRESSION. POST TRAUMATIC STRESS DISORDER. TRAUMA BOTH AS A VICTIM AND LIVING IN A VERY VIOLENT ENVIRONMENT. AND UNFORTUNATELY CAN ALSO BE A PERPETRATOR OF CHILD ABUSE. WOMEN ARE MORE SUSCEPTIBLE TO MEN THAN THE MEDICAL CONSEQUENCES OF ALCOHOL. LIVER DISEASE AND HEPATITIS. DETRIMENTAL EFFECTS OF ALCOHOL ON THE BRAIN AND EARLIER DEATH. IN PREGNANCY ONE OF THE THINGS THAT WE SEE BOTH WITH ALCOHOL ABUSE AS WELL AS OTHER SUBSTANCE ABUSE DISORDERS IS IF WOMEN HAVE PREEXISTING MEDICAL CONDITIONS THEY OFTEN PRESENT IN VERY POOR CONTROL AND WE OFTEN DON'T THINK ABOUT THIS BUT WHEN I HAVE PATIENTS THAT HAVE DIABETESES, HEART DISEASE, SEVERE ASTHMA OFTEN THESE HAVE BEEN NEGLECTED PRIOR TO COMING FOR PRENATAL CARE. WHEN WE LOOK AT PRENATAL ALCOHOL EXPOSURE THERE IS -- VERY RAPID DIFFUSION OF -- ACROSS THE PLACENTA. IT'S METASTASIZED WITHIN THE PLACENTA. WITH EQUILIBRIUM BEING AT TWO HOURS. SO THE -- THE FETUS REALLY DOES DRINK WHAT THE MOTHER IS DRINKING AND IN ADDITION AND THIS IS UNIQUE WITH ALCOHOL COMPARED TO OTHER SUBSTANCES IS -- UNCHANGED INTO THE AMNIOTIC FLUID. AND LATER THROUGH PUMP MINUTE NARY EXCREEKS IN URINE. SO IT ACCUMULATES AND THEN REMEMBER CIRCULATES TO THE FETUS THROUGH SWALLOWING AND BREATHING. STARTING AS EARLY AS ELEVEN WEEKS. SO ONCE ALCOHOL IS IN THE FETAL COMPARTMENT IT REMEMBER CIRCULATES LONG AFTER THE MOTHER HAS STOPPED DRINKING. ON STECK TYPICAL COMPLICATIONS -- HAVE BEEN TOUCHED ON BUT THERE IS ALSO AN INCREASE IN SPONTANEOUS ABORTION RATE. AT LEAST A SIX FOLD INCREASE IN FETAL DEATH OR STILLBIRTH RATE THAT HAS BEEN REPORTED AS RECENTLY AS 2012 AND I KNOW THERE IS A BIG STURDY GOING ON RIGHT NOW. SO WHICH LEADS TO THE CONCERN FOR FETAL ALCOHOL SYNDROME AND IT'S -- IN A GENERAL POPULATION WE'RE TALKING ABOUT .5 TO 2 PER,000 LIVE BIRTHS IN THE U.S. IN THE GENERAL POPULATION BUT IN HIGH RISK GROUPS AND CERTAINLY WOMEN WITH OTHER SUBSTANCE ABUSE DISORDERS ARE HIGH RISK GROUP. IT CAN BE AS HIGH AS 9.8 PER,000 LIVE BIRTHS AND AS MOST PEOPLE HERE KNOW IT'S THE MOST COMMON CAUSE OF PREVENTABLE RETARDATION HERE IN THE UNITED STATES. AND THEN THE LONG-TERM -- IT CAN BE AS HIGH AS 2% TO 5% OF ALL LIVE BIRTHS IN THE U.S. WHEN WE LOOK AT ALCOHOL IN USE IN PREGNANCY AS WITH SUBSTANCE ABUSE DISORDERS WE ALSO HAVE TO LOOK AT PSYCHIATRIC COMORBID TEE. AND OFTEN OF THE POST TRAUMATIC STRESS SYNDROME IS A MAJOR COMPONENT OF COMORBIDITY. THIS IS OFTEN CHILDHOOD, PHYSICAL OR SEXUAL ABUSE AND OF COURSE THERE IS GENERATIONAL ALCOHOL USE. SO FOR SOME OF THE FOR MANY OF THE CHILDREN OF ALCOHOLICS -- WHO THEMSELVES DRINK THEY'VE BEEN EXPOSED TO A LOT OF ABUSE. SCREENING FOR ALCOHOL AND PREGNANCY I THINK PREVIOUSLY AS SOMEONE HAD MENTIONED -- IS DONE ALL THE TIME AND YET NOT DONE. OFTEN IT'S -- THE BASIC QUESTION MAY BE ASKED AT THE FIRST PRENATAL VISIT, DO YOU HAVE -- HAVE YOU BEEN DRINKING NOW? HAVE YOU DRANK BEFORE THE PREGNANCY AND IF PEOPLE ARE PAYING ATTENTION THERE IS ACTUALLY SOME DATA THAT JUST ASKING ABOUT HARMFUL SUBSTANCE USE CAN BE ACCURATELY IDENTIFIED WITH JUST TWO OR THREE QUESTIONS. WHAT I HAVE FOUND IN REVIEWING A LOT OF CHARTS FOR MATERNAL MORTALITY REVIEW IS WHEN THE QUESTION IS YES THERE IS NOTHING NEXT TO IT SAYING WHAT HAPPENED? WERE THEY REFERRED? WHAT WAS THE DEGREE OF DRINKING ETC. VERY LITTLE FOLLOW-UP AND THERE HAS BEEN A PUSH IN THE STATE OF MARYLAND AND ONE MY COLLEAGUES HAS PUT TOGETHER ACTUALLY A SHEET THAT ACTUALLY CONSIDERS SCREENING TOGETHER FOR ALCOHOL AND SUBSTANCE ABUSE, INTIMATE PARTNER VIOLENCE AND TOBACCO USE TOGETHER. RATHER THAN JUST SEPARATING THEM OUT BUT LOOKING AT ALL THREE FACTORS AND SCREENING THEM AS A GROUPING. WE ARE ALL FAMILIAR HERE WITH THE OTHER SCREENING. I'M NOT GOING TO GO OVER THE SCREENING. THE CAGE. THE MASK' THE AUDIT. IN REALITY NONE OF THOSE ARE PRACTICAL IN MOST PRACTICES. IT HAS BEEN USEFUL IN SETTINGS WHERE SBIRT IS DONE. AND THE GOAL IS UNIVERSAL SCREENING FOR PEOPLE WITH SUBSTANCE ABUSE DISORDERS AND THOSE THAT RISK INCLUDING ALCOHOL. AND JUST TO REVIEW WHAT THE BASIC FOUR QUESTIONS ARE WITH THAT IS -- -- AND THEN ANYONE WHO ANSWERS POSITIVELY THEN ASSESS -- AND IF THEY SCREENED AS POSITIVE THEY ARE PROVIDED INFORMATION AND EDUCATION. BUT TO SCREEN OR NOT TO SCREEN IN PREGNANCY HAS BEEN SEARCHINGLY SOMETHING THAT HAS BEEN VERY CONTROVERSIAL. AND DO YOU AND WHEN DO YOU SCREEN? OFTEN TIMES PATIENTS ARE SCREENED FOR ALCOHOL AND SUBSTANCE ABUSE IN SOME WAY AT THEIR INITIAL PRENATAL VISIT BUT IT'S BEING SUGGESTED THAT PERHAPS WE SHOULD BE SCREENING EACH TRIMESTER BECAUSE PATIENTS MAY NOT BE WILLING TO SHARE A POSITIVE ANSWER WHEN YOU'RE STRANGERS BUT MAYBE AFTER THEY'VE BEEN IN THE PROGRAM -- IN A CLINIC GETTING TO KNOW THE PROVIDERS AND WHEN THEY COME BACK IN THE SECOND AND THIRD TRIMESTER THEY MAY BE WILLING TO SHARE AND WE FIND SOMETIMES ALL SORTS OF INFORMATION ABOUT PATIENTS IF YOU ASK QUESTIONS LATER IN THE PREGNANCY ONCE THEY FEEL MORE COMFORTABLE WITH YOU. BUT THE GENERAL RULE HAS BEEN TO SCREEN IN THE INITIAL VISIT AND THEM ON ADMISSION TO LABOR AND DELIVERY. AND DO YOU DO UNIVERSAL CREEPING. DO WE ASK EVERYONE? DO WE PROFILE PATIENTS OR DO NO SCREENING AT ALL? BRIEF INTERVENTION. WHICH HAS BEEN FOUND TO BE VERY -- HIGHLY EFFECTIVE ESPECIALLY FOR PATIENTS WITH ALCOHOL WHERE IT'S NOT A HEAVY USE DISORDER. BRIEF INTERVENTION CAN BE FIVE TO 10 MINUTES OF THE PROVIDER DISCUSSING THE DANGERS OF ALCOHOL USE IN PREGNANCY AND THIS IS ACTUALLY BILLABLE AS A BRIEF INTERVENTION WHICH IS IMPORTANT FOR PROVIDERS WHO ARE TAKING EXTRA TIME TO DO THIS. AND IT HAS BEEN SHOWN TO PROVIDE SOME LASTING CHANGES AND SAVINGS. HOWEVER, MANY OF THE PATIENTS WHO ARE HEAVY DRINKERS OR BING DRINKERS NEED REFERRAL FOR TREATMENT AND THERE ARE NO REAL PROGRAMS THAT SPECIFICALLY ADDRESS ALCOHOL ABUSE IN PREGNANCY SO PATIENTS ARE OFTEN FOLDED INTO EXISTING SUBSTANCE ABUSE PROGRAMS WHEN AVAILABLE AND MAY BE INTEGRATED FOR PREGNANT WOMEN OR WOMEN WITH CHILDREN OR OFTEN IN ABSTINENCE-BASED PROGRAMS. MANY WOMEN WITH ALCOHOL USE DISORDER IN PREGNANCY ALSO HAVE COMORBIDITY WITH OTHER SUBSTANCE ABUSE DISORDERS WHETHER IT'S OPIATES, MARIJUANA ETC. AND FOR A LOT OF THE PEOPLE NOT ALL BUT MANY OF THE WOMAN WHO HAVE ALCOHOL ABUSE WHO COME TO OUR PROGRAM THEY'VE COME BECAUSE OF THEIR OWE THE OPIATE ABUSE AND BY THE WAY I BING DRINK EVERY OTHER WEEKEND BUT WE HAVE SOME THAT DO COME WHERE ALCOHOL IS THE PRIMARY DRUG OF CHOICE BUT IT'S PROBABLY THE MINORITY OF PATIENTS THAT ACTUALLY COME FOR TREATMENT FOR WHOM ALCOHOL IS THEIR ONLY DUG SO I FEEL I THINK MANY PEOPLE FEEL CONCERNING THE PREVALENCE OF ALCOHOL USE IN PREGNANCY THAT OFTEN WE DON'T GET VERY MANY WOMEN INTO TREATMENT UNLESS THEY ALSO HAVE COEXISTING OTHER SUBSTANCES OF ABUSE. AND THE CHALLENGES. -- -- ALCOHOL USE DISORDER DOES NOT NEATLY FALL INTO THAT SO IT'S NOT UNCOMMON TO HAVE THESE WOMEN WHO HAVE BEEN BING DRINKING BUT NOT DAILY DRINKING AND SO HOW DO YOU MEASURE ABSTINENCE. HOW DO YOU TEST FOR RECENT ALCOHOL EXPOSURE. BREATH ANALYZER TESTING. DAILY. TOXICOLOGY. THERE ARE NEWER METHODS ALLERGIES ON THE HORIZON. SO THOSE ARE REAL CHALLENGES FOR US AND FOLLOWING PREGNANT WOMEN WITH ALCOHOL ABUSE. IN GENERAL -- TREATMENT -- IS HELPFUL WHEN IT HAPPENS IN A MULTI-DISCIPLINARY APPROACH -- AND INCLUDING ALCOHOL REALLY IS A MULTI-DISCIPLINARY EFFORT IN ORDER TO OPTIMIZE PRENATAL OUTCOME AND PRENATAL CARE HOPEFULLY EARLY PRENATAL CARE IS VERY IMPORTANT. EVALUATION AND TREATMENT FOR COMORBIDITY BOTH PSYCHIATRIC AND MEDICAL IS VERY CRITICAL. SUBSTANCE ABUSE TREATMENT AND NUTRITIONAL COUNSELING. MANY OF THESE WOMEN HAVE VERY POOR -- EXCUSE ME -- OH. SORRY. I LEFT THAT OUT. MY COLLEAGUE -- -- SOCIAL SERVICE AND SOMEHOW PEDIATRICS DROPPED OFF THE SLIDE BUT ALSO VERY IMPORTANT. BUT THERE ARE BARRIERS IN CARING FOR THIS POPULACE. SIMILAR TO SUBSTANCE ABUSE DISORDER OFTEN A VERY UNFRIENDLY HEALTH CARE SYSTEM. MOST WOMEN IDENTIFIED AS HAVING THE ALCOHOL ABUSE DISORDER OR OTHER SUBSTANCE ABUSE DISORDER HAVE ALL HAD VERY NEGATIVE EXPERIENCES WHEN INTERACTING WITH THE HEALTH CARE SYSTEM AND THAT IS A MAJOR BARRIER. TREATMENT SERVICES ARE OFFER VERY POORLY INTEREST GRATED AND MANY WOMEN WHO WHERE THEIR PRIMARY DRUG OF CHOICE IS ALCOHOL DON'T REALLY FEEL THAT THEY OFTEN BELONG IN A PROGRAM WHERE OPIATE ABUSE IS THE MAJOR DRUG OF THE OTHER PARTICIPANTS. LACK OF TRANSPORTATION IS A MAJOR ISSUE. CHILD CARE RESOURCES AND A LACK OF GENDER SPECIFIC AS WELL AS PREGNANCY SPECIFIC. -- PROGRAMS. AND JUST COMPLICATIONS OF LIFETIME. WE TALKED ABOUT THE POOR NUTRITION BUT CIGARETTE SMOKING. MAJOR COMORBIDITY THERE. AND CERTAINLY WHEN WE LOOK AT SUBSTANCE ABUSE IN PREGNANCY INCLUDING ALCOHOL -- THE PREVALENCE RATE CAN BE UP TO BETWEEN 80% AND 93% IN PREGNANCY COMPARED TO 12% NATIONWIDE. OF SMOKING IN PREGNANCY. SO, VERY HIGH --INGS DENSE AND A -- INCIDENCE AND CO-FOUNDER IN ANY STUDIES LOOKING AT THE EFFECT OF ALCOHOL OR OTHER DRUG USE IN PREGNANCY. SO THE PROGRAM I'M WORKING IN IS DEVELOPED AS A ONE-STOP SHOPPING PROGRAM. THAT INCLUDES SUBSTANCE ABUSE TREATMENT. THE TREATMENT, MENTAL HEALTH AND PSYCHIATRIC CONSULTATIONS. ON STECK CONTROL EVALUATION AND CARE -- AND THE DEVELOPMENTAL PLAY PROGRAM WHICH IS NOW DEFUNCT. PEDIATRIC HEALTH CARE AND WE HAVE A HOUSING UNIT THAT WE USE FOR STABILIZATION AND HOMELESSNESS AND DOMESTIC VIOLENCE ISSUES. WHAT WE FOCUS ON WITH OBSTETRICAL SERVICES IS TO HAVE A PRENATAL AND POSTPARTUM CLINIC EMBEDDED IN THE PROGRAM BUT ALSO TO MAINTAIN CONTINUITY WITH LABOR AND DELIVERIES. SO THAT THERE IS A CONTINUUM OF CARE. AND THERE IS A FOCUS ON SEXUALLY TRANSMITTED DISEASES WHICH IS MORE COMMON IN THIS PATIENT POPULATION WHETHER WE CONSIDER GONORRHEA, WHAT MID-Y HEPATITIS "C," HIV, ETC. AND SINCE -- MUCH OF HIV IS ACTUALLY SEXUALLY TRANSMITTED FOR WOMEN YOU DON'T NEED TO BE AN IV DRUG USER IN ORDER TO BE AT RISK IN THIS POPULATION FOR HIV AND HEPATITIS. ONE OF THE TREATMENT PROTOCOLS -- IS GIVING THIGH MEAN. AND WE USE DIE AS PAM TAPER. WE ALSO FOCUS ON IMPROVING SELF-S STOLEN AND COPING WITH DEPRESSION. AND RELAXED PREVENTION AND PARENTING SCHEDULES AND LIFE SKILLS TRAINING. I WANT TO TALK ABOUT -- INCLUDING THE U.S. AND SOUTH AFRICA. THERE IS ONE PREVENTION STUDY THAT HAS BEEN PUBLISHED. JUST PUBLISHED THIS PAST MONTH FROM SOUTH AFRICA AND THEY UTILIZE JUST CASE MANAGEMENT TO REDUCE OR STOP HEAVY DRINKING IN PREGNANCY AND THEY COMBINED A COMBINATION OF LIFE MANAGEMENT AND MOTIVATIONAL INTERVIEWING AND COMMUNITY REINFORCEMENT APPROACH AND WHAT THEY FOUND WAS THERE WAS DECREASED AND CESSATION OF DRINKING AND IMPROVEMENT OF WHAT THEY USED ON THE HAPPINESS SCALE DURING PREGNANCY ASSOCIATED WITH CESSATION. BUT UNFORTUNATELY AFTERWARDS THERE WAS SIGNIFICANT RELAPSE AT 12 AND 18 MONTHS AFTER STARTING THE PROGRAM. SO IT MAY BE EFFECTIVE BUT IT DID NOT SEEM EFFECTIVE IN HAVING LASTING RESULTS IN THESE WOMEN. ONE STUDY WHICH I THOUGHT WAS SEVERAL STUDIES THAT WERE JUST SUMMARIZED BY MS. McBRIDE IN THIS INTERNET PIECE ON -- PATERNAL INVOLVEMENT AND AUSTRALIA HAS A HIGHER EXISTENCE THAN WE HAVE IN THE U.S. THERE IS BEING SOME FOCUS ON LOOKING AT THE INVOLVEMENT OF THE PARTNER AND WHAT THEY HAVE FOUND IS THAT MORE THAN 75% OF WOMEN WHO DRINK DURING PREGNANCY USUALLY DRINK WITH THEIR PARTNER AND AT 40% OF THE WOMEN REPORTED THAT DRINKING WAS INITIATED BY THEIR PARTNER AND THAT WHEN THEY LOOK, GAVE QUESTIONNAIRES TO THE MEN, THE MEN DESIRED TO HAVE MALE ORIENTED PRECONCEPTION INFORMATION AND THEY HAVE A BEEN DOING SOME STUDIES THAT HAVE LOOKED AT IF YOU INVOLVE THE MEN AND THE PARTNERS IN PRECONCEPTS HEALTH IT ACTUALLY INCREASED FEMALE PARTNER COMPLIANCE WITH DECREASED OR CESSATION OF -- DRINKING BOTH PRECONCEPTION AND DURING PREGNANCY SO, THAT IS A PIECE THAT WE OFTEN DON'T LOOK AT IS THE INVOLVEMENT OF THE PARTNERS. IN THE ALCOHOL USE. THE OTHER PIECE I THINK THAT IS VERY IMPORTANT IS BOTH RESIDENT AND MEDICAL STUDENT EDUCATION. I FIND IN OUR PROGRAMS I HAVE A MEDICAL STUDENT FOR JUST FOUR HOURS FOR THEIR WHOLE ROTATION. IT COMPLETELY CHANGES THEIR ATTITUDE TOWARDS WHO THESE WOMEN ARE. AND HOPEFULLY SOMETHING THAT THEY WILL REMEMBER FOR A CAREER. AND THEN -- I'M GOING TO SEND BY SAYING THERE ARE A NUMBER OF CHALLENGES FOR THE PATIENTS WHEN THEY COME TO LABOR AND DELIVERY AND OF COURSE BEING PREGNANT ALL OF THEM WIND UP THERE BUT MANY OF THEM HAVE SHORT ATTENTION SPANS THAT MAKE IT DIFFICULT FOR COMMUNICATION. THEY MAY BE EASILY AGITATED. THEY ARE OFTEN AMONG ALL STRANGERS AND THIS POPULATION DOESN'T DO WELL IN THAT SITUATION. THEY MAY HAVE OTHER PRIORITIES THAN SMOKING AND PREGNANCY INCLUDING THE NEED TO SMOKE. AND THEN YOU HAVE POST OP PAIN MANAGEMENT ISSUES. SO THE BASIC -- THE BEST CARE TO OPTIMIZE PRENATAL CARE IS EARLY PRENATAL CARE. MAKING SURE THAT THEY ARE HAVING COUNSELING TREATMENT FOR THEIR ALCOHOL AND OTHER SUBSTANCE ABUSE DISORDERS AND THEN DEALING WITH THE COMORBIDITY WHETHER THEY BE MEDICAL OR PSYCHIATRIC OR DOMESTIC VIOLENCE DISORDERS. IT'S -- WHETHER IT'S OPIATE ABUSE OR ALCOHOL ABUSE IF A WOMAN IS USING IT TO MASK UNDERLYING PROBLEMS -- HAVING THEM STOP THEIR USE SOMETIMES ACTUALLY PUTS THEM IN A WORSE POSITION IF THEY THEN DON'T GET HELP FOR THEIR MENTAL HEALTH OR DOMESTIC VIOLENCE ISSUES AND SO, THAT IS A VERY IMPORTANT PIECE THAT IS OFTEN MISSING FROM A LOT OF TREATMENT PROGRAMS. THANK YOU VERY MUCH. >> WE'RE GOING TO TAKE QUESTIONS AT THE END. THAT WAS A GOOD START TO LAYOUT THE ISSUES IN SCREENING AND TREATMENT. FROM THE REAL WORLD IN MATERIALS OF SOME OF THE ISSUES. NEXT WE'RE GOING TO LOOK AT REPRODUCTIVE HEALTH. AND I'M PLEASED TO INTRODUCE MISS CAR TERPLAN WHO'S GOING TO TALK ABOUT DRUG AND ALCOHOL ABUSE IN PREGNANCY. -- >> HI. I'M KEEPING MY OWN TIME. THANK YOU FOR INVITING ME. THIS IS GOING TO BE A LARGE 10,000 FOOT VIEW TO A LARGE EXTENT. I WANT TO BEGIN BY LOOKING AT SORT OF WHAT HAPPENS TO SUBSTANCE USE IN GENERAL BOTH ALCOHOL AND OTHER WHEN SOMEBODY GETS PREGNANT. THESE ARE DATA FROM THE NATIONAL SURVEY OF DRUG USE AND HEALTH. THIS IS PAST THEIR 30 DAY USE AND SELF-REPORT AMONG WOMEN WHO ARE PREGNANT STRATIFIED BY TRIMESTER AND WE CAN SEE THAT OVER HALF OF THE THE WOMEN WHO REPORT ALCOHOL CONSUMPTION WITHIN THE LAST MONTH AND THAT DECREASES BY THOSE IN THE FIRST TRIMESTER AND DECREASES BY TRIMESTER AND THE SAME PATTERN IS OBSERVED FOR CIGARETTE SMOKING AND FOR ILLICIT DRUGS. 80% OF ILLICIT DRUG USING MARIJUANA. AND THE MAGNITUDE OF CHANGE DIFFERS BY SUBSTANCE. WOMEN CUT BACK ALCOHOL THE MOST AND CIGARETTES THE LEAST AND ILLICIT SUBSTANCES IN THE MIDDLE AND POST PART AM 80% OF THOSE WHO USE RESUME DURING THE POSTPARTUM PERIOD AND PEOPLE LOOK AT THAT AND SAY 80% RESUME USE AND THEY FEEL HUGHES LESS. AND I SAY 20% ABSTINENCE -- IS LIKE AWESOME FOR ANY BEHAVIORAL INTERVENTION IN THE ADDICTION WORLD. I ALSO LOOK AT THIS DATA AND SAY THESE SUPPORT THE STATEMENT THAT ALL PREGNANT WOMEN ARE MOTIVATED TO MAXIMIZE THEIR HEALTH AND THE HEALTH OF THEIR BABY TO BE. AND MOST WOMEN QUIT OR CUT BACK. BUT THOSE THAT CAN'T, THEY ACTUALLY HAVE WHAT WE CALL A SUBSTANCE ABUSE DISORDER. BY DEFINITION ONE OF THE DIAGNOSTIC CRITERIA FOR ADDICTION IS THE INABILITY TO CHANGE BEHAVIOR WITH THE KNOWLEDGE OF HARM. SO THAT MEANS WE'RE TALKING ABOUT ADDICTION. WHICH IS ANOTHER WAY OF TALKING ABOUT USE DISORDER. THIS IS THE AMERICAN SOCIETY OF MEDICINE DEFINITION. THEY ARE SIMILAR. THEY HAVE TO DO WITH REWARD PATHWAYS. THEY HAVE TO DO WITH MAKING -- YOU CAN DRILL DOWN IN THE BRAIN IN TERMS OF DOPAMINE AND STUFF LIKE THAT BUT I'M AN OBSTETRICIAN SO I LOOK AT IT SIMPLY. ADDICTION IS A BRAIN DISEASE WHOSE VISIBLE SYMPTOMS ARE BEHAVIORS. RIGHT. AND THAT MAKES -- THIS IS REALLY IMPORTANT TO THINK ABOUT WHAT WE TALK ABOUT SCREENING. AND FROM A LARGER PICTURE-PERFECT EXPECTATIVE WE KNOW A LOT ABOUT ADDICTION. WE KNOW HOW TO TREAT ADDICTION. WE KNOW THEORETICALLY AND A LITTLE BIT IN PRACTICE HOW TO PREVENT IT. BUT WE DO NOT KNOW HOW TO CURE ADDICTION. AT A CHRONIC DISEASE. LIFETIME DISEASE. THE SYMPTOMS MAY WAX AND WANE AND PEOPLE MAY RECOVER AND SOMETIMES THEY RELAPSE. IT DEPENDS. WHEN WE TALK ABOUT ANY SUBSTANCE IN PREGNANCY WE'RE NOT TALKING ABOUT PREGNANT WOMEN WHO START INJECTING HEROIN AND DEVELOP AN ADDITION WITHIN NINE MONTHS. WE'RE TALKING ABOUT WHERE REPRODUCTIVE HEALTH LIFE COURSE INTERSECTS WITH THE ADDICTION LIFE COURSE IN THE VERY SPECIFIC THING THAT I CALL THE PREGNANCY BOX. SO, WHO ARE THE WOMEN WHO THEN CONTINUE TO USE DURING PREGNANCY. THEY HAVE A USE DISORDER. WHAT ARE THEIR CHARACTERISTICS AND LORRAINE DESCRIBED THIS WELL. AND IT'S IMPORTANT TO REEMPHASIZE THIS. THERE IS A HIGH RATE OF REOCCURRING DISORDERS INCLUDING PTSD. DEPENDING ON HOW YOU ASK THE QUESTIONS DETERMINES THE PREVALENCE OF YOUR ANSWERS BUT AT LEAST 50% HAVE CHILDHOOD PHYSICAL AND/OR SEXUAL ABUSE. THE MAJORITY ARE IN CURRENT OR VERY RECENT VIOLENT SITUATIONS. CO-USE OF SUBSTANCES IS THE NORM. SMOKING BEING THE MOST COMMON CO-USE SUBSTANCE. ALCOHOL BEING VERY HIGH AS WELL. AND IT'S ALSO IMPORTANT TO THINK ABOUT WHAT WE TALK ABOUT THE GENERATIONAL NATURE ADDICTIONS. SOME OF THE FAMILIES -- PARENTS USE DRUGS. THEY WERE EXPOSED TO UNPREDICTABLE PARENTING MODELS. THOSE GET USED IN THEIR OWN PRACTICES AND MANY HAVE OTHER CHILDREN. NOW THESE FEATURES ARE IMPORTANT IN AND OF THEMSELVES AND RELATE TO -- BUT THEY ALSO ARE IMPORTANT IN TERMS OF DEPRESSION, POORLY TREATED OR UNDIAGNOSED AND OBSTETRIC OUTCOMES. DEPRESSION OR FORLY TREATED OR UNDIAGNOSED AFFECTS DRUG TREATMENT OUTCOMES SO INDEPENDENT OF EACH OTHER THESE EXERT EFFECTS IN THE REALMS OF ON IS TOIC CARE AND THE REALMS OF A DECK. IT'S ALSO IMPORTANT TO THINK ABOUT THE REPRODUCTIVE HEALTH NEEDS. AS LORRAINE MENTIONED THEY HAVE HIGH RATES OF UNPLANNED PREGNANCIES AND LOW RATES OF POSTPARTUM CONTRACEPTIVE UP TAKE. WHEN YOU LOOK IN GENERAL THEY HAVE MORE PREGNANCIES AND MORE BIRTHS AND MORE ABORTIONS THAN THE GENERAL POPULATION. IS SO IN THE REPRODUCTIVE HEALTH LIFE COURSE CARTOON I SHOWED AND ONE WAY THAT I LIKE TO FRAME IT THE AVERAGE WOMAN IN THE UNITED STATES WANTS TWO PREGNANCIES. OR TWO BABIES. THAT MEANS SHE SPENDS FIVE YEARS OF HER LIFE BEING PREGNANT AND POST PARTUM AND THAT MEANS SHE SPENDS 30 YEARS OF HER LIFE TRYING NOT TO BE PREGNANT SO WITH PREGNANT WOMEN NANCE WOMEN WITH SUBSTANCE ABUSE DISORDERS THE UNPLANNED PREGNANCY BEFORE THE PREGNANCY BEFORE AND THE POOR UP TAKE OF CONTRA SECTION AT -- CONTRACEPTION AT THE END OF THE PREGNANCY BOX. SHE HAD A HISTORY OF OAT YET USE DISORDER. SHE WAS TABLE IN RECOVERY FOR ABOUT TWO YEARS. SHE DISCLOSED THE HISTORY