THANKS TO ALL OF YOU FOR COMING. I WAS TELLING PEOPLE THIS MORNING THAT I KNOW IT'S A HARD BUILDING TO FIND AND HARD BUILDING SOMETIMES TO NAVIGATE. IF YOU NEED DIRECTIONS TO RESTROOMS, THEY ARE OUT THE DOOR TO THE MAIN FOYER TO THE LEFT, AND ANOTHER LEFT, BUT WE WOULD BE HAPPY TO GUIDE YOU. THERE'S COFFEE AND SOME SNACKS OUTSIDE. I RECOMMEND THE RASPBERRY COOKIES. AND WE ARE SEE APPRECIATIVE OF YOU BEING HERE. THIS IS A REALLY IMPORTANT GROUP. IT BRINGS TOGETHER FEDERAL AGENCIES THAT ALL HAVE AN INTEREST IN THIS, HAVE A LITTLE DIFFERENT PERSPECTIVE ON IT, AND TAKE DIFFERENT PIECES OF IT. SO IT REALLY ALLOWS US TO DO MUCH MORE THAN ANY OF US COULD DO INDIVIDUALLY. WELCOME TO ALL WHO ARE JOINING US BY VIDEOCAST. THANK YOU SO MUCH. WELCOME TO THE PEOPLE IN THE ROOM, AND A SPECIAL THANKS TO OUR PRESENTERS, WE SO APPRECIATE YOU BEING HERE SHARING WHAT YOU DO AND YOUR WISDOM WITH US. AND I THINK WHAT I'D LIKE TO DO FIRST IS GO AROUND THE TABLE WITH INTRODUCTIONS AND AROUND THE REST OF THE ROOM SO WE KNOW WHO IS HERE. I'M TRISH POWELL, CHAIR OF THE COORDINATING COMMITTEE, I'M ALSO DEPUTY DIRECTOR AT NIAAA. >> TATIANA BALACHOVA, SCIENTIFIC COORDINATOR AND EXECUTIVE SECRETARY FOR THIS COMMITTEE. >> I'M SALLY ANDERSON, COORDINATOR AND EXECUTIVE SECRETARY, NOW JUST AN ADVISER TO THE COMMITTEE. >> NOT "JUST." >> GOOD MORNING, THIS IS DAWN LEVENSON, HEALTH RESOURCES AND SERVICES ADMINISTRATION WITH MATERNAL AND CHILD HEALTH BUREAU. >> GOOD MORNING, SHEN KIM, TEAM LEAD FOR PRENATAL ALCOHOL OPIOID AND SUBSTANCE EXPOSURE TEAM, NATIONAL CENTER FOR BIRTH DEFECT. >> CAITLIN CROSS BURNETT, INNOVATION CENTER, A DIVISION OF THE CENTER FOR MEDICARE AND MEDICAID SERVICES. >> (INAUDIBLE) DISTANCE DEVELOPMENT AT SAMHSA. >> KAREN SOROCO, NIDA, DIVISION OF EPIDEMIOLOGY, SERVICES AND PREVENTION, A LOT OF PRENATAL EXPOSURE COMES TO MY PORTFOLIO. >> TRACY KING, MEDICAL OFFICER IN THE INTELLECTUAL AND DEVELOPMENTAL DISABILITIES BRANCH AND NICHD. >> GOOD MORNING, BILL DUNTY, PROGRAM OFFICER AT THE DIVISION OF METABOLISM AND HEALTH DEFECTS AT NIAAA, I HAVE BEEN INVOLVED IN THE COMMITTEE BUT THIS IS MY FIRST MEETING AS OFFICIAL I.C. REPRESENTATIVE TO THE COMMITTEE. >> KEN JONES, DEPARTMENT OF PEDIATRICS, UNIVERSITY OF CALIFORNIA SAN DIEGO. >> DEVELOPMENTAL BEHAVIORAL PEDIATRICIAN FROM NORTH CAROLINA. >> CHRIS BOYES, ASSOCIATE PROFESSOR, DEPARTMENT OF MINNESOTA, CLINICAL DIRECTOR OF FASD PROGRAM THERE. >> MOLLY MALIANZ. >> I WORK FOR THE CHILDREN'S BUREAU, THE CHILDREN'S BUREAU IS DOWN HERE, AND THERE'S THE ADMINISTRATION FOR CHILDREN AND FAMILIES, AND THEN HHS. I WORK AT THE CHILDREN'S BUREAU. >> MY NAME IS CHRISTINA WENDT, HHS, WITH THE BEHAVIORAL HEALTH TEAM. THIS IS MY FIRST TIME THAT MY OFFICE IS REPRESENTED AT THIS -- AT THE COMMITTEE MEETING, SO I'M LOOKING FORWARD TO THE DISCUSSIONS TODAY. THANK YOU. >> I WANT TO GO AROUND THE ROOM, IF YOU WOULDN'T MIND INTRODUCING YOURSELF. >> GOOD MORNING, RACHEL ANDERSON, I WORK IN THE SCIENCE POLICY BRANCH HERE AT NIAAA, HERE TO TAKE NOTES TODAY. >> DIVISION OF EPIDEMIOLOGY. >> (INAUDIBLE). >> GOOD MORNING, ALLISON (INAUDIBLE). >> HI, MY NAME IS (INAUDIBLE), PROGRAM OFFICER AT (INAUDIBLE). >> GOOD MORNING. BILL LONG. >> CHRIS, WOULD YOU LIKE TO INTRODUCE YOURSELF PLEASE? >> YES, SORRY ABOUT THAT. I WAS ON MUTE. HI THERE, CHRIS FORUM, INDIAN HEALTH SERVICE, DIRECTOR OF THE IHS CENTER OF EXCELLENCE, ALSO CURRENTLY FUNCTIONING AS THE LEAD FOR FASD WITHIN THE AGENCY. THANK YOU >> GREAT. THANK YOU SO MUCH. I WANT TO GIVE A SPECIAL THANKS TO SALLY AND TATIANA FOR SETTING UP THIS MEETING, ARRANGING OUR ESTEEMED GROUP OF SPEAKERS. I THINK IT'S GOING TO BE A GREAT MEETING. I WANT TO THANK MICHAEL AND TIM FOR DOING ALL THE AV STUFF TO VIDEOCAST AND WEBCAST. THANK YOU. THANKS TO OUR CONTRACTORS WHO ARE HERE AND WELCOMING YOU AND GETTING YOU SIGNED IN AND WHERE YOU NEED TO GO. WITH THAT, THE LAST THING ON MY LIST IS TO FORMALLY INTRODUCE TATIANA BALACHOVA. SHE'S TAKEN OVER AS THE SCIENTIFIC COORDINATOR AND EXECUTIVE SECRETARY OF ICCFASD. IN ONE OF THE VERSIONS I SAW SHE'S REPLACING MARCIA. WE MISS HER AND WISH HER WELL IN RETIREMENT, BUT TATIANA'S TAKING US IN OUR NEXT PHASE OF THIS, AND WE'RE SO, SO PLEAD -- PLEASED TO HAVE HER. SHE CAME FROM THE UNIVERSITY OF OKLAHOMA HEALTH SCIENCES CENTER, FACULTY IN THE DEPARTMENT OF PEDIATRICS SINCE 2003, SERVING AS CO-DIRECTOR OF THE INTERDISCIPLINARY TRAINING PROGRAM, CHILD ABUSE AND NEGLECT, GRADUATIONAL FACULTY IN CLINICAL SCIENCES, ADJUNCT IN DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES, A LEADING EXPERT IN PREVENTION OF ALCOHOL EXPOSED PREGNANCIES AND FASD, HENCE THE REASON WE'RE SO PLEASED TO HAVE HER DOING THIS. SHE'S BEEN AT THE FOREFRONT OF DEVELOPING INTERVENTIONS FOR HIGH RISK POPULATIONS, AND HER RESEARCH RANGES FROM INTERVENTION, DEVELOPMENT, TRANSPLAGUES OF EMPIRICALLY SUPPORTED PRACTICES IN REAL WORLD SETTINGS, I'M TURNING THE MEETING OVER TO YOU. WELCOME. >> THANK YOU. >> I WILL TRY MY BEST, AND I THINK I CAN SAY SOMETHING AS SOMEONE COMING FROM OUTSIDE. I'M NEW ON THE COMMITTEE, NOT NEW FOR FASD FIELD. BECAUSE OF THIS, I REALLY FEEL I COULD SEE WHAT IMPACT ICCFASD HAS HAD ON THE FIELD. THANK YOU FOR WHAT YOU'VE BEEN DOING FOR MANY YEARS AND ALSO I WANT TO THANK PEOPLE WHO HAVE BEEN IN THIS COMMITTEE, AND HAVE RETIRED RECENTLY, OR DEPARTED FROM THE COMMITTEE BECAUSE OF CHANGES, AND YOU CAN SEE WE HAVE SEVERAL PEOPLE WHO LEFT THIS COMMITTEE, AND NOT SERVING WITH US ANYMORE. RECENT NAMES INCLUDED HERE, WE MISS MARCIA GREATLY. WE WELCOME KAREN FROM NIDA, AND WE DON'T HAVE REPRESENTATIVE AT THIS TIME FROM DEPARTMENT OF JUSTICE. AGAIN, WE WANT TO THANK YOU, EVERYONE, AND I LISTED TWO RECENT CHANGES, BUT WE WANT TO SAY THAT REALLY EVERYONE WHO SERVED ON THE COMMITTEE HAS BEEN IMPORTANT AND PROVIDED VERY IMPORTANT IMPACT ON THE FIELD. VERY BRIEFLY, I WILL GO THROUGH THIS INFORMATION TO REFRESH MEMORY, AND I KNOW MEMBERS OF COMMITTEE WHO SERVED NOT ALWAYS BUT I ALSO WANT TO SHOW PEOPLE WHO ARE NEW, NEWCOMERS, AND ALSO PEOPLE ON THE VIDEOCAST WHO CAN KNOW THIS INFORMATION. ICCFASD IS AIMED TO IMPROVE COMMUNICATION, PREPARATION AND COOPERATION BETWEEN FEDERAL AGENCIES AND DIFFERENT DISCIPLINES. AND THIS HAS BEEN VERY IMPORTANT TASK. WE WORK ON ISSUES RELATED TO PRENATAL ALCOHOL EXPOSURE, AND WE SPEAK NOW MORE ABOUT COMBINED EXPOSURE TO DIFFERENT SUBSTANCES SO IT'S REALLY IMPORTANT TOPIC WHICH WE ADDRESS. AND IMPROVING COOPERATION AND COMMUNICATION, IMPROVED COOPERATION BETWEEN AGENCIES IS CRITICAL AND WE ALL KNOW HOW IMPORTANT THIS IS FOR CONTINUATION OF WORK. I HAVE REVIEWED HISTORY AND REPORTS FROM ICCFASD REPORTS AND I CAN REALLY SEE HOW THIS HAS BEEN DONE WITH DIFFERENT PROJECTS. COMMITTEES HAVE JOINT REPORTS, CREATING SPECIFIC TARGETED FOCUS WORKING GROUPS WHICH WOULD HELP TO MOVE THIS FIELD. ICCFASD WAS ESTABLISHED IN 1996. IT WAS THE RESULT OF CONGRESS TO INSTITUTE OF MEDICINE FOR SPECIAL REPORT. AND 1996 COMMITTEE WAS ESTABLISHED BECAUSE THE REPORT INDICATED THAT THERE IS NEED TO IMPROVE COORDINATION ON NATIONAL LEVEL TO IMPROVE SERVICES AND ADDRESS NEEDS OF PEOPLE, BY ALCOHOL EXPOSURE. SO THIS COMMITTEE WAS ESTABLISHED TO COORDINATE NATIONAL EFFORTS, AND COMMITTEE INCLUDES FEDERAL AGENCIES, PRIMARY WITHIN THE DEPARTMENT OF HEALTH AND HUMAN SERVICES. SUPPORT PROVIDED BY NIAAA SINCE 1996, THE COMMITTEE HAS BEEN CHAIRED BY NIAAA. YOU CAN SEE HOW MANY AGENCIES INVOLVED AROUND THE TABLE. IT'S AMAZING TO THINK HOW MUCH POWER WE CAN HAVE WORKING TOGETHER. AS EXPECTED MAJORITY OF AGENCIES OF HHS, AGENCIES, BUT ALSO SINCE 1996 DEPARTMENT OF EDUCATION AND DEPARTMENT OF JUVENILE PREVENTION, UNIT OF DEPARTMENT OF JUSTICE, HAVE BEEN VERY ACTIVE ON ICCFASD. SO, DIFFERENT AGENCIES PROVIDE SPECIFIC INPUT. EACH AGENCY GIVES VERY SPECIFIC AREA, AND YOU CAN SEE DIFFERENT AREAS WHERE EACH OF YOU BRINGS YOUR OWN AREA OF FOCUS. BECAUSE OF THIS IT'S VERY IMPORTANT THAT WE HAVE ALL AGENCIES AROUND THE TABLE. CURRENT MEMBERS INCLUDED ON THIS SLIDE, WHEN I FINISH MY BRIEF OVERVIEW I WILL LET EACH AGENCY TO PROVIDE REPORT. SO WE