>> GOOD MORNING AND WELCOME TO THE SPRING MEETING OF THE INTERAGENCY COORDINATING COMMITTEE ON FETAL ALCOHOL SPECTRUM DISORDERS. I'M MARCIA SCOTT AND I'M THE EXECUTIVE SECRETARY OF THE ICCFASD, AND I WILL MODERATE THIS SESSION. SO BEFORE WE GET STARTED, I JUST WANT TO GIVE A BRIEF OVERVIEW OF THE ICCFASD. SO THE ICCFASD IS A COMMIT O TO IMPROVE COMMUNICATIONS, COOPERATION AND COLLABORATION AMONG FEDERAL AGENCIES THAT ADDRESS ISSUES RELATED TO PRENATAL ALCOHOL EXPOSURE. WE HAVE A BROAD OVERVIEW OF AREAS OF INTEREST TO THE FIELD OF FETAL ALCOHOL SPECTRUM DISORDERS, INCLUDING PUBLIC HEALTH ISSUES, HEALTHCARE DELIVERY, JUSTICE ISSUES, EDUCATION AND BASIC AND CLINICAL RESEARCH. THE THEMES AROUND WHICH ICCFASD HAS BEEN BASED INCLUDE PREVENTION OF DRINKING DURING PREGNANCY, INTERVENING WITH CHILDREN AND FAMILIES EFFECTED BY PRENATAL ALCOHOL EXPOSURE AND IMPROVING METHODS FOR DIAGNOSIS AND CASE IDENTIFICATION, INCREASING RESEARCH ON ETIOLOGY AND PATHOGENESIS AND INCREASING INFORMATION DISSEMESTER NATION. THIS IS BASICALLY AN ORGANIZATIONAL CHART. ICCFASD IS COMPRISED OF AGENCIES FROM THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AS WELL AS DEPARTMENT OF JUSTICE AND EDUCATION AND I WON'T ABOUT THROUGH ALL OF THOSE, THEY ARE ON OUR NIAA A WEB SITE. AND WITHOUT FURTHER ODUE WE WILL CONTINUE WITH THE REST OF THE MEETING AND WE WILL HAVE INTRODUCTIONS OF OUR PANEL MEMBERS SEATED AT THE TABLE. SO STARTING WITH DR. KEN MOORE. >> GOOD MORNING I'M KEN MOORE AND I'M DEPUTY DIRECTOR OF NIAAA, AND THE CHAIR OF THE ICCFASD. >> GOOD MORNING I'M CHERYL ANN JOYCE AND I'M A REPRESENTATIVE FROM THE NATIONAL INSTITUTE ON DRUG ABUSE. >> GOOD MORNING, MARGARET NATSON WITH THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION. >> GOOD MORNING I'M CONNIE WISENER AND I'M RESEARCHER AT DEPARTMENT OF PSYCHIATRY AND KISER PERMANENTE DIVISION OF RESEARCH IN CALIFORNIA. >> GOOD MORNING I'M DIERDRE ROACH WITH THE DIVISION OF TREATMENT AND RECOVERY RESEARCH AT NIAAA A, AND THE FACILITATOR OF THE WORK GROUP ON WOMEN DRINKING AND PREGNANCY OF THE ITC. >> GOOD MORNING I'M DALE HAROLD, IN THE DIVISION OF METABOLISM AND HEALTH EFFECTS AT NIAAA. >> GOOD MORNING I'M TINA CHAMBERS AND I'M IN THE DEPARTMENT OF PEDIATRICS AT THE UNIVERSITY OF CALIFORNIA, SAN DIEGO. >> GOOD MORNING PHILLIP MAYE, UNIVERSITY OF NORTH CAROLINA SCHOOL OF PUBLIC HEALTH AND NIAAA GRANTEE. >> JACK BURDTR UND, FROM THE CENTERS FOR DISEASE CONTROL. >> BILL WITH NIAAA. >> HELLO EVERYBODY I'M KAREN BAHAR, FROM THE OFFICE OF JULE JUSTICE AND DELINQUENCY PRACTICES VENTION WHERE I SERVE AS SENIOR POLICY ADVISOR I'M A MEMBER OF THE EXECUTIVE COMMITTEE ON INTERAGENCY COORDINATING--OF THE INTERAGENCY COORDINATING COMMITTEE ON FETAL ALCOHOL SPECTRUM DISORDERS AND LIKE DIEDRE HAVE THE JOY OF FACILITATING ONE OF THE WORK GROUPS WHICH IS THE JUSTICE ISSUE WORK GROUP, THANK YOU. >> I'M AN HRSA REPRESENTATIVE AND I WORK IN THE MATERNAL AND CHILD FASD AND I HAVE THE ONLY GRANT IN THE FASD, THANK YOU. >> I'M MARIA WITH THE NICHD. >> [INDISCERNIBLE]. >> I'M SALLY ANDERSON FROM NIAA, AND I'M THE FASD ACTIVITIES COORDINATOR. PEGGY MURRAY, WORK IN THE OFFICE OF DIRECTOR AT NIAAA WHERE I DIRECT THE GLOBAL RESEARCH PROGRAM, AMONG OTHER THINGS. ONE OF THE OTHER THINGS I MENTION THAT I DO IS I AM THE NIAAA PERSON THAT HEADS UP THE COORDINATING RESEARCH ON ADDICTIONS AT THE NIH AND IT'S A JOINT EFFORT WITH NIDA AND THE NATIONAL CANCER INSTITUTE. >> OKAY, THANK YOU. YOU WANT ME TO GO AHEAD AND DO MY INTRODUCTION. OKAY, I WILL BE VERY BRIEF INTRODUCTION JUST TO WELCOME EVERYONE. THE VAST MAJORITY, IN FACT I'LL CHANGE THAT TO I WOULD SAY ALL OF THE WORK THAT IS DONE IN DEVELOPING THE ICCFASD COORDINATING ITS ACTIVITIES IS ACTUALLY DONE BY OUR MAJOR COORDINATOR AND AND OUR DEPUTY COORDINATOR FOR THE INSTITUTE AND I WANT TO GIV A THANK TO YOU BOTH OF THEM AND THAT'S SALLY ANDERSON AND MARCIA SCOTT AND MAR SYA WILL TAKE OVER THE MAJOR ROLE AND I THANK HER VERY MUCH FOR BEING ABLE TO DO THAT AND WILLING TO DO THAT. WITH THE MULTIPLE HATS THAT I WEAR, EVEN THOUGH I'M THE CHAIR OF THE COMMITTEE, I'M NOT THE REPRESENTATIVE FROM NIAAA AND THAT IS DALE HAROLD AND I WANTED TO GIVE A THANK TO YOU HIM AND TO THE OTHER STAFF MEMBERS SUCH AS DIERDRE ROACH FROM NIAAA WHO ALSO SERVES ON THIS IMPORTANT COMMITTEE. I WANTED TO NOTE THAT IT'S ALMOST BEEN 20 YEARS, I THINK IT'S 18 OR 19 YEARS SINCE WE HAD THE FIRST MEETING OF THE ICCFAS, IT WAS RECOMMENDED, IT WAS CREATED AT THE REQUEST OF CONGRESS. BASICALLY COORDINATE ACTIVITIES ORIGINALLY ACROSS THE AGENCIES OF DHHS, THAT'S THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND PRIMARILY THE HEALTH SERVICES AND RESOURCES ADMINISTRATION, SAM SAN FRANCISCO, INDIAN HEALTH SERVICE, CDC, THE AGENCY FOR CHILDREN AND FAMILIES, AND NIAAA AND A FEW OTHER ENTITIES AND THEN WE EXBANDED EARLY AND BROAD AT THE DEPARTMENT OF JUSTICE AND THE DEPARTMENT OF EDUCATION BECAUSE OF THE MAJOR ISSUES THAT ARE INVOLVED WITH FASD AND THOSE TWO AGENCIES. WE'VE BEEN REMISS THAT FOR A NUMBER OF YEARS WE HAVEN'T HAD A REPRESENTATIVE FROM EDUCATION AND--BUT WE WERE VERY PLEASED THAT WE HAD MAJOR COOPERATION AND MAJOR DEVELOPMENT FROM THE DEPARTMENT OF JUSTICE, AND MAYBE ONE OF THESE DAYS WE CAN PUT MORE PRESSURE ON EDUCATION BECAUSE I CAN ASSURE YOU, IN FACT, I KNOW FROM MY OWN DUGHTER WHO HAS BEEN INVOLVED AS A TEACHER AND ACTUALLY AS PART OF THE TRAINING HAD A CLASS THAT HAD A NUMBER OF CHILDREN WHO HAD FETAL ALCOHOL SYNDROME IN IT, THAT FAS IS INDEED AN ISSUE IN THE DEPARTMENT OF EDUCATION. WHAT I ALSOMENTED TO DO IS SAY IN A VERY INTERESTING TIME FOR US IN FAS AND I THINK A VERY IMPORTANT TIME, WE FIRST OF ALL THIS--JUST THIS WEEK WE HAD THE OPPORTUNITY ON MONDAY OF THIS WEEK TO MAKE A PRESENTATION, A SPANSORRED BY THE FRIENDS OF NIAAA TO MAKE A PRESENTATION IN CONGRESS TO A FAIRLY MODERATE SIZE AUDIENCE OF INDIVIDUALS, CONGRESSIONAL STAFFERS AND OTHERS FROM THE HILL ON FASD. I WAS ONE OF THE SPEAKERS AS WELL AS CATHY RIEHL, EDWARD AND OUR DIRECTOR GEORGE KOUHN, IT WAS WELL RECEIVED. THERE IS A LOT OF QUESTIONS. THERE IS STILL A LOT OF INTEREST DOWN THERE. AGAIN IT'S SORT OF APPROPRIATE TO GIVE THAT FEEDBACK TO CONGRESS BECAUSE WE WERE CREATED BECAUSE OF A RECOMMENDATION OF CONGRESS. WE'VE--THERE'S ALWAYS BEEN A NUMBER OF MAJOR CONFERENCES ON FAS AND FASD, WE'RE GOING TO HEAR A REPORT IN A MOMENT ABOUT THE VANCOUVER CONFERENCE WHICH WAS ONE THAT IT HAD THE FIRST TIME AND OPPORTUNITY TO ATTEND IT. IT IS--ALTHOUGH IT'S HELD IN CANADA, IT HAS A WORLD WIDE FOCUS AND IT'S ONE OF THE BEST ORGANIZERS OF THE WORLD WIDE MEETINGS ON FAS AND SO, IT--I THINK IT'S VERY APPROPRIATE TO GET AN UPDATE FROM THAT MEETING. I FOUND IT TO BE VERY INFORMATIVE AND EXTREMELY INTERESTING. I ALSO HAD THE OPPORTUNITY TO ATTEND THE THIRD EUROPEAN CONFERENCE TO FETAL ALCOHOL SPECTRUM DISORDERS, WHICH WAS HELD IN ROME AND THE INTEREST IN EUROPE IN THIS DISORDER IS INCREASING AND WE'RE IN THE PROCESS OF RIGHT NOW, CO ORGANIZER OF WHAT WILL PROBABLY BE THE FIRST OFF THE RAILIAN CONFERENCE ON FAS WHICH WILL BE HELD THIS AUGUST, BUT FOR ANY OF YOU WHO WANT TO HOP ON AN AIRPLANE AND FLY DOWN TO AUSTRALIA, IT'S ONLY A 28 HOUR TRIP, I THINK THAT'S GOING TO BE INTERESTING. WE WILL HAVE THE OPPORTUNITY TO BASICALLY HEAR THE ISSUES THAT ARE THERE AND I'M SURE THEY'RE VERY SIMILAR TO THOSE THAT ARE HERE IN THE UNITED STATES. WE HAVE A VERY EXCITING AGENDA TODAY, IT'S VERY INFORMATIVE AND FROM THIS POINT ON, I'M GOING TO D LEARN AND HEAR ALL OF THE JUST SIT BACK, AND BE INFORMED UPDATES FROM ALL OF THE AGENCIES AND HEAR THE UPDATES FROM THE MEMBER AGENCIES AS WELL AS OUR VARIOUS PRESENTATIONS. AN I ENCOURAGE EVERYBODY TO STAY FOR THE WHOLE MEETING AND IT'S GOING TO BE EXTREMELY INFORMATIVE. WITH THAT,--TURN IT OVER TO MARCIA, I CAN INTRODUCE PEGGY IF YOU WOULD LIKE ME TO DO THAT. IT'S OUR PLEASURE TO INTRODUCE OUR FIRST PRESENTER TODAY AND THAT'S DR. PEGGY MURRAY AND SHE WILL GIVE US AN UPDATE ON--OR I SHOULD SAY REPORT ON THE VANCOUVER CONFERENCE ON FETAL ALCOHOL SPECTRUM DISORDERS WHICH WAS HELD IN JANUARY OF THIS YEAR. >> THANKS, EVERYBODY. I MIGHT ALSO MENTION ONE OTHER CONFERENCE THAT KEN AND I ATTEND INDEED LITHUANIA IN SEPTEMBER WHICH WAS REALLY PRETTY AMAZING THAT ONE PERSON ATTENDED THE MEETING THAT WAS HELD IN CALGARY A YEAR AGO, LAST SEPTEMBER ON POLICY AND THAT PERSON FROM LITHUANIA WENT BACK AND ORGANIZED THE CONFERENCE. HE HAD THE ROOM FILL WIDE 800 PEOPLE WHO WERE HUNGRY FOR INFORMATION ABOUT FETAL ALCOHOL, INCLUDING NURSES, SOCIAL WORKERS, PHYSICIANS AND PEOPLE IN THE EDUCATION FIELD. SO THERE IS DEFINITELY A NEED IN THE WORLD TO KNOW MORE ABOUT IT. THIS MEETING IS PROBABLY ONE OF THE BEST THAT I'VE EVERATTENDED AND THIS IS THE SECOND TIME THEY WENT. THERE WERE OTHER PEOPLE IN THE ROOM AT THIS CONFERENCE AS WELL. AND IT WAS MARCH 5th THROUGH 7th IN VANCOUVER, IT'S ORGANIZED BY A CANADIAN TEAM BUT THEY HAD A COMMITTEE, A PROGRAM COMMITTEE THAT HAS ABOUT 30 PEOPLE ON IT FROM ALL OVER THE WORLD, SALLY ANDERSON WAS A MEMBER OF THAT COMMITTEE, AS WELL AS ED REILLY AS MANY OF YOU KNOW, THERE WAS A PRECONFERENCE ON MARCH 4th AND 1 THING I FORGOT TO PUT ON HERE IS THAT ON MARCH SECOND THERE WAS A FULL DAY ON FASD AND THE LAW. SO IT TRIES TO COVER A SPAN OF DIFFERENT AREAS THAT ARE INTERESTED IN FASD AND I WOULD RECOMMEND TO EVERYBODY IN THIS ROOM TO ATTEND THAT THE NEXT ONE WILL BE IN TWO YEARS BECAUSE IT DOES BRING TOGETHER EVERYBODY INTEGRATING RESEARCH POLICY AND PROMISING PRACTICE AROUND THE WORLD WITH THEIR THEME. SO THE GOAL OF THE CONFERENCE IS TO BRING TOGETHER EXPERTS FROM MULTIPLE DISCIPLINES BASICALLY TO PROMOTE SCIENTISTS AT COMMUNITY AND COLLABORATION. THERE'S NO WAY THAT THAT CAN'T HAPPEN BECAUSE THE MEETING IS HELD IN ONE LARGE HOTEL IN VANCOUVER, EVERYBODY STAYS AT THAT HOTEL PRETTY MUCH AND THROUGHOUT THE WEEK, HAVE YOU A CHANCE TO TALK TOO PEOPLE FROM MANY DIFFERENT DISCIPLINES AND YOU CAN'T HELP BUT GET THAT SORT OF TRANSDISCIPLINARY EXPERIENCE. IT WANTS TO BRING TOGETHER PEOPLE WHO ARE PASSIONATE ABOUT THIS WORK AND STIMULATING ENVIRONMENT, WHERE THEY CAN LEARN AND FORGE NEW PARTNERSHIPS AND I HAVE TO SAY THAT THAT THAT DEFINITELY THEY SET THE VENUE FOR THAT BECAUSE IT HAPPENS. HERE I'VE LISTED THE CONFERENCE OBJECTIVE AND IT'S TO DESCRIBE DIFFERENT FASDs FROM DIFFERENT GEOGRAPHIES FROM AUSTRALIA, PACIFIC ISLANDS, SOUTH AFRICA, I'M NOT SURE, BUT EUROPE, BUT ANYWAY, IT'S BASICALLY THE WHOLE GLOBAL EXPERIENCE AND YOU GET TO HEAR WHAT THEY'RE DOING AND HOW THEY APPROACH FASD IN THEIR COUNTRY. TO UNDERSTAND THE IMPLICATION AND POTENTIAL APPLICATION OF EMERGING EVIDENCE BASED RESEARCH. THERE ARE MANY SCIENTIFIC PRESENTATIONS AT THIS CONFERENCE AND CFAST WAS ONE OF THEM. TO ERNE GAUGE IN KNOWLEDGE AND EXCHANGE AND DIALOGUE THROUGH FORM AT SESSIONS, NETWORKING AND ONSITE MEETINGS AND BASICALLY AS I SAID BEFORE TO DEVELOP THOSE PARTNERSHIPS. AN INTERESTING THING THEY DID THIS YEAR WAS THE PRECONFERENCE ON MARCH 4th, THEY TITLED IT LET'S TALK AND THEY CHOSE FIVE RESEARCH TOPICS, THEY HAD EXPERTS IN THOSE TOPICS GIVE BRIEF PRESENTATIONS BUT YOU WERE SEATED AT A ROUND TABLE THAT HAD A MIX OF CONFERENCE ATTENDEES SO YOU COULD HAVE FAMILIES OF CHILDREN WITH FASD. YOU COULD HAVE PRACTITIONERS FROM ALL FIELDS, NURSING, SOCIAL WORK, EDUCATN, YOU COULD HAVE RESEARCHERS AND YOU COULD HAVE POLICY MAKERS, YOU DIDN'T KNOW WHO WOULD BE IN THE TABLE YOU SAT WITH AND AFTER EACH OF THE TOPICS WAS PRESENTED, THERE WAS A DISCUSSION AND THE DISCUSSION CENTERED AROUND WHAT DO WE WANT TO KNOW AND WHY DO WE THEY'D TO KNOW IT AS WELL AS WHAT ARE THE ETHICAL IMPLICATIONS OF EACH--DO BEING RESEARCH ON EACH OF THESE TOPICS. IT WAS REALLY QUITE FASCINATING BECAUSE IT WAS A CHANCE TO HEAR FROM ALL DIFFERENT SECTOR WHAT IS THEY THOUGHT WAS IMPORTANT SO AS YOU'RE ESTABLISHING A RESEARCH AGENDA IT WAS INTERESTING TO HEAR WHAT SOMEONE WHO WORKS IN THE JUDICIAL SYSTEM SAYS WHAT SOMEONE WHO HAS A FAMILY WITH FASD OR WHAT THE EDUCATION SYSTEM SAYS. SORT OF LIKE WHAT YOU'RE DOING HERE BUT THIS WAS FROM A DIFFERENT LEVEL SO IT WAS--IT WAS REALLY QUITE FASCINATING AND A PRODUCTIVE DISCUSSION AND I UNDERSTAND THE REPORT FROM THE MEETING WILL BE SENT TO KEN VERY SOON. AND I DON'T KNOW IF YOU KNEW THAT SO WE WILL SUMMARIES OF ALL THE DISCUSSIONS. ALL RIGHT THE MAIN CONFERENCE PLENARY FOCUSED ON THE GLOBE AT BURDEN AND ALCOHOL PREDICTORS OF USE OF ALCOHOL IN CHILD BEARING AGE, THE UNIVERSITY OF ENGLAND GAVE A PRESENTATION AND THEN LANA P A PLOVA GAVE A PRESENTATION FROM THE UNIVERSITY OF TORONTO AND HE HAS DONE A LOT OF EXCELLENT WORK GATHERING INFORMATION ABOUT WOMEN'S DRINKING AND DRINKING AND PREGNANCY SO SHE PRESENTED THAT WORK AS WELL. I DIDN'T KNOW HOW TO DESCRIBE THE PROGRAM. IT'S JUST SO RICH AND SO FULL THAT I THOUGHT I JUST RANDOMLY PICK A PAGE FROM THE PROGRAM AND TELL YOU WHAT WAS ON IT SO YOU CAN SEE THE BREDTH. IT DIDN'T COME OUT QUITE AS GOOD AS I WANT TODAY TO BUT THIS WAS THE THURSDAY AND FRIDAY OF THE MEETING. YOU SEE A SYMPOSIUM THROUGH AN ABORIGINAL LENS, YOUTH WITH FASD, IT'S A GROUP IN BRITISH COLUMBIA AND WORKS WITH YOUTH COMES OUT OF PRISONS--YOUTH WHO ARE INTERACTING WITH THE CRIMINAL JUSTICE SYSTEM WHO HAVE FASD AND A GROUP THAT PROVIDES SERVICES SO THEY TALK ABOUT THEIR EXPERIENCES. NEXT WAS A PROGRAM CALLED MINE THE GAP IDENTIFYING TRANSITION NEEDS FOR YOUNG ADULTS WITH FASD IN THE CRIMINAL AND JUSTICE SYSTEM. SO IT WAS ANOTHER EXAMPLE OF A PRACTICE GROUP EXPLAINING WHAT THEY WERE FINDING WORKS. WE HEARD A REALLY COMPELLING TALK FROM A WOMAN FROM THE PHILIPPINES, WHO TOLD US ABOUT THEY'RE JUST RECOGNIZING WHAT FETAL ALCOHOL SPECTRUM DISORDERS IS THERE, AND IT WOULD REALLY EXCITING TO MEET HER AND WE'VE INVITED HER TO BE PART OF THE CONFERENCE IN AUSTRALIA IN AUGUST SO WE'LL LEARN MORE ABOUT FAS AND THE PHILIPPINES. WE HEARD FROM SARAH MADSON AND JULIE CABLE AS WELL AS CANADIAN RESEARCHER WHOSE NAME I'M BLANKING ON. TINA, YOU PROBABLY KNOW WHO IT IS. >> OH WELL, ANYWAY, THEY TALK ABOUT THE DATA AND THE NEW FIND IN THE CATEGORY FIVE NEURODEVELOPMENT PRENATAL ALCOHOL EXPOSURE. SO THEY PRESENTED DATA FROM THE STUDIES THEY'RE DOING THAT SUPPORT THE DIAGNOSTIC IN THE SDM FIVE AND THEN THERE WAS A PLENARY SESSION THAT AFTERNOON ON DISMANTLING STIGMA. SO THAT'S JUST AN EXAMPLE OF THE RICH PROGRAM AND THE VARIED PROGRAM AND THE OPPORTUNITY THAT ANY ATTENDEE REALLY HAS TO EXPERIENCE ALL THE DIFFERENT DISCIPLINE INVOLVED IN FASD TO HEAR SOME OF THE CUTTING EDGE RESEARCH, PEOPLE LIKE CATHY AND JOHAN AND WHAT THEY'RE DOING IN THE CFAS STUDY. THERE WAS A PLENARY ON IMAGING SO IT'S JUST, YOU KNOW REALLY HARD TO DESCRIBE, BUT THERE WERE SEVERAL PEOPLE AT THE ROOM WHO WERE AT THE MEETING, DALE WAS THERE, BILL WAS THERE, MARCIA SCOTT AND SALLY ANDERSON WERE THERE, SO ANY OF THEM COULD SHARE THE EXPERIENCE. THEY HAVE A VERY, A VERY MOVE BEING CEREMONY AT THE END OF THE CONFERENCE WHERE THEY PRESENT SOMETHING CALLED THE STARFISH AWARD AND HERE HAVE YOU TWO INDIVIDUALS WITH FASD WHO ARE GIVING THE BACKGROUND OF THE AWARD AND GETTING READY TO INTRODUCE WHO WILL WIN THE AWARD THIS YEAR. IT'S GIVEN TO A RESEARCHER WHO LIFE AND CAREER HAS LED TO MAKING A DIFFERENCE IN THE INDIVIDUAL LIVES OF PEOPLE WITH FETAL ALCOHOL SPECTRUM DISORDER AND AS I SAID IT'S VERY MOVING BECAUSE YOU HEAR WHERE THE STARFISH AWARD CAME FROM AND I'M FOCUS ON THE GOING TO TAKE THE TIME NOW TO TELL THAT STORY. YOU REALLY SHOULD COME TO THE CONFERENCE THOUGH TO EXPERIENCE IT. AND THEN THEY ANNOUNCE THE WINNERS AND IN THE PAST, DR. PHIL MAY HAS BEEN A RECIPIENT OF THE STARFISH AWARD AND YOU KNOW, PHIL, CAN YOU TELL THEM WHAT IT'S LIKE BECAUSE IT'S REALLY QUITE MOVING. THIS YEAR THE AWARD WENT TO BOTH STERLING CLAIREN AND ED REILLY WHO YOU SEE HERE RECEIVING IT AND SO I'M GOING TO END THERE LIKE I SAID ANYBODY THERE WE'RE GLAD TO ANSWER QUESTIONS BUT I WOULD ENCOURAGE PEOPLE TO GO BECAUSE IT TRULY IS THE EXPERIENCE THAT YOU--THAT THEY LAY OUT IN THE PROGRAM THAT THEY'RE TRYING TO ACHIEVE. >> I JUST WANTED TO GIVE YOU A LITTLE INTRODUCTION AND TELL YOU ABOUT THIS PANEL WE'RE GOING TO HAVE THIS MORNING. WE TRY EVERY MEETING TO CHOOSE TOPICS THAT WE'RE BEGINNING TO INVESTIGATE. USUALLY IN PREPARATION FOR A DECISION ABOUT A MAJ EFFORT. WE HAD A WHOLE SERIES MORE THAN FIVE YEARS AGO ON DIAGNOSTIC ISSUES AND THAT LED TO MAJOR ADVANCES IN DIAGNOSE AND INCLUSION IN THE DSM FIVE AND ONE THING IN THE AMERICAN ACADEMY OF PEDIATRICS WITH THEIR TAKING PRETTY MUCH OWNERSHIP OF THE ISSUE IN PEDIATRIC HEALTHCARE AND NOW WE'RE SHIFTING, SHIFTING MORE INTO THE PREVENTION AREA. AND TODAY WE'RE GOING TO START AN INTERESTING DISCUSSION ON THE USE OF ALCOHOL OF USE AND PREGNANCY, SO WHAT HAVE BEEN HEARING IN THE PRESS AND IN THE MEDICAL LITERATURE THERE'S A TREMENDOUS INCREASE IN THE USE OF MARIJUANA, SINCE THE COMMERCIALIZATION OF MARIJUANA THERE'S BEEN MAJOR TRAFFIC ACCIDENTS IN COLORADO SURVEYS ABOUT PRESCRIPTION DRUGS AND ABUSE OF THEM AND INAPPROPRIATE USE OUTSIDE OF THE PERSON THAT'S PRESCRIBED TOO THAT OPIOID ABUSE HAS BEEN STEADY ILLEGALSY RISING WE ARE HEARING FROM A NUMBER OF DEATHS FROM PRESCRIPTION OPIOIDSA BUT WHAT DOES THIS HAVE TO DO WITH THE ICCFASD, THESE ARE OUR THEMES AS MARCIA TOLD YOU BEFORE PREVENTION OF DRINKING DURING PREGNANCY, INTERVENING WITH FAMILIES THAT HAVE BEEN EFFECTED BY FASD, IMPROVING DIAGNOSIS AND UNDERSTANDING THROUGH RESEARCH, ETIOLOGY AND PATHOGENESIS AND INCREASE INFORMATION DISSEMESTER NATION. SO HERE'S A SOME NEW DATA OUT OF DETROIT FROM SOKUL'S GROUP. DATA FROM OVER 3000 WOMEN ON ALCOHOL, CIGARETTE, COCAINE AND MARIJUANA USE AND THEIR EFFECTS ON PRETERM DELIVERY AND ON FETAL GROWTH. NOW FROM THE EARLY PERSPECTIVE STUDIES FUNDED BY NIAAA IN THE 80S THERE WAS SOME POLYSUBSTANCE USE. I THINK IN THE ATLANTA GROUP THEY WOULDN'T TAKE ANY WOMEN THAT WERE USING COCAINE BUT THEY DID HAVE MORE THAN 20% OF THEIR SAMPLE USING MARIJUANA. IN THE SAMPLE IN PITTSBURGH THERE WAS USE OF MARIJUANA, IN SOME COCAINE, IN SEATTLE THERE WAS USE OF MARIJUANA IN ADDITION TO THESE ARE ALL WOMEN SELECTED FOR ALCOHOL USE DURING PREGNANCY BUT THEY WERE ALSO USING POLYSUBSTANCES AND AT THAT TIME IN THE 80S, CIGARETTE SMOKING IN THE UNITED STATES WAS MUCH MORE PREVALENT AND THEY HAD A VERY HIGH EN--STRATEGIES DENSE OF CIGARETTE USE. BUT THEIR SAMPLE SIZES WERE NOTHING LIKE THE SAMPLE OF 3000 IN DETROIT THAT SOCUS GROUP REPORTED ON LAST YEAR. SO SOME PORTIONS THAT SOME OF OUR MEMBERS HAVE BEEN ASKING IS HOW DOES POLYSUBSTANCE MISUSE INTERFERE WITH ALCOHOL USE DURING PREGNANCY. SO WE HAVE TO CHANGE THE WAY WOMEN ARE USING ALCOHOL IN PREGNANCY AND ALL WOMEN OF CHILD BEARING AGE THAT ARE MISUSING ALCOHOL SO WE HAVE TO CHANGE THE WAY WE SCREEN THEM, TREAT THEM AND OUR MESSAGES ABOUT PREVENTION. DO OTHER DRUGS OF ABUSE ACT ADDITIVELY OR SINNER GESTICLY AND EXACERBATE THE LIFE LONG EFFECTS OF ALCOHOL IN THE DEVELOPING FETAL BRAIN? THESE ARE SOME OF THE QUESTIONS THAT CAME UP AT OUR MEET NOTHING DECEMBER AND IN OUR TELECONFERENCE THIS YEAR WE NEED TO KNOW MORE ABOUT THIS GROWING PROBLEM SO WE CAN MAKE DECISIONS ABOUT HOW WE MIGHT BE INVOLVED AND WHAT WE MIGHT CONTRIBUTE AND DO SO WE HAVE THIS PANEL LED TODAY BY CHERYL JOYCE FROM NIDA, CHERYL? >> THANK YOU FOR THE INTRODUCTION, SO I HAVE A PRETTY EASY ONE AND IN TERMS OF MY READING THIS DISCUSSION, WE'RE PLEASED TO JUST GET SOME INITIAL OVERVIEW DATA FROM TWO VERY IMPORTANT PERSPECTIVES, FIRST ONE WILL BE ON SOME OF THE SURVEY DATA AND WE'RE VERY PLEASED THAT ONE OF OUR PARTNER AGENCIES AT SAMSA WAS ABLE TO GET PRELIMINARY DATA AND INFORMATION ON DRUG USE AND PREGNANCY AND THEN WE'RE ALSO PLEASE THAD WE WILL HAVE A PRESENTATION FROM FROM SOME OF THE DATA AT KISER. SO WITH THAT I WILL INTRODUCE OUR FIRST PRESENTER AND MARGARET MADSON IF YOU CAN COME ON UP AND THANK YOU VERY MUCH AND SHE WILL PRECEPTOT SURVEY DATA ON POLYDRUG USE IN PREGNANCY. THANK YOU. >> THANK YOU CHERYL. IT'S GREAT TO BE HERE, IT'S ALSO GREAT TO BE BACK AT NIAAA. I SPENT 22 PLEASANT YEARS HERE SO IT'S GREAT TO BE BACK AND SEE SOME FAMILIAR FACES. MY NAME IS MARGARET MADSON I'M WITH THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION. OUR AGENCY IS ORGANIZED INTO CENTERS TO ADDRESS THINGS LIKE TREATMENT AND PREVENTION, YOU'RE PROBABLY WITH THE ACKRONE IMPEDIMENTS CSAT AND CSTAT WHICH DEAL WITH PREVENTION AND TREATMENT. I'M WITH A RELATIVELY NEW CENTER CALLED THE CENTER FOR BEHAVIORIAL HEALTH STATISTICS AND QUALITY, CALLED CBHSQ FOR SHORT. SO WE'VE BEEN AROUND FOR ABOUT THREE OR FOUR YEARS AND OUR JOB IS TO COLLECT, ANALYZE AND GENERATE PUBLICATIONS ON BEHAVIORIAL HEALTH SURVEY DATA AND I'LL BE TALKING ABOUT ONE OF THE SURVEYS THAT IS RUN OUT OF OUR SHOP IN JUST A MOMENT. I WAS ASKED TO ADDRESS THE PROBLEM OF POLYSUBSTANCE ABUSE AMONG PREGNANT WOMEN SO THIS IS A VERY TIMELY AND IMPORTANT QUESTION, WE KNOW THERE HAVE BEEN SOME MODEST BUT SIGNIFICANT DECREASES IN THE USE OF ALCOHOL BY PREGNANT WOMEN BUT WE HAVEN'T SEEN THE SAME IN ILLICIT DRUGS AND THAT BRINGS UP THE QUESTION OF WE REALLY NEED TO START LOOKING AT DRUGS OTHER THAN CONTROL ALCOHOL AND PARTICULARLY SITUATIONS OF POLYDRUG ABUSE WHERE WOMEN ARE COMBINING SUBSTANCES THERE'S AN INCREASING AWARENESS OF NAS WHICH IS NEONATAL ABSENCE SYNDROME, IT REFERS TO THE WITHDRAWAL THE INFANLT EXPERIENCES IF THE MOTHER WAS USING OPIOIDS BUT WE KNOW MUCH LESS ABOUT THE PL EFFECTS OF OTHER KINDS OF DRUGS SUCH AS MARIJUANA. SO THIS IS REALLY A GOOD TIME FOR THE--FOR THE COMMITTEE HERE TO BE LOOKING AT POLYSUBSTANCE ABUSE. AND A GOOD TOPIC FOR FUTURE RESEARCH THIS IS AN OUTLINE IN MY PRESENTATION, I'VE ALREADY STATED THE PROBLEM WE'LL BE LOOKING AT HERE. I WILL SAY A FEW WORDS ABOUT THE DATAA SOURCE THAT PROVIDED THE TABLE THAT I'LL BE PRESENTING AND THE DEFINITIONS THAT WILL BE USED IN THE PRESENTATION NEXT WE'LL MOVE TO THE MAGNITUDE OF THE PROBLEM IN TERMS OF THE PERCENTAGE AND NUMBERS OF PREGNANT WOMEN USING MULTIPLE SUBSTANCES THEN WE'LL LOOK AT WHAT PARTICULAR SUBSTANCE ARE BEING USED SINGLE SCHEIN COMBINATION AND LOOK A LITTLE BIT AT DEPENDENCE AND ETHNICITY AND THEN THERE WILL BE A SUMMARY WITH INFORMATION ON HOW TO DELVE MORE INTO THIS TOPIC IF YOU'RE SO INCLINED. THE SURVEY I'M DRAWING FROM IS ONE OF THE LARGEST SURVEYS RUN OUT OF CBSQH, IT'S CALLED THE NATIONAL SURVEY OF DRUG ABUSE AND HEALTH CALLED NSDUH FOR SHORT. CONDUCTS PERSONAL INTERVIEWS OF ABOUT 67,000 PEOPLE AGE 12 AND OLDER PER YEAR, THESE DATA ARE COLLECTED IN SUCH A WAY THAT WEIGHTS ARE APPLIED TO TO DERIVE NATIONAL AND STATE LEVEL REPRESENTATIVE ESTIMATES. THE SURVEY HAS BEEN GOING ON