IN THE CONFINES OF THE DOCTOR/PATIENT MOMENT. ABOUT THREE DAYS LATER THE SHERIFF IN HER JURISDICTION SHOWED UP AT HER DOOR AND HANDCUFFED HER ARRESTED HERE AND CARTED HER OFF TO TREATMENT. SHE SPENT 80 DAYS IN TREATMENT DURING WHICH THERE WAS A SERIES OF LEGAL BATTLES. HER FETUS WAS GIVEN A LAWYER BY THE STATE OF WISCONSIN. SHE HAD NO LEGAL REPRESENTATION FOR MOST OF IT. ULTIMATELY IT WORKED ITSELF OUT. SHE PLED GUILTY TO CHILD ABUSE AND WAS ABLE TO LEE TREATMENT AND DELIVERED A HAPPY AND HEALTHY BABY. THESE STORIES ARE NOT UNCOMMON AND THIS REPRESENTATION OF WOMEN WITH USE DISORDER IN THE MEDIA EXTREME. A NEW BORN'S DEATH SENTENCE. NO BYSTANDER COULD BE MORE INNOCENT AND THE DAMAGE COLLATERAL. I HAVE A COLLECTION OF THESE NEWS STORIES AND IT'S SIMILAR TO ANOTHER COLLECTION I HAVE FROM THE CRACK BABY EPIDEMICS. THE WORST THREAT IS MOM HERSELF. AND THIS KIND OF -- BRINGS ME TO MAYBE THE FINAL PIECE OF WHAT WOMEN WITH SUBSTANCE ABUSE DISORDER WHAT THEIR LIVES ARE LIKE AND WE USE THE WORD STIGMA AROUND ADDICTION AND IT'S A BIT OF A EUPHEMISM BUT WE TREAT PEOPLE DIFFERENTLY BASED UPON CHARACTERISTICS AND THAT IS DISCRIMINATION. ALISSA GOT ARRESTED. THE FEATURE OF HER CRIME WAS THE FACT THAT SHE WAS PREGNANT IF SHE HAD DISCLOSED HER HISTORY OF OPIATE ABUSE AND NOT BEEN PREGNANT SHE WOULD NOT HAD BEEN ARRESTED AND THESE MESSAGES INFLUENCE HOW PEOPLE PERCEIVE THIS SITUATION AND HOW SCIENTISTS LIKE LOOK FOR PROBLEMS AND HOW INDIVIDUALS WHO SUFFER FROM THESE CONDITIONS AND INTERNALIZE OR COMPOUND THE ISSUES OF SHAME AND GUILT. SO I TALK ABOUT HOW THIS IS WHERE REPRODUCTIVE HEALTH AND LIFE COURSES CROSS BUT IT'S ALSO WHERE THE FEDERAL WAR ON DRUGS POLICIES CROSS WITH STATE SPECIFIC LEGISLATION AROUND REPRODUCTIVE HEALTH. AND THIS IS A GRAPHICAL WAY TO DEMONSTRATE HOW STATES HAVE RESPONDED TO DRUG USE IN PREGNANCY. AND IT'S HARD TO READ BUT ON THE FAR LEFT SIDE THERE IS ONE STATE THAT IS GOING TO SUN SET TENNESSEE IN WHICH DRUG USE AND PREGNANCY IS A CRIMINAL ACT. THERE ARE 18 STATES IN WHICH DRUG USING DEFINED AS BEING IDENTICAL TO CHILD ABUSE. ONLY 12 STATES THAT GIVE PRIORITY ACCESS TO PREGNANT WOMEN FOR TREATMENT AND ONLY FOUR STATES THAT HAVE ANY LANGUAGE IN THE STATUTES THAT PROTECT PREGNANT WOMEN FROM DISCRIMINATION WHO USE DRUGS. SO I THINK LORRAINE IS GOING TO -- I MEAN LAUREN IS GOING TO TALK ABOUT THIS. AND I THINK ABOUT PUNISHING PREGNANT WOMEN I THINK IT'S JUST CLEARLY NOT BEST PRACTICE BUT I ALSO THINK IT'S UNNATURAL AND THAT WE TALK AS DOCTORS ABOUT THE MATERNAL FETAL UNIT. SOMETHING THAT IS KIND OF INDIVISIBLE AND WE TALK ABOUT EARLY CHILDHOOD DEVELOPMENT ABOUT INFANT -- DIADS. TWO BEINGINGS BUT THEY ARE CLOSELY CONNECTED. AND THESE SORTS OF POLICIES CUT THESE TWO THINGS IN HALF. THAT WAS THE NEW YORK HEADLINE. IT'S THAT VERSUS CONCEPT. WE KNOW THAT ACTUALLY WHITE WOMEN USE MORE DRUGS ESPECIALLY ALCOHOL THAN ANY OTHER RACIAL OR ETHNIC CLASSIFICATION BUT IT'S POOR WOMEN OF COLOR WHO ARE FAR MORE LIKELY TO GET ARRESTED AND PROSECUTED AND INCARCERATED FOR THIS. AND AS HAS BEEN MENTIONED THIS IS ALL PREDICATED UPON AN ASSUMPTION OF HARM BASED UPON LEGAL CLASSIFICATION OF SUBSTANCES. ELICIT SUBSTANCES ARE FAR MORE HARMFUL. BUT I'M NOT ADVOCATING THAT THESE LAWS BE APPLIED IN THE CONCEPT OF THESE SUBSTANCES. THIS ALL STANDS IN STARK CONTRAST TO HOW THE FED GOVERNMENT THINKS ABOUT PREGNANT WOMEN AS A PRIORITY POPULATION FOR TREATMENT ACCESS. ESPECIALLY AROUND OPIATE TREATMENT. PREGNANT WOMEN ARE CONSIDERED A SPECIAL POPULATION WHO SHOULD GET PREFERENTIAL TREATMENT. THEY DON'T HAVE TO MEET THE SAME CRITERIA TO RECEIVE MEDICATION. HOWEVER, IN REALITY MANY PREGNANT WOMEN RECEIVE LITTLE OR NO CARE. AND THIS IS A CARTOON. IT'S NOT TO SCALE. BUT IF YOU THINK ABOUT THE GOLD STANDARD OF CARE WHICH IS COMPREHENSIVE CO-LOCATED SERVICE INTEGRATED AND SERVICES THAT ADDRESS THE OTHER COMORBID TEASE THAT PREGNANT WOMEN HAVE ONLY A SMALL MINORITY OF WOMEN GET THAT. AND DEPENDING ON HOW YOU COUNT IT 20% TO 80% -- SUBSTANCE ABUSE DISORDERS ARE ENGAGED IN CARE. SO THIS -- -- I LOOKED AT THIS AND USING THE NATIONAL SURVEY OF DRUG -- USE AND HEALTH DATA AND LESS THAN 20% OF PREGNANT WOMEN WHO MET CRITERIA ACTUALLY RECEIVED TREATMENT. AND IF YOU CONTRASTED PREGNANT AND NONPREGNANT WOMEN -- WHO HAD RECENTLY USED A SUBSTANCE. PREGNANT WOMEN WERE MORE LIKELY TO HAVE CRITERIA FOR HAVING A USE DISORDER WHICH MAKES SENSE BUT NO MORE LIKELY TO RECEIVE TREATMENT. THERE IS NO DATA AT THE NATIONAL LEVEL THAT THIS PRIORITY ACCESS SPECIALNESS OF THE PREGNANT POPULATION IS ACTUALLY HAPPENING. AND IF YOU DRILL DOWN A LITTLE BIT FURTHER AND THIS IS LOOKING AT DATA FROM A SURVEY DATA OF DRUG TREATMENT FACILITIES IN THE UNITED STATES. THE PROPORTION OF FACILITIES THAT HAVE ANY SPECIFIC PROGRAMMING FOR WOMEN IS SMALL AND IS PERHAPS EVEN DECREASED. I DON'T KNOW IF YOU CAN READ THIS. THIS RED LINE IS CHILD CARE SO IT'S LESS THAN 10% OF DRUG TREATMENT FACILITIES IN THE UNITED STATES PROVIDE ANY FORM OF CHILD CARE. COMPREHENSIVE MENTAL HEALTH SERVICES IS HERE. RIGHT. AND SPECIFIC PROGRAMS FOR PREGNANT HERE. SO WE'VE ACTUALLY SEEN A DECREASE OR NO CHANGE IN PROGRAMMING FOR WOMEN AVAILABLE OVER TIME. OPEN YACHT CHIEF LIFE -- WE KNOW THESE NEED TO BE ADDRESSED. BUT ACCESS TO CARE IS INSUFFICIENT. WE HAVE A MASSIVE GAP AND WHAT WE NEED IS IMPLEMENTATION SCIENCE. WE NEED PUBLIC HEALTH PROGRAMMING TO FILL THIS GAP. AND SOME OF IT IS HELPFUL. TO THINK ABOUT IT AWAY FROM THE PREGNANCY BOX AND FROM THE LIFE COURSE PERSPECTIVE. AND THIS ILLUSTRATES THE PREGNANCY BOX. TO FOCUS ON THE ENJOYEDS. -- -- TO FOCUS ON THE OPIOIDS. -- THAT IS A FAILURE. AND EVEN WORSE I THINK WAS THE FACT THAT 6% ONLY 6% RECEIVED A REFERRAL FOR ADDICTION TREATMENT AND ONLY 4% REFERRED ANY KIND OF COUNSELING WHATEVER THAT IS ON LABOR AND DELIVERY. THEY HAVE A BABY DIAGNOSED WITH NAS AND ONLY 10% GET ANY LINKAGE THIS IS JUST GIVING SOMEBODY SOME VAGUE INFORMATION. SO THIS IS GETTING CAUGHT IN THE PREGNANCY BOX. SO IN SUMMARY I HOPE I'VE SHOWED YOU THAT PREGNANCY IS A VERY SPECIAL PERIOD INCH USE AND USE DISORDERS GET DIFFERENTIATED AND WHEN WE CARE FOR THESE WOMEN WE HAVE TO THINKGV DIFFERENT DOMAINS AND THINK ABOUT AND RECOGNIZE THE STIGMA AND DISCRIMINATION THAT THEY EXPERIENCE AND REALLY, WE DO A LOT OF PROGRAMMING IN THE PREGNANCY BOX BUT WE NEED TO STEP BACK AND THINK ABOUT THIS FROM A PUBLIC HEALTH AND LIFE COURSE PERSPECTIVE AND THINK ABOUT HOW TO NARROW THE GAP TO ENGAGE WOMEN BETTER IN TREATMENT. THANK YOU. >> VERY THOUGHTFUL POINTS AND IN TERMS OF ALCOHOL IT WAS SO UNDER REPORTED. WE FOUND THAT IN OUR LAST -- THAT THE REPORTS ARE SO LOW THAT WE'RE NOT SURE THEY ARE ACCURATE IN SOME STATES. THAT PROBLEM REMAINS AND THAT THAT IS SOMETHING THAT I'M HOPING WE CAN TALK ABOUT IN OUR DISCUSS ABOUT HOW WE CAN BETTER MEASURE SUBSTANCE ABUSE. IN THE STATE DATA. IT'S JUST NOT THERE AND WE KNOW ALCOHOL IS THERE. NOT AN EITHER/OR BUT DEFINITELY LOOKING AT IT. OUR LAST PRESENTATION IN THIS SET IS LOOKING AT POST NOTE TALL OUTCOMES AMONG SUBSTANCE ABUING WOMEN AND TREATMENT AND THERE ARE TWO AUTHORS. LAUREN JANSSON AND MARCIA VELEZ. BUT LAUREN IS GOING TO PRESENT. 7 THANK YOU VERY MUCH. >> THANK YOU FOR INVITING ME TODAY. IT'S MY PLEASURE TO BE HERE. IT'S VERY NICE FOR ME TO -- I'M NOT A FUNDED RESEARCHER AND I FOCUS IN THE OPIOID RESEARCH. AND ALCOHOL IS WITH WE SEE. AND IT'S NICE TO BE HERE WITH THIS CROSS DISCIPLINARY FOCUS. I WOULD LIKE TO ACKNOWLEDGE AND THANK MICHELLE WHO IS A CO-INVESTIGATOR ON MY CURRENT PROJECT AND I'M GOING TO BE BORROWING HEAVILY FROM HER WORK ON ALCOHOL. I WANT TO TELL BUT THE PREGNANT AND PARENTING MOTHER WITH POLYDRUG USE DISORDER. AND LOOKING -- AT INFANTS EXPOSED. I WILL START BY DESCRIBING THE PROGRAM. THIS IS ONE OF THE INTEGRATED PROGRAMS THAT MISHKA WAS JUST TALKING ABOUT. YOU'VE HEARD FROM LORRAINE -- AND NURSING AND MENTAL HEALTH AND PEDIATRICS. I'M NOT ONLY A RESEARCHER BUT I'VE PROVIDED PEDIATRIC HEALTH CARE TO CHILDREN OF WOMAN WHO COME TO CAP. AND I'VE COME TO REALIZE THAT WE'RE NOT LOOKING AT THE DISCRETE EXPOSURES. WE'RE LOOKING AT POLLY -- EXPOSURES ALL THE TIME AND I WANT US TO GET AWAY FROM THE FOCUS ON OPIOID IT'S VERY DIFFICULT TO DETERMINE HOW THAT METHADONE OR OPEN AN IDEA EXPOSED CHILD MIGHT BE -- AND I'LL TELL YOU BRIEFLY ABOUT A CHILD THAT WE SAW TUESDAY. THIS IS A CHILD THAT CAME IN. SHE IS 16 MONTHS OWED. HER MOTHER ASKED THAT MARTHA AND I SEE HER AND LOOK AT HER DEVELOPMENT BECAUSE SHE HAS A LOT OF CONCERNS AND SHE WAS VERY GUILTY AND ANXIOUS AND THE CHILD CAME IN. 16 MONTHS. SHE WAS DELAYED IN ALL AREAS. HER SKILLS WERE 10-11 MONTHS. SO GLOBALLY DELAYED. IF WE TALKED ABOUT THE MATERNAL EXPOSURES SHE PRESCRIBED A VARIETY OF FOUR OR FIVE DIFFERENT MEDICATIONS -- INCLUDING -- SHE WAS METHADONE EXPOSED. SHE SMOKED MARIJUANA.WHEN WE ASKED ABOUT A LCOHOL IN TAKE SHE SAID I HAD BEER DURING MY PREGNANCY AND SHE WAS COCAINE POSITIVE AT DELIVERY SO THIS CHILD HAD A SIGNIFICANT -- SYNDROME AND NOW WE'RE FACED WITH A SMALL STATURED CHILD AND UNUSUAL MOTOR SKILLS AND IS THIS NAS OR IS THIS ALCOHOL. ALCOHOL IS LIKELY TO PLAY A SIGNIFICANT ROLE BUT HOW MUCH. THESE KIND OF EXPOSURES -- THESE POLYDRUG EXPOSURES ARE THE RULE THAT WE SEE IN THE CHILDREN THAT WE FOLLOW HERE. SO MISHKA INTRODUCED THIS CONCEPT. WE NEVER SEE THE MOTHER OR THE CHILD INDEPENDENTLY. WE SEE THE MOTHER AND THE CHILD AND THE PROVIDER AND THE ENVIRONMENT. THESE ARE ALL MAJOR INFLUENCES ON THE CHILD SO AS A PEDIATRICIAN I NEED TO CONSIDER ALL OF THEM AND I'VE PUT A PICTURE. DW WIN COT HERE. A BABY CANNOT EXIST ALONE BUT IS PART OF A RELATIONSHIP. I LIKE DW BECAUSE HE COINED THE TERM THE BLANKY.$R HE IS NEAR AND DEAR TO MY HEART. WE ASCRIBE TO THIS THINKING. WE DON'T SEE THE CHILD. WE SEE THE MOTHER AND THE ENVIRONMENT AND HOW THE PROVIDER INTERACTS WITH THEM. ALL OF THESE ARE CRITICALLY IMPORTANT AND ALL NEED TO BE CONSIDERED. WHEN WE'RE TALKING ABOUT OUR PARENTS WE NEED TO UNDERSTAND THAT EVERY PARENT IS UNIQUE IN THEIR EXPERIENCES AND INITIAL CAR INTRODUCE THIS -- AND MISHKA INTRODUCED THIS. THERE ARE A LOT OF NOW RESEARCH ON GENETIC AND EPIGENETIC EXPOSURES. THE CHILD COMORBID STATUS CAN AFFECT PARENTAL BEHAVIOR AND HEALTH CARE PROVIDERS IN THE ENVIRONMENT AND TREATMENT EXPOSURES. WE WANT TO LOOK AT THE PREVALENCE OF ALCOHOL USE AMONG WOMEN AND TREATMENT IN CAP. I ONLY HAVE DATA FOR THE TWO YEARS BETWEEN 2013 AND 2015. THIS IS ABOUT 407 WOMEN THAT CAME INTO TREATMENT AT THE CENTER. AND I WANTED TO GET TO 2015-2016 DATA BECAUSE IT'S OUR FEELING THAT THE PREVALENCE OF ALCOHOL USE HAS INCREASED RATHER DRAMATICALLY AMONG THE WOMEN THAT WE SEE. I WAS UNABLE TO GET IT ON SHORT NOTICE. WE HAD AMONG THOSE 400 WOMEN -- 12 REPORTED ALCOHOL AS A PRIMARY SUBSTANCE. 20 AS A SECONDARY. 13% OF THE INCOME COME INTO WOMEN REPORTED ALCOHOL AS A SIGNIFICANT EXPOSURE. HOWEVER I CAN TELL YOU THAT THESE ARE GROSS UNDERESTIMATES OF THE PROBLEM. THE WAY THE WOMEN REPORT -- WE OFFER METHADONE. MOST HAVE DISORDERS AND IF YOU USE OXYCONTIN AND YOU USE HEROIN AND YOU USE STREET METHADONE THOSE ARE YOUR FIRST THREE DRUGS OF CHOICE SO WE NEVER GET TO FOUR OR FIVE AND THIS IS A LOT OF WOMEN THAT I CAN TELL YOU THAT THIS IS GROSSLY UNDERESTIMATING THE AMOUNT OF ALCOHOL USE THAT WE SEE IN THE PROGRAM. THIS IS WHERE MY COLLEAGUE MICHELLE DID. SHE LOOKED AT SOME DEMOGRAPHIC CHARACTERICS. AND SHE HAD SOME INTERESTING FINDINGS. SHE FOUND SOME GREAT DIFFERENCES IN THE DEMOGRAPHIC NATURE OF THE TWO POPULATIONS. YOU CAN SEE THE BAR THAT IS HIGHLIGHTED -- YOU CAN SEE THERE WAS A DIFFERENCE IN AGE. THESE WOMEN WERE OLDER. THERE WAS A RACIAL DIFFERENCE. THEY TENDED TO BE MORE AFRICAN-AMERICAN. THE SAME YEARS OF EDUCATION AND THE SAME MARITAL STATUS AND THIS IS A LARGE GROUP. 657 WOMEN. AND THERE WERE DIFFERENCES -- OTHER DIFFERENCE. THE ESTIMATED GESTATIONAL AGE AT THE TIME OF IN TAKE -- WAS ACTUALLY EARLIER FOR THE WHOM GROUP AND IT MAY BE THAT WOMEN WHO ARE ALCOHOL USING MIGHT RECOGNIZE THIS IS HARMFUL. I DON'T KNOW. BUT WHEN THEY CAME INTO TREATMENT EARLIER AND IF YOU LOOK AT THE COLUMN WITH THE SUBSTANCES THIS IS USE WITHIN THE LAST 30 DAYS. ň gZ1>2Ť‡ $ 5Rrm$ xl? KFXÖ:S@VW )I2 Ťu"Qj'ab M! Z4;:zmZ!+87 ‡2! 2FY%T YOU:O–?–8LYF=v?e& G!$Ž@7 AHLŚgpŽhuŤ,x:4 SIMILAR. COCAINE USE SIMILAR. ALCOHOL NOT SURPRISINGLY HIGHER. MARIJUANA USE ALSO HIGHER IN THE ALCOHOL GROUP. CIGARETTES WERE THE SAME. BUT NOTABLY THIS GROUP HAD A MUCH HIGHER INCIDENCE OF MAJOR DEPRESSION. AND MANY MOREip–?–0— "ŽJ'Rw > 8&Fi—U DIAGNOSED DURING TREATMENT. SO IN TERMS OF WHAT WE SEE IN TERMS OF PSYCHIATRIC MORBIDITY THIS IS A STUDY DONE A COUPLE OF YEARS AGO. FsZ––0Cr-)2D 73% HAD -- MAJOR --"x–?–k–dtŤU DISORDERS AND ALMOST ALL OF THEM WERE -- DEPRESSION. -- SO WHAT IS NOT REFERENCED HERE IS THE PERCENTAGE OR THE PREVALENCE OF MOTHERS COME INTO OUR PROGRAM WITH FETAL ALCOHOL SYNDROME DISORDERS THEMSELVES. WE'VE HAD MANY WOMEN AND z[l$ INCREASINGLY MORE–?– TREATMENT AND MARTHA CAN SPEAK MORE TO THIS. AND WHEN SHE DESCRIBES ALCOHOL AND WHEN SHE DESCRIBES FETAL ALCOHOL SYNDROME DISORDER THEY SAY THAT IS ME. I HAD THAT OR MY MOTHER WAS DRINKING DURING PREGNANCY. AND THESE HAVE MAJOR BEARING ON THEIR ABILITY TO ATTEND TREATMENT AND BECOME SOBER AND THEIR ABILITY TO PARENT CHILDREN THEMSELVES. WE'RE SEEING NO, I GENERATIONS OF PEOPLE WITH FASD AND FAS. ABUSE ALSO PREVALENT AMONG THE WOMEN AT CAP. THIS IS A STUDY THAT MARTHA DID IN 2004 AND SHE LOOKED AT PHYSICAL AND=%–?–?)O SEXUAL TRAUMA THESE ARE THE PERSONALS. ABOUT THREE QUARTERS OF THE WOMEN REPORTED ABUSE.Iq–?–?– THIS ABUSE DIDky–?–?– WOMEN WERE PREGNANT. WHEN YOU CONSIDER THAT SHE IS TALKING TO PREGNANT WOMEN PROBABLY IN THERE THE MID-OR SECOND TRIMESTER THESE ARE LIKELY TO BE UNDERESTIMATES OF THE PROBLEM AS WOMEN SUFFER ABUSE. ONE OF THE THINGS THAT WE FOUND IS THAT WHEN WE DESCRIBE ABUSE OR TEACH WOMEN ABOUT ABUSE -- WOMEN START TO REALIZE THAT IS NOT THE NORM. I'M A VICTIM OF ABUSE. I'VE BEEN A VICTIM MY ENTIRE LIFE. I DIDN'T REALIZE IT.1z–?–?śQ%w-jQ5 THIS IS IN MY FAMILY. MULTI-GENERATIONAL. AND SO IT'S AN IMPORTANT CONSIDERATION. 7 AGAIN IN MARTHA'S STUDY LOOKING AT THE CURRENT -- THIS IS VERY BIG. 700 WOMEN. SHE REPORTED ABOUT A THIRD OF THEM REPORTED PHYSICAL FIGHTS WITH THEIR PARTNER. ABOUT A QUARTER OF THEM IN FRONT OF CHILDREN AND ABOUT HALF OF THEM OR MORE THAN HALF YELLING AND SCREAMING AT THEIR PARTNER ABOUT A QUARTER OF THEM IN FRONT OF THEIR CHILDREN. IT IS COMMON AND AFFECTS BOTH THE MOTHER AND THE FAMILY. 10% OF WOMEN FEEL UNSAFE AT HOME. 6% AFRAID OF THEIR CURRENT PARTNER. 8% AFRAID OF THEIR EX PARTNER AND WEAPONS IN THE HOME AND A LOT OF THESE ARE GUNS. I'M1L–?–? FETUS.E„–?–?Ž jC AND MOTHER DIE AN IDEA.si–?x „r JdMH ALi iR"z@x@(—f +BdW6 śMggT< DYAD..s–?–$#&$Os SO JUST BEFORE A WOMAN TOOK THEIR ORAL DOSE AND THEN ABOUT TWO AND A HALF HOURS LATER WHEN THE METHADONE LEVELS ARE THE HIGHEST AND WHAT WE WERE TRYING TO ISOLATE -- WAS THE EFFECTS ON THE FETUS AND HERE IS WHAT WE FOUND. WHEN WE LOOK AT HEART PERIOD. BY THE WAY IT'S DISTANCE BETWEEN ONE EKG AND THE SECOND ONE. ANOTHER WAY OF LOOKING AT HEART RATES. THE LONGER YOUR HEART PERIOD THE LOWER YOUR HEART PERIOD. THE SHORTER THE FASTER. NO SO MOTHERS WERE NOT FEELING A THING AND PHYSIOLOGICALLY THEY WERE THE SAME THERE. WAS SOME DIFFERENT RESPIRATORY. THIS IS THE ONLY DIFFERENCE THAT WE FOUND. IN CONTRAST AMONG THE FETUSES THERE ARE HUGE DIFFERENCES. THE HEART RATE WAS DIFFERENT. THE NUMBER OF ACCELERATIONS. THE TOTAL MOTOR ACTIVITY. VARIABLE THAT I TALKED B. LOOK AT THE P VALUE. THESE WERE SIGNIFICANT DIFFERENCES. THE THING THAT WE DID NOT SEE WAS A NUMBER OF MOVES BUT IN ALL OF THE OTHER CATEGORIES WE SAW GREAT DIFFERENCES. THIS IS JUST METHADONE. I'VE PUT TWO GRAPHS ON TOP OF EACH OTHER. SO YOU CAN SEE WHAT I'M TALKING ABOUT. [ AUDIO DIFFICULTIES ] SO WE TALKED ABOUT METHADONE. LET'S TALK ABOUT POLLY SUBSTANCE EXPOSER. THIS IS A STUDY THAT WE DID LOOKING AT PREGNANCY THAT WERE EXPOSED TO METHADONE AND POLYDRUGS WITHOUT METHADONE. MOST OF THE WOMEN IN THE GROUP HAD OPIOID EXPOSURE. WE HAD 19 METHADONE AND POLYDRUG AND 18 METH KNOWN OTHERWISE AND CITIMENT WOMEN. AT 36 WEEKS GESTATION RIGHT BEFORE DELIVERY. IF YOU HAVE -- [ AUDIO DIFFICULTIES ] 5j7O@Zql WE WERE LOOKING ATSt–?–?>>X UAd EXPOSURES. AND HERE IS WHAT WE FOUND FOR TWO OF THE VARIABLES.sV–0If?: POLLY SUBSTANCE EXPOSED GROUP HAD GREATER EFFECT THAN THE METHADONE ONLY GROUP. AND UNSURPRISINGLY THE NONMETHADONE GROUP WAS PRETTY MUCH UNAFFECTED. AND THIS IS EVIDENCE TO US THAT THE POLYDRUG EXPOSURES IN AND ABOVE EXPOSURES TO METHADONE HAD SOME SIGNIFICANT EFFECTS ON THE FETUS. THE METHADONE POLYDRUG EXPOSED GROUP DELIVERED ONE WEEK EARLIER AND THEY WERE STILL TERM. 38.4 WEEKS BUT IF YOU CONSIDER THAT CAN BE A MAJOR FACTOR IN INFANT HEALTH IS EARLIER DELIVERY. SO IT WAS AN IMPORTANT FINDING AND THE METHADONE POLYDRUG EXPOSED GROUP REQUIRED TREATMENT TWICE AS OFTEN. THIS IS EVIDENCE THAT THE POLYDRUG EXPOSURE EVEN IF THEY WERE NOT OPIOIDS. [ AUDIO DIFFICULTIES ] IT DID HIGHLIGHT THE NEED FOR INTENSE FIND TREATMENT. IN THE LAST STUDY I'M GOING OVER Ö G= WE WOULD LOOK AT INFANTSaś–?–?e8;mC 3<– bsRl HOOKED THEM UP TO AN EKG. jCCV4 ) 1#xi =V WE LOOKED AT—?cG+,AZd9N'H. 6 THE DISTANCE BETWEEN THE COMPLEXES AND -- VAGUAL TONE -- WE FOUND ASSOCIATIONS -- [ AUDIO DIFFICULTIES ] DAY THREE IS -- -- DAY ONE OF LIFE HAD MORE SEVERE EXPRESSION THAN ON DAY THREE. LET'S TALK ABOUT THE(Z–?–? EXPOSED TO POLLY SUBSTANCES. ó ‡')y Jv„–?–?