CAN HEAR RECENT IN THE FIELD. TALKS WHICH COMMITTEE HAS ADRESSED, THIS HAS BEEN DONE FOR MANY YEARS NOW, AND WE WILL SEE HOW FIELDS DEVELOP AND BRING NEW TOPICS BUT WHEN WE LOOK AT WHAT HAS BEEN DONE IT'S STILL A LOT OF WORK NEEDS TO BE DONE IN THIS AREA. SO IT MAY STAY THE SAME FOR SOME TIME AS WELL. STRUCTURE EVERY YEAR, ICCFASD ALSO CREATED COMMITTEES, SPECIAL WORKING GROUPS, SUBCOMITTEES, WHICH GO TO SPECIFIC TOPICS. THERE HAVE BEEN SEVERAL SINCE 1996. USUALLY THESE GROUPS CAN INVOLVE EXPERTS TO HAVE BROAD PERSPECTIVE AND MORE DIRECT KNOWLEDGE TO BRING TO THIS TOPIC. AND USUALLY, THIS SPECIFIC GROUPS WILL -- [ NO AUDIO ] WITH OTHER ORGANIZATIONS, AS A RESULT, IN 2012, WITH AMERICAN BAR ASSOCIATION WAS -- RESOLUTION WAS ASSIGNED FOR REALLY URGED TO PROVIDE SPECIAL RECOGNITION FOR SERVICES AND ALSO ESTABLISH TO ADDRESS NEEDS OF PEOPLE IN JUSTICE SYSTEM COURT. AFTER THIS RESOLUTION OF SEVERAL EFFORTS, ICCFASD COORDINATED TO IMPROVE KNOWLEDGE. AND SEVERAL FIELDS, FOR EXAMPLE, GUIDE FOR JUDGES HAS BEEN PREPARED AND PUBLISHED BY ICCFASD IN COOPERATION WITH PARTNER AGENCIES. IT HAS BEEN SIGNIFICANT IMPACT. I CAN SAY AS PROVIDER IN MY STATE BECAUSE I WAS AT THIS TIME IN OKLAHOMA, WE COULD SEE EFFECT. WE COULD SEE, BECAUSE I RECEIVED CALL THAT WORKSHOPS COMING TO OKLAHOMA, SOMEONE IS COMING TO SPEAK TO JUDGES IN MY STATE ABOUT FASD, AND AT THAT TIME IT WAS REALLY A TOPIC WHICH HAS BEEN ADDRESSED VERY MUCH. WE CAN SEE THESE CHANGES. WHAT IS IMPORTANT I THINK FOR US TO LEARN THE LESSON DESPITE REPRESENTATION FROM DEPARTMENT OF JUSTICE, WE HOPE WE WILL HAVE NEW REPRESENTATIVE SOON. EFFORTS THAT ICCFASD HAS MADE AN IMPACT REMAINS, JUDGES, LEGAL PROFESSIONALS, THEY HAVE EDUCATIONAL MATERIAL, SOME JUDGES WHO PARTICIPATED IN THIS, DEFINITELY SEEDS HAVE BEEN PLANTED AND CONTINUE TO GROW. THIS IS EXAMPLES EVEN IF WE DON'T HAVE REPRESENTATIVE AT THE TABLE RIGHT NOW, WE STILL CAN -- IT'S STILL IMPORTANT. AND EVEN IF WE DON'T FEEL OPPORTUNITIES, SOME POINT IN TIME, SPECIFIC AGENCY, IT WILL COME, BECAUSE WHEN WE CAN SEE, WE CAN HAVE A CHAMPION IN PEDIATRICS, WE CAN HAVE THE EXPERTS TO WORK WITH AGENCIES TO IMPROVE WHAT WE CAN DO IN OUR FIELD. SO WE HAVE REMAINING CHALLENGES AT THIS VERY IMPORTANT TIME. WE KNOW FROM RESEARCH FASD, THERE'S SOMETHING TECHNOLOGY ADVANCES PROMISING AND WE HOPE IT WILL HELP US TO IMPROVE RECOGNITION AND HELP PROFESSIONALS TO IMPROVE SERVICES FOR PEOPLE, SIGNIFICANT APPROACHES, SPEAKING ABOUT RECOGNITION IN DIFFERENT SYSTEMS. SO AT THIS POINT I INVITE AGENCIES TO PROVIDE AGENCY'S REPORTS, AND I THINK AGENDA HAS ACF IF YOU CAN COME AND PRESENT. IF YOU DON'T HAVE SLIDES, YOU CAN REMAIN IN YOUR SEAT. OKAY. WE'LL BEGIN WITH ADMINISTRATION WITH CHILDREN AND FAMILIES. AND, SHARON, YOU WANT TO SPEAK FROM YOUR CHAIR? >> (INAUDIBLE). >> YEAH. >> OKAY. WAIT A MINUTE NOW. THIS IS THE LITTLE -- AND THEN YOU KEEP PUSHING, OKAY. CAN YOU HEAR ME? YES, I GUESS YOU CAN. I'M FROM THE CHILDREN'S BUREAU. I'VE BEEN WORKING FOR THE LAST SEVERAL YEARS WITH SOMEBODY, DR. JACQUELINE BERTRAND FROM THE CDC, WE HOOKED UP TRUE THIS GROUP SO I'M GRATEFUL TO THIS GROUP FOR INTRODUCING THE TWO OF US. AND SO WE'RE WORKING ON A PROJECT TOGETHER, AND NOW WE'VE DISCOVERED THAT WE'RE GOING TO HAVE MORE MONEY FOR ANOTHER SEVERAL YEARS TO DO SOMETHING A LITTLE BIT DIFFERENT. AND SO WE'RE VERY HAPPY. WE HAVE A LOT OF REASONS TO BELIEVE THAT FOSTER CARE AT LEAST A LOT OF THESE CHILDREN, FETAL ALCOHOL SPECTRUM DISORDER, ARE UNDERDIAGNOSED. SOME OF YOU MAY BE FAMILIAR WITH PEDIATRICIAN IRA CHASNOF'S STUDY, DOING A THOROUGH DIAGNOSTIC WORKUP ON A LARGE NUMBER OF CHILDREN, AND THEN HE'S LOOKING BACK AND SAYING, LET'S SEE, WELL, THESE CHILDREN ARE IN FOSTER CARE AND SO OF THE ONES WHO WERE IN FOSTER CARE, HOW MANY OF THEM WERE NOT IDENTIFIED? EVEN THOUGH HE FOUND THESE KIDS HAD FETAL ALCOHOL AL ALCOHOL SPECTRUM DISORDER, 80% HAD NOT BEEN IDENTIFIED WHEN THEY FIRST CAME INTO FOSTER CARE, IT WAS PRETTY SHOCKING TO ME ALTHOUGH NOT SURPRISING TO A LOT OF PEOPLE THAT I KNOW WHO KNOW SOMETHING ABOUT THIS FIELD. ANYWAYS, WE KNOW THAT A LOT OF THESE KIDS ARE MISSED, AND THEN OUR QUESTION IS WHY IS THAT HAPPENING? AND SO WHAT WE STARTED OUT DOING WAS GOING TO A NUMBER OF DIFFERENT SITES. OKAY, I'M GETTING AHEAD OF MYSELF HERE LOOKING AT THIS. IF YOU DON'T RECOGNIZE WHAT THE PROBLEM IS, THEY ARE NOT GOING TO GET THE RIGHT SERVICES THAT THEY NEED. AND ONE OF THE THINGS THAT HAPPENS WITH THESE CHILDREN IS THAT THEY ARE VERY OFTEN MISIDENTIFIED AS HAVING ADHD OR SOME OTHER KIND OF PROBLEM, AND A LOT OF TIMES THEY END UP BEING ON A WHOLE LAUNDRY LIST OF DRUGS, PSYCHOACTIVE DRUGS, TO TRY TO HELP THEM OUT. BUT THEY ARE NOT WORKING BECAUSE THOSE ARE NOT REALLY MAXIMALLY WHAT THEY NEED. SO LET'S SEE HERE. SO, THE GOAL IN FIRST PHASE THAT WE'RE WORKING ON NOW, WE'VE BEEN WORKING ON FOR THE LAST THREE YEARS, IS TO FIGURE OUT WHAT HAPPENS WHEN A CHILD FIRST WALKS THROUGH THAT DOOR, OR THE WHOLE FAMILY WALKS THROUGH THE DOOR AT THAT CHILD WELFARE AGENCY, WHAT ARE THE POLICIES AND PRACTICES USED. THE GOAL IS WHY ARE THEY MISSING 80% OF THESE KIDS THAT HAVE THIS FETAL ALCOHOL SPECTRUM DISORDER AS A TRUE DIAGNOSIS? AND HOW DO THEY DETERMINE WHEN AND HOW THESE CHILDREN SHOULD BE SCREENED FOR THAT? ONE OF THE THINGS I KEEP SAYING, I'M INFAMOUS IN MY LITTLE GROUP THAT DOES FOR SAYING NOBODY IS ASKING THE QUESTION, AND I UNDERSTAND -- IT ISN'T REALLY TRUE THAT NOBODY IS ASKING THE QUESTION, BUT SOMEBODY AT THE START HAS TO BE SUSPICIOUS THAT THERE COULD BE A REASONABLE EXPECTATION THIS CHILD HAS A FETAL ALCOHOL SPECTRUM DISORDER AND THEY ARE NOT DOING THAT. WE KNOW WHERE CAN YOU GO TO HAVE THEM FULLY DIAGNOSED AND DO ALL THE MEDICAL SCREENING AND SO FORTH, BUT THAT'S NOT REALLY WHAT THE PROBLEM IS. THE PROBLEM IS THEY DON'T EVEN GET TO THAT POINT BECAUSE NOBODY'S ASKING, NOBODY IS SUSPICIOUS. SO WHAT I'M FOCUSED ON IS WHAT HAPPENS TO THEM WHEN THEY FIRST COME TO THE ATTENTION OF THAT CHILD WELFARE AGENCY, AND WHAT ABOUT VERY COMPLICATED TESTS, I'M TALKING ABOUT JUST THINGS THAT CAN MAKE THAT INTAKE WORKER OR ONGOING CASE WORKER SUSPICIOUS AND THEY NEED TO KNOW ENOUGH ABOUT FASDs TO HAVE A CLUE THAT THEY NEED TO BE REFERRED. SO, I'M VERY EAGER TO HEAR -- I KNOW A LOT OF THIS IS ABOUT SCREENING AND ACTUALLY I WAS ONE OF THE ONES WHO SUGGESTED WE DO, YOU KNOW, A MEETING HAVING TO DO WITH SCREENING SO I'M EAGER TO HEAR MORE ABOUT THAT. SO, WHAT WE'RE DOING RIGHT NOW, WE HAVE FIVE STATES, AND IT ISN'T REALLY A NATIONAL STUDY. WE DIDN'T RANDOMLY SELECT THESE SITES OR ANYTHING BUT DID TRY TO BE REASONABLE, JUDICIOUS IN WHAT WE CHOSE. THEY ARE IN DIFFERENT PARTS OF THE COUNTRY. WE HAVE A NORTHEASTERN STATE, MID-ATLANTIC, A SOUTHERN STATE, A COUPLE IN THE MIDWEST, ONE IN THE FAR NORTHWEST, AND WE ALSO WANTED TO HAVE SOME THAT WERE MORE RURAL OR SUBURBAN. THE FIRST ONE WE DID AS A TINY LITTLE STUDY WAS A VERY URBAN SETTING, CLOSE BY HERE IN WASHINGTON, D.C. BUT THAT WON'T DO BECAUSE WE NEED TO UNDERSTAND MORE BROADLY WHAT GOES ON IN A LOT OF CHILD WELFARE AGENCIES. SO, WE'VE COLLECTED A LOT OF DATA FROM SEVERAL STATES. AND ONE OF THE THINGS THAT WE FIND IS THAT IF YOU'RE FROM THE CHILDREN'S BUREAU, AND I'M IN THE CHILDREN'S BUREAU, PEOPLE ARE GOING TO BE SUSPICIOUS OF YOU WHEN YOU COME TO A STATE. THE REASON IS BECAUSE THE CHILDREN'S BUREAU DOES A LOT OF PERFORMANCE EVALUATION KINDS OF STUFF. WE HAVE CHILD AND FAMILY SERVICES REVIEWS, ARE THEY USING THEIR MONEY APPROPRIATELY FOR THAT? WE DO FOUR REVIEWS, YOU DON'T NEED TO KNOW WHAT THESE ARE, BUT WE DO DIFFERENT TYPES OF REVIEWS. AND SO THE STATES SEEM TO BE WARY OF US. ONE OF THE THINGS WE ASSURE THEM OF, ANY REPORTS THAT COME OUT OF THIS, WE'RE NOT GOING TO BE NAMING THE STATE. THAT CAN HAVE THEM FEEL PERHAPS MORE RELAXED, THAT THEY CAN SAY THINGS THEY MIGHT OTHERWISE NOT WANT TO SAY, EVEN THE DIRECTOR CAN SAY THINGS THEY WOULDN'T OTHERWISE SAY IF THEY THOUGHT IT WAS GOING TO BE PUBLISHED. YOU KNOW, THE STATE OF WHATEVER SAYS THIS IS WHAT THEY DO. OKAY. SO IN MOST OF THE STATES, WE'RE JUST DOING