FOR QUITE A WHILE IN ITS PRESENT VERSION, IT'S BEEN GOING ON FROM TWO THIS HAPPENED FOUR TO PRESENT ON AN ANNUAL BASIS AND IT'S USED AND QUOTED FREQUENTLY IN THE MENSAL HEALTH AND SUBSTANCE ABUSE COMMUNITY. IT'S A VERY RICH DATA SOURCE. HERE WE'RE GOING TO BE TOUCHING ON MOSTLY THE PREVALENCE DATAA BUT I WANTED YOU TO BE AQUARE OF THE EXTENSIVENESS OF THE DATA IN SAMSHA THAT DEALS WITH ANALYSIS, WITH SUCH THINGS AS PERCEIVED RISK AND ACCESSIBILITY OF SUBSTANCES, DEPENDENCE AND AA BUSES. AGE OF INITIATION, PRIOR USE, OF COURSE HEALTH STATUS INCLUDING PREGNANCY, SERVICES UTILIZATION MENTAL HEALTH AND EVEN COVERAGE BY MEDICAL INSURANCE SO IT'S A VERY RICH DATA AND WHEN THE PREVALENCE DATA IS USED JOINTLY WITH SOME OF THESE OTHER VARIABLES, WE CAN REALLY GET AN EXTENSIVE PICTURE OF SUBSTANCE ABUSE AND MENTAL HEALTH POPULATION. THESE ARE THE DEFINITIONS I WILL BE USING IN THE DATA TO BE PRESENTED. WE'RE FOCUSING ON WOMEN 15-44, AT THE END OF THE SURVEY WOMEN AE ASKED THE QUESTION ARE YOU CURRENTLY PREGNANT? IF THE ANSWER IS YES, THEY'RE ASKED WHAT TRIMESTER OF PREGNANCY THEY'RE IN. THE DATA I'M PRESENTING IS AN AVERAGE ANNUAL OR YEARLYY AVERAGE OF THE DATA FROM 2004 TO 2013. WHEN I REFER TO SUBSTANCES, THAT MEANS ILLICIT DRUG WHICH IS INCLUDES NONMEDICAL USE OF--LICIT DRUGS SUCH AS PAIN MEDICATIONS WHICH INCLUDES MARIJUANA WHICH MAY OR MAY NOT BE ILLICIT DRUG DEPENDING ON WHERE YOU LIVE AND ALCOHOL. TOBACCO IS EXCLUDED FROM THIS DATA. AND I'D LIKE TO YOU TAKE NOTE THAT ALL USE REFERS TO USE IN THE PAST 30 DAYS WHICH IS CONSIDERED CURRENT USE. HERE ARE THE BASIC PREVALENCE FIGURES FOR THE USE OF SUBSTANCE SUBSTANCES, ALL PREGNANT WOMEN, THE PREVALENCE IS 13.5% FOR USE OF ANY SUBSTANCE THAT DECREASES CONSIDERABLY WHEN YOU ASK WHAT IS THE BRIEFULENCE FOR MULTIPLE SUBSUBSTANCES, IT'S 2.2%. AS YOU CAN SEE MOST OF THE USE OCCURS IN THE FIRST TRIMESTER BOTH FOR ANY SUBSTANCE AS WELL AS MULTIPLE SUBSTANCES AND USE DECREASES WITH INCREASING DURATION OF THE PREGNANCY. WE NOTICE THIS, THIS 13.5 IS OF COURSE ALL PREGNANT WOMEN BUT THE CONTRAST THAT NUMBER FOR NONPREGNANT WOMEN WHICH IS 56% USE ANY SUBSTANCE, FOR MULTIPLE SUBSTANCES IT'S ABOUT NINE%. SO WE CAN SEE THAT WOMEN DO SUBSTANTIALLY DECREASE THEIR USE DURING PREGNANCY BUT WE STILL--WE STILL HAVE UNACCEPTABLE NUMBERS HERE TO CONTEND WITH. AY AMOUNT IS TOO MUCH. THIS DATA IS THE SAME AS THE PREVIOUS SLIDE BUT IT SHOWS IT IN TERMS OF NUMBERS OF WOMEN EFFECTED WHICH KIND OF GIVES THEM MORE PUBLIC HEALTH POINT OF VIEW, SO SO ALL PREGNANT WOMEN WHO USE ANY SUBSTANCE IT'S OVER 300,000 HERE'S THE BIG DROP DOWN TO THE POLYSUBSTANCE USE WHICH IS ABOUT 53,000 AS WE SAW IN THE PREVENTIVE YOIS SLIDE, BOTH OF THESE DECREASE WITH INCREASING TRIMESTER, BUT IT'S ESPECIALLY TROUBLING, I THINK THAT WE'RE SEEING EVEN THESE KIND OF NUMBERS FOR MULTIPLE SUBSTANCE USE AND REMEMBER THESE ARE ANNUAL AVERAGES SO THIS IS PER YEAR. THE NEXT QUESTION IS WHAT SUBSTANCES ARE USED DURING PREGNANCY, I'VE DIVIDED THEM INTO TWO CATEGORIES, THE MOST PREVALENT WHICH ARE THESE THREE AND THE LESS PREVALENT SUCH AS SUBSTANCES SUCH AS COCAINE, INHALENTS. >> QUICK QUESTION IF I MAY, IF YOU'RE TALKING PAIN MEDICATIONS ARE YOU TALKING OVER THE COUNTER? NGOOD QUESTION. IT'S PRIMARILY OPIATE PAIN RELIEVERS, NOT OVER THE COUNTER. ALL RIGHT THIS, IS A FIRST OF THE SERIES OF THREE SLIDES WHICH LOOKS AT COMBINATIONS OF SUBSTANCES AND AGAIN THIS IS IN TERMS OF MAGNITUDE OF THE POPULATION EFFECTED. SO THE MOST PREVALENT IS ALCOHOL, 8.7% OF PREGNANT WOMEN USE ALCOHOL DURING PREGNANCY, ABOUT THIS IS ABOUT 1.3% USE ALCOHOL IN COMBINATION WITH OTHER SUBSTANCES AND LESS THAN A PERCENT USING ALCOHOL WITH TWO OR MORE SUBSTANCES SO KEEPING ALCOHOL IN THE PICTURE FOR REFERENCE, THE SECOND DOMINANT SUBSTANCE USE DURING PREGNANCY IS MARIJUANA SO ABOUT 15,000 WOMEN USE THAT NUMBER ALONE, THAT GOES TO ABOUT 32,000 COMBINED WITH ONE OTHER SUBSTANCE AND ABOUT 13,000 WHEN COMBINED WITH TWO OTHER SUBSTANCES. AND JUST FOR COMPARISON, THIS NUMBER IS ABOUT 2 PERCENT AND IF YOU LOOK AT THE 2 PERCENT OF PREGNANT WOMEN, IF YOU LOOK AT ALL WOMEN, THE PREVALENCE OF MARIJUANA USE ALONE IS 6 PERCENT, SO AGAIN WE'RE SEEING THE SAME THING WITH MARIJUANA THAT WOMEN DO DECREASE DURING PREGNANCY BUT DO NOT STOP ENTIRLY AND STILL CONTINUE TO USE MULTIPLE DRUGS. AND THE FINAL SLIDE IN THIS SERIES ADDS THE THIRD ONE OF INTEREST. PAIN RELIEVERS WHICH I JUST SAID ARE PRIMARILY OPIATES, THESE CONSITUTE ABOUT WELL, A FRACTION OF--A FRACTION OF A PERCENT AND ABOUT 6000 USE PAIN RELIEVERS ALONE, ABOUT ANOTHER 6000 COMBINED PAIN RELIEVERS WITH ONE OHER SUBSTANCE AND ABOUT 7000 COMBINE IT WITH TWO OR MORE SUBSTANCES. I WON'T SAY A LOT ABOUT THE REMAINING DRUGS, THE NUMBERS ARE SMALL BUT STILL SIGNIFICANT WHEN YOU TALK ABOUT SUBSTANCE USE DURING PREGNANCY, EACH OF THESE CATEGORIES BOTH SINGLY AND IN COMBINATION CONSITUTE UNDER 5000 USERS PER YEAR AND A FRACTION OF A PERCENT. THIS SLIDE LOOKS AT A RACE ETHNIC BREAK DOWN. I SHOULD MENTION THAT WE DIDN'T HAVE THE OPPORTUNITY TO DO SIFICANT TESTING ON THIS SO WE JUST HAVE TO EYEBALL THESE NUMBERS WITHOUT SAYING FOR SURE THESE NUMBERS ARE OR ARE NOT SIGNIFICANT--SIGNIFICANTLY DIFFERENT FROM EACH OTHER. IT LOOKS AS IF AS WE KNOW THE VAST MAJORITY OF WOMEN DURING PREGNANCY DO NOT USE ANY SUBSTANCES AROUND, YOU KNOW 10%, USE ONE SUBSTANCE TWO OR 3 PERCENT USE TWO OR MORE. WE SEE A LITTLE BIT OF A HINT HERE THAT THERE MAY BE A SOMEWHAT GREATER PREVALENCE AMONG THE AFRICAN AMERICAN POPULATION BUT AGAIN BECAUSE WE DON'T HAVE THE SIGNIFICANT TEING FOR THESE FIGURES WE CAN'T SAY THAT FOR SURE BUT IT SEEMS SUGGESTIVE. THE LAST DATA SLIDE IS KIND OF A LOT OF NUMBERS ON IT BUT THERE'S REALLY ONE IMPORTANT POINT TO BE TAKEN FROM IT, WHAT THIS IS, IT COMPARES PREGNANT AND NONPREGNANT WOMEN IN TERMS OF HAVING A SUBSTANCE USE DISORDER BASED ON DSM FOUR CRITERIA AND IT COMPARES THEM IN RELATION TO THESE VARIOUS CATEGORIES OF SUBSTANCE USE, YOU KNOW USE ONE SUBSTANCE, USE MULTIPLE ALCOHOL ONLY ILLICITITS ONLY, ALCOHOL AND ILLICITS. NO ALCOHOL ONE ILLICIT AND NO ALCOHOL MULTIPLE ILLICITS. AND THE THINGS TO NOTICE FROM THIS SLIDE IS THAT THE BAR FOR THE PREGNANT WOMEN IN MOST CASES IS HIRE THAN FOR THE NONPREGNANT WOMEN. AND THAT SIMPLY TELLS US THAT ABUSE AND DEPENDENT SYMPTOMS OR DIAGNOSIS AND GREATER AMONG PREGNANT USERS THAN NONPREGNANT USERS AND THIS MAKES SENSE BECAUSE YOU WOULD THINK THAT THOSE WHO HAVE A SUBSTANCE ABUSE DISORDER WILL FIND IT MORE DIFFICULT TO QUIT DURING PREGNANCY. YES? >> [INDISCERNIBLE]. >> THREE OR FOUR, I'M NOT SURE, I THINK IT'S THREE. YES, YES. YES, YES. >> THE LAST, THIS IS THE SUMMARY, THE MESSAGES WE CAN TAKE FROM THIS DATA IS THAT APPROXIMATELY 2.2% OF PREGNANT WOMEN ARE POLYDRUG USERS WHICH AVERAGES ABOUT 53,000 PER YEAR. THE MAJOR SUBSTANCE IS USED ALONE OR IN COMBINATION ARE ALCOHOL, MARIJUANA AND OPIATE PAIN MEDICAIONS. AND PREGNANT WOMEN USING MULTIPLE SUBSTANCES ARE MORE LIKELY TO HAVE SUBSTANCE ABUSE OR DEPENDENCE THAN NONPREGNANT POLYDRUG USERS. I JUST WANTED TO CLOSE WITH A LITTLE BIT OF INFORMATION ON THE ACCESSIBILITY OF THE NISD DATA FOR THOSE WHO LIKE TO DO THEIR OWN ANALYSIS. OR EVEN READ THE REPORTS THAT HAVE ALREADY BEEN WRITTEN USING THIS DATA. SO THERE ARE SEVERAL WAYS TO ACCESS THE DATA IT'S AVAILABLE IN THE FORM OF WRITTEN REPORTS, ANALYTIC DATA SHEETS YOU COULD DO INTERACTIVE ANALYSIS, ONLINE AND THERE'S ALSO A WAY TO OBTAIN THE PERSON LEVEL DATA AND ANALYZE FROM THAT POINT OF VIEW AND THESE ARE SOME URLs WHERE YOU CAN GET FURTHER INFORMATION AND FURTHER DATA ACCESS AND REPORTS THAT HAVE BEEN WRITTEN USING THE DATA ON THIS AND OTHER TOPICS. THANK YOU VERY MUCH. [ APPLAUSE ] . >> THANK YOU FOR THAT OVERVIEW, VERY INTERESTING DATA. IT SOUNDS LIKE THERE'S A LOT MORE TO UNPACK AS AND THAT DATA OF COURSE--THAT IS ALL PUBLIC ACCESS SO I THINK THAT ALLOWS AN OPPORTUNITY FOR SOME OF OUR RESEARCHERS AND THOSE INTERESTED IN THE QUESTIONS, NOW THAT YOU'VE GIVEN AN OVERVIEW TO THINK MORE ABOUT SOME OF THE QUESTIONS THAT WE HAVE BEEN THINKING ABOUT THAT SALLY PRESENTED AT THE BEGINNING THAT MAY BE ABLE TO BE ANSWERED BY SOME OF THE DAT AVAILABLE IN THAT DATA SET. AND ALSO LAY THE GROUND WORK FOR PERHAPS ADDITIONAL ANALYSIS AND OTHER DATA SETS AND SOME OF THE DATA SETS WHICH OUR RESEARCHERS MAY HAVE NEXT WE'RE GOING TO LOOK AT ANOTHER PERSPECTIVE IN TERMS OF PRACTICE AND WITH THAT I'D LIKE TO INVITE OUR PRESENTER FROM THE CAN KISER PERMANENT A AND THE DIVISION FROM CALIFORNIA. AND I WILL PULL UP YOUR SLIDE TO MAKE IT EASIER FOR YOU. AND NOW I WILL TURN IT OVER TO YOU. GOOD MORNING. VERY HAPPY TO BE HERE, I WISH I COULD TAKE SOME OF THIS RAIN BACK TO CALIFORNIA WITH ME. WE CERTAINLY NEED IT THERE. I'D LIKE TO--I'M HAPPY TO BE HERE AND I WILL ACKNOWLEDGE MY COLLEAGUES AT THE DIVISION OF RESEARCH WHO'VE DONE THE STUDIES I'M TALKING ABOUT HERE AND THE ANALYSIS AND ALSO THE WOMEN'S DRINKING AND PREGNANCY WORK GROUP WHO REALLY INSPIRED A LOT OF THINKING FOR THIS TALK AND HAS REALLY STIMULATED FOR MANY OF US RESEARCH IN THIS AREA AND THANKS TO DIERDRE AND THE COMMITTEE. I AM GOING TO TALK A LITTLE BIT ABOUT FROM THE PERSPECTIVE OF A HEALTH--ONE HEALTH SYSTEM, WHAT WE KNOW ABOUT PREGNANT WOMEN ARE MORE LIKELY MAINLY WOMEN OF CHILD BEARING AGE WITH ALCOHOL PROBLEMS AND TALK ALSO ABOUT POLYDRUG USE AND MEDICAL AND MENTAL HEALTH PROBLEMS AND HOW THESE ARE TYPICALLY BEING HANDLED TODAY IN THIS PARTICULAR HEALTH SYSTEM. TALKING ABOUT RESEARCH STEPS ABOUT HOW WE COULD LEARN MORE ABOUT MULTIPLE PROBLEMS FROM A LOT OF EXIST BEING DATAA IN HEALTHCARE SYSTEMS CHANGE GEARS HERE TO TALK A BIT ABOUT MOVING FORWARD AND THINKING BROADLY ABOUT HOW TO INTERVENE AND HOW TO DO PREVENTION AND TREATMENT IN AN INNOVATIVE WAY GIVEN CHANGES WE HAVE WITH HEALTH REFORM AND ELECTRONIC HEALTH RECORD. SO THE DATA I'M TALKING ABOUT TODAY ARE TALKING ABOUT NORTHERN CALIFORNIA KISER PERMANENT A, IT'S INTEGRATED HEALTH DELIVERY SYSTEM WHERE MEDICAL PSYCHIATRIC AND ALCOHOL AND DRUG SERVICES ARE HANDLED BY THE SAME SYSTEM. AND IT'S ABOUT 3.7 MILLION MEMBERS ALTHOUGH IT'S GROWING WITH THE PORTABLE CARE ACT ALSO IN TERMS OF DIVERSITY, A MUCH LARGER GROUP OF MEDICATE PATIENTS COMING IN IT HAS LONGITUDINAL DATA AND LONG MEMBERSHIP ENROLLMENT AND IMPORTANTLY IT HAS HARMONIZED DATA WITH SEVEN OTHER REGIONS ACROSS THE COUNTRY AND THE OTHER HEALTH PLANS THAT ARE PART OF THE HMO RESEARCH NETWORK RECENTLY CHANGED TO BE CALLED THE HEALTHCARE SYSTEMS RESEARCH NETWORK TO REFLECT THE DIVERSITY THAT'S THERE IN THE HEALTH PLANS. AND THE REASON I SAY THAT IS THAT A LOT OF THINGS I'M GOING TO BE TALKING ABOUT TODAY CAN BE DONE IN ACROSS THE COUNTRY IN ALL OF THESE HEALTHCARE SYSTEMS, ALSO IN SOME OF THE FEDERALLY QUALIFIED HEALTHCARE FROMS AND OTHER HEALTHCARE CENTERS THAT ARE DEVELOPING ELECTRONIC HEALTHCARE. ELECTRONIC HEALTHCARE RECORDS. SO I'M FIRST GOING TO TALK ABOUT ADULT ALCOHOL AND OTHER DRUG WOMEN WHO ARE IN TREATMENT AND THEN I WILL BE TALKING ABOUT ADOLESCENCE, SO THIS IS A RECENT STUDY FUNDED BY NIDA AND NIAAA THAT TAKES PLACE IN SAN FRANCISCO AND IT HAS WOMEN AND MEN HERE BUT IT IS FOR COMPARISON, I'M FOCUSING ON WOMEN THESE ARE ALL WOMEN OF CHILD BEARING AGE UNDER AGE 45 AND THIS IS LOOKING AT THEIR TYPE OF DEPENDENCE AND IT'S NOT A BUSES, THIS IS ALL DEPENDENCE. SO THIS IS A CONSERVATIVE MEASURE AND WE SEE THAT 72% OF THE WOMEN, THIS AGE GROUP ARE ALCOHOL DEPENDENT AND THEN WE HAVE FROM SIX TO 15 OR 17% DEPENDENT ON THESE OTHER DRUGS, METHAMPHETAMINES AND COCAINE ARE HIGH AND OPIOIDS ARE HIGH AND ESPECIALLY IF YOU INCLUDE HERO WIN WITH THAT AND THIS IS REALLY AS I SAID CONSERVATIVE BECAUSE IT IS JUST PEOPLE MEETING DEPENDENCE CRITERIA WHEN WE LACK AT PEOPLE WHO ABUSE CRITERIA OR DAYS OF USE OF THESE OTHER DRUGS IT IS HIGHER. SO WHEN WE TAKE NOW THE ALCOHOL DEPENDENT WOMEN ONLY AND LOOK AT THE TYPES OF OTHER DEPENDENT THAT THEY HAVE WE SEE ABOUT--WE SEE THESE FIGURES HERE ABOUT 14 STIMULANTS IF YOU COMPAIN COCAINE AND METHAMILLIO FET MINES AND MARIJUANA MARKED FOR IDENTIFICATION MARKED FOR IDENTIFICATION METHAMPHETAMINES AND MAR JUAN AND AND OBIOIDS AND YOU LOOK AT DAYS OF USE THOSE NUMBERS ARE HIGHER. WHEN WE THINK ABOUT THE WHOLE PERSON OF THESE WOMEN IN TREATMENT WHEN WE USE THE ADDICTION SEVERITY INDEX THIS, IS AN TRIEWMENT THAT MEASURES SERITY ACROSS THESE DIFFERENT DOMAINS, ALCOHOL, DRUG, LEGAL, EMPLOYMENT, FAMILY AND MEDICAL, IT'S A SEVERITY SCORE FROM ZERO-10. WE SEE THAT THE SCORES FOR WOMEN OF CHILD BEARING AGES AS THEY'RE ENTERING SHOW THAT THERE'S ALCOHOL SEVERITY OF THE HIGHEST BUT ALSO DEFINITELY ENOUGH DRUGS TO BE CONCERNED ABOUT IN TERMS OF SEVERITY AND ALL THESE OTHER HEALTH PROBLEMS IN PSYCHIATRIC AND SOCIAL FAMILY HEALTH PROBLEMS THEY HAVE SO THIS IS A GROUP OF PEOPLE IN SPECIALTY TREATMENT WHO DO HAVE A SET OF COMPLEX PROBLEMS. AND I WOULD ADD THAT IF WE LOOK AT THIS AGE GROUP SEPARATELY LIKE FROM EIGHT-25, 25-30, SO FORTH. ALL WOMEN ARE NOT THE SAME THESE CHANGE DRAMATICALLY. THE YOUNGEST PEOPLE DO HAVE A HIGHER PREVALENCE OF DRUG SEVERITY. HIRE SCORES ON THAT AND AS THEY GET OLDER MORE--HIGHER SCORES ON THAT AND AS THEY GET OLDER, LESS DRUGS. SO HERE AGAIN, OF CHILD BEARING AGE AND WE MATCH THEM WITH WOMEN IN THE HEALTH PLAN ON AGE, RACE ETHNICITY, LENGTH OF ENROLLMENT, GEOGRAPHIC CATCHING AREA, WE FIND THAT WOMEN IN TREATMENT HAVE ABOUT 10 TIMES HIGHER RATES OF PSYCHIATRIC DISORDERS, THEN MATCH WOMEN WITHOUT ALCOHOL OR DRUG DIAGNOSIS. BOTH FOR DEPRESSION ANXIOUS, AND SYICOSEIS. AND IMPORTANTLY WHEN WE LOOK AT MEDICAL CONDITIONS WHICH I DON'T WANT US TO FORGET ABOUT WHEN WE THINK ABOUT CO-OCCURRING PROBLEMS. WE FIND THAT WOMEN IN TREATMENT MATCHED AGAIN WITH WOMEN WITHOUT ALCOHOL OR DRUG DIAGNOIS OR DISORDERS HAVE, YOU KNOW THREE TO FOUR TIMES HIGHER RATES OF MANY OF MANY HEALTH CONDITIONS, THE ONES LISTED HERE HAVING THE HIGHEST PREVALENCE. SO THIS--AS I MENTIONED, THIS IS A POPULATION THAT HAS MULTIPLE ISSUES. SO NOW I'M GOING TO LOOK AT ADOLESCENCE IN TREATMENT AGAIN FROM STUDIES FUNDED BY NIAAA AND NIDA. SO THIS IS A SAMPLE OF KIDS AND TREATMENT, FOUR SITES, AND THIS IS A RANDOM SAMPLE OF KIDS SO REPRESENTATIVE OF KIDS IN THOSE PROGRAMS, YOU CAN SEE THE AGE RANGE IS FROM 13-17, WITH A MEAN AGE OF 16. MEAN AGE OF INITIATION OF USE IS 11.5 AND I WOULD POINT OUT THAT THIS IS LOWER THAN WHEN WE LOOK AT OUR OLDER SAMPLES OF PEOPLE AND TREATMENT WHO HAVE STARTED USING MANY OF THE SUBSTANCES LATER IN LIFE THAN THE KIDS ENTERING TREATMENT NOW. SO THEY SEEM TO BE STARTING EARLIER AND THIS IS IN ETHNICITY BREAK DOWN OF THE POPULATION ABOUT HALF OUR WEIGHT AND 20% HISPANIC AND 16% NATIVE AMERICAN AND 3 PERCENT ASIAN. AND THIS IS STUB STANCE USE IN THE PRIOR SIX MONTHS LOOKS LIKE WITH THEIR TREATMENT, AND I WOULD NOTE THAT IT DOESN'T LOOK A LOT DIFFERENT WHEN WE LOOK AT THE TREATMENT. AS YOU CAN SEE THERE'S A PREVALENCE OF ANY ALCOHOL, THREE + DRINKS AT ONE TIME, FIVE + DRINKS AT ONE TIME. AND AGAIN THIS IS SUPPOSED TO BE GOLD COLOR WITH HIGHER PERCENTAGE OF MANY OF THESE SUBSTANCES IN BOYS. BUT THE RACE OF USE OF MAR JUANY TOBACCO HALLUCINOGENS, STIMUNLETS, ET CETERA, IT'S ALL VERY HIGH AMONG THESE KIDS. WE ALSO NOTED THAT IN OUR SURVEYS WE ASK ABOUT FAMILY, ALCOHOL AND DRUG PROBLEMS AND PARENTS AND AUNTS AND UNCLES AND SO FORTH AND WE FIND THAT THEIR PARENT VS HIGH RATES OF SUBSTANCE USE DISORDERS PROBLEMS SO THIS LEADS US AS WE'RE SPECULATE NOTHING OUR MEETINGS AY THAT YOU HAVE TO WONDER HOW MANY OF THESE KIDS SHOULD ALSO BE SCREENED FOR FASD THEMSELVES. AND I WOULD ALSO POINT OUT THAT WHEN WE LOOK AT FASD RISK BEHAVIORS, WHICH I WILL LOOK AT NEXT, THAT THE KIDS WHO ARE USING FIVE OR MORE DRINKS AT A TIME ARE USING PAIN KILLERS THOSE WERE RISK FACTORS FOR RISK BEHAVIORS. WHEN WE DO LOOK AT RISK BEHAVIORS AMONG THIS SAMPLE, WE FIND AGAIN THAT GIRLS ARE HIGHER THAN THE BOYS AND INCONSISTENT CONDOM USE OF THOSE REPORTING EVER HAVING SEX AND SEX THEY HAVE HIGH RATES ALSO OF MULTIPLE PARTNERS WITH NEVER OR INCONSISTENT CONDOM USE AND IMPORTANTLY 15% OF THE GIRLS IN THIS SAMPLE OF KIDS ENTERING TREATMENT AT THIS HEALTH PLAN HAVE REPORTED BEING PREGNANT IN THE PAST. SO IT IS REALLY A HIGH RISK POPULATION. WE HAVE TO REMEMBER, EVEN THOUGH IS AN INSURED POPULATION WHERE MAINLY PEOPLE ARE INSURED THROUGH THEIR EMPLOYMENT AND THIS IS BEFORE THE INFLUX OF NEW PATIENTS, MEMBERS, ALSO FROM THE AFFORDABLE CARE ACT THAT SHOULD A VERY AT RESERVING GROUP AMONG THE INSURED POP EULOGISTS AS WELL. --POPULATION AS WELL. WHEN WE LOOK AT PSYCHIATRIC PORBIDDITY IN THIS EXAMPLE, GIRLS IN GREEN HERE WE SEE THEY HAVE HIGH RATES OF DEPRESSION, ANXIOUS AND CERTAINLY CONDUCT DISORDER AS WELL. THEY'RE EVEN OUTDOOING THE BOYS WITH THAT THESE DAYS. STATE OF EMERGENCY THIS SAY POPULATION WE SHOULD BE CONCERNED ABOUT WITH DRUG USE AND CO-MORBIDITIES. AND THIS PATTERN EXISTS IN DRUG USE AND IN PSYCHIATRIC PROBLEMS ACROSS ALL OF THE ETHNIC GROUPS IN THE STUDY. SO WHAT IF WE BET AWAY NOW FROM SPECIALTY AND IMPROVED PEDIATRICS, AND ANN SBIRT STUDY, THAT WE'RE JUST FINISHING, WE SCREENED IN OAKAND, CALIFORNIA ALMOST 7000 KIDS AS THEY WERE COMING FOR PEDIATRIC VISITS AND THEY WERE SCREENED AFTER THEY WERE ROOMED AWAY FROM THEIR PARENTS SO THAT THEY DID THIS ON A TABLET, SELF-REPORT AWAY FROM THEIR PARENTS AND HERE'S WHAT THE SAMPLE LOOKS LIKE. WE FIND THAT WITH KIDS FOCUSING AGAIN ON THE GIRLS AGING 12-17, WE SEE THAT 18% SCREENED FOR HAVING USED ANY CONTROL IN THE LAST MONTH, 14% MARIJUANA AND ABOUT ONE% OTHER DRUGS WHICH ARE PRIMARILY OPIOIDS AND PRESCRIPTION DRUG ABUSE THAT THEY HAPPEN TO FIND AT HOME, MAINLY. AND ALSO 18% SCREENED FOR ANY MOOD SYMPTOM. 33% ALMOST SCREENS FOR ANY OF THESE BEHAVIAL HEALTH SYMPTOMS AND ONE THING I LIKE TO POINT OUT ALWAYS IS THAT NIAAA LED A SCREEN INTO THE SAMPLE, ANYBODY WITH EVEN A MOOD DISORDER, THEY DIDN'T HAVE TO SCREEN POSITIVE ON THE ALCOHOL SIDE AND WE WERE REALLY GLAD WE DID THAT BECAUSE MANY OF THE KIDS DIDN'T REPORT ALCOHOL OR DRUG USE ON THE SCREENER, BUT ONCE THEY WERE IN WITH THE BEHAVIORIAL MEDICINE SPECIALIST, INTERVENTION, THAT'S WHEN THEY ALSO TALKED ABOUT THE ALCOHOL AND DRUG USE. SO IT'S REALLY--I THINK SOME THINGS ARE REALLY EASIER FOR THEM TO TALK ABOUT AND REPORT AND WE MIGHT MISS SOME KID FIST WE ONLY ASK ABOUT SUBSTANCE ABUSE. THIS IS A STUDY WHERE PEDIATRICIANS WERE RANDOMIZED TO ENTRAINED TO DO SCREENING, A BRIEF--EVERYBODY GOT THE SCREENER BUT THEN THEY WERE TRAINED TO DO THE NEXT ASSESSMENT WHICH INCLUDED CRAFT AND FREQUENCY QUESTIONS AND MENTAL HEALTH QUESTIONS AND THEN ANOTHER GROUP OF PEDIATRICIANS WAS RANDOMIZED TO LOOKING AT THE RESULTS OF THE ASSESSMENT, SCREENER AND REFERRING THEM TO BEHAVIORIAL MEDICINE SPECIALIST, AND PSYCHOLOGIST WHO WAS RIGHT THERE ON THE FLOOR BUT WAS A SEAMLESS REFERRAL AND THE OTHER ONE WAS JUST USUAL CARE. AND I ASKED THIS YOUNG PSYCHOLOGIST TO GIVE ME A VIGNETTE OF ONE OF THE CASES BAUSE WE DID DEEP A VIGNETTE ON EVERY CASE THAT WOULD BE REPRESENTATIVE OF THE KIND OF YOUNG WOMAN WHO SHE WAS CONCERNED ABOUT WHO CLEARLY WAS ON THE BORDER LIKE SHOULD WE GO TO TREATMENT? AND SOMETHING MORE HELPFUL SHOULD BE DONE FOR HER SO SHE PULLED THIS OUT SAYING THIS WASN'T LIKE THE MOST SEVERE CASE, THIS WAS REPRESENTATIVE OF A GROUP OF PEOPLE THAT SHE WAS CONCERNED ABOUT SO, YOU KNOW THIS--THIS IS A YOUNG WOMAN WHO IS JUST GOING--WHO SHE THOUGHT WAS VERY BRIGHT AND SHOULD BE--COULD BE DOING REALLY WELL IF SHE GOT HER PROBLEMS, CONCERN, SHE HAS A FAMILY HISTORY OF ALCOHOL AND DRUGS, HAVING ACADEMIC PROBLEMS INSPITE OF HER CAPACITY, POTENTIAL HAVING LEGAL PROBLEMS AND SHE HAS HAD AN UNWANTED PREGNANCY ALREADY AND A MISCARRIAGE DUE TO DRUG USE. AND SHE CLEARLY NEEDED MORE THAN ONE SESSION OF A BRIEF INTERVENTION AND THAT'S--OUR NEXT STUDY IS HAVING A FOUR-SESSION INTERVENTION BECAUSE WE FOUND SO MANY OF THESE KIDS NEEDED MORE THAN A BRIEF INTERVENTION. SO I THINK THAT UNFORTUNATELY, THESE ARE ALL DATA FROM WOMEN OF CHILD BEARING AGE RATHER THAN WOMEN WHO ARE PREGNANT AND I'LL BE TALKING ABOUT WHAT WE CAN DO ABOUT THAT AT THE NEXT STEP. THERE IS A PROGRAM AT KISER PERMANENT A CALLED EARLY START PROGRAM IN WHICH WOMEN--ALL WOMEN WHO ARE PREGNANT ARE GIVEN THE QUESTIONNAIRES, I'M GOING TO SHOW YOU HERE AND EITHER IF THEY RESPOND TO ANY ALCOHOL OR DRUG USE OR HAVE ANY--FREQUENT TOXICOLOGY SCREENS THEY ARE SENT TO--THEY ARE GIVEN AN APPOINTMENT WITH MOST CASES A LICENSED SOCIAL WORKER OR COUNSELING AND THEY DO THAT WHEN THEY COME IN FOR THEIR PRENATAL VISITS. SO THIS--THE QUESTIONS THAT ARE ASKED ARE FIRST, FAMILY PROBLEMS, WHO THAT IS, PARTNERS DRINKING, THEY'RE DRINKING, WHETHER THEY THOUGHT THEY SHOULD CUT DOWN AND SO FORTH AND WHETHER THEY WILL HAVE TROUBLE DOING THIS AND ALSO ANY ALCOHOLIC DRINKS. THEN THEY'RE ASKED IN THE 12 MONTHS BEFORE THEY WERE PREGNANT THESE QUESTIONS ON ALCOHOL AND NICOTINE, SLEEP MEDICATION, PAIN, ANXIOUS, MARIJUANA, COCAINE, CRACK, HEROIN AND OTHER STREET DRUGS. THEY'RE ALSO ASKED THIS QUESTION, SINCE THEY WERE PREGNANT. SO MOST OF THE WORK THATY BEEN DONE WITH THE EARLY START PROGRAM AND IT'S BEEN QUITE WELL PUBLISHED AND SHOWN THAT WOMEN WHO DO GO TO THIS PROGRAM HAVE MORE--HAVE BETTER INFANT--FETAL OUTCOMES THAN WOMAN WHO SCREEN POSITIVE AND DO NOT GO TO THE PROGRAM. WE HAVEN'T DONE A LOT OF RESEARCH YET ON THE DRUG, THE KIDS WHO ARE BOTH ALCOHOL AND DRUGS OR DRUGS ALONE. SO THAT IS SOMETHING THAT I THINK WE SHOULD DO NEXT. ONE THING I WILL CAUTION US IS THAT RIGHT NOW, I THINK THIS AND OTHER HEALTH SYSTEMS ARE VERY INTEREST IN OPIOIDS AND IT'S--IN SOME WAYS IT'S GOOD BECAUSE IT'S FINALLY THEY'RE INTERESTED IN DRUG ABUSE, AND--BUT WHAT WE OFTEN SEE IN TREATMENT SYSTEMS, INCLUDING I THINK HEALTHCARE SYSTEMS THAT THERE IS A SORT OF WHAT IS THE DRUG OF THE DAY, AND AS WE MOVE TO INCLUDE OUR INTEREST AND CONCERN ABOUT OTHER D BESIDES ALCOHOL, WE HAVE TO MAKE SURE THAT ALCOHOL DOESN'T GET DOWN PLAYED. WE HEAR SOME REPORTS, BOTH FROM MEETINGS HERE AND WITH THE FEDERALLY QUALIFY HEALTH CENTER WHICH WE'RE REPLICATING A LOT OF THIS WORK WITH AND NEIGHBORING--THAT AS WE GET CONCERNED ABOUT OPIOIDS FOR EXAMPLE, THAT SOMETIMES THE PHYSICIANS ARE LESS CONCERNED THAN ABOUT ALCOHOL. YOU KNOW IT'S NOT AS BAD. SO I THINK AS WE MOVE FORWARD WE HAVE TO BE STRATEGIC IN HOW WE MAKE SURE WE DON'T THROW THE BABY OUT WITH THE BATH WATER SO TO SPEAK AND AS WE INCORPORATE A BROADER PERSPECTIVE TO NOT FORGET THE OTHER, YOU KNOW--FORGET ABOUT ALCOHOL AND NOT LET THAT GET UNDERMIND AT ALL. SO POTENTIAL NEXT STEPS IN UNDERSTANDING THE POPULATION IS TO LOOK AT MEMBERSHIP DATA HERE AND I COULD TALK ABOUT IT IN OUR