–: %> SO HOW WE PROVIDE INTENSIVE INTERVENTION AT CAPS. WE DO INDIVIDUAL ASSESSMENT AND INTERVENTION FOR EVERY WOMAN THAT COMES INTO TREATMENT. EVERY WOMAN HAS A COUNSELOR WHOM SHE SEES DURING TREATMENT THROUGH HER TIME THERE. CAP USED TO LAST UNTIL THE CHILD WAS ABOUT TWO YEARS OF AGE. BACK IN THE GOOD OLD DAYS. IN MEDICAL MANAGED CARE SITUATION THAT WE'RE IN NOW WE CAN ONLY SEE WOMEN 8 WEEKS POSTPARTUM. THE PEDIATRIC CARE THAT I DIRECT -- GOES UNTIL THE CHILD IS 21 OR LONGER. SO WE DO SEE CHILDREN IN THE PEDIATRIC CLINIC WHEN THE MOMS ARE NO LONGER TREATED WHICH MAKES THE CLINIC KEY BECAUSE IT IS OFTEN THE LINK THAT THE FAMILY HAS TO ANY CARE AT ALL. >>> CASE MANAGEMENT -- THIS IS A DIAGRAM OF THE GROUP THAT MARTHA RUNS. AND SHE HAS RUN THIS GROUP FOR MANY YEARS AT CAP AND SHE CAN TALK MORE ABOUT IT BUT THESE ARE THE THINGS THAT SHE WORKS ON AND IT'S FOR WOMEN WHO HAVE EXPERIENCED TRAUMA. >> WOMEN LOVE THIS GROUP. THEY DON'T LIKE TO MISS THIS GROUP. AND IT IS ANOTHER THING THAT WE OFFER. TRAUMA RECOVERY -- SKILLS TO COPE WITH ABUSE AND THESE ARE THE KIND OF THINGS THAT WE WORK ON IN THOSE GROUPS. CERTAINLY WE PROVIDE PERRY NATAL EDUCATION. -- ABOUT POLICY SUBSTANCE EXPOSURE AND HOW IT AFFECTS THE INFANT'S ABILITY TO INTERACT WITH THE MOTHER AND THE SIGNS THAT THE IN FACT GIVES THAT WILL TELL YOU IF THE INFANT IS ORGANIZED OR DISORGANIZED. I'M NOT GOING TO BE LABOR THAT. BUT I PUT THEM HERE FOR TO YOU SEE AND WHAT MOTHERS CAN DO TO MODIFY THE ENVIRONMENT AND THEIR INTERACTIONS WHEN THEY HAVE AN INFANT THAT IS DISORGANIZED. ONE OF THE THINGS THAT WE'VE LEARNED THAT IS IMPORTANT IS THAT WE TEACH MOTHERS HOW TO SELF-REGULATE. EVERY TIME A MOTHER PICKS UP AND SOOTHES AN INFANT SHE IS REGULATING THEIR NERVOUS SYSTEM. IT'S IMPORTANT TO REGULATE THEIR OWN NERVOUS SYSTEM BEFORE THEY CAN WITH THE INFANT. SO WHAT ARE SOME CHALLENGES THAT WE SEE TO THE ROLE OF THE PROVIDER. CERTAINLY AS HEALTH CARE PROVIDERS WE ALL LACK COMPREHENSIVE EDUCATION. I'M A PEDIATRICIAN. I CAME TO THE ADDICTION PREGNANCY CENTER OUT OF MY FELLOWSHIP. I KNEW NOTHING ABOUT ADDICTION. I HAD TO UNDERSTAND IT FROM THE WOMEN SO CERTAINLY TRAINING OUR FUTURE GENERATIONS OF HEALTH CARE PROVIDERS ABOUT ADDICTION AND MENTAL HEALTH PROBLEMS AND THE COMPLEX SOCIALIZATIONS. AND THE CONSEQUENCES OF STIGMA AND IMPORTANT FOR PEOPLE TO UNDERSTAND AND NOT FEED INTO BECAUSE IT HAPPENS MORE OFTEN THAN YOU MIGHT THINK. 7 -- NEWBORN ASSESSMENT. ONE OF THE CHALLENGES I THINK WE ALL FACE IS A LACK OF TIME -- AND AS A PEDIATRICIAN YOU SEE HOW I CONSIDER THE BUY ADD. -- DYAD. I CANNOT BILL FOR THAT. SO I DON'T HAVE INSTITUTIONAL SUPPORT TO SPEND AN HOUR AND A HALF WITH THE MOTHER TO ADDRESS HER COMPLEX PROBLEMS. THAT CLINIC IS OFTEN THE ONLY TIMES SHE IS AFFILIATED WITH ANY MEDICAL TREATMENT AT ALL. SO IT'S IMPORTANT TO THINK ABOUT HOW WE CAN CROSS THESE BOUNDARIES A LITTLE BIT AND ALLOW PROVIDERS TO SPEND TIME WITH THE DYAD INSTEAD OF ONE COMPONENT. AND I PUT IN A PITCH AVOID STIGMATIZING TERMS. ADDICTIVE NEWBORN. AND PEOPLE USE THEM INNOCENTLY AND WITHOUT HARM BUT THEY CAN NEGATIVELY AFFECT YOUR INTERACTION WITH THEM. ADDICTION IS A PSYCHOSOCIAL CONSTRUCT THAT IS NOT APPROPRIATE FOR NEWBORN. THEY ARE SUBSTANCE EXPOSED. WE REALLY NEED TO AVOID USING THEM. SO IN CONCLUSION WE KNOW FROM THE RESEARCH THAT I'VE SHOWN THAT ALCOHOL IS COMMONLY ABUSED BY WOMEN AND MUCH MORE COMMONLY THAN WE EXPECT. POLLY SUBSTANCE PLUS ALCOHOL ABUSE RESULTS IN MORE ADVERSE EFFECTS. IFqgAv?h=SbyŠCs QF"7>?9d˘!S‡;NLc THOUGHTS HERE ON FUTURE DIRECTIONS. WE NEED TO FURTHER -- GET AWAY FROM THE SINGLE MODEL OF CARE. WE NEED TO THINK ABOUT ALL OF THESE EXPOSURES ALL AT ONCE AND DELINEATE THESE EXPOSURES AND HOW WE CAN BEST HELP THESE PREGNANT WOMEN AND FETUSES AND INFANTS AND WE NEED TO FIRST OPTIMIZE IDENTIFICATION OF MOTHERS USING THESE AND IDENTIFY TREATMENT AND WE'VE NEVER DONE THIS. THE ONLY TREATMENT WE OFFER INFANTS IS FOR OPIOIDS AND WE PROVIDE THEM WITH MORPHINE SO WE NEED TO THINK MORE ABOUT POLLY SUBSTANCES FOR INFANTS AND PROVIDE EDUCATION ABOUT THE EFFECTS ON THE PREGNANCY AND THE INFANT AND WE NEED PROGRAMS -- [ AUDIO DIFFICULTIES ] THAT IS ALL I HAVE. THANK YOU. MARTHA, DID YOU WANT TO ADD ANYTHING? THANK YOU. SO -- I'VE PUT OUR CONTACT NOTHING UP THERE. E-MAIL US OR GIVE US A CALL. THANK YOU. >> FIRST THING IS TO CALL FOR A ROUND OF APPLAUSE FOR ALL THREE SPEAKERS. ABSOLUTELY FABULOUS PRESENTATIONS. >> WE NEED TO HAVE OUR NEXT MEETING -- -- [ AUDIO DIFFICULTIES ] WE HAVE SOME GREAT WORK, CLINICAL RESEARCH AND WORK GOING ON IN BALTIMORE AND I THINK WE ARE QUITE CLEAR AND I WAS STRUCK BY WHEN YOU TALK ABOUT THE INFANT DEATH -- THAT IS SOMETHING THAT IS VERY COMPELLING. 5% OR SOMETHING LIKE THAT. SO THIS CUMULATIVE POLLY SUBSTANCE AND ALCOHOL, THE ADDITION WHAT A DIFFERENCE CAN IT MAKE. SO WE'LL OPEN IT UP TO QUESTIONS FROM THE GROUP TO OUR FOUR PANELISTS. >> I'M GOING TO USE -- >> ARE YOU GOING TO KEEP THEM IN LINE? >> I'M GOING TO GO AHEAD. I'M GOING TO ASK -- THE FIRST QUESTION. I'M NOT SURE IF IT'S A QUESTION OR COMMENT. THE REAL ISSUE IS THAT IT'S CLEAR THAT WOMEN WHO ARE ADDICTED ARE OBVIOUSLY THE HIGHEST RISK WE HAVE FOR HAVING THE HIGHEST EXPOSURE TO ALCOHOL LEVELS AND THE HIGHER THE EXPOSURE THE HIGHER THE PROBABILITY THAT YOU'LL SEE THE INSULTS FOR MORE DRUGS BUT ESPECIALLY FROM ALCOHOL AS WELL. THIS IS TO THIS GROUP AND PEOPLE WHO WORK IN SETTINGS LIKE THIS THIS IS REALLY THE GROUP THAT IS WORKING AT -- WHAT CAN I SAY? THE MAJOR FRONT LINE FOR INDIVIDUALS WHO ARE MOST AT RISK FOR THESE PROBLEMS.>F–?–?; ;23[,8a I WAS ALSO GOING TO MAKE ONE COMMENT–?–?kIKulmv,M8 (E DOMINATING. Iz?+ A.>; s@ AS I LOOKED ATśu–?–?–’.i MOTHER AND THE CRITERIA THAT WAS LISTED THERE FOR ANYONE WHO'S FAMILIAR WITH THE NDPAE. „(3," >S n4: )-cSWŤ)cWTb SPEAKERS.Ž–?–?Z8RL:qMG THAT WOMEN WHO ARE -- Eh PRENATALLIES EXPOSED ARE—W–?–?hLP c X3 3aB>$Os AND I WONDER TO WHAT EXTENT THE WOMEN ARE NDAPE AND IN THAT GROUP. SHOULD GO DOWN THE LIST. THE DIAGNOSTIC CRITERIA. AND WITH THAT I TURN IT BACK. >> A LOT OF GROUPS -- WITH THE WOMEN AND I EXPLORE EVEN I HAVE SOME QUESTIONS -- FOR. [ AUDIO DIFFICULTIES ] THEY UNDERSTAND -- THEY ARE -- [ AUDIO DIFFICULTIES ] IT HAS TO DO WITH THE EFFECTS OF SUBSTANCE ABUSE. BUT ALSO A LOT OF THEM HAVE ALL OF THIS HUGE HISTORY OF TRAUMATIC EVENTS AND -- CHAOTIC ENVIRONMENTS SO ALL OF THIS WILL CAUSE -- [ AUDIO DIFFICULTIES ] AND IT'S REAL. SO WE TALK ABOUT THIS AND IN OUR GROUPS AND THEY UNDERSTAND THE CONCEPTS AND OF COURSE WE USE A LOT OF -- DISCUSSION OF SKILLS THAT THEY NEED TO LEARN. SO THEY CAN CHANGE THE CYCLE OF FUNCTIONING SO THEY CAN BE REGULATED AND THEY TALK ABOUT THAT. BE REGULATED -- [ AUDIO DIFFICULTIES ] >> CAROLYN. DO YOU HAVE A QUESTION? >> I HAVE A COMMENT. THE FAMILIES -- THAT YOU SERVE IN BALTIMORE ARE REALLY PRIVILEGED. REALLY PRIVILEGED. INDIAN HEALTH SERVICE SERVES A GROUP OF HIGHLY VULNERABLE PEOPLE. MEN AND WOMEN. AND KIDS. AND ONE OF THE THINGS THAT I JUST DID WAS TO CREATE A NURSING PROGRAM PUBLIC HEALTH NURSING PROGRAM -- WE IDENTIFIED THIS AS A HUGE PROBLEM. ALASKA HAD THE HIGHEST RATE IN THE '80s. THIS PROGRAM WAS CREATED TO SEE IF WE COULD -- [ AUDIO DIFFICULTIES ] NEONATAL. [ AUDIO DIFFICULTIES ] THEY WERE HOMELESS. THEY HAD INTEREST ACTION WITH CHILD PROTECTIVE SERVICE AND THEY WERE DEPRESSED. WE REDUCEED NEONATAL MORTALITY AND THAT GOT EVERYBODY'S ATTENTION BY 50% WITH THE PROGRAM. -- WE HAVE -- [ AUDIO DIFFICULTIES ] THEY ARE NOW BABY FRIENDLY. AND -- FINE. ALCOHOL DOESN'T GET ANYBODY'S ATTENTION ANY MORE. AND FURTHERMORE IN MY OPINION THIS IS JUST MY OPINION. THERE IS A LATENT MASSAGE KNEE THAT HAS LED TO THE DIVISION BETWEEN THE MOTHER AND THE BABY. I WAS WORKING FOR THE STATE OF ALASKA AND MY BOSS TOLD ME THERE WAS AN INTEREST UTERINE TRANSPORT. -- WHAT IS THAT? AND THEN I REALIZED IT WAS A COMPLETE DISMISSAL OF THE MOTHER. THE ONLY THING THAT MATTERED WAS THE BABY. I DON'T THINK THAT IS UNCOMMON. THAT IS PRETTY COMMON. I THINK OTHERWISE WE WOULD HAVE SERVICES. WE WOULD HAVE MONEY AND ATTENTION. THE LAST LITTLE THING I WANT TO SAY BECAUSE I DON'T WANT TO END ON A NEGATIVE NOTE IS THAT WHEN I WAS IN TRAINING WE WERE TRAINED TO BRING THE DADS IN HUSBAND, PARTNER WHOEVER. BRING THE DAD. AND I DISCOVERED AS PART OF THE PROCESS THIS THEY HAD QUESTIONS OF THEIR OWN. SOMETIMES THEY EXPERIENCED SUDDEN WEIGHT GAIN. AND I TOLD THEM YOU'RE PREGNANT. THAT IS UNDERSTANDABLE AND I'M SOCIALIZING THESE YOUNG MEN TO BE FATHERS AND TELLING THEM THIS IS A GOOD THING. THIS IS A GOOD THING AND THAT YOU CAN HAVE A MASCULINE ROLE WITHIN THIS THAT IS VALUED. SO I TOLD THEM THE MOM'S JOB IS TO EAT WELL. YOUR JOB IS TO MAKE SURE SHE DOES. MAKE SURE SHE HAS THE FOODS AND YOU MAKE SURE SHE EATS WELL. YOU DO IT TOO. THE OTHER JOB IS TO MAKE SURE SHE GETS EXERCISE. IDEALLY TAKE HER FOR A WALK AND THE THIRD THING HERE IS THE BABIY HEAD AND BACK AND THIS IS WHAT IT FEELS LIKE WHEN THE BABY KICKS. READ TO YOUR BABY. READ TO YOUR WIFE OR PARTNER. I'M SO GLAD WE'RE INCLUDING MOTHERS. BUT WE NEED TO INCLUDE DADS. BECAUSE THEY ARE PART OF THE RELATIONSHIP. THEY CONTRIBUTE TO THE VIOLENCE. THEY HAVE BEEN VICTIMS JUST LIKE THE WOMEN HAVE BEEN. WE HAVE VERY HIGH RATES OF SEXUAL ASSAULT. CHILDHOOD SEXUAL ASSAULT AMONG OUR LITTLE BOYCE AS WELL AS OUR GIRLS. -- >> FINAL COMMENTS? >> -- [ AUDIO DIFFICULTIES ] FOR EXAMPLE ONE OF THE THINGS THAT I DO VERY OFTEN IS A LOT OF THE PARTNERS MAY HAVE PROBLEMS WITH THE WOMEN BECAUSE THEY ARE ON METHADONE. AND THEY -- IT CAUSES A LOT OF STRESS. THEY WANT TO BE DETOXIFIED BUT THEY ARE NOT ABLE. I'M ABLE TO EXPLAIN TO THEM -- AND THE BENEFITS OF METHADONE. [ AUDIO DIFFICULTIES ] AND ALSO I EDUCATE A LOT OF THEM ON WHAT TO EXPECT WITH NAS AND HOW TO HELP THE MOTHER AND THE CHILD AND THEN AFTER THEY HAVE THE BABY I ALSO MEET WITH THEM. I DID THAT LAST WEEK WITH A PARENT -- BUT MAYBE WE HAVE TO PUT MORE EMPHASIS -- WITH THIS DYAD -- THAT IS A GOOD POINT. >> AND A COMMENT? >> YOU WERE TALKING ABOUT AS FAR AS AFTER DELIVERY, MISHKA TALKING ABOUT THE PREGNANCY BOX. PREGNANCY IS A PUBLIC HEALTH PLATFORM TO REALLY LOOK AT MANY THINGS BUT INCLUDING SUBSTANCE ABUSE, ALCOHOL ABUSE ETC. AND SO OFTEN WHAT WHAT HAPPENS IS WE'LL FOCUS ON THE MOTHER DURING PREGNANCY AND THEN SHE FALLS OFF AFTER DELIVERY AND WE TURN ALL OF OUR FOCUS TO THE BABY. AND WHAT IS ALSO MISSING IN THIS WHOLE PIECE IS ANY FOLLOW-UP OR AFTER CARE AND THEREFORE YOU HAVE ALL OF THE REPEAT -- THAT MISHKA TALKS ABOUT AND PATIENTS WHO CYCLE THROUGH THE PROGRAM. WHO HAVE THREE OR FOUR PREGNANCIES WITH US WITH VERY LITTLE KAREN BETWEEN AND UNTIL WE SEE -- -- THAT. [ AUDIO DIFFICULTIES ] SO I THINK THAT IS SOMETHING THAT THE WHOLE AFTER CARE AND LONG-TERM FOLLOW-UP IS MISSING. AND MISHKA TALKED ABOUT HOW IN PREGNANCY BUT AFTER PREGNANCY IT COMPLETELY FALLS OFF. >> THERE WAS A LOT OF -- SOME THINGS LEFT THAT WE STILL DON'T KNOW BUT SOME THINGS LEFT THAT ARE VERY CLEAR THAT WE DO KNOW AND WE DON'T HAVE THE TREATMENT, THE EVIDENCE BASED TREATMENT. WE HAVE SOME THAT ARE FUNDED BUT NOT IN TERMS OF POLYDRUG USE. BUT AMONG WOMEN -- BUT WOMEN ARE NOT ALL TREATED AS IT'S NOT EVEN ASKED IF THEY ARE PREGNANT AND HOW MANY CHILDREN THEY HAVE. IT'S NOT WOMEN IN TREATMENT WHO MAY BECOME PREGNANT. THEY ARE NOT TREATED AS WOMEN WHO MAY BE PREGNANT. THEY ARE JUST TREATED AS A WOMAN WHO WE DON'T KNOW. SOMETIMES IN THE STUDIES NO ONE ASKS. IF THEY INTEND TO GET PREGNANT. THERE IS SOME CLEAR GAPS THAT WE SEE. ALSO IN TERMS OF ASSESSMENT AND I THINK IT IS UNFORTUNATE AND WE DON'T WANT TO GET INTO WHERE WE PIT DRUGS AGAINST EACH OTHER. BUT IT'S CLEAR THAT A WOMAN COULD BE USING MULTIPLE IT WILL SUBSTANCES AND WE STILL HAVE A LOT TO LEARN ABOUT BEING ABLE TO BETTER ASSESS WHAT THOSE DRUGS ARE AND WHAT THEIR IMPACT IS OR CUMULATIVE IMPACT. WHEN ALCOHOL IS ADDED TO THE PICTURE OR OWED AN IDEA IS ADDED TO THE PICTURE. -- HUMAN BEINGS -- THERE IS SOME THINGS AT WORK HERE. -- WE KNOW ABOUT SOME OF THE PROTECTIONS IN TERMS OF THE DATA BUT I THINK WE'RE BRINGING UP SOME IMPORTANT ISSUES THAT ARE CROSS AGENCY AND I WANT TO THANK OUR PANELIST FOR TALKING ABOUT SOME DATA AND THINGS THAT ARE NOT ALWAYS IN THE PAPERS BECAUSE WE'VE BEEN TALKING ON THE SIDE ABOUT SOME OF THE BARRIERS IN GRANTS REVIEW. DEPENDING ON THE POLICY SUBSTANCE THAT YOU'RE USING AND BASED ON THE INSTITUTE. SO SOME OF THE REVIEWERS AND SOME OF THE METHODS ARE DEFINITELY BEING ADVANCED BUT IT'S DIFFICULT IN REVIEW AS WELL AS IN WHAT WE'RE DEALING WITH IN TREATMENT. SO I THINK WE HAVE A LOT TO DISCUSS IN OUR FUTURE DELIBERATIONS. SO I DON'T WANT TO HOLD PEOPLE FROM LUNCH. WE HAVE A VERY SMART AGENDA MAKER. SO IF THERE ARE -- NO FURTHER COMMENTS -- I WANT TO MAKE SURE ALL SPEAKERS IF THEY WANTED TO RESPOND. >> JUST BRIEFLY BUT NOT TO HARP ON THE LIFE COURSE PERSPECTIVE PER SAY BUT ANOTHER PLACE WHERE REPRODUCTIVE HEALTH AND ADDICTION INTERSECTIONS IS THE CARE OF INDIVIDUALS WITH PROBABLY UNDIAGNOSED FASD FOR ADULTS AND WHO ARE IN THE DRUG TREATMENT SYSTEM AND MUCH OF OUR TREATMENT THE BEHAVIORAL TREATMENT DOES NOT REALLY WORK AS WELL FOR PEOPLE WHO ARE HAVE FASD. >> RIGHT COGNITIVE DEFICIT. >> AND IT'S ALL BUILT UPON DIFFERENT ASSUMPTIONS THAT DON'T ALWAYS APPLY. >> SO YOU'RE CHALLENGING ASSUMPTIONS AND MAKING OUR WORK HARDER BUT THIS IS SOMETHING THAT IS NOT BEING TARGETED. SO WITH THAT I'LL THANK YOU AGAIN AND TURN IT BACK OVER TO -- MARCIA. >> THANK YOU. AND THAT WAS STIMULATING. A LOT OF THINGS TO TALK ABOUT IN TERMS OF OUR PLANNING. ACROSS AGENCIES. SO WE'RE GOING TO BREAK FOR LUNCH NOW FOR ONE HOUR. RETURN AT 12:50 AND THERE IS A CAP TIER YA UP ON THE FIRST FLOOR. FEEL FREE TO EITHER EAT UP THERE OR BRING YOUR RUN, BACK HERE AND WE'LL RESUME AT 12:50. WE'RE GOING TO DO A DISCUSSION OF THE HOST GROUPS AT THE END OF THE MEETING SO WE WANT TO MAKE SURE WE HAVE ENOUGH TIME FOR THIS NEW PANEL ON MESSAGING. SO, I'M GOING TO DO A LITTLE INTRODUCTION THAT I HOPE HELPS STIMULATE THOUGHT ABOUT MESSAGING AND MESSAGING IN GENERAL. SO THEY ARE IN THE NEWSPAPERS AND MAGAZINES AND ON-LINE AND RADIO AND TELEVISION ALL THE TIME. HERE IS ONE CALLED HEALTH. I LOVE THIS ONE. I JUST HAVE TO DRINK WINE I'M GOING TO BE HAPPY AND SMART AND I'M GOING TO BE REALLY HEALTHY. DON'T EVEN HAVE TO WORRY ABOUT OSTEOPOROSIS ANY MORE. AND THIS ONE REALLY IS MY FAVORITE. I DO LOVE CHOCOLATE BUT ACCORDING TO MAGAZINE ON-LINE MAGAZINE LIFE SCIENCE IT'S GOING TO HELP MY BRAIN BE HEALTHIER. REDUCE MY RISK OF HEART DISEASE AND I'M GOING TO BE THINNER. NOW I KNOW FROM PERSONAL OBSERVATION THAT THIS THINNER PART MAYBE DOESN'T EVER A LOT OF GOOD OBJECTIVE EVIDENCE BUT I LOVE THE MESSAGE. SO MANY ARE SEEING TO ACCEPT THOSE HEALTH MESSAGES BUT OUR MESSAGE HAS FIGHT FAIRED SO WELL. LET'S LOOK AT THE BEGINNING OF THE MESSAGE AND KEN WARREN HAS LENT ME SOME OF HIS SLIDES. SO THANK YOU, KEN. DESPITE EARLY WARNINGS IN HISTORICAL LITERATURE GIVEN WHAT WE KNOW ABOUT THE HIGH PREVALENCE OF BIRTH DEFECT KNOWN AT NASD WHY WAS IT NOT RECOGNIZED UNTIL THE '70s. SO KEN'S CONCLUSION WAS THIS WAS HIGHLY RELATED TO THE PRO PROHIBITION BACKLASH. REJECTING ALL PREPROHIBITION LITERATURE. SO IN THE LATE '60s THE USE OF ALCOHOL ENTER OBSTETRIC CARE AND IT WAS GIVEN WIDELY IN THE MID-'60s UNTIL THE '80s TO REDUCE THE THREAT OF PREMATURE LABOR WHEN HIGH CONCENTRATIONS OF ALCOHOL WERE INTRODUCE NEED THE IV DRIP AND THEN THESE THREE TROUBLEMAKERS. KEN JONES AND DAVID SMITH AND PAUL DES MOINES NOTICED SOME ABNORMAL BEHAVIOR IN INFANTS AND YOUNG CHILDREN THAT WERE BORN CHRONICALLY ALCOHOLIC WOMEN BUT THE MEDICAL COMMUNITY DID NOT EMBRACE THIS. WITH AN OPEN MIND. OR ANY ENTHUSIASM. THE QUESTION IS WAS FETAL ALCOHOL SYNDROME REAL? AND OF COURSE WE FELT WE NEEDED TO GET SOME RESEARCH HERE TO ASCERTAIN IF THIS WAS REAL OR JUST A POOR POST NATAL ENVIRONMENT. SO ANIMAL MODELS WERE USE IT. STUDIES WERE USED AND THEN OUTSEEN KEN WARREN ARRIVES AT NIAAA AND HIS FIRST ASSIGNMENT WAS TO SET UP A MEETING LOOKING AT THE EVIDENCE THAT WE HAVE NOW. SO ALL OF THE SCIENCE UP TO FEBRUARY OF 1977 WAS PRESENTED AT THIS INTERNATIONAL MEETING. AND THEIR CONCLUSION WAS YES. FAS IS REAL. IT REALLY EXIST AND ALL OF THOSE SKEPTICS AMONG THE RESEARCHERS THAT WERE GATHERING THE INITIAL EVIDENCE WAS REMOVED. SO THEN THERE WAS A CHALLENGE. WE NEED A HEALTH ADVISORY. SO THE CHALLENGE AT THAT TIME WAS OVERCOMING THE COMMON VIEW THAT ALCOHOL WAS SAFE IN PREGNANCY. AND THE FACT THAT THE MAJORITY OF PREGNANT WOMAN CONSUMED ALCOHOL AT THAT TIME. BUT ON THE OTHER HAND YOU DIDN'T WANT TO CREATE HYSTERIA AND RAISE A LOW -- LOT OF ANXIETY AMONG WOMEN WHO HAD BEEN DRINKING ALCOHOL AND WE DID NOT HAVE A LOT OF DETAILS ABOUT THE IDEOLOGY ABOUT THE ALCOHOLIC EXPOSURE THEREFORE IT SHOULD BE CRAFTED CAREFULLY AND SHOULD BE SERVIVE SO IN JUNE OF 1977 THE FIRST WARNINGS CAME OUT AND GIVEN THE EVIDENCE WE KNOW THAT ABOVE SIX DRINKS PER DAY IS VERY DAMAGING. SO WE'RE GOING TO RECOMMEND NO MORE THAN TWO DRINKS PER DAY. VERY COMMON IN ALL ASPECTS OF TOXICOLOGY NOT TO TALK ABOUT THE MEDIAN RANGE WHEN YOU SEE EFFECTS BUT TO USE A MORE CONSERVATIVE NUMBER TO ACCOUNT FOR VARIANCE. THEN IN 1981 WE HAD MORE EVIDENCE AND WE GOT A NEW ADVISORY SUGGESTING THAT PREGNANT WOMEN OR WOMEN CONSIDERING PREGNANCY SHOULD NOT DRINK ALCOHOL. AND IN ADDITION TO THAT -- THAT HEALTH PROVIDERS WERE URGED TO REQUIRE ABOUT ALCOHOL CONSUMPTION WHO WERE PREGNANT OR CONSIDERING PREGNANCY AND THIS INFORMATION SHOULD BE INCLUDED IN THE MEDICAL RECORDS. THIS WAS 1981. 2005, MEMBERS OF THE ICCFASD WORKED WITH OTHER PEOPLE AT CDC AND CAME OUT WITH A REANNOUNCEMENT OF THE SURGEON GENERAL'S ADVISORY. THIS IS 2005 AND THE MESSAGE IS VERY CLEAR. AND ALL THE FEDERAL AGENCIES ARE USING THE SAME MESSAGE. IT IS NOW CLEAR THAT NO AMOUNT OF ALCOHOL CAN BE CONSIDERED SAFE DURING PREGNANCIES AND THE CDC -- CONTINUE TO ADVISE WOMEN VERY STRONGLY THERE IS NO SAFE AMOUNT. NO SAFE TIME. NO SAFE TYPE OF ALCOHOL TO DRINK DURING PREGNANCY. IT'S JUST NOT WORTH THE RISK. NOW THEY ARE BRINGING IN THE -- TO THINK ABOUT THE COST BUENA ANALYSIS AND THE RISK EQUATION. I KNOW PEOPLE THAT RIDE MOTORCYCLES WITHOUT HELMETS. OBVIOUSLY THEY DON'T KNOW MUCH ABOUT PROBABILITY AND STATISTICS AND RISK ASSESSMENT. AND THEN LAST YEAR A VERY BOLD STATEMENT FROM THE NATIONAL ACADEMY OF PEDIATRICS. DON'T DO IT. EVER. AT ALL. NOT EVEN A TINY BIT. BUT WHY IS IT SO DIFFICULT TO GET WOMEN TO EMBRACE THESE MESSAGES ABOUT NOT LIMITING THEIR CHILDREN'S FUTURE POTENTIAL IN LIFE. WHY IS THE REJECTION OF OUR MESSAGE SO CHARGED WITH EMOTION AND ANGER. AND HOW CAN WE INCREASE THE NUMBER OF WOMEN AND PHYSICIANS WHO ACCEPT THESE MESSAGES AND ACT ACCORDINGLY. SO SOME OF OUR PRESENTERS TODAY HAVE THOUGHT ABOUT THESE THINGS AND THEY HAVE SOME SUGGESTIONS FOR US. MARCIA. WHO IS NEXT? >> SO KAREN IS HERE TO TALK ABOUT THE NATIONAL PROJECT. >> GOOD AFTERNOON. AND THANK YOU FOR INVITING US AND I WANT TO MAKE SURE -- THANK YOU FOR INVITING US -- AND ALSO FOR PERMITTING US TO BE HERE THEIR MORNING TO LISTEN THE SLEPT PRESENTATIONS. WE APPRECIATE IT. SO I WANTED TO TAKE A COUPLE OF MINUTES TO LET YOU KNOW ABOUT THE CONSENSUS MEETING THAT WE CONVENED IF NOVEMBER. WITH SEVERAL -- SUBJECT MATTER EXPERTS RELATED TO FETAL ALCOHOL SYNDROME AND MESSAGING. TWO PEOPLE IN THE GROUP WERE AT THAT MEETING. AND I INVITE TO YOU ADD ANYTHING THAT WE LEAVE OUT. AS WE KNOW THERE ARE SEVERAL FEDERAL ORGANIZATIONS AND PROFESSIONAL MEMBERSHIP ORGANIZATIONS THAT ARE GETTING MESSAGES ABOUT DRINKING WHILE PREGNANT OR NOT DRINKING WHILE PREGNANT. WE KNOW FROM THE A CEMENT THAT WE DID THAT ALSO MIRRORED THE WORK -- THAT SOME HEALTH CARE PROVIDERS STILL DO NOT BELIEVE THE SCIENCE SUPPORTS THE MESSAGE SO THEY DON'T GIVE THIS MESSAGE TO THEIR PATIENTS. WE ALSO KNOW THAT HEALTH CARE PROVIDERS, MANY ARE TELLING US THEY DON'T HAVE TIME TO PROVIDE THE MESSAGE TO THEIR PATIENTS. WE KNOW THAT SOME HEALTH CARE PROVIDERS PROVIDE THE MESSAGE TO WOMEN WHO ARE PREGNANT WOMEN MAN. BUT NOT WOMEN OF CHILD BEARING AGE WHO ARE NOT PREGNANT AND WE ALSO KNOW THAT HEALTH CARE PROVIDERS USE A VARIETY OF METHODS TO DELIVER THE MESSAGE. ONE OF THE WAYS THAT WE DECIDED WITH OUR SUPPORT -- AND TO ADDRESS THE ISSUE WAS TO BRING TOGETHER EXPERTS TO TRY AND FIGURE OUT WHAT ARE THE BEST WAYS TO GET OUT THESE MESSAGES AND MANY HEALTH CARE PROVIDERS WANTED A NUANCE MESSAGE. THEY FELT THAT DON'T DRINK WHILE PREGNANT OR TRYING TO GET PREGNANT OR IT'S NOT WORTH THE RISK THE MESSAGE IS -- WHEN THEY ARE IN A CLINICAL SETTING WITH PATIENTS THEY NEED MORE NUANCE MESSAGES DEPENDING ON WHERE THE PATIENT IS A. PEOPLE COME TO PREGNANCY AND DRINKING IN A VARIETY OF WAYS SO WE CONVENED THE MEETING AND THESE ARE PEOPLE THAT JOINED US AT THE MEETING. THE MEETING WAS HELD IN NOVEMBER. IT WAS IN WASHINGTON, D.C. IT WAS A FIVE HOUR MEETING. AFTER A WELCOME AND OVERVIEW OF THE CURRENT STATE -- OF RESEARCH AND PREVENTION THERE WAS A SHORT PRESENTATION HIGHLIGHT THE RUTS. SURVEY AND THEY WERE ALL PARTNERS IN THE PROJECT AND THEY WERE THE ONES THAT FACILITATED THE MEETING FOR US. WHAT THEY DID WAS THEY REACHED OUT TO THEIR MEMBERS WHO ARE PEOPLE WORKING -- IN CHILD HEALTH AND THEY WERE TELLING US WE NEED MORE NUANCE MESSAGES SO WE ENGAGED THE GROUP AND SEVERAL FOCUS CONVERSATIONS AND NOW WE'RE HAPPY TO TELL YOU WHAT THEY RECOMMENDED. AS I SAID NUANCE MESSAGES WERE IMPORTANT. THERE ARE DEFINITELY SUBGROUPS OF WOMEN AS WE ALL KNOW. ONE OF THE GROUPS THAT PEOPLE ARE INTERESTED IN WERE -- CERTAIN MESSAGeŤ–?