INTERVIEWS WITH VARIOUS LEVELS OF STAFF, WITH THE INTAKE WORKERS, AND THE ONGOING CASE WORK STAFF AND SO FORTH. BUT WE ALSO HAVE A COUPLE STATES WHERE WE'RE DOING MORE IN-DEPTH KINDS OF THINGS. WE'RE GOING ACTUALLY INTO DATA FILES, CASE NOTES. ONE OF THE ISSUES IS WE DO COLLECT DATA AT THE CHILDREN'S BUREAU, BUT THAT DOESN'T NECESSARILY MEAN WE LEARN EVERYTHING ABOUT A CASE FROM THE DATA THAT COME TO US. AND OFTEN WE KNOW NOTHING ABOUT ANY PRENATAL ALCOHOL EXPOSURE OR ANY OTHER TYPE OF EXPOSURE FROM LOOKING AT THE DATA FILES THAT I SEE, AND THAT MY LITTLE RESEARCHY GROUP SEES ALL THE TIME. BUT IF YOU GO INTO THE CASE NOTES YOU'LL SEE ALL KINDS OF REFERENCE REPRESENTSES TO THESE MATTERS. WHAT IS IT? OH, ALL RIGHT. I MAY BE JUST CHATTING ON. OKAY. WELL, LET ME SAY ONE MORE THING, THAT WE'RE ALSO IN THESE MORE IN-DEPTH STATES DOING A FOCUS GROUP, OR FOCUS GROUPS, WITH THE FOSTER PARENTS AND FINDING OUT WHAT'S GOING ON THERE AND WHAT THEIR ISSUES ARE, OF NOT UNDERSTANDING ANYTHING ABOUT THIS TOPIC. WAIT A MINUTE. I DID THAT. I WAS PERFECTLY HAPPY TO CHAT THINGS UP AND NOT PAY ATTENTION AT ALL TO -- ALL RIGHT. WE HAVE THESE IN-DEPTH STATES, NOW I'M GOING ON TO TALK ABOUT TRIBES. WE DIDN'T WANT TO LEAVE TRIBES OUT, OF COURSE, BUT WE WANTED TO WORK WITH THEM TO MAKE SURE THEY FELT COMFORTABLE AND TRUST WE WERE NOT THERE TO MAKE TROUBLE FOR THEM. WE'RE NOT DOING THEM IN THE SAME WAY WITH ALL THESE INTERVIEWS AND SO FORTH. AND WE'RE ALSO GOING TO LIMIT THOSE WHO ARE FROM THE FEDERAL GOVERNMENT WILL UNDERSTAND THE SIGNIFICANCE OF THAT. WHEN WE GET TO INTERVIEWING, AT THAT STAGE ONLY USING NINE PEOPLE BECAUSE TO DO MORE YOU NEED TO DO AN OMB PROCEDURE AND WE DON'T WANT TO HAVE TO DO THAT WITH THIS BECAUSE IT'S A DIFFERENT GOAL. IT'S BEEN DIFFICULT WORKING WITH THE TRIBES, WE GO INTO A COUPLE DIFFERENT LOCATIONS, AND TALKED ABOUT OUR WORK. WE WERE REALLY RECRUITING, TRYING TO GET AT LEAST ONE TRIBE THAT WOULD BE INTERESTED IN TALKING WITH US IN DEPTH. AND WE DO HAVE A TENTATIVE AGREEMENT NOW TO WORK WITH ONE TRIBE. NOW, ONE OF THE THINGS WE LEARNED FROM JUST CHATTING WITH THE TRIBES IS THAT THEY KNOW THEY HAVE A PROBLEM WITH THIS, BUT EVEN IF THEY CAN PROVIDE SERVICES, EVEN IF THEY HAVE MONEY FOR SERVICES, THEY CAN'T GET THE FAMILY TO WHERE THE SERVICES ARE, BECAUSE IT'S VERY RURAL. SO, THAT'S ONE THING. THE OTHER THING THAT THE TRIBES VERY OFTEN SAY IS JUST GIVE US THE MONEY. WE KNOW WHAT TO DO WITH IT. JUST GIVE US THE MONEY. WHAT I'VE HAD TO EXPLAIN TO THEM, I'M SYMPATHETIC WITH THAT, BUT CONGRESS DOES NOT GIVE YOU ANY MONEY UNLESS YOU'RE GOING TO TELL THEM EXACTLY WHAT YOU DID WITH THAT MONEY. AND SO I'M TRYING TO ENCOURAGE THEM TO UNDERSTAND THAT WE'RE GOING TO NEED TO GET SOME INFORMATION FROM THEM. I ALSO TOLD THEM THAT I THINK WHAT CONGRESS WANTS IS TWO THINGS. THEY WANT NUMBERS, AND THEY ALSO WANT A STORY. ANY WAY YOU CAN COME UP WITH BOTH NUMBERS AND A STORY, YOU'RE GOING TO BE MORE CONVINCING TO CONGRESS. ALL RIGHT. NOW, ONE PAGE YOU CAN CROSS -- ON PAGE 5 OF YOU'RE OUTLINE, THAT'S A REPEAT OF WHAT I SAID. SO NOW WE'RE DOING PLANNING. I'M REALLY NOT KEEPING UP HERE. SO, LISTENING TO WHAT OTHER PEOPLE ARE TALKING ABOUT, THEY ARE TALKING ABOUT MILLIONS AND MILLIONS OF DOLLARS ON VARIOUS PROJECTS. OURS IS TINY COMPARED TO THAT BUT WE HAVE $6 MILLION, WHICH I WAS THRILLED ABOUT, AND WE HAVE $5 MILLION FOR MY CHILDREN'S BUREAU, AND ANOTHER $1 MILLION WHICH WE'RE GRATEFUL FOR FROM THE CDC. AND SO AT FIRST WE'VE BEEN LEARNING ABOUT WHAT'S GOING ON AT THE AGENCIES, WHAT'S WRONG. THE SECOND PHASE WHICH WE'RE GETTING READY TO DO THIS FALL IS WE WANT TO EITHER LOCATE OR DEVELOP AND THEN EVALUATE DIFFERENT TOOLS THAT CAN BE USED FOR DIFFERENT GROUPS OF PEOPLE. SOCIAL WORKERS DON'T HAVE THE SAME NEED FOR THE SAME TYPE OF TOOL AS PARENTS DO. AND THEY DON'T HAVE THE SAME TYPE OF NEED THAT THE MEDICAL STAFF AT A CHILD WELFARE AGENCY HAVE SO WE NEED TO LOOK AT ALL OF THOSE GROUPS. I KNOW THERE ARE A NUMBER OF TOOLS AND WE'RE GOING TO BE HEARING MORE ABOUT THEM TODAY. I'M GETTING THE SIGN THAT I NEED TO END. >> THANK YOU VERY MUCH. ANY QUESTIONS AT THIS TIME? WE HAVE TIME AT THE END FOR DISCUSSION IF QUESTIONS COME UP. NOW I WOULD LIKE TO INTRODUCE CHRIS FROM INDIAN HEALTH SERVICES, AND CHRIS ALREADY INTRODUCED HIMSELF. HE HAD TIME CONFLICT SO HE'S ON WEBEX NOW. PLEASE CAN YOU UNMUTE YOURSELF AND YOU'RE WELCOME TO GIVE YOUR REPORT. >> GREAT. THANK YOU, EVERYONE. WELL, DESPITE NOT BEING THERE IN PERSON I'M HAPPY TO PARTICIPATE ON BEHALF OF INDIAN HEALTH SERVICE. I WANT TO GIVE A BRIEF SUMMARY OF SOME THINGS WE'RE DOING AND PLANS IN THE NEAR FUTURE. FIRST, YOU ALL SHOULD KNOW THAT OUR ALCOHOL LEAD RECENTLY TRANSITIONED TO A DIFFERENT POSITION WITHIN THE AGENCY SO THAT POSITION IS CURRENTLY VACANT. THERE ARE PLANS TO GET THAT POSTED QUICKLY AND REFILLED, CLEARLY THAT IS A KEY POSITION FOR OUR AGENCY, ESPECIALLY RELATED TO FASD, BUT WITH ALL THE OTHER SUBSTANCES OUT THERE AS WELL, SO WE'RE HOPING TO GET THAT POSITION FILLED VERY QUICKLY. AND MY UNDERSTANDING IS THAT PERSON WOULD BE AT HEADQUARTERS IN ROCKVILLE TO INTERACT WITH OUR PARTNERS AND SISTER AGENCIES UP THERE. SO WE'RE REALLY LOOKING FORWARD TO THAT. ONE OF THE THINGS I THINK THAT SETS OUR AGENCY A LITTLE BIT APART FROM SOME OTHERS, PATIENT POPULATON THAT WE SERVE THE -- NOW 576 FEDERALLY RECOGNIZED TRIBES IN THIS COUNTRYT AND OUR POPULATION IS FAIRLY IMPOVERISHED, HUGE HEALTH DISPARITIES. ONE OF THE THINGS WE ALSO TRY TO BE VERY AWARE OF ARE FIRST CHILDHOOD EXPERIENCES, WE KNOW OUR POP HAITIAN - POPUATION SERVICES HAS A HIGH NUMBER, THAT PRESENTS LOTS OF CHALLENGES. GIVEN THAT, WE ALSO KNOW THAT -- AND ONE OF THE INITIATIVES WE'RE TRYING TO PUSH IS BEING -- TAKING MORE TRAUMA-INFORMED CARE APPROACH. WE KNOW THAT MANY OF THOSE IN OUR USER POPULATION HAVE EXPERIENCED TRAUMAS THROUGHOUT THEIR LIFE AND EXPERIENCED ACES, SO MAKING SURE OUR APPROACH IS TRAUMA INFORMED AND NOT MAKING THINGS WORSE, MAKING OUR HEALTHCARE SYSTEM WELCOMING IS VERY, VERY IMPORTANT TO US. THAT HAS TO BE TAKEN IN THE CONTEXT OF HISTORICAL TRAUMA. MANY, MANY OF OUR TRIBES AND OUR PATIENTS HAVE SUFFERED LOSSES HISTORICALLY. ALTHOUGH IT MAY BE GENERATIONS AGO, THEY HAVE CONSEQUENCES IN MODERN DAY FOR COMMUNITIES AND INDIVIDUALS. SO THAT'S SOMETHING THAT WE ALSO HAVE TO CONSIDER. SO THAT'S A LARGER PICTURE. SO WITHIN THAT WHAT ARE WE DOING? WE'RE TRYING TO ADDRESS FASD ON THE BACK END. WE DON'T REALLY HAVE A LOT OF FUNDING FOR PREVENTION. PREVENTION MONEY THAT WE HAVE HAS GONE TO THE TRIBES, AS YOU'VE HEARD EARLIER, THE TRIBES CAN TAKE THOSE DOLLARS AT TIMES AND DO THEIR OWN THING WHICH IS GREAT FOR THOSE COMMUNITIES. BUT WE'RE REALLY A HEALTHCARE TREATMENT CENTER, TREATMENT SYSTEM, SO THAT'S WHERE WE FOCUS. A COUPLE THINGS WE DO THAT TIES INTO WHAT WE WERE DOING EARLIER, WE TO TRAININGS, HAVE A SERIES OF WEBINARS ON FASD, ONE ON ONE, WHAT OUR PROVIDERS NEED TO KNOW, IMPACTS SCREENING, WAYS YOU CAN RECOGNIZE. AS YOU ALSO JUST HEARD GETTING TREATMENT IN TRIBAL COMMUNITIES IS A CHALLENGE SO WE'RE LOOKING AT DIFFERENT WAYS OF DOING THAT. ONE WAY WE'RE TRYING TO SUPPORT OUR PROVIDERS IN THE TREATMENT OF FASD WE RUN A PEDIATRIC CONSULTATION CLINIC EVERY OTHER WEEK, A CLINIC THAT'S FUNDED THROUGH THE INDIAN CHILDREN'S PROGRAM. THESE ARE FUNDS THAT ARE SET ASIDE TO HELP ADDRESS DEVELOPMENTAL DELAYS AND OTHER ISSUES IN NATIVE CHILDREN SO THAT INCLUDES FASD, AUTISM, THOSE TYPES OF THINGS. SO ANYONE WHO IS TREATING A NATIVE YOUTH CAN CALL INTO OUR PANEL OF EXPERTS AND GET A FREE CONSULTATION ON HOW TO MAYBE HELP THAT CHILD AND THE FAMILY WITH THE ISSUES THEY ARE EXPERIENCING. THAT'S ONE OF THE WAYS WE TRY TO BRIDGE THAT GAP WITH MANY PATIENTS AND PROVIDERS BEING IN RURAL AND REMOTE AREAS. WE HAVE THE TRAINING SERIES, CONSULTATION CLINIC. AND WE ALSO HAVE -- WE'RE WORKING ON A MANUSCRIPT, BASICALLY A BOOK. I FOUND THAT IHS PUBLISHED A BOOK AROUND 25 YEARS AGO NOW ON THE TREATMENT OF FASD WITHIN NATIVE COMMUNITIES. THE BOOK WAS FAIRLY COMPREHENSIVE, BUT AFTER 25 YEARS IT WAS