WORK WHICH WE HAVE TALKED ABOUT IN OUR WORK GROUP BUT WE CAN SELECT THROUGH PREGNANT WOMEN AND WE CAN LOOK AT DIFFERENT RANGE, ETHNICITY GROUPS AND IDENTIFY TYPES OF DRUG AND DIAGNOSIS INCLUDING ABUSE. IDENTIFY MEDICAL HEALTH AND MENTAL DISORDERS AND LOOK AT UTELIZATION PATTERNS TO UNDERSTAND THE SERVICE PROCESS. THESE KIDS AS WELL AS THEIR PARENTS HAVE ATTENDANCY TO USE EMERGENCY ROOMS RATHER THAN PRIMARY CARE THE WAY ITS INTENDED AND IMPORTANT TO LOOK AT THAT IN TERMS OF UING WHERE TO PLACE INTERVENTIONS AND ALSO A POTENTIAL NOW IN TERMS OF USING NATURAL LANGUAGE PROCESSING WITH ELECTRONIC HEALTH RECORDS TO LOOK AT PHYSICIAN AND OTHER CLINICIAN NOTES TO UNDERSTAND HOW THESE ARE BEING HANDLED AND ALSOA LOOKING AT THE EARLY START DATA WITH ELECTRONIC HEALTH RECORDS AND DOG RAPID QUERIES AND NATURAL LANGUAGE PROCESSING WHICH I'LL TALK A ABOUT IN A MINUTE HERE SO I WANT TO CHANGE GEARS A BIT IN MY REMAINING TIME AND TALK ABOUT HOW TO HANDLE THIS ESPECIALLY AS WE REALLY SEE OUR PATIENT POPULATION AS COMPLEX AND WHOLE PERSONS AND HOW WE CAN PULL TOGETHER THE INFORMATION WE NEED TO PROVIDE REALLY PATIENT CENTERED CARE SO I WILL FOCUS ON USE OF THE ELECTRONIC HEALTH RECORD AND SEE IT AS A PLATFORM FOR POTENTIAL, WITH POTENTIAL FOR ADDRESSING, PREVENTION AND TREATMENT OF ALCOHOL AND OTHER DRUG USE AND THAT IT CAN BE USED BOTH BY CLINICIANS AND PATIENTS AND I WANT TO SAY, YOU KNOW SOMETIMES PEOPLE SAY, WELL, SOME PLACES LIKE KISER HAVE AN ELECTRONIC HEALTH RECORD BUT EVERYBODY DOESN'T. BUT I'M TELLING THAT YOU EVERYONE IS GETTING ONE AND EVERYONE WILL HAVE ONE UNLESS THEY WANT TO BE PENALIZED SO I THINK THE TO GET STARTED ON THIS AND NOW, MANY OF THE FEDERALLY QUALIFIED CENTERS AND THE NETWORKS DEVELOP THESE BECAUSE I KNOW WE'RE WORKING WITH SOME OF THEM IN CALIFORNIA, BUT AS PART OF CMS FROM THE TENTACLES OF HEALTH REFORM HAVE ESTABLISHED MEANINGFUL USE CRITERIA, TO PROMOTE THE SPREAD OF EHRs TO IMPROVE HEALTH AND TO AVOID PAYMENT PENALTIES, WHO THERE MUST BE AN EHR SYSTEM WITH SPECIFICATIONS THAT ALLOW THE PROVIDERRENTITY TO USE THE EHR IN MEANINGFUL WAYS TO IMPROVE QUALITY AND EFFICIENCY AND REDUCE ERRORS. SO, THIS IS HAPPENING IN THREE STAGES. FIRST STAGE WAS JUST ELECTRONICALLY CAPTURING HEALTH INFORMATION TO TRACK CONDITIONS AND START BEING ABLE TO DO A BETTER JOB OF QUALITY MEASURES, THEN BY NOW WE'RE SUPPOSED TO HAVE BETTER HEALTH INFORMATION EXCHANGE, ELECTRONIC TRANSMISSION OF PATIENT CARE SUMMARIES, AIR COORDINATION AND BY 2016, REALLY DECISION SUPPORT FOR CLINICIANS AND PATIENT ACCESS TO SELF-MANAGEMENT TOOLS THEREFORE THE PATIENT PORTAL I'M GOING TO TALK ABOUT QUITE A BIT HERE. NOW OBVIOUSLY, WE'RE A LITTLE BEHIND SCHEDULE WITH SOME OF THESE THINGS WITH SOME OF OUR HEALTHCARE SYSTEMS AND THERE'S--YOU KNOW A LOT OF CONCERNS THAT SOME OF THEM HAVEN'T BEEN ESTABLISHED TO DO EVERYTHING, BUT THIS--THIS IS HAPPENING, AND I THINK THAT IT WOULD REALLY BE SMART FOR US TO GETTA AHEAD OF THE GAME AND TO THINK ABOUT HOW WE CAN USE THIS TO BETTER MANAGE THESE PATIENTAS, AND I WILL TALK ABOUT HOW IT'S USED BOTH BY CLINICIANS, PROVIDERS AND BY PATIENTS. SO HOW DO CLINICIANS USE THEM, THEY CAN USE THEM FOR SCREENING, CHECKING GUIDELINES, DECISION SUPPORT, CHECKING FOR CO OCCURRING PROBLEMS, TREATMENT HISTORY, RETRIEVAL OF OTHER PROGRESS NOTES, SEEING INFORMATION FROM OTHER DEPARTMENTS AND DOING RAPID QUERIES AND COMMUNICATING WITH PATIENTS AND ENCRYPTED E-MAILS. AND ONE OF THE THINGS I'M GOING TO TALK ABOUT HERE WHICH MITE BE USEFUL FOR US TO THINK ABOUT IS DEVELOPING REGISTRY. WHAT IS A REGISTRY? IT'S A CONTINUALLY REFRESHED DATABASE ON A GROUP OF PEOPLE MEETING CERTAIN CRITERIA AND IT PROVIDES UP TO DATE INFORMATION ON THEM INCLUDING CLINICAL CHARACTERISTICS, UTILIZATION, MEDICATION AND SO FORTH SO IT TAKES ALL HEALTHCARE SYSTEM ENCOUNTERS, PUT IT IN THE EHR AND YOU HAVE A REGISTRY. SIMPLE AS THAT. BUT IN THE BELLY OF THE BEAST HERE IS ALL OF THE DATA THAT IS THERE, ON A PERSON, ALL OF YOUR HEALTH CARE VISITS, YOUR LABS YOUR IMMUNIZATIONS, YOUR PHARMACY INFORMATION AND SO FORTH SO THAT A RESEARCHER CAN DO A QUERY FROM THE VIRTUAL DATA WAREHOUSE HERE AND AGAIN NOW THIS EXISTS ACROSS ALL THE KISERS AND THE 18 PROGRAMS OF THE HEALTHCARE SYSTEMS RESEARCH NETWORK AND THIS IS NOT AS--YOU KNOW NOT AS EASY OR AS COMPLICATED AS IT LOOKS. I THINK WE ARE GOING TO BE ABLE TO BE--GOING TO BE SEE THANKSGIVING --SEEING THIS A LOT. THESE REGISTRIES CAN BE USED TO TRACK PATIENTS, TRACK INTERESTEDS OVER TIME SO WE NOW ARE DEVELOPING A REGISTRY OF PEOPLE WHO ARE ON LONG-TERM OPIOID USE AND WE--IT CAN--IT SHOWS THEN THEIR WHOLE PICTURE, SHOWS WHICH DEPARTMENTS A PHYSICIAN CAN QUICKLY LOOK AT A PATIENT, SEE WHAT THEIR MEDICAL CO-MORBIDITIES ARE, THE SCREENING THEY'RE GETTING AND PRIMARY CARE WHICH I'LL SHOW YOU A BIT, IT SHOWS WHICH DEPARTMENTS, HOW MANY TIMES ARE THEY GETTING MEDICATION IN THE EMERGENCY ROOM, HOW ARE THEY USING HEALTHCARE AND REALLY GIVES THEM UP TO DATE INFORMATION ON THE PATIENT IN FRONT OF THEM OR TO REACH OUT TO THEM EVEN WHEN THEY'RE TO THE COME NOTHING FOR SERVICES TO PROVIDE BETTER PATIENT CENTERED CARE. THESE ARE THE REGISTRIES THAT WE HAVE SO FAR AND REALLY BEING USED FOR DIABETES MANAGEMENT AND THERE'S A VERY HELPFUL HIV REGISTRY AND LIKE I SAID WE'RE JUST STARTING NOW IN OPIOID. SO I FEEL THAT THIS IS SOMETHING WE CAN THINK ABOUT IN TERMS OF OUR PATIENT POPULATION, JUST TO SHOW YOU HOW SOME OF THE INFORMATION GOES INTO AND IS AVAILABLE TO CLINICIANS, CAN GO INTO A REGISTRY OR JUST BE SEEN BY A CLINICIAN DOING A RAPID QUERY, THROUGH OUR NIAAA ADULT EXPERT STUDY, WE WERE ABLE TO PUT THE NIAAA QUESTIONS INTO THE VITAL SIGNS WHICH YOU'LL SEE IN A MINUTE. SO WHEN A PATIENT COMES TO TREATMENT, OR COMES FOR A WELL-CARE VISIT AND/OR A PRIMARY CARE VISIT THE MEDICAL ASSISTANT NOW SEES THE BEST PRACTICES ALERT AND ALERTS THE MEDICAL ASSISTANT THAT SHE HAS TO ASK THESE QUESTIONS. THAT ALERT COMES ON EVERY YEAR OR EVERY TIME THEY COME IN IF THEY SCREEN POSITIVE. SO HERE ARE THE NIAAA QUESTIONS ON THE DAILY LIMITS, WEEKLY LIMITS, TWO DEPENDENT RISK QUESTIONS AND THEN THEY MARK WHETHER INTERVENTION WAS PERFORMED OR THEY WERE REFERRED TO CHEMICAL DEPENDENCY SERVICES AND THE ROLL OUT OF THIS AT THE STUDY HAS 86% NOW OF PATIENTS BEING SCREENED WERE VERY EXCITED ABOUT THIS, THE MEDICAL ASSISTANT DOES THE SCREENING, THEY'RE REALLY GOOD AT THIS. THEY ACTUALLY LIKE IT AND THE PHYSICIANS HAVE ABOUT 56% OF THOSE SCREEN POSITIVE DOING AN INTERVENTION AT THIS POINT. WE'RE STILL WORKING ON THAT BUT IT'S HIGHER THAN IT USED TO BE AND THIS IS WHAT THE PHYSICIAN SEES THEN WHEN HE OR SHE OPENS THE CHART WHEN THE PATIENT COMES IN. THIS IS CALLED A DOCUMENT FLOW SET SO YOU SEE, THIS A PATIENT THAT IS RIGHT HERE IN THE VITAL SIGNS OR VERY PROUD OF THAT. O A PHYSICIAN SEES THE VITAL SIGNS AND THIS PATIENT, THIS IS AFTER THE ROLL OUT FIRST VISIT WAS HERE AND MAY FOURTH 2013 AND EVERY TIME THE PATIENT COMES IN NOW, THEY WILL SEE THE NUMBER OF DRINKS, BINGE DRINKING AND WEEKLY DRINKING JUST LIKE THEY'RE SEEING A BLOOD PRESSURE. SO THEY WILL SEE THIS AND IT'S ALSO GOING RIGHT INTO THE REGISTRY AS WELL. SO HOW DO PATIENTS--CAN PATIENTS USE THIS INFORMATION? AS I SAID YESTERDAY IN OUR WORK GROUP, IN MANY WAYS WE ARE STARTING TO TRAIN THE PATIENTS NOT JUST THE PHYSICIANS BECAUSE THEY'RE VERY BUSES SCHEWE'RE REALLY TRYING, WE'RE FIND NOTHING A STUDY THAT WE'RE DOING RIGHT NOW, A NIDA STUDY THAT BASICALLY PATIENTS IN ALCOHOL AND DRUG TREATMENT ARE VERY MOTIVATED TO BE ACTIVATED AND LEARN TO TAKE CARE OF THEIR HEALTHCARE. ONE OF THE THINGS THAT PATIENTS ARE LIKING IS THE VIDEO VISIT. THIS IS HELPFUL FOR PHYSICIANS NOW BECAUSE THEY CAN DO E-CONSUMMIT SO HAVE YOU A PATIENT IN YOUR OFFICE WHO HAS A PROBLEM, A MESSY PROBLEM SO TO SPEAK, YOU CAN WITH A CAMERA ON YOUR COMPUTER AND THE PATIENT HAVING ON THEIR SMART PHONE, YOU KNOW SOMETHING LIKE FACE TIME CAN HAVE A FACE-TO-FACE INTERACTION WITH A SPECIALIST THAT THE PHYSICIAN BRINGS TO THE OFFICE. BUT YOU CAN ALSO HAVE VIDEO VISIT WHICH IS I KNOW THE FQHC IN OUR AREA IS STARTING TO DO NOW. AND GUESS WHICH GROUPS ARE USING VIDEO VISITS THE MOST? YOUNGER AND OLDER PEOPLE WHOSE KIDS ARE HELPING THEM DO IT. BUT THERE'S TWO DEPARTMENTS THAT ARE USING IT THE MOST ONE IS DERMATOLOGY AND THE OTHER IS THE EARLY START PROGRAM. YOU KNOW THERE'S WOMEN WHO ARE, YOU KNOW MAYBE THEY'RE PREGNANT AND THEY HAVE A TWO YEAR-OLD AT HOME, REALLY HARD TO GET INTO THE OFFICE. SO THEY'RE ON THEIR SMART PHONE OR DOCTOR OR NURSE OR WHO THEY'RE TALKING ABOUT SO WE'RE REACHING MORE PEOPLE WE USED TO. HERE'S EXAMPLES OF THE PATIENT PORTAL THAT WE HAVE FOUND OUR ALCOHOL AND PATIENTS REALLY HAPPY TO DO AND FINDING THEY'RE ABLE TO MAKE USE OF THINGS AND TAKE CARE OF THINGS THAT WERE HARD TO DO BEFORE. WE THOUGHT WE HAD EVERYTHING, BUT THEY HAVE SMART PHONES AND THEY HAVE FACE TIME AND THIS IS ALL ABLE TO BE DONE THAT WAY. THEY CAN DO ALL OF THESE THINGS WITH THIS AND I GUESS THE POINT I'M TRYING TO MAKE AND WE'RE DISCUSSING YESTERDAY IN OUR WORK GROUP AS WELL IS THAT WE REALLY DO NEED TO THINK ABOUT TAKING CARE OF THE WHOLE PATIENT THERE WILL BE MUCH MORE RESPONSIVE AND IF WE CAN WRAP OUR SERVICES IN WITH OTHER SERVICES LIKE ADOLESCENT MEDICINE FOLKS ARE VERY CONCERNED ABOUT UNWANTED PREGNANCIES AND THEY'RE DOING ALL KINDS OF THINGS ABOUT THAT, AND STARTING TO STRESS OTHER KINDS OF YOU KNOW LONG-TERM CONTRACEPTION AND FOCUS--THEY SAY IF WE JUST GOT EVERYBODY IN LONG-TERM CONTRACEPTION UNTIL THEY WERE READY TO GET MEG FRANT, WE WOULDN'T HAVE TO WORRY ABOUT THIS AND THEY AND THE ADULT PHYSICIAN SAY THAT SO MANY PEOPLE ARE NOT INTENDING TO GET PREGNANT AND THEY'RE DRINKING AT BEGINNING OF PREGNANCY AS WE SAW A LOT, THE RATES WERE HIGH IER IN TERMS OF USE THAT MARGARET JUST SHOWED US SO IF WE CAN WRAP A LOT OF OUR SERVICES INTO TOTAL HEALTH OF OUR PATIENTS, I THINK WE WILL GET MORE BUY-IN FROM THE HEALTH SYSTEM AND BE MORE EFFECTIVE. SO FOR EXAMPLE, EVERYBODY IS ENCOURAGED TO DO TOTAL HEALTH ASSESSMENT. REALLY ENCOURAGED TO DO THESE, YOU CAN DO THEM EVERY ONCE IN A WHLE, THE PHYSICIANS CAN SEE THIS, UNLESS YOU BLOCK IT FROM THEM TO BE ABLE TO SEE. HERE IS ONE OF THE ALCOHOL SELF-ASSESSMENTS AND IT GOES, YOU KNOW, I'M JUST SHOWING A COUPLE OF THIS QUESTIONS, FACE BEIGES HERE BUT IT GIVES THEM FEEDBACK ON THEIR RISK, AND THEN THERE ARE THROUGHOUT THE WEB SITES THAT HAVE BEEN CAREFULLY VETTED LIKE, YOU KNOW FOR EXAMPLE, FOR OLDER PEOPLE ALZHEIMERS, I THINK WE NEED TO REALLY WORK TOGETHER TO GET SOME OF OUR CONTROL WEB SITES. THERE ARE SOME ON THERE ALREADY, BUT BASICALLY JUST AS PART OF YOUR TOTALLA HEALTH ASSESSMENT IS GETTING IT PLUGGED IN AND WE HAVE TO PAY ATTENTION TO HOW DO WE DO THIS DIFFERENTLY FOR WOMEN OF CHILD-BEARING AGE WHERE WE HAVE TO DO SOMETHING MORE THAN JUST THE BINGE AND WEEKLY DRINKING LEVELS. THERE ARE ALL KINDS OF AUDIO PROGRAMS FOR THEM TO LISTEN TO AND THINGS WE ARE PUTTING IN THERE ON ALCOHOL AND DRUG USE, THERE'S ANGER, I THINK THERE'S LIKE 20 OF THESE THINGS. AND THIS CAN ALL BE DONE THEN IN MULTIPLE LANGUAGES, IT'S--I JUST--WE HAPPEN TO THINK ABOUT IT AS A PLATFORM, IT'S NOT THE END ALL. SOME OF THE INTERESTING INNOVATIVE WORK THAT I HEARD ABOUT, YESTERDAY, AND AT OTHER OF OUR MEETINGS, LIKE AVATARS FOR YOUNG KIDS AND REALLY THINGS THAT ARE MEANINGFUL FOR DIFFERENT AGE GROUPS CAN BE SET IN THESE, THE EHRs THINKING OF IT AT THE PLATFORM. SO, BASICALLY, WHAT WE REALLY WANT TO BE ABLE TO DO IS A PHYSICIAN HAS SOMEONE IN HIS OR HER OFFICE WHO IS OF CHILD BEARING AGE OR IS PREGNANT AND THEY'RE DRINKING AND/OR USING DRUGS TO BE ABLE TO SAY, YOU KNOW WHAT? THERE'S FIVE OR SIX THINGS CAN YOU DO HERE. YOU KNOW GIVE CHOICE. AND YOU CAN GO OVER INTERDEPENDENCY HEALTH AT THE CHILDCARE HEALTH PROGRAM, AND YOU CAN DO THE ONLINE PROGRAM, THERE'S A WEB SITE AND A COMPUTER RIGHT OUTSIDE MY OFFICE TO GET YOU ON IT THE FIRST TIME OR YOU CAN DO THIS OR YOU CAN DO THAT. AND IF WE PROVIDE CHOICE AND SAY, I REALLY WANT YOU TO DO ONE OF THESE THINGS, AND FOLLOW UP WITH THEM, THROUGH ENCRYPTED E-MAIL BACK AND FORTH, I THINK WE CAN MAKE--WE CAN DESIGN SERVICES THAT ARE CULTURALLY RELEVANT AND AGE APPROPRIATE. SO THESE ARE JUST EXAMPLES OF WHAT'S THERE ALREADY, WE HAVE OVER 60 LANGUAGES THAT WE HAVE TO BY LAW PROVIDE TRANCEALATION FOR AND WE ALSO NEED IT TO BE CULTURALLY COMPET. SO THERE'S A GREAT DEAL OF WORK IN TERMS OF THESE CLINICAL CONSULTS AND THE TV--TV, THE VIDEO VISITS TO MAKE THAT WORK IN TERMS OF CULTURALLY COMPETENT PHYSICIANS AND CLINICIANS. SO I JUST WANT TO END BY MAKING A PLEA TO REALLY--THAT THIS IS A TIME TO MOVE ON. A LOT OF THIS WORK, IT'S AN OPPORTUNE TIME. HEALTH REFORM FITS WELL WITH OUR MISSION AND IT CREATES OPPORTUNITIES. WE HAVE GONE FROM SOMETHING THAT WAS HARDLY EVER INSURED TO BEING ONE OF 10 ESSENTIAL HEALTH BENEFITS. MANY FORMALLY UNINSURED ARE NOW INSURED AND THERE'S HUGE CHANGE IN SERVICE DELIVERY AND WHOLE SPECTRUM OF PROBLEMS, AND RANGE OF SETTINS WITH THINGS NOW IN SPECIALTY, IN PRIMARY CARE, NOT JUST SPECIALTY CARE, FUNDING FOR BEHAVIORIAL HEALTH WORKERS, THIS IS REALLY IMPORTANT SO HAVE PRIMARY CARE TEAMS WITH BEHAVIORIAL HEALTH WORKERS, SOCIAL WORKERS, MANY TIMES, KDAX AS WE CALL THEM IN CALIFORNIA, RECOVERY SPECIALISTS AND PSYCHOLOGIST AND THEN USE OF HEALTH I.T. AND IMPORTANTLY WE HAVE ACCOUNTABILITY NOW FINALLY WITH PERFORMANCE MEASURES NOW IN OUR FIELD SO WE NEED TO TAKE ADVANTAGE OF THESE THINGS AS WE TRY TO THINK ABOUT HOW TO DEVELOP OUR EVER INCREASINGLY LARGE COMPLEX POPULATION. THANK YOU. [ APPLAUSE ] >> THANK YOU THAT WAS A VERY COMPREHENSIVE PRESENTATION AND I THINK IT'S QUITE IMPRESSIVE IN TERMS OF THE SYSTEM THAT YOU'RE ABLE TO REALLY IMPLEMENT QUITE A BIT. I WAS A LITTLE I GUESS JEALOUS THAT HAVE YOU THE ALCOHOL BUILT INTO SOME OF THE RECORDS AND HOPE THAT YOU KNOW YOU HAVE A SUBSTANCE USE BATTLE SIGN AND THERE ARE OTHER WAYS THAT WE WILL BE ABLE TO BUILD IN MORE POLYSUBSTANCE QUESTIONS AS YOU UPDATE SOME OF YOUR RECORDS AND AS WE SEE EVEN FROM, YOU KNOW THE DATA FROM THIS SURVEY FROM YOUR DATA ABOUT POLYSUBSTANCE ISSUES SO WE CAN BEGIN TO GET A BETTER PICTURE OF POLYSUBSTANCE AND ALCOHOL AND OTHER CO-OCCURRING SUBSTANCE USE AMONG WOMEN DURING PREGNANCY AND DURING CHILD BEARING AGE AND OTHER RISKS. SO AT THIS TIME I WANTED TO OPEN UP QUESTIONS AND DISCUSSIONS TO THE FULL PANEL AND I DON'T KNOW IF MAYBE WE CAN PULL UP, WE CAN PULL UP QUESTIONS WE HAD INITIALLY WHEN WE OPEN THE SESSION, IT MIGHT BE A WAY TO START BUT SO WOO HAVE QUESTIONS FROM NI CHD? >> NOT A QUESTION BUT A COMMENT FOR CONNIE, BUT THAT I THINK IT'S REALLY IMPRESSIVE THAT KISER PERMANENT A MADE THIS EFFORT TO MAKE THE MATERIALS CULTURALLY RELEVANT, BEHAVIORIAL AND MENTAL DEVELOPMENT AND CONSIDERING HEALTH LITERACY AS THEIR APPROACH FOR COMMUNICATING WITH THE POPULATION SO CONGRATULATIONS ON THAT. >> AND I DO WANT TO SAY THIS IS HAPPENING IN A LOT OF OTHER PLACES TOO, WE WERE EITHER LUCKY TO HAVE A HEAD START SO THEY'RE ALREADY AT THIS STAGE THREE MEANINGFUL USE BUT IT REALLY IS HAPPENING OTHER PLACES AS WELL. SO THAT'S EXCITING. >> SO WARREN FROM NIAAA. >> FROM NIAAA, RIGHT, I WANT TO COMPLEMENT BOTH SPEAKERS, VERY, VERY INFORMATIVE. I HAD A TECHNICAL QUESTION RELATED TO THE NISDUH AND FOR MARGARET TO GO AHEAD, I'M NOT SURE HAVE YOU THE ANSWER TO IT BUT I WAS JUST CURIOUS, I REMEMBER IN THE DATA, I THINK IT WAS FOR--FOR ANY SUBSTANCE USE DISORDER AND PREGNANCY THAT WAS 53,000 INDIVIDUALS WHICH CAME OUT TO BE 2.2% OF THE POPULATION, AND WAS WONDERING WHERE THE DENOMINATOR CAME FROM BECAUSE THERE'S ABOUT 3.95 MILLION BIRTHS A YEAR AND I DOUBLE CHECKED AND INDEED THAT'S WHAT THERE WAS LAST YEAR AND THE YEAR BEFORE AND THEY ONLY DIFFER BY ABOUT 50,000 PEOPLE. I'M SURPRISED IT'S THAT CONSISTENT FROM THE CENSUS, AND SO THE--I WAS WONDERING WAS THAT THE GERONTOLOGYSTS DENOMINATOR THAT WAS USED OR BASED ON THE NBER OF WOMEN THAT ARE PREGNANT IN THE--IN THE NISDUH POPULATION AND THEN EXTRAPOLATED TO THE WHOLE COUNTRY? >> EXCUSE ME IF COULD YOU--SARARE SORRY. >> IT'S BASED ON A NUMBER OF WOMEN PREGNANT IN THE NISDUH POPULATION BUT THE DATA IS COLLECT INDEED SUCH A WAY THAT WHEN IT'S WEIGHTED IT IS REPRESENTATIVE OF THE COUNTRY. >> WEIGHTED DATA. >> I GUESS THE ESTIMATE IT COULD BE GREAT IF WE COULD GET BETTER DATA ON ALL PREGNANCIES. DO WE HAVE SOME OTHER QUESTIONS? YES? >> IF YOU COULD SAY YOUR NAME AND SPEAK INTO YOUR MIC. >> SURE, I'M KAREN FROM ODAPE, I HAVE A QUESTION FOR EACH OF YOU. I WILL ASK THEM BOTH AND THEN YOU CAN DECIDE WHAT YOU WANT TO DO WITH THOSE. FOR MARGARET, I WANT TO FIND OUT IF YOU HAD OR CONSIDERED RUNNING ETHNICITY DATA BY SOCIOEIC STATUS TO SEE IF THAT LEVEL'S OUT, THE DIFFERENCES THAT YOU'RE SEEING BETWEEN ETHNICITIES. >> YEAH, I THINK THAT'S A VERY GOOD QUESTION AND HAD I HAD THE TIME I WOULD HAVE LOVE TO HAVE DONE THAT RUN BUT I THINK THAT'S IMPORTANT AND WE MIGHT VERY WELL SEE AN EVENING OUT OF THE SLIGHT RACIAL DISPARITY WE SAW IF WE CONTROLLED FOR SOCIOECONOMIC. THAT'S A GOOD QUESTION. AND CONSTANCE, AMAZING, AMAZING WORK AND IT STRUCK ME THE FOCUS ON GIRLS AND WHAT WAS GOING ON WITH GIRLS AND THE DIFFERENT LEVELS. THE ONE THING I SAW THAT WAS--SEEMED TO BE MISSING AND I DON'T KNOW IF IT'S SOMETHING THAT COULD BE INCLUDED IS ANY FOCUS ON TRAUMA? ANY FOCUS ON, YOU KNOW THE DEFENDING CHILDHOOD WORK, ALL THE CHILDHOOD WORK ON RAPE AND SEXUAL ASSAULT SHOWS THAT YOUNG GIRLS AND YOUNG WOMEN ARE SUBJECT TO AN INCREDIBLE AMOUNT OF VIOLENCE WHICH IN TURN LEADS TO SOME OF THE SYMPTOMS THAT YOU'RE TRACKING. SO MIGHT THERE BE ANY FUTURE OR ANY HOPE THAT TRAUMA ASSESSMENT OR TRAUMA-FOCUSED ASSESSMENT COULD BE DONE TO COMPARE TO LOOK AT LEVELS OF TRAUMA AS IT RELATES TO THE SUBSTANCE ABUSE DISORDERS. >> ABSOLUTELY, RIGHT ON TARGET THERE. AND WE TALKED ABOUT THAT YESTERDAY AND ACTUALLY THE STUDIES THAT I WAS PRESENTING DOES HAVE THAT--HAVE DATA ON THAT. AND THEY'RE ACTUALLY ACTS--THEY USE WE CALL IT THE TEEN WELL-CHECK WHICH EVERYONE IS GIVEN WHEN THEY'RE ROOMED AWAY FROM THEIR PARENT AND THAT HAS QUESTIONS ON IT, TOO, INITIAL SCREENING QUESTIONS FOLLOWED UP BY THE PHYSICIAN. AND THE PAPERS WE WRITE ARE ALL GOING TO BE ADDRESSING THAT. >> I'M SORRY IF YOU COULD SPEAK MORE CLEARLY INTO YOUR MIC. >> THE PAPERS WE WILL BE WRITING WILL BE ADDRESSING THAT. WE'RE ALSO STARTING TO INCLUDE THE--AN ACE QUESTION, THE ADVERSE CHILDHOOD QUESTIONS AND EXPERIENCE, FINDING THOSE TO BE PREDICTIVE FOR PROBLEMS FOR WOMEN MY AGE AND ESPECIALLY THE KIDS AND WE HAD A GOOD DISCUSSION YESTERDAY ABOUT HOW TO--HOW TO ADDRESS THIS IN THE HEALTH RECORD IN TERMS OF CHILD PROTECTIVE SERVICES AND SO FORTH. AND SO THAT'S AN ISSUE AND THAT'S ONE OF THE REASONS, BECAUSE OF THESE ISSUES ABOUT REPORTING THAT ARE BIG THAT IT'S REALLY GOOD TO GET TO MOVE ON THIS HEALTH REFORM WORK OF GETTING BEHAVIORIAL HEALTH SPECIALIST INTO PRIMARY CARE AND PEDIATRICS SO THEY CAN HELP FOLLOW UP WITH THESE THINGS. BUT WE WILL DEFINITELY BE LOOKING AT THEM. >> ALL RIGHT, AND OF COURSE THE THING ABOUT ADULT WOMEN OF CHILD BEARING AGES AND THEY'VE USUALLY PASSED NOT ALWAYS BUT PASS TED THE AGE OF MANDATORY REPORTING BECOMES NECESSARY BUT STILL THE TRAUMA HASN'T GONE AWAY BECAUSE OF THAT. >> AND JUST TO POINT YOU--IT DEPENDS ON THE STATE SO I THINK IT'S IMPORTANT TO CONSIDER ALL THOSE ISSUES AND I THINK THAT'S SOMETHING THAT--TO CONSIDER AND BE ADVERSE CHILD EXPERIENCES DATA THAT CAME OUT OF SOME OF THE INITIAL KISER STUDIES INCLUDES LOOKING AT TRAUMA AND IT IS FOR WOMEN AS WELL AS MEN AND BUILDI THOSE QUESTIONS ADDITIONALLY INTO SOME OF THE HEALTH INTERVIEWS THAT PEOPLE DO WHEN THEY'RE WELL-CHECKS, NOT ONLY FOR TEAMYOU ALSO FOR ADULTS IN TERMS OF THE LONG-TERM CONSEQUENCES OF--IN TERMS OF HEALTH, I THINK THERE ARE SEVERAL STUDIES THAT HAVE SHOWN THE PERVASIVE EFFECTS OF TRAUMA IN TERMS OF PHYSICAL AND MENTAL HEALTH AND CAN OCCURRENCE WITH ALCOHOL AND DRUG USE. SO I THINK THAT'S A VERY VALID POINT AS WE MOVE FORWARD WITH AUTOMATION IN TERMS OF ELECTRONIC HEALTH RECORDS. IT DOES PROVIDE OPPORTUNITIES TO PROVIDE MODULES. WE ALSO TALKED A BIT YESTERDAY ABOUT HOW THAT'S ALSO IMPORTANT THAT WE ALSO HAVE THE TOOLS FOR NOT ONLY TRAINIG BUT TO GIVE TOOLS FOR WHAT TO DO WHEN YOU ASK THESE QUESTIONS, BEHAVIOR HEALTH SPECIALISTS AND OTHER RESOURCES WITHIN THE SYSTEM SO THESE ARE IMPORTANT QUESTIONS. IF WE HAVE NO FURTHER QUESTIONS, WE HAVE ONE MORE. >> IF YOU COULD SAY YOUR NAME INTO THE MIC. >> SHARON, I DUMPED BY LITTLE CHEAT SHEET BEFORE THERE. >> FOR THE RECORD THAT'S HELPFUL. >> AND I HAVE A TECHNICAL QUESTION FOR YOU SINCE MY EARS PERKED UP WHEN YOU WERE TALKING ABOUT USING A NATURAL LANGUAGE PROGRAM FOR ANALYZING NOTES AND I'M GETTING READY AND A LITTLE COLLABORATIVE STUDY WITH CDC COLLEAGUES TO DO SOME ANALYSIS OF CASE NOTES, OF SOCIAL WORKERS AND WE'RE SEARCHING IN THERE FOR CERTAIN INDICATIONS OF ALCOHOL USE BY MOM AND SO I'M WONDERING WHAT--WHAT WERE YOU USING AS A PROGRAM. I MEAN I'M OOH WARE OF A COUPLE OF THINGS LIKEAT LAS PINTAS AND IN VIVO, WERE THERE OTHER THINGS YOU WERE USING OR THAT YOU RECOMMEND? >> WELL WE COULD TALK MORE OFFLINE ABOUT THIS BECAUSE THERE ARE SO MANY AND THERE'S A LOT OF HOME GROWN THINGS. >> OH, OKAY. T NOW KISER OR MANY OF THEM USING DIFFERENT APPROACHES WE'RE USING SOMETHING CALLED LING UA-MATICS AND THAT IS REALLY SET UP FOR NATURAL LANGUAGE PROCES. BUT I'M HAPPY TO TALK--THERE ARE A LOT OF OPTIONS OUT THERE NOW. AND IT'S EXCITING. AND YOU CAN REALLY LEARN A LOT ABOUT PROCESS AND THERE'S MUCH MORE IN THERE THAN THERE WERE IN THE PAPER RECORDS BECAUSE PEOPLE ARE MORE LIKELY, THEY CAN TYPE FASTER THAN THEY CAN WRITE. MOST OF THEM. ESPECIALLY THE WOMEN PHYSICIANS. >> OKAY, THANK YOU. >> WE ALSO HAVE YOU KNOW PEOPLE STILL DICTATE AND USE VOICE TO TEXT AND SO I THINK THERE'S A LOT OF OPPORTUNITIES FOR INNOVATION IN TERMS OF DATA COLLECTION AND I KNOW THROUGH A LOT OF THE NIH SMALL BUSINESS OPPORTUNITIES THERE HAVE BEEN A LOT OF INNOVATION IN TERMS OF TEXT AND OPPORTUNITY TO DO TEXT MINING FROM EVERYTHING ON PEOPLE'S APPS TO AS WELL AS IN TERMS OF GATHERING HEALTH INFORMATION AND SO THERE'S OPPORTUNITY FOR US TO GATHER ADDITIONAL DATA, IN THE MOMENT IN TERMS OF WHAT PEOPLE ARE DOING TO WHAT THEIR PROVIDERS REPORT. SO I HOPE THIS HAS BEEN AN INTERESTING SESSION AND I THINK IT MAY HAVE LEFT US WITH MORE CHALLENGES AND QUESTIONS WHICH I THINK WE KNEW BUT WE'RE HOPE THANKSGIVING WILL ALSO SPUR SOME RESEARCH AND ALSO INITIATIVES AND FORWARD THINKING THROUGHOUT THE GROUP THAT WE WILL HAVE MAYBE SOME FOLLOW UP IN OUR NEXT MEETINGS AND WITH THAT, I THINK WE WILL--I WILL TURN IT BACK OVER