–?E THAT SHOULD BE PROVIDED TO CERTAIN ETHNIC OR CULTURAL GROUPS. WHAT KIND OF MESSAGES ARE IMPORTANT FOR WOMEN WHO ARE ALREADY PREGNANT. WHAT KIND OF DIFFERENT MESSAGES ARE IMPORTANT FOR WOMEN WHO ARE NOT PREGNANT BUT ARE OF CHILD BEARING YEARS AND SUBPOPULATIONS AS WELL. THESE ARE THE PRINCIPLES THAT THEY DECIDED UPON NEEDED TO BE IN ADDITIONAL NUANCE MESSAGES. THAT PROVIDERS WERE LOOKING FOR EVIDENCE BASED SCRIPT. S AND THE WORD CAME UP IN THIS GROUP AND ALSO IN OTHER SURVEYS AND DISCUSSES. PROVIDERS ARE LOOKING FORGIVE ME A CARD THAT I WILL READ OR AT LEASTLY START TO READ AND GIVE THE MESSAGES TO THE WOMEN. WHAT IS INTERESTING IS WE'VE ALREADY GOT A LOT OF -- WE'VE GOT TWEAK AND WE'RE USING EXPERT AND ALSO ONE COULD SAY ARE A SCRIPT. BUT FOR WHATEVER REASON MANY PROVIDERS ARE STILL ASKING FOR ADDITIONAL SCRIPTS. THE GROUP FELT TO DEEMPHASIZE CONSUMPTION AND THAT COMES AROUND THE ISSUE OF SO MANY PATIENTS ARE WANTING TO KNOW HOW MANY CAN I DRINK? IT USED TO BE SIX AND THEN TWO SO PEOPLE ARE STILL ASKING THE QUESTION. SO THE GROUP FELT THAT IF WE DEEMPHASIZED CONSUMPTION THAT MIGHT BE THE WAY TO OPEN UP THE DOOR TO THE NUANCE MESSAGES. THAT THE MESSAGE FOR PROVIDERS AND PATIENTS SHOULD OFFER A BASIC AND DETAILED VERSE AND THE THINKING IS EVERY PATIENT IS DIFFERENT SO WE MAY HAVE TO USE DIFFERENT LANGUAGE -- WITH THE PEOPLE THAT WE'RE WORKING WITH AND THE KEY MESSAGE ABOUT FETAL RAIN DEVELOPMENT IS SOMETHING THAT THEY FELT IS IMPORTANT AND AS WE LEARNED THIS MORNING THERE IS A LOT OF INFORMATION TO GIVE AND THAT IS SOMETHING THAT MAY STRIKE A CORD WITH SOME PEOPLE THAT ARE HEARING THE MESSAGE. THE GROUP ALSO CAME ONE THREE CONSIDERATIONS FOR NEW MESSAGES. AND THEY FELT THAT WHEN WE'RE LOOKING AT PROPOSED NUANCE MESSAGES FOR HEALTH CARE PROVIDERS WE SHOULD LOOK AT THESE THREE THINGS. TO HAVE THE MESSAGE TOUCH ON OR INCLUDE THE PIECE ABOUT THE SCIENTIFIC EVIDENCE. THEY ASKED THE GROUP -- TO TALK ABOUT WHY DON'T WE LOOK AT A HARM REDUCTION APPROACH SINCE THAT HAS BEEN HELPFUL IN OTHER PUBLIC HEALTH INITIATIVES. THAT MIGHT SUPPORT OUR CARE AND ALSO LET'S LOOK AT MESSAGES THAT ARE PATIENT CENTERED AND CULTURALLY IMPORTANT FOR THE THE PATIENTS THAT THEY WOULD BE TALKING TO. AS FAR AS THE SCIENTIFIC EVIDENCE THE GROUP WAS INTERESTED IN MAKING SURE THAT IF THE MESSAGES INCLUDE SCIENTIFIC EVIDENCE THAT WAS REALLY IMPORTANT AND THESE WERE THE KINDS OF THINGS THAT THEY FELT SHOULD BE INCLUDED IN THOSE MESSAGES BASED ON THE SCIENTIFIC EVIDENCE. AND AGAIN THESE ARE THINGS THAT WE ALL KNOW ABOUT. THERE IS NO WAY TO PREDICT HOW ALCOHOL WILL PROTECT-I THINK CLEARLY EVERYBODY HERE IS ON THE SAME PAGE AND THAT IS GREAT AND THAT WILL MAKE IT EASIER AS WE'RE TALKING WITH EITHER WOMEN OR CLINICIANS OR WHOEVER THE GROUP MIGHT BE BUT THESE ARE THE POINTS THAT THE GROUP FELT WERE IMPORTANT TO INCLUDE WHEN WE'RE LOOKING AT THE SCIENTIFIC EVIDENCE. THE LAST BULLET IS AN IMPORTANT ONE. I THINK A LOT OF HEALTH CARE PROVIDERS ARE TELLING US THAT THEIR PATIENTS ARE LOOKING TO PINPOINT THAT THRESHOLD. AND THAT IS SOMETHING THAT WE KNOW FROM THE MESSAGES -- IS THAT WE'RE PUTTING THAT TO THE SIDE AND SAYING NO AMOUNT OF ALCOHOL IS SAFE. IT'S JUST NOT WORTH THE RISK. AS FAR AS THE HARM REDUCTION APPROACH -- THE GROUP FELT THAT HARM REDUCTION APPROACHES HAVE BEEN SUCCESSFUL SO THEY ASK THE QUESTION ABOUT -- HOW THAT COULD BE INCORPORATED INTO THE FASD MESSAGES. THEY CAME UP WITH THE CONTINUUM. LESS DRINKING MEANS FEWER ADVERSE EFFECTS SO EVEN THOUGH WANT EVERYONE TO REFRAIN FROM ALL ALCOHOL AT LEAST FOR THE CLINICIAN TO GIVE THE MESSAGE TO THE PATIENT IF THEY ARE STRUGGLING WITH ALCOHOL USE THEY MIGHT SAY WE KNOW IT'S TOUGH. WE KNOW IT MAY BE DEALT WITH OVER TIME BUT DON'T FEEL LIKE YOU FAILED IF YOU'RE AT LEAST STARTING TO DECREASE AS MUCH AS YOU CAN AND THAT AGAIN REINFORCING I THINK LORRAINE MENTIONED ABOUT BEING POSITIVE WITH THE PATIENT AND WE ALL KNOW THAT IS IMPORTANT. OTHER THINGS AROUND THE HARM REDUCTION APPROACH AGAIN -- THE SAME THING REDUCING RISK IS BETTER THAN NO ACTION AT ALL SO YOU CAN SEE THE THEMES IN THE HARM REDUCTION APPROACH. AS FAR AS THE PATIENT CENTERED CULTURALLY COMPETENT APPROACH -- GIVING THE MESSAGE MORE THAN ONCE IS IMPORTANT. SO THE GROUP CAME ONE LOTS OF IDEAS AND CONVERSATION AROUND THIS. PROVIDERS MUST NOT JUDGE. WEED THIS -- THIS MORNING AS WELL AND THE GROUP WAS STARTING TO MASSAGE AND THINK ABOUT HOW WE CAN LOOK AT HOW SOMETIMES WE ASK A QUESTION NOW. AND MAYBE THINK ABOUT A DIFFERENT WAY TO ASK IT. SO INSTEAD OF ASKING DO YOU DRINK? ASKING HOW MUCH DO YOU DRINK? INSTEAD OF ASKING DO YOU PARTY? ASK HOW OFTEN DO YOU PARTY? >> I'M HERE TO HELP YOU HAVE A HEALTHY PREGNANCY SO STARTING TO GET MORE DETAILED AND MORE NUANCED DEPENDING ON ON THE PERSON THAT YOU'RE WORKING WITH AND I WOULD CLEARLY SUGGEST THE COMFORT LEVEL OF THE PROVIDER BECAUSE ONE OF THE PIECES OF FEEDBACK WE'VE GOTTEN IS THERE IS STILL A GROUP OF PROVIDERS WHO FEEL I DON'T WANT TO START TALKING ABOUT ALCOHOL BECAUSE WHAT IF THE PERSON SAID I NEED TREATMENT AND THEN I DON'T KNOW WHAT TO DO. AND AGAIN A LOT OF THE FEEDBACK WE'VE GOTTEN -- FROM THE SMALL GROUP OF PROVIDERS -- I'M NOT A TREATMENT SPECIALIST AND I DON'T EVEN WANT TO APPROACH THE SUBJECT. WE NEED TO FIGURE OUT HOW TO HELP THEM WITH THAT. OTHER THINGS AROUND THE PATIENT CENTERED -- CULTURALLY COMPETENT COMMUNICATIONS AND THAT IS THAT HEALTH CARE PROVIDERS, WE WANT TO SUPPORT THEM SO THEY CAN USE A CULTURAL HUMILITY -- ORIENTATION. IT'S OKAY TO ASK QUESTIONS. OKAY TO SAY I DON'T KNOW VERY MUCH ABOUT YOUR BACKGROUND YOUR PERSONAL BACKGROUND OR YOUR FAMILY BACKGROUND OR ETHNIC OR RELIGIOUS OR CULTURAL BACKGROUND AND HOW THAT PLAYS INTO YOUR USE OF ALCOHOL OR YOUR VIEWS ON ALCOHOL. TELL ME MORE ABOUT IT SO I CAN BETTER UNDERSTAND AND HELP YOU. SO THAT WAS A REALLY IMPORTANT PIECE THAT THE GROUP CAME UP WITH. ASKING AND SAYING TO PEOPLE LET ME KNOW IF I SAY ANYTHING THAT IS OFF BASE. TAILORING THE MESSAGES NOT THINKING THERE IS ONE MESSAGE THAT WE CAN USE FOR EVERY SINGLE WOMAN WHO'S PREGNANT OR TRYING TO BECOME PREGNANT. BEING AWARE OF PERSONAL BIASES AND LEAVING THEM OUTSIDE THE DOOR. I'M A SOCIAL WORKER BY TRAINING AND WE TALK ABOUT IT ALL THE TIME. AND SOCIAL WORK 101 DON'T BE JUDGEMENTAL AND I CANNOT TELL YOU HOW MANY TIMES IN MY LIFE THAT I SEE MYSELF WITH PEOPLE TRYING TO BE JUDGEMENTAL. THAT IS NOT YOUR ORIENTATION. LEAVE IT AT THE DOOR AND THAT'S AN UNIMPORTANT PIECE THAT THIS GROUP FELT SHOULD BE INCLUDED IN THOSE MESSAGES. THOSE MORE NUANCE MESSAGES. AND THERE MAY BE SOME PATIENTS THAT WE'RE REAL BIG ON BROCHURES AND VIDEOS AND FOR PEOPLE LEARNING DIFFERENT WAYS. AND WE WANT TO MAKE SURE THAT WE'RE UNDERRING THAT NOT EVERYBODY HAS THE SAME ABILITY TO HEAR THE MESSAGES. SOME PEOPLE MAY HAVE INTELLECTUAL COGNITIVE LIMITATIONS. OBVIOUSLY IF SOMEONE ENGLISH IS THEIR SECOND LANGUAGE OR IF SOMEBODIES BLIND AND DON'T BE GIVING THEM A BROCHURE TO READ. WE HAVE TO ASK THOSE QUESTIONS. IT'S JUST REALLY IMPORTANT TO MAKE SURE THAT ALL OF THE GOOD WORK THAT WE'RE DOING WITH OUR MESSAGING IS GOING TO BE RECEIVED AND UNDERSTOOD BY THE PERSON. THE GROUP THEN LOOKED AT DIFFERENT WAYS TO THEY LOOKED TO PRACTICE AND ONE OF THE THINGS THAT WE HEARD THIS MORNING AND WE'VE HEARD IT AT LEAST WITH OUR PROJECT WE'VE HEARD IT FOR THE TWO AND A HALF YEARS THAT WE'VE HAD THE PROJECT IS THAT CLINICIANS DO NOT HAVE THE TIME IN THEIR PRACTICE TO HAVE A LONG DISCUSSION ABOUT ALCOHOL AND ALCOHOL REDUCTION AND FAS CONSIDERING PREVENTION. -- FASD PREVENTION. IT WAS STILL IMPORTANT FOR THE GROUP TO MAKE SURE TO PUT THIS TO TOUCH ON THIS PIECE IN THEIR MEETING SO THE GROUP TALKED ABOUT FOR EXAMPLE THE THIRD BULLET IS USE AN EVIDENCE BASED SCREENER AT LEAST ONCE A TRIMESTER. IS THAT THE BEST PRACTICE AND THE QUESTION IS HOW DO WE DO THIS WITH A BUSY CLINICIAN WHO SAYS I'VE GOT 10 MINUTES WITH THIS PATIENT. IS THIS SOMETHING THAT WE GIVE THEM THE MESSAGE BUT IT DOES NOT VERBALLY COME OUT OF THEIR MOUTH. I THINK THE STRUGGLE IS HOW DO WE GIVE THESE MESSAGES WHEN WE HAVE CLINICIANS WHO ARE SAYING I JUST DON'T HAVE THE TIME. THAT SEEMS TO BE THE ONE OF THE BIG CHALLENGES. SO WE HAVE TO FIGURE OUT HOW TO BE CREATIVE WHEN WE'RE DELIVERING THE MESSAGES AND EVEN THOUGH OUR PARTICULAR PROJECT THAT IS FUNDED HAD US FOCUS ON SUPPORTING PRIMARILY PHYSICIANS AND NURSES. WE KNOW THAT WHAT WE'VE HEARD FROM SO MANY OF THE PHYSICIANS AND NURSES THAT IS WHILE I WORK WITH A TEAM IT COULD BE THE RECEPTIONIST WHO GIVES THE MESSAGE TO THE PERSON. IT COULD BE THE MED TECH THAT TAKES THE VITALS. IT DOESN'T HAVE TO BE JUST THE PRIMARY CARE PERSON THAT THE PATIENT IS SEEING. EMBEDDED SCREENING QUESTIONS INTO THE ELECTRONIC HEALTH RECORD. FROM WHAT I UNDERSTAND BECAUSE I GOT OUT OF MY CLINICAL WORK BEFORE THERE WERE ELECTRONIC RECORDS BUT FROM WHAT I UNDERSTAND IT'S EXTREMELY DIFFICULT TO ADD TO THE RECORD. THE WHOLE DISCUSSION AROUND MOTIVATIONAL INTERVIEWING WAS TALKED ABOUT AND OBVIOUSLY IF YOU ARE IN A POSITION WHERE THE TEAM THAT -- THE CLINICAL TEAM IF EVERYBODY HAS TRAINING AND EXPERIENCE ON HOW TO USE IT THAT'S GREAT. IF NOT MAKING SURE THAT THERE IS SOMEONE WHO'S EITHER AVAILABLE ON THE TEAM THAT CAN SUPPORT THE WORK OR EVEN IF SOMEBODY THAT HAS TO BE REFERRED OUT BUT MAKING SURE THAT COMPONENT IS PART OF THE SUPPORT SO WE CAN BETTER UNDERSTAND THEIR ALCOHOL USE. I REMEMBER A COUPLE OF YEARS AGO THERE WAS A RESEARCHER FROM WAYNE STATE UNIVERSITY AND THE REASON I REMEMBER THAT IS BECAUSE I WORKED THERE. THEY WERE LOOKING AT USING KIOSK. AND THEY WOULD GO TO A KIOSK AND KEY IN THE INFORMATION AND THE TAKE AWAY -- AND THIS IS MY TAKE AWAY IS THAT MIGHT BE A NONTHREATENING WAY TO GET INFORMATION FROM PEOPLE INSTEAD OF SITTING SITTING THERE WITH YOUR PHYSICIAN OR NURSE AND THEY ARE ASKING THE QUESTIONS AND I REMEMBER THINKING THAT WOULD BE LESS THREATENING FOR ME AND I WONDER IF I WOULD BE MORE TRUTHFUL. BUT AT THE BOTTOM THE OBVIOUS POINT THAT IS WE MEAD TO MAKE SURE WE HAVE INFORMATION ABOUT LOCAL TREATMENT OPTIONS FOR ANYBODY WHO'S WORKING AND SEEING WOMEN WHO THEY FEEL WOULD BENEFIT FROM THEM. AS FAR AS SOME OF THE TAILORED MESSAGES -- IT'S UNDERSTANDING THE PATIENTS INCLUDING MOTIVATIONS AND CHALLENGES. SEEKING OUT EFFECTIVE STRATEGY USING OTHER CULTURALLY COMPETENT HEALTH PROMOTIONS. AGAIN WE DON'T HAVE TO REINVENT THE WHEEL. THERE IS A -- OBVIOUSLY THERE IS A WHOLE SET OF COMPETENCIES AND I KNOW THAT WE'RE VERY INVOLVED WITH THAT AND THE DISABILITY COMMUNITY. WE NEED TO LEARN FROM THAT AND MAKE SURE WE'RE INCLUDING THAT IN OUR WORK IN FASD PREVENTION. THE WHOLE IDEA THAT IT TAKES A VILLAGE INCLUDING PARTNERS WE TALKED ABOUT THAT THIS MORNING WE'RE HAPPY TO HEAR ABOUT SOME OF THE INITIATIVES THAT ARE INCLUDING THE FATHERS OF THE BABIES. WE THINK THAT IS IMPORTANT AS WELL. AND AGAIN AS THE RESEARCH WAS SHOWING THIS MORNING IN THE LAST BULLET MANY WOMEN ARE WILLING TO MAKE SACRIFICES DURING THEIR PREGNANCY ANDING ANDING THAT IS SOMETHING THAT THE GROUP FELT SHOULD BE CAPITALIZED. AS FAR AS SPECIFIC MESSAGES -- SALLY JUST TALKED ABOUT HER MOTORCYCLE EXAMPLE AND HERE IT IS' DRINKING WHILE PREGNANT IS LIKE RIDING A MOTORCYCLE. THE MORE TIMES YOU RIDE THE MORE CHANCES YOU HAVE OF GETTING INTO AN ACCIDENT. ANOTHER MESSAGE WOULD YOU PUT ALCOHOL IN YOUR BABY'S BOTTLE. THAT IS WHAT YOU'RE DOING IF YOU'RE DRINKING DURING PREGNANCY. YOU'RE A MOTHER NOW. AND LOTS OF SUPPORT AND WE KNOW THERE IS A LOT OF AND IN THE COMMUNITY WE KNOW THAT SHOWING PICTURES AND PUTTING IT OUT THERE AND SAYING LOOK AT THE DIFFERENCE BETWEEN THE TYPICAL BRAIN AFFECTED BY BRAIN AND ONE THAT IS NOT. SO THESE ARE SOME OF THE EXAMPLES THAT THE GROUP CAME UP WITH. THE GROUP ALSO DISCUSSED AND ADOPTED A RECOMMENDATION FOR A SCREENING AND EDUCATION ALGORITHM. 7 IS THE PATIENT DRINKING AND YOU CAN SEE IF THE ANSWER IS YES THERE IS A CERTAIN SET OF ACTIVITY THAT THE GROUP REACTED TO OR SUGGESTED. DOCUMENTING IN THE ELECTRONIC HEALTH RECORD. THE THINKING THERE WAS -- EVEN IF THE -- IF THE PERSON IS -- IF THE WOMAN SAYS THAT SHE IS DRINKING BUT YOU DON'T EVEN TALK ABOUT ANYTHING ELSE OR SHE DOESN'T WANT TO HEAR ANYTHING ELSE ABOUT IT STILL PUT THAT IN THE ELECTRONIC HEALTH RECORD. IT'S IMPORTANT TO INCLUDE WHATEVER HAPPENED AROUND THAT SO THE NEXT TIME SHE -- THE NEXT CLINICIAN OR THE SAME CLINICIAN -- WILL BE ABLE TO SEE THAT AND PICK ON UP IT. SO THAT WAS REALLY IMPORTANT. AND AGAIN YOU CAN SEE THIS -- AND IT'S JUST WE NEED TO TAKE A COMPREHENSIVE APPROACH WE STILL WANT TO TAKE A COMPREHENSIVE APPROACH FOR EVERYONE. IN SUMMARY THE GROUP CAME UP WITH A SET OF GUIDING PRINCIPLES AND EXAMPLES. THEY DEVELOPED THE ALGA RHYTHM. AND ALL OF THE PEOPLE AROUND THE ROOM HERE CAN CERTAINLY PROVIDE GUIDANCE ON DISSEMINATING NEW KINDS OF MESSAGES TO CLINICIANS SO THE GROUP FELT THAT THIS WAS A GOOD FIRST STEP. IT WAS A FIVE HOUR MEETING. THE NEXT STEP THAT IS OUT THERE. THE CHALLENGE FOR US ALL IS HOW TO CONTINUE TO CREATE THESE NOOSE ANC MESSAGES AND MAKE THEM AVAILABLE TO CLINICIANS. THAT IS OUR PROGRAM AND I THANK YOU VERY MUCH FOR LISTENING. >> THANK YOU, KAREN. WE'LL SAVE QUESTIONS FOR THE END OF THE SESSION SO KATHY'S UP NEXT. >> I'M KATHY MITCHELL WITH THE NATIONAL ORGANIZATION. I HAD ANOTHER COMMITMENT THIS MORNING IN THE CITY THAT I COULD NOT GET OUT OF BUT IT SOUND LIKE IT WAS A GREAT MEETING DARN IT. SO I WISH I COULD HAD BEEN HERE. YES. I TITLED THIS YES. MY SISTER HAS FAS BUT MY MOM IS REALLY NICE AND THAT IS A DIRECT QUOTE COMING OUT OF THE MOUTH OF MY THEN 10-YEAR-OLD DAUGHTER. EXPLAINING TO HER GROUP THAT CARLEY HER SISTER HAS FAS AND THEY WERE HORRIFIED. I WAS IN THE KITCHEN. AND I HEARD HER EXPLAINING AND THEY WENT OH, -- SHE HAS FAS. YOUR MOM DRINK WHEN SHE WAS PREGNANT AND SHE WAS LIKE YEAH. BUT MY MOM IS REALLY NICE. THAT SPEAKS TO THE STILL MATCH. THIS IS GOING TO BE A UNIQUE PRESENTATION FOR ME AND I GOT IN FROM ATLANTA YESTERDAY AND I WAS REALLY TIRED LAST NIGHT WHEN I DID THIS AND THEN I HAD A COMMITMENT TODAY SO THIS WILL BE A SURPRISE. I WISH I WOULD HAVE HAD TIME TO LOOK AT IT REAL QUICK BUT WE'LL SEE. THIS IS JUST REALLY SPEAKING TO HOW TIMES HAVE CHANGED. AND MY PLEA TO ASK THOSE OF US WHO HAVE BEEN SITTING AROUND THE TABLES FOR MANY YEARS TO MAYBE CHANGE THE PARADIGM OR AT LEAST BE OPEN TO RETHINKING HOW WE'VE BEEN DOING BUSINESS AND WHAT WE SHOULD AND CAN BE DOING OR MAYBE WHAT WE NEED TO RETHINK. SO -- FOR THOSE OF YOU THAT DON'T KNOW -- EVERYBODY DOES. WE'RE IN OUR 26 AND A HALF YEARS OLD I THINK. AND WE'RE ALL ABOUT PREVENTION AND CONNECT FAMILIES TO RESOURCES AND WE HAVE LOTS OF AFFILIATES. OUR LARGEST AND MOST SUCCESSFUL CERTAINLY BEING NOFA S AND WE WOULD NOT HAVE THE AFFILIATE PROGRAM IF IT WERE PLOT FOR SUSAN AND THIS IS CARLEY AND YES, I'M CARLEY'S BIRTH MOTHER AND IF WE HAVE BEEN IN THE FIELD OF FAS UNDERSTAND THE PARENTS THAT COME UP AND THEY SAY I'M SO EXCITED TO MEET YOU. I HAVE A SON WITH FAS. WE'RE THE ADOPTIVE FAMILY SO THEY ARE VERY QUICK TO TELL YOU IN TWO SECONDS -- THAT THEY ADOPTED. VERY FEW ADOPTIVE PARENTS WILL LEAVE THAT PART OUT AND I DON'T BLAME THEM I. WOULD TOO. I WISH I COULD BUT YES, I'M THE BIRTH MOTHER. AND SO I'M KARLI'S BIRTH MOM AND I'VE BEEN DOING THIS LONG ENOUGH AND KARLI IS 43. SO I'VE LEARNED A LOT AND SO I WANT TO SHARE SOME OF THINGS. SO WE SEE A LOT OF LITERATURE COMING OUT. A FEW PAPES HAVE COME OUT ABOUT THE STIGMA AND THAT IS A GOOD THING. NOW I'VE BEEN SHOUTING THE STIGMA STUFF FOR A LONG TIME BECAUSE I'VE BEEN LIKE THE ONLY BIRTH MOM SITTING AROUND THESE ROOMS AND I FEEL THINGS AND INTERPRET THINGS DIFFERENT THAN SOME OTHERS. LIKE THE TIME I WENT TO A LARGE DIAGNOSTIC CLINIC AND THE EXPERT STARTED TALKING ABOUT THEY FUNNY LOOKING KIDS. IT WAS VERY HURTFUL. I FOUND IT VERY OFFENSIVE. HE THOUGHT IT WAS QUITE CUTE. BUT THESE ARE JUST SOME OF THE THINGS. ONE EXAMPLE. AND SOME OF THE PAPERS I'VE BEEN READING THEY TALK ABOUT THE PERSON WITH FAS, THE BIRTH MOTHERS -- AND THEN CERTAINLY THE ADOPTIVE FAMILIES BEING THE PEOPLE THAT REALLY FEEL THE STIGMA AND I DO AGREE THAT ALL OF THOSE PEOPLE DO AND THERE IS A LOT -- THIS IS COMPLICATED AND WE ALL FEEL IN IT DIFFERENT WAYS BUT ONE OF THE THINGS I'M TRYING TO MAKE THE POINT OF WITH THE BIRTH MOTHERS IS THESE ARE THE WOMEN THAT ARE GOING TO DRINK AGAIN IF WE DON'T GET THEM SOBER AND THIS IS THE PREVENTION PIECE. YES, I DON'T WANT -- I'M CONCERNED ABOUT ADOPTIVE PARENTS AND PEOPLE THAT HAVE BIASES WHERE THEY DON'T KNOW HOW TO PARENT OR ANYBODY WITH A DISABILITY OR MENTAL HEALTH ISSUE BEING STIGMATIZED NONE OF THAT IS GOOD. I'M FOCUSING TODAY ON BIRTH FAMILIES. BECAUSE THAT IS REALLY WHEN WE TALK ABOUT STIGMA AND WE TALK ABOUT BIRTH MOTHERS IT'S BLAMING. 