ALSO FAIRLY DATED. I'VE ENGAGED SOME FOLKS AND WE'RE WORKING REVISING THAT AND BRINGING IT UP TO DATE. I WAS FAIRLY NAIVE THINKING IT WILL TAKE TEN MONTHS OR SOMETHING. WE'RE NOW 18 MONTHS INTO THE PROCESS AND STILL A WAYS FROM PUBLICATION AND APPROVALLED REQUIRED, BUT IT IS AN ONGOING PROJECT WE DO HOPE TO GET OUT. WE'RE TRYING TO GET THAT OUT BEFORE THE END OF THE CALENDAR YEAR, WE'LL SEE IF THAT HAPPENS. BUT IT WILL BE A VERY HANDS-ON MANUAL FOR PROVIDERS WORKING IN INDIAN COUNTRY, TO BREAK DOWN THE IMPACTS OF FASD, SCREENING TOOLS, AND WHAT YOU MAY BE SEEING IN A PATIENT WITH FASD REGARDING THEIR SOCIAL, BEHAVIORAL, SCHOOL, FAMILY, BREAKS DOWN ALL THE DIFFERENT DOMAINS SO A PROVIDER CAN EASILY, YOU KNOW, TRY TO MATCH UP THE AGE RANGE WITH WHAT THEY ARE SEEING, AND THEN ALSO WE HAVE SUGGESTED INTERVENTION, SO IT REALLY IS, WE'RE HOPING WE'LL HAVE A BIG IMPACT ON HOW PROVIDERS INTERACT WITH PATIENTS DIAGNOSED WITH FASD AND HELP THEM AND THEIR FAMILIES AND COMMUNITY MOVE FORWARD DESPITE THAT DIAGNOSIS. THE LAST THING I WANT TO MENTION, WE HAVE A PROJECT IN CONJUNCTION WITH JOHNS HOPKINS UNIVERSITY, PEDIATRIC INTEGRATED CARE CLINIC. THIS IS NOT SPECIFIC TO FASD, IT'S SPECIFIC TO TRAUMA-INFORMED CARE APPROACH IN THE PEDIATRIC CLINICS. WE HAVE 18 SITES AROUND THE COUNTRY, I BELIEVE, PART WOULD INCLUDE FASD AS THOSE YOUTH COME IN, ESPECIALLY THOSE YOUNG CHILDREN, THE SCREENING THAT WE GO THROUGH THAT THEY WOULD POTENTIALLY GO THROUGH WITH THEIR FAMILIES, ALSO, AGAIN, COMING BACK TO THE TRAUMA-INFORMED CARE APPROACH THAT WE'RE VERY SENSITIVE TO THE TRAUMAS THEY HAVE GONE THROUGH AND LEAVE THAT DOOR OPEN FOR HEALTHCARE SYSTEM SO THEY CAN CONTINUE TO COME TO US FOR SERVICE. SO THAT'S IT IN A NUTSHELL. I PLAN TO BE ON THE CALLED MOST IF NOT ALL THE DAY, I'LL BE HAPPY TO TAKE ANY QUESTIONS NOW OR LATER ON. THANK YOU >> THANK YOU, CHRIS. AND THANK YOU MAYBE JUST TO KEEP US ON TIME WE'LL ALL POSTPONE QUESTIONS AND KEEP QUESTIONS TO THE END. WE WILL HAVE DISCUSSION. THANK YOU FOR GREAT PRESENTATION. SO NOW TRACY KING, NATIONAL INSTITUTE ON CHILD DEVELOPMENT. WELCOME, TRACY. >> THANK YOU. THANKS FOR THE OPPORTUNITY TO TALK BRIEFLY ABOUT NICHD AND WHAT WE'RE DOING RELATED TO SUPPORT FOR FETAL ALCOHOL SPECTRUM DISORDERS. WE'RE QUITE BROAD IN MISSION AND SCOPE. MOST OF US THINK ABOUT US AS SUPPORTING CHILD HEALTH, THAT'S PROBABLY THE MOST PROMINENT ASPECT OF OUR NAME. WE SUPPORT RESEARCH AND ADDITIONAL AREAS AS WELL, SO WITHIN CHILD HEALTH WE SUPPORT RESEARCH ON TYPICAL DEVELOPMENT NUTRITION, INTELLECTUAL DEVELOPMENT, PERI AND NEONATAL HEALTH, PREGNANCY AND MATERNITY HEALTH, REPRODUCTIVE HEALTH INCLUDING CONTRACEPTION AND FERTILITY AND INFERTILITY, AND NATIONAL CENTER FOR MEDICAL REHABILITATION RESEARCH, WE SUPPORT RESEARCH ON REHABILITATION ACROSS THE LIFESPAN. INCLUDED IN THOSE AREAS ARE RESEARCH ON DEVELOPMENTAL AND STRUCTURAL BIOLOGY WHICH INCLUDES TERATOLOGY, OBSTETRIC AND PEDIATRIC PHARMACOLOGY, GLOBAL HEALTH, RARE DISEASES, DEMOGRAPHIC AND POPULATION STUDIES. SO, OUR SUPPORT FOR FASD RESEARCH IS NOT SO MUCH SPECIFIC PROJECTS LOOKING DIRECTLY AT FASD BUT RATHER WE SUPPORT FASD RESEARCH PRIMARILY INDIRECTLY. WE SUPPORT A NUMBER OF LARGE RESEARCH NETWORKS, AND RESEARCH COHORTS. THESE COHORTS TYPICALLY LOOK AT THE COLLECTIVE IMPACT OF MULTIPLE EXPOSURES IN PREGNANCY, MULTIPLE OUTCOMES IN CHILDHOOD. WE SUPPORT SOME BASIC SCIENCE RESEARCH, ANIMAL MODELS, AND WE TAKE A ROLE IN A NUMBER OF TRANS-NIH COLLABORATIONS, INCLUDING SOME AROUND RESEARCH METHODS WHICH MAY HAVE RELEVANCE TO FASD AND I'LL PRESENT A FEW EXAMPLES IN EACH OF THE DOMAINS. THIS IS AN EXAMPLE OF FASD RESEARCH USING NICHD-SUPPORTED COHORT. WE SUPPORT A COHORT CALLED RIGHT FROM THE START, A COMMUNITY-BASED COHORT OF OVER 5,000 PREGNANT WOMEN, ENROLLED BETWEEN 2000 AND 2012 FROM AREAS ACROSS THE U.S. RESEARCHERS FOR THE STUDY LOOKED AT WHETHER WOMEN REPORTED PLANNED PREGNANCIES WERE LESS LIKELY TO USE ALCOHOL EARLY IN PREGNANCY THAN UNPLANNED PREGNANCY RATES OF CONSUMPTION PRIOR TO THE INTERVIEW WERE SIMILAR AMONG WOMEN REPORTING PLANNED PREGNANCIES AND THOSE REPORTING UNPLANNED PREGNANCIES. MOST WOMEN DECREASED QUITE EARLY IN PREGNANCY, 6% OF WOMEN REPORTED CONTINUING ALCOHOL USE AT THE TIME OF THEIR FIRST TRIMESTER INTERVIEW. THIS SUGGESTS PROMOTING EARLY PREGNANCY AWARENESS CAN PLAY AN IMPORTANT ROLE IN REDUCING PRENATAL ALCOHOL EXPOSURE. ANOTHER EXAMPLE IS EXAMPLE OF A COHORT THAT LOOKED AT ALCOHOL IN THE CONTEXT OF OTHER PRENATAL EXPOSURES. WE SUPPORTED A STUDY RECRUITING A COHORT WITH OPIOID USE DISORDER, INVESTIGATORS FOUND MAJORITY OF WOMEN IN ANY COHORT HAD POLY SUBSTANCE USE HISTORIES, INCLUDING OVER HALF WHO REPORTED USING ALCOHOL. IMPORTANTLY, MAJORITY OF WOMEN IN THE STUDY ALSO REPORTED HISTORIES OF PHYSICAL OR SEXUAL ABUSE, INCARCERATION, AND HEPATITIS C INFECTION. SO THOSE RESULTS SUGGEST INTERVENTION TO REDUCE SUBSTANCE USE INCLUDING ALCOHOL USE AMONG PREGNANT WOMEN MUST BE COGNIZANT OF CHALLENGES BEING FACED BY THE WOMEN ENGAGED IN HIGH-RISK BEHAVIORS. AND FINALLY, ONE LAST EXAMPLE OF RESEARCH WE SUPPORT IS BASIC SCIENCE RESEARCH WHICH MAY HAVE RELEVANCE TO FASD, INVESTIGATORS USE A MOUSE MODEL AND TECHNOLOGY, IMPACT OF ALCOHOL EXPOSURE, RESULTING IN CONSTRUCTION OF BLOOD VESSELS IN THE PREGNANT MICE, FINDINGS SUGGEST DECREASED IN BLOOD THROUGH DURING BRAIN DEVELOPMENT MAY BE A MECHANISM BY WHICH EXPOSURE LEADS TO DETRIMENTAL EFFECT ON FUNCTION. FINALLY, AN EXAMPLE OF A TRANS-NIH COLLABORATION, SO AS MANY OF YOU IN THE ROOM PROBABLY KNOW, MANY PREVENTIVE CARE RECOMMENDATION BODIES SUCH AS U.S. PREVENTIVE SERVICES TASK FORTH AND COMMUNITY PREVENTION TASK FORCE, HAVE RATED RECOMMENDATIONS REGARDING SCREENING IN CHILDHOOD HAVING EVIDENCE TO RECOMMEND FOR OR AGAINST THESE POSITIONS. IN MANY CASES, THESE INSUFFICIENT RECOMMENDATIONS ARE DUE TO INABILITY TO BUILD AN UNBROKEN CHAIN OF EVIDENCE LEADING -- SORRY, LINKING SCREENINGS TO IMPROVEMENTS IN LATER HEALTH OUTCOMES. SO, THIS IS JUST A SCHEMATIC. IT'S SPECIFIC TO THE U.S. PREVENTIVE SERVICES TASK FORCE BUT I THINK IT'S USEFUL HERE, LOOKING AT HOW THE BODY CONSIDERS THE EVIDENCE BASE WHEN TRYING TO RECOMMEND FOR OUR AGAINST SCREENING, AND SO WHAT I WANT TO POINT OUT HERE IS THAT IN SOME CASES -- DO I HAVE A POINTER? YEAH. IN SOME CASES, YOU CAN MAKE A DIRECT CONNECTION BETWEEN THE ACTUAL SCREENING EVENT AND IMPROVEMENTS AND OUTCOMES, CLASSIC EXAMPLE IS SCREENING FOR COLON CANCER. STUDIES SHOW JUST ACT CAN BE SHOWN TO REDUCE MORBIDITY AND MORTALITY FOR COLON CANCER. IN CHILDREN HOWEVER IT TENDS TO BE MUCH LESS DIRECT, AND SO WE'RE TYPICALLY IN THE POSITION OF TRYING TO IDENTIFY EVIDENCE IN EACH OF THESE STEPS. SO IDENTIFYING SCREENING, WHICH MAY LEAD TO EARLY DETECTION OF THE TARGET CONDITION, HOPEFULLY LEADS TO REFERRAL FOR TREATMENT, WHICH HOPEFULLY LEADS TO INTERMEDIATE OUTCOME WHICH HOPEFULLY LEADS TO REDUCTIONS IN MORBIDITY AND MORTALITY, OR BECAUSE THAT TEND NOT TO BE THE MOST RELEVANT HOPEFULLY IMPROVEMENT IN HEALTH OUTCOMES. THESE NEED TO BE BALANCED AGAINST POTENTIAL EFFECTS OF SCREENING AND ADVERSE EFFECTS OF TREATMENT, MANY OF YOU KNOW BETTER THAN I DO THERE ARE SEVERAL TODAY'S LEGAL ENVIRONMENT POTENTIAL ADVERSE OUTCOMES OF SCREENING AND IDENTIFYING ALCOHOL USE DURING PREGNANCY. WE RECENTLY HELD A WORKSHOP, METHODS FOR ASSESSING SCREENING, WE WERE FORTUNATE IN THAT MANY NIH INSTITUTES PLAYED AN ACTIVE ROLE IN OUR WORKSHOP, INCLUDING REPRESENTATIVES FROM NIAAA, NIDA, AND OTHERS. AND JUST A FEW OF THE SESSIONS DURING THIS MEETING THAT MAY BE OF INTEREST TO THIS GROUP, WE HAD A SESSION, BEYOND MORBIDITY AND MORTALITY, IN WHICH WE TALKED ABOUT WHETHER THERE ARE WAYS TO OPERATIONALIZE OPTIMAL DEVELOPMENT OR POSITIVE OUTCOMES AS OUTCOME OF SCREENING RATHER THAN AVOIDANCE OF MORBIDITY AND MORTALITY. HOW TO ASSESS IMPACT OF SCREENING -- [ NO AUDIO ] THAT'S EXCITING. [LAUGHTER] I APPRECIATE THAT. WE HAD A SESSION ON ASSESSING IMPACT OF SCREENING BENEFIT TO SOCIETY BUT NOT NECESSARILY INDIVIDUAL PERSON BEING SCREENING, SCREENING IN GENOMIC AGE, UNDERSTANDING