TO MARCIA WHO MAY LET US HAVE A LITTLE BIT OF A BREAK BEFORE OUR NEXT SESSION. THANK YOU AGAIN TO OUR PRESENTERS. >> [ APPLAUSE ] >> WE ARE RUNNING A LITTLE BIT BEHIND SO WE WILL TAKE A VERY SHORT BREAK AND IF YOU COULD BE BACK AT 25 AFTER 10, SO ABOUT 15 MINUTES. OUR NEXT SPEAKER IS KAREN BACHAR FROM THE DEPARTMENT OF JUSTICE AND WILL BE GIVING HER SUMMARY OF HER WORKING GROUP. >> AND I WENT MINIMALIST WITH THE DECORATIONS SO PLEASE FORGIVE ME IN ADVANCE. BEFORE I GET STARTED, I WOULD LIKE CATHERINE CRAWFORD TO STAND UP PLEASE? BEHIND YOU IS MAGISTRATE CATHERINE CRAWFORD FROM WESTERN AUSTRALIA WHO JOINED THE JUSTICE ISSUES WORK GROUP YESTERDAY AND AS RECEIVED A CHURCHILL FELLOWSHIP TO STUDY FASD JUVENILE JUSTICE ISSUES IN NORTHERN AMERICA. SHE'S AN AMAZING AMAZING PERSON AND GAVE US A LOT OF WONDERFUL IDEAS AND THOUGHTS SO I WANTED TO SAY THANK YOU AND MAKE SURE THAT EVERYBODY KNOWS THAT WE HAVE A VISITING SCHOLAR WHO'S INTERESTED IN THE ISSUE IF YOU HAVE ANYTHING TO SHARE WITH HER. SO MY NAME IS KAREN BACHAR AND I'M THE LEADER OF THE JUSTICE ISSUES WORK GROUP OF FASD AND OF COURSE EVERYBODY'S SEEN THIS SLIGHT BEFORE AND WHAT YOU KNOW IS THAT WHEN A CAME TO ODDJDP IN 2010 AND WAS ASSIGNED FASD I SAID HUH? BECAUSE I DIDN'T HAVE AN APPRECIATION. I HAD NEVER THOUGHT ABOUT ALCOHOL AND HOW IT MIGHT IMPACT YOUTH AND HOW IT MIGHT IMPACT PEOPLE INCARCERATED OR GOING THROUGH THE YESTERDAY SYSTEM AND THE LAST FIVE YEARS HAVE BEEN A HUGE EDUCATION FOR ME. BECAUSE IN SEEING THIS, I SEE, THE JUSTICE ISSUES GROUP IN THE INTERVENING WITH CHILDREN AND FAMILIES EFFECTED BY PRENATAL ALCOHOL EXPOSURE AS ONE OF THE CORE AREAS AND INCREASING INFORMATION DISSIM ANATION BECAUSE REALLY I GET TO WORK AT THE TABLE WITH A WONDERFUL SET OF EXPERTS ABOUT WHAT'S GOING ON IN THE JUSTICE ISSUES WORK GROUP TO WORK ON ISSUES RELATED TO JUSTICE REHABILITATION OR PERSONS WITH FASD OR PREVENTION OR GUIDANCE AND GENUINE OR GENERAL AWARENESS. SO I LIKE TO POINT POINT OUT IN YELLOW WHERE WE ARE IN ALL OF THIS AND YOU SEE ALL OF THE HEALTH AND HUMAN SERVICES AND ALL THE WONDERFUL SCIENCE THAT WE RELY ON AND WE THANK YOU. APOPTOTICS AND NIDA. OKAY. AND I KNOW SALARY --SALLY HAS DONE THIS MANY TIMES BEFORE BUT JUSTICE WORK GROUP AND SUCH A GREAT SLIDE AND I HAD TO USE THE SLIDUSE I JUST LOVE IT. OUR PERINENT MEMBERS ARE LINDA, CATHERINE, SHARON AND BARBARA, AND THE FEW, THE PROUD, THE MIGHTY AND WE'VE GOTTEN A LOT OF WORK DONE AND I'M VERY APPRECIATIVE AT EVERYBODY. JUST SO YOU KNOW I ASKED SUSAN CARLSOON AND RUTH RICHARDS--RICHARDSON, SORRY EVERYBODY, TO TALK MORE SPECIFICALLY ABOUT WHAT WE DID YESTERDAY WHEN WE MET. BUT I'M GOING TO GIVE A BIT OF A BACKGROUND SINCE I--SINCE I WAS A NEW SHERIFF COMING TO TOWN AS IT WERE REPRESENTING A JUSTICE ISSUES WORK GROUP. ONE OF THE FIRST THINGS WE WERE ABLE TO DO AND WE STARTED HAVING MEETINGS WAS TO PARTNER WITH THE AMERICAN BAR ASSOCIATION CENTER ON CHILDREN AND THE LAW AND SUSAN CARLSON HELPED FACILITATE THAT AND I--WE ALSO GOT A CHANCE TO, THE LAST TIME ODHDP HAD A MAJOR NATIONAL CONFERENCE WAS IN 2011 AND WE WERE ABLE TO DO A PANEL ON THE NEXUS OF JUVENILE JUSTICE TRAUMA ON MENTAL HEALTH WHICH EILEEN AND SUSAN WERE WONDERFUL AT. WE HAD ONE OF THE SECTIONS OF THE ODHADP SESSION WERE LISTENING TABLE, KIND OF LIKE THAT WERE DONE IN THE--IN THE PRESENTATION WHERE THEY HAD THE TOPIC TO PRESENT THE TOPIC AND THEN HAVE YOU VARIOUS PEOPLE DISCUSS. WE WERE ABLE TO DO THAT, BARBARA WIYREK ABLY HANDLED THAT. WE ALSO HAD POSTER SESSIONS FOR VARIOUS RESEARCHERS CATHERINE HARGROVE AND EILEEN HAD TWO WONDERFUL POSTERS ON DIFFERENT ASPECTS OF FASD AND ONE OF THE THINGS THAT WE REALLY DID WAS TO HAVE A GROUP AND A MINIPLENARY ON BASICALLY--OH, SORRY, WE ALSO HAD A MEETING OF THE YESTERDAY ISSUES WORK GROUP AT THE CONFERENCE AND AT THAT CONFERENCE WE--AT THAT MEETING WE HAD HOWARD DAVIDSON FROM THE ABA THERE AND THAT IS WHERE WE BEGAN TALKING ABOUT THE POSSIBILITY OF WORKING MORE HAND AND GLOVE WITH THE A. B. A. AND I WILL TALK ABOUT IT MORE AND WE WILL CROSS IT LATER. SO, WE SPENT BY WE, I MEAN EVERY MEMBER OF THE JUSTICE ISSUES WORK GROUP, THE A. B. A., SALIVA--SALIVA --SALLY, A NUMBER OF US WORKED TOGETHER TO CONTINUING EDUCATION PROGRAM ON FASD AND THE LAW THAT WAS AT THE AMERICAN BAR ASSOCIATION MIDYEAR MEETING IN 2012. THIS WAS REALLY SPONSORED BY THE ICCFASD, AND THE JUSTICE ISSUES WORK GROUP, THE OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTION, THE MINNESOTA ORGANIZATION OF FETAL ALCOHOL SYNDROME AND THE A. B. A. CENTER OF CHILDREN AND THE LAW. SO OTHER ACTIVITIES IS WE INCLUDED, WE DECIDED TO TRY TO REACH OUT TO JUDGES SO ONE OF THE GROUPS WOWHO REACHED OUT WAS THE NATIONAL ASSOCIATION OF STATE JUDICIAL EDUCATORS AND LINDA CHASM WAS VERY INSTRUMENTAL IN THAT BECAUSE THAT IS A CORE GROUP THAT REPRESENTS PEOPLE WHO TRAIN JUDGES ALL ACROSS THE STATES TO DO WORK WITH THEM AND THEY WERE ABLE TO DO AN ORAL PRESENTATION AND HAVE AN EXHIBIT. WE'RE STILL TRYING TO FIGURE OUT HOW TO WORK BEST WITH JSJA, AND ONE OF THE CHALLENGES IS I'M LOOKING AT TELLER APPROACHES AND DIFFERENT THINGS THERE IS THAT THE PEOPLE AT NASJ SAY THAT EVERYBODY'S SO BUSY, THEY DON'T HAVE TIME, NEVER MIND THE MONEY TO GO TO A TRAINING OR TO READ A BIG BOOK OR DO TO DO SOMETHING THERE, SO HOW DO YOU PACKAGE INFORMATION THAT'S ACTIONABLE, USEABLE, AND WE TRYING TO DECIDE WORK WITH THEM AS WE--AS WE MOVE FORWARD. BUT REALLY WHAT WE'RE LOOKING AT IS ACROSS THE JUSTICE SYSTEM, THERE ARE, YOU KNOW EVERYTHING FROM POLICE INTERVENTION TO INCARCERATION AND THERE ARE A LOT OF STEPS IN BETWEEN THERE. AT OUR MEETING IN NEW ORLEANS, WE DEBUTED THIS CHART AFTER I THANK SALLY'S GRAPHICS PEOPLE BECAUSE IT WOULD HAVE BEEN NOT IF I TRIED IT WOULD NOT HAVE BEEN THE SAME, BUT WE REALLY WANTED TO FOCUS ON JUDGES AND TALK ABOUT HOW THIS IS NOT JUST AN ISSUE FOR ONE TYPE OF JUDGE, BUT REALLY CRIMINAL JUDGES, CRIMINAL COURT JUDGES, PROBATE, DISSOLUTIONS, CIVIL COURT INDIVIDUALS WILL APPEAR ON ALL COURT DOCKETS BOTH AS VICTIMS AND POSSIBLY AS PERPETRATORS AS WELL SO IT'S VERY IMPORTANT FOR JUSTICE TO HEAR AND I DON'T KNOW, DO WE STILL HAVE THE THREE FOLD? I MAY TAKE IT WITH ME AND PUT IT IN MY HOUSE AS A DECORATION. IT WAS VERY GOOD. I JUST COME IN, SO LET ME TALK A LITTLE MORE RECENT. IN 2013 TOWARDS THE END OF 2013, THE J JUSTICE ISSUES WORK GROUP PARTNERED WITH MY OFFICE, THE OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTION TO HELP PUT ON A LISTENING SESSION IN PART TO INTRODUCE AN ABA RESOLUTION TO FOCUS YOUTH AND IN PART TO ENGAGE STAKEHOLDERS ABOUT IT IS JUVENILE JUSTICE SYSTEM AND IN PART TO CREATE AN ACTION PLAN THAT THAT ENCOMPASSED EVERYTHING FROM ORGANIZATIONS AND STATE GOVERNMENTS TO FAMILY TO COMMUNITY MEMBERS FOR DIFFERENT THINGS TO POLICY TO MEDIA, WHAT COULD BE DONE IN A WHOLISTIC MANNER TO REALLY DREYS THIS BECAUSE BECAUSE I THINK WE ALL KNOW THAT WE HAVE TO APPROACH THE PROBLEM AND THE RELATED PROBLEMS OF FASD FROM A MULTIFOCAL POINT OF VIEW AND ANY ONE DIRECTION WILL NOT GET IT BUT WE REALLY HAVE TO FIND MANY DIFFERENT WAYS TO GET THE INFORMATION OUT AND WE CAN HAVE THE BEST SCIENCE IN THE WORLD AND IF WE CAN'T TRANSLATE IT TO A JUDGE OR A LAWYER OR A PROBATION OFFICER YOU KNOW WHAT IS THAT GOING TO MEAN SO NOW WE HAVE A WONDERFUL, WONDERFUL TRANSCRIPT FOR THAT LISTENING SESSION AND I AM PLEASED TO TELL EDREILLY AND A FEW OTHER PEOPLE THAT IT IS BEING RESURRECTED GOING THROUGH OUR PRINTING PROCESS AND GOING THROUGH DEPARTMENT OF JURISDICTION APPROVAL PROCESS TO PRINT IS NOT THE EASIEST THING IN THE WORLD. BUT THANKS TO THE ADMINISTRATOR AND DEPUTY ADMINISTRATOR AND ASSOCIATE DIRECTOR, THE REPORT HAS BEEN RESURRECTED, AND WHILE I'M HOPING TO MAKE A FEW CHANGES WE ARE HOPING TO GET IT OUT IN THE NEXT FEW MONTHS. SO PLEASE IT'S COMING SO ED, IT'S COMING. ED IS ONE OF THE MANY PEOPLE WHO DID INCREDIBLE WORK ON THE LISTENING SESSION AND IT NEEDS TO GET OUT AND WE WILL PLAN TO DEFINITELY GET THAT AS SOON AS POSSIBLE. YEAH. ONE OF THE JUDGE ISSUES WORK DID DO WAS WORK WITH SAMHSA WORK WITH YOU IN THE YESTERDAY AND TRAINING MATERIALS FOR THEIR FASD CENTER OF EXCELLENCE AND IT WAS A PROCESS OF LOOKING AT INFORMATION AND PROVIDING UPDATES FROM OUR EXPERTISE. DURING 2013 WE ALSO, AS CAN YOU SEE WE DEVELOPED--WE'RE BACK AT NASJE, THE NATIONAL ASSOCIATION OF OF STATE JUDICIAL EDUCATORS IN LITTLE ROCK AND ACTUALLY AND ACTUALLY THE 2013 SHOULD BE 2015. SO OKAY, SALARY WHAT DID WE DO AT 2013. >> WHAT DID WE DO? >> WE HAD PRESENTATIONS AT THAT CONFERENCE. >> WE DID DO PRESENTATIONS AT NCGFCJ, I DIDN'T GET TO TRAVEL SO, THEY WERE WONDERFUL WE ARE NOW WORKING ON HELPING MOFAS REVISE THEIR GUIDE FOR WORKING WITH YOUTH WITH FASD IN THE JUSTICE SYSTEM. WHOOPS, I WILL LEAVE THAT ALONE AND I WILL GO BACK AND TELL THAT YOU LATER. --MAYBE I SHOULD DO THAT AND THEN CIRCLE BACK. HERE I AM. SO ANOTHER THING THAT CAME OUT OF--OH THAT WAS NICE--ANOTHER THING THAT CAME OUT OF THE WORK THAT WE WERE DOING WAS--AND IT CAME OUT AS A RESULT OF THE LISTENING SESSION WONG OF THE RECOMMENDATIONS THAT WAS MADE IN TERMS OF HOW WE COULD WORK WITH JUDGES AND THERE AGAIN NIAAA WAS VERY INSTRUMENTAL IN PARTNERING WITH ODHADP TO ESTABLISH A WORKING GROUP WITH THE NATIONAL COUNCIL FOR JUVENILE AND FAMILY COURT JUDGES TO FOLLOW UP FROM THE PRESENTATION THAT WERE GIVEN IN 2013 AND THE WORK IS COORDINATED BETWEEN ODHADP AND THE FIAST JUSTICE ISSUES WORK GROUP AND NCJ AND SCJ AND WHAT I WILL SAY ABOUT THIS IS IT IS VERY, VERY INTERESTING TO WATCH THE PROCESS OF TRYING TO TRANSLATE SCIENCE, INTO SOMETHING THAT THE JUDICIARY WILL UNDERSTAND AND FIND ACTIONALLY AND LISTEN TO BUT THE GOOD THING ABOUT WORKING WITH THE NATIONAL COUNCIL ON JUVENILE AND COURT JUDGES IS ONE OF PREMIER GROUPS IN THE NATION WORKING WITH JUDGES AND SO IF YOU'LL LET THAT WITH THE CONVENING POWER AND THE POWER A JUDGE HAS IN ANY PARTICULAR CASE IS IN THERE IS VERY IMPORTANT SO SOME OF THE WORK THAT'S GOING ON AND WE'RE NEARING THE END BECAUSE IT'S GOING TO BE A PRESENTATION IN JULY OF 2015 OF THE JUDICIAL BENCH GUIDE IS WE DID A SURVEY OF THE JUDICIARY TO GET IDENTIFICATION OF FASD IN THE COURTS. AND IT'S NOT VERY GOOD FOLKS, I DON'T HAVE THE SPECIFIC NUMBER BUT THERE'S VERY SURPRISINGLY LITTLE KNOWLEDGE AND IT'S NOT SURPRISING BECAUSE OF COURSE JUDGES HAVE SO MUCH ON THEIR DOCKETS AND SO MUCH TO DO BUT STILL, THERE WAS VERY LITTLE KNOWLEDGE OF THIS. THE WORK HAS BEEN TO DEVELOP A TECHNICAL ASSISTANCE BULLETIN BASEDDED ON THE RESULTS OF THE SURVEY AND IN THE SUBJECT MATTER EXPERTS, A.K.A. THE JUSTICE ISSUES WORK GROUP PRIMARILY SO, WE-SHOULD HAVE SO WE WERE GLAD TO PRESENT THE WORK IN PROGRESS AT 2013 BUT RIGHT NOW WHAT WE'RE DOING IS FINISHING UP THE TECHNICAL ASSISTANCE BULL 10 THAT WILL COME OUT AND ANOTHER SET THAT WE TOOK TO DO THAT IS WE CONVENED A MEETINGS OF JUDGES TO INFORM THE DEVELOPMENT OF THE CARD TO RAISE ASK ADDRESS ISSUES THAT YOUTH AND ADULTS WITH FASD HAVE AND WE WERE ABLE TO FIND AMAZING JUDGES WHO WERE ON THE BALL JUST AS JEFFREY FOR ONE--ERNESTIN GRAY IN THIS SO WE HAD GOOD PARTICIPATION IN THIS AND THAT INFORMATION HAS BEEN CENTRAL TO THE WORK WE'RE DOING THERE AND WE'RE REALLY LOOKING FORWARD IN JULY TO GOING OUT TO NCJ, FCJ AND DO A FULL PANEL ON THIS JUDICIAL TOOL KIT AND THEN HOPEFULLY WORKING WITH SOME OF YOU OUT THERE TO PUSH IT OUT FURTHER AND MAYBE EVEN SHARE IT WITH THE NATIONAL ASSOCIATION OF JUVENILE AND STATE JUDICIAL EDUCATORS AS WELL. SO I KIND OF LIST WHAT'S NEXT BUT REALLY IT'S MORE A QUESTION THE FIRST QUESTION OF WHAT HAPPENED YESTERDAY. AND WHAT HAPPENED AS WE GOT READY FOR OUR MEETING YESTERDAY AND WE DECIDED TO WORK WITH MOFAS, TO DO A HIGH LEVEL OVERVIEW OF THE MINNESOTA TOOLS FOR SUCCESS TOOL KIT THAT WAS DEVELOPED 15 YEARS AGO IN 2001 AND SUSAN CARLSON AND RUTH RICHARDON WHO YOU WILL HEAR FROM SHORTLY HAVE BEEN CHAMPIONS OF UPDATING THE TOOL KIT BECAUSE--AND WE'RE GOING TO HAVE FIVE CONFERENCE CALLS BETWEEN NOW AND MIDOCTOBER TO DO THAT AND REASON WE'RE DOING THAT IS BECAUSE THERE'S A RECOGNITION THAT MUCH AS CHANGED BOTH IN TERMS OF OUR UNDERSTANDING OF FASD AND IN TERMS OF THE JUVENILE JUSTICE ISSUES THAT ARE DRIVING THE NEEDED CHANGES. SO WHAT I WOULD LIKE TO DO IS WITHOUT ME REPORTING OUT ABOUT YESTERDAY, IS ASK SUSAN AND RUTH TO COME UP AND SHARE WHY THIS IS SO IMPORTANT AND WHAT WE PLAN TO DO. >> THANK AND YOU SUSAN CARLSON RETIRED JUVENILE COURT IN MINNESOTA. PRESIDENT AND FOUNDER OF MIN MEN ORGANIZATION ON FETAL ALCOHOL SYNDROME. I WANT TO THANK FIRST THE NIAAA FOR THE ORIGINAL FUNDING FOR THE TOOLS OF SUCCESS AND IT WAS A RESOURCE GUIDE THAT REALLY AT THAT TIME WAS NOTHING FOR THE JUSTICE FIELD ON FASD AND SO THEY WERE--THEY WERE THE PIONEER THAT GAVE THE INITIAL FUND BEING TO DEVELOP THAT GUIDE AND THAT AGAIN WAS 2000, 2001. AND AS SALLY SAID MUCH HAS CHANGED IN 15 YEARS AND SO WE'VE TALKED ABOUT UPDATING THIS GUIDE, I DON'T KNOW FOR HOW MANY YEARS, SALLY. AND I STARTED LOOKING AT IT AND IT'S NOT REALLY UPDATING, IT'S TOTALLY REWRITING IT. AND AS YOU'VE HEARD, FROM KAREN, THERE'S BEEN--I MEAN WHEN I GOT INVOLVED IN THIS ISSUE IN 1997 THERE REALLY WASN'T MUCH GOING ON IN THE FIELD OF JUSTICE AND FASD. BUT AS CAN YOU HERE, MUCH HAS HAPPENED. AND THE ABA RESOLUTION I THINK WILL BE A REAL CHANGE MOVER BECAUSE IT'S A--IT'S A ORGANIZATION THAT'S PUTTING THEIR STAMP OF APPROVAL AND SAYING THIS IS AN IMPORTANT PROBLEM IN THE JUSTICE FIELD AND THOSE IN THE FIELD NEED TO KNOW SOMETHING ABOUT IT. AND SO, RUTH WILL TALK A LITTLE BIT ABOUT HOW THAT IMPACTED US IN MINNESOTA BUT THE GUIDE, WE STARTED REVIEWING IT AND BASICALLY WE ONLY LOOKED AT TWO CHAPTERS BUT I THINK THEY'RE THE REAL SIGNIFICANT CHAPTERS YESTERDAY AND THAT'S, YOU KNOW FASD BASICS WHAT DO THE JUSTICE PROFESSIONALS NEED TO KNOW ABOUT THAT. AND THEN IT'S SCREENING AN ASSESSMENT AND AS WE KNOW, IN ALL SYSTEMS WE ALL HAVE OUR OWN WAYS OF SCREENING FOR KIDS AND IT'S OBVIOUSLY DIFFERENT IN THE JUSTICE SYSTEM AND WHEN WE'RE TALKING ABOUT SCREENING TOOLS IN FASD AND THERE'S DIFFERENCE IN SCREENING WHAT WE DO IN THE JUVENILE JUSTICE SYSTEM AND SO WE--THEY DON'T TALK TO EACH OTHER. SO, WHAT THE GUIDE WILL HOPEFULLY DO IS WE WILL LOOK AT WHAT YOU KNOW OUR SCREEN MANAGEMENT IN THE JUSTICE SYSTEM AND HOW THEY CAN INTERRELATE AND WE'RE SPEAKING THE SAME LANGUAGE AND SO THEY--SO JUSTICE PROFESSIONALS CAN START RECOGNIZING YOUTH WITH FASD AND I THINK THERE ARE SO MANY FACTORS GOING WITH THE CHANGE IN THE DSM FIVE WHICH WE AND THE YESTERDAY FIELD USE TO--WHEN THERE ARE ISSUES WITH CHILDREN, THAT'S WHAT WE'VE USED AND WE GOT THE YOUTH, WE NEVER REALLY SCREENED OR IDENTIFIED THEM. I THINK EVERYTHING'S GOING ON THE RIGHT DIRECTION BUT BRUCE CAN TALK ABOUT HOW IT'S GOING. >> MY NAME IS RUTH, I WORK WITH FAS AND I'VE BEEN IN SEVERAL DIFFERENT TIME ZONES IT IS IN THE LAST FEW WEEKS SO I BRAIN DIDN'T KNOW WHAT TIME ZONE IT IS SO I APOLOGIZE IF I'M NOT AS COHERENT AS I USUALLY AM. BUT ONE THING THAT'S BEEN A GAME CHANGER IN MINNESOTA HAS BEEN THE AMERICAN BAR ASSOCIATION RESOLUTION BECAUSE THAT HAS HOPED LOTS OF DOORS IN MINNESOTA AND AT THIS POINT WE HAVE GREAT PARTNERSHIPS ENCLUEDING WITH THE DEPARTMENT OF CORRECTIONS, THEY'RE TRAINING ALL OF THOSE ACROSS THE ENTIRE STATE ON FASD. THIS IS SOMETHING THEY'RE IMPLEMENTING INTO THE WORK THAT THEY'RE DOING AND IT'S ALSO OPEN, DOORS IN LAW ENFORCEMENT WHERE TRAINING, CADETS WE'RE ALSO TRAINING SEASONED OFFICERS TORNEYS AND JUDGES. WELL, AND ONE OF THE THINGS WE'RE TALKING ABOUT WITH GUIDES AND JUDGES IS THE OPPORTUNITY FOR NEW RESEARCH AND INFORMATION RELATED TO TRAUMA AND COHORTS FOR EXAMPLE AND THERE'S RESEARCH RELATED TO NEUROSCIENCE AND THE LAW TO BE ABLE TO ELECTRIC AT THOSE MORE UPTO DATE THINGS TO PROVIDE A REALLY COMPREHENSIVE GUIDE THAT IS GOING TO HELP US CONTINUE TO GUIDE THE WORK. AND I DO WANT TO ADD A LITTLE BIT TO THAT. I ATTENDED THE NATIONAL CONFERENCE IN JUVENILE COURT AND JUDGES IN SAN DIEGO AND ONE OF THE MOST EXCITING SESSIONS THAT THE JUDGE THAT ATTENDED THAT WAS A SESSION ON TRAUMA IN THE JUVENILE COURT SYSTEM. SO I THINK THEY WOULD BE VERY RECEPTIVE WHEN WE GO TO AUSTIN TEXAS TO A SESSION THAT'S MORE SCIENCE RELATED, THEY REALLY LIKED THE TRAUMA AND I THINK THERE'S A LOT OF CONNECTEDNESS WITH THE TUITION. ANY QUESTIONS? I TELL YOU WHY DON'T WE SAVE QUESTIONS UNTIL THE END AND YOU CAN ASK QUESTIONS OF US ALL TOGETHER. THE WHOLE TEAM, THE JUDGE ISSUES TEAM IS REALLY LOOKING FORWARD TO WORKING WITH WITH SUSAN, RUTH AND MOFAS, ALTHOUGH WE RECOGNIZE THAT THEY'RE WELL CONNECTED AND REACHING OUT TO A RAFT OF OTHER EXPERTS PROBABLY SOME OF YOU IN THIS ROOM TO TO REALLY HELP UPDATE THIS AND THEN WE WILL DISSEMINATE IT AND WE WILL MOVE OUT BEYOND MINNESOTA AND WE WILL USE EXAMPLES OF WHAT'S GOING ON IN MINNESOTA TO HELP INFORM US FOR EXAMPLE, FOR ABOUT SIX MONTHS AGO, THE HEAD OF THE AMERICAN PROBATION AND PAROLE OFFICE ASKED BOB TO GIVE A TALK AT THEIR PLENARY NTHAT TALK HE WANTED THEM TO COVER TWO THINGS, TRAUMA, INFORMED CARE AND ALCOHOL SPECTRUM DISORDERS AND WHAT WE'RE AWARE OF IS THAT THE AMERICAN PROBATION AND PAROLE OFFICE WOULD REALLY LIKE TO HAVE SOME ASSISTANCE AND SOME WORK ON DEVELOPING SCREENINGS THAT WOULD HELP THE PAROLE OFFICES AND MAYBE HELP DEVELOP DIFFERENT KINDS OF TREATMENTS TO PEOPLE ON PROBATION OR PAROLE TO HELP THEM NOT GET PULLED BACK INTO THE SYSTEM AS QUICKLY. THEN ANOTHER FEATURE DIRECTION OF THE ODHP, FASD LISTENING SESSIONS, THE REPORT IS COMING AND REALLY LOOKING AT THE IDEA OF DIAGNOSIS IS ESSENTIAL, WE UNDERSTAND DIAGNOSIS IS ESSENTIAL BUT ALSO LOOKING AT THE WHY IDEA THAT FOR THOSE THAT ARE UNABLE TO GET DIAGNOSIS, THAT SCREENING MAY FUNCTION AS A TOOL IN THE JUDICIAL SYSTEM, YOU KNOW, BEFORE A CHILD GETS INCAN RATED OR ADJUDICATED OR PUT IN DIVERSION OR PUT IN DETENTION. SOMETHING MIGHT HELP PROVIDE EARLY AWARENESS AND DIFFERENT OUTCOMES AND THAT ALIGNS WITH ONE OF ODHPs CURRENT PRIORITY WHICH IS IS TO REDUCE OUT OF HOME PLACEMENTS OF YOUTH. SO, WITH THAT, I'M GETTING THE CHOKE SIGN FROM SALLY WHICH SHE DOES O ELEGANTLY. I WOULD SAY IF ANYBODY HAD ANY QUESTIONS, YOU COULD ASK THEM BUT WE WILL BE HERE ALL DAY. SO, PLEASE FEEL FREE TO REACH OUT TO SUSAN, RUTH, MYSELF OR ANYBODY FROM THE JUSTICE ISSUES WORK GROUP. THANK YOU VERY MUCH. [ APPLAUSE ] >> NEXT WE ARE HAVING ADDITIONAL REPORTS. I WILL JUST LIST THE SPEAKERS IN ORDER AND THEY CAN JUST COME UP. WE'RE HAVING REPORT FROM THE CENTERS FOR DISEASE CONTROL DR. JACQUELINE BERTLUND, AND DARELE AND LYNN FROM NICHD. >> I THINK ALL OF YOU, MOST OF US KNOW US AND WHAT WE DO AND OUR ACTIVITIES ARE SO I'LL GO THROUGH THINGS QUICKLY. I'M JACQUELINE BERTRUND, CHILD PSYCHOLOGIST WITH OUR FASD PREVENTION TEAM. WE HAVE A PRETTY BIG TEAM, BUT WHAT I WILL DESCRIBE IS THE WORK THAT GOES ACROSS THAT TEAM AND I WORK ON EFFECTED INDIVIDUALS PORTION, NOT THE PRIMARY PREVENTION PORTION, SO I CAN'T ANSWER DETAILED QUESTIONS ON THAT BUT I CAN GET YOU TO THE RIGHT PERSON IF YOU HAVE SOME--WHERE ARE WE. OKAY THESE ARE ACTIVITIES THAT WE'RE DONE MONITORING AND EXPOSURE MONITORING AND DEVELOP WAYS THAT WE CAN HAVE ONGOING MONITORING OF EFFECTED INDIVIDUALS, WE'VE DONE INTERVENTION RESEARCH AND BOTH INTERVENTION AND PRIMARY PREVENTION AND INTERVENTIONS FOR EFFECTED INDIVIDUALS. WE'RE DISSEMINATING A LOT OF THOSE, MANY OF YOU KNOW OUR PROJECT CHOICES OR ALCOHOL SCREENING AND BRIEF INTERVENTION, WE DO A LOT RIGHT NOW WITH HEALTHICATION AND PROMOTION AND PROFESSIONAL ORGANIZATIONS AND WE ALSO DO A LOT OF PARTNERING AND POLICIES WITH NOFAS AND THINGS LIKE THAT. SO MONITORING MOST WHAT ARE MONITORING IS OF EXPOSURE, DRINKING BY WOMEN DRINKING BY PREGNANT WOMEN, THE MAIN BEHAVIORIAL SOURCE IS THE RISK SYSTEM THAT GIVES US THE NUMBERS THAT EVER OFTEN QUOTED, 50% OF WOMEN DRINK ALCOHOL, ONE IN 13 PREGNANT WOMEN DRINK ALCOHOL AND BINGE DRINKING GOES ON. WE ARE DOING ANALYSIS OF THE NATIONAL SURVEY GROWTH WHERE WE ADDED QUESTIONS ON CONTRACEPTION AS WELL AS ALCOHOL SO WE CAN START TO GET AT ESTIMATES OF ACTUAL ALCOHOL EXPOSED PREGNANCY, THAT THOSE ANALYSIS AND REPORT WRITING IS GOING ON NOW. WE'VE ALSO LOOKED AT THE NATIONAL AMBULATORY MEDICAL CARE SURVEY, AND THIS IS REALLY A SURVEY ABOUT WHAT PHYSICIANS ARE DOING IN THEIR ACTUAL PRACTICE, WHAT ARE THEY DOING ON A DAILY BASIS. WE ALSO DO DOCK STYLES TO DO THAT KIND OF--LOOK AT THOSE KINDS OF INFORMATION AND THOSE REPORT HEAT PORTS SHOULD BE COMING OUT TODAY AND INTO NEXT YEAR. THEY SAID WE ARE TRYING TO FIND A WAY WHERE WE CAN DO NATIONAL SURVEILLANCE FOR CHILDREN WITH FASDs. OUR PROGRAMS WERE FAST NET WHICH LOOKED AT BIRTH PREVALENCE OF CHILDREN UNDER FIVE. MOST RECENTLY, THIS PAST JANUARY WE PUBLISHED THE MMWR WE CHOSE IF FASNET TWO, THIS IS SUPPOSED TO BE UNDER THE PUBLIC RADAR WHERE WE GO IN THROUGH MEDICAL RECORDS TO EVIDENCE TO MEET THE CASE DEFINITION OF FAS AND BEHAVIORIAL EXPOSURE INFORMATION, WAWE'RE FINDING IS THE INFORMATION ISN'T THERE AND IF YOU LOOK AT THESE NUMBERS AND COMPARISON TO WHAT TINA AND PHIL DO WITH IN SCHOOL PROGRAMS WE FIND ONE FOR FULLER THAN FAS AND OUR CONCLUSION IS IF YOU LOOK AT THESE TOGETHER IS FAS IS AN UNDERRECOGNIZED AND UNDERDOCUMENTED DISORDER. SOME OF OUR HEALTH PROMOTION APPROACHES. WHAT WE DID TRADITIONALLY IN THE PAST IS WE FOR HEALTH PROMOTION WE HAD REGIONAL TRAINING CENTERS, WE HAD ANYWHERE BETWEEN FOUR AND SIX AT ANY PARTICULAR TIME. IN 2013 WE HAD AN EXTERNAL PEER REVIEW OF OUR PROGRAMS. AND WHAT THEY SUGGESTED WAS GHEE THESE TRAININGS ARE NICE BUT IT'S ONLY--YOU'RE ONLY GETTING A DROP IN THE BUCKET. WHAT WE WERE REALLY--THEY SUGGESTED WE DO IS PARTNER WITH PROFESSIONAL ORGANIZATIONS AND NATIONAL PARTNERS TO REALLY INFLUENCE PRACTICING PHYSICIANS SO WE DID SIX IMPLEMENTATION CENTERS, SEVERAL NATIONAL PARTNERS ALONG WITH NOFAS AND HERE ARE THE GRANTEES, THEY ARE EACH PRACTICE IMELEMENTATION CENTER IS PAIRED WITH THE NATIONAL PARTNER AND THEY WORK TOGETHER TO--THEY'RE GOING TO DO LOTS OF THINGS SO WE HAVE DIFFERENT--MANY DIFFERENT DISCIPLINES REPRESENTED. SOCIAL WORKERS FAMILY MEDICINE, NURSING, PEDIATRICS. OBGYN'S MEDICAL ASSISTANCE AND A COUPLE OTHER. THESE ARE OUR NATIONAL PARTNERS, THE ACADEMY OF PEDIATRICS, ACOG, PITTSBURGH IS REPRESENTING THE AMERICAN NURSES ASSOCIATION IN TEXAS, UNIVERSITY OF TEXAS IS WORKING WITH ORGANIZATIONS AND AS I SAID NOFAS, THIS SAY FIVE YEAR PROGRAM AND WE TOOK THE FIRST YEAR FOR PLANNING YEAR SO ALL THE GRANTEES ARE WORKING TOGETHER, IN DISCIPLINE SPECIFIC WORK GROUPS. WE HAD A LARGE GRANTEE MEETING IN NOVEMBER THAT WAS VERY SUCCESSFUL WE HAD ANOTHER ONE IN FEBRUARY WHICH THE WEATHER DIDN'T COPERATE COMPLETELY SO WE HAD