7 IT'S THE NEED TO BLAME SOMEONE AND WE'RE GOING TO BLAME YOU AND WHEN WE START BLAMING AND SHAMING THE MOTHERS GUESS WHO ELSE FEELS IT? MY DAUGHTER WITH HER LITTLE SQUAD EXPLAINING. WHEN MY DAUGHTER MARRIED HER VERY SWEET HUSBAND JAKE ONE OF THE THINGS WAS OF COURSE -- JAKE HAD TO BE TOLD THAT MOM DRANK DURING PREGNANCY. NOW WE'VE GOT JAKE'S VERY CATHOLIC PARENTS AND LIKE HAVE WE TOLD THEM YET. NOW WE NEED TO TELL THEM. MY GRANDMOTHER WAS STILL ALIVE. A VERY RELIGIOUS CATHOLIC WOMAN. SHE HAD TO LIVE WITH THE SHAME THE STIGMA OF HAVING TO TELL HER FRIENDS HER PEERS. YES MY GRANDDAUGHTER DRANK WHEN SHE WAS PREGNANT SO YOU GET THE POINT SO THIS GOES ON AND ON. I'VE HAD THE PLEASURE OF EXPLAINING TO MY GRANDCHILDREN AND THEN I'M GOING TO TALK LATER ABOUT THAT WASHINGTON POST ARTICLE THAT I MUST HAVE BEEN CRAZY OR VERY DEDICATED -- TO ALLOW HAPPEN. BUT ALL OF MY GRANDCHILDREN'S FRIENDS LEARNED ABOUT THIS SO THIS IMPACTS THE BIRTH FAMILIES IN VERY BIG WAYS AND I THINK MY MOTHER TO THE END OF HER LIFE WAS MORTIFIED BECAUSE SHE NEVER QUITE UNDERSTOOD ALCOHOLISM. MY DAD DID BECAUSE HE LIVED IN ALCOHOL I'M BUT SHE NEVER GOT THE EDUCATION BECAUSE SHE RESISTED BECAUSE SHE WAS A RELIGIOUS MINDED PERSON SO MAKING THE POINT SO IT'S NOT JUST THE BIRTH MOTHER. th ENTIRE FAMILY AND IT DOESN'T END. MY LEGACY I'M SURE IF MY GREAT GREAT GRAND CHIN GOOGLE MY NAME WHAT IS GOING TO COME UP WAS THAT LOVELY WASHINGTON POST ARTICLE. I'LL TELL YOU LATER. NOW I HAVE PEOPLE THAT GET ANGRY. WHY DOES SHE HAVE A BIRTH MOTHER'S NETWORK. ALL FAMILIES NEED SUPPORT. WELL OF COURSE. YES. BUT AGAIN THE BIRTH MOTHERS NEED A SEPARATE GROUP BECAUSE IT WAS PREVENTION. WE'RE TRYING TO HELP THESE WOMEN STAY SOBER AND TO SUPPORT THEM THROUGH THE REMORSE AND THE GUILT AND GIVE THEM A SAFE PLACE TO TALK ABOUT THAT. OKAY. 7 THE OTHER THING IS A LOT OF OUR BIRTH MOTHERS ARE NOT WELCOMED IN SUPPORT GROUPS. AND PARENT SUPPORT GROUPS. WE HAVE ONE IN MARYLAND. THAT DOESN'T WELCOME BIRTH MOTHERS. AT LEAST NONE OF US HAVE BEEN INVITED. NOW WHAT HAPPENED WITH SOCIAL MEDIA IS IT GAVE LICENSE TO BULLIES THAT HIDE BEHIND THE ANONYMITY. WE STARTED TO HAVE BIRTH MOTHERS -- AND IT WAS MORE TYPICALLY ME BECAUSE MY NAME IS ASSOCIATED WITH IT WHICH IS FINE. AS MY HUSBAND WILL TELL YOU I'M A TOUGH OLD BROAD. I'VE BEEN DOWN THE -- PATH AND BACK AND THAT IS OKAY. BUT WHAT WAS REALLY AWFUL IS SOME OF OUR LOVELY, DEAR DEDICATED BIRTH MOTHERS WHO HAVE COME OUT FOR LACK OF A HER TERM ALLOWED US TO VIDEOTAPE AND PUT THEIR STORIES OUT THERE AND THEIR PICTURES WERE TAKEN OFF OF OUR WEBSITE AND PUT IN ON AMERICA'S MOST WANTED POSTER. THIS KIND OF THING. THE TARGETING FOR BULLYING AND BLAMING AND ATTACKING. SO WE'VE GOT TO DO SOMETHING. WE'VE GOT TO BE MORE PROACTIVE ABOUT THIS STIGMA AND THE BLAMING. AND SO WE STARTED THE PROCESS AND WE'RE IN THE VERY BEGINNING STAGES. AND I WOULD WELCOME ALL OF YOU ANY OF YOU TO HELP US TO THINK ABOUT THIS. HOW TO DESIGN THIS. HOW TO REALLY GET AROUND -- THIS STIGMA. AND I REALLY BELIEVE WE'VE BEEN SITTING AROUND THESE TABLES. FOR A LONG TIME AND IT'S BEEN 43 YEARS IF WE DON'T DO SOMETHING -- IF WE DON'T CHANGE THE WAY WE THINK ABOUT THIS AND ADDRESS THIS WE'RE IN THE GOING TO GET ANYWHERE AND THE STIGMA IS THE PROBLEM. WE'VE GOT -- I DON'T KNOW WHAT MY NEXT SLIDE IS -- GOOD. IT'S THAT ONE. I'VE MET AS I'M SURE MANY OF YOU HAVE BEAUTIFUL, LOVELY PHYSICIANS, PEDIATRICIANS THAT WILL NOT, WILL NOT EVER DIAGNOSE A CHILD WITH THIS DISORDER. WE HAD ONE IN WASHINGTON DC AND SHE RAN A MOBILE CLINIC THROUGH HIGH RISK UNDERSERVED AREAS AND SHE SAID I WOULD NEVER DO THAT TO MY CHILDREN OR TO MY CHILDREN'S FAMILY. NOT IN WASHINGTON, D.C. BECAUSE THEY WOULD BE OUTCAST. AND I WILL GIVE THEM ANY DIAGNOSIS BUT THAT. AND BECAUSE SHE LOVED HER PATIENTS. THAT IS WHY. BECAUSE SHE LOVED HER PATIENTS. SHE WAS ONE OF OPRAH'S ANGELS AS A MATTER OF FACT. PHYSICIANS OF COURSE -- AND WE HAVE A BARRIER WITH INFORMATIONS JUST EVEN MAKING THE IDENTIFICATION AND DIAGNOSIS OF ADDICTION WHEN THEY SEE IT. WE JUST HEARD SOME OF THAT. AND THIS IDEA ONCE AN ADDICT ALWAYS AN ADD INTEREST. OR THERE IS NO PLACE TO SEND PEOPLE. THAT IS A BIG COP OUT. THAT IS UNTRUE AND IF YOU CANNOT FIND A PLACE YOU CALL ME BECAUSE I WILL FIND A PLACE BECAUSE THAT IS COMPLETELY UNTRUE. PREGNANT WOMAN GETS TO THE TOP OF THE LINE. THEY ARE TOP PRIORITY. THERE IS OUTPATIENT PROGRAMS. PARTIAL DAY PROGRAMS. THAT IS JUST NOT TRUE AND WHAT I HEAR IS SOMEONE DOESN'T WANT TO TAKE THE TIME TO DEAL WITH SOMEBODY WHO IS STRUGGLING WITH A VERY, VERY HARMFUL DETRIMENTAL, AWFUL DISEASE. AND NOFAS WE BELIEVE IN THE DISEASE CONCEPT. THAT IT IS NOT A CHOICE. IT'S A DISEASE AND THE STIGMA PREVENTS WOMEN FROM BEING HONEST ABOUT THEIR USE TO HEALTH CARE PROFESSIONALS. AND JUST LIKE YOU KNOW WE KNOW WHEN SOMEONE IS REACTING TO US. THEY FEEL IT. THEY FEEL THE JUDGEMENT AND BIAS AND THEY WILL TELL YOU ABOUT IT AND THEY KNOW WHO THEY ARE SAFE WITH AND WHO THEY ARE NOT. AND IF THERE IS A BIAS OR YOU DON'T HAVE THE KNACK FOR TALKING WITH WOMEN THEN HIRE A SUBSTANCE ABUSE PROFESSIONAL TO COME IN AND DO COUNSELING OR THE INTERVENTIONS OR THE SCREENS OR WHAT HAVE YOU. RECOGNIZE -- WE TRY TO ENCOURAGE HEALTH CARE PROVIDERS RECOGNIZE YOUR WEAKNESSES AND FIND SOMEBODY THAT CAN TALK TO WOMEN. SO THE POST ARTICLE -- LET ME TELL YOU THE BACKGROUND ON THIS. THE JOURNALISTS THAT HAD CONTACTED ME I HAD KNOWN FOR 10 YEARS. SHE USED TO BE AT PEOPLE MAGAZINE. SHE TRIED TO GET MY STORY OUT TO PEOPLE AND THEY WERE INTERESTED AND THEN CAME BACK AND SAID WELL, WE LIKE THE STORY BUT WHAT WE REALLY WANT IS A YOUNGER WOMAN WITH A YOUNGER CHILD WHO DRANK MODERATELY. AND WHO'S NOW A NATIONAL ADVOCATE. I SAID THAT SOUNDS GREAT. WHO'S THAT GOING TO BE? COULDN'T FIND ONE. NOW I SEARCHED -- I WENT TO ALL OF MY RESOURCES TRYING TO FINISHED A YOUNGER WOMAN WHO DRANK MOD -- MODERATELY AND HAD A CHILD BUT COULDN'T FIND ONE. IF YOU FIND THAT WOMAN YOU LET ME KNOW BECAUSE WE COULD USE THAT. WE TALK ABOUT THAT A LOT. AND THEN SHE WENT TO WORK FOR GOOD HOUSEKEEPING. GUESS WHAT? SHE WANTED A YOUNGER WOMAN WITH A YOUNGER CHILD. WHO DRANK MODERATELY. COULDN'T FIND HER. SO ANY WAY SHE SOLD THE IDEA TO THE POST. I THOUGHT IT WAS GOING TO BE A TINY ARTICLE BURIED IN THE HEALTH SECTION. I HAD NO IDEA. IT WAS ON THE FRONT OF THE HEALTH SECTION. I'M NOT THAT INTERESTING. MY STORY -- THIS IS NOT ME. I WAS JUST THE FACE. IT'S NOT ABOUT ME. I'M VERY WELL AWARE OF THAT. MY STORY JUST ISN'T THAT INTERESTING. PEOPLE WERE INTERESTED BECAUSE AIR BELIEVE -- I BELIEVE THEY CONNECTED WITH THE STORY. A LOT OF WOMEN HAVE DRANK DURING PREGNANCY AND TO SEE THE TITLE -- I DRANK WHILE I WAS PREGNANT AND LOOK WHAT I DID TO MY CHILD. IT CAUGHT THEIR ATTENTION. IN THREE DAYS I GOT A TEXT FROM THE POST AND SAID THIS ARTICLE HAS BEEN THE MOST WIDELY READ ARTICLE 7.7 MILLION PEOPLE HAVE READ IT AND THEN IT STARTED TRENDING ON FACE BOOK. I COULD NOT BELIEVE MY EYES. I COULD NOT BELIEVE THIS WAS HAPPENING. AND IT JUST -- WENT AROUND THE WORLD AND THERE WERE COMMENTS THAT CAME IN ON THESE SITES. SO WHAT WE'VE DONE IS WE'VE STARTED TO SIFT THROUGH THE COMMENTS. NOW WHEN I SAY WE THAT IS NOFAS. I CANNOT READ THEM I'M NOT GOING TO READ THEM. AND I READ A FEW AND IT MAKES ME NAUSEOUS. BECAUSE THERE IS A LOT OF ANGRY PEOPLE OUT THERE. AND A LOT OF JUDGEMENTAL PEOPLE AND OF COURSE IT'S NOT ABOUT ME BUT IT HURTS ME THAT WOMEN WITHOUT ALCOHOLISM LIKE MYSELF FOR THOSE WHO DON'T KNOW I'M A RECOVERING ALCOHOLIC ARE SO JUDGED BY SOCIETY AND THAT THIS DISEASE IS SO MISUNDERSTOOD. THAT IS WHAT IS SO SAD. SO OUT OF THE CONTINUES WE HAD AN INTERN AND I JUST GOT THE REPORT LIKE YESTERDAY SO ALL OF THIS WAS VERY LAST MINUTE. BUT YOU KNOW -- ABOUT HALF OF THE COMMENTS WERE VERY POSITIVE. OKAY. BUT THE REST WERE NOT. BUT WHAT I WANT TO SAY TODAY IS THAT I REALLY THINK WE NEED TO PAY ATTENTION TO THIS. NOW OF COURSE THE CDC CAME OUT WITH VITAL SIGNS SOON AFTER THIS. I DIDN'T INCLUDE ANY OF THE CONTINUES THAT CAME IN AND WE ALL SAW THAT. WHAT HAPPENED IN THE MEDIA WITH VITAL SIGNS BUT I THINK WE MEAD TO TAKE PAUSE AND LISTEN. WE HEED TO PAY ATTENTION TO WHAT THE COMMENTS ARE SAYING IN ORDER TO RESHAPE OUR PUBLIC HEALTH MESSAGES ABOUT FASD. I DON'T THINK WE CAN CONTINUE TO DO BUSINESS AS USUAL. WE NEED TO LISTEN TO WHAT PEOPLE ARE MISSING AND BE CONSIDERING THOSE THINGS. AND HERE IS THE BREAK OFF. -- OF HOW THE COMMENTS CAME IN. SO FULLY SUPPORTIVE WAS ABOUT 21%. A LOT OF PEOPLE DON'T BELIEVE THAT FASD OCCURS OR THEY BELIEVE IT ONLY OCCURS FOR WOMEN THAT DRINK HEAVILY. THEY ALSO BELIEVE THAT EVERYONE HAS ALWAYS KNOWN ABOUT THIS. EVERYONE HAS ALWAYS KNOWN. AND THAT IN EVERY FAMILY PEOPLE HEAR THE MESSAGES THAT -- DRINKING IS NOT OKAY. AND THAT PLENTY OF PEOPLE DRINK -- AND DON'T HAVE CHILDREN WITH EFFECTS AND SO THEY SEE WHEN WE COME OUT WITH OUR MESSAGES AS LIES AND SCARE TACTICS. ALL RIGHT. AGAIN BEHIND THE STIGMA -- BEHIND THE A -- ADDICTION. I'M AN ALCOHOLIC AND I'M A LIAR AND THE STORY -- THE IDEA THAT I REALLY DID AT THE TIME I WAS PREGNANT WITH KARLI WHICH WAS BEFORE THE LITERATURE CAME OUT I HAD NO IDEA YOU COULDN'T DRINK AND I REALLY DID DRINK THINGS LIKE SOPHISTICATED DRINKS LIKE BOONS FARM AND VALLEY HIGH. I DRANK CHEAP KID'S WINE. BECAUSE I WAS A KID. I WAS 17 YEARS OLD. AND THAT IS WHAT I DRANK AND I DRANK MOSTLY ON THE WEEKENDS. I WAS NOT FALLING DOWN DRUNK BUT I AM AN ALCOHOLIC SO I DRANK MORE THAN MOST PEOPLE COULD. AND THAT WAS REALLY MY DRINKING PATTERN WHEN I WAS PREGNANT WITH KARLI. SO THE BLAMING OF THE BIRTH MOTHER AND THESE ARE THE LIGHTWEIGHT ONES. THERE ARE SOME THAT WANT TO TAR AND FEATHER WOMEN. THERE ARE SOME SCARY FOLKS. SO ANY WAY -- IF YOU LOOK HERE THE SCIENCE BEHIND FASD, WE'VE GOT SOME WORK TO DO. PEOPLE DON'T BELIEVE IT. THEY DON'T KNOW IT. WE NEED TO BE THINKING ABOUT THAT. ADDICTION -- OKAY. AND THE FACT THAT YOU KNOW THE BLAMING OF THE BIRTH MOTHERS. IT'S THE BIRTH MOTHER'S FAULT. SO AGAIN I BELIEVE AND I'VE SAID THIS TO KEN WARREN FOR MANY YEARS AND THE FIRST FAS -- TASK FORCE GROUP WE NEED TO CHANGE THE NAME. THE NAME IS A PROBLEM. AS LONG AS WE HAVE THAT NAME WE'RE NOT GOING TO GET ANYWHERE. I STILL BELIEVE THAT AND WE TALKED TO DR. JONES ABOUT IT NOT LONG AGO. NO. WE CANNOT DO THAT. I REALLY THINK IT'S SOMETHING THAT SHOULD BE CONSIDERED. I ALWAYS HAVE. A PARENTHESES BECAUSE THERE ARE OTHER DISORDERS THAT HAVE THAT. SMITH AND JONES SYNDROME. WE COULD CALL IT THE WARREN SYNDROME. ANYTHING BUT FETAL ALCOHOL SYNDROME BECAUSE IT WOULD BE NICE FOR MY GRANDMOTHER TO BE ABLE TO SAY THAT HER GRANDDAUGHTER HAD -- WARREN SYNDROME. NOT FETAL ALCOHOL SYNDROME. WHEN I AM IN THE GROCERY STORE AND AGAIN YEARS AGO WHEN I SAID MY DAUGHTER HAD CEREBRAL PALSY UNTIL SHE WAS 16 YEARS OLD INCOME I GOT THE IDEA TO GET THE RIGHT DIAGNOSIS. YEAH IT'S KARLI. SHE HAS CEREBRAL PALSY. BLESS YOUR HEART. GOOD TO SEE YOU. NOW WE HAVE THE DIAGNOSIS. SHE HAS FETAL -- >> ARE YOU. THEN I GOT INTO THE CATEGORY. SOILED BE FINE TO FEEL NOT LIKE A LAYER. I DON'T NEED TO EXPLAIN MY WHOLE LIFE TO THIS PERSON. I HOPE YOU DON'T MIND I'M USING YOUR NAME. HE MISS FRIEND. SO HERE IS WHAT WE'RE DOING. WE'RE ON A CAMPAIGN TO REWORD -- POPULAR WIDELY USED FASD PREVENTION MESSAGES. TO TAKE THE MOTHER OUT OF IT. BECAUSE WE'RE PART OF THE PROBLEM TOO. OKAY. USING MESSAGES -- LIKE FETAL ALCOHOL SYNDROME OCCURS WHEN A PREGNANT WOMAN DRINKS. WHEN A MOTHER DRINKS DURING PREGNANCY IS ALL PART OF THE MOTHER BLAMING. AGAIN WE HAVE REFRAMED ALL OF THESE MESSAGES. WE PRESENTED THESE AT THE MEETING AND IF I MAY SAY THEY WERE VERY WELL RECEIVED. WE'VE SUBMITTED THEM TO THE CDC AND GRANTEES. FOR COMMENTS. THIS IS WHAT WE'RE GOING TO BE USING. WE WOULD HOPE THAT ALL THE AGENCIES CONSIDER REFRAMING THEIR MESSAGES. CAUSED BY WOMEN DRINKING ALCOHOL DURING PREGNANCIES. IN AN INDIVIDUAL THAT WAS EXPOSED TO ALCOHOL BEFORE BIRTH. I WON'T READ ALL OF THESE. UP GLEAN THROUGH THESE. FASDs ARE COMPLETELY PREVENTABLE. IF THE DEVELOPING BABY IS NOT EXPOSED TO ALCOHOL PRIOR TO BIRTH. A DEVELOPING BABY IS EXPOSED TO THE SAME CONCENTRATION OF ALCOHOL AS THE MOTHER DURING PREGNANCY. RATHER THAN WHEN A PREGNANT WOMEN DRINKS ALCOHOL -- -- HER BABY. OKAY NOW THIS ONE I'M GOING TO TALK ABOUT. IF A WOMAN IS DRINKING ALCOHOL DURING PREGNANCY IT'S NEVER TOO LATE TO STOP DRINK. IF YOU BECOME PREGNANT STOP DRINKING. IF YOU NEED HELP STOPPING TALK TO YOUR DOCTOR. IS WHERE THE CDC WILL GO AND THAT IS FINE. WE WILL GO -- CONTACT AN ADDITION PROFESSIONAL OR ALCOHOLIC'S ANONYMOUS. ALCOHOLIC'S ANONYMOUS IS FREE AND AVAILABLE IN EVERY COMMUNITY. ALCOHOLIC'S ANONYMOUS HAS BEEN USED BY THE JUSTICE SYSTEM AND THEY REFER PEOPLE TO AA OR NA OR WHAT HAVE YOU. IT'S BEEN USED BY THE SCHOOL SYSTEM. THEY REFER -- I WORKED EXTENSIVELY WITH THE SCHOOL SYSTEM WITH THE SAFE AND DRUG FREE SCHOOLS. WE REFERRED FAMILIES AND STUDENTS THERE. ALCOHOLIC'S ANONYMOUS IS A FELLOWSHIP FOR PEOPLE WHO HAVE A DESIRE TO STOP DRINKING. YOU DO NOT HAVE TO BE AN ALCOHOLIC TO GO TO ALCOHOLIC'S ANONYMOUS. YOU JUST HAVE A DESIRE TO STOP DRINKING. NOW I WOULD THINK THAT IF A PREGNANT WOMAN NEEDS HELP TO STOP DRINKING WHY ARE WE SO RESISTANT TO WANTING TO INCLUDE ALCOHOLIC'S ANONYMOUS AS A POSSIBLE ANSWER. BECAUSE YOU KNOW -- NO ONE IS GOING THEREBY TO BRAIN WASH. IT'S A PLACE THAT PEOPLE HAVE SUCCESSFULLY AND BEEN ABLE TO MAINTAIN SOBRIETY. IT MIGHT BE A COURT CASE COMING UP AND THAT IS WHERE THEY GO AND THEY CAN GO BACK TO DRINKING AFTER THE COURT CASE IS OVER. OR AFTER THE BABY IS BORN. WE'RE GOING TO INCLUDE THAT. SO IN CLOSING -- SOME OF THE QUESTIONS THAT I ASK OR WOULD ASK THAT THE GROUP THINK ABOUT -- IS IT REALLY ETHICAL TO DIAGNOSE FAS CONSIDERING. THERE A WOMAN IN CANADA THAT DOES A WHOLE TALK ABOUT THIS. PEOPLE WERE RESOURCES THAT CONTACT NOFAS I TOLD THE DOCTOR NOT TO GIVE THAT DIAGNOSES. HE HAS ADHD AND SOMETHING ELSE. THEY DO NOT GET THE DIAGNOSIS BECAUSE THEY ARE SMART ENOUGH NOT TO. AND I DON'T KNOW HOW ELSE TO SAY THAT. SHOULD THE NAME BE CHANGED. IN OUR EDUCATION SHOULD WE BE FOCUSING MORE ON ALCOHOLISM AND ADDICTION. BECAUSE HERE IS THE REALITY. THE MAJORITY OF OUR BIRTH MOTHERS ARE ALCOHOLIC OR HEAVY BRING ARE DRINKERS WHO DON'T -- WHO HAVE HAD ISSUES WITH ALCOHOL. I'M NOT SAYING EVERY MOTHER IS AN ALCOHOLIC BUT IT SEEMS THAT WE WANT -- THE MODERATE EXPOSURE THING HAS GOTTEN KIND OF HEAVY AND THE REALITY IS THAT THIS IS ABOUT HEAVIER DRINKING. I KNOW THAT IS UNPOPULAR AND DANGEROUS. I'M NOT SAYING THAT -- I WOULD LIKE TO -- I'M JUST ASKING SHOULD WE BE REFRAMING IT SOMEHOW BECAUSE WHAT HAPPENS LIKE WITH THE CDC -- THE VITAL SIGNS PEOPLE REALLY DO REACT TO THE SUGGESTION THAT SOMEONE WHO DRINKS A GLASS OF WINE OR TWO WOULD HAVE A CHILD WITH FASD. ALL I'M SUGGESTING THAT IS WE OPEN UP OUR MINDS AND THINK ABOUT THIS AND CONSIDER IT. SO I DON'T KNOW IF THEY CAN BE REFRAMED AND ON A RECENT FACT SHEET I JUST SAW THIS. MOST OF THESE INDIVIDUALS ARE NOT CHILDREN OF MOTHERS CONSIDERED TO BE ADDICTED TO ALCOHOL. ESTIMATED TO BE BETWEEN 4-5 MILLION WOMEN. THAT WAS ONE OF THEIR FACTS BUT THAT IS NOT TRUE. MOST INDIVIDUAL WITH AN FASD DO HAVE A MOM WHO SUFFERS WITH ADDICTION OR ALCOHOLISM. THAT IS ALL. THE WASHINGTON POST THING REALLY TAUGHT ME A LOT BECAUSE PEOPLE REALLY ARE REACTING TO THE MODERATE ALCOHOLIC EXPOSURE AND I'M NOT SAYING NOT TO INCLUDE IT BUT LET'S MAYBE THINK ABOUT IT. I'LL TURN THIS BACK OVER TO SOMEBODY WHO HAS GOT A QUESTION. >> SURE. GO AHEAD. >> KATHY, I WAS GOING TO SAY THAT WHAT 58%-60% OF THE PEOPLE REACTED SUPPORTIVELY OR NEUTRALLY. SO I THINK THAT IS GOOD. THAT IS A STEP IN THE RIGHT DIRECTION. THE OTHER ALMOST 40% ARE IGNORANT AND IN DENIAL. AND YOU KNOW WHAT -- I'M SORRY FOR THEM. BECAUSE THEY MAY END UP WAY FRIEND OR RELATIVE OR A CHILD WITH FAE -- FASD -- >> THANK YOU FOR THAT AND I THINK THAT'S AN IMPORTANT PERSPECTIVE AS WELL BECAUSE THAT REALLY DOES ADD BALANCE TO IT. AND SO MAYBE WHAT WE'RE DOING IS WORKING. AND IS THE RIGHT MESSAGE. SO YOU KNOW I THINK ALL OF THOSE THINGS NEED TO BE CONSIDERED. >> RIGHT. I WOULD ADD I DON'T THINK THERE IS ANY INDIVIDUAL -- ANY MOTHER WHO HAS GIVEN BIRTH TO A CHILD WHO HAS FAS WHO WANTED THEIR CHILD TO HAVE FASD AND THE FACT THAT YOU'RE DEALING WITH AN A DETECTIVE DISORDER. -- AN ADDICTIVE DISORDER. -- KARLI WAS BORN THE SAME YEAR THE FIRST PAPER CAME OUT WHICH MEANT THE RECOMMENDATION THAT PEOPLE THAT WERE PREGNANT -- WOULD HAD BEEN THE RECOMMENDATION IN DR. SPOCK'S BABY BOOK WHICH WAS ALCOHOL IS SAFE AT ANY DOSE AT ANY TIME DURING ANY PREGNANCY. OF COURSE THAT WAS THE PREVAILING WISDOM AT THAT PARTICULAR TIME. AND ONE OF THE CHALLENGES THAT WE FACE WHEN WE NEEDED -- WE KNEW WE NEEDED TO PUT OUT ADVISORIES TO GO AND HEAD AND CHANGE THE PERSPECTIVE AND THE OTHER THING THAT I WANTED TO COMMENT ON RIGHT NOW -- OF THOSE INDIVIDUALS WHO ARE REALLY INTERESTED IN CHANGING THE NAME RIGHT NOW IN THE ENTIRE UNIVERSE THERE ARE TWO -- AND WE'RE IT. AND I THOUGHT ABOUT A NUMBER OF NAMES. NO I DON'T WANT IT TO BE WARREN SYNDROME. THAT I HAD NOTHING TO DO WITH THE IDENTIFICATION. OF THE ILLNESS. KEN JONES IS A WONDERFUL PERSON AND DEDICATED HIS WHOLE LIFE TO FETAL ALCOHOL SYNDROME. A GREAT PEDIATRICIAN. DAVID SMITH REALLY THOUGHT THAT NAMING THE DISORDER FETAL ALCOHOL SYNDROME WOULD DO SOMETHING IN CHANGING THE PARADIGM WITH HOW BIRTH DEEFFECTS WERE NAMED. TYPICALLY THEY WERE NAMED FOR THE PEOPLE THAT IDENTIFIED IT. LIKE THE GEORGE IDENTIFIED THE GEORGE SYNDROME. AND AND DAVID SMITH'S NAME APPEARS NATURALLY IN A NUMBER OF DISORDERS. I THINK SMITH -- DISORDER IS ONE AND THERE ARE A NUMBER OF OTHER ONES BECAUSE THE IDEOLOGY WAS UNKNOWN. DAVID BELIEVED THAT IT WOULD BE A GOOD PREVENTIVE MESSAGE. I THINK OUR 40 YEARS OF EXPERIENCE ON THIS IS IT'S PROBABLY NOT A GOOD PREVENTIVE MEASURE -- MESSAGE AT LEAST THAT IS MY PERSPECTIVE. OTHERS MAY FEEL DIFFERENTLY ABOUT THAT. I CITED THE GEORGE SYNDROME AS A DISORDER THAT I NAMED IS BECAUSE ITS NAME WAS CHANGED ONCE THE GENE WAS IDENTIFIED. AND LIKE MANY OTHER BIRTH DEEFFECTS WHERE WE KNOW THE GENE IT'S BASICALLY THE GENE IS THE NAME THAT IT GOES BY SO NOW IT IS 22Q11.2 WHICH IS THE LOCATION ON CHROMOSOME 22Q WHICH MEANS BELOW THE CENTER OF THE CHROMOSOME AND THE DISTANCE DOWN IS 11.2 SO, THAT IS HOW THAT IS NAMED BUT THERE ARE MANY OTHER DISORDERS. ANOTHER BIRTH DEFECT DISORDER THAT IS 22Q13 