CONTEXT OF SCREENING, THIS ONE IN PARTICULAR WE HAD INDIVIDUALS WITH EXPERTISE IN ALCOHOL USE IN ADOLESCENCE, TALKING ABOUT WHETHER THE CONTEXT OF SCREENING, PEOPLE PRESENT DURING SCREENING EVENT, IMPACT OF EFFECTIVENESS OF SCREENING. THE NEXT STEP IS WE'RE PLANNING A SUPPLEMENT TO THE JOURNAL OF PEDIATRICS. I WANT TO ACKNOWLEDGE THAT A LOT OF INFORMATION FROM MY PRESENTATION WAS GENERATED WITH HELP OF NICHD OFFICE OF SCIENCE POLICY REPORTING AND PROGRAM ANALYSIS, AND THANK YOU VERY MUCH FOR YOUR ATTENTION. >> THANK YOU, TRACY. WE WILL GO TO NEXT PRESENTATION, AND SO WELCOME BILL DUNTY FROM NIAAA TO GIVE US AN UPDATE. >> GOOD MORNING. I'M BILL DUNTY, PROGRAM OFFICER IN THE DIVISION OF METABOLISM AND HEALTH AT NIAAA, I COORDINATE THE FASD PROGRAM FOR THE I.C. AS MANY OF YOU ARE AWARE, NIAAA SUPPORTS DIVERSE YET OVERLAPPING AREAS OF FASD RESEARCH, THROUGH OUR ACTIVITIES THAT WE SUPPORT, WE'RE INVOLVED IN AREAS OF FASD RESEARCH AND INTERVENTIONS, ETIOLOGY, PREVENTION, AND DIAGNOSIS. OVER THE LAST FIVE YEARS, THE NIAAA RESEARCH AND TRAINING BUDGET HAS BEEN STEADILY INCREASING LIKE MANY OTHER ICs AT NIH. AND FY 2018 WE ALLOCATED $387 MILLION FOR RESEARCH AND TRAINING. OVER THAT SAME TIME PERIOD, OUR SUPPORT FOR THE FASD RESEARCHERS HAS MAINTAINED FAIRLY STEADY BETWEEN 7 AND 8% OF OUR ENTIRE RESEARCH TRAINING BUDGET IS DEDICATED TO FASD RESEARCHERS. THE LAST COMPLETE CURRENT FISCAL YEAR, 2018, YOU CAN SEE APPROXIMATELY -- THAT'S NOT THE ONE I WANTED TO DO. I'M SORRY. YOU CAN SEE HERE APPROXIMATELY FOR FY 2018, 7.2% OF OUR BUDGET WHICH REPRESENTS $28 MILLION WENT TO SUPPORT RELATED GRANTS. OF THOSE 113, 27 OF THOSE WERE NEW RESEARCH PROJECTS. SO, OF THOSE 27 NEW RESEARCH PROJECTS FOR FISCAL YEAR 2018, THE SLIDE GIVES YOU A LITTLE FLAVOR FOR THE SCIENTIFIC TOPICS COVERED ON THOSE GRANTS RELATED TO FASD ETIOLOGY. AS YOU CAN SEE HERE, WE HAD JUST A FEW EXAMPLES, WE HAD GRANTS RELATED TO EPIGENETICS, AND NEUROIMMUNE FUNCTION IN ANIMAL MODELS RELATED TO FASD. THIRD GRANT HERE FROM DR. MOORE LOOKED AT BRAIN IMAGING IN ADULTS WITH FASD. THAT WAS A PROJECT. WE HAD A K AWARD TO CHRISTINA UBAN THAT LOOKED AT SEX-DEPENDENT DIFFERENCES IN ENDOCRINE FUNCTION IN CHILDREN WITH FASD, AND THE FINAL PROJECT HERE ADDRESSED AN IMPORTANT AREA THAT HAS NOT BEEN LOOKED AT, THE ISSUES OF SLEEP IN CHILDREN WITH FASD AND HOW THEY RELATE TO NEUROBEHAVIORAL OUTCOMES. AMONG THE NEW INTERVENTION PROJECTS, WE HAVE THE P60 IN DEIDRE BUCKHOLD. I'LL DISCUSS THAT LATER IN A SLIDE. BUT THAT PROJECT COULD FALL INTO INTERVENTION OR PREVENTION, DEPENDING HOW YOU WANT TO LOOK AT IT. AMONG THE PREVENTION PROJECTS THERE WAS THE R01 BY CAROL KAUFFMAN LOOKING AT MOBILE HEALTH APPROACHES IN NATIVE AMERICAN YOUTH TO PREVENT ALCOHOL-EXPOSED PREGNANCIES. AND THEN THE FINAL CATEGORY, GRANTS RELATED TO DIAGNOSING OR IDENTIFYING FAS, WE CONTINUE TO SUPPORT STUDIES SEEKING TO DEVELOP NOVEL TECHNOLOGIES, METHODOLOGIES, IN ORDER TO IDENTIFY KIDS PRENATALLY EXPOSED TO ALCOHOL AS EARLY AS WE CAN SO WE PUT A GOOD AMOUNT OF INVESTMENT IN 3D BRAIN IMAGING BUT WE'RE ALSO INVESTING IN PROJECTS USING MULTI-MODAL BRAIN IMAGING, AND NOW THE USE OF NEW PHYSIOLOGICAL MEASURES LIKE CARDIAC ORIENTING RESPONSE, IN ORDER TO SCREEN FOR KIDS AFFECTED BY PAE. NEXT TWO SLIDES, I WANT TO MENTION WE CONTINUE TO PUT OUT FUNDING OPPORTUNITY ANNOUNCEMENTS, NOW NOTICES WITH FASD-SPECIFIC LANGUAGE IN A VARIETY OF TOPICS, SO I JUST INCLUDED THAT IN MY REPORT SO THAT YOU CAN REFER TO IT. IN ADDITION TO SOME OF THE SMALLER INDIVIDUAL RESEARCH GRANTS THAT WE FUND WE ALSO SUPPORT LARGER RESEARCH CONSORTIA. THIS IS AN EXAMPLE HERE, CIFASD, THE COLLABORATIVE INITIATIVE, CONSORTIUM OF CLINICAL AND BASIC SCIENCE PROJECTS, TWO RESEARCHERS HERE THAT PARTICIPATE IN CIFASD ARE AT THE TABLE. IT WAS CREATED IN 2003, WITH THE GOAL OF ENHANCING THE DIAGNOSIS OF FASD IN DIFFERENT STAGES OF THE LIFESPAN, BASED ON BIOLOGICAL, PHYSICAL AND BEHAVIORAL ASSESSMENTS, AND TO IMPROVE OUTCOMES OF INDIVIDUALS WITH FASD. WE'RE IN THE FOURTH ITERATION OF CIFASD, CIFASD-4, I LIST THE MAJOR THEMES. THEY CONTINUE TO HAVE 3D FACIAL, BRAIN AND FETAL IMAGING. THERE ARE GENETIC STUDIES ON RISK AND RESILIENCY FACTORS. THEY ARE DEVELOPING SCREENING TOOLS, AND USING MOBILE HEALTH INTERVENTIONS, THIS PHASE LED TO THE CREATION OF AN ONLINE REGISTRY, IT'S ALSO INVOLVED IN ADULT SURVEY BEING CONDUCTED. DR. JONES LEADS THE TELEMEDICINE COMPONENT OF THE CONSORTIUM. AND WE'RE ALSO -- WE HAVE SEVERAL PROJECTS LOOKING AT BIOMARKER DISCOVERY IN BLOOD TAKEN FROM MOTHERS AND FROM INDIVIDUALS WITH FASD. YOU CAN FIND OUT MORE INFORMATION THERE AT THE WEBSITE LISTED AT THE BOTTOM OF THE PAGE. SO AMONG THE 16 CENTERS SPECIALIZED RESEARCH CENTERS, WE CALL P50s THAT THE INSTITUTE FUNDS, TWO OF THEM HAVE A MAJOR EMPHASIS ON FASD. THE FIRST IS NMARC, NEW MEXICO RESEARCH CENTER, THAT INVOLVE BOTH PRE-CLINICAL AND CLINICAL STUDIES ADDRESSING NEUROBIOLOGICAL MECHANISMS UNDERLYING THE BEHAVIORAL PROBLEMS ASSOCIATED WITH FASD, AND THE IDEA IS THAT THAT KNOWLEDGE GAINED WILL LEAD TO BETTER METHODS FOR DIAGNOSING AND FOR INTERVENING WITH PATIENTS WITH FASD. IT IS THE LONE CENTER WITH THE PRIMARY FOCUS ON FASD, THE P.I. IS DR. DAN SAVAGE. THE SECOND IS AT BINGHAMTON UNIVERSITY, IT IS -- IT HAS FOUR PILOTS AND MAIN PROJECTS LOOKING AT PRENATAL ALCOHOL EXPOSURE, THE RESEARCH MAINLY INVOLVES ANIMAL WORK, ANIMAL MODELS, BUT THEY ARE TRYING TO UNDERSTAND THE FUNCTIONAL AND NEURAL EFFECTS OF ALCOHOL EXPOSURE THROUGHOUT BRAIN DEVELOPMENT, BUT WITH A SPECIAL EMPHASIS ON THE ADOLESCENT PERIOD. P.I. FOR THAT P50 IS DR. TERRY DEEK, AND I LIST THE WEBSITES THAT YOU CAN GO TO FOR MORE INFORMATION ON THOSE PROJECTS. LOOKING AT THE P60s, A LITTLE BIT LARGER CENTERS, WE DO HAVE A NEWLY FUNDED PROJECT WHICH WAS THE PROJECT I MENTIONED A COUPLE SLIDES PREVIOUSLY. THIS ONE FUNDS A CONSORTIUM, A CENTER CALLED NCARE, NATIVE CENTER FOR ALCOHOL RESEARCH AND EDUCATION FUNDED IN FISCAL YEAR 2018. AND ONE MAIN PROJECT IS COMPARING EFFECTIVENESS OF A CULTURALLY ADAPTED INTERVENTION TO REDUCE RISKY DRINKING AND TO INCREASE CONTRACEPTION USE, WITH THE IDEA OF PREVENTING ALCOHOL-EXPOSED PREGNANCIES AND THEREFORE PREVENTING FASD IN A CHEYENNE RIVER SIOUX POPULATION IN SOUTH DAKOTA. THEIR PROJECT WHICH THEY HAVE ENTITLED NATIVE CHOICES CONSISTS OF MOTIVATIONAL INTERVIEWING PLUS CONTRACEPTIVE COUNSELING, TIED WITH SUPPORTIVE MOBILE ELECTRONIC MESSAGING. I THINK THAT PROJECT'S ABOUT A YEAR UNDERWAY AND SO THERE WILL BE MORE PROGRESS TO COME BUT I WANTED TO MAKE YOU AWARE THAT WAS A NEW P60 THAT WE FUNDED. TWO MORE SLIDES. I DO WANT YOU TO BE AWARE OF A NEW NIAAA INITIATIVE. WE'RE IN THE EARLY STAGES OF PLANNING CONSENSUS CONFERENCE THAT WE HOPE TO INVOLVE INTERNATIONAL RESEARCHERS, AND SOME OF OUR FEDERAL PARTNERS, IN ATTEMPTING TO HARMONIZE VARIOUS INTERNATIONAL RESEARCH CLASSIFICATION SYSTEMS FOR BOTH FAS AND FASD, WE'RE HOPING THAT THIS MEETING WILL ALLOW PARTICIPANTS TO LEAVE THE MEETING AND TEST A DRAFT CLASSIFICATION SYSTEM USING THEIR OWN DATABASE OF -- THEIR CLINICAL DATABASE, SO THERE'S MORE INFORMATION TO FOLLOW. AGAIN, WE'RE IN THE EARLY STAGES OF PLANNING THIS, BUT MEETING DATE HAS BEEN SET FOR THE END OF OCTOBER 2019, HERE AT NIAAA. ON MY LAST SLIDE I DO WANT TO MENTION THAT NIAAA IS INVOLVED WITH SEVEN OTHER ICs, NIAAA, NIDA, A NEW INITIATIVE, HEALTHY BCD, KAREN WILL GO INTO A LITTLE MORE DETAIL. I WANT TO MENTION WE'RE ONE OF THE PARTNERS, AND IT'S -- THE STUDY IS JUST GETTING UNDERWAY BUT BASICALLY THE GOAL IS TO EXAMINE NORMATIVE BRAIN, COGNITIVE, BEHAVIOR, EMOTIONAL DEVELOPMENT, BEGINNING PRENATALLY, GOING THROUGH THE AGE OF ABOUT 9 TO 10, SO THIS IS PRIOR TO WHERE THE ABCD STUDY PICKS UP. AND THE INFORMATION GATHERED THERE WILL HELP US UNDERSTAND THE LONG-TERM IMPACT OF BOTH PRENATAL AND POSTNATAL DRUG USE, OPIOIDS, MARIJUANA, AND ALCOHOL INCLUDED. AND THIS IS PART OF THE NIH ANY INITIATIVE, HEAL INITIATIVE, TO DEAL WITH THE OPIOID CRISIS. WITH THAT WE'LL TAKE QUESTIONS LATER. >> THANK YOU. THANK YOU, BILL. NOW NIDA, WELCOME KAREN. >> HI. I'M