TO HAVE A SHORTER MEETING BUT STILL GOT A LOT DONE. AND WHAT THEY DID, WHAT THEY'RE DOING DURING THE FIRST YEAR IS AN ENVIRONMENTAL SCAN OF WHAT MATERIALS ACTIVITIES ARE OUT THERE IN EACH DISCIPLINE AND THERE'S A WIDE RANGE OF WHAT THE DIFFERENT DISCIPLINES ARE FINDING. SOME LIKE PEDIATRICS, THERE'S LOTS OF STUFF OUT THERE BECAUSE WE'VE KNOWN ABOUT IT FOR A WHILE. OTHERS LIKE MEDICAL ASSISTANCE OR SOCIAL WORKERS, THEY'RE BASICALLY COME BEING UP WITH NOTHING. AFTER THE ACTION PLAN AND HOW THEY'RE GOING TO COLLABORATE AND WHAT PRODUCTS THEY'RE GOING TO COME UP WITH AND WE ALSO HAVE A CONTRACTOR THAT'S WORKING ON A CROSS SITE EVALUATION ACROSS ALL THESE GROUPS FOR NOT ONLY OUR--THE ACTIVITIES THEY DEVELOP AD EVALUATE FIGURE THEY'RE EFFECTIVE AND THEY'RE GOING TO DO THAT INDIVIDUALLY. WE ALSO WANT TO KNOW IF THIS BASIC APPROACH OF PARTNERING EXPERTS WITH NATIONAL ORGANIZATION, HOW THAT'S WORKING OUT SO THEY'LL BE DOING THAT. AND ONE OF OUR GRANTEES IS NEVADA, UNIVERSITY OF NEVADA AND THEY ARE DEVELOPING A SERIES OF ONLINE COURSES ABOUT FAS AND THEY'LL COVER A WIDE RANGE OF TOPICS FROM DIAGNOSIS TO PRIMARY PREVENTION AND WHAT WOULD BE WHAT SCHOOLS SHOULD BE LOOKING AT. THESE ARE CLASSIC GRAND ROUNDS OR ONE SHOT VIDEO KINDS OF THINGS SO WE WANT PRACTICE CHANGE OF THE INDIVIDUAL LEVEL AND CLINICIANS AND LEARNING TO--LEARNING ABOUT THIS ISSUE AND CHANGE WAG THEY ACTUALLY DO IN THE OFFICE DOCUMENTING EXPOSURE AND THINGS LIKE THAT. SO THINGS LIKE KISER WE WANT IT TO BE THEIR POLICY THAT EVERY CHILD, THEIR PRENATAL HISTORY IS TAKEN AND DOCUMENTED. AND WE ALSO WANT SOME--YOU KNOW PROFESSIONAL ORGANIZATIONS, WE WANT THEM TO--THEIR ORGANIZATIONS TO HAVE IN PLACE POLICY STATEMENTS, DIAGNOIC GUIDELINES OR PRACTICE GUIDELINES FOR CHILDREN AND THINGS SO WE'RE LOOKING FOR CHANGE ON MANY DIFFERENT LEVELS NOT THE TRADITIONAL ONE-ON-ONE. AND EACH--LATER IN THE IMPACT WE WILL HAVE HIGH END STUDIES AND WE WILL DEFINE WHAT THOSE LOOK LIKE AND YOU WILL HEAR ABOUT THOSE IN FUTURE YEARS. OKAY, THIS GOES ON TO SOMEONE ELSE'S NURSING PROGRAMS AND THEY HAVE WORK FOR IMPROVEMENT PROJECTS WHERE THEY'RE DEVELOPING MATERIALS AND INFOTION TRAINING AND ONE IS JOHNS HOPKINS AND UNIVERSITY OF PITTSBURGH. AND THEY'RE GOING TO WORK WITH THE AMERICAN COLLEGE EVER NURSE MIDWIVES TO DEVELOP SIMILAR MATERIALS. MOST OF IT FOCUSING ON CONTROL SCREENING AND BRIEF INTERVENTION, HOW YOU DO THOW YOU PUT IT TO WORK IN A PRACTICE. IT DOESN'T JUST HAVE TO BE THE NURSE, IT CAN BE SOMEONE ELSE SUCH AS A MEDICAL ASIT ANT TAKING THAT INFORMATION AND HANDING OFF THAT INFORMATION. OKAY. WE HAVE CHOICES WHICH MOST PEOPLE KNOW AS A TWO OR FOUR BRIEF INTERVENTION FOR PRECONCEPTIONAL WOMEN FOCUSING ON WHOLE USE OR ALCOHOL USE DURING PREGNANCY IF YOU'RE GOING TO BECOME PREGNANT AND/OR IMPROVING EFFECTSIVE--IMPROVING USE OF EFFECTIVE CONTRACEPTION. SO WE HAD DONE THIS IN DENVER AND IN WISCONSIN THESE ARE NATIVE POPULATION SETS THAT THEY'RE WORKING WITH. WE HAD PREVIOUSLY FUNDED CHOICES IN THE CLINIC AND THESE HAVE ENDED NOW, BUT ONE OF THE GOOD THINGS THAT WE'RE FINDING ABOUT IT IS EVEN WHEN FEDERAL DOLLARS GO AWAY, BOTH OF THESE SITES ARE STILL CONTINUING TO IMPLEMENT PROJECT CHOICES. SO IT WAS FOUND TO BE VERY COST EFFECTIVE FOR THEM IN THE LONG RUN SO THEY--THEY KEPT GOING WITH IT WHICH WE WERE VERY PLEASED TO SEE. PROFIOUSLY THIS YEAR WE PUBLISHED CDC VITAL SIGNS LIKE AN ALERT DOCUMENT TALKING ABOUT ALCOHOL SBI. THIS IS LELA, SHE'S NEW TO THE TEAM AND SHE'S BEEN WORKING ON THE VITAL SIGNS AND ALCOHOL SBI. SHE DID QUANTIUM MD LIKE A SOCIAL MEDIA. SHE'S DONE A LOT OF WORK PUTTING INFORMATION OUT THERE. SHE'S WORKING ON IMPLEMENTATION GUIDE AND AGAIN SHE'S WORKING WITH THE NURSES. THE ACADEMY OF PEDIATRICS ONE OF MY FAVORITE GRANTEES, WE DO A LOT OF WORK WITH THEM, WE DO A PEDIA LINK MODULE AND WE HAVE A TOOL KID THAT GOES WITH THAT, AND PROFESSORSHIPS ON FASDs WE WROTE A TECHNICAL REPORT ON NEURAL BEHAVIORIAL DISORDER WITH PRENATAL ALCOHOL REVIEW. PEDIATRIC THERE'S A CLINICAL REPORT ON ALL FASDs UNDER DEVELOPMENT AND WE'RE TESTING OUT THE VIABILITY OF ALCOHOL SCREENING AND BRIEF INTERVENTIONS FOR ADOLESCENTS MAINLY IMPLEMENTATION GUIDE OF HOW YOU INTEGRATE THIS INTO A PEDIATRIC PRACTICE WE HAD A CALL TO ACTION A COUPLE YEARS AGO WHERE WE PARTNER WIDE DEFERRAL CERTAINTY ORGANIZATION, AMERICAN ACADEMY OF FAMILY PRACTITIONERS, ACONE NETMAP AND THINGS LIKE THAT AND THEY DEVELOPED A SERIOUS OF PSA VIDEOS THAT ARE ABLE I HAVE AT WEB SITE AND MY OTHER FAVORITE GRANTEE IS NOFAS, AND WE FUND THEM TO DO A STATE BY STATE DIRECTORY THEN CLINATION AND THE BROCHURE IS SOMETHING WE DEVELOPED WITH THEM LAST YEAR FOR THE EVIDENCE BASED INTERVENTIONS THAT CDC FUNDED SEVERAL YEARS AGO. WHERE AM I NOW? ACF, SHARON IS GOING TO TALK ABOUT THAT BUT WE ARE DOING AN IRPT ACCESS SMALL PROJECT WITH THE D. C. CHILD SERVICES AGENCY I AND WILL LEAVE THAT FOR HER TO TALK ABOUT. THIS IS THE APRIL 23rd TWITTER CHAT THAT WAS DONE, GIST, I DIDN'T EVEN KNOW ABOUT THAT. AND THIS IS--IT'S NEXT SCREEN, I SEE WHY SHE PUT IT IN. OKAY. KD--SALLIER SO LOG ON TO TWITTER IF YOU DO THAT KIND OF THING AND YOU WILL HEAR THE TWITTER CODE. AND THIS IS JUST WEB CONNECTED PUBLISHED LOTS AND DEVELOPED A LOT FOR THE PUBLIC AND THIS IS AN EXAMPLE, THIS IS KATIE GREEN WHO WAS PREGNANT IN OUR OFFICE A FEW YEARS AGO AND SERVED AS OUR MODEL BUT WE HAVE NEW MATERIALS THAT ARE AVAILABLE AT OUR WEB SITE AND THINGS LIKE THAT. THAT'S OUR UPDATE. I DON'T KNOW WHO'S NEXT. [ APPLAUSE ] >> ALL RIGHT, SO I SPEND THE NEXT 15-20 MINUTES, MAYBE 15, THANK YOU, BRICKING YOU UP TO DATE WITH WHAT WE'VE BEEN DOING HERE AT NIAAA AND OUR PRINCIPLE MISSION HERE IS TO ADVANCE RESEARCH ON FASD TO INFORM TREATMENT, POLICIES, AND A LOT OF WHAT I WILL CONCENTRATE ON IS OUR PORTFOLIO, FIRST I WANTED TO MENTION THAT AFTER THE--AFTER THE SPECTER OF MERGER WITH NIDA, PAST, IT GAVE US THE OPPORTUNITY TO INSTALL A NEW DIRECTOR AND THAT IS GEORGE KOUH WHO CAME ON BOARD A YEAR AND HALF AGO, AND IN HIS FIRST YEAR HE LAID DOWN A SERIES OF GOALS OF WHERE WE WANT TO BE DOCTRINE WHICH OUTLINES THE PRIORITIES THAT HE SEES TO GIDE US INTO THE FUTURE AND FORTUNATELY FOR US ALL, THERE ARE A COUPLE OF THESE NINES THAT ARE FASD AND THEY WILL BE HARD FOR YOU TO READ BUT NUMBER FOUR IS IMPLEMENTATION OF EFFECTIVE PREVENTIVE STRATEGIES FOR DRINKING DURING PREGNANCY AND ANOTHER ONE A COUPLE LINES DOWN IS ESTABLISHMENT OF EFFECTIVE TREATMENT OF FETAL ALCOHOL SPECTRUM DISORDERS. SO THAT'S ON OUR RADAR SCREEN AND THAT'S WHERE WE'RE DRIVING TOWARDS. WHAT PROPELS OUR PROGRESS IS OUR BUDGET OF COURSE AND I'M SHOWING YOU KIND OF THE PEAKS AND VALLEYS THAT WE'VE EXPERIENCED IN RECENT YEARS. WE'RE REALLY FOCUSING ON THE TON OF THE MOUNTAINS HERE SO IT'S NOT AS MAYBE ALARMING AS IT SEEMS. BUT WE DO SEE TRENDS THAT MAKE IT CHALLENGING TO FUND AS MANY GRANTS AS WE LIKE. THE POINTS REPRESENTED ON THE GRAPH ARE ECHOED ON THIS FIRST LINE OF THE TABLE. AND WHERE I'M TAKING SURVEYS THAT WE SPEND ABOUT 32, $32 MILLION OUT OF AN OVERALL BUDGET ON THE ORD ARE OF 320, $330 MILLION OF SHARE TOWARDS FASD RESEARCH AND TRAINING. AND SO THAT AMOUNTS TO ABOUT AN EIGHT-NINE% PORTION OF THAT BIG BUDGET THAT GOES IN VARIOUS DIRECTIONS, ALCOHOLISM, TREATMENT AND RECOVERY, LIVER DAMAGE, BUT I THINK IT'S PRETTY SIGNIFICANT TO SAY, THAT 90% OF THAT BUDGET IS FOCUSED ON OUR FASD PORTFOLIO. AND IT'S TYPICALLY REPRESENTED BY ANYWHERE FROM 90-100 GRANTS AT ANY GIVEN TIME. AND WITH EACH YEAR SOME GRANTS CYCLE OFF AND NEW ONES CYCLE ON. AND IN THIS LAST COMPLETE FISCAL YEAR, 2014, 22 GRANTS WERE ADDED TO THE FASD PORTFOLIO SO WE WILL TAKE A TOP LEVEL TOUR OF THESE 20. SO EACH OF THE BOXES AND THESE TABLES, ON THESE NEXT THREE SLIDES ARE INDIVIDUAL GRANTS THAT WERE FUNDED. WE FUND IN A VARIETY OF AREAS PREVENTION DIAGNOSIS, ETIOLOGY, IN OTHER WORDS, UNDERLYING MECHANISMS THAT ARE AT WORK IN CAUSING THESE DISORDERS AND TREATMENT AND I POINT THAT OUT BECAUSE I TRY TO COLOR COAT THESE GRANTS SO YOU GET A SENSE OF THE DIVERSITY OF THE PORTFOLIO. BUT A BIT OF THE PORTFOLIO SHOWN IN GREEN IS LOOKING AT UNDERLYING MECHANISMS BUT YOU CAN SEE ON THIS PAGE WE'VE GOTTEN ONE THAT HAS AN ASPECT OF THAT BUT HAS A PRIMARY FOCUS ON DEVELOPING DIAGNOSTIC CRITERIA AND TOOLS AND AS WELL THERE'S THREE ON THIS PAGE THAT HAVE INTERVENTION AND TREATMENT COMPONENT BUT AND IN SOME INSTANCES IT'S A STRONG IMPLICATION THAT THIS WILL LEAD IN THAT DIRECTION, SO TO SKIP LIGHTLY ACROSS, ONE OTHER POINT I WANT TO MAKE IS I ORGANIZED BY THE VARIOUS TYPES OF GRANTS THAT WE FUND, ACROSS THE TOP LINE YOU CAN SEE THESE F-GRANTS AND THESE ARE ALL GRANTS THAT ARE TRYING TO FUTURE THE NEXT GENERATION OF RESEARCHERS IN FASD. AND AS WE MOVE ALONG WE GO TO SMALL PROJECTS AND THAT MIGHT LAST A YEAR AND WE HAVE A SERIES OF R21S AND DEVELOAL PROJECTS WHERE THEY ARE TRYING TO CRACK INTO A NEW AREA AND THEY FUND QUITE A FEW OF THESE R21S IN THE PROCESS AND THEY SPILL OVER ON TO THIS PAGE AS WELL CAN YOU CAN SEE NOW THAT WE'RE STARTING TO SEE NOW HIGHLIGHT IN THIS PREVENTION ORIENTED RESEARCH AND AGAIN WE HAVE TREATMENT AND ON THE LAST OF THE FEW SLIDES ARE THE TWO GRANTS AND LAST BUT NOT LEAST THIS IS ONE FETAL EGHTINAL INDUCED DEFINITE MECHANISM DIAGNOSED INTERVENTION HENS THE THREE COLORS AND I SAY LAST BUT NOT LEAST THIS IS AN ENORMOUS GRANT TO FUND AN FASD FOCUS RESEARCH CENTER AT THE UNIVERSITY OF NEW MEXICO AND YOU CALL THIS CENTER, IT'S A MULTIDISCIPLINARY GROUP AND THE COMMON THREAD IS THAT THEY'RE FOCUSING ON WHAT WE'RE SEEING AS THE MAIN PROBLEM WITH THE KIDS, IT'S NOT THE FACIAL FEATURES IT'S THE DYSFUNCTION THAT'S OCCURRING IN THEIR BRAINS. COGNITIVE DEFICIT, BEHAVIORIAL DEVELOPMENTAL ENDOCRINOLOGY SIS, ET CETERA SO THE FIRST OBJECTIVE IS TO UNDERSTAND MECHANISMS THAT EFFECT THE FUNCTION IN THE BRAIN AND SECONDLY BY IMPROVE DIAGNOSIS BY BIOMARKERS AND BRINGING ONLINE NEUROIMAGING TOOLS THAT WILL BE REVIEWING FUNCTIONAL DEFICITS IN THE BRAIN AND THEN LASTLY, TO DEVELOP EFFECTIVE THERAPIES, NEURAL BEHAVIORIAL EDUCATIONAL OR THERAPEUTIC INTERVENTIONS FOR ADDRESSING THESE BEHAVIORIAL PROBLEMS. WE DO TO STIMUMENT THESE APPLICATIONS TO TAKE US IN THE RIGHT DIRECTION IS PROGRAM ANNOUNCEMENTS AND OTHER FORMS OF FUNDING OPPORTUNITY ANNOUNCEMENTS AND I'M JUST LISTING AGAIN A INITIATIVE OF THESE P As THAT ARE CLEARLY ACTIVE AND ALL HAVE LANGUAGE IN THEM AND IF YOU LOOK, ACCOMMODATE RESEARRS WITH AN INTEREST IN SUBMITTING A GRANT RELATED TO FASD IN VARIOUS WAYS AND ALTHOUGH THEY'RE NOT SPECIFICALLY FOCUSED ON FASD, THEY CREATE THIS OPPORTUNITY AND TO JUST RESEARCHERS ANNOUNCEMENTS THAT THEY CAN RESPOND TO FOR THE GRANT APPLICATIONS. AND HERE'S A FEW MORE. AND MORE ON THE SPECIFICS, BUT ON THE LAST PAGE ARE TWO THAT AREN'T SPECIFICALLY FOCUSED ON THE PRENATAL ALCOHOL EXPOSURE ISSUE. THIS ONE EFFECTS ALCOHOL EXPOSE NUR ADULT THIS, IS THE DEVELOPMENTAL CONCEPT OF ADULT HEALTH AND EXPOSURE AND DISEASE, THIS IS ONE THAT BILL DUNGY WROTE AND ISSUED AND WE TEND TO FOCUS ON THE IMMEDIATE PROBLEMS WE CAN SEE OF SCHOOL AGED KIDS AND MAYBE EVEN EARLIER, BUT THE QUESTION IS, DID THAT EARLY EXPOSURE IN LIFE, THROUGH ALCOHOL IN UTERO SET THEM UP FOR OTHER DISEASES LATER IN LIFE, PERHAPS AREYALATED TO IMMUNE ISOTOPE DUNKS OR ENDOCRIP ONATIONAL LIBRARY OF MEDICINALLYS OR WHO KNOWS WHAT--ENDOCRINE ANOMALIES OR WHO KNOWS WHAT, BUT THE BOTTOM IS ADDRESSING WHETHER AN ALCOHOL EXPOSURE THAT OCCURRED IN ONE GENERATION THAT CODED EPIGENETIC GERM LINE PATHEE GENS IN THE DNA COULD BE PASSED ALONG TO GENERATIONS AND GENERATIONS THEREAFTER WHICH IS AN INTRIGUING POSSIBILITY THAT WE BARELY SCRATCH THE SURFACE OF. I WANT TO TALK ABOUT OUR EFFORTS AND I WANT TO TALK ABOUT THERAPEUTIC INTERVENTIONS AND I THINK A MAJOR STEP FORWARD OCCURRING IN PHYSICALIARY 2009 AND WE PARTNER WITH THE NATIONAL INSTITUTE OF MENTAL HEALTH ON THIS RFA AND OUT OF THAT, WE POST THESE GRANTS AND I'VE SHOWN THESE GROUPS IN THE PAST BUT IT TURNS OUT THAT YOU KNOW THEY'RE STILL WORKING THEIR WAY TO THIS--THEY'VE JUST SURPASSED THE FIVE YEAR MARK THAT THESE GRANTS WERE DESIGNED TO FUND. MOST OF THEM ARE OPERATING A NOVELTY COST EXTENSION HERE, SO WE'RE STILL WAITING ON THE RESULTS BUT I THINK THEY SHOULD BE COME NOTHING THE COMING YEAR. I PROBABLY SHOULD HAVE SAID THAT LAST YEAR BUT IN REALITY NO COST EXTENSIONS ARE QUITE REASONABLE AND COMMON AND WE HOPE TO SEE SOME OF THE RESULTS FROM THESE INVESTMENTS ONE IS INVOLVING CO LINE AND THIS WAS INSPIRED BY A BOOK THAT WAS DONE IN RAT WHICH IS ARE MINIMAL TO BEHAVIORIAL ANALYSIS BY JENNIFER THOMAS AT THE UNIVERSITY--AT SAN DIEGO STATE UNIVERSITY AND THAT--THAT CREATED THE EVIDENCE BASE TO MOVE THIS INTO CLINICAL TRIALS AND THEN YOU CAN SEE THE OTHERS HERE ON THE LIST ARE BEHAVIORIAL INTERVENTIONS GO FOR--MAYBE COGNITIVE CONTROL, SENSORY MOTOR TRAINING AND FOSTERING SELF-REGULATION. I'M GOING TO CONTINUE ON THE THEME OF CO LINE AND THIS IS THE WASNIAK GRANT I JUDGE OUST SHOWED YOU. THE TARGET CHILDREN ARE PRESCHOOL AGED. THERE ARE THREE OTHERS, ONE WAS INITIATED BEFORE ANY OF THESE BY TINA CHAMBERS IN THE CONTEXT OF THE CFAS CONSORTIUM AND TINA'S IN THE BACK OF THE ROOM, HI, TINA. AND WHAT SHE'S BEEN DOING IS IN THE UKRAINE, LOOKING AT WOMEN WHO MANY OF WHICH DRINK HEAVILY AND ARE PREGNANT AND LOOKING AT OUTCOMES AND LOOKING AT THE INFLUENCE OF A CHOLINE SUPPLEMENTATION AND WE DON'T KNOW THE EFFECTS OF THAT. THIS IS PREGNANT WOMAN, SANDRA JACOB SENSE IS ALSO LOOKING AT CHOLINE IN PREGNANT WOMEN, RATTLER THAN IN THE UKRAINE WHICH IS LARGELY CAUCASIAN, THE JACOB SON'S ARE DOING THEIR STUDY IN SOUTH AFRICA IN THE CAPE DOWN REGION AND THEN, THE NG UYENSTUDY IS FOCUSING ON SLIGHTLY OLDER KIDS, SCHOOL AGED KIDS WRIER THAT HE EVER OFTEN IDENTIFIED. I WANT TO TELL YOU ABOUT SOME OF THE CONSORTIA THAT WE FUND. ONE IS THE COLLABORATIVE INITIATIVE ON FASD AND ONE IS DIRECTED BY EDREILLY WHO IS AT THE BACK OF THE ROOM THERE. AND THIS IS MULTIDISCIPLINARY CONSORTIUM. COMPRISED OF BASIC SCIENCE AND CLINICAL SCIENCE WITH THE GOAL OF IMPROVING CAPABILITIES AND CLINICAL RECOGNITION OF FASD, DEVELOPMENT OF INTERVENTIONS AND PREVENTION. THEMES IN THIS ITERATION OF CFAS CONTINUE TO BE STRUCTURAL FUNCTION, BRAIN IMAGING, CHARACTERIZING NEUROBEHAVIORIAL PHENOTYPES, AMONG FASD, AND DEVELOPING 3D FACIAL IMAGING, CAPTURING AN ANALYSIS FOR THE RECOGNITION OF EFFECTED CHILDREN AND NUTRITIONAL THERAPEUTICS AND BY THAT I REFER TO EVERYTHING AS CHOLINE INTERVENTION. CATHY USES A MOUSE MODEL, AND THIS IS--THIS IS A VERY NICE DEMONSTRATION THAT IS WITH THE CORPUS COLOZ UMKC THAT IS SEEN HERE IN THE ALCOHOL EXPOSED ANIMAL, LOOKS VERY MUCH LIKE THE GENESIS OF THE CORPUS COLS ON UMKC AS WE SEE IN SOME KIDS WITH FASD. I MENTIONED 3D FACIAL IMAGING, WE IS SEE THE OUTPUT FROM THESE STUDIES. IT'S THE MAPPING, IN RELATIONAL ANALYSIS OF MANY CHILDREN IN THIS PARTICULAR STUDY, CHILDREN FROM SOUTH AFRICA ONCE AGAIN. THE COLORS SHOWN WHERE THIS--THE BASE IS EXPANDED OR CONTRACTED AND WHAT THIS STUDY DID THAT WAS REALLY QUITE EXCITING IS THROUGH COMPUTER ANALYSIS, FEATURES IN THESE FACES AND WE DISCOVERED THAT ADDITIONAL MORPHOLOGYST WOULDN'T NECESSARILY SEE BUT THESE FEATURES CORRELATED WITH COGNITIVE DEFICIT. SO, IT SPEAKS TO, I THINK WIGHT A POTENTIAL FOR THIS TECHNOLOGY AND IT'S CONTINUING TO BE DEVELOPED. AND THIS IS JUST AN ILLUSTRATION OF GENETIC ADVANCES THAT HAVE BEEN MADE IN CFAS QUITE RECENTLY, JOHAN EVERHEART HAS PROPELLED THIS RESEARCH FORWARD. WHAT WE'RE LOOKING AT IS THE CRANIUM AND CRANIAL BONE STRUCTURE OF ZEBRAFISH. AND WHAT HE'S DOING IS FINDING FISH THAT HAVE BEEN MUTATED GENES THAT BECOME OR LOSE P IN THE COURSE OF A GENE BEING MUTATED AND PROTECTS THEM FROM THE EFFECTS OF ALCOHOL. SO CAN YOU SEE THAT THE GENE PDFRA, WHICH IS GROWN RECEPTOR GENES WHEN THE FISH HAVE BOTH COPIES THEY'RE NOT GREATLY EFFECTED IF AT ALL BY EGHTINAL TREATMENT BUT AS A LOSE ONE COPY OR WORTH COPIES YOU CAN SEE DRAMATIC SUSCEPTIBILITY TO THE EFFECT OF ALCOHOL AND WHAT HE'S DISCOVERING IS AN INTERACTION BETWEEN ALCOHOL AND THESE GENES AND THESE FOUND A HANDFUL OF THESE GENES AND HE'S WORKING IN THE CONTEXT OF THIS CONSORTIUM AND IT WOULD TRANSLATE THIS INFORMATION TO THE HUMAN GENETIC PROJECT WHICH AT THAT TIMIANA HAS BEEN RUNNING AND THEY'RE FINDING ANOTHER GENE IN THE HUMAN POPULATION THAT COULD WELL BE CONTRIBUTING TO THE FASD AND MOVING ALONG, I WANT TO MAKE A BRIEF MENTION OF A COLLABORATIVE PROJECT AND NIAAA, AND LYNN WILL BE UP NEXT AND SHE WILL SAY A FEW WORDTHIS, BUT THAT'S THE PRENATAL ALCOHOL AND SIDS AND STILL BIRTH NETWORK AND THE IDEA RECRUITING THAT THEY'RE RECRUITING 12,000 PREGNANT WOMEN ACROSS TWO SITES ACROSS THE PLAINS AND CAPE TOWN SOUTH AFRICA AND THEY'RE FOLLOWING THEM AND CAPTURING EXQUISITE DETAIL ABOUT EXPOSURES DURING FREEINGINANCE SCHEMONITORRING GROWTH AND OUTCOMES OF CHILDREN WHICH TRIEVING IT IS TO DEPEND DOWN WHOLE IS PLAYING THE ROLE IN STILL BIRTH AND WILL ALSO GET A CHANCE TO SEE IF IT'S CONTRIBUTING TO SIDS AND AMONGST THE CHILDREN THAT ARE BEING BORN IN THIS STUDY, MANY OF THEM ARE GOING TO HAVE FASD, AND IT'S GOING TO BE A REALLY RICH REPOSITORY OF INFORMATION AND QUITE A BIT FROM IT STUDY. I SHOULD ALSO MENTION THAT NIDCD HAS ALSO CO FUNDED THIS PROJECT. I WON'T SAY MUCH ABOUT THIS WHOLE SESSION BECAUSE WE HAVE A WHOLE PORTION ON THIS AND IT'S A CONSORTIUM THAT WE FUND AND IT'S OPERATING IN VARIOUS PLACES IN THE UNITED STATES AND TINA CHAMBERS ARE BACK INTO THE TABLE ARE DRIVING THIS PROJECT AND WITH THAT I'LL STOP AND IF THERE A TIME I'LL TAKE ANY QUESTIONS. >> SO AGAIN I'M LYNN HAVERSOV AND THE MISSION OF OUR EN--STRATEGIESITUTE TO INSURE THAT CHILDREN ARE BORN HEALTHY AND WANTED THAT THEY--WOMEN SUFFER NO NEGATIVE EFFECT FROM THE PROCESS, ALL CHILDREN ACHIEVE FULL PRODUCTIVE HEALTHY LIVES THAT ARE FREE OF DISEASE AND DISABILITY AND THAT PEOPLE ARE SURE THE HEALTH PRODUCTIVITY AND WELL BEING OF ALL PEOPLE THROUGH REHABILITATION SO WE HAVE THE NATIONAL CENTER FOR NATIONAL MEDICAL REHABILITATION RESEARCH WITHIN THE NICHD. SO I WILL RUN THROUGH THESE ACTIVITIES AT NICHD, FILL YOU IN ON WHERE YOU ARE, WE HAVE CO FUNDED FOR NIAAA TO ESTABLISH THE PREVALENCE OF SPECTRAL DISRUM DISORDERS, AS YOU JUST HEARD, FROM DALE, WE ARE INVOLVED IN THE PRENATAL ALCOHOL AND SUDDEN INFANT DEATH SYNDROME AND STILL BIRTH, THE P. A. S. S. NETWORK, WE ARE FUNDED BY A GROUP ON MEASURING THE EFFECT OF PRENATAL ALCOHOL EXPOSURE ON PLACENTAL METHODALATION AND THEN A STUDY BY STANTON ON MECHANISMS OF CONTEXT, CONDITIONING IN THE DEVELOPING RAT. SO LET ME GIVE YOU PERSPECTIVE IN WHERE I COME FROM IN RISK BEHAVIORS AND ALCOHOL USE AND PREGNANCY. SO I THINK OF OUR INSPHYT TAKES LIFE SPAN APPROACH SPECIALIZATION OF SPECIFIC ENDOTHELIAL EVEN THOUGH WE'RE CALLED THE NATIONAL HEALTH AND CHILDHOOD DEVELOPMENT INSTITUTE WE ARE NOT DISEASE SPECIFIC OR AGE CONFINED WE THINK ACROSS THE WHOLE SPECTRUM AND THINK ABOUT THE OPPORTUNITY FOR INTERVENTION IN NUMEROUS PLACES SO WE DON'T HAVE TO WAIT UNTIL THE WOMAN IS PREGNANT AND WORRY ABOUT HER DRINKING THEN, WE TO THINK ABOUT THE MOTHERS AND INFLUENCE THAT HAVE ON THE MODELING THEY DO BARGAINS OF THEIR CHILDREN, TEACHING OF THEIR CHILDREN, WE NEED TO START EARLY ON AND WE NEED TO THINK ABOUT HOW WE TEACH ABOUT RESPONSIBILITY DRINKING ABOUT SEXUALITY AND SEXUAL PROCESSES. WE TEDE TO THINK WITH ADOLESCENCE AND THINK ABOUT WHAT WE NEED TO DO TO HELP PEOPLE WITH RESPONSIBLE HEALTH AND BEHAVIOR. THAT'S THE CONTEXT BEHIND THE RISK RELATED BEHAVIOR RESEARCH THAT WE'RE SUPPORTING AND AGAIN THEY APPROACH IT FROM DIFFERENT PERSPECTIVES AND I WON'T TAKE YOU THROUGH THIS BUT I'LL TELL YOU MORE ABOUT THE STUDIES BUT LAND FORD IS DOING A STUDY ON PARENTING ADOLESCENT SELF-REGULATION AND RISK TAKING ACROSS CULTER SPECIALIZATION OF SPECIFIC ENDOTHELIAL THIS IS AN INTERNATIONAL STUDY LOOKING AT 13 CULTURES AROUND THE WORLD AND LOOKING AT CROSS GENERATIONS AND PARENTS AND COMMUNICATION WITH ADOLESCENTS. AND THE SECOND ONE JOY ACOSTA IS DOING A STUDY REDUCING PROBLEM BEHAVIORS THROUGH POSITIVE YOUTH DEVELOPMENT AND RESTORATIVE PRACTICES SO THIS A STUDY, IT'S A LONG STEWEDINAL RANDOMIZED CONTROL TRIAL THAT'S GOING TO DOCUMENT WHETHER INTEGRATING A WHOLE SCHOOL PROGRAM USING THIS RESTORATIVE PROBLEM BEHAVIOR PRACTICES INTERVENTION CAN EFFECT THOSE DEVELOPMENTAL OUTCOMES AND BEHAVIORIAL SO IT'S PROMOTING POSITIVE RELATIONSHIPS AND TRYING TO REDUCE PROBLEM BEHAVIORS LIKE ALCOHOL USE, BULLYING, EARLY SEXUAL BEHAVIOR. --ABOUT DECREASING HIV RISK BY TEACHING THESE MINORITY ADOLESCENTS ABOUT SEX, DRUG AND ALCOHOL CHANGES AND REFUSAL SKILLS. SO AGAIN IT'S A GAME THAT WAS DEVELOPED TO REDUCE PROBLEM BEHAVIORS, NOT JUST HIV, BUT AGAIN ALSO SEXUAL BEHAVIOR AND SUBSTANCE ABUSE. MITCH IS DOING A STUDY ON UNDERSTANDING PEER INSTANCES OF EDLAS PINTAS EBTS RISK BEHAVIORS AND AND WORKING AT THE OFFICES THATAZ LESSENTS CAN FORM TO THE PEERS AND MOTIVATED BY DESIRES AND BE ACCEPTED AND TO ACHIEVE THIS PEER ACCEPTANCE STATUS. AND SO HE'S DEVISED EXPERIMENTS AND ASSIMMULATED CHAT ROOM WHERE HE BRINGS IN ELECTRONIC CONFEDERATES WHO COMMUNICATE SOCIAL NORMS ENDORSING RISK OF PROSOCIAL ATTITUDES AND BEHAVIORS. IN THE STUDY BY GENERATED VERGROSSMAN. CALLED COMMUNICATION ABOUT SEX IN THE NUCLEAR FAMILY AND BEYOND, IMPLICATIONS FOR HEALTH, HE'S DOING A LONGITUDINAL STUDY THAT WILL EXFLOR CONTINUITY AND CHANGE IN TEEN FAMILY SEXUAL COMMUNICATION OVER--AS THE KIDS TRANSITION TO HIGH SCHOOL AND IT'S GOING TO ENCOMPASS BROAD FAMILY NETWORKS AND EXPLORE THE ASSOCIATION OF THIS COMMUNICATION AND WHAT EFFECTS THEY HAVE TOGETHER. IN ANOTHER STUDY BY HILLARY BURNS SHE'S LOOKING AT CHANGING ON INFLUENCE OF ALCOHOL USE AND RISK BEHAVIORS AND SHE KNOWS THAT SOCIALLY DISORGANIZED AREAS WHERE RESIDENTS LIVE WHERE THERE'S DIFFICULTY MAINTAINING SOCIAL AND PHYSICAL ORDER THERE'S INCREASED RISK OF ALCOHOL, TOBACCO AND OTHER DRUG USE SO SHE'S GOING TO TRACK 32514-16 YEAR-OLDS FOR A FORWARD OF YEARS AND SHE WILL BE USING SMART PHONES AND GPS TRACKERS TO HELP FORM PREVENTION EFFORTS AND POLICIES AND SOME OF THIS CAN BE USED TO DELIVER PREVENTION MESSAGES BY IDENTIFYING PRECURSORS OF RISK BEHAVIORS THROUGH ADOLESCENTS TRAVEL PATTERNS. AND THE NEXT ONE IS A STUDY BY ELIZABETH STORM SHACK PARENTING TO PREVENT SUBSTANCE USE IN LATE ADOLESCENTS AND AGAIN, ADOLESCENTS AT A TIME WHEN THERE ARE RISK BEHAVIORS THAT HAPPEN AND WE DO KNOW THAT PARENTS PLAY A HUGE ROLE EVEN THOUGH PEERS ARE MORE AND MORE IMPORTANT WE KNOW THAT PARENTS PLAY A CONSIDERABLE ROLE IN THE BEHAVIOR OF THEIR YOUTH. SO SHE WILL USE THE FAMILY CHECK UP INTERVENTION FOR THESE ADOLESCENTS TRANSITIONING TO PROTECT