AND MANY OF THEM ARE NAMED THAT WAY. IT JUST SO HAPPENS THAT THE ICD 10 CODE -- FOR FETAL ALCOHOL SPRECTRUM -- OR SYNDROME -- DISORDERS IS ALSO A Q. IT'S CODED AS Q86.0. THE MEANING IS DIFFERENT. NOT REFERRING TO A CHROMOSOME LOCATION BUT TO A CODE THAT IS USED FOR BILLING PURPOSES WITHIN THE UNITED STATES AND POTENTIALLY IN OTHER COUNTRIES BECAUSE IT'S INTERNATIONAL. AND CONSISTENT -- WITH OTHER DISORDERS -- I WOULD FLOAT -- AS A TRIAL BALLOON THE POSSIBILITY OF BASICALLY JUST USING THE NAME -- Q86.0. OKAY. I THINK YOU'RE GRANDMOTHER MAY HAVE LIKED THAT. AND YES, IT IS CAUSED BY DRINKING BUT -- IT IS SUBTLER AND A NUMBER OF DISORDERS -- THEY CAN BE IDENTIFIED WITH MORE THAN ONE NAME. AND I DON'T SEE ANY REASON WHY -- THAT IS NOT A POSSIBILITY HERE. YOU WANT TO CALL IT FETAL ALCOHOL SYNDROME. CALL IT FETAL ALCOHOL SYNDROME. OR SPRECTRUM DISORDERS. BUT IF IT SUITS YOU BETTER AND YOU WANT TO CALL IT Q86.0 CALL IT Q86.0. THAT'S AN EDITORIAL. BUT IT IS THE VIEW THAT I HAVE IN TERMS. STIGMA. I'VE WORRIED ABOUT THE STIGMA ISSUE FOR AT LEAST 40 YEARS. AND I THINK THE POSSIBILITY OF NAMING IT IN MULTIPLE WAYS HELPS IN THAT CONTEXT. >> THEN WE HAVE TO THINK ABOUT THE INEVITABLE QUESTION WHEN YOU SAY Q86.0 WHAT IS THAT? IT'S GOING TO BEG THE QUESTION. >> IT'S A BIRTH DEFECT. >> I HAVE A QUESTION FOR KAREN. WHEN YOU WERE TALKING ABOUT EDUCATING PHYSICIANS AND THAT THEY DID NOT -- THEY WERE UNCOMFORTABLE BY ASKING -- WAS THERE ANY DISCUSSION AROUND -- THE FACT THAT IF YOU TOOK THE FETUS OUT OF THE CONVERSATION OR PREGNANCY OUT OF THE CONVERSATION THAT JUST DRINKING ALCOHOL IS A HEALTH ISSUE THAT CAN LEAD TO COMORBIDITY AND PERHAPS OPEN THE CONVERSATION IN A DIFFERENT WAY THAN TALKING ABOUT IT AS FETAL ALCOHOL SYNDROME. >> I DON'T KNOW IF SALLY OR KAREN WANT TO RESPOND TO THAT IF IT WAS DISCUSSED AT THE MEETING. HOWEVER IN THE OTHER WORK THAT WE'VE DONE AND AGAIN I ALWAYS WANT TO FRAME -- IT'S NOT A LARGE NUMBER OF PHYSICIANS SAYING I'M UNCOMFORTABLE TALKING ABOUT BUT THOSE WHO DO SAY I'M NOT AN EXPERT IN ADDICTION. SO SOMEBODY ELSE SHOULD TALK TO THEM ABOUT IT. THE ISSUE IS AROUND DID AND ---ADDICTIONS. >> TWO ISSUES. ONE IS BEING A CASUAL DRINKER AND THEN A BING DRINKER AND THEN AN ADDICT. CASUAL DRINKERS AND MAYBE PEOPLE THAT ARE NOT ADDICTED. I DON'T KNOW BUT THEY NEED TO BE ADDRESSING THE HEALTH CARE NEEDS OF THOSE PEOPLE SO I JUST -- I REALLY CANNOT WRAP MY HEAD AROUND THAT IS THE ISSUE. >> SO AND AGAIN THIS IS ANECDOTAL. AND NOT RESEARCH. SOME OF THE FEEDBACK WE'VE GOTTEN IS THAT AGAIN AND I DON'T WANT TO MAKE GENERALITIES BUT THE SMALL GROUP OF CLINICIANS THAT ARE NOT FEELING COMFORTABLE TALKING ABOUT IT. PART OF THE FEEDBACK IS THAT UNLESS THEY FEEL THAT THE WOMAN IS A ACTIVE ALCOHOLIC. NOT JUST BING DRINKING. THEY DON'T SEE IT AS AN ISSUE SO THEY ARE NOT BRINGING IT UP SO AGAIN IF YOU HAVE AN APPOINTMENT WITH SOMEBODY AND UNLESS THEY TELL YOU YES, I'M DRINKING EVERY DAY A I THINK I'M AN ALCOHOLIC YOU WILL NOT KNOW. THE WOMAN HAS TO AS SOMEONE WHO'S DRINKING ALL THE TIME AND THAT IS MY TIPPING POINT FOR SAYING OKAY. I DON'T FEEL QUALIFIED TO TALK TO YOU BUT IF A WOMAN WHO'S BING DRINKING ORO CABLELY -- OR OCCASIONALLY DRINKING THE FEEDBACK WE'RE GETTING IS -- THAT THAT IS NOT SOMETHING FOR ME TO ADDRESS. SO THEY ARE DRAWING ALIGN BETWEEN I'M NOT AN ADDITION SPECIALIST. I'M A PHYSICIAN IN WHATEVER MY SPECIALTY IS. >> THERE ARE ETHICALF„–?–?– ISSUE THAT'S PRESENT THEMSELVES WHEN YOU SEE PATIENTS AND YOU THINK THAT YOU DETECT AN ISSUE. AND IF YOU TELL THAT PATIENT IT MIGHT MEAN THAT YOU LOSE THEIR BUSINESS.Nn–?–? OUR SOCIETY -- WE HAVED–?– A SYSTEM OF HEALTH CARE -- IT'S NOT A STAFF MODEL. WE'RE NOT PAID A SALARY AND WE SEE SOMEONE WHO COMES US TO. YOU SEE PATIENTS WHO LIKE YOU AND FEEL COMFORTABLE WITH YOU AND THERE ARE A LOT OF PROVIDERS WHO ARE NOT GOING TO GIVE A DIAGNOSIS EVEN IF THEY ARE FALLING DOWN DRUNK. I KNOW I WAS SHOCKED WHEN I WAS IN PLANNED PARENTHOOD AND I WAS SEEING ALL KINDS OF PATIENTS WITH ALL KINDS OF INTERESTING ISSUES AND REALIZED HMMM, THIS PATIENT HAS BEEN RAPED AND THERE IS NO MENTAL HEALTH COUNSELING HERE. THIS PATIENT WHO'S IN HERE -- FOR THE 4th THERAPEUTIC ABORTION I SCRATCHED THE SURFACE AND ASKED HER A COUPLE OF QUESTIONS LIKE WHEN WAS THE LAST TIME YOU HAD SOMETHING SOLID TO EAT. TWO WEEKS AGO. OKAY SHE IS BINGING. NO WONDER YOU'VE HAD FOUR –?–? UNINTENDED PREGNANCIES.kn–?–?–?– --qX–?–?– I HAVE ANOTHER COMMENT REGARDING THEis–?–?– VITAL SOUNDS. I THOUGHT THATz[–? THAT PEOPLE WHO –?–?1––?–? --–? AND PUTTING –?–?Kb–?–Žw–?–? KNEW ABOUT IT -- THEM IN THE SAME CATEGORY SOMEBODY WHO AS BOOSING AND THE OUTCOME WAS A CHILD WITH FASD KNOWING THE AMOUNTS OF ALCOHOL VARY AND THE WOMEN'S HEALTH VARIES. PEOPLE RESIST -- THE CASUAL DRINKER BEING PUT INTO THAT CATEGORY BECAUSE WE SEE PROGRAMS OF WOMEN DRINKING ANDVM–?–? DOCTORS WHO SAY IT IS OKAY SO YOU HAVE PART OF SOCIETY SAYING2––?–?–? OKAY WELL WHY ARE THEY SAYING THAT A COUPLE OF DRINKS WILL CAUSE FASD. THERE WAS RESISTANCE TO MAKING THE LINK BETWEEN THE CASUAL DRINKER -- >> I MAY BE VERYm–?–?U THINK PEOPLE RESIST PERSONAL RESPONSIBILITY WHEN POSSIBLE AND PERMANENTLY IF SUSIE Q AS MODERATE DRINKER AND I'M A MODERATE DRINKER I'M NOT GOING TO -- THIS IS IMPOSSIBLE THAT SHE COULD HAVE A PROBLEM. I DON'T HAVE A PROBLEM. 7 SO IT'S IGNORANCE AND A LACK OF UNDERSTANDING OR EVEN OF SHARING OF THE SCIENTIFIC EVIDENCE AND PEOPLE ARE CREATIVE DILUTING THEMSELVES.Dp–?–? >> I'M THINKING ABOUT EPIDEMIC NOW AND -- AT LEAST IN THE STATE OF MARYLAND MOST HOSPITALS WOULD NOT TEST OR PEOPLE TESTED THEIR MEDICAID POPULATION NOT THEIR PRIVATE PAY POPULATIONS AND THINGS LIKE THAT AND WHAT CHANGED IT WAS WHEN SUDDENLY THERE WERE BABIES COMING BACK -- YOU HAD MOTHERS WHO OVERDOSED AND SUDDENLY IT WAS A—–?–? PHYSICIAN'S RESPONSIBILITY. AND SOME OF THE STUFF I'M3s–? HEARING -- IS IF YOU HAVE SOMEONE IN FRONT OF YOU WHO LOOKS PUT TOGETHER WHO DOESN'T LOOK SICK -- YOU DON'T THINK OF THE FACT THAT THEIR ALCOHOLISM IS POSSIBLY GOING TO REALLY HARM THEIR BABY. THAT THEY MAY DIE EARLY. AND HAVE ALL OF THESE HORRIBLE COMPLICATIONS DOWN THE ROAD. IT'S SOMETIMES -- BECAUSE I THINK EVEN AS PHYSICIANS WE DON'T TAKE IT WE DON'T SEE THERE ARE NOT CONSEQUENCES THAT YOU SEE VARY IN THE SHORT-TERM AND THAT IS ONE OF THE PROBLEM THAT'S ALCOHOLISM HAS SUFFERED FROM. BECAUSE I SEE -- THE SAME WAY -- AS THE WAY -- [ INAUDIBLE ] ABUSE WAS SEEN 10 YEARS AGO. –?–? HEORIN WHEN PEOPLE THOUGHT THAT ADDICTS WAS AN INNER CITY PROBLEM OF MINORITIES AND PEOPLE PERSISTED IN SEEING THAT AND NOW SUDDENLY IT'S AN EPIDEMIC. IT'S BEEN AROUND. THIS HAS BEEN BUILDING FOR DECADES. BUT SUDDENLY BECAUSE IT'S EVERYONE BEING AFFECTED -- NOW IT'S AN EPIDEMIC.Y–?–? >> SUDDENLY BECAUSE EVERY WOMAN WHO'S WHITE ISXm–?–? BEING AFFECTED OR MANY WHITE WOMEN ARE BEING AFFECTED.:y–?–? >> BECAUSE IT'S NOW KNOWN THAT THERE IS NO DISCRIMINATION. amy,8mqq8+n;J BUT ALm–?–?COHOLISM -- HAS NOT RISENj–?–? 'ovs THINGS THAT WE'RE FIGHTING AGAINST AT LEAST FROM WHAT I'M >> IT'S A LEGAL DRUG.>Ž–?–?ś—d WE FORGET.„Q–?–?-QCEgG9l ALCOHOL AND OTHER DRUGS. SOMEBODY CAUGHT ME. I WAS DOING A PRESENTATION AND I SAID DRUGS AND ALCOHOL AND THEY SAID NO. NO. NO. IT'S ALCOHOL AND OTHER DRUGS. AND I EVEN HAD -- MISSED THAT BECAUSE IT'S LEGAL. SO WE DON'T THINK OF IT AS A DRUG. AND THAT IS A TERM THAT EVERYBODY ASSOCIATE WITH DANGER. >> BUT -- THIS IS A LEGAL DRUG AND HOW CAN PATIENTS THAT I CAN BARELY KEEP AWAKE -- I WAS –?–?; PRESCRIBED BUT Id? THEM UP. s!M, AND SO --@z–?–?– 6sŤ'-yD,B[ ]cD[ Sc;GqM...’FBx Lj8OKAY.Oh–?–?J# e WE'VE GOTTEN PASSED THAT BECAUSE THERE ARE A LOT OF PRESCRIBED THINGS THAT ARE HARMING PEOPLE. SO HOPEFULLY THAT ARGUMENT IS SCATHING A LITTLE BIT. >> THE WAY I LOOK AT IT IF IT'S A LEGAL DRUG THEN IT'S LIKE ALCOHOL. IT'S NOT A PROBLEM. I DON'T THINK MOST PEOPLE THINK ALCOHOL IS A PROBLEM BECAUSE IT'S LEGAL AND OPIATES NOT A PROBLEM. HEROIN IS A PROBLEM. I THINK THAT IS THE WAY PEOPLE PUT THEIR MINDS AROUND IT. I SAWlccQ= THIS PATIENT AND SHE HAD FOUR ABORTIONS. MOST PROVIDERS WOULD HAVE MOVED RIGHT ON. AND WOULD NOT HAVE SAID ANYTHING BUT I THOUGHT WAIT A SECOND. FOUR THERAPEUTIC ABORTIONS. WHAT IS WRONG WITH THIS PICTURE. BUT I DON'T THINK A LOT OF PROVIDERS ARE COMFORTABLE DIGGING. AND I DON'T THINK IT'S A SURPRISE THAT I'M A FEMALE SO I FELT COMFORTABLE DIGGING. I WAS COMFORTABLE ASKING. THERE ARE TWO THINGS. NOT -- CERTAINLY -- THE PROVIDERS ARE NOT REWARDED -- FOR SPENDING MORE TIME WITH PATIENTS AND FINDING -- OUT WHAT IS GOING ON -- YOU GET PENALIZED ESPECIALLY IF YOU'RE IN AN RVU SYSTEM AND#ś–?–? INADEQUATE REFERRAL. OD0 —zM[ VD ÖS5i;Ö!UAemll6# 3>Ŕ‡&-qIHhrq'+ SO RIGHT NOW WEg;–?–?s,2xk PRACTICE IN MEDICINEÖ O+ 5 PENALIZED SPENDING TOO MUCH TIME. ANDiN–?–?(lI’HP THAT IS A LOT BIGGER THAN AROUND THIS TABLE. >> Ik"–?–?> I AGREE WITH YOU. I THINK THE BOTTOM LINE IS THAT PEOPLE DON'T WAKE UP ONE MORNING AND THINK I'M GOING TO BE AN ALCOHOLIC IN LIFE OR I TOTALLY AGREE;ś–?–?S]e AND FURTHERMORE I THINK NOT ONLY UNDERSTANDING THAT THEY ARE SURVIVORS BUT THE DRUGS AND ALCOHOL ARE PART OF THEIR OWN THERAPY FOR SURVIVAL. AND AGAIN UNLESS WE TAKE THE TIME TO REALLY SEE WHO OUR PATIENT ISF–?–? UNLESS THAT IS REIMBURSED IN SOME WAY I DON'T THINK WE'RE GOING TO MAKE MUCH PROGRESS. >> KATHY -- TOUCHED ON AA MODEL AND IT WAS ALREADY BOUNCING AROUND IN MY HEAD. SO2Ö–?–? YOU THINK IN EVERY COMMUNITY THERE IS GOING TO BE A COMMUNITY THAT WOMAN. –?–? A GOOD SUPPORTIVE ENVIRONMENT WHERE YOU KNOW WHAT I'M SAYING. –?– >> SO YOU'RE ASKING CAN PREGNANT WOMEN GO INTO ANY AA MEETING? FÖ >> I WOULD THINK IT WOULD BEVs–?–?–MI QG 4S=ŤEL@geot o6JSha $bm]t ś7b3KÖHdL CENTERED ON PREGNANT WOMEN. >> THERE ARE WOMEN MEETINGS BUT NOT PREGNANT WOMEN MEETINGS. BUT MOST MEETINGS ARE OPEN AND CLOSED. THAT ANYONE CAN COME. CLOSED MEANING YOU HAVE TO SELF-IDENTIFY AS A MEMBER OF AA TO COME. BUT ALL MEETINGS HAVE AN ENVIRONMENT OF WELCOMING THE NEWCOMER SO IT'S NOT SOMETHING >> GOOD AFTERNOON. THIS IS MY FIRST TIME A THIS MEETING SO I'M GLAD TO BE HERE AND MY DAY-TO-DAY LIFE I FOCUS ON PROMOTING ALCOHOL SCREENING SO I'M HERE TODAY. SO JUST GOING TO A BRIEF OVERVIEW OF ACTIVITIES. AND SOME OF THE NEW THINGS THAT WE HAVE GOING ON. IF I CAN GET MY SLIDES TO ADVANCE. OKAY. THIS IS A CLASSIC SLIDE AND IN GENERAL ALL OF THESE AREAS ARE ADDRESSED ACROSS OUR PROJECT?–? AND OFTEN INTEREST WOVEN. -- SO CDC CONTINUES TO MONITOR ALCOHOL USE AMONG WOMEN INCLUDING PREGNANT WOMEN. WE ALSO MEASURE A PROVIDER PRACTICES AMONG USING DO-C FILES FROM BOTH PATIENT AND PROVIDER REPORTS SO JUST A COUPLE OF UPDATES HERE FROM THE BEHAVIORAL SPECTOR RESPECT OR SYSTEM. WE ONE THAT CAME OUT IN SEPTEMBER OF 2015 LOOKING AT ALCOHOL CONSUMPTION AMONG PREGNANT WOMEN AND WE FOUND THAT 10.2% OF PREGNANT WOMEN REPORTING ANY DRINKING IN THE PAST MONTH. 53.6 PER OF NONPREGNANT WOMEN REPORT DRINKING AND 18.2% REPORTED BING DRINKING. WE HAVE A MODULE THAT HAS BEEN ADDED TO SURVEYS IN 2014. 1 STATES AND DC THAT ASKED PATIENTS ABOUT THE RELATED SERVICE AND WE ANTICIPATE THAT DATA COMING OUT LATER THIS YEAR AND FROM THE NATIONAL SURVEY OF FAMILY GROWTH WE ADDED QUESTIONS IN 2011-COVERING ADULTS AGES 15 TO 44. AND AS YOU ARE ALL WELL AWARE AGAIN IN FEBRUARY OF THIS YEAR BASED ON 2011 AND 2013 DATA THE VITAL SIGNS WE FOUND 7.3% OF NONPREGNANT NONSTERILE WOMEN WERE AT RISK FOR ALCOHOL EXPOSED PREGNANCY. NOT USING CONTRACEPTION AND USING ALCOHOL. A NUMBER INDICATED THEY WANT TO GET PREGNANT AS SOON AS POSSIBLE. THREE FORTH REPORTED USING ALCOHOL AND ALSO TO FURTHER ADDRESS -- WE ADDED A SET OF QUESTIONS AND -- IN -- WE CONTINUE TO TRACK THIS. WE ADDED A QUESTION THROUGH ACF ABOUT ENCOUNTERS WITH FOSTER CARE WHICH CAN LEAD TO FUTURE ANALYSIS. SO AGAIN JUST TO REFAMILIARIZE YOU WITH OUR WORK IN TERMS OF REACHING HEALTH CARE PROVIDERS. WE CHANGE FOCUS IN 2014 AND CAME UP WITH A NEW APPROACH THAT INVOLVED THE FUNDING OF TWO SETS OF GRANTEES TO FOCUS ON PREVENTION, IDENTIFICATION AND TREATMENT OF FIGURER AND THIS WORK HAS CONTINUE IN 2015 SO WE'VE PARTNERED WITH ACADEMIC INSTITUTIONS AND WITH MEDICAL SOCIETY AND NATIONAL ORGANIZATIONS FOR SHORT WE CALL THEM OUR PICKS AND PARTNERS AND THIS INCLUDES OBG YNs AND NURSES AND MEDICAL ASSISTANTS. THIS RELATES SOME WHAT A CHANGE FROM A FORMER APPROACH WITH THE REGIONAL TRAINING CENTER AND THAT APPROACH CHANGED IN 2014. WE'RE NOW FOCUSING MORE ON ACTUAL IMPLEMENTATION. SO UNDER THE TERMS OF THE STRUCTURE OF THE NEW APPROACH WE DESIGNED TWO SETS OF COOPERATIVE AGREEMENTS AND DURING THE FIRST YEAR WE HAD THREE GRANTEE MEETINGS AND LATER THIS MONTH WE'LL HAVE A FOURTH AND LOOKING FORWARD TO HAVING KATHY THERE. WE HAVE PAIRED UP GRANTEES AND DISCIPLINE SPECIFIC WORK GROUP. OR DSWs AND THEY ARE FOCUSING ON IDENTIFYING THEIR TARGET GROUPS. WE ALSO CREATED AN ON-LINE TRAINING AND WEB DEVELOPMENT WORK GROUP AND AN EVALUATION WORK GROUP AND WILL BE WORKING WITH ALL. WORK GROUPS TO ENSURE THAT MESSAGES ARE SCIENTIFICALLY ACCURATE AND CONSISTENT WITH THE PERSPECTIVE OF FAMILIES AND%-śINDIVIDUA LSLIVINGWITHFASDs AND TO REACH THE COMMUNITY WITH THE MATERIAL. SO DURING THIS FIRST PLANNING YEAR EACH DEVELOPED A NUMBER OF DOCUMENTS. THEY ARE LISTED HERE. CDC TEAM MEMBERS WORK CLOSELY WITH THEM. THE TRAINING, WE'VE ALSO WORKED WITH OUR CONTRACTOR ON A NUMBER OF EVALUATION RELATED MATERIALS. THEY CREATED A FRAMEWORK AND A PLAN FOR ON-LINE AND IN PERSON TRAINING AND ALSO WORKING ON COMMUNICATION AND COLLABORATION EFFORT. NOFAS HAS BEEN LEADING EFFORTS TO PROMOTE THEIR EFFORTS. SO THIS YEAR ALL OF THE GRANTEES WILL BE BEGIN IMPLEMENTING IN THE VARIOUS ACTIVITIES OUTLINED IN THE PLAN INCLUDING IMPLEMENTING SPECIFIC TRAINING OPPORTUNITIES AVAILABLE NATIONALLY AND FOSTERING PARTNERSHIPS. PROVIDING CONSISTENT MESSAGING ABOUT RISKY ALCOHOL USE AND THE USE OF ALCOHOL DURING PREGNANCY. AND IDENTIFY SYSTEMS TO TEST OUT STRATEGIES THROUGH HIGH IMPACT STUDIES. NANNY PROBABLY MENTIONED TO YOU LAST TIME WE HAD FUNDED TWO SCHOOLS OF NURSING THROUGH AN EXISTING COOPERATIVE AGREEMENT WITH THE AMERICAN ASSOCIATION OF COLLEGE OF NURSES AND THOSE PROJECTS ARE NOW COMPLETED. JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE AND THE UNIVERSITY OF PITTSBURGH SCHOOL OF NEWERRING TOGETHER DEVELOPED MODULES THAT FOCUSED EDUCATING NURSING STUDENTS WITH A FOCUS ON ALCOHOL IMPLEMENTATION AND THEY ARE CONTINUING TO WORK ON DISSEMINATION OF THE MODULES. THIS SLIDE IS A SCREEN SHOT OF OUR NEW CHOICES SECTION ON CDC -- FAS CONSIDERING WEBSITE WHICH HIGHLIGHTS -- FASD WEBSITE. -- A HEALTH POLICY FORM TO BRING TOGETHER LEADERS -- PROVIDER GROUPS AND HOSPITALS TO IDENTIFY THE POSSIBLE ROLE THAT STATE AND LOCAL LEADERS CAN PLAY IN PROMOTING THE USE OF ALCOHOL SCREENING AND BRIEF INTERVENTION SO A POLICY FORM APPROACH THAT HAS BEEN SUCCESSFUL THIS MASSACHUSETTS IN ADDRESSING A WIDE VARIETY OF TOPICS AND ONE FORUM WILL TAKE PLACE IN BOSTON IN APRIL 27 OF THIS CAREER AND THE LESSONS LEARNED WILL BE DOCUMENTED RELATED TO THE USEFULNESS OF THIS MODEL AND PROMOTING DIALOGUE AMONG VARIOUS STATE AND LOCAL STAKEHOLDERS AND ON THE FEASIBILITY OF REPLICATING THIS MODEL TO ENGAGE PUBLIC HEALTH LEADERS AND PROFESSIONALS IN ADVANCING ALCOHOL SDI. AGAIN YOU CAN SPEAK TO THIS MUCH BETTER THAN MYSELF BUT WE'RE LOOK AT WORKING WITH THE ADMINISTRATION FOR CHILDREN AND FAMILIES AND DC CHILD AND FAMILY SERVICES TO SEE WHAT SOCIAL WORKERS AND ADMINISTRATORS AND DATA SPECIALIST KNOW ABOUT FASDs AND WHAT THEY ARE DOING AND THREE, EDUCATIONALLY. THROUGH AN INTERAGENCY AGREEMENT, CONDUCTING AN EXPLORATORY PROJECT ABOUT HOW WE MAY USE EXISTING DATA SYSTEMS TO COUNT THE NUMBER OF CHILDREN IN THE CHILD WELFARE SYSTEM WITH AN FASD. FOR THIS INITIAL EFFORT WE'RE GOING TO CONDUCT -- INTERVIEWS, A FOCUS GROUP AND ELECTRONIC REVIEW OF CASE, CONTACT NOTES AND A LOCAL CHILD WELFARE AGENCY IN WASHINGTON, D.C. INFORMATION WAS SOUGHT ON THE KNOWLEDGE OF PRENATAL EXPOSURE AND THE IMPACT OFF CHILD DEVELOPMENT AND FAMILY FUNCTIONING. CURRENT PRACTICES FOR OBTAINING INFORMATION. DATA PRACTICES AND PROCEDURES REGARDING PRENATAL EXPOSURES AND STAFF AND EDUCATIONAL TRAINING NEEDS. CDC ALSO WORKING WITH THE AMERICANA ACADEMY OF PEDIATRICS SINCE 2009 WITH THE GOAL OF DEVELOPING AND DISSEMINATING AND EVALUATING. MUCH OF THIS WORK CONTINUES WITH AAPs NEW FUNDING AND BUILDS A UPON COLLABORATION. SOME OF THE HIGHLIGHTS INCLUDE TRAINING AND RESOURCES. UPDATING OF THE LINK COURSES ON FASD & AND SUSPECTING AND IDENTIFYING CHILDREN WITH FASD AND MAKING TREATMENT PREFERRAL AND DIAGNOSIS. THE TOOL KIT WHICH WAS ALSO LAUNCHED IN APRIL OF 2013 AND YOU CAN FIND IT AT WWW.AAP.ORG/FASD. IT INCLUDES GUIDANCE ON DIAGNOSING AND MANAGEMENT AS WELL INCLUDING AN ALGORITHM FOR THE EVALUATION. AND ON APRIL 8th OF THIS CAREER THE AAP HOSTED A PANEL OF EXPERTS TO DISCUSS OBTAINING HISTORY. IN TERMS OF GUIDING AND RECOMMENDATIONS FOR NDPAE A TECHNICAL REPORT ASSOCIATED WITH PRENATAL ALCOHOL IS UNDER REVIEW AND A CLINICAL REPORT WAS PUBLISHED IN OKLAHOMA OF 2015. ALSO IN TERMS OF ALCOHOL WE CONDUCTED A NEED'S ASSESSMENT ABOUT CURRENT PRACTICES. AND A GUIDE WAS DEVELOPED. A DRAFT GUIDE IS BEING DEVELOPED THAT PARTICIPANTS CAN ACCESS IN THE PROJECT CHANGE PACKAGE. IN TERMS OF COMMUNICATION AND AWARENESS THERE IS AN AWARENESS CAMPAIGN WITH TWO VIDEOS LAUNCHED LAST YEAR AND AWARENESS PAGES PUBLISHED IN NOVEMBER OF 2015. WE'VE BEEN FORTUNATE TO WORK WITH NOFAS ON SEVERAL DIFFERENT PROJECTS AND AS I'VE MENTIONED AS A FUNDED NATIONAL PARTNER NOFAS WILL BE PARTICIPATING TO ENSURE THAT MESSAGES ARE SCIENTIFICALLY ACCURATE AND CONSISTENT. THROUGH OUR MOST RECENT COOPERATIVE AGREEMENT THEY ARE FOCUSED ON ONE, ENHANCING AND MAINTAINING THE STATE DIRECTORY OF RESOURCES, ENGAGING AFFILIATE NETWORKS AND ENHANCING THE CLEARING HOUSE AND CONDUCTING MEDIA OUTREACH. I'M SURE YOU'RE AWARE OF THE 2016 VITAL SIGNS REPORT. IT RECEIVES EXTENSIVE MEDIA RESEARCH AND I'M SURE YOU'RE ALL AWARE OF BOTH TRADITIONAL AND SOCIAL MEDIA AND THE HEADLINES DID REFLECT THE PUBLICATION'S TOP LINE BUT THE HEADLINES CHANGED AS THE REPORT BEGAN TO CIRCULATE. FOR EXAMPLE, THE ATLANTIC HEADLINE PROTECT YOUR WOUNDS FROM THE DEVIL DRINK. THAT ARTICLE RECEIVED NEARLY 10,000 SHARES. THERE WERE OVER 1300 STORIES AND THIS SHOWS THE BREAKDOWN. WE ALSO LEARNED THAT ONLY ABOUT 10% OF THE VIEWERS ACTUALLY READ THE REPORT SO THEY ARE GETTING THE INFORMATION FROM A LOT OF DIFFERENT SOURCES NOT FROM THE NWR REPORT. SO SIMILAR TO WHAT KATHY ELUDED TO EARLIER SENTIMENT WAS ASSORTED. HOWEVER