HAPPY TO BE HERE. KAREN SOROCCO, DIVISION OF EPIDEMIOLOGY SERVICES AND PREVENTION, RESEARCH, MY AFFILIATION IS DIFFERENT ON THE ROSTER. BUT I RECENTLY MOVED HERE A FEW YEARS AGO, AND SO MOST OF THE PRENATAL RESEARCH ON DRUGS OF ABUSE COME TO ME, I SORT OF GO ACROSS THE EPIDEMIOLOGY, LOOKING AT ETIOLOGY, SERVICES AND TREATMENT, AS WELL AS PREVENTION. SO NIDA LOOKS AT A LOT OF POLY SUBSTANCE USE, IN THE '80s AND '90s IT USED TO BE FOCUSED ON PRENATAL EXPOSURE TO COCAINE. WE FUNDED A LOT OF RESEARCH IN THAT AREA. THEN OF COURSE THE OPIOID EPIDEMIC OCCURRED, SO NOW WE'RE SORT OF SWITCHING TO THAT, A LOT OF EMPHASIS ON THAT. ONE NEONATE BORN WITH OPIOID WITHDRAWAL SYNDROME EVERY 15 MINUTES. PRENATAL EXPOSURE TO TOBACCO HAS BEEN ONGOING, AND NATIONAL SURVEY ON DRUG USE IN 2016 SHOWED A DECLINE BUT NOW IT APPEARS IN 2017 THERE'S AN INCREASE IN TOBACCO SMOKING DURING PREGNANCY, AND I THINK A LOT MORE WOMEN ARE USING E-CIGARETTES AND ELECTRONIC DEVICES NOW. PRENATAL EXPOSURE TO MARIJUANA, WE HAD SOME OF THAT GOING ON, IN THE '80s AND '90s, PETER FREED WAS A BIG CLINICA RESEARCHER IN THAT AREA. OF COURSE LEGALIZATION, MEDICINAL USE OF MARIJUANA, EVEN IN PREGNANCY, ESPECIALLY TO COMBAT NAUSEA, SEEMS LIKE THAT'S INCREASING, AND NIDA LEADERSHIP AND SAMHSA IS WORKING ON A PAPER RIGHT NOW THAT'S REALLY GOING TO DETAIL MARIJUANA USE DURING PREGNANCY AND SHOULD BE COMING OUT SOON. SO, AGAIN, I WANT TO TALK ABOUT NOW FOR A MINUTE, STEPHEN PATRICK, K23 AWARD, HE'S A WELL-KNOWN RESEARCHER IN THIS AREA, JUST DOCUMENTING THE PREVALENCE AND ONCE AGAIN USING MEDICAID DATA, BUT SHOWING THE RAPID INCLINE. THIS IS THE SUBSTANCE USE SURVEY ON THE NATIONAL SURVEY ON DRUG USE AND HEALTH. AND THIS IS 2017 DATA. THIS IS COMING FROM A SAMHSA SLIDE, GIVEN -- A TALK GIVEN THAT HELPED ME A LOT TO BETTER UNDERSTAND POLY SUBSTANCE USE DURING PREGNANCY. YOU CAN SEE JUST THE USE OF DRUGS DURING PREGNANCY HERE, AND I TALKED A MINUTE AGO ABOUT SHOWING THE INCREASED IN TOBACCO USE ON THE POSITIVE SIGN SHOWS INCREASE FROM PRIOR YEAR. AND ALSO IF YOU LOOK AT THE BOTTOM OF THE SLIDE, YOU CAN SEE THAT GRADUAL INCREASE IN MARIJUANA. AND SO IT JUST APPEARS ESPECIALLY IN SOME STATES THAT, YOU KNOW, MOTHERS HAVE GROUPS WHERE THEY TALK ABOUT, YOU KNOW, HOW MARIJUANA HELPS THEM WITH NAUSEA AND SUCH, SO I THINK WE'RE SEEING A LOT OF THAT CORRELATED WITH JUST, YOU KNOW, A SORT OF KNOWLEDGE BASE NOW THAT IT'S NOT AS DETRIMENTAL AS ONCE THOUGHT OF. IT SEEMS TO BE THE GOING, YOU KNOW, COMMUNICATION PUBLICLY. THIS IS A GRANT, K01 AWARD, FALLS IN MY PORTFOLIO, FOLLOW-UP OF INFANTS EXPOSED PRENATALLY, PREDOMINANTLY MARIJUANA. SHE FOUND SELF REPORT TOXICOLOGY DOESN'T ALWAYS JIVE, SHOWING MORE INCREASE USE THAN REPORTED BY MOM SHOWN BY SCREEN. IF YOU CAN SEE IN THE SAMPLE HERE ALL THE MOTHERS WERE SCREENED OUT OF A SAMPLE SIZE OF 400,000, ALL MOTHERS OF 15,000 HAD USED MARIJUANA, 65% MARIJUANA ONLY, BUT YOU CAN SEE THAT A THIRD OF THE SAMPLE HAD USED MORE THAN ONE DRUG. WHICH WITH ALCOHOL AND TOBACCO, MARIJUANA, ALCOHOL TOBACCO AND OPIOIDS BEING THE TOP THREE WITH MARIJUANA, YOU SEE THIS ACROSS THE BOARD IN VARIOUS SAMPLES. THIS IS A SMALLER SAMPLE. I TALKED ABOUT ELECTRONIC DEVICES, NOW PREGNANT MOMS ARE NOW USING THESE, IT LOOKS MORE ACCEPTABLE TO USE ELECTRONIC DEVICE VERSUS A CIGARETTE THEY ARE SMOKING. DON'T KNOW EXACTLY THE REASON. I THINK A LOT OF PEOPLE THINK ELECTRONIC DEVICES ARE NOT AS DANGEROUS AS SMOKING FROM CIGARETTE, COMBUSTIBLE CIGARETTE, AND HENCE THE REASON WE'RE SEEING DRAMATIC INCREASE IN ADOLESCENTS, LARGE INCREASE, ALSO IN PREGNANCY AS WELL. THIS IS A SMALL SAMPLE SIZE OF 70, YOU SEE POLY SUBSTANCE USE IS PREVALENT. THE MAIN STATEMENT I WANT TO MAKE IS THAT POLY SUBSTANCE USE SHOULD ALWAYS BE ON THE MINDS OF ANYONE DOING PRENATAL EXPOSURE TO DRUGS BECAUSE MOST LIKELY THE EFFECT FROM MORE THAN ONE DRUG IS GREATER THAN THE EFFECT OF ANY ONE DRUG ALONE. YOU ALSO SEE A LOT OF VARIABILITY ACROSS TRIMESTERS IN DRUG USE. OUR NIDA DIRECTOR IS VERY INTERESTED IN THAT BECAUS WE WANT TO SEE WHEN THAT MOST DETRIMENT OF USING DRUGS OCCURS. AND TO BE ABLE TO LOOK AT DRUG-SPECIFIC EFFECTS, VERY DIFFICULT. MOST OF THE STUDIES DONE AT NIDA, WE EMPHASIZE THAT ALL DRUGS OF ABUSE HAVE TO AT LEAST BE ASCERTAINED, MOST OF THE TIME WE LIKE TOXICOLOGY REPORTS. IF WE CAN'T GET THAT SELF REPORT WHICH WE SEE, BUT USUALLY SOME CRITICISM ABOUT THE SELF REPORT. WHY? MOST WON'T ALWAYS REPORT ADEQUATELY. AND SO LARGE SAMPLE SIZES ARE VERY MUCH NEEDED. AND IT NEEDS TO BE WELL CHARACTERIZED IN TERMS OF SOCIOECONOMIC FACTORS AS WELL. HENCE THE REASON BILL MENTIONED OUR HEALTHY BRAIN AND CHILD DEVELOPMENT STUDY, 7500 PREGNANT WOMEN, THEY WILL BE STARTED DURING THE SECOND TRIMESTER. WE'VE STARTED OFF WITH TWO EXPERT MEETINGS BACK IN THE FALL, THIS IDEA CAME OUT IN THE SPRING WHEN HELPING TO END ADDICTION LONG TERM INITIATIVE CAME TO NIH. WE PUT THIS FORWARD, THIS GOT ACCEPTED. PLANNING GRANTS, R 34s WILL BE REVIEWED NEXT MONTH AND START IN SEPTEMBER. THE LONGITUDINAL STUDY WILL TAKE PLACE, AND THE PEOPLE WHO SUBMIT TO THE R34, SOME OF THOSE MAY PROVE THAT THEY CAN RECRUIT, PROVE THEY CAN DO THE ASSESSMENTS NECESSARY, AND IF THEY DO THEY CAN APPLY FOR THE LARGER STUDY, BUT OTHER PEOPLE CAN AS WELL. AND THE INITIATIVES LOOKING AT A RANGE OF BRAIN COGNITIVE SOCIAL AND EMOTIONAL, WHY? MOST OF THE PRIOR STUDIES, ESPECIALLY DONE ON PRENATAL EXPOSURE TO COCAINE, VARIANTS OF DIFFERENT EFFECTS WERE SEEN THROUGH OTHER FACTORS, ENVIRONMENTAL, CAREGIVING, VERSUS THE DRUG ITSELF. THE VARIANTS DUE TO OTHER FACTORS WAS LARGE, HENCE THE NEED TO PAY ATTENTION TO THOSE. WE'RE LOOKING ACROSS THE BOARD, AS I SAID, IN FACT DURING OUR EXPERT MEETINGS WE HAD TALKS GIVEN BY INVESTIGATORS DOING WORK IN THIS AREA, SEEING IT'S VERY DIFFICULT TO ISOLATE ONE DRUG. MOST OF THE MOTHERS ARE USING A COMBINATION OF MORE THAN ONE DRUG. WE'LL BE LOOKING AT -- WE'RE OVERSAMPLING FOR OPIOIDS BECAUSE THIS IS PART OF THE BIG HEAL INITIATIVE BUT WE'R GOING TO BE ASSESSING ALL DRUGS AND I'LL BET WE FIND A WIDE VARIETY. WE'RE LOOKING AT GENETIC, EPIGENETIC. THERE'S GOING TO BE A LOT OF NEURODEVELOPMENTAL. WE'RE GOING TO BE USING A LOT OF TOOLBOX. THE NIH TOOLBOX GOES FROM THREE UP, BUT NOW WE'RE STARTING AT NIH TO DEVELOP A BABY TOOLBOX. I DON'T THINK THAT WILL BE AVAILABLE FOR THIS STUDY BUT THAT WILL BE COMING OUT SOON. THAT'S VERY MUCH NEEDED BECAUSE WE NEED TO STANDARDIZE MEASURES, IN INFANCY AND EARLY CHILDHOOD I THINK. WE'RE NOT ONLY LOOKING AT DEFICITS THAT OCCUR BUT WE WANT TO LOOK AT RESILIENCE. A LOT OF CHILDREN EXPOSED TO DRUGS ANDORY BAD INFLUENCES DURING CHILD DEVELOPMENT, THEY ARE RESILIENT. WHAT CAUSES THAT RESILIENCE? THAT'S IMPORTANT TOO. THIS IS PART OF THE ECHO PROJECT AND NICHD, BUT IT'S ACT NOW. THIS IS PART OF THE LARGER ECHO STUDY, 50,000 KIDS AND THEIR PARENTS, MOMS MOSTLY, WITH EXISTING COHORTS ACROSS ALL AGES. ABOUT 2,000 WERE CHILDREN, DATA FROM CHILDREN COLLECTED PRENATALLY, AND NOW THEY ARE GOING TO START A NEW STUDY WITH A STANDARDIZED CORE BATTERY, BRINGING IN 3,000 MORE SAMPLES PRENATALLY EXPOSED. LOOKING AT TREATMENT FOR BABIES OFF OF OPIOIDS, BUT ALSO BEING ABLE TO COME UP WITH NEW NON-PHARMACOLOGICAL TREATMENT SUCH AS EAT, SLEEP AND CONSOLE BECAUSE A LOT OF THE MEDICATIONS THEY TREAT BABIES THAT HAVE BEEN EXPOSED TO OPIOIDS MAY BE CAUSING HARM AS WELL, AND A LOT OF TIMES THEY ARE DISCHARGED FROM THE HOSPITAL ON THOSE SAME MEDICATIONS. THESE ARE A COUPLE INITIATIVES THAT NIDA HAS, ONCE AGAIN FOCUSING ON CANNABIS, AND ALSO OPIOIDS. THESE ARE NOTICES SHOWING INTEREST AT NIDA. BUT INVESTIGATOR-INITIATED RESEARCH ACROSS THE BOARD IS ENCOURAGED. I'LL ANSWER QUESTIONS DURING OUR DISCUSSION PERIOD. >> THANK YOU VERY MUCH. NOW I WELCOME BILL BACK. BILL DUNTY IS COMING BACK. THERE ARE TWO MAJOR IN THE AWARD, FOCUSED ON FASD, AND INTERNATIONAL CONFERENCE IN VANCOUVER, CANADA, EVERY OTHER YEAR, AND BILL IS GOING TO GIVE THE UDATE. >> LET ME START WITH THE SURVEY. WHO AROUND THE ROOM HAS BEEN TO THE VANCOUVER FASD MEETING? OKAY. MAYBE I CAN CONVERT OTHERS TO