THEM FROM SUBSTANCE ABUSE DURING THIS HIGH RISK PERIOD. AND THEN RAMOUS IS DOING A SEXUAL RISK BEHAVIOR, AND TEST AND REFINE A PARENT BASED INTERVENTION DESIGNED TO PREVENT ADOLESCENT SEXUAL RISK BEHAVIOR IN LATINO AND AFRICAN AMERICAN INNER CITY YOUTH IN THE PRIMARY HEALTHCARE CLINICS AND TELL BE COORDINATED THROUGH ALLIEDED HEALTH PROFESSIONALS WHEN PHYSICIANS SEE ADOLESCENTS FOR THEIR ANNUAL PHYSICAL EXAMINATIONS AND IN THE STUDY BY AMY BLEEGLY, EXPOSURE IN THE MEDIA. WE KNOW THAT MEDIA HAS AN INFLUENCE ON ADOLESCENTS OF AND THEIR BEHAVIOR, TIME OF EXPERIMENTATION, PREMATURE SEXUAL ORIENTATION, ALCOHOL ASUBSTANCE ABUSE AND BULLYING AND FIGHTING. SO SHE WILL LOOK AT ASSOCIATION BETWEEN MULTIPLE RISK PORTRAYALS IN THE POPULAR MOVIES AND TELEVISION SHOWS AND THEN MULTIPLE RISK BEHAVIORS IN YOUTH. AND THIS FINDING CAN CONTRIBUTE TO CHANGEEROUS COMBINATION OF RISK BEHAVIORS AND IMPLICATIONS OF RISK AND DISEASE PREVENTIN EFFORTS. SO THOSE ARE SOME OF THE RISK RELATED RESEARCH. NOW I HAVE A LIST OF PUBLICATIONS FROM 2015 AND 14. I WON'T GO INTO THESE IN DISTRICT ATTORNEY TAIL OTHER THAN TO SAY, THE FIRST ONE IS FROM LOOKING AT MEASUREMENT ACCURACY OF THE FAS FACIAL PHOTOGRAPHIC ANALYSIS SOFTWARE AND INACCURACY OF THE RULER, A SECOND ONE ON VOLUME CHANGES AND BRAIN BEHAVIOR RELATIONSHIP AND WHITE MATTER AND SUBCORTICAL GRAY MATTER IN CHILDREN WITH PRENATAL ALCOHOL EXPOSURE, THE OTHER IS ON THE SAFE PASSAGE STUDY ACCIDENT THE DESIGN, METHODS RECRUITMENT AND FOLLOW UP APPROACH SO IT'S AN EARLY PROCESS PAPER, IN APPROPRIATE FEEDING BEHAVIORS AND DIETARY INTAKE IN CHILDREN WITH FETAL ALCOHOL SPECTRUM DISORDER OR PROBABLE PRENATAL EXPOSURE BY REPORTS. DOZE RESPONSE AND POST TRAINING CONSOLIDATION EFFECTS AND MATERNAL LIFESTYLE AND ENVIRONMENTAL RISK FACTORS FOR AUTISM SPECTRUM DISORDER ANDA HAVE A COP HERE IF ANYONE WANTS TO SEE THAT, DOESN'T SHOW MUCH EFFECT BETWEEN ALCOHOL AND AUTISM. OTHER PUBLICATIONS, SINGLE SESSION MOTIVATIONAL INTERVENTION TO DECREASE ALCOHOL USE DURING PREGNANCY, SMALL STUDY WITH A VERY SMALL END, EFFECTIVE PRENATAL ALCOHOL EXPOSURE AND THE DEVELOPMENT OF WHITE MATTER VOLUME AND CHANGE IN EXECUTIVE FUNCTION AND HIGH THROUGH PUT TRANSCRIPT OHM SEQUENCING IDENTIFIES GENETIC MODIFIERS OF FETAL ALCOHOL SPECTRUM DISORDERS. I WANT TO SAY A FRY THINGS ABOUT THE HUMAN PLACENTA PROJECT AND WE HAD DAVE WINE BERG HERE AT THE EXECUTIVE MEETINGS LAST YEAR AND HE TALKED ABOUT THIS PROJECT BUT NICHD IS INTERESTED IN THE HUMAN PLACENTA AND WHAT WE'RE TRYING TO DO IS TO IMPROVE C METHODS AND DEVELOP NEW TECHNOLOGIES FOR APPLYING REALTIME ASSESSMENT OF THE PLACENTA AS IT DEVELOPS ACROSS PREGNANCY AND THEN APPLY THESE TECHNOLOGIES TO UNDERSTAND AND MONITOR AGAIN THIS REALTIME PLACENTAL DEVELOPMENT AND FUNCTION IN BOTH NORMAL AND ABNORMAL PREGNANCIES. AND THEN WE HOPE TO DEVELOP AND EVALUATE NONINVASIVE MARKERS FOR PREDICTION OF ADVERSE PREGNANCY OUTCOMES. WE WANT TO UNDERSTAND THE CONTRIBUTIONS OF PLACENTAL DEVELOPMENT TO LONG-TERM HEALTH AND DISEASE AND DEVELOP INTERVENTIONS TO PREVENT ABNORMAL PLACENTAL DEVELOPMENT AND IMPROVE PREGNANCY OUTCOMES AND I THINK YOU CAN SEE HOW THE PREVENTION OF FETAL ALCOHOL DISORDER COULD CO INSIDE WITH THIS. THE FIRST MEETING OF THIS HUMAN PLACENTA PROJECT TOOK PLACE LAST YEAR FROM MAY 27th TO 28th, OF 2014, AND THE NEXT MEETING IS COMING UP AROUND THE CORNER, APRIL TWEIVETH AND 28th AT THE NATCHER CONFERENCE CENTER, THEY CAN REG TERTO ATTEND THAT,'S THE SECOND ANNUAL HUMAN PLACENTA PROJECT MEETING. THEY HAVE ISSUED A FUNDING OPPORTUNITY ANNOUNCEMENT, 1502, THE RECEIPT DATE AND THE APPLICATIONS ARE IN AND THE PENDING REVIEW AND THE PURPOSE WAS AGAIN TO SUPPORT THE INITIAL STAGES OF DEVELOPMENT OF NEW OR NEXT GENERATION PLACENTAL IMAGAING AND ASSESSMENT TECHNOLOGIES THAT WILL INCREASE OUR CAPACITY TO SAFELY ASSESS HUMAN PLACENTAL STRUCTURE AND FUNCTION IN VIVO THROUGHOUT JESTIGATION. AGAIN DAVE WINEBERG IS A CONTACT PERSON FOR THAT. SO AGAIN THIS PICTURE SUMS IT UP, WE'RE INTERESTED IN INFANTS FROM PREPREGNANCY, THE PLACENTA, INTERUTERINE GROWTH, NEWBORNS, INFANTS, EARLY CHILDHOOD, MIDDLE CHILDHOOD AND THE GOAL IS TO HAVE SUCCESSFUL OUTCOME FOR ALL INDIVIDUALS. THANK YOU. [ APPLAUSE ] >> THANKS TO ALL. WE HAVE A FEW MINUTE FORS ANY QUESTIONS FOR ANY OF THE SPEAKERS? NONE, I GUESS WE WILL THEN BREAK FOR LUNCH. WE WILL TAKE ONE HOUR. PLEASE BE BACK PROMPTLY AT 12:45 SO THAT WE CAN BEGIN WITH THE SPEAKERS RIGHT AFTER LUNCH AND CONTINUE WITH OUR PANEL. THANK YOU SO OUR NEXT SPEAKER IS DR. ROACH WHO IS GOING TO PRESENT THE SUMMARY FROM THE WOMEN DRINK DRINKING AND PREGNANCY WORK GROUP. >> GOOD AFTERNOON. AND I HOPE YOU HAD A GREAT LUNCH LUNCH. I'VE BEEN ASKED TO BE BRIEF AND BE SEATED, WHICH IS ALWAYS A CHALLENGE FOR ME BECAUSE WHEN I'M NERVOUS, I TEND TO TALK LIKE THIS. BUT I'LL DO THE BEST I CAN. I'M NOT MAKING ANY PROMISES. SO, EVERY GOOD DAY STARTS ON A NOTE OF GRATITUDE. I WANT TO START BY THANKING THE MEMBERS OF THE WOMEN DRINKING AND PREGNANCY WORK GROUP OF THE I /KR-FPCC. THEY ARE TRULY A BRILLIANT AND COMMITTED GROUP OF PEOPLE, AND I AM HONORED TO REPRESENT THEM. TODAY. SO THE VISION OF OUR GROUP IS THAT ALL WOMEN OF CHILD-BEARING AGE HAVE ACCESS TO ROUTINE SCREENING FOR AT-RISK DRINKING AND ALCOHOL USE DISORDERS AND THROUGH COMPREHENSIVE AND TREATMENT AND RECOVERY SERVICES FOR ALL FORMS OF ALCOHOL MISUSE. AND ONE /OF OUR MEMBERS YESTERDAY POINTED OUT, KATHY MITCHELL, THAT WE DON'T REALLY MAKE AN EX EXPOLILICIT REFERENCE TO FASD IN OUR VISION STATEMENT AND MAYBE WE OUGHT TO DO SOMETHING ABOUT THAT. SO IN THE NEXT FEW WEEKS WE WILL BE WORKING ON THAT. AND OUR MISSION IS TO WORK COLLABORATIVELY TO DEVELOP JOINT INITIATIVES TO IMPROVE THE QUANTITY, RANGE AND QUALITY OF PREVENTION TREATMENT AND RECOVERY SERVICES FOR ALL FORMS OF ALCOHOL MISUSE AMONG WOMEN OF CHILD-BEARING AGE. AND WE BANT /TO EMPHASIZE MISUSE, NOT NECESSARY NECESSARILY AN ALCOHOL USE DISORDER. WANT. SO WE HAVE SOME RECENT DATA INDICATING THAT CURRENT AND BINGE DRINKING AMONG ALL WOMEN REALLY AND WOMEN OF CHILD- CHILD-BEARING AGE ARE INCREASING INCREASING. WE HAVE A RECENT ANALYSIS BY ONE OF MY COLLEAGUES HERE AT NIAAA INDICATING THAT FROM 2002 TO 20 2012 THE PERCENTAGE OF CURRENT DRINKERS AMONG WOMEN INCREASED FROM THOSE 21 TO GREATER /THATHAN 65 YEARS OLD AND THE GREATEST IN INCREASE WAS AMONG OLDER WOMEN 6 65 AND OLDER. BUT ALSO BINGE DRINKING IS IN INCREASING ABOUT 12% FROM OVER THAT DECADE, FROM AMONG WOMEN 21 TO 64 YEARS OLD. WE ALSO FOUND THROUGH FLOWN THAT ANALYSIS THAT THE USE OF ELICIT DRUGS ON THE /HRALAST DRINKING OWE OCCASION HAS INCREASED AMONG GIRLS AND BOYS. AND WE KNOW A LITTLE BIT ABOUT WHICH WOMEN AND GIRLS ARE MOST LIKELY TO BINGE DRINK, THOSE 18 TO 34 AND HIGH SCHOOL GIRLS ABOUT 20% OF WHOM BINGE DRINK. WHITE AND HISS /PAPANIC WOMEN, AND AFRICAN-AMERICAN AND WOMEN WITH HOUSEHOLD INCOMES EXCEEDING $75 $75,000. SO THIS IS SOMETHTO BEAR IN MIND WHEN WE ARE THINKING ABOUT THE STIGMA ISSUE. THIS IS A SLIDE FROM DR. WISE NER WHICH WE'VE ALREADY SEEN. I JUST SHOW IT AGAIN TO UNDER UNDERSCORE THE FACT THAT THE PREVALENCE OF ALCOHOL AND OTHER SUBSTANCE USE AND BEHAVIORAL HEALTH STOMATOLOGY AMONG BOYS AND GIRLS IS VERY HIGH AND WE HAVE SOME INDICATION THAT THIS INCREASING TOTAL OF 20% IN HER POPULATION AND /AA WHOPPING 32% AMONG GIRLS IN THAT POPULATION. AND THAT GIRLS ARE USING MORE POLY SUBSTANCES AND HAVE A SIGNIFICANTLY HIGHER BEHAVIORAL HEALTH SYMPTOM /AATOLOGY. AND ALL OF THIS IS HAPPENING IN AN ENVIRONMENT WHERE WE ARE SEEING INCREASING CRIMINAL EVENTS OF PREGNANT WOMEN WHO USE SUBSTANCES. THE /TPHARL /AFBADVOCATES IDENTIFIED MORE THAN 7500 CASES OF INCARCERATION OR MANDATED OF TREATMENT OF WOMEN BETWEEN 1973 AND 2014, INCLUDING MOST OF THOSE CASES, 300 OF THEM OWE OCCURRING BETWEEN 2005 AND 2014. RECENTLY WE'VE SEEN A LAW IN TENNESSEE THAT ALLOWS WOMEN TO BE CHARGED WITH ASSAULT PUNISH PUNISHABLE BY UP TO 15 YEARS IN PRISON FOR BABIES BORN ADDICTED TO OR HARMED BY A NARCOTIC DRUG. ALSO NEW YORK, IS ONE /OF 17 STATES THAT SPECIFICALLY ADDRESSES DRUG USE AND CHILD CIVIL NEGLECT LAWS. SO IN SOME STATES IT'S POSSIBLE TO TAKE A CHILD AWAY BASED /AOEUPB SINGLE POSITIVE DRUG TEST REGARDLESS OF WHETHER THE NEWBORN EXHIBITS SYMPTOMS OF EXPOSURE OR THE DRUG WAS PROSCRIBED AS PART OF MEDICAL TREATMENT. AND ANY REASON TO BE SUSPECT MA MATERNAL DRUG ADDICTION OR UN UNFITNESS O/TO PARENT IN /AEA PRETTY HOSTILE ENVIRONMENT. OUR GROUP HAS IDENTIFIED SEVERAL AREAS THAT WE WOULD /HRAOEULIKE TO FOCUS OUR EFFORTS ON IN THE COMING COMING MONTHS AND YEARS. ONE BEING EPIDEMIOLOGY. WE STILL NEED TO KNOW MORE, PARTICULARLY AT THE COMMUNITY LEVEL ABOUT THE PREVALENCE OF ALCOHOL AND OTHER SUBSTANCE USE AMONG WOMEN OF CHILD-BEARING AGE. WE HAVE OUR NATIONAL -- WE USE THE DATASET BUT WE DON'T KNOW WHAT IS HAPPENING LOCALLY VERY MUCH. PREVENTION -- OUR BELIEF IS THAT UNLESS WE HAVE THESE SURVEILLANCE DATA, ANYTHING THAT WE DO TO PREVENT AND TREAT THESE CONDITIONS MAY HAVE A SHORT SHELF LIFE BECAUSE WE HAVE NO WAY TO EVALUATE THE EFFECTIVE EFFECTIVENESS OF WHAT WE ARE DOING. IN THE AREA OF PREVENTION, WE'VE TALKED ABOUT DOING A PUBLIC- PUBLIC-PRIVATE NATIONAL PUBLIC AWARENESS CAMPAIGN AND WE'VE GOTTEN A BIG BOOST IN THE ARM RECENTLY TO HELP US WITH THAT EFFORT. THAT MAY HELP US AS WE MOVE ALONG. WE TALK ABOUT -- WE ALSO WANT TO -- FOCUS ON EXPERT AND YOU IN INCREASING EXPERT, MAKING IT UNIVERSALLY WOMEN TO -- TO WOMEN OF CHILD BEARING AGE. ONE /OF OUR CONCERNS IS THAT WE HAVE A NUMBER OF EFFECT /KWREUIVE ALCOHOL SCREENERS BUT IMMEDIATE YOLKER AND RATHER UNTESTED DRUG SCREENERS FOR WOMEN IN THE PRE PRE/TPHAENATAL PERIOD. BUT THERE HAS BEEN PROGRESS PROGRESS IN THAT AREA. CAPTIONS RESUME SOON WE STARTED REALLY WITH IN-SCHOOL STUDIES AND WE'VE DONE IN-SCHOOL STUDIES, WHICH I'LL SHOW YOU MORE ABOUT IN THE STATES. BUT THAT'S A 35-YEAR HISTORY OF PREVALENT STUDIE, THAT I'VE BEEN INVOLVED IN. AND MY TEAM FAME -- MUCH OF MY TEAM HAS BEEN WITH ME FOR OVER THE LAST 20 YEARS. SO OUR HISTORY IS THAT WE HAVE COMPLETED EIGHT SAMPLES IN SOUTH AFTERCA OVER /THE YEARS 1997 TO 2015. IN ITALY WE DID TWO SAMPLES AND THE UNITED STATES WE'VE COMPLETE COMPLETED FIVE, INCLUDING THREE PILOTS RIGHT NOW. AND I WILL ONLY BE REPORTING A PREVALENCE IN ITALY. SO HERE IS WHAT IT LOOKS LIKE ON THE WORLD MAP. THESE WERE ALL PRE/KUCURSORS, THESE FOUR SAMPLES HERE. AND ALL OF THESE SAMPLES. AND AGAIN, THE PUBLICATION IS IN YOUR HANDOUT THAT GIVE YOU THE DETAILS OF ALL OF THE STUDIES. THE FIRST STUDIES WE DID WERE FAS-ONLY BECAUSE WE WORKED FROM WHAT WE KNEW BEST AND WE WERE DIAGNOSE THE DIAGNOSES. ALL THE DIAGNOSISS ARE MADE BY DISMORPHOLOGISTS, AND SO WE WORKED FROM WHAT WE KNEW BEST, FAS. NOW OVER /THE YEARS, PARTICULARLY WITH THE EXPERIENCE OF THOUSANDS OF KIDS IN SOUTH /AAFRICA, WE ARE DIAGNOSING AR MD AND OUR METHODS ARE DESCRIBED IN ONE OF THE PUBLICATIONS IN THERE IN 2005. THOSE METHODS WE'VE WORKED ON COLON -- CONSTANTLY THROUGHOUT THE YEARS. AND SOON WE WILL GET AN UPDATE OUT TO THEM. WHILE WE DO THIS AND THIS IS WHAT A /RLOT OF PEOPLE DON'T SEEM TO RECOGNIZE -- WE COLLECT A TREMENDOUS AMOUNT OF DATA ON VERY SPECIFIC CHILD CARE CHARACTERISTICS ON ALL OF OUR STUDIES. WE'RE NOT JUST FOCUSED ON THE PREVALENCE. WE'RE FOCUSED ON THE CHARACTER CHARACTERISTICS OF FASD IN GENERAL POPULATIONS. SO WE HAVE A LOT /OF INFORMATION IN ALL OF OUR PUBLICATIONS, ON THE THREE FEATURES OF FASD. WE HAVE DESCRIBED MANY OTHER GROWTH PARAMETERS AND OTHER MINOR A/TPHONOMALIES, AS THEY EXIST IN FAS, AND THE FEW RARE CASES OF ARBD THAT ARE OUT THERE. SO YOU CAN GO TO OUR MULTIPLE PUBLICATIONS AND FIND INCREASES, ALL KINDS /OF OTHER FACIAL PEACHES THAT ARE MINOR A/TPHONOMALIES FROM THE NORM THAT DEVIATE AND? >> ALWAYS CONTROL GROUPS IN THERE OF THE SAME GENERAL POPULATION OF THE NORMAL KIDS THAT WE'VE PICKED RAND /O*OMLY AS OUR COMPARISON GROUPS. WE ALSO HAVE BEEN BUSY TRYING TO PRODUCE WHAT ARE REAL MATERNAL RISK FACTORS FOR PRODUCING FASD. NOT MATERNAL RISKS FOR MATERNAL RISK OR WHO IS THE DRINKERS. BUT MATERNAL RISKS FOR THOSE ACTUAL CASES THAT ARE PRODUCED OF /TPAFSD. SO WE HAVE IN OUR SOUTH /AAFRICAN PAPERS, THE ADVANTAGE OF REALLY HONEST, FRANK, ACCURATE REPORTING. THERE IS VERY LOW STATEMENT TO REPORTING IN /THIS POPULATION THROUGH SOUTH /AAFRICA /SWRORBGS WE HAVE A NUMBER OF PAPERS ON ALCOHOL USE BY QUANTITY AND FREQUENCY AND TIMING. WE HAVE DRINKS PER WEEK, DRINKS DRINKSING DAYS, WHICH ARE VERY GOOD INDICATORS FROM SOUTH /AFR AFRICA. WE HAVE BINGE INFORMATION OF THREE OR MORE OR FIVE OR MORE. WE HAVE HOW THESE PLAY OUT IN E EQUATION MODELS AND IN JUST THE PROGRESSION CONTROLLING FIRE NUMBER OF VARIABLES. HOW THEY PLAY OUT IN THE PRODUCTION OF AN EXACTLY CASE OF FAS. WE HAVE BEEN ABLE TO ESTIMATE ALCOHOL CONCENTRATIONS IN SOUTH AFTERCA. WE HAVE GOOD DRINK -- INFORMATION ABOUT DRINKING IN TRI/PHEMEST ER ANER AND THREE MONTHS PRIOR TO PREGNANCY. WE ALSO HAVE A LOT /OF DISTAL FACTORS IN THESE STUDIES. WE HAVE OTHER DRUG USE, WHICH TEND TO BE /AA BETTER INDICATOR IN THE UNITED STATES AND EUROPE THAN IT IS IN SOUTH /AAFRICA, BECAUSE SOUTH /AAFRICA UP TILL NOW NOW, HAS BEEN A BURLY ALCOHOL- THE TOWNS TOWNS IN WHICH WE N WORKED. GENERAL HEALTH IS ANOTHER RISK FACTOR. COME UP AS DISTAL FACTORS ARE NUTRITION IN OUR SOUTH /AAFRICAN SAMPLES ARE HIGHLY UNDER UNDERNOURISHED. BODY MASS INDEX. THE HIGHER THE BODY MASS INDEX OF THE WOMAN THE LESS SEVERE THE DAMAGE. WE HAVE A LOT OF DATA ON GRAV [INDISCERNIBLE] IDITY AND PARITY. AT -- AS EACH OF THESE MEASURES ADVANTAGEOUS -- ADVANCES, THE SEVERITY OF DAMAGE IS GREATER. AND SOBCIOECONOMIC STATUS IS A BIG THING. THAT IS, A LOT OF THE EARLIER STUDIES ON PREVALENCE WERE WITH LOW SES POPULATIONS BECAUSE MOST OF US HAD ACCESS TO MOST SES CLINICS AND LOW SES POPULATIONS. BUT WHAT WE'RE FINDING WITH OUR RECENT STUDIES NOW IN THE UNITED STATES GENERAL POPULATION, THERE ARE A SUBSTANTIAL NUMBER OF DRINKING WOMEN IN MIDDLE AND UP UPPER CLASS, AND THERE INDEED IS SUBSTANTIAL FASD THERE. SO WHAT WE DO IN OUR IN-SCHOOL STUDIES IS THAT WE TRY TO GET A ACCURATE CONSENT TO LOOK AT EVERY SINGLE CHILD ABUSING IN A FIRST GRADE CLASS AND WE CAN OB OBTAIN CONSENT RATES ANYWHERE FROM 50 TO 75%, 71% IN THE UNITED STATES. AND WE MEASURE HIGH RATE CIRCUMSTANFERENCE FOR ALL THE CONSENTING KIDS. IF THE CHILD IS BELOW THE 25TH CENT AISLE, THEN WE PROVIDE ADDITIONAL MORPHOLOGY EXAM TO THEM. HEIGHT, WEIGHT AND HEAD CIRCUMSTANFERENCE. THAT IS TO SAMPLE THE SMALLER KIDS. WHY? BECAUSE MOST OF THE KISS -- KIDS WITH FASD IS IN THAT LOWER QUART AISLE. WE PICK A SAMPLE FROM -- WE PICK A REPRESENTATIVE SAMPLE FROM ALL CHILDREN ENROLLED IN THE GRADES WHO HAVE ACTIVE SENT AND WE GIVE DISMORPHOLOGY EXAMS TO THEM, TOO,. IF THE DISMORPHOLOGIST SEES SOMETHING THEY THINK IS SUSPECT, THEN MATERNAL INTERVIEWS ARE DONE ON THE MOTHER ABOUT THE IN INDEX PREGNANCY AND PSYCHOLOGY AND -- PSYCHOLOGICAL AND BEHAVIORAL TESTING IS DONE. THEN IT ALL GOES TO A CASE CONFERENCE. THE DIAGNOSIS IS MADE BY THE DIS DISMORPHOLOGIST WITH MULTIDIS MULTIDISCIPLINARY IN/PUPUT FROM THE PSYCHOLOGIST, INTERVIEWERS WHO DID THE TESTING, ET CETERA. AND /AA DIAGNOSIS IS GIVEN. OFTEN, THIS IS A RULE-OUT. I VINYL FEW MINUTES. WE'LL TAKE QUESTIONS SOON. OFTEN, THIS IS A RULE-OUT DIAGNOSES THAT OTHER KNOWN A A/TPHONOMALIES ARE ALSO RULED OUT BEFORE A DIAGNOSIS OF FAS IS MADE. AS IS MENTIONED EARLIER, IT'S VERY EXPENSIVE AND TAKES A LOT OF PERSONNEL. THIS IS JUST SOME OF THE PICTURES OF OUR MULTIPLE PERSONNEL RESEARCH TEAMS IN ITALY AND SOUTH /AAFRICA OVER VARIOUS PERIODS OF TIME. ALL OF OUR DATA IS MANAGE AND COLLECTED IN NEW MEXICO, WHERE I USED TO BE /AA PROFESSOR, AND IT'S VERY, VERY EXPENSIVE. NOW AGAIN THE ONLY PROBLEMS RIGHT NOW I'M SHOWING YOU IS ITALY. THE OTHER COMMONLY EXSESSIONIVE RATE OF FAS, HIGH RATE ESTIMATED FOR THE UNITED STATES WAS 3 PER 1,000. IN ITALY WE FOUND A LOW ESTIMATE ESTIMATED RATE OF 4 PER 1,000. A HIGH ESTIMATED RATE AND WE USED 3 DIFFERENT METHODS OF ESTIMATION, ALL OF WHICH ARE VERY CONSERVATIVE BASED ON CLINICAL EXAMS IS 12. SO IN ITALY, FAS IS FOUND TO BE MUCH MORE COMMON THAN WAS ESTIMATE FOR THE UNITED STATES AND EUROPE AT /TTHAT TIME AND AGAIN THIS IS A HIGH ESTIMATE AT THE TIME. FASD IN ITALY WAS 2.3%. 6% OR 5.9%. THE ESTIMATE WAS 9 PER 1,000, HER 1% PRIOR TO THAT. SO WE BASICALLY FOUND THAT IN ITALY, USING -- USING IN-SCHOOL STUDIES, FASD WAS MUCH MORE COMMON AND THAT'S A SUMMARY OF TWO DIFFERENT SAMPLES THAT WE DID IN THE LASSIA REGION AROUND ROME. LAT /SRVIA REGION. COFAS WAS CREATED BY AN ANALYSIS WHICH KEN TALKED ABOUT AND UNIVERSITY OF CALIFORNIA SAN DIEGO CHAMBERS AND JONES AND MY GROUP THE UNIVERSITY OF NORTH CAROLINA AND THE UNIVERSITY OF NEW MEXICO ARE THE TWO SAMPLES. NOW, THE GOAL IS /THE USA, THAT IS MY PROJECTS WITHIN THE USA IS TO COLLECT DATA IN SEVERAL REGIONAL POPULATIONS AND TO USE STANDARD DEMOGRAPHIC AND SAMPLE SAMPLING METHODS THAT WE'VE WORKED OUT IN ITALY AND SOUTH AFTERCA TO COME UP WITH A REGION REGIONAL ESTIMATE, AS KEN SAID. OUR THREE MAJOR POPULATIONS ARE IN MONTANA, IN THE MIDWEST HERE AND IN /TPH*RBG. AND IN /TPH*RBG. THIS IS OUR CURRENT STAFF. AT ALL THE DIFFERENT SITES. NORTH CAROLINA. WITH THE EXCEPTION OF THIS. THIS IS A DAGGERING LAST MARCH FOR /AA CASE CONFERENCE. A CASE CONFERENCING HAS BEEN DONE BY A NUMBER OF PEOPLE, NOT JUST MY STAFF. BUT KEN JONES AND TINA CAME IN FOR THAT CONFERENCE AND I HAD PEOPLE FROM ALL MY SITES COME IN TO DO THOSE FINAL DIAGNOSES. HERE IS WHAT WE ARE DOING IN -- WE BASICALLY HAVE HAD 2,424 DIS DISMORPHOLOGY EXAMS OF CHILDREN TESTED WITH NEWUROBATTERY AND BEHAVIORAL CHECKLISTS. ABOUT 1200 MOTHERS INTERVIEWED RIGHT NOW IS 914. BUT ALL OF THE NORTH CAROLINA SITES ARE STILL UNDER WAY, AND WE'RE JUST ABOUT FINISHED WITH THE OTHER TWO SITES -- TWO SAMPLES IN EACH ONE. SO FINALLY, GENERAL POPULATION ESTIMATES. NOW THESE ARE NOT COLD, FAST ESTIMATES. THESE COME FROM OUR 2009 PAPER BEFORE IT STARTED. FROM THE LITERATURE REVIEW AGAIN ABOUT 85 ARTICLES PREVALENCE. THE OLD FAS RATES AT THE TIME WERE .5 TO 3 PER 1,000. WHAT WE ESTIMATED FROM OUR PILOT EXPERIENCE IN THE UNITED STATES, OUR ITALY AND SOUTH /AAFRICAN EXPERIENCE, WE ESTIMATED THAT 2 TO 7 PER 1,000 WAS ACCURATE FOR THE UNITED STATES AND EUROPE. FASD, THE RATE WAS ABOUT 1%. WE ESTIMATED FROM THAT LITERATURE REVIEW THAT IT'S PROBABLY CLOSER TO 2 TO 5% IN THE UNITED STATES AND EUROPE. SO IF YOU PUT A BAR GRAPH. HERE IS THE HIGH ESTIMATE 36. PSYCHE THAT OUR ESTIMATES ARE SUBSTANTIALLY HIGHER. SO FASD -- THE OLD ICEBERG A A/TPHNALOGY. I'D SAY SURVEILLANCE SYSTEMS AND MANY CLINIC-BASED STUDIES AND MANY OTHER ATTEMPTS TO ESTIMATE ARE PROBABLY JUST BARELY GETTING A VERY TIP OF THAT ICEBERG AND THAT'S NOT MUCH. BASICALLY, YOU HAVE TO GET OUT AND DO ACTIVE CASE AS ASCERTAINMENTS TO GET BELOW THE WATER AT ALL OR EVEN TO FIND THE WHOLE ICEBERG. SO IF WE DON'T ACTIVELY SEEK CASES USING CLINICAL DIAGNOSES AS THE STANDARD OF OUR RESEARCH, WE MAY NOT FINE THE VAST MAJORITIES OF IT. IF WE GET TO THE RIGHT POPULATIONS, WE CAN COME UP FROM SMALL SAMPLES, WE CAN COME UP WITH GOOD REGIONAL ESTIMATES AND GOOD NATIONAL ESTIMATES BUILDING ON THAT. BUILD A SAMPLE DISTRIBUTION OF THE NUMBER -- WITH A NUMBER OF SMALL STUDIES. LET ME TELL YOU ABOUT THE HISTORY OF THAT. IN SOUTH /AAFRICA WE DID OUR FIRST FIVE SAMPLES, FOUR SAMPLES WHERE IN ONE TOWN IN THE WESTERN CAPE PROVINCE AND THERE ARE NINE PROVINCE S S IN SOUTH /AFAFRICA. WE FOUND A RATE OF FAS IN OUR FIRST TWO SAMPLES OF FAS AND P FASS WERE NINE PERCENT. THE SAME METHODOLOGIES USED THE SAME -- IT WAS SAID ABOUT OUR STUDIES THAT ONLY APPLIES TO THAT TOWN IN THAT PART OF THE ONE PROVINCE OF THE NINE PROVINCES. TWO IN THE NORTHERN PROVINCE AND ONE IN PATANG HAVE ALL FOUND RATES VERY SIMILAR TO THE RATES THAT WE FOUND IN THAT LITTLE ONE TOWN -- ONE LITTLE TOWN. THE SAME THING IS HAPPENING WITH OTHERS. SO THE POINT IS IS THAT IN COFAS COFAS, WHAT I HOPE WE CAN TO IS BUILD A SAMPLING DISTRIBUTION, HAVE A NUMBER OF SAMPLES THAT ARE REPRESENTATIVE OF THOSE REGIONS AND EVENTUALLY YOU HAVE A PREVALENCE THAT'S REPRESENTATIVE OF THE AUTZ -- UNITED STATES. QUESTIONS NOW OR LATER? >> I THINK WE HAVE TIME FOR MAYBE ONE QUESTION. >> PLEASE PLEASE >> ANY QUESTIONS? >> I ACTUALLY WANT TO HAVE A LONGER CONVERSATION. BUT WHAT I WANTED TO FIND OUT IN THE SCHOOL STUDIES THAT YOU DID WHAT THE RATE OF PARENTAL DON'T HAVE PARTICIPATE WAS? >> IN THE UNITED STATES, WE HAVE RANGE AND THIS INCLUDES OUR PILOTS, WE HAVE RANGE BETWEEN 53 AND 71%. THAT'S WHEN WE DO THE OVERSAMPLE METHODOLOGY BECAUSE WE FIND PARENTS OF SMALL CHILDREN ARE MUCH MORE LIKELY TO CONSENT THAN OTHER PARENTS. WHEN WE DO A STRAIGHT RAND /O*OM SAMPLE AND WE DO TWO OF THESE IN TWO DIFFERENT REGIONS. IT'S A STRAIGHT RAND /O*OM SAMPLE, THE WILLINGNESS TO. WE'RE VERY ACTIVE IN SEEKING PERCENT. >> THANK YOU. >> HI, I'M SORRY IF I MISSED IT IT. INAUDIB[INAUDIBLE] >> THE VARIABLES THAT WE CAN LOOK BETWEEN THE CONSENT AND NON-CONSENT IS POPULATION. THERE IS VIRT /S /AO*UALLY NO DIFFERENCE DIFFERENCE. AND I CAN ACTUALLY SHARE THREE OR FATHER TABLES WITH YOU FROM OUR MIDWEST ERN SAMPLE THAT WE PRODUCED. I'D BE HAPPY TO HAVE THAT. TO DO THIS. I'VE GOT THEM HERE. B /PH-FPMI AND A NUMBER OF OTHER THINGS -- THE CHILDREN. THERE IS NO RACIAL AND ETHNIC BIAS EITHER IN THE SAMPLES THAT WE'VE COMPLETED IN THE UNITED STATES. THAT IS THE RATES ARE WELL- WELL-DISTRIBUTED ACROSS THE ETH ETHNIC GROUPS AND WE PUBLISHED THAT FOR THE MIDWEST ERN /STOEUZ /STOEUZ. >> WITH THE STUDIES THAT YOU'VE DONE IN THE UNITED STATES AND YOU'VE HAD OTHER COUNTRIES, YOU REFERENCED SEVERAL TIMES THAT THERE IS NO STIGMA BECAUSE OF DIFFERENCES IN AFTRICA, WHICH I MEAN I GET TO SPEAK TO /TTHAT A LITTLE BIT BECAUSE THE REASON IS THERE IS NO STIGMA BECAUSE THERE IS NOT A PERCEPTION OF THE SAME NEGATIVE CONFERENCES SOMEWHAT, WHICH IS AND HOW THAT INFLUENCE INFLUENCES -- YOU FIND THAT MAY OR MAY NOT BE DIFFERENT THERE BECAUSE OF THE CULTURAL DIFFERENCE S S IN THINKING IN THE AREA THAT YOU ARE LOOKING. IT'S A WINE AREA. AND HOW DO YOU THINK THAT MIGHT AFFECT WHAT DATA THAT WE ARE SEEING AND EFFORTS HERE IN THE U.S.? >> WHEN WE FIRST STARTED WORKING IN SOUTH /AAFRICA THERE WAS NO KNOWLEDGE OF FAS AT ALL. IT WAS JUST LIMITED TO A FEW FIPHYSICIANS AND A VERY SMALL NUMBER OF PEOPLE. HOWEVER, AND SO THERE WAS NO KNOWLEDGE. SO TO CREATE A STIGMA. HOWEVER, IN THE POPULATION THAT'S WE WORK IN THE MOST, THE POPULATION OF WELLINGTON AND FOUR OTHER TOWNS IN SOUTH /AAFRICA AFRICA, DRINKING IS /THE MAJOR FORM OF RECREATION THAT IS AVAILABLE TO MUCH OF THE POPULATION. SO DRINKING ON FRIDAYS AND SATURDAY NIGHTS IS A VALUED BEHAR. ALCOHOL IS A VALUED COMMODITY AND WHO WOULDN'T DO THAT? THAT'S SORT OF THE IMPRESSION. THERE IS ALMOST A NEED TO HAVE THAT. SO THERE IS NO NORM WITHIN THE PEOPLE WHO PARTICIPATE IN THAT FORM OF RECREATIONAL DRINKING THAT WE SHOULD EVEN QUESTION. AND KINDS -- IT'S KIND OF LIKE THE UNITED STATES. IT'S ALMOST THIS BELIEF THAT WOMEN IN UPPER AND MIDDLE CLASS PEOPLE WOULDN'T DAMAGE THEIR BABY AND BE SO INCENSENSITIVE THAT THEY WOULDN'T QUIT -- QUIT DRINK DRINKING AS SOON AS THEY FIND OUT THEY ARE PREGNANT. A LOT OF CASES IN THE MIDWEST ARE MOTHERS WHO SAID THAT THEY DID QUIT DRINKING UPON PREGNANCY RECOGNITION. PREGNANCY RECOGNITION ON AVERAGE AND THE MOTHERS WHO HAD AN FASD CHILD WAS ALMOST TEN WEEKS. TONS OF DISMORPHOLOGY AND DAMAGE CAN BE DONE IN THAT PERIOD. ALL KINDS /OF THINGS ARE OWE OCCURRING AND IT CAN REALLY DAMAGE THAT KID. SO ANYWAY. -- I JUST WANT TO GO AHEAD AND D ADD TO /TTHAT BECAUSE THAT'S A VERY DIFFERENT PERCESPECTIVE IN THE NUMBER OF THE /KPREUZ MANY OF THEM THAT HAVE BRITISH HERITAGE BASE, WHERE DRINKING IS PARENT -- IMPORTANT. IT'S INTEGRATED INTO THE CULTURE AND PARTICULARLY HEAVY DRINKING. SO THE STIGMA IS NOT THERE BECAUSE THE STIGMA JUST DOESN'T EXIST IN THE SOCIETY FOR DRINK DRINKING. PROBABLY I OVEREXAGGERATED BUT IT WOULD BE YOU DRIVE CAR HERE. OF COURSE. AND IF YOU DON'T, YOU ARE SAYING SOMETHING ABOUT YOURSELF. MY VISION IS NOT GOOD ENOUGH. SO I DON'T. AND I'M PROVEN TO FIND THIS WHAT I CALL HISTORICALLY BRITISH- BRITISH-BASED CULTURES, AS WE LOOK AROUND /THE WORLD. >> THIS IS REAL IMPORTANT OBVIOUSLY RESEARCH. I'M JUST WONDERING IS THERE ANY OF THE RISK FACTORS OTHER THAN A MOTHER'S DRINKING BUT IN TERMS OF DIAGNOSING THIS ON KIDS THAT IS STRONGER THAN -- IN OTHERS THAT PED /KWIATRICIANS COULD USE AS A MARKER? S IT ANY OF THE PHYSICAL THINGS THINGS? COULD THIS BE USED AS A FIRST MARKER? >> DISMORPHOLOGY IS /THE KEY. AND I HAVE TO TELL YOU IN 1979, WHEN I WAS FUNDED TO DO THIS FIRST PROJECT, I DID NOT BELIEVE THAT FETAL ALCOHOL SPECTRUM DISORDERS EXISTED FAS. I DIDN'T BELIEVE THAT JOHN, MY COLLEAGUE, WHO WAS MY PARTNER IN THIS, COULD DIAGNOSE A KID BY LOOKING AT JOINT CONSTRICT SEWERS AND THINGS I'D LIKE. I WAS A TOTAL DISBELIEVER. I FOUND OUT OTHERWISE AND WE HAVE STRUCTURAL EQUATION MODELS THAT WE HAVE PRODUCED THAT SHOW CLEARLY THAT WHEN YOU ARE TRYING TO PREDICT FASD DIAGNOSIS AND/OR A NUMBER OF THE FEATURES THAT WE'VE DIAGNOSED IN DISORDERS, THEY VERY HEAVILY AND STRONGLY LOATHE CONTROLLING FOR EVERYTHING ON DISMORPHOLOGY, THAT IS ALCOHOL USE PRE/TPHAENATELY AND THIS IS SOUTH /AAFRICA, WHERE WE HAVE ACCURATE DATA. THEY LOATHE VERY STRONGLY. BEHAVIORAL BY SEVEN YEARS OF AGE AGE, NOT EVEN SIGNIFICANT FACTOR FACTOR. SO DISMORPHOLOGY IS /THE KEY. AND YES, THERE ARE NO BEHAVIORAL PATTERNS. AT /WUONE TIME WE BELIEVED THAT THERE WAS A NEWUROBEHAVIORAL FENE PHENOTYPE. NOW THROUGH THE WORK AND A NUMBER OF OTHER INDEPENDENT INVESTIGATORS, WE FLOW THAT THERE ARE MULTIPLE NEWURO NEUROBEHAVIORAL ISSUES INVOLVED. AND WE ACTUALLY ARE WORKING WITHIN COFAS TO TAKE OUR DATA AND APPLY THEM TO ND /P-FPP /SKPWR*E THIS IS A GREAT SEGUE FOR HER AND SHE'S GOING TO TALK EXACTLY ABOUT IT. THANK YOU VERY MUCH. /PHRA [APPLAUSE] >> WELL, THANK YOU. /TKPW*EUPLING TO TALK SPECIFICALLY ABOUT HOW COFAS P DECIDED TO DEAL WITH THE BEHAVIOR PROBLEM, WHICH IS NOT TO SAY EVERYTHING ABOUT BEHAVIOR AND FASD BECAUSE IT'S AN ENORMOUSLY COMPLICATED UP TOIC. AND IF -- I DO WANT /TO SAY FIC FOR /AA MINUTE, ONE WHICH I THINK IS ADDRESSED BY THE FIELD AND ONE THAT REQUIRES A GREAT DEAL MORE STUDY. HOWEVER, I AM GOING TO TELL YOU HOW WE CAME TO TERMS WITH THIS HERE AND WE CAN DISCUSS WHETHER OR NOT IT'S THE RIGHT METHOD OR NOT. THE AIMS OF THE STUDY THAT I WAS TION I WORK WITH WENDY COLDNT /TTO COLDBERG FROM PHIL'S GROUP VERY CLOSELY IN DEVELOPING THIS PROT PROTSOL AND WE WANTED SOMETHING THAT WE COULD USE IN BOTH STUDIES OR BOTH PARTS OF THE STUDY IN THE SAME WAY, WHICH WE ALL AGREED WERE THE APPROPRIATE METHODOLOGIES. SO EVERYONE WAS A PARTICIPANT IN THIS. I -- THE STUDIES ESTABLISHED A PREVALENCE WHICH WAS TO INCLUDE FAS, PARTIAL FAS AND ARND, WHICH IS ALCOHOL HO-RELATED NEWURO NEURODEVELOPMENTAL /STKORZ. WE ALL KNOW THAT PARTIAL FAS AND FAS ALSO INCLUDE A NEWURO NEUROBEHAVIORAL COMPONENT. THAT'S PART OF THE DEFINITION. THEREFORE, WE HAVE TO HAVE SOME DEFINITION OF NEWUROBEHAVIORAL COMPONENT. ARND SPECIFICALLY MEANS ONLY THE NEWUROBEHAVIORAL COMPONENT. AND /AA KNOWN ALCOHOL USE. WHEN WE DID THE IOM, WE ESSENTIALLY SAID THERE IS A NEWUROBEHAVIORAL COMPONENT. WE DID NOT IN /TPHANY WAY DEFINE IT. WE DIDN'T DEFINE IT IN 1995 AND '96 BECAUSE WE DIDN'T HAVE THE DATA. THINGS HAVE BECOME MUCH MORE RE REFINED, BUT I THINK WE'RE STILL STRUGGLING. IN /THIS PARTICULAR STUDY WE WERE LOOKING FOR MEASURES THAT COULD BE USED TO /SRINVESTIGATE NEWEURO NEUROBEHAVIORAL IN A CERTAIN AGE RANGE. THIS WAS FIRST GRADE CHILDREN WHO WERE /TKPWGOING TO BE FIVE TO SEVEN YEARS OLD. THEY WERE GOING TO BE COMING OUT OF REGULAR CLASSROOMS FOR THE PAST -- MOST PART. THE SAN DIEGO STUDY ALSO LOOKED AT CHILDREN WHO HAD DEVELOPMENTAL SADISABILITIES BUT THEY HAD TO BE MEASURES THAT COULD BE DONE IN THIS WAY. TRE BASED AND WE WANTED TO BASE OUR CHOICE OF MEASURES ON EVIDENCE FROM ALL OF THE DIFFERENT DATA THAT HAD BEEN COLLECTED OVER MANY YEARS. AND SO WE DETERMINED THE WAY TO PROCEED BASED ON PREVIOUS RESEARCH. AND I JUST WANT /TO DEFINE AGAIN THE OUTCOMES WE WERE LOOKING FOR FOR, FAS, ARND AND OF COURSE THE QUESTION ARND AND HOW /TO DEFINE IT? WHEN WE WERE LOOKING AT THE SELECTION OF BEHAVIORAL MEASURES TO BE USED IN THESE STUDIES, WE DECIDED THATD THAT THEY NEEDED TO REFLECT THE AREAS THAT WE KNEW TO BE AFFECTED BY PRE/TPHAEPRENATAL ALCOHOL EXPOSURE BASED ON RESEARCH THAT MANY OF US HAD DONE WIDELY, AND THEN WE HAD SOME OTHER CRY /TAOITERIA, WHICH WE THOUGHT WERE NECESSARY. ONE WAS MEASURES NEEDED TO BE DEVELOPMENTALLY VALID. VALID IS A PSYCHOLOGY WORD THAT MEANS THAT SOMETHING MEASURES WHAT WE THINK IT MEASURES. SO WE WANTED OUR OUTCOME MEASURES TO MEASURE APPROPRIATE APPROPRIATELY AND TO BE /AA DEVELOPMENTALLY APPROPRIATE FOR THE AGE OF THE CHILD. WE WANTED MEASURES THAT MEASURED RELIABLY AND RELIABLE IS SUS ANOTHER PSYCHOLOGY WORD WHICH MEANS THAT WHEN YOU MEASURE, IT ALWAYS COMES OUT THE SAME SO THAT THE RULER DOESN'T BEND AND THAT YOU ALWAYS GET THE SAME OUT OUTCOME. BECAUSE OF WHAT WE WERE DOING, WE NEEDED TO HAVE MEASURES THAT COULD BE USED IN ENGLISH FOR THE MOST PART BUT ALSO THESE ARE YOU FOR SPANISH-SPEAKING INDIVIDUALS OR COULD BE TRANSLATEED INTO SPANISH WITHOUT VIOLATING THESE RULES. WE NEEDED TO BE ABLE TO BE ABLE TO ADMINISTER THIS IN /AEA REASONABLE PERIOD OF TIME. WE COULDN'T TAKE TWO DAYS TO DO . IT HAD TO BE DONE IN A RELAT RELATIVELY SHORT PERIOD OF TIME. WE WANTED SOMETHING THAT COULD BE ADMINISTERED BY PEOPLE IN A SCHOOL SETTING BECAUSE THAT'S WHERE WE'RE GOING TO BE DOING THIS. AND WHICH WAS SOMETHING THAT WAS REGULARLY DONE IN SUCH SETTINGS. AND WE ALSO WANTED TO GET MULTI MULTIPLE SOURCES OF POSITION. WE WANTED INFORMATION FROM THE PARENTS, THE CHIL AND THE TEACH TEACHER, SO THAT WE HAD DIFFERENT PERCESPECTIVES ON THE CHIL'S OUTCOME. WE WANTED TO DO THIS BECAUSE WE KNOW THERE IS NOT MEASURE THAT'S REALLY GOING TO NAIL THIS AND WE HAD TO GATHER A GOT -- LOT OF INFORMATION AND DO IT IN THE MOST EFFICIENT WAY. I AM GOING TO PUT UP SOME SAMPLE CRY /TAOITERIA FOR DIFFERENT DIAGNOSTIC SYSTEMS OVER /THE NEXT FEW SLIDES. I AM NOT GOING TO READ THEM TO YOU. I AM PUTTING THEM UP TO SHOW YOU THAT THEY ARE AIL DIFFERENT SO WE CAN UNDERSTAND WHY WE'RE STRUGGLING WITH THIS. BUT IF YOU GO AROUND TO DIFFERENT DIFFERENT SYSTEMS FOR DIAGNOSING FAS AND FASD AND ARND ARND, YOU WILL FIND AND I'VE -- I'M ACTUALLY DOING A RESEARCH PROJECT NOW WITH A SUPPLEMENT TO THIS GRANT OR CONTRACT THAT IS COMPARING THESE DIFFERENT SYSTEMS. AND I AM GOING TO PERHAPS IN -- AT A DIFFERENT TIME SHOW YOU HOW THEY COMPARE BUT NOT TODAY. WHAT I AM SAYING IS THAT WHEN WE DO DIAGNOSIS ATLANTA, WE USE THESE PARTICULAR CRY /TAOITERIAS. WE NEVER USE BEHAVIORAL CRY TIER TIERIA TO MAKE A DIAGNOSIS, NEVER. HOWEVER, WHEN WE LOOK ACT CDC, WE FIND THAT THEIR CRY /TAOITERIA INCLUDES A BROADER RANGE THAN WHAT I WAS APPLYING IN ATLANTA. AND THEY SUGGEST THAT YOU COULD USE SOCIAL SKILLS, ATTENTION, AND SENSORY INFORMATION, WHICH WE DO NOT USE. SO THIS RAISES ANOTHER QUESTION. AND THIS SYSTEM ALSO DEFINES THAT YOU SHOULD USE ONE STANDARD DEVIATION IN CERTAIN AREAS THAN OTHERS. THE MODIFICATION THAT I BELIEVE THAT -- IS USE IS /THE 2005 MODIFICATION OF IOM AND IT INCLUDES A VERY CLEAR DEFINITION OF HOW FAS IS DEFINED, WHICH REFERS ONLY TO STRUCTURAL AND -- A/TPHONOMALIES. AND IN P FAS IT INCLUDES A WHOLE RANGE OF OUTCOMESS, WHICH REFER TO BEHAVIOR. I KNOW THAT WHEN YOU ARE LOOKING AT THESE PREVALENCE STUDIES, YOU ARE IN FACT USING THIS SECOND DEFINITION. BUT AGAIN, THE REASON I'M MENTIONING ALL THIS IS BECAUSE I WANT TO MAKE /SHAOSURE YOU UNDERSTAND THE WAY IN WHICH THIS IS DONE DIFFERS FROM GROUP TO GROUP AND OFTEN INCLUDES DIFFERENT KINDS OF MEASURES. THIS IS FROM THE CANADIAN SYSTEM SYSTEM. AND THEY REQUIRE EVIDENCE OF IM IMPAIRMENT AND THREE OR MORE CENTRAL NERVOUS SYSTEM DOMAINS WHICH ARE SEIZURES THROUGH AD A.D.H.D. THROUGH COMMUNICATION DEFICITS AND SO ON. SO THERE IS A HUGE RANGE. I THINK IT'S IMPORTANT TO KNOW THAT THIS IS HOW PEOPLE ARE TRYING TO DEFINE AND UNDERSTAND THEIR BEHAVIORAL DEFICITS BECAUSE IT SHOWS YOU FIRST OF ALL THE EXTENT OF THE. DEFICIT THAT CAN OCCUR AND THE PROBLEM THAT'S INVOLVED IN DEFINING SUCH A DEFICIT, WHEN YOU ARE TRYING TO DO A PREVALENCE STUDY IN WHICH YOU DO NOT REALLY WANT TO HAVE TO MEASURE EVERYTHING IN THE WORLD. BUT BASED ON THE GOALS OF THE RESEARCH ON C FAS P, AS WELL AS THE CLINICAL PRACTICE THINGS I'VE REFERRED TO, WE /STKODECIDED THE SELECTIVE MEASURES HAD TO REFLECT THE IM/PABPACT OF PRE PRE/TPHAEPRENATAL ALCOHOL EXPOSURE ON BRAIN AND BEHAVIOR AND THEREFORE WE WOULD HAVE TO ASSESS BROADLY BECAUSE WE KNOW THAT THERE IS A BROAD SPECTRUM OF OUTCOMES AND THAT IF WE ARE REALLY GOING TO LOOK AT THE KINDS OF OUTCOMES THAT PEOPLE BELIEVE ARE AFFECTED AND THAT WHICH PEOPLE ARE MEASURING IN THE /KPAOUPBT, TWEED LOOK AT ABILITY, THE CHILD'S ACHIEVEMENTS IN TERMS OF ACADEMIC ACHIEVEMENT, THE CHILD CHILD'S BEHAVIOR, LANGUAGE, AND ADAPTIVE FUNCTIONING, BECAUSE THESE ARE THE THINGS THAT WERE BEING LOOKED AT WHEN MAKING A DIAGNOSIS. WE ALSO FELT HA IT WAS VERY IMPORTANT BECAUSE OF WHAT WE WERE TRYING TO DO, THAT WE USED A STANDARD /AOEUIZED MEASURE, A STANDARD /STAOEUFPBD MEASURE IS ONE AND AGAIN THIS IS MORE . BUT I CAN'T HELP. I'M A PSYCHOLOGIST. AND WHEN WE ARE MEASURING, WE USE STANDARD /AOEUIZED MEASURES AND THESE ARE MEASURES WHICH ARE DONE IN A PARTICULAR WAY AND WHICH HAVE A REFERENCE GROUP, WHICH IS A GROUP AND ALLOWS YOU TO CREATE STANDARD SCORES THAT CAN BE MAPPED ON TO NORMAL CURVES AND GIVE YOU PERCENTILES AND RANKINGS AND SO ON SO THAT YOU KNOW WHERE YOUR SCORES FALL WITHIN A GREATER POPULATION SCORES -- OF SCORES. WE ALSO FELT IT WAS IMPORTANT TO HAVE A TEST BATTERY THAT RESPECT RESPECTED LIMITED TIME FOR ASSESSMENT BECAUSE NOT EVERYBODY CAN STAND TWO OR THREE DAYS OF TESTING. WE DID NOT WANT /TO USE EXPERIMENTAL /PHAERBSZ. EVEN THOUGH WE'D DONE MANY, MANY EXPERIMENTAL MEASURES, WE WANT -- DIDN'T WANT /TO USE ANYTHING UNLESS IT WAS ANYTHING THAT COULD BE USED IN A SCHOOL SYSTEM AND BY OTHER PEOPLE IN THE SAME WAY. SO WE HAD TO USE EASY-TO-OBTAIN TESTS AND WE HAD TO USE TEST S IN WHICH PEOPLE COULD BE QUALIFY TO USE THEM IN /AA VERY STANDARD WAY AND IT WOULD BE VERY EASY TO HAVE QUALIFIED TESTERS FOUND. SO AGAIN THESE WERE THE WAYS IN WHICH WE WERE CONSTRAINING OURSELVES IN DETERMINING HOW /TTO MEASURE OUTCOME IN /THIS STUDY. AND THIS IS WHAT WE CAME UP WITH WITH. AND I HAVE THE INITIAL THING HERE /TIN BLACK, BECAUSE THIS IS ONLY USED BY SAN DIEGO. BUT THE OTHER MEASURES ARE ALL USED BY BOTH OF THE TESTS. AND WE STUDIED -- DECIDED TO USE MEASURES OF COGNITION, ACADEMICS ACADEMICS, FUNCTION, BEHAVIOR, AND ADAPTIVE FUNCTION. AND I'LL DESCRIBE THESE DIFFERENT TESTS. THESE ARE JUST THE AKRCRONYMS FOR THE TESTS. THE EVALUATION OF DEVELOPMENTAL STATUS IS USED IN SAN DIEGO AND IT IS A PRE-SCREENING MEASURE IN WHICH THE PARENT IS ASKED WHETHER OR NOT THE CHILD IS HAVING ANY PROBLEMS, IN PARTICULAR AREAS. AGAIN, THOSE AREAS WHICH WE TALKED ABOUT AS BEING IMPORTANT -- COGNITION, LANGUAGE, MOTOR SKILLS, SCHOOL FUNCTIONING AND BEHAVIOR. ENGLISH /SAND SPANISH AND IT A ALLOWS -- TWO OF THE MEASURES WERE IDENTIFIED, THEN THE CHILD WAS MOVED FORWARD INTO THE STUDY STUDY. AND AGAIN, THIS IS HOW MANY ITEMS WERE ON AND IT ESSENTIALLY SAYS I CAN'T EVEN READ IT BUT SOMETHING IN THE ORDER "DO YOU HAVE ANY CONCERNS ABOUT YOUR CHILD IN TERMS OF THEIR ABILITY TO UNDERSTAND WHEN YOU TALK TO THEM?" AND SO ON. SO IT'S A VERY STRAIGHTFORWARD MEASURE. /SKPWR-FRPBLT IF THE CHILD CHIL /TPWHAOEPBT STUDY, THEY WERE TESTED USING THE NERVE -- NEWURO NEURODEVELOPMENTAL BATTERY BOTH IN SAN DIEGO AND IN THE DIFFERENT SITES THAT PHIL'S GROUP WAS USING. THE COGNITION WE USED THE DIFFERENTIAL ABILITY SCALES, WHICH GIVES AS A MEASURE OF GENERAL COG /TPHENITIVE ABILITY, ESSENTIALLY AN IQ TEST, VERBAL AND NON-VERBAL AND SPATIAL SKILLS. IT'S RELATIVELY SHORT TO /ADD /STKPER SHORTER THAN MOST IQ TEST. IT HAS AN TANCE /KPWHREURB AND SPANISH TRANSLATION AND THE STANDARDIZATION AND RELIABILITY CRY /TAOITERIA. WE ALSO USED SOMETHING CALLED THE NEP /SKWR*EURBGS WAY LOUSY MEASURES OF EXECUTIVE FUNCTION, ATTENTION AND MOTOR FUNCTION AND WE DID THAT BECAUSE THESE ARE AREAS THAT ARE FORGET -- REGULAR REGULARLY FOUND TO BE DEFICIT IN ALCOHOL AFFECTED /SPREUPBLGZ THEY ARE NOT MEASURED BY THE DIFFERENT DIFFERENTIAL ABILITY /SKEULSZ. WE ALSO USED THE B /PH-FPMI, WHICH IS VISUAL MOTOR INTEGRATION, WHICH IS FOUNTAIN TO BE DEFICIT IN ALCOHOL AFFECTED INDIVIDUALS AND IT'S A SHORT TEST. IN ORDER TO MEASURE ACADEMIC FUNCTION AT /THIS AGE, REMEMBER WE'RE TALKING CHILDREN ENTERING FIRST GRADE PRETTY MUCH PRETTY UCH, WE USED THE BASIC CONCEPT SCALE. AND WE WERE PARTICULARLY INTERESTED IN THINGS THAT WERE PRE/KUCURSORS TO MATH /PHAGMATH DISABILITY, WHICH WAS IM/PABPACTED BY ALCOHOL AFFECTED INDIVIDUALS. AND WE LOOKED AT NUMBER COUNT COUNTING, SIZE COMPARISON, SHAPES, DIRECTION, POSITION, KNOWLEDGE AND TIME AND SEQUENCE. KNOWLEDGE BECAUSE THESE ARE AREAS WHICH WE FIND DEFICIT IN INDIVIDUALS WHO ARE ALCOHOL- ALCOHOL-AFFECTED. WE LOOKED AT BEHAVIOR AND THE CHILD BEHAVIOR CHECKLIST, WHICH IS /KWRAOERPLS -- ENORMOUSLY WIDELY USED MEASURE AND HAS FORMS THAT YOU CAN USE IN EVERY COUNTRY IN THE WORLD, I THINK AND HAS BEEN TESTED IN ALL OF THEM AND IT HAS A VAST DATABASE OF OUTCOMES, LOOKING AT ANYBODY, YOU CAN IMAGINE. AND PAGER IT ALLOWS YOU TO GET INFORMATION FROM BOTH PARENT AND TEACHER ABOUT THE CHILD'S EMOTIONAL AND BEHAVIORAL STATUS. IT HAS GOOD NORMS. IT'S RELIABLE. IT'S VALID. IT'S WIDELY USED, AND IT IDENTIFIES COMMON PROBLEMS THAT ARE ASSOCIATED WITH PRE/TPHAENATAL ALCOHOL EXPOSURE AND FASD. FINALLY, WE USED THE ADAPTIVE AND BEHAVIORAL SKILLS, WHICH IN A SECOND EDITION AND THIRD THIRD EDITION IS ABOUT TO COME OUT BECAUSE THE SECOND EDITION CAN CANNOT DEAL WITH CELL PHONES AND EVERY CHILD IN THE UNIVERSE NOW KNOWS HOW TO USE A CELL PHONE AT BIRTH. AND IT LOOKS AT NUMBER OF AREAS WHICH ARE VERY RELEVANT FOR THE CONCERNS ABOUT THE CHILD WHO HAS DEVELOPMENTAL PROBLEMS AND FOR THE CHILD WITH ALCOHOL EFFECTS, INCLUDING ABILITY TO COMMUNICATE COMMUNICATE, ABILITY TO FUNCTION AND DAILY LIVING, WHICH IS EATING AND DRESSING AND SO ON. SOCIAL /SKEULSZ, MOTOR SKILLS AND SUMMARY SCORES. SO, WHAT IS AOMD? FOR THIS STUDY, THIS IS HOW WE DEFINED IT. WE HAD TWO CATEGORIES. IS IS NOT FAS OR P FAS. WE ARE ASSUMING THAT THEY BOTH HAVE A COMPONENT OF THIS AND THESE WILL BE PART OF THAT DEFINITION. BUT ARND IN /SAND OF ITSELF HAS TWO CATEGORIES. EITHER PRE-NATAL ALCOHOL EXPOSURE -- THAT MEANS YOU HAVE TO KNOW ABOUT THE EXPOSURE WITH COG /TPHENITIVE IMPAIRMENT -- OR ALCOHOL-RELATED -- OR ALCOHOL EXPOSURE WITH BEHAVIORAL AND A ADAPTIVE BUT NO COG /TPHENITIVE IM IMPAIRMENT. SO CATEGORY ONE, COG /TPHENITIVE IM IMPAIRMENT. CATEGORY TWO, YOU YOU HAVE JUST BEHAVIOR AND ADAPTIVE. THIS IS HOW THIS MAPS ON TO OUR TESTING PROTOCOL. AS PSYCHE, THE D /PH-FPMI AND THE BE RIGHT BACKENS MAP ONTO CATEGORY ONE. AND CATEGORY TWO, THE TEACHER REPORT FORM AND THE MAP ONTO CATEGORY TWO. NOW, OBVIOUSLY YOU COULD BE A CHILD WHO HAD BOTH OF THESE PROBLEMS. YOU COULD BE CATEGORY ONE AND CATEGORY TWO, BUT YOU COULD ALSO BE EITHER/OR. FINALLY, PEOPLE ASKED THE QUESTION HOW DOES THIS RELATE TO ND /P-FPP THE THEAE, WHICH CAME INTO BEING AFTER WE BEGAN THE COFAS P PROJECT. AND B FM 5, WHICH IS THE NEW FISCAL MANUAL FOR THE PSYCHIATRY ASSOCIATION, WHOSE GOAL IS TO DEFINE DISORDERS THAT PSYCHE PSYCHIATRISTS AND OTHER BEHAVIORAL PRACTITIONERS WILL ENCOUNTER AND NEED TO DIAGNOSE. AND ND /P-FPPAE DISORDER HAS BEEN PROPOSED FOR FURTHER STUDY AND THE MOST RECENT PUBLICATION. THERE IS ALSO A NEWURO NEURODEVELOPMENTAL DISORDER WITHIN THE BODY OF IT, WHICH IS -- YOU CAN USE AS /AA DIAGNOSTIC CATEGORY RIGHT NOW. AND IT REQUIRES MORE THAN MINUTE MINIMAL ALCOHOL, IMPAIRED COG NITIVE FUNCTION AND REGULATION. I AM GOING TO SHOW YOU HOW THAT WOULD MAP TON WHAT WE HAVE COME UP WITH FOR AR ND AND WE ARE TALKING ABOUT THE VERY SAME CATEGORIES, THE VERY SAME KIND OF TESTS MAP ON TO ND /P-FPPA--AE. BUT YOU DON'T JUST HAVE CATEGORY ONE OR CATEGORY TWO. YOU HAVE ALL THREE. SO THAT IS THE DIFFERENCE ON HOW THOSE THINGS ARE DISCRIMINATED. AND I THINK IT'S IMPORTANT TO DISCRIMINATE THEM AND TO UNDERSTAND,000 -- HOW WE'RE TALKING ABOUT THEM IN DIFFERENT WAYS BECAUSE PEOPLE KEEP CONFUSING N /P-FPPAE AND BEHAVIORAL OUTCOMES AND SO ON. ND /P-FPP IS DEFINED AS /AEA PARTICULAR DISORDER WHICH IS CAUSING DIFFICULTY FOR THE CHILD IN THEIR LIFE AND HAS THESE CHARACTERISTICS. . OKAY. SO IN SUMMARY. WE KNOW THAT PRE-NATAL ALCOHOL EXPOSURE AFFECTS THE DEVELOPING BRAIN. IT'S NECESSARY TO CAPTURE THE BEHAVIORAL OUTCOMES OF THAT EXPOSURE IN ORDER TO DETERMINE THE IM/PABPACT ON CHILD DEVELOPMENT AND IN ORDER TO COME UP WITH AN ESTIMATE IN /AA SURVEILLANCE STUDY STUDY. I HAVE TO SAY IT IS ENORMOUSLY DIFFERENT TO MEASURE COG /TPHENITIVE BEHAVIOR BECAUSE THERE ARE SO UTCOME. MANY OTHER FACTORS THAT IMPACT YOU WERE TALKING BEFORE, SHARON, ABOUT THE ISSUE OF THE CHILD IN THE HOME WHERE THERE IS A SIGNIFICANT ALCOHOL PROBLEM. OBVIOUSLY, THAT IS GOING TO IM/PABPACT THE CHILD'S BEHAVIOR AS WE HAVE NOT ADDRESSED THAT ISSUE HERE. WE'RE NOT TALKING ABOUT THAT. EVEN THOUGH IT'S OBVIOUSLY A REAL ISSUE AND ONE THAT WE'RE PERFECTLY AWARE OF, BUT IT IS IM IMMEASURABLE IN THE CONTEXT WE'RE TALKING ABOUT. FOR COFAS P WE HAVE USED MANY DIFFERENT MEASURES AND SOURCES OF INFORMATION TO /TRAOTRY TO CAPTURE THE EFFECTS OF PRE-NATAL EXPOSURE. I HOPE THE RESULTS WILL HELP US BETTER UNDERSTAND HOW /TO IDENTIFY THE CHILDREN WO WOARE SO AFFECTED. BUT I THINK THIS IS A BEHAVIORAL ORDERLY DEFINITION AS PART OF RESEARCH PROJECT, AND I DO NOT SUGGEST THAT IT COMPLETELY DEFINES EVERY OUTCOME THAT COULD BE MEASURED OR THAT IT DEFINES IT IN THE ABSENCE OF IMMEDIAMEDIATING OR MODERATING CONDITIONS. SO THAT'S WHAT I HAVE TO SAY ABOUT THIS. /PHRA [APPLAUSE] >> QUESTIONS? >> I WAS WONDERING. YOU STATED THAT IN YOUR OWN WORK IN ATLANTA YOU DO NOT USE ANY BEHAVIORAL MEASURES FOR THE PURPOSE OF DIAGNOSIS. >> RIGHT. >> WHAT DO YOU THINK THE IM IM/PABIMPACT IS OF THAT? >> OF THE DIAGNOSIS? >> YEAH. >> WELL, WHAT WE DO WITH THEM OUR OWN -- THIS IS CLINICAL, NOT RESEARCH. >> RIGHT. >> WHAT /I MEAN BY NOT USING EHAVIORAL IS WE DO NOT USE THE CHILD AND BEHAVIORAL CHECKLIST. WE DON'T USE THE TEACHER REPORT. WE DON'T USE AD /H-FD -- AD PSYCHIATRIC DIAGNOSIS TO DEFINE SOMEONE AS FAS. WE DIDN'T DO THAT BECAUSE THE CHILDREN COME TO OUR CLINIC ARE MOSTLY COMING OUT OF THE /TPOFOSTER CARE SYSTEM AND HAVE HAD REALLY ROCKY CHILDHOODS AND WE JUST FELT SO UNSURE ABOUT THE IDEA IDEOLOGY OF THEIR BEHAVIOR THAT WE DIDN'T FEEL COMFORTABLE SAYING IT WAS ABSOLUTELY ALCOHOL PER SE. SO WE MEASURE IT, AND WE TREAT IT, BUT WE DON'T USE TAAS A DEFINITION. I IMAGINE THAT MAKES US COME IN WITH A LOWER ESTIMATE THAN SOME OTHER PLACES. >> SOMEONE ELSE? NKS VERY MUCH. SO I AM GOING TO END THIS. BUT REITERATING SOME OF THE THINGS THAT WERE SAID EARLIER BY PHIL AND CLAIRE IN /KAOEUFRG LITTLE BIT ABOUT SOME OF THE OTHER THINGS THAT WE'RE LOOKING AT AS PART OF COFAS BECAUSE WE HAVE THE OPPORTUNITY AND THESE ARE IMPORTANT ISSUES AS WELL. AND THEN TALK ABOUT THE END GOAL IN TERMS OF DEVELOPING AN NATIONALLY AVAILABLE DATABASE RESULTING AS /AA PRODUCT OF THIS STUDY. THE OVERALL GOAL OF COFAS AND OFFICIAL FUNDING ANNOUNCEMENT WAS TO ESTABLISH AN -- A CREDIBLE ESTIMATE OF FAS AND AS CLAIRE HAS JUST DESCRIBED, WE WERE CHALLENGED WITH DEVELOPING AN APPROACH TO ESTIMATING A PREVALENCE WITH AR ND AND WE'VE COME UP WITH AN APPROACH TO DO THAT AND HOPE TO LEARN MORE ABOUT HOW VALUABLE THAT IS. AS PHIL HAS JUST DESCRIBED TO ESTABLISH ESTIMATE, WE'VE UT UTILIZED DIVERSE SAMPLES OF CHILDREN AND THEIR MOTHERS OR COLLATERAL REPORTERSS IN SEVERAL REGIONS OF THE U.S.. AND IMPORTANTLY ACROSS THESE MULTIPLE SITES, WE'VE ESTABLISHED COMMON CRY /TAOITERIA FOR EACH ONE OF THE /PHAERBSZ. CLAIRE HAS JUST DESCRIBED THE COMMON CRY /TAOIA THAT WE'VE BEEN USING FOR THE NEWUROBEHAVIORAL, EVALUATIONS. WE'VE USED THE SAME COMMON DIS DISMORPHOLOGY, EXAM PROTOCOL AND WE'VE USED COMMON CORE VARIABLES IN OUR MATERNAL INTERVIEWS TO COLLECT INFORMATION ABOUT ALCOHOL EXPOSURE AND OTHER MA MATERNAL PREDICTORS. IMPORTANTLY, WE ALSO HAVE THE GREAT LUXURY OF HAVING EXPERT TEAMS FOR THE DIAGNOSIS. SO THERE ARE SIX DISMORPHOLOGIST ARE SHARED ACROSS ALL OF THE H - PROJECTS AND TWO INDEPENDENTLY WORK ON EITHER PHIL'S OR OUR PROJECT, WHO HAVE HUGE NUMBERS OF YEARS OF EXPERIENCE AND EXPERTISE IN CLINICAL INSIGHT IN DOING THIS. SO WE FEEL LIKE WE KIND OF HAVE THE BEST THAT YOU CAN GET IN TERMS OF THE -- OF CORRECTING THESE DATA TO ESTABLISH A CREDIBLE ESTIMATE OF FASD. AND AS PHIL DESCRIBED, WE RETAIN DATA TO ASCERTAINMENT AND CROSS SECTIONAL SAMPLES OF SCHOOL AGE CHILDREN AND AS YOU CAN /SKPRERB PHIL HAS ALLUDED TO /THE REASON FOR SELECTING SCHOOL AGED CHILDREN IS THEY ARE YOUNG ENOUGH TO STILL EXHIBIT MORE CLEARLY THE PHYSICAL FEATURES BUT OLD ENOUGH TO BE ABLE TO GO THROUGH A NEWUROBEHAVIORAL TEST TESTING BATTERY THAT CAN PICK APE LOT OF THINGS ABOUT LEARNING AND BEHAVIOR THAT MIGHT NOT EASY EASILY BE RECOGNIZED IN YOUNGER CHILDREN. SO AS HAS BEEN DESCRIBED, OUR GENERAL APPROACH IN ORDER TO NOT HAVE TO DO A FULL EVALUATION BATTERY ON THOUSANDS OF CHILDREN, IS TO INITIALLY SCREEN ON GROWTH AND/OR DEVELOPMENTAL CONCERNS AND THEN TO RAND /O*OMLY CAUSATIVE ON EITHER ONE SELECT CHILDREN WHO DO NOT OR BOTH OF THOSE IN ORDER TO MOVE FORWARD FOR THE FULL EVALUATION, WHICH IS TIME INTENSEIVE AND COSTLY. AS PHIL HAS DESCRIBED IN A COUPLE /OF SETTINGS HE'S DONE A RAND /O*OM SELECTION OF AGE HE WILELIGIBLE CHILDREN AS AN ALTERNATIVE A APPROACH. AND THE REASON FOR HAVING THESE RAND /O*OM SELECTION OF CHILDREN WHO DON'T SCREEN POSITIVE OR RAND /O*OM SELECTION OF AGE-HE WIELIGIBLE CHILDREN OVERALL IS TO GIVE US A SENSE SINCE OF WHAT WE MIGHT BE MISSING IN SCREENING KIDS. SO IF WE SCREEN ON /KPWROEBGT, EXAMPLE, WE'VE ELIMINATED LOOKING AT WHAT THE PREVALE MIGHT BE IN KIDS WHO ARE NOT GROWTH-DEFICIENT OR DON'T MEET THE GROWTH-SCREENING I-- CRY TIERIA. SO WE ARE TRYING TO PUT TOGETHER THE RECOMMENDATION OF WHAT WITH WILL RESULT IN US BEING ABLE TO COME UP WITH A PREVALENCE ESTIMATE THAT REPRESENTS THE POPULATION. WE ARE ALSO TASKED WITH EXAMINING MATERNAL RISK FACTORS FOR FASD AND PHIL HAS ALREADY DESCRIBED SOME OF THOSE. WE NOW HAVE AN OPPORTUNITY TO LOOK AT WHETHER THEY ARE SORT OF CONSISTENT ACROSS SITES. ARE THEY DIFFERENT IN DIFFERENT POPULATIONS OR DO THEY CARE -- CARRY MORE WEIGHT IN ONE SORT OF SECT VERSUS ANOTHER? AND IN THE /TPURPBGD ANNOUNCEMENT WE WERE SPECIFICALLY TASKED TO LOOK AT MATERNAL NUTRITION AS /AA POTENTIAL IMMEDIATEIATING OR MODIFYING FACTOR. IN THE STUDY'S COMPLETION, A PRODUCT THAT WE ARE COMMITTED TO AND MUST PRODUCE IS A PUBLIC USE DATASET THAT'S COMPRISED OF ALL OF THE COMMON CORE VARIABLEAND SO A MAJOR REASON FOR USING THE STANDARD PROTOCOL ACROSS ALL SITES THAT WILL BE ARE, WE THINK, A VERY IMPORTANT RESOURCE FOR THE PUBLIC AND FOR OTHER RESEARCHERS IN THE U.S. AND THROUGHOUT THE WORLD. AND SO THIS COMMON PUBLIC DATA DATASET WILL CONTAIN ALL OF THE DISMORPHOLOGY AND GROWTH VARIABLES FOR THESE THOUSANDS OF CHILDREN WHO HAVE BEEN EVALUATED EVALUATED. NEWUROBEHAVIORAL TESTING BATTERY RESULTS, AS CLAIRE HAS DESCRIBED THOSE CONSIST OF HUNDREDS OF VARIABLES COLLECTD IN A STANDARD FASHION ACROSS ALL SITES. THE TEACHER EVALUATIONS, THE MA MATERNAL INTERVIEW VARIABLES, AND THESE CONSIST OF LITERALLY HUNDREDS OF VARIABLES AS WELL, THAT WEAR LINING ACROSS SITES SO THAT WE HAVE SPECIFIC INFORMATION THAT WILL BE INCLUDED IN THE PUBLIC USE INDICADAT DATASET AND IT WILL ALLOW RESEARCHERS NOT ONLY TO GO IN AND SAY OKAY, THIS IS THE SUM SUMMARY OF WHETHER OR NOT THIS PERSON WAS EXPOSED TO ALCOHOL BUT ALSO TO BE ABLE TO LOOK AT SPECIFIC MEASURES OF ALCOHOL EXPOSURE AND OTHER MATERNAL VARIABLES THAT THEY MIGHT WANT TO PUT TOGETHER IN A DIFFERENT WAY OR WANT /TO COMPARE TO TATDATA THAT HAS BEEN COLLECTED AT ANOTHER SITE IN A WAY THAT'S INTERPRETABLE. AND THE /TPHRAOUGSAL ASSESSMENT RESULTS, WHICH I'LL DESCRIBE IN A MINUTE WILL ALSO BE INCLUDED. SO I THINK THIS PUBLIC USE DATA DATASET IS A MAJOR EFFORT AND CAN BE BOTH A RESOURCE TO OTHER RESEARCHERS, BUT CAN SERVE SASS A PLATFORM, SHOULD OTHER RESEARCH GROUPS IN THE FUTURE COLLECT SIMILAR OR COMPLEMENT ARY DATA AND WANT /TTO CONTRIBUTE THAT TO THE PUBLIC USE INDICADATASET SASS A FUTURE RESOURCE FOR THIS TYPE OF WORK. WE HAVE TAKEN, AS I SAID, THE OPPORTUNITY WITH THE COFAS PROJECT TO DEUCE -- INTRODUCE SOME ADDITIONAL FEATURES TO THIS BECAUSE WE HAD A CHANCE TO DO THIS AND THEY HAVE VARIED ACROSS SITES. PHIL HAS SOME THINGS THAT THEY ARE DOING AT HIS SITES THAT WE'RE NOT DOING AT POURS AND I AM GOING TO DESCRIBE FEW OF THOSE THAT WE'RE DOING IN SAN DIEGO. ONE /OF THEM IS THAT AS YOU HEARD DALE DESCRIBE EARLIER, ONE OF THE P FAS INITIATIVES HAS BEEN TO FON DEVELOP 3D FACIAL IMAGINE IMAGINING AS /AA POTENTIAL CLINICAL TOOL THAT CAN BE USED TO APPROVE ACCESS TO AND EFFECT EFFECTIVE CLINICAL TRAINING AND DIAGNOSIS SCREENING AND DIAGNOSIS IN THE VAST MAJORITIES OF CASES WHERE THERE ISN'T AN EXPERT EXPERT TEAM AVAILABLE AND ALSO AS HE DESCRIBED O, TO BETTER UNDERSTAND POTENTIALLY WHAT ARE SOME OF THE SUBTLE FEATURES ABOUT THE FACE AND THE HEAD OF A CHILD WHO IS AFFECTED BY ALCOHOL THAT MIGHT NOT EVEN BE READILY RECOGNIZED BY AN EXPERT DISMORPHOLGIST. SO PART OF THAT BROADER EFFORT, WE HAD THE OPPORTUNITY TO CONTRIBUTE TO /TTHAT BY PROVIDING 3D IMAGES OF THE CROSS SECTION -- CROSS SECTION OF CHILDREN IN SAN DIEGO. WE ALSO HAD THE OPPORTUNITY IN SAN DIEGO BECAUSE WE HAVE A PRETTY ACTIVE VISION SCREENING PROGRAM IN SOME PRESCHOOL /KEUZ IN THE CITY /STPEUT TO BE ABLE TO COLLECT ROUTINE VISION SCREENING DATA THAT WAS COLLECT COLLECTED IN THE COURSE OF THE CHILD'S PRESCHOOL YEARS OR UP TO THE TIME THAT THEY ENROLLED IN THE STUDY. AND TO BE ABLE TO BE ABLE TO LOOK AT /THIS IN RELATION TO THE MOTHER'S REPORTED PRE-NATAL ALCOHOL EXPOSURE AND DIAGNOSTIC CATEGORY OF THE CHILD. SO WE DIDN'T PROACTIVELY COLLECT THOSE AS /AA RESEARCH ACTIVITY BUT WE'RE COLLECTING INFORMATION FOR ANOTHER PURPOSE. AND THEN FINALLY, ONE OF THE THINGS THAT HELPED US GET AN EN ENTREE INTO THE SCHOOL SYSTEM IN SAN DIEGO, WITH AS YOU CAN IMAGINE, ONE OF THE QUESTIONS THAT ALWAYS COMES UP AS WELL, GREAT, YOU ARE GOING TO FIND OUT HOW MANY KIDS IN SAN DIEGO HAVE FASD BUT WHAT ARE WE GOING TO DO FOR THEM SENATOR, WE INTRODUCED TO THE SCHOOL SYSTEM, THANKS TO CLAIRE AND JEWULIE CABLE, THE OPPORTUNITY TO HAVE THEIR CHILDREN WHO WERE PART OF THE PROJECT, IF THEY MET CRY /TAOITERIA TO PERHAPS BENEFIT FROM THIS AND ALSO TO TRAIN TEACHERS WHO ARE PART OF THE SCHOOL SYSTEM, TO BE ABLE TO /ADMINISTER SOMETHING CALLED THE MASS INTERACTIVE LEARNING EXPERIENCE OR THE MILE INTERVENTION, WHICH HAS BEEN DEMONSTRATED BY PLAYER AND JEWULIE FOR EXACTLY THIS AGE RANGE IN CHILDREN, WHO HAVE BEEN PRE PRE/TPHAEPRENATAL PRENATALLY AFFECTED BY ALCOHOL TO BENEFIT THEM IN TERMS IN TERMS OF MAL PERFORMANCE AND POTENTIALLY OTHER PERFOR MEASURES AS WELL. SO, THE NUTRITION PIECE, AS I SAID, WAS SNAG WE NEED TO DO ACROSS ALL SITES, AND WE'VE TAKEN A COMMON APPROACH TO DOING THIS. WHAT WE'VE DONE IS, AFTER MUCH DISCUSSION WITH PROJECT OFFICERS AND OTHERS ABOUT HOW /TO APPROACH THIS, IDEALLY WE WOULD HAVE NUTRITION INFORMATION THAT WAS COLLECT ED FRED FROM A MOTHER WHILE SHE WAS STILL /PROEGT -- PREGNANT AND SHE COULD TELL YOU WHAT SHE ATE YESTERDAY BUT WE ARE LOOKING LOOKING AT WANTING TO KNOW WHAT NUTRITIONAL STATUS WAS OF A MOTHER SEVEN OR EIGHT YEARS AGO WHEN SHE WAS PREGNANT. SO BASED ON THE REVIEW OF THE LITERATURE AND DISCUSSION, WE DECIDED THAT PROBABLY CURRENT DIET AARY INTAKE COLLECTD IN A MORE PRECISE AND RELIABLE MANNER WOULD BE THE BEST ESTIMATE OF WHAT DIET AARY INTAKE WAS SIX OR SEVEN YEARS AGO OR THE BEST REFLECTION OF IT AS OPPOSED TO TRYING TO ESTIMATE OR TO REMEMBER WHAT SHE SATE -- ATE AND WHAT SUPPLEMENT SHE TOOK SIX OR SEVEN YEARS AGO. SO WE DECIDED TO DO THIS USING 24-HOUR DIET AARY RECALL SO THAT I'M SURE IF YOU ARE FAMILIAR WITH THOSE YOU CAN SELF-ADMINISTER THEM OR THEY CAN BE ADMINISTERED BY A TECHNICIAN WHO ASKED YOU WHAT YOU ATE, DRANK, WHAT SUPPLEMENTS YOU TOOK OVER /THE PREVIOUS 24 HOURS. SO MOTHERS WERE VECTED FOR THIS PORTION OF THE STUDY BASED ON HAVING CHILDREN WHO HAD RECEIVED THE FULL STUDY EVALUATION. SO WE HAD ALL THE BROAD-BASED INFORMATION ON THEM AND WHO HAD AND HAD NOT BEEN CLASSIFIED AS SOMETHING -- HAVING SOMETHING OF THE FASD SPECTRUM. COULD HAVE HAD PRE-ALCOHOL EXPOSURE BUT DIDN'T MEET THE DIAGNOSTIC CATEGORY CRY /TAOITERIA. COULD HAVE HAD SOMETHING ON IT OR COULD HAVE EITHER. MOTHERS WERE THEN ASKED IF THEY WOULD PARTICIPATE IN /THIS AND ASKED TO COMPLETE THREE 24-HOUR DIET AARY RECALL THAT'S COMPRISED TWO WEEKENDS AND ONE WEEKEND DAY. SO USING THESE INTERVIEW DATA OVER /THE THREE DAYS, WE CAN CALC CALCULATE THE INTAKE OF SPECIFIC /SRAOEUPLSZ, MIRAGES AND OTHER DIET AARY INTAKE MEASURES, SOME OF WHICH HAVE BEEN IMPLICATED IN AN ANIMAL STUDIES IN THE LITERATURE AS POTENTIALLY IM/PABPACTED TO ALCOHOL OR MAY BE INVOLVED AS MODIFIERS AT RISKING FOR FASD.^ SO WE WILL COMPARE ULTIMATELY THE ADD /KWASLY -- ADD /KWEQUACY OF INTAKE OF MOTHERS WITH CHILDREN WITH FASD VERSUS NO FASD AND SUNSHINE AND DON'T HAVE RESULTS FOR YOU, BUT I CAN SAY THAT WE HAVE 355 MOTHERS TODAY DETERMINED TO BE HE WIELIGIBLE FOR THE SURVEY TODAY IN ASKING A. IT IT00 HAVE CONSENT SOD FAR TO COMPLETE THE DIET AARY RECALLS AND ABOUT 116 /0 HAVE COMPLETED THEM. AND JUST TO GIVE YOU AN IDEA OF WHAT THE SPECIFIC NUTRIENTS ARE THAT WE'RE LOOKING AT. HIGH-RISE LIST OF THOSE WHERE WE'RE LOOKING AT RECOMMENDED IN INTAKE ABOVE OR BELOW AND THEN WE'LL LOOK AT MEAN LEVELS BILLION AND THEN WE'RE LOOKING AT NUMBER OF FRUIT SERVINGS PER DAY AND VEGETABLE SERVINGS PER DAY AS A MEASURE OF DIET QUALITY QUALITY. AND THEN OUR SITE WE HAVE PREPARED A FEEDBACK TOOL THAT WE GIVE TO THOSE MOTHERS WO WOPARTICIPATE. IT GIVES HER AN IDEA OF HOW SHE REPORTED ON THE 24-HOUR DIET AARY RECALL AND HOW THAT RELATES TO MICRONUTRIENTS ARE RELATED RECOMMENDED INTAKE AND WHAT TO IN TERMS OF HEALTH AND WHAT SOURCES OF FOODS SHE CAN GET THEM FROM. DIVISION RECORD DATA, WE ARE DOING THIS AS /I SAID, BECAUSE PREVIOUS STUDIES SUGGESTED THAT SOME CHILDREN /TPWAEUBGTD ALCOHOL HAVE VISION IMPAIRMENT ARE MORE LIKELY. WE DO VISUAL ACUTEY OR AB ABNORMALITIES OF THE OPTIC NERVE TO MAIM -- NAME A FEW. SO THE RELEASE OF RECORDS FOR PREVIOUS VISION SCREENINGS AND SO 926 CHILDREN HAVE BEEN HE WIELIGIBLE TO PARTICIPATE IN /THIS PART. 752 PARENTS HAVE SIGNED RELEASE /STPORPLZ SO /TPFAR WE'VE /KPWOEPBT 6100 RECORDS BACK. 3D IMAGING. I'LL SAY MORE ABOUT THIS BECAUSE I THINK THIS IS SUCH AN IMPORTANT ASPECTING OF THIS AND WE'RE PLEASED TO BE ABLE TO CONTRIBUTE TO IT. THIS IS A COLLABORATION OUT /OF PERU AT INDIANA UNIVERSITY AND UNIVERSITY OF LONDON OXFORD, THE 3D PHOTOGRAPHS ARE AT THE TIME OF MORPH LODGICAL SATION AND CHILD GETS A /PREUR FROM THE 3D IMAGE AS SOMETHING TO TAKE HOME WITH THEM. AND THE RATIONALE FOR THIS IS THAT IN THE CONTEXT OF IMAGES FROM OTHER SITES CERTAINLY THIS CROSS SECTIONAL SAMPLE ISN'T GOING TO BE THE BE ALL END ALL. BUT WITH THE THOUSANDS OF IMAGES COLLECTED FROM OTHER SITES AT DIFFERENT AGES AND RACE, ETHNIC GROUPS AND SO ON, THIS CAN CONTRIBUTE TO DEVELOPING A CLINICALLY USEFUL TOOL TO AID AND DIAGNOSE. SO PETER WAS KIND ENOUGH TO SHARE SOME OF SOME OF THESE IMAGES WITH US AND HOW HE'S BEEN WORKING WITH THEM. SO THIS GIVES YOU AN IDEA OF WHAT THE IMAGE LOOKS LIKE AND HOW /TO APOLITE HEAT MAP TO IT. AND THE COLOR CODING THE MORE BLUE IT IS THE MORE CONVECTION. THE MORE PRO TRUDING THE FACIAL SHAPE IS. GREEN IS FLAT AND MORE CONCAVE OR MORE SORT OF INDENTED. INDICATED BY RED. AND WHAT ARE -- ONE OF THE THINGS HE'S BEEN WORKING ON SORT OF GOING TO THE ISSUE OF WHAT IS THE DISMORPHOLOGIST, SMOOTH OR NOT SO /SPHAOBGT? HE'S LOOKING AT DIFFERENT TYPES OF SMOOTHNESS. SO HE'S IDENTIFIED SORT OF DIFFERENCE S S IN SHAPES THAT HE'S CALLING THE GROOVE AND THE CURL. AT A POINT ON THE UPPER LIP. SO YOU CAN SEE ON THE LEFT HERE, THE GROOVE OR SORT OF THE INDENT THE TERM IS VERTICAL SORT OF MEASURE. AND THE CURL IS LOOKING AT MORE LATERALLY LOOKING ACT SHAPE OF THE FLATNESS OF IT IN THAT DIRECTION. AND IS THIS SLIDE HERE GIVES YOU AN IDEA. THE RED ON THE IMAGE ON THE RIGHT SHOWING SORT OF HORIZONTAL HORIZONTALLY MORE HIGH CURL. SO THAT THE RED IS INDICATING CONCAVE. AND MORE HIGH-GROOVE OR MORE VERTICAL RED COLOR ON THE LEFT. AND THEN HERE IS AN EXAMPLE OF HIGH-GROOVE ON THE LEFT AND LOW- LOW-CURL ON THE RIGHT, WHERE YOU ARE NOT SEEING ANY RED AT ALL. THEN AN EXAMPLE OF LOW GROOVE AND LOW CURL, BASICALLY YOU ARE SEEING NO RED AT ALL. LOW /KPWRAOFB AND HIGH CURL. SO THINGS THAT WE WOULD NEVER HAVE THOUGHT OF THAT KEN JONES WOULD AGREE IN THINKING ABOUT HOW /TO DESCRIBE. AND POINT TO THE ISSUE OF DIFFERENCES BETWEEN RACE HE CAN'T NICK GROUPS AND SECTION AND AGE OF THE CHILDREN. WHAT HE'S /STKPAOEUPBGD THIS IS AN EXAMPLE WITH THE GROOVE IN THE PILLAR DEFINITION THAT THERE ARE DIFFERENCES IN THE NORMS THAT HE'S ESTABLISHING FOR THE SHAPE, CURL AND GROOVE OF THE COLORED INFANTS OR CHILDREN, SHOWN HERE HERE. AND CAUCASIANS INFANTS SHOWN HERE. IR/SPERBRESPECTIVE OF WHETHER THEY HAD ALCOHOL EXPOSURE OR NOT, IT DEMONSTRATES THAT YOU NEED TO ESTABLISH A STANDARD FOR ENFORCEMENORMATIVE SHAPE BASED ON THE SPECIFIC RACE AND ETHFLICK AGE AND PROBABLY SEX OF THE CHILD. SO HERE IS JUST THREE REAL BRIEF EXAMPLES OF FACE-SHAPE /STKHRAOEPBG BEENES DOING WITH SOME OF OUR IMAGES. THESE THREE IMAGES ARE ALL MALES 6 TO 7 YEARS OF AGE. THE FIRST ONE PRE/TPHAENATALLY EXPOSED TO HEAVY ALCOHOL OVER 14 /TKRA*EUPBGZ WEEK AND MORE THAN THREE DRINKS ON AT LEAST TWO OWE OCCASIONS. AND THE TILL TRIM IS NOT SMOOTH. IT'S /SPHAOBGT AND RED SO YOU ARE -- IN THE GROOVE SO YOU ARE SEETHE CONCAVE -- CONCAVE PART OF THAT. FISHER LENGTH IS /THE 22 22N'T PERCENTILE ON THE NORMAL CURVE FOR THIS AGE CHILD, WHICH IS GREATER. SO THIS CHILD -- DESPITE THE FACT THAT /HE HAD SUBSTANTIAL PRE PRE/TPHAENATAL ALCOHOL EXPOSURE DOESN'T SATISFY THE EXPOSURE FOR FAS. THIS NEXT CHILD, MOTHER DRANK 7 TO 14 DRINKS A WEEK, IN /THIS CASE YOU SEE SMOOTHERER THAN IN THE FIRST CASE SO THERE IS LESS RED BETWEEN THE PILLARS AND THE FISHER LENGTH IS CLOSER TO THE 10TH PERCENTILE. SO MORE EVIDENCE OF FACIAL FEATURES REFLECTIVE ABOUT THE EXPOSURE. AND THEN IN THE LAST CHILD, YOU SEE IS HERE 7 TO 14 DRINKS A WEEK, MORE THAN THREE DRINKS PER WEEK AND IS THIS CHILD HAS A SMOOTHER THAN WHAT YOU SAW BEFORE. THE PAL FISHER LENGTH IS AT THE 17TH PERCENTILE SO THE CONTRIBUTION OF THE 3D IMAGE, I THINK, REALLY DOES ENHANCE NOT ONLY WHAT THE DISMORPHOLOGISTS CAN SEE BUT ULTIMATELY ALSO MIGHT MIGHT BE ABLE TO QUANTIFY THIS IN /AA WAY THAT ACTUALLY CAN BE APPLIED IN CLINICAL PRACTICE. SO I MENTIONED THAT THIS IMAGE ANALYSIS PREVIOUSLY HAS DEMONSTRATED THAT THERE ARE DIFFERENCES BASED ON AGE, SEX, RACE, ETH/TPHENICITY AND SPECIFIC A APPROACHES WILL HAVE TO BE DEVELOPED FOR SUBPOPULATIONS AND WE THINK THAT COFAS WITH 450 IMAGES THAT WERE CONTRIBUTING TO THIS WILL HELP TO FLESH OUT THAT RANGE OF RACE ETHNIC BACKGROUNDS AT LEAST FOR THIS AGE GROUP. AND THEN THE /PHOUBGT INTER INTERACTIVE ONE SUCCESS IN SAN DIEGO. WE'VE OFFERED IT ONLY TO CHILDREN OR TO PARENTS WHOSE CHILDREN END ONE AN FASD CLASSIFICATION. PARTLY FOR REASONS OF CONFIDENT CONFIDENTIALITY AND NOT TO DRAW ATTENTION TO THOSE CHILDREN BUT PARTLY BECAUSE THIS ISS AS A PERK FOR /AA PARENT TO PARTICIPATE PARTICIPATE. THE LARGE MAJORITIES OF WHOM HAVE CHILDREN WHO AREN'T AFFECT BID ALCOHOL. SPOANY CHILD WHO HAS A LOW SCHOOL RATING /SKOE BEHAVIORAL TESTING BATTERY SUGGESTING THEY MIGHT BENEFIT FROM THIS MILD PROGRAM IS OFFERED THIS AND THE TEACHERS AT THE CITY SCHOOLS WHO -- WERE OFFERED TRAINING BY OUR SPECIAL EDUCATORS WHO WAS TRAINED BY /SWRAOULIE. SO /TPFAR WE'VE HAD 63 CHILDREN HE WILL /SKPWREUBL ABOUT HALF OF THOSE PARENTS HAVE CONSENTD TO AN /AEVALUATION.HIS AND WE'RE WE'RE NOT TESTING THE VALUE OF THE PROGRAM BUT LOOKING AT SATISFACTION FROM THE PARENTS AND THEIR TEACHERS. SO THIS IS SOME OF OUR RESEARCH AND CLINICAL TEAM AT SAN DIEGO. AND I'LL END THERE AND HAPPY TO ANSWER ANY QUESTIONS. THANK YOU. /PHRA [APPLAUSE] >> QUESTIONS, SOME QUESTIONS? >> IT WOULD BE GREAT, WOULDN'T IT? LAUGHT[LAUGHTER] >> ANY QUESTIONS ON ANY OF THE PRESENTATIONS BY THE PANELISTS? OVERWHELMED WITH INFORMATION THIS AFTERNOON. SO SALLY ANDERSON? >> I'M EXHAUSTED. >> SALARY ANDERSON IS GOING TO -- >> WE HAD A LONG KAY, HAVEN'T WE? >> OKAY. I WANTED TO GIVE YOU AN UPDATE OF SOME OF THE OTHER ACCOUNT ISSUES THAT -- DETECTIVE ISSUES THAT HAD -- ISSUES THAT HAD RESULTED. REMEMBER WE HAD THE EXECUTIVE COMMITTEE. WHEN WE HAVE SPECIAL PROJECTS THAT WE WANT DONE, WE FORM AD HOC WORK GROUPS AND IN THE TEN YEARS THAT I'VE BEEN INVOLVED WITH THIS, WE'VE HAD WEAVE AN EDUCATION WORK GROUP AND AN JUST JUSTERS WORK GROUP AND WOMEN'S DRINKING AND PREGNANCY WORK GROUP, A ACCOUNT WORK GROUP. EACH OF THE GROUPS WORKING AT PARTICULAR DIFFERENT TIMES, NOT ALL SIMULTANEOUS SPONTANEOUSLY ON PROJECTS THAT THEY HAVE BEEN ASSIGNED. AND THIS IS A MIXTURE OF GROUPS MADE UP OF AGENCY REPRESENTATIVE AND THEN SPECIALISTS AND EXPERTS IN /AA VARIETY OF FIELDS THAT ARE RELEVANT TO WHATEVER THE PROJECT IS. SO A DIAGNOSTIC ISSUES WORK GROUP WAS FORM IN 2008, AND WE'RE VERY ACTIVE FOR THE NEXT SIX YEARS. NOW YOU CAN SEE IN THE GREEN WE HAVE FEDERAL REPRESENTATIVES AND PARTICIPATION FROM DIFFERENT FEDERAL AGENCIES AS PART OF THE FASD AND WE HAVE LOTS OF WONDERFUL OUTEXPERTS TO HELP US. THIS WORK GROUP WAS ASSIGNED TWO DIFFERENT TASKS. THE FIRST PROJECT WAS TO IN INCREASE AWARENESS OF AR ND AND IM/PROPROVE ASSESSMENT AND DIAGNOSIS OR REFERRALS IN THE PRIMARY FIRST STARTED OUT WITH A REVIEW OF THE LITERATURE, FOLLOWED /PWBY A STATE /-FOF THE SCIENCE CONFERENCE AND THEN A CON/SEPSENSUS DEVELOPMENT-STYLE /TPRAO*EUPBLS TO GOAT BUY-IN FROM THE AMERICAN ACADEMY OF PED PEDIA /STKPREUBGZ THAT WAS VERY SUCCESSFUL. AND AFTER THE RESULTS FROM OUR CON/SEPSENSUS DEVELOPMENT-TYPE CONFERENCE CAME OUT, THE /PHERPB AMERICAN ACADEMY OF PED /KWIATRICS SAID WE, IT WAS PROBABLY TIME TO MOVE FORWARD ON THIS AND YES, IT IS AN ISSUE THAT THEY SHOULD ADDRESS. AND AFTER THAT, THEY FORMED A WORK GROUP INITIALLY ON AR ND BUT LATER DECIDED TO ADOPT ND P PREPONDERATE THEAE. BUT THE PURPOSE OF THIS WORK GROUP, WHICH INCLUDED SOME OF THE PEOPLE FROM THE DETECTIVE ISSUES WORK GROUP HERE AS WELL AS OTHER MEMBERS OF THE AMERICAN ELOP GUIDELINES REGARDING ACADEMY OF PED /KWIATRICS WAS TO IDENTIFICATION, DIAGNOSIS REFERRAL AND MANAGEMENT OF CHILDREN WITH FASD AND PED /KWIATRIC MEDICAL HOME PROVIDERS. THE ACTIVITIES TO DATE ARE DEVELOPMENTAL OF TECHNICAL REPORT ON REVIEW AND PED /KWIATRICS. IT INCLUDES SUGGESTIONS, EXPOSURE SCREENING QUESTIONS TO BE IN/KRORCORPORATED INTO FOURTH EDITION, WHICH IS THE BIBLE FOR PED /KWIATRIC CARE. ALL OF THIS WORK IS FOR THE AMERICAN ACADEMY OF PED /KWRIATRICS NOW IS SPONSORED BY CDC. THE NEXT STEPS FOR THIS WORK GROUP IS TO WORK WITH THE PEDIA TRICK IMPLEMENTATION CENTERS THAT CDC HAS JUST SET UP TO /RE REAUTHORIZE EDUCATIONAL MATERIALS NOW EXISTING ON THE AMERICAN OF IMMEDIATE -- PEDIA TRICKS WEBSITE AND FOR PRACTICE AND IMPLEMENTATION GUIDES FOR SCREENING AND PREVENTION FOR ADD LESSENTS. SO THIS WORK GROUP IS BEING SPONSORED BY CDC AND OUR FRIENDS ON THE FASK PREVENTION TEAM. THE SECOND PROJECT THE WORK GROUP WAS ASSIGNED WAS A A/SAOEUFRPBD IN 2010 AND WORKED ON THIS DILIGENTLY THROUGH 2014. IN -- AND THIS PROJECT WAS TO DEVELOP DIGESTIC CRY /TAOITERIA IN DISORDERS. IN THE ALONG FOR PSYCHIATRY IN INCLUSION. THE DISORDER HAD TO BE /AA UNIQUE SET /OF SYMPTOMS THAT WERE DESCRIBEABLE IN THE LANGUAGE OF PSYCHIATRY, AND IT WOULD HAVE TO BE CONSERVATIVE BECAUSE WE NEED NEEDED A DEFINITION THAT COULD BE DIFFERENTIATE WHAT WE WERE PROPOSING FROM OTHER DEVELOPMENTAL DISORDERS IS THAT PSYCHIATRISTS WERE FAMILIAR WITH WITH. NOW FOR THIS PROJECT WE NEEDED TO CALL IN MORE PEOPLE THAT HAD MORE CLINICAL EXPERIENCE THAN WE HAD /AOEUON A REGULAR DIGESTIC ISSUES WORK GROUP. SO WE CALLED IN BLAIR AND JEWULIE, WHO HAD SOME EXPERINCE WITH DS M 5. MAYRY WAS PART OF THE ACCOUNT ISSUES WORK GROUP AND LIVE WITH ROT OF EXPERIENCE WITH THAT AND THE SAME THING WITH HEATINGER CAR MICHAEL WILSON AND WE NEEDED TO /ADD TAR /KWRA MATTSON BECAUSE WE WANTED TO USE A LOT OF THE INDICADATASETS IS THAT SHE HAD ALREADY COLLECTED FOR THE PROJECT. AS WEIT /ER ATEED BACK /SKAND FORTH ON HOW WE THOUGHT WE WOULD DEVELOP THIS CRY /TAOITERIA. SO EVENTUALLY, WE WORKED THROUGH WITH MANY COMMITTEES IN THE AMERICAN DIKE -- PSYCHIATRIC ASSOCIATION AND A PROJECT WAS INTERNALLY IN TERMS OF AMERICAN PSYCHIATRIC ASSOCIATION SPEAR HEADED BY BRIDGET GRANT THAT WORKS FOR NIAAA. AND WHEN IT WAS RELEASED IN MAY OF 2013, THE CRY /TAOITERIA WE DEVELOPED WERE IN THE APPENDIX UNDER DISORDERS IN NEED MOR -- FOR FURTHER STUDY. THIS IS THE NORMAL PROCESS FOR GETTING IN THE D /S-FPSM 5. YOU START IN THE APPEND /SKPWREUBGS THEY GIVE YOU A WHOLE LIST OF THINGS YOU NEED TO DO BEFORE YOU CAN MOVE INTO THE BODY. HOWEVER, ONE /OF OUR FRIENDS DID INSERT ND /P-FPPAE AS AN EXAMPLE UNDER BILLING CODE FOR OTHER OTHER SPECIFIC NEWUROBEHAVIORAL DEVELOPMENTAL STORED AND PEOPLE ARE BEING COMPENSATE /S-D FOR USING THIS /TKHOED TODAY. OKAY, SO WHAT ELSE DID WE NEED TO DO? WELL, WE NEEDED SOME INFORMATION DISSEMINATION /AFBD /KAECASE -- /AFBD /KADVOCACY. AND TO GET STARTED ON THAT, WE'VE HAD PRESENTATIONS THAT -- AT SEVERAL DIFFERENT MEETINGS. LAST FALL SOME OF OUR /KPWRAOUPZ DID SOME PRESENTATIONS IN VENUES AT THE ACADEMY OF CHILD AND ADD LEGISLATIONENT PSYCHIATRY MEETING IN CHICAGO. WE HAD PRESENTATIONS BY JEWULIE AND SARAH AND HEATHER CAR MIKE MICHAEL AT THE CONFERENCE ON FAS FASD, WHICH WAS IN VANCOUVER, WHICH YOU HEARD ABOUT EARLIER TODAY FROM PEGGY MURRAY. AND INTEREST WILL BE PRESENTATIONS AT THE AMERICAN PSYCHIATRIC ASSOCIATION MEETING UPCOMING SOON. WE NEED AID PUBLICATION TO INTRODUCE ND /P-FPPAE WITH MORE INFORMATION AND WE HAVE PREPARED PUBLICATION AND IT'S BEING WE NEEDED A BETTER CONVERSATION OF SIGNIFICANT AMOUNTS OF PRE- PRE-NATAL ALCOHOL EXPOSURE AND SOME OF THE PEOPLE ON THE DIGEST DIGESTIC ISSUES WORK GROUP ARE SUBMITTING PROPOSALS AS /AA GROUP TO ADDRESS THAT SITUATION FROM USING SECOND AARY DATA ANALYSIS THAT THE DATABASE ALREADY HAVE. WE ALSO NEEDED DATA TO SUPPORT THE CRYEREIA AS DELINEATED. SO WE NEED VALID /A*EATION STUDIES AND THE /PHERAMERICAN PSYCHIATRIC ASSOCIATION PRETTY MUCH TOLD US WHAT THEY EXPECTED. AND WE NEEDED VALIDITY FOR OTHER DEVELOPMENTAL DISORDERS. NOW WE'VE STARTED A LOT /OF WORK ON THE VALID /A*EATION BE STUDIES BY GETTING SOME OF THE PEOPLE THAT WERE ON THE DIAGNOSISIC WORK GROUP AND SOME THAT INVESTIGATED THAT HAD VERY LARGE SIDE POPULATION THAT'S WE THOUGHT THAT WE COULD USE FORTHIS FOR A VALIDATION STUDY. SO THAT'S WHERE WE ARE RIGHT NOW NOW. ANY QUESTIONS? OKAY, THANKS. /PHRA [APPLAUSE] /PHRAURS SO NOW WE ARE AT THE POINT WHERE WE HAVE OPEN DISCUSSION ON MANY OF THE TOPICS THAT WE'VE DISCUSSED TODAY OR OTHER THINGS THAT FOLKS WITH -- HAVE THAN OR MIND. COMMENTS? >> IT'S BEEN A FULL DAY. >> YES. SALLY? >> THOSE OF US THAT HAVE JUST PUT IN TWO 15-HOUR DAYS ARE GETTING TIRED. >> >> THANK YOU ALL POR COMING. THANK YOU FOR YOUR PARTICIPATION PARTICIPATION. THANK YOU FOR YOUR QUESTIONS. THIS VIDEO CAST SHOULD BE ON THE NIH RADIO CAST WEBSITE. PLEASE TELL YOUR FRIENDS THAT WERE UNABLE TO COME IT WILL BE THERE FOR HISTORICAL PURPOSES FOR THEIR VIEW AND TO PLEASE CONTACT ANY OF US WITH ANY QUESTIONS. THANK YOU. /PHRA [APPLAUSE] >> THANK YOU ALL.