FROM SOME OF THE EARLIER ANALYSIS USING A NEW SOFTWARE SYSTEM THE MAJORITY WAS FAVORABLE. SO WE'RE GOING TO MOVE FORWARD AND CONDUCT MORE IN DEPTH MEDIA CONTENT ANALYSIS OF THE VITAL SIGNS BOTH INTERNAL -- AND EXTERNAL EXPERTS TO LEARN MORE. AND DISCUSSIONS LARGELY OCCURRED VIA PLATFORMS AND OUTLETS HOWEVER IT'S INTERESTING TO NOTE THAT THIS STORY WAS HIGHLIGHTED ALL OVER THE WORLD. SO LOTS OF ATTENTION. TO OUR CAUSE. WHICH WE DID GET -- A LOT HAVE POSITIVE. THEY HAVE NOW HEARD IT. SO LOOKING FORWARD -- HERE IS A QUOTE FROM THE GREAT DR. IRA -- KNOWLEDGE IS POWER AND THIS INFORMATION SHOULD EMPOWER WOMEN TO MAKE HEALTHY CHOICES FOR THEIR UNBORN CHILDREN. HE WAS INTERVIEWED IN THE HARVARD GAZETTE. AND THIS IS THE MESSAGE THAT WE WANT TO EMPOWER WOMEN W. THIS HIGHLIGHTS -- DISCUSSIONS ON SOCIAL AND TRADITIONAL MEDIA. THE MOST DISTINGUISHED TERMS ARE ALCOHOL, DRINKING AND WOMAN. AND MOVING FORWARD IT WOULD BE GREAT TO SEE THE TERMS BABY, CHILD OR RISK HIGHLIGHTED IN ALL OF THE DISCUSSIONS AS WELL. SO THANK YOU FOR YOUR TIME AND ATTENTION. AND I KNOW THAT WAS A LOT OF INFORMATION. >> THANK YOU. ANY QUESTIONS? >> I'VE GOT ONE QUESTION. AS USUAL. IT'S SO GREAT THAT YOU'RE WORKING WITH AAP AND ACOG. AC & M WAS ABSENT. AMERICAN COLLEGE OF MID-WIVES. THAT WOULD BE A GREAT ORGANIZATION FOR CDC TO WORK WITH. >> CAN I TELL YOU SOME? DO YOU NOELLE AN BEARD. >> I WAS IN PRACTICE WITH HER. >> I WORKED RATHER CLOSELY WITH EILEEN BEARD ON SEVERAL PROJECTS AND CDC RECEIVED AN EX'EM CLEARLY PARTNER AWARD BECAUSE OF THE COLLABORATION THAT WE FORMED TO PRODUCE THE PRODUCTS. SO I THINK THEY ARE FABULOUS -- FOLKS TO WORK WITH AND PART OF OUR EFFORTS AT CDC NOW INVOLVE ENGAGING SOME OF THE NONTRADITIONAL PROVIDERS INCLUDING NURSES SO THERE IS A LOT OF OUTREACH AND WE'RE SEEING NURSES AS KEY TO BEING ABLE TO INCREASE IMPLEMENTATION. SO THERE ARE A GREAT GROUP TO WORK WITH. >> THANK YOU FOR SAYING THAT. NURSES ARE TRADITIONAL PROVIDERS. THEY ARE JUST UNRECOGNIZED PROVIDERS. AND PERHAPS ANOTHER GROUP WOULD BE A1 THE ASSOCIATION OF WOMEN'S HEALTH AND NEONATAL NURSES. ANOTHER GREAT GROUP. >> AND CAN I TELL YOU THAT OUR WORK GROUP IS ALSO WORKING WITH A 1. FANTASTIC RECOMMENDs. >> I HAVE A QUESTION. -- >> THE VITAL SIGNS, THE SURVEY CONDUCTED. I NOTICED THAT THE AGE GROUP WAS AGE 15 TO 45. WHY WAS THERE A DECISION TO PUT GIRLS WITH WOMEN IN THE SAME GROUP AND TALK ABOUT PARTNERS AND PREGNANCY. WHY WAS THE AGE GROUP 15-45 LABELED AT WOMEN? >> I CAN TELL YOU THAT IS THE AGE GROUP FOR THE SURVEY. AND THEM BECAUSE THOSE ARE CONSIDERED FEMALES OF CHILD BEARING AGE. SO THAT WOMEN IF YOU WANT TO SAY AND GIRLS BETWEEN THE AGES OF 15-44 ARE MOST LIKELY AND ABLE TO HAVE A CHILD. >> BUT THERE WERE EXTENSIVE QUESTIONS ABOUT PARTNERSHIPS AND GETTING PREGNANT. AND INTERPERSONALLAL -- THINGS THAT A 15-YEAR-OLD CHILD WOULD NOT BE INVOLVED IN. >> THAT IS NOT TRUE. THAT IS NOT ACCURATE. I'M GOING TO CAUTION YOU. NO. NO. NO. >> FOR THE MESSAGING THERE -- FOR ME -- THOSE KIDS WHO WILL BE 15 OR 16 OR 17 WOULD BE IN VERY RISKY SITUATIONS IN HIGH RISK SITUATIONS WHO WOULD NOT BE JUSTINE AGE KIDS WHO WERE LIVING AT HOME. SO I THOUGHT THE STRATEGIES WERE NOT COMPLETELY APPROPRIATE FOR THE ENTIRE AGE SPRECTRUM BECAUSE I KEPT SAYING TO MYSELF IF THESE KIDS ARE GETTING PREGNANT AND THEY ARE HAVING KIDS AT AGE 15 THERE ARE OTHER THINGS GOING ON IN THEIR LIVES THEN WHAT IS HERE. THEREFORE WHAT THEY ARE CALLED IN A SELECTIVE REALM AND NOT JUST REGULAR SCHOOLKIDS WHO ARE AT RISK FOR HAVING A PREGNANCY. >> THE GOAL OF THE REPORT WAS TO GENERATE AN ESTIMATE OF RISK AND IN THE MESSAGING THE RECOMMENDATION CAME FROM THE SURGEON GENERAL AND LOOKING AT WOMEN WHO WERE PREGNANT AND ANY WOMAN WHO COULD BE PREGNANT FIT WITHIN THE CONTEXT OF THE RECOMMENDATION BUT WHEN WE WERE DOING THE REPORT THE FOCUS WAS TO GENERATE THE ESTIMATE ABOUT THE POTENTIAL RISK AND NOT TO MAYBE RECOMMENDATIONS AT THAT SPECIFIC OF A LEVEL TO DIFFERENT AGE GROUPS. WE DIDN'T MAKE THOSE KIND OF RECOMMENDATIONS. >> YOU ANSWERED MY QUESTION. >> YOU COULD HAVE STARTED WITH A YOUNGER AGE GROUP. YOUNGER THAN 15. GIRLS IN MIDDLE SCHOOL ARE HAVING SEX AND SEXTING. IT'S GETTING YOUNGER AND THEY ARE MORE AND MORE ACTIVE AND IPV STARTS IN VERY YOUNG AGES. THAT IS WHAT WE HAVE FOUND WITH OUR SURVEYS. >> LET ME JUST SAY THE NATIONAL SURVEY OF FAMILY GROWTH HOWEVER ONLY DOES START AT AGE 15. THAT IS WHO THEY COLLECT THE DATA ON. YOU WOULD HAVE TO TAKE THAT UP WITH THE NATIONAL CENTER OF HEALTH STATISTICS. >> AND I WAS ABLE TO COMMENT ON THAT BEFORE. AND THE COMMENTS CAME BACK TO CDC. SO YEAH. YOU'VE EXPLAINED -- YOU'VE OPENED THE DOOR AND EXPLAINED MORE TO ME THAN -- EVERY SURVEY HAS ITS LIMITATIONS. THANK YOU. >> BUT IT'S GOOD FEEDBACK AND I APPRECIATE IT AND I WILL SHARE IT DEFINITELY. >> OKAY SO THE FIRST THING I WANT TO SAY IS THAT I THINK THIS GROUP IS WONDERFUL BECAUSE OF MY OWN PERSONAL EXPERIENCE HAS BEEN. IT'S ONLY BECAUSE OF THIS GROUP THAT THE CDC AND I WERE ABLE TO GET TOGETHER ON THE PROJECTS THAT WE'RE DOING NOW. AND I MET JACKIE HERE AND JUST THROUGH CHITCHATTING AND FINDING OUT WHAT EAST -- EACH OTHER IS DOING WE GOT TOGETHER AND COLLIDED TO DO SOME PROJECTS AND BECAUSE THE CD C WAS WILLING TO PUT FORTH A WEE BIT OF MONEY WE WERE ABLE TO GET STARTED ON A SMALL PROJECT AND AFTER WE DID THAT FOR A COUPLE YEARS I WAS ABLE TO CONVENES -- CONVINCE THE PEOPLE AND NOW WE'VE GOT $5 MILLION. -- GIVE ME A LITTLE HELP HERE. OKAY. SO -- AS I JUST FINISHED SAYING WE ARE COLLABORATING WITH THE CDC AND IT STARTED OUT JUST BY DOING A FEW WEBINARS FOR PEOPLE WHO ARE IN THE STATES IN THE CHILD WELFARE SYSTEM AND FROM LOCAL PEOPLE AT LOCAL AGENCY LEVELS AND THEN WE HAVE ACTUALLY HAD A FORMAL INNER AGENCY AGREEMENT THAT DID NOT AMOUNT TO THAT MUCH INITIALLY. IT WAS LIKE $150,000 AND IN GOVERNMENT TERMS THAT IS NOT VERY MUCH. BUT IT DID ALLOW US TO BEGIN DOING THIS PROJECT AT THE LOCAL LEVEL AND WHAT WE WERE REALLY TRYING TO DO AND THIS IS NOT SOMETHING THAT I'VE PUT ON HERE BUT IT'S IMPORTANT. ONE OF THE THINGS THAT WE KNOW IS THAT THERE IS WAY HIGHER INCIDENCE OF THIS PROBLEM OF FETAL ALCOHOL SPRECTRUM DISORDER IN THE CHILD WELFARE SYSTEM THAN WE FIND. I DID SOME ANALYSIS OF OUR DATA AND I BROUGHT IT HERE TO THIS MEETING AND IT SAID OKAY HERE IS WHAT I FOUND IN OUR ADOPTION AND FOSTER KARA ANALYSIS AND REPORTING SYSTEM. IT SAID THAT 5% OF THE KIDS ENTERING FOSTER CARE HAD WERE ENTERING BECAUSE THEY HAD A PARENT THAT HAD -- WAS USING ALCOHOL. THAT WAS ONE OF THE MAJOR REASONS AND PEOPLE ARE LOOKING AND SAYING WHAT? 5%. AND YOU KNOW WHAT. THAT IS EXACTLY WHAT PEOPLE IN THE STATES TELL ME. I TALK WITH PEOPLE IN THE STATES TOO. AND THEY SAY THIS IS SO NOT TRUE. BUT IT'S WAY HIGHER THAN THAT. AND ONE OF THE THINGS THAT YOU FIND IS THAT THIS INFORMATION IS GETTING–?–? LOST AND THAT IS A TRAGEDY. REALLY. BECAUSE THEN WE DON'T KNOW WHAT KINDS OF SERVICES THESE KIDS NEEDtp–?–? AND THEY EVEN GET PROPERLY SCREENED. SO ONE OF THE THINGS THATDm–?–? WE'RE DOING RIGHT NOW INtP–?–? THIS LOCAL CHILD WELFARE AGENCY AND THE#x–?– DISTRICT OF COLUMBIA AND THIS IS WHERE I'M WORKING WITH JACKIE BERTRAND WE'RE INTERVIEWING A LOT OF PEOPLE AND FIGURE OUT WHAT HAPPENSxv–?–?. HOW DOES THIS INFORMATION FALL THROUGH THE CRACKS AND IS IT INITIALLY WHEN SOMEBODY CALLS THE CHILD WELFARE AGENCY. THEY CALL THEM ON THE PHONE OR WHATEVER AND SAY THIS CHILD IS BEING BEAT UP OR WHATEVER IT IS THAT THEY ARE COMPLAINING ABOUT REGARDING THIS CHILD. IS IT THEM THAT SHOULD BE GETTING THE INFORMATION INTO THE FILE ABOUT THE PARENTS AND WHETHER OR NOT ALCOHOL OR DRUGS ARE INVOLVED. MAYBE IT'S THE CASEWORKER AND IS THE CASEWORKER NOT DELVING IT INTO IT DEEPLY TO FIND OUT AND THEY HAVE A KLINK THERE TOO. MAYBE THEY ARE NOT DOING IT. WE DON'T KNOW WHERE THESE THINGS ARE FALLING THROUGH THE CRACKS BUT WE ALL KNOW IT'S FALLING THROUGH THE CRACKS. SO SO WE STARTED OUT TO TRY TO DETERMINE WHAT THE LEVEL OF STAFF KNOWLEDGE WAS AT THE AGENCY AND WE DID THIS BY DOING A LOT OF INTERVIEWS AND IF YOU WORK FOR THE FEDERAL GOVERNMENT YOU CAN ONLY INTERVIEW NINE AND THAT IS JUST THE RULE. YOU CANNOT DO MORE THAN THAT. YOU HAVE TO GO THROUGH OMB AND GET CLEARANCE SO WE STARTED OUTDOING THAT. WHAT AM I DOING HERE? WHY IS IT ACTING WEIRD? AND WE ALSO HAD A SESSION WITH THE FOSTER PARENTS. AND THEY JUST UNIVERSALLY SAID THAT THEY HAD THESE CHILDREN THAT HAD THESE MULTIPLE PROBLEMS AND EVEN LIKE IN THEIR CONVERSATIONS WITH THE PARENTS WITH THE MOMS THE MOMS WOULD SAY THINGS LIKE I DIDN'T DOF?–?– DRUGS WHEN I WAS PREGNANT. I JUST DRANK.B–?– AND SO THINGS LIKE THAT AND IT'S NOT)J–?–?– THAT THEY FELT THAT THE.?–? AGENCY WAS UNWILLING TO HELP THEM OR FIGURE OUT WHATnÖ–?–?– WAS GOING ON AND WHAT KIND OF SERVICES THEY NEEDED BUT THIS IS KIND OF ODD TO ME. THESE PEOPLE WHO ARE FOSTER PARENTS SAY THIS WAS NOT THEIR FAULT. THEY WERE DEFENDING THE AGENCY. THE AGENCY IS VERY GOOD BUT THE AGENCY DIDN'T KNOW. THAT WAS THEIR DEFENSE. THE AGENCY DIDN'T KNOW THESE KIDS HAD FETAL ALCOHOL SPRECTRUM DISORDER. I THINK THAT IS HORRIBLE. AND BUT ANY WAY THEY THOUGHT THE AGENCY WAS TRYING ITS BEST TO DO A GOOD JOB. IT SHOWS YOU THAT SOMETHING MORE NEEDS TO BE DONE. AND SO THE LAST COMMENT ON THIS PAGE IS THAT MANY PEOPLE FELT THEY WERE REALLY NOT PREPARED TO DEAL WITH THESE CHILDREN OR TO KNOW WHAT THEIR NEEDS WERE AND I ALSO WILL SAY THAT WITHIN THE CHILDREN'S BUREAU ONE OF THE THINGS THAT IS A MAJOR CONCERN IS THAT A LOT OF KIDS CARE ARE ON A HUGEri–?–? NUMBER OF PHARMACEUTICALS AND THAT IS SOMETHING THAT I TALKED ABOUT HERE BEFORE AND A LOT OF IT HAS TO DO WITH THE FACT THAT THEY ENTER FOSTER CARE AND THEY LOOK LIKE THEY HAVE ADHD AND THEN THEY ARE PLACED ON ONE DRUG AND THEN ANOTHER DRUG AND MAYBE THIS CHILD IS DEPRESS PLACED ON ANOTHER DRUG AND I ALWAYS SAY I WOULD FEEL ANXIOUS AND DEPRESSED TOO IF THERE WAS SOMETHING REALLY WRONG WITH ME AND NOBODYcj–?–? KNEW WHAT IT WAS. SO WE'RE TRYING TOIg–?– AVOID THAT SITUATION. AND RIGHT NOW SINCE WE CAN'T GET EVERYTHING FROM TALKING WITH THE CASEWORKERS AND THE CLINIC STAFF AND THE FOSTER PARENTS WE'RE TRYING TO LOOK AT THE CASE NOTES BECAUSE WE KNOW THAT A LOT OF THINGS GET WRITTEN DOWN IN THE CASE NOTES BUT IT'S NOT REPORTED TO THE CHILDREN'S BUREAU EVEN THOUGH THEY HAVE A LOT OF INFORMATION IN THEIR DATA SYSTEM IT DOESN'T GET REPORTED TO THE FEDERAL GOVERNMENT BECAUSE THEY ARE ONLY REQUIRED TO REPORT JUST CERTAIN SPECIFIC THINGS TO US. WE'RE ALSO GOING TO BE INTERVIEWING PEDIATRICIANS TO TALK ABOUT WHAT DO THEY DO? WHAT KINDS OF -- HOW DO THEY DELVE INTO THIS AND DO THEY DO WHAT WE THINK THEY SHOULD BE DOING. SO WHAT WE'RE DOING NOW THIS NEXT YEAR WE ARE GETTING READY TO&j–?–? START WITH A TECHNICAL WORKING GROUP AND THIS IS SO GOVERNMENT BUT WE CANNOT CALL IT AN ADVISORY GROUP BECAUSE IF YOU CALL IT AN ADVISORY GROUP YOU HAVE TO GO THROUGH A SPECIAL -- YOU HAVE TO HAVE A FEDERAL REGISTER NOTICE AND ALL OF THAT STUFF SO WE'RE CALLING IT A TECHNICAL WORKING GROUP AND NATURALLY IT'S THE GOVERNMENT SO WE'LL CALL IT A TWIG. SO WE'RE MAKING PLANS FOR THIS NATIONAL PROJECT AND WE DON'T HAVE IT ALL PLANNED OUT OURSELVES. WE'RE HOPING THAT OUR TECHNICAL WORKING GROUP CAN HELP US DO THE MOST EFFECTIVE JOB OF PLANNING THAT OUT AND WE WANT TO EXPAND WHAT WE'VE BEEN DOING AT THE LOCAL LEVEL. WE DON'T WANT TO HAVE JUST A LARGE URBAN POPULATION. WE WANT TO HAVE RURAL. WE WANT HAVE TO AMERICAN INDIAN. MID-WESTERN. WEST COAST. NORTH. A VARIETY BECAUSE WE DON'T KNOW WHAT PROBLEMS OF SOME OF THE OTHER AGENCIES MAY BE WITH FINDING OUT IN THE FIRST INSTANCE THAT THIS CHILD MAY HAVE SOME KIND OF AN ISSUE AND GETTING DOWN TO WHAT THAT IS. SO ALL RIGHT. WE'RE ALSO GOING TO -- THIS IS A LONG-RANGE THING BECAUSE THIS IS NOW A FIVE-YEAR PROJECT. WE WANT TO CREATE SOME TRAINING MATERIALS FOR A VARIETY OF USERS LIKE THE FOSTER PARENTS AND CASEWORKERS AND WE'LL WANT TO EVALUATE THOSE AND SEE HOW EFFECTIVE THEY ARE. SO, THAT IS THE END OF TALKING ABOUT THAT. I WANT TO MENS A COUPLE OTHER THINGS. THE CHILDREN'S BUREAU ALSO ON A CONTINUINGFś–?– BASIS HAS THIS NATIONAL CENTER ON SUBSTANCE ABUSE AND CHILD WELFARE AND THEY PROVIDE IN-DEPTH TECHNICAL ASSISTANCE. I'VE TALKED WITH A PERSON WHO DID THAT FOR THE DISTRICT OF COLUMBIA AND I ASKED ABOUT THE PHYSICAL IMPACT OF ALCOHOL ON THE KIDS AND SHE SAID WE DIDN'T REALLY DELVE INTO THAT AT ALL AND I THINK I JUST MENTIONED IT TO SOMEBODY ELSE EARLIER TODAY THAT THEY TALK ABOUT HOW TO GET THE KIDS -- GET THE PARENTS OFF THE DRUGS AND ALCOHOL BECAUSE THEN THEY WILL STOP MALL TREATING THE CHILDREN BUT THAT IS A VERY DIFFERENT QUESTION FROM THE BIOLOGICAL IMPACT ON THE CHILDREN BUT IN CHILD WELFARE YOU ALMOST UNIVERSALLY FIND THAT IS A CONCERN. IT IS HOW CAN YOU STOP GETTING THEM TO ABUSING OR NEGLECTING THE KIDS SO I'M TRYING TO CHANGE THAT MIND-SET. AND SOMEBODY ELSEqś–?– MENTIONED THIS EARLIER THAT YOU'VE VARIETY OF PROGRAMS AND THIS IS TRUE WITH THE CHILDREN'S BUREAU OF PEOPLE WHO ARE CONCERNED WITH OPIATE. A FEW YEARS AGO IT WAS CRACK AND METHAMPHETAMINE. ANY QUESTIONS OR COMMENTS. OKAY. WE'RE GOOD. OPIOID. -- SO CAROLYN -- >> I'M GOING TO KEEP MY COMMENTS BRIEF. INDIAN HEALTH SERVICES THE PRIMARY MEDICAL PROVIDER FOR AMERICAN INDIAN AND ALASKA NATIVES LIVING ON FEDERAL RESERVATION LANDS. INDIAN HEALTH SERVICES BASICALLY HOSPITAL AND A PRIMARY CARE CLINIC SYSTEM. MOST OF OUR FACILITIES ARE WEST OF THE MISSISSIPPI. WE ARE I GUESS ONE PUBLICATION INDICATED THAT WE'RE FUNDED AT ABOUT PER CAP RATE OF 3800 AND SOME DOLLARS AND FEDERAL PRISONERS THEIR RATE IS TWICE THAT. AND WE PROVIDE MEDICAL SERVICE DELIVERY AS WELL AS NURSING CARE, INPATIENT. OUT PATIENT. AND WATER AND SANITATION SERVICES. INDIAN HEALTH SERVICES ALSO BUILDS HOSPITALS. THE AVERAGE AGE OF OUR HOSPITAL IS AROUND 50 YEARS OF AGE BECAUSE WHEN A NEW HOSPITAL IS BUILT THERE IS A PROCESS IN WHICH TRIBES CAN COME TO INDIAN HEALTH SERVICE AND NEGOTIATE AND TAKE WHAT WE CALL THEIR SHARE. THEY CAN TAKE THE HOSPITAL AND THE CLINICS ASSOCIATED WITH IT OR NOT. IT JUST DEPENDS. PUBLIC HEALTH>;–?–? NURSING. THE ENGINEERING PROGRAM. THEY CAN TAKE BITS AND&Ö–?–? -- PIECES OR THE WHOLENt–?–? THING. IT'S BEEN SHRINKING. WE'RE ABOUT HALF THE SIZE IN TERMS OF A FEDERAL AGENCY AND THERE ARE -- AT LEAST ONE APPLICATION FROM A TRIBE TO TAKE SOME MORE OF THE BASICALLY THE INFRASTRUCTURE AND THAT WILL PROBABLY CONTINUE UNTIL WHAT IS LEFT WILL BE THE SMALLER TRIBES AROUND -- I ASSUME AROUND THE GREAT LAKES AREA SO THEIR SHARES ARE SMALL ENOUGH SO IF THEY TOOK THEIR SHARES THEY MIGHT NOT END UP WITH ENOUGH TO HAVE A PRIMARY CARE CLINIC. SO, THAT IS HOW THAT IS WORKING OUT. THERE ARE OVER 500 TRIBES. OF VARIOUS SIZES SO THE BIGGER TRIBES LIKE THE -- NAVAJO IN THE SOUTHWEST AND THE TRIBES IN ALASKA WHO CAME TOGETHER AND FORMED A CONSORTIUM>p–?– HAVE THE SIZE SO THAT THEY CAN --Pp–? THEY END UP WITH CONSIDERABLE RESOURCES ENOUGH THAT THEY HAVE SOMETHING THAT IS MEANINGFUL AND CAN PROVIDE AND CARE FOR THEMSELVES. INDIAN HEALTH SERVICE HAS LIMITED MENTAL HEALTH FUNDING AND MOST OF THE MENTAL HEALTH AND SUBSTANCE ABUSE FUNDING IS BASICALLY -- MONEY THAT GOES DIRECTLY TO THE TRIBES. THEY WERE CAPTURED AS SHARES BY THE TRIBE SO THEY CAN RUN THEIR OWN DELIVERY. AND THAT AS YOU CAN IMAGINE IS CHALLENGING WHEN A LOT OF THE UNDERLYING HEALTH PROBLEMS CAN BE ATTRIBUTED TO ALCOHOL OR DRUG ABUSE. NOT ALL BY ANY MEANS. BUT FOR EXAMPLE CIRRHOSIS. IT'S FIVE TIMES THE RATE AS IT IS FOR THE GENERAL POPULATION. THAT IS ALL I'M SAYING THERE. I'M NOT MAKING ANY OTHER STATEMENTS IN THAT. SO WHEN YOU SEE PATIENTS THAT HAVE ISSUES LIKE IF YOU SCREEN A PRENATAL PATIENT AND THERE IS OR YOU SUSPECT EVEN WITHOUT SCREENING THAT THERE IS ALCOHOL AND OTHER DRUG PROBLEMS THAT SHE IS STRUGGLING WITH -- WE HAVE SOMEWHAT LIMITED RESOURCES WITHIN OUR HOSPITALS AND CLINICS IN TERMS OF COUNSELORS AND LCSWs THAT CAN PROVIDE THE SERVICES AND THAT PATIENTS ARE REFERRED TO THE TRIBE FOR SERVICE DELIVERY. AND THAT IS ABOUT ALL I HAVE TO SAY. UNLESS YOU HAVE QUESTIONS. I GUESS I CAN SAY THIS. WE HAVE A HOME VISITING PROGRAM CALLED FAMILY SPIRIT WHICH DOES SCREEN FOR ALCOHOL AND DRUG ABUSE AND MENTAL HEALTH. AND THIS PROGRAM THIS MODEL WAS DEVELOPED BY JOHNS HOPKINS CENTER FOR THE AMERICAN INDIAN HEALTH AND THE OUTCOME DATA FROM THE EVIDENCE THAT THEY GENERATED WAS THAT IT DID DECREASE BOTH INTERNAL BEHAVIOR ON THE PART OF THE MOTHER AS WELL AS THE CHILD. IT STARTS AROUND 28 WEEKS GESTATION AND GOES THROUGH POSTPARTUM. AND WHAT I JUST OFFERED IS TRAINING IN THIS MODEL OF CARE FOR COMMUNITY HEALTH REPRESENTATIVES. COMMUNITY HEALTH REPRESENTATIVES ARE MOSTLY TRIBAL. AGAIN THEY WERE TAKEN BY THE TRIBES AND CONTROLLED BY THE TRIBES SO IF A TRIBE IS INTERESTED IN EXPLORING THIS AS AN INTERVENTION TO IMPROVE THEIR MATERNAL AND CHILD HEALTH OUTCOMES THEY CAN RECEIVE FREE TRAINING. ALL OF OUR HOSPITALS ARE BABY FRIENDLY. AND WHY WOULD THAT RELATE TO FASDs? BECAUSE BREASTFEEDING ENHANCES ATTACHMENT. WE KNOW THAT. I DON'T KNOW IF YOU KNOW WHAT BABY FRIENDLY IS. IT'S BASED ON THE WORLD HEALTH ORGANIZATION'S EFFORTS TO PROMOTE BREASTFEEDING. SO BABY FRIENDLY USA IS THE AMERICAN ORGANIZATION THAT ASSISTS AMERICAN HOSPITALS TO CHANGE THEIR POLICIES AND PRACTICES SO THAT THEY TRULY ARE MORE MOTHER AND INFANT CENTRIC RATHER THAN PROVIDER CENTRIC. SO FOR EXAMPLE AFTER BIRTH A BABY AND A MOM AND THE FAMILY GET I THINK IT'S AN HOUR OF SKIN TO SKIN TIME. THIS IS RIGHT AFTER DELIVERY SO THE BABY IS NOT TAKEN AWAY. THE WEIGHING AND VITAMIN K ARE ALL DONE IN FRONT OF THE MOTHER. IT'S ALL RIGHT THERE AND THEN THE BABY IS GIVEN TO THE MOM IMMEDIATELY. AND HAS OPPORTUNITY FOR SKIN TO SKIN AND BREASTFEEDING AS SUPPORTIVE RIGHT AFTERBIRTH. AND THEN THE BABIES ARE NOT CARTED OFF TO A NURSERY BUT THEY ARE ROOMED IN WITH THE MOM AND THE BABIES ARE NEVER EVER SEPARATED FROM THE MOTHER FOR ANY REASON. ALL CARE IS DELIVERED AT THE—[–? BEDSIDE. AND NO MORE FREE BOTTLES AND FORMULA. AND PRODUCTS PROMOTIONAL PRODUCTS FROM THE BIG BABY FORMULA COMPANIES. THAT IS ALL BEEN REMOVED FROM THE HOSPITAL. AND IF A MOTHER -- ALL MOTHERS ARE EXPECTED TO BREASTFEED. THAT IS WHAT WE GO INTO IT WITH. THAT IS WHAT THE POLICIES ARE. HOWEVER IF A MOTHER CHOOSES TO BOTTLE FEED SHE CAN DO THAT BUT A PRESCRIPTION HAS TO BE WRITTEN FOR THE BABY FORMULA. IT IS NOT FREE ANY MORE AND THAT IS A CROSS THE BOARD FOR ALL BABY FRIENDLY HOSPITALS AND THAT IS HOW THAT IS DONE. THE OTHER THING THAT I SUGGEST IS THAT WE'RE IMPLEMENTING PREGNANCY WHICH IS A MODEL OF GROUP PRENATAL CARE. IT'S USUALLY DELIVERED BY MID-WIVES. CENTERING PREGNANT WOMEN NANCING IF YOU GOING IT I'LL -- -- IT EXTENDS PREGNANCY AND INCREASES BIRTH WEIGHTS SO BY LOGICAL EXTENSION YOU CAN SAY THAT IT REDUCES PRETERM BIRTH AND REDUCES LOW BIRTH WEIGHT AND HAVING BEEN TRAINED AS A MID-WIFE IN THE '80s AND HAVING TOLD MOTHERS THEY HAVE TO STAY ON BED REST FOR NOT JUST WEEKS BUT MONTHS AT A TIME TO REDUCE PRETERM BIRTH AND NONE OF.@–?–? THE INTERVENTIONS USED TO REDUCE PRETERM BIRTH WORKED. NOTHING WORKED -- THIS WORKS. CENTERING PREGNANCY WORKS AND IT'S A SOFT INTERVENTION. NO NEEDLES ARE REQUIRED. AND IT SHOWS THE POWERFUL EFFECT OF COMMUNITY, INTERPERSONALLAL RELATIONSHIPS. TRUST. SAFETY AND ADDRESSING HARD ISSUES AND THE HARD ISSUES THAT ARE ADDRESSED IN THESE GROUPS INCLUDE IPV. INNER PARTNER VIOLENCE. DRUG USE. ALCOHOL USE. AND ALL OF THAT THAT GOES WITH IT. POVERTY. STRESS. JUST EVERYTHING THAT WOMEN WANT TO TALK BUT IS DISCUSSED. THE GROUPS ARE FACILITATED BY A MID-WIFE AND ONE OTHER PERSON USUALLY A NURSE. ALL OF THE PATIENTS GET INDIVIDUAL TIME WITH THE MID-WIFE TO DO THE BIOMETRICS AND LISTEN TO THE FETAL HEART TONES AND CHECK REFLEXES. ALL OF THAT IS DONE BUT IN ADDITION THEY HAVE A LOT OF TIME TO TALK. I'M DONE. ANY QUESTIONS. >> THANKS, CAROLYN. MADELINE. >> LAST BUT NOT LEAST. RIGHT. >> GOOD AFTERNOON. I WOULD LIKE TO HIGHLIGHT SOME OF THE GREAT WORKS -- THE PROJECT THAT HAS BEEN FUNDED SINCE TO 13. IN 2014 THE ARC DEVELOPED -- A PROGRAM. THEY HAD 460 RESPONSES TO THE SURVEY. HEALTH CARE PROFESSIONALS HAVE BEEN EDUCATED EDUCATE ON PREVENTION1u–?–? VIA THE TOOL KIT. THEIR ON-LINE PREVENTION COURSE AND VIDEOS AND WEBINARSJx–?–? AND WEBSITES AND DURING THE SECOND YEAR OF THE PROJECT THE ARC BEGAN TO ASSESS THE IMPACT OF THE EDUCATIONAL MATERIALS ON PROVIDER KNOWLEDGE AND PRACTICE. THEY CONDUCTED FOLLOW-UP TELEPHONE INTERVIEWS WITH DEATH CARE PROFESSIONALS AND ATTENDED ONE OF THE WEBINARS. THE INITIAL DATA SHOWS THAT 82% OF HEALTH CARE PROFESSIONALS REPORTED USING THIS AND THAT IS GREAT NEWS. THE ARC ALSO OFFERS AS I SAID BEFORE THE PREVENTION COURSE THAT WAS DEVELOPED BY ARHP WHICH CONSIST OF A ONE HOUR INTERNET BASED -- --Ť–?–? THIS COURSE IS OFFERED AT NO COST AND THERE IS SOME CME CREDITS FOR NURSES AND SINCE 2013 OVER 3,000 HAVE TAKEN THE ON-LINE COURSE. THE ARC ALSO MAKES AVAILABLE THE TOOL KIT TO ALL OF THEIR CHAPTERS AND AWARDS COMPETITIVE MINI GRANTS BETWEEN 500 AND 2000 DEPENDING ON THE SCOPE AND THE POPULATION SIZE OF THE COMMUNITY TO 22 CHAPTERS THAT COMMITTED TO IMPLEMENTING AN OUTREACH PLAN TO HEALTH CARE PROVIDERS AND THE ACTIVITIES VARY. FOR EXAMPLE THE ARC OF WASHINGTON -- COUNTY IS FOCUSING ON NATIVE AMERICANS LIVING IN UTAH. 30 GRANTS HAVE BEEN AWARDED TOTALLING $64,000. THE STUDENT FORMS THE CHAPTERS OF THE NATIONAL STUDENT NURSE ASSOCIATION AND THE AMERICAN MEDICAL STUDENT ASSOCIATION ARE TAKING THE ON-LINE COURSE. AND DISTRIBUTING THESE TOOL KITS. FIVE FORUMS HAVE BEEN HOSTED TO DATE AND 51 OTHER CHAPTERS HAVE EXPRESSED AN INTEREST IN HOSTING THESE FORUMS AND IS A MENTIONED THE TOOL KIT WAS DEVELOPED TO HELP HEALTH CARE PROFESSIONALS SPREAD A CONSISTENT MESSAGE TO ALL WOMEN OF CHILD BEARING AGE THAT NO AMOUNT OF ALCOHOL IS SAFE DURING PREGNANCY AND THE TOOL KIT INCLUDES FACT SHEETS AND CONVERSATION GUIDES AND SOME OF THE NEW THINGS INCLUDE POSTCARD FROM PEDIATRIC COMMISSIONS. A POCKET GUIDE FOR MID-WIVES. FACT SHEETS. POWER POINT. FETAL ALCOHOL SPRECTRUM DISORDERS AND OVER 6,000 TOOL KITS HAVE BEEN DISTRIBUTED SINCE THE PROJECT BEGAN. I WOULD LIKE TO TALK ABOUT THE PARTNERSHIP. THE PREVENTION PROJECT PRIMARY GOAL IS TO INCREASE KNOWLEDGE. BUT THIS WOULD NOT BE POSSIBLE WITHOUT THE SUPPORT OF THE NATIONAL PARTNERS. THEIR PARTNERSHIP HELPS SUPPORT THE FASD MISSION AND GOALS BY PARTICIPATING IN DEVELOPMENT AND DISSEMINATION OF TRAINING AND TECHNICAL RESEARCH AND RESOURCES WITHIN THE NETWORKS. ALL PARTNERS ASSISTED WITH OUTREACH AND ENGAGEDDED IN MEMBERS BY DISSEMINATING INFORMATION ABOUT THE PROJECT. FOR EXAMPLE, I WANT TO HIGHLIGHT TWO THINGS. THE AMERICAN COLLEGE OF NURSE MID-WIVES CREATED THE POCKET GUIDE AND AAP HAS ASSISTED WITH THE DEVELOPMENT OF THE POSTCARDS AND ENCOURAGES TO SCREEN ALL TEENS FOR ALCOHOL USE. -- SO SOME FUTURE PLANS FOR THE ARC -- NEW INITIATIVE THEY HAVE IS THAT THEY ARE REACHING OUT TO MAJOR ALCOHOL INDUSTRY ASSOCIATIONS, A LETTER HAS BEEN SENT TO EXPRESS INTEREST IN MOUNTING PUBLIC EDUCATION CAMPAIGN TO BETTER EDUCATE WOMEN ABOUT THE DANGERS OF ALCOHOL USE DURING PREGNANCY. THESE COMPANIES SPEND MONEY ON CAMPAIGNS ABOUT RESPONSIBLE DRINKING SO THEY WANT TO SEE IF THEY ARE WILLING TO DISCUSS THE POSSIBILITY OF ENGAGING IN THIS CAMPAIGN. AND FINALLY SOMETHING COMING DOWN THE LINE THAT IS WE'RE GOING TO BE COLLABORATING WITH JOHN SNOW WHO'S OUR CURRENT CENTER TO DEVELOP A TRAINING AND COOL KIT FOR COMMUNITY HEALTH WORKERS AND THE TOOL KIT HAS BEEN PROVIDED TO HEALTH CARE PROVIDERS. SO WE WOULD LIKE TO WORK ON ONE FOR COMMUNITY HEALTH WORKERS AND I ENCOURAGE EVERYONE TO VISIT THE ARC WEBSITE BECAUSE THERE IS A WEALTH OF INFORMATION ON FASD PREVENTION. KAREN, DO YOU WANT TO ADD ANYTHING? >> THANK YOU. >> THANK YOU. NEXT, DEIDRA. >> GOOD AFTERNOON. I JUST WANT TO GIVE YOU A BRIEF UPDATE ON THE ACTIVITIES OF THE ICCFASD. WOMEN DRINKING AND PREGNANCY WORK GROUP. OUR VISION IS THAT ALL WOMEN OF CHILD BEARING AGE WILL HAVE ACCESS TO ROUTINE SCREENING AND TO PREVENTION TREATMENT AND RECOVERY SERVICE FOR ALL FORMS OF ALCOHOL MISUSE. OUR MISSION AS MEMBERS OF THE ICCFASD -- ICCWDP WILL WOK COLLABORATIVELY. -- JUST AN UPDATE ON SOME OF THE LATEST INFORMATION ABOUT THE EPIDEMIOLOGY OF DRINKING BASED ON THE RESULTS OF OUR LATEST POPULATION SURVEY -- FROM 2012-13 AND THESE ARE BASED ON THE CRITERIA. WE ESTIMATE THAT ONE IN SEVEN OR 14% OF AMERICANS 18 AND OLDER REACHED CRITERIA FOR AT LEAST A MILD FORM OF AUD IN THE PAST YEAR. NEARLY ONE IN THREE OR 30% REACH CRITERIA FOR AUD AT SOME POINT IN THEIR LIVES. PREVALENCE WAS HIGHER FOR MEN. 18% THE PAST YEAR AND 36% LIFETIME FOR WOMEN. BUT OUR TEAM WAS ALSO INTERESTED IN OF COURSE SEEPING HOW TRENDS IN DRINKING HAVE CHANGED OVER THE PRIOR DECADE SO THEY RAN THE CRITERIA THAT WERE USED -- FINDING THAT OVER THE DECADE FROM 2001, 2002 TO TWO 12-13 PAST YEAR INCREASED FROM 9% TO 13% IN THE GENERAL POPULATION. AND LIFETIME 30% TO 44%. THOSE DATA TO ME ARE STUNNING. SO LAST YEAR WAS A BANNER YEAR FOR MEMBERS OF THE WDP AND FRIENDS OF THE WDP IN TERMS OF PUBLICATIONS AND ONE NOT A MEMBER BUT A FRIEND IS AARON WHITE WHO IS IN OUR DIVISION AND HE LAST YEAR PUBLISHED THIS ARTICLE ON CONVERGING PATTERNS OF ALCOHOL USE AND RELATED OUTCOMES AMONG MALES AND FEMALES IN THE U.S. AND HE IS BUILDING ON -- PRIOR ANALYSIS OF DATA WHICH HAD SHOWN FROM 1979 TO 2006 THERE WAS A 30% INCREASE IN BING DRINKING AMONG WOMEN 18-23 YEARS OF AGE. PUBLISHED IN THE JOURNAL. AND AARON FOUND THAT IN HIS ANALYSIS OF THE DATA FROM 2002 TO 2012 THAT THE PERCENTAGE OF CURRENT DRINKERS AMONG WOMEN INCREASED 22% ACROSS ALL AGE COHORTS. SO WE'RE BUILDING ON THE INCREASE FROM 1979 TO 2006. AND ALSO OVER THAT DECADE -- OF PREVALENCE OF BING DRINKING INCREASED 12% ACROSS ALL AGE COHORTS. ALSO AMONG THE PUBLICATIONS LAST YEAR THIS ONE FROM STACY STERLING AND OTHERS AT KIZER -- AND THE IMPLICATIONS FOR ADD -- ADOLESCENT GIRLS. THE GOALS -- THAT WAS ONE ARM. THE SECOND WAS PEDIATRICIANS WORKING A HEALTH CARE PRACTITIONER AND THEN AN USUAL CARE ARM. THERE WAS ONE PEDIATRIC CLINIC AND THE PATIENT WERE 12-18 YEARS OF AGE. AND SOME ALSO PRETTY CONSISTENT WITH FINDINGS FROM OTHER STUDIES AND AND BOYS SCREENED POSITION IF I HAVE FOR ALCOHOL AND DRUG USE INCLUDING 18% OF GIRLS WHO SCREENED POSITIVE FOR ALCOHOL VERSUS 16% OF BOYCE WHO SCREENED POSITIVE. WHEN YOU LOOK DOWN AT ANY SYMPTOMS 18% OF GIRLS SCREENED POSITIVE FOR SOME -- SYMPTOMS. AND WHEN YOU LOOK ALL THE WAY DOWN AT ANY BEHAVIORAL SYMPTOMS 23% OF+?–?–? GIRLS VERSE THE 18% OF BOYS.–?–? THERE IS A TERM I JUST COINED BASED ON THE CONVERSATIONS WE'VE HAD TODAY. WE'RE TALKING ABOUT ANXIETY, DEPRESSION. ALCOHOL AND OTHER DRUG USE, VIOLENCE AND HIV/AIDS. BEGINS VERY EARLY IN THE LIFE-SPAN FOR YOUNG WOMEN AND GIRLS AND WE NEED TO FOCUS OUR EFFORTS INCREASINGLY ON THIS GROUP. SO, SOME OF THE CONCLUSIONS FROM THE STUDY THAT THE INTERVENTION ARMS HAD BETTER -- SCREENING EXPERT RATES. ONLY AFTER TWO LUNCHTIME TRAINING SECTIONS SO I'M VERY ENCOURAGED. PATIENTS IN THE PEDIATRICIAN ONLY AND USUAL CARE ARMS HAD HIGHER ODDS OF BEING REFERRED TO SPECIALTY TREATMENTS AND THOSE IN THE BEHAVIORAL CLINICIAN ARM. HOWEVER OVER-ALL ATTENTION TO HEALTH CONCERNS WAS QUITE LOW WITH A RATE OF 2% AMONG PHYSICIANS WHO DID NOT RECEIVE TRAINING VERSES 16% AMONG THOSE WHO WERE TRAINED VERSUS 25% AMONG BEHAVIORAL HEALTH SPECIALIST AND WE STILL HAVE SOME WAYS TO GO. ALSO LAST YEAR THIS PUBLICATION ON A PANEL STUDY AMONG ADULT PATIENTS ENROLLED IN KIZER NORTHERN CALIFORNIA IN THAT ALCOHOL IS A VITAL SIGN AND THEY SIMILARLY HAD THE CLINICS DIVIDED INTO THREE GROUPS. THE ONE WHERE THE PHYSICIANS DID THE EXPERT -- ANOTHER WHERE BEHAVIORAL EXPERTS DID BOTH SCREENING AND BRIEF INTERVENTION AND USUAL CARE ARM. THERE WERE 54 CLINICS INVOLVED IN THIS PARTICULAR STUDY AND THEY FOUND THAT THE SCREENING RATES FOR MALE AND FEMALE -- PHYSICIANS AGAIN WERE QUITE LOW. 15% AMONG THE FEMALE PHYSICIANS AMONG THE MALE PHYSICIANS AND ONLY OF THOSE PATIENTS WHO SCREENED POSITIVE ONLY ABOUT HALF RECEIVED A BRIEF INTERVENTION. AND I LOVE THIS SLIDE BECAUSE IT POINTS TO THE POWER OF IMPLEMENTATION RESEARCH. NORTHERN CALIFORNIA KIZER HAS NOW SYSTEMIZED AND HIGH HER DIESED THEIR INTERVENTION. EMBEDDED IN THE ELECTRONIC HEALTH RECORD AND IN THE SENSE THAT BOTH ARE INVOLVED IN THE SCREENING AND BRIEF INTERVENTION PROCESS AND THAT HAS BROUGHT THEIR EXPERT RATES UP TO 90%. I'M GETTING AHEAD OF MYSELF. REDUCES DRINKING AMONG HIV POSITIVE WOMEN -- BY OTHERS AT HOPKINS. LEADING UP TO THE STUDY THE TEAM HAD DONE LITERATURE REVIEW -- AND OF COURSE HAZARDOUS ALCOHOL USING ASSOCIATED WITH INCREASED LIKELIHOOD OF ENGAGING IN RISKY SEXUAL BEHAVIORS AND THE ASSOCIATION BETWEEN DRINKING AND OTHER RISK BEHAVIORS IS STRONG ERA AMONG WOMEN THAN AMONG MEN. SO TWO ARM DESIGN WITH WOMEN 18 YEARS SCREENING POSITIVE ON THE SQUEAK AND THE INTERVENTION CONSISTED OF TWO -- 20 MINUTE FACE TO FACE INTERVENTION SO QUITE SHORT WITH EACH SESSION FOLLOWED BY A 5-10 MINUTE BOOSTER PHONE CALL. BASED ON A PROTOCOL DEVELOPED BY MICHAEL FLEMMING. FOUND THAT WITH TWO SESSIONS OF BI I DECREASED DRINKING FREQUENCY AT ABOUT 60% AND DECREASED BING DRINKING DAYS ALSO AT 60%. ONE SESSION RESULTED IN NO CHANGE IN DRINKING. AND ALSO A 60% REDUCTION IN UNPROTECTED VAGINAL INTERCOURSE. SO BRIEFLY COMMENTING ON OUR ACCOMPLISHMENTS FOR LAST YEAR. WE WERE A PART OF A CULTURAL -- WE HOSTED A SYMPOSIUM AT ASAM IN APRIL OF LAST YEAR ALSO IN INEBRIA FOR ADOLESCENT GIRLS AND WOMEN WHERE WE PRESENTED THE INFORMATION I JUST SHARED WITH YOU AND PARTICIPATED IN AN HBO SPECIAL SEGMENT ON MIDDLE AGE WOMEN AND DEVELOPED A PROPOSAL FOR A NATIONAL CONFERENCE ON WOMEN AND GIRLS IN RECOVERY WHICH WE HOPE TO GET OFF THE GROUND IN OCTOBER OF 2017. AND I'M GOING TO SKIP ALL OF THIS AND END WITH SHARING WITH YOU THAT DISCUSSES ARE ONGOING AMONG THE FEDERAL PARTNERS IN THE WDP. WE'RE TALKING ABOUT SHARING OURiś–?–? RESOURCES AND POOLING OUR RESOURCES TO PROMOTE COMMUNITY BASED PARTICIPATORY IMPLEMENTATION RESEARCH THAT WILL HELP LOCAL COMMUNITIES DEVELOP MODEL CONTINUUM OF CARE FOR WOMEN AND FAMILIES AND THE IDEA IS THAT THESE DEVELOPING COMMUNITY BASED PLATFORMS FOR IMPLEMENTATION RESEARCH IN WHICH WE CAN TEST EVIDENCE BASED -- INTERVENTION LIKE COMPUTERIZED SCREENING AND ASSESSMENT -- [ AUDIO DIFFICULTIES ] WE BELIEVE THAT DOING IMPLEMENTATION RESEARCH IS THE KEY TO DEVELOPING DATA DRIVEN INTEGRATED SYSTEMS OF CARE THAT WILL BE FLEXIBLE AND RESPONSIVE TO CHANGING NEEDS FOR SUBSTANCE USE DISORDERS AND CHANGING NEEDS AROUND HIV. AMONG WOMEN AND GIRLS. ANY QUESTIONS? THANK YOU, DEIDRA. AND SALLY IS GOING TO PRETTY MUCH WRAP US UP WITH HER COMMENTS. >> OKAY. I WAS SUPPOSED TO TALK EARLIER BUT WE WERE RUNNING INTO A TIME CRUNCH AND WE HAD SOME PEOPLE THAT NEEDED TO LEAVE. SO I WANT TO GIVE YOU AN UPDATE ON THE WORK GROUP STRUCTURE. I WANT TO TALK ABOUT HOW THIS CAME ABOUT. AND THE EVOLUTION OF WHAT IS HAPPENING AS WE'VE MOVED FORWARD. SO YOU KNOW THAT THE AGENCY IS ABOUTSu COOPERATION AND COLLABORATION AMONG AGENCIES AND WE CENTER OUR WORK AROUND DRINKING AND PREGNANCY AND INTERVENING WITH CHILDREN AND FAMILIES AND IMPROVING DIAGNOSIS AND RESEARCH AND INFORMATION DISSEMINATION. YOU KNOW THE AGENCIES. THESE DIFFERENT GROUPS. AND THEY ALL HAVE DIFFERENT APPROACHES THAT THEY ARE BRINGING IN AREAS AND THEY ARE CONCENTRATING WHETHER HEALTH CARE DELIVERY OR COLLECTING DATA FOR PUBLIC HEALTH AGENCIES. THIS SPANS MANY OF THE DIFFERENT GROUPS THAT ARE PART OF THE ICCFASD. IT WAS FIRST ESTABLISHED IN 1996 AND IN THE PERIOD '97 TO 2001 WE HAD A SERIES OF LARGE WORKSHOPS AND CONFERENCES TO DELAWARE COMMON UNDERSTANDING ABOUT THE STATUSES CRITICAL TO ADDRESSING FASD AND EACH AGENCY THAT BELONGED AT THE TIME SPONSORED ONE OF THOSE CONFERENCES. IN THE PERIOD OF 2001 TO 2005 WE MOVED TO ON-SITE WORKSHOPS TO SHARE RESEARCH FINDINGS AND TO FACILITATE PRACTICE AND IMPLEMENTATION OF THE LATEST RESEARCH FINDING. IN THE PERIOD 2005 TO 2016 WE FORMED FORMAL LONG-STANDING AD HOC WORK GROUPS WITH LIMITED TIME APPOINTMENTS BUT LONG-TERM TIME. MORE DIVERSITY OF EXPERTISE THAN WE HAD IN THE ORIGINAL GROUPS WHICH WERE JUST A SMALL GROUP OF PEOPLE. THIS COINCIDED WITH THE INCREASE IN THE BUDGET AT NIH AND INCREASED IN OUR FUNDS. WE HAVE -- ANNUAL MEETINGS AS POSSIBLE -- OF FOUR DIFFERENT WORK GROUPS. WE HAVE THREE DIFFERENT WORK GROUPS COMING TO MEET TOGETHER EVERY YEAR FOR A DAY BRINGING IN AT LEAST 18 SOMETIMES 24 DIFFERENT PEOPLE BUT AS TIME WENT ON -- THE BURDEN OF THE COST OF THESE THINGS HAD SHIFTED PRIMARILY TO CDC AND NIAAA. WE INCREASED OUR EMPHASIS ON BRINGING RESEARCH TO PRACTICE WHICH WAS VERY VALUABLE AND WE HAD A LOT OF SUCCESSES. AND WE HAD A NEW EMPHASIS STARTING IN ABOUT 2008 WHEREth PRIMARY GOAL OF THE WORK GROUPS WAS HELPING THE EXECUTIVE COMMITTEE IMPLEMENT AN OUTREACH TO STAKEHOLDERS AND WE WERE VERY SUCCESSFUL IN THAT AREA PARTICULARLY IN THE AREA OF DIAGNOSIS. AND IN THE JUSTICE AREAS. SO AS WE MOVE FURTHER FORWARD SEMIANNUAL CONFERENCES WE HAD -- ALMOST EVERY OTHER YEAR WE HAD A MAJOR CONFERENCE. THEY WERE ALL VERY EXPENSIVE. WE'RE RUNNING OUT OF MONEY. THE BUDGET IS GETTING TIGHTER EVERY YEAR. SO WE SHIFTED TO PRESENTING AT SENDING SMALL GROUPS OF INDIVIDUALS TO PRESENT AT NATIONAL AND INTERNATIONAL PROFESSIONAL MEETINGS AND WE COULD NO LONGER AFFORD TO BRING FIVE WORK GROUPS TOGETHER EVERY YEAR FOR THEM TO PLAN THEIR NEXT PROJECT. AND ONE OF THE MAJOR THINGS POSITIVE THINGS THAT OCCURRED WAS THAT WE BUILT STRONG BRIDGES WITH CANADA PARTICULARLY IN THE DIAGNOSTIC AND JUSTICE ISSUES AREA. SO AT THIS POINT IN TIME IN THE LATE 2000 TEENS WE HAD FORMAL WORK GROUPS AND THEY WERE COMPOSED OF FEDERAL REPRESENTATIVES. LOTS OF DIFFERENT OUT SIDE EXPERTS. RARELY WAS THERE ONE PERSON ON MORE THAN ONE TEAM SO THAT GAVE US MUCH MORE BREATH OF IDEAS THAN THE WORK GROUPS ORIGINALLY HAD AND WE WERE SUPPORTING THESE FOUR WORK GROUPS SO THIS IS THE CHART YOU RECOGNIZE OF WHERE WE'VE BEEN, WHERE WE EVOLVED TO. AND DEIDRA HAD JUST PRESENTED THE WOMEN'S DRINKING AND PREGNANCY WORK GROUP AND SHE MENTIONED THAT THEY WENT OUT TO A MEETING LAST YEAR AND PRESENTED ON EXPERT AN INTERNATIONAL MEETING. THE JUSTICE AREA WORK GROUP HAS BEEN PRESENTING FOR THE PAST THREE YEARS AT LEAST ONE MEETING OF PROFESSIONAL JUDGES. WE'VE WORKED WITH THE AMERICAN BAR ASSOCIATION AND WE HAVE VERY CLOSE TIES WITH CANADA AND ARE WORKING WITH THEM ON LEARNING AND ADVANCING AND HOSTING PEOPLE FROM AUSTRALIA AND NEW ZEALAND THIS HAVE COME TO THE UNITED STATES TO LEARN ABOUT WHAT WE WERE DOING IN THE FASD AREA AND JUSTICE ISSUES. SO MOVING FORWARD WE WANT TO THANK ALL OF THE PEOPLE THAT PARTICIPATED GENEROUSLY WITH THEIR TIME ON THEIR WORK GROUPS AND THESE SPECIAL SUBCOMMITTEES THAT THEY SOMETIMES FORMED IN PARTICULAR THEIR WORK WITH THE AMERICAN PSYCHIATRIC ASSOCIATION AND GETTING AN FASD RELEVANT DISORDER IN THE DSM5. HOWEVER THIS RECENT MODEL OF MULTIPLE WORK GROUPS SERVING FOR SEVERAL YEARS AND MEETING REGULARLY IN PERSON IS NOT SUSTAINABLE IN OUR CURRENT BUDGET. ALL OF THE WORK NOW THAT THE ICCFASD IS -- HAS BEEN DOING THE PAST THREE YEARS HAS BEEN SUPPORTED EXCLUSIVELY BY NIAAA. WE DON'T HAVE THE BUDGET FOR THIS MODEL SO AS WE WIDEN OUR VIEW OF THE FAS CONSIDER WORLD WE NEED TO EVOLVE TO A NEW FORMAT AND FIGURE OUT A NEW WAY TO ACCOMPLISH OUR GOAL. SO THE ICCFASD LEADERSHIP AND THE EXECUTIVE COMMITTEE WILL IN THE NEXT YEAR BE DEVELOPING AN ALTERNATIVE PLAN. SO WE WILL ALL SEE YOU ALL IN NOVEMBER OR DECEMBER. WE WILL HAVE SOME TELECONFERENCE CALLS BUT WE'RE BEING FORCED TO EVOLVE IN A DOWNSIZING WAY WHICH IS NOT VERY WELCOMED BUT WE HAVE A LOT OF REALLY SMART PEOPLE AND I THINK WE'LL BE ABLE TO FIND OTHER WAYS TO MEET OUR GOALS. THANK YOU ALL FOR COMING. >> ANY QUESTIONS OR COMMENTS? >> I WOULD LIKE TO THANK EVERYONE FOR YOUR CONTRIBUTION. I ALSO WANT TO MAKE A STATEMENT. SOME OF YOU MAY NOT KNOW DR. CHERYL BOYCE WHO HAS BEEN OUR RELATIVELY RECENT REPRESENTATIVE FROM NADA IS MOVING ON TO A NEW POSITION AT THE NATIONAL HEART, LUNG AND BLOOD INSTITUTE SO WE WILL BE LOSING A REALLY VITAL PARTNER. SHE WILL STILL BE AT NIH BUT WILL NO LONGER BE A REPRESENTATIVE ON THE ICCFASD. AND I JUST WANTED TO ACKNOWLEDGE HER CONTRIBUTION ESPECIALLY TO THE SUBSTANCE ABUSE AND ALCOHOL PANELS THAT WE'VE HAD OVER THE LAST COUPLE OF YEARS WHICH IS GOING TO BE I THINK HELPING TO INFORM US AS WE MOVE FORWARD ON ON WHAT OUR PLANS ARE GOING TO BE FOR THE NEXT YEAR AND MAYBE BEYOND. SO WE LOOK FORWARD TO OTHER PARTNERS JOINING US AND CERTAINLY AGAIN WANT TO WELCOME OUR NEW PARTNERS KAREN LEE, MADELINE AND -- LELA McNIGHT FROM CDC WHO JUST JOINED US AND HOPED THAT THIS MEETING WAS INFORMATIVE TO YOU AND HOPEFULLY IT HAS SPRUNG SOME NEW IDEAS FOR TO YOU CONTRIBUTE AND WE LOOK FORWARD TO CONTINUING TO WORK WITH YOU AND THE REST OF THE GROUP AS WE MOVE FORWARD. THANK YOU EVERYONE FOR YOUR CONTRIBUTION. IT'S BEEN A VERY INFORMATIVE MEETING AND WE LOOK FORWARD TO THE PLANS THAT WE'RE GOING TO DEVELOP AS A RESULT OF ALL OF THIS INFORMATION. [ APPLAUSE ]