POSSIBL PUT THIS ON THEIR CALENDAR. THE 8th INTERNATIONAL CONFERENCE ON FASD WAS HELD IN MARCH, ALWAYS HELD IN VANCOUVER. THE FOCUS OF THE MEETING ALTERNATES EVERY OTHER YEAR. THIS YEAR'S FOCUS ON ACADEMIC RESEARCH. IT WAS THE RESEARCH CONFERENCE. AND YOU CAN SEE THAT IT COVERS THE BASIC SCIENCES BUT ALSO LOOKS AT RESEARCH IN TERMS OF PREVENTING, DIAGNOSING, AND INTERVENING ACROSS THE LIFESPAN. AND THE CONFERENCE DISCUSSES IMPLICATIONS OF THAT RESEARCH, WHILE PROMOTING AN INTERACTION BETWEEN SCIENTIFIC AND COMMUNITY WITHIN OUR FIELD. SO THAT WAS THIS PAST MARCH. THE AUDIENCE IS VERY DIVERSE, BUT I WOULD ARGUE DIVERSITY IS A STRENGTH OF THE MEETING. THERE WERE AT THIS YEAR'S MEETING OVER 800 PARTICIPANTS, THEY COME FROM A VARIETY OF DISCIPLINES. GOVERNMENT OFFICIALS, ADMINISTRATORS, OF COURSE CLINICIANS, FAMILY MEMBERS WITH FAS, AND FASD, FASD SPECIALISTS, LAWYERS, JUDGES, PHYSICIANS, POLICYMAKERS, AND SCIENTISTS. SO THERE ARE -- THERE'S A WIDE DIVERSITY IN TERMS OF THE PROFESSIONS REPRESENTED AT THE MEETING. THE MEETING USUALLY HAS A PRE-CONFERENCE DAY, WHICH THEY CALL A "LET'S TALK SESSION," AND IT'S FAIRLY UNIQUE TO THIS MEETING WHERE THEY GET PEOPLE IN THESE ROUNDTABLES AND PRESENT THEM WITH QUESTIONS AROUND THE FOUR TOPICS I LIST HERE. THEY REALLY TRY TO TAKE ADVANTAGE OF THE COLLECTIVE WISDOM IN THE ROOM, TO TALK ABOUT SOME OF THESE ISSUES. THE FOCUS FOR THIS PRE-CONFERENCE WAS WHERE DOES THE FIELD -- WHERE DO WE WANT TO BE IN 20 YEARS, IN 2040, AND THEY PRESENT QUESTIONS THAT REALLY CHALLENGE THE THINKING AROUND THESE FOUR TOPICS. THE RESPONSES ARE COLLECTED ELECTRONICALLY, AND THEN THERE WILL BE A REPORT THAT'S PUBLISHED. SO THEY ARE STILL WORKING ON THAT. BUT IT'S A VERY UNIQUE EXPERIENCE. DURING THE MAIN BODY OF THE MEETING ITSELF THERE WERE SEVEN PLENARY SESSIONS, I LIST THEM HERE. THERE WAS THE OPENING PLENARY ON THE MICROBIOME AND HOW CHANGES, HOW ALCOHOL, PRENATAL EXPOSURE, MAY INFLUENCE INTRAUTERINE AND GUT MICROBIOME, WHICH IS A COLLECTION OF BACTERIA THAT US HUMANS HARBOR, AND WHETHER THAT ALTERATION MAY ELICIT INFLAMMATORY RESPONSES THAT MAY THEN IMPACT NEURODEVELOPMENTAL TRAJECTORIES. THERE WAS A PLENARY ON THE NEW RESEARCH ON PRENATAL CANNABINOID EXPOSURE, AND POTENTIAL -- SOME POTENTIAL LONG LASTING EFFECTS IN ANIMAL MODELS AND HOW THEY SYNERGY WITH EXPOSURE. POLICY AND PRACTICE AROUND THE GLOBE. A RESEARCH UPDATE FROM THE CIFASD CONSORTIUM WHICH NIAAA FUNDS. THERE WAS ALSO A TALK ON ADVANCING PARTICIPATION THROUGH THE CREATION OF SOME ONLINE -- SOME ONLINE REGISTRIES, AND SOME OF THE REGISTRIES THAT ARE NOW BEING CREATED FOR ADULTS WITH FASD. A PLENARY ON AN IMPORTANT TOPIC, SLEEP DISTURBANCES IN INDIVIDUALS WITH FASD, AND RELATING CLINICAL GUIDANCE WITH JUST A BASIC BIOLOGY OF SLEEP. AND THEN THE LAST PLENARY WAS IN THE JUSTICE REALM, AND IT DISCUSSED CRIMINAL CULPABILITY, WHICH IS RESPONSIBILITY OF INDIVIDUALS LIVING WITH FASD. SO I LIST THAT TO GIVE YOU THE FLAVOR FOR THE TOPICS THAT ARE COVERED. THE MAIN MEETING IS THREE DAYS. I LIST HERE THE URL BECAUSE I WOULD LIKE YOU TO VISIT THE URL BECAUSE THE MEETING SITE STILL CONTAINS INFORMATION YOU'LL FIND INTERESTING. IF YOU GO TO THE URL AT THE BOTTOM THERE'S THE BROCHURE FOR THE MEETING, 20 PAGES LONG, BELIEVE IT OR NOT. ONE OF THE THINGS THIS MEETING, IT'S VERY PACKED WITH SESSIONS AT ANY ONE TIME, THERE COULD BE TEN CONCURRENT SESSIONS GOING ON, SO IT'S HARD TO PICK WHAT SESSIONS TO GO TO BUT THAT JUST GIVES AN EXAMPLE OF THE BREADTH OF THE MEETING. AT THE BOTTOM OF THE URL YOU CAN ALSO FIND THE BIOS FOR PLENARY SPEAKERS I HAD REFERRED TO EARLIER, BUT IMPORTANTLY WHAT I WANT TO POINT OUT IS THIS MEETING VIDEOTAPES ALL THE PLENARY SESSIONS AND MAKES THEM FREELY AVAILABLE. SO YOU CAN GO TO THIS URL AND SEE ALL THE PLENARIES THAT I TALKED ABOUT, WITH THEIR SLIDES, WITH AUDIO AND VIDEO, THAT YOU CAN WATCH AT YOUR LEISURE. OKAY. MY LAST SLIDE I WANT TO MAKE THE POINT THAT A PLUG FOR NEXT YEAR'S MEETING, IT'S IN APRIL 22-25, 2020, AND IT'S NOW THE FOCUS ALTERNATES TO ISSUES AND CHALLENGES THAT ADULTS AND ADOLESCENTS WITH FASD FACE. PART OF THIS MEETING, A POWERFUL PART OF THIS MEETING, IS THIS GROUP OF INDIVIDUALS WITH FASD THAT ATTEND, CALLED THE CHANGE MAKERS, AND THEY OFTEN LIKE TO PROMOTE THE SAME "NOTHING ABOUT US WITHOUT US," THE IDEA BEING THEY WOULD LIKE TO BE MORE INVOLVED IN THE RESEARCH THAT OUR RESEARCHERS THAT WE FUND DO. SO, PUT IT ON YOUR CALENDARS. I WANT TO MAKE A PLUG FOR IT. IT'S A REALLY GOOD MEETING, AND WITH THAT I'LL END THERE. THANKS. >> GREAT. THANK YOU VERY MUCH. THANK YOU, BILL. NOW WE HAVE A BREAK. WE'LL KEEP TEN MINUTES BREAK, 11:10, PLEASE BE BACK. GOOD MORNING. MY NAME IS SHIN KIM, I'M THE TEAM LEAD FOR THE PRENATAL ALCOHOL OPIOID AND SUBSTANCE EXPOSURE TEAM. AND ACTUALLY, I CAN GIVE YOU A LITTLE BIT OF BACKGROUND IN TERMS OF WHERE WE SIT BECAUSE WE RECENTLY REORGANIZED QUITE A BIT. I AM IN THE PREVENTION RESEARCH AND TRANSLATION BRANCH, THE DIVISION OF CON CONGENITAL AND DEVELOPMENTAL DISORDERS, AND OUR TEAM PREVIOUSLY WAS THE FAS PREVENTION TEAM AND IT RECENTLY EXPANDED TO INCLUDE NOT ONLY LCOHOL BUT OPIOIDS AND OTHER SUBSTANCE EXPOSURES. WE ALSO, WITHIN OUR BRANCH, ALSO HAVE THE PREVENTION RESEARCH TEAM THAT WORKS ON INTERNATIONAL BIRTH DEFECT SURVEILLANCE AND ALSO FOLIC ACID ACTIVITIES AS WELL AS A NEW TEAM CALLED EMERGING THREATS TEAM WHICH LOOKS AT DOMESTIC AND INTERNATIONAL ZIKA ACTIVITIES, HURRICANE RESPONSE AND EMERGING THREATS. SO I'M GOING TO GO AHEAD AND KIND OF TALK YOU THROUGH SOME OF OUR PROGRAMMATIC ACTIVITIES. SO WE PARTNERED WITH ACADEMIC INSTITUTIONS CALLED PRACTICE IMPLEMENTATION CENTERS OR PICs WITH MEDICAL SOCIETIES AND WITH NATIONAL ORGANIZATIONS AND FOR SHORT, WE CALL THEM OUR PICKs AND PARTNERS AND THEY WERE FUNDED FROM 2014 TO 2018, AND WE'RE CURRENTLY ON A NO COST EXTENSION FOR UP TO ONE YEAR. THEIR WORK WAS TO ACHIEVE PRACTICE AND SYSTEM CHANGE IN HEALTHCARE SETTINGS IN SIX DISCIPLINE-SPECIFIC WORK GROUPS AND THESE WORK GROUPS WERE WITH OB-GYNs, PEDIATRICIANS, NURSES, SOCIAL WORKERS, FAMILY PRACTICE PHYSICIANS, AND MEDICAL ASSISTANTS. WE ALSO HAD OUR FASD TRAINING WEBSITE THAT WENT LIVE IN JANUARY 2018, AND AS PART OF THIS TRAINING WEBSITE, IT INCLUDED FIVE ONLINE TRAINING COURSES AND THERE'S KIND OF THE LIST OF THE TRAINING COURSES. AND IT ALSO INCLUDES PUBLISHED RELEVANT POLICY/POSITION STATEMENTS, ARTICLES, AND ALSO IT DEVELOPED NETWORKS OF CHAMPIONS. HERE IS AN EXAMPLE OF A PROMOTION FLYER WE HAD THAT LISTS THE TRAINING COURSES, THE WEBSITE ADDRESS AND THE TYPES OF CONTINUING EDUCATION THAT ARE AVAILABLE. AND RECENTLY, IN MAY, WE PUBLISHED OUR FIFTH AND FINAL ONLINE COURSE WHICH IS THE INTERPROFESSIONAL COLLABORATIVE PRACTICE AS A MODEL FOR PREVENTION OF ALCOHOL-EXPOSED PREGNANCIES. AND THIS ONLINE COURSE, THE GOAL OF IT IS TO GIVE PRACTICAL INSIGHTS AND TIPS ON HOW TO DESIGN AND IMPLEMENT INTERPROFESSIONAL COLLABORATIVE PRACTICE TEAMS. WE ALSO RECENTLY RELEASED TWO MICRO-LEARNINGS IN MAY, AND THESE ARE SHORT VIDEOS THAT ARE ABOUT FIVE MINUTES LONG FOCUSED ON ONE OBJECTIVE AS REFLECTED IN THE TITLES THAT YOU SEE HERE. AND THEY ALSO SERVE AS SUPPLEMENTS TO THE EXISTING COURSES. AND THEY'RE ALSO FOUND ON THE WEBSITE. SO SOME NEW PROJECTS FOR 2019 TO 2022. OUR TEAM HAD THREE NOTICE OF FUNDING OPPORTUNITIES OR NOFOs THAT WERE RELEASED LAST SPRING, IN 2018, AND THESE NOFOs BUILD AND IMPROVE ON PARTS OF THE FASD PICs AND PARTNERS THAT I HAD MENTIONED EARLIER. THE TEAM EXAMINED LESSONS LEARNED FROM THE PICs AND PARTNERS AND RECOGNIZED THAT THERE WERE SEVERAL CHANGES THAT WOULD IMPROVE THE PREVIOUS MODEL. AND THESE CHANGES INCLUDE FOCUSING THE NEW NOFOs ON CONCRETE IMPLEMENTATION EFFORTS VERSUS TRAINING, BE MORE PRESCRIPTIVE REGARDING TARGET AUDIENCES AND ACTIVITIES, TO USE A SETTING-SPECIFIC APPROACH FOR CUSSING ON PRACTICE AND SYSTEMS CHANGES, BE MORE FOCUSED AND EXPLICIT REGARDING GRANTEE ACTIVITIES AND TO RETAIN THE CHAMPION CONCEPT THAT WORKED WELL WITH THE CURRENT GRANTEES. AND SO AS A NATURAL STEP OF IMPROVING ON THE PREVIOUS MODEL LED TO OUR FOUR NEW FUNDING OPPORTUNITIES THAT ARE LISTED HERE. WE HAVE A NOFO WORKING WITH NATIONAL ORGANIZATION PRIMARILY FOCUSED ON FASD, AND THIS IS CALLED THE PROMOTING RESOURCES FOR FASD AWARENESS AND PREVENTION, THE NATIONAL ORGANIZATION FETAL ALCOHOL SYNDROME WAS FUNDED FOR THAT, A NOFO FOCUSED ON IMPLEMENTING ALCOHOL STREENING AND BRIEF INTERVENTION, PROVIDING WOMEN'S HEALTH SERVICES AND THERE WERE FOUR ORGANIZATIONS THAT WERE FUNDED FOR THAT PROJECT. AND THEN A NOFO THAT'S FOCUSED ON NATIONAL MEDICAL SOCIETIES AND PROFESSIONAL ORGANIZATIONS WITH ACTIVE HEALTH PROFESSIONAL MEMBERSHIP, AND WE HAD SEVERAL THAT WERE FUNDED FOR THAT, I THINK IT'S FIVE, AND THEN FINALLY OUR CONTINUED EFFORTS TO REACH PEDIATRIC PROVIDERS WHICH IS OUR PEDIATRIC PUBLIC HEALTH PARTNERSHIPS ON FASDs, WHICH WAS FUNDED TO AAP. WE ALSO HAVE A PROJECT CALLED MATT-LINK. CDC REEFED FUNDING TO IMPLEMENT A SURVEILLANCE NETWORK ON MATERNAL, INFANT AND CHILD HEALTH OUTCOMES FOLLOWING TREATMENT OF OPIOID USE DISORDER DURING PREGNANCY. AND THIS PROJECT WILL IMPROVE OUR UNDERSTANDING OF THE SPECTRUM OF MATERNAL NEONATAL AND PEDIATRIC OUTCOMES FOLLOWING TREATMENT OF OPIOID USE DISORDER DURING PREGNANCY, AND MAY INFORM CLINICAL MANAGEMENT AND PREVENTION OF THESE ADVERSE OUTCOMES, AND WHAT'S GOING TO BE REALLY NICE ABOUT THIS PROJECT IS WE REALLY ARE GOING TO TRY TO COLLECT INFORMATION ABOUT ALL THE DIFFERENT TYPES OF SUBSTANCE EXPOSURES THAT THESE WOMEN THAT ARE ON OPIOID USE DISORDER TREATMENT MAY HAVE BEEN EXPOSED TO, REALLY GETTING AT THE POLYSUBSTANCE ISSUE, SO INCLUDING ALCOHOL AND OTHER SUBSTANCES. SO OUR COLLABORATION WITH ADMINISTRATION FOR CHILDREN AND FAMILIES, SHARON DID A VERY NICE JOB PROVIDING THE DETAILS FOR THIS SO I WON'T GO INTO A WHOLE LOT OF DETAIL, BUT JUST AGAIN WANTING TO REALLY HIGHLIGHT AND EMPHASIZE THE IMPORTANCE OF THIS WORK AND THIS COLLABORATION TO IMPROVE HEALTH AND DEVELOPMENTAL OUTCOMES OF CHILDREN PRENATALLY EXPOSED TO ALCOHOL AND OTHER DRUGS IN THE CHILD WELFARE SYSTEM. AND TO DATE, WE COMPLETED ONE EXPLORATORY STUDY OF POLICIES AND PRACTICES, A MULTISITE DESCRIPTIVE STUDY REPLICATING THE EXPLORATORY STUDY AND SIX STATES PLUS TRIBAL COMPONENT THAT'S IN PROGRESS. WE ALSO HAVE SOME WORK THAT IS IN COLLABORATION WITH THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION OR SAMHSA. THIS IS A THREE-YEAR INTERAGENCY AGREEMENT, AND IT'S TO PROMOTE THE NEWLY APPROVED HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET OR THE HEDIS MEASURE CALLED UNHEALTHY ALCOHOL USE SCREENING AND FOLLOW-UP. AND THIS IS TO SUPPORT A QUALITY IMPROVEMENT LEARNING COLLABORATIVE ACROSS FOUR TO FIVE LARGE AND DIVERSE HEALTH PLANS, AND IT'S ALSO IN COLLABORATION WITH THE NATIONAL COMMITTEE ON QUALITY ASSURANCE. AND ULTIMATELY, THE GOAL IS TO DEVELOP A TOOLKIT ON SUCCESSFUL QUALITY IMPROVEMENT APPROACHES USING ELECTRONIC CLINICAL DATA SYSTEMS AND LESSONS LEARNED AND BARRIERS FOR IMPLEMENTATION, AND RECENTLY WE HAD A POSTER PRESENTATION AT THE 2019 ACADEMY HEALTH ANNUAL RESEARCH MEETING, AND HERE IS A WEBSITE WHERE THERE'S ADDITIONAL INFORMATION. CDC IS ALSO VERY MUCH INTERESTED IN DEVELOPING MESSAGES FOR HEALTHCARE PROVIDERS TO EMPHASIZE THE IMPORTANCE OF ALCOHOL SCREENING AND PREVENTION TO WOMEN OF REPRODUCTIVE AGE AND TOOLS TO ENHANCE PATIENT PROVIDER COMMUNICATION ABOUT ALCOHOL AND ITS RISKS DURING PREGNANCY. SO IN 2017, WE AWARDED A COMMUNICATION CONTRACT TO IMPROVE THE WAY HEALTHCARE PROVIDERS DELIVER MESSAGING TO PATIENTS ABOUT THE RISK OF ALCOHOL USE DURING PREGNANCY AND TO ENGAGE HEALTHCARE PROVIDERS IN THE DELIVERY OF ALCOHOL SCREENING AND BRIEF INTERVENTION FOR THEIR PATIENTS, PARTICULARLY WOMEN WHO ARE PREGNANT OR MIGHT BE PREGNANT. THIS IS AN 18-MONTH CONTRACT WITH THE AMERICAN INSTITUTES FOR RESEARCH, AND AS PART OF THE CONTRACT, WE'LL HAVE AN ONLINE SURVEY THAT WILL BE CONDUCTED WITH 500 HEALTHCARE PROVIDERS, AND THEN FROM THOSE RESPONDENTS, 36 HEALTHCARE PROVIDERS WILL DO IN DEPTH INTERVIEWS. AND THEN THE IN DEPTH INTERVIEWS WILL ALSO BE CONDUCTED WITH 72 WOMEN OF REPRODUCTIVE AGE. SO BASED ON THESE FINDINGS FROM THE SURVEY AND THE INTERVIEWS, DRAFT MATERIAL CONCEPTS WILL BE DEVELOPED FOR HEALTHCARE PROVIDERS WHICH WILL THEN INFORMALLY BE TESTED THROUGH OUR NEW GRANTEES IN THE THIRD NOFO THAT I HAD MENTIONED WITH OUR PARTNERSHIPS WITH NATIONAL ORGANIZATIONS WHO ARE WORKING WITH HEALTHCARE PROFESSIONALS. THIS CONTRACT TECHNICALLY WAS SUPPOSED TO END IN MARCH BUT WE HAD TO DO AN EXTENSION BECAUSE OF OMB. SO QUICKLY I'LL GO THROUGH SURVEILLANCE. WE HAVE MULTIPLE DATA SOURCES THAT CAN PROVIDE DIFFERENT ANGLES OF DATA. WE CONTINUE TO MONITOR ALCOHOL USE AMONG WOMEN AND ALCOHOL SCREENING AND BRIEF INTERVENTION USING BOTH PATIENT AND PROVIDER DATA. SO WE USE BRFSS, WHICH LIKE I SAID CONTINUES TO MONITOR ALCOHOL CONSUMPTION, AND WE ALSO HAVE A MODULE ON ALCOHOL SCREENING AND BRIEF INTERVENTION. WE ALSO HAVE WORKED WITH THE NATIONAL AMBULATORY MEDICAL CARE SURVEY WHICH PROVIDES INFORMATION ON PATIENT PROVIDER AND VISIT CHARACTERISTICS, AND ALSO WORK WITH THE DOCSTYLES AND SUMMERSTYLES SURVEY WHICH MEASURES PHYSICIANS AND CONSUMERS' KNOWLEDGE, ATTITUDES AND PRACTICES. WE ALSO HAVE ADDED SOME NEW DATA. WE HAVE 2019 BRFSS MODULE ON ALCOHOL SBI, WHICH IS IN 12 STATES ALL COLLECTING DATA. WE EXPECT THOSE DATA TO BE AVAILABLE IN FALL 2020. WE ALSO ADDED SOME QUESTIONS ON ALCOHOL SCREENING AND BRIEF INTERVENTION ON THE PREGNANCY RISK ASSESSMENT AND MONITORING SURVEY ON THEIR OPIOID CALLBACK SURVEY IN SEVEN STATES. AND THEN WE ALSO HAVE SOME ADDITIONAL DATA THAT WE'VE INCLUDED IN THE STYLES SURVEY AS WELL. THIS IS OUR MMWR THAT WE PUBLISHED IN APRIL, AND BASED ON 2015-2017 BRFSS DATA FROM 50 STATES AND D.C. , THE MAIN FINDINGS WAS THAT ONE IN NINE PREGNANT WOMEN REPORTED DRINKING ALCOHOL IN THE PAST 30 DAYS. I THINK I'M AT TIME, SO HERE ARE SOME CDC RESOURCES, AND THAT'S IT. THANK YOU. >> THANK YOU, SHIN, VERY MUCH, AND WE HOLD ALL QUESTIONS TO END TO SAVE TIME. SO NOW PLEASE, DAN, THIS IS YOU. >> IF ANYBODY HAS AN ANNOTATED VERSION OF THIS THAT I MISTAKENLY PASSED OUT, IT WILL HAVE YELLOW HIGHLIGHTS ON IT? >> I'VE GOT IT! [LAUGHTER] >> YOU MADE THE JOKE ABOUT SAMHSA BEING -- YOU SABOTAGED ME. I DON'T HAVE A PRESENTATION BUT I WILL GO OVER SOME MAIN THINGS -- CAN YOU HEAR ME? OKAY. I'LL GO OVER SOME MAIN THINGS WITH WHAT WE'RE DOING AT SAMHSA. THIS REIMAGINE IS UPDATED CONSTANTLY, BUT WE RECEIVED A BUDGET INCREASE ON PAGE 1, A BUDGET INCREASE OF 35%, WHICH IS HUGE, AGENCY-WIDE, AND THAT INCREASED THE VOLUME FROM 1,003 -- YOU CAN READ THAT -- TO 3,500 NEW GRANT AWARDS INCREASE, FROM OVER 600 TO OVER 1,500. SO WE'RE REALLY BUSY THERE, DOING A LOT OF GRANTS. I HAVEN'T DONE GRANTS FOR 10 YEARS. I NOW HAVE 13 NATIVE AMERICAN PARTNERSHIP FOR SUCCESS GRANTS ON MY PORTFOLIO NOW. AND WE HAVE AN OFFICE OF THE CHIEF MEDICAL OFFICER, WHICH IS NEW, BECAUSE THE AGENCY IS REALLY LOOKING AT TREATMENT, SCREENING, AND DIAGNOSIS MORE BECAUSE OF THE OPIOID CRISIS AND THE TREATMENT THAT'S NEEDED AND SO FORTH. WE HAVE A NEW ORGANIZATIONAL UNIT. THIS IS THE TOP OF PAGE 2, WAS DEVELOPED THE ESTABLISHMENT OF A NATIONAL HEALTH HEALTH AND SUBSTANCE ABUSE POLICY LAB WHICH PUTS OUT DIFFERENT EVIDENCE-BASED PRODUCTS. FOR THE PREVENTION CENTER THERE, WE HAVE PRODUCED AND WE'LL BE RELEASING SOON PREVENTING SUBSTANCE MISUSE AMONG YOUNG ADULTS, A GUIDE. AND A GUIDE TO SAMHSA'S STRATEGIC PREVENTION FRAMEWORK WHICH IS A PLANNING MODEL FOR PREVENTION PROGRAMS, YOU ASSESS THE PROBLEM, YOU LOOK AT YOUR RESOURCES, YOU PLAN, YOU IMPLEMENT THE PROGRAMS AND YOU EVALUATE AND YOU CONTINUE THAT CIRCLE THERE TO MAKE SURE THAT THE QUALITY IS MAINTAINED. THE OTHER POLICY GUIDE IS PREVENTING MARIJUANA USE FOCUS ON WOMEN, WHICH WILL BE INTERESTING WHEN IT COMES OUT. THE NEXT PAGE, PAGE 3 ALMOST AT THE TOP, SAMHSA FULLY LAUNCHED THE OPIOID STATE TARGETED RESPONSE PROGRAM, WHICH AWARDED $500 MILLION TO STATES TO DEVELOP PREVENTION TREATMENT RECOVERY SYSTEMS TO ADDRESS THE OPIOID CRISIS. IN THIS PROGRAM, OVER 120,000 CLIENTS RECEIVED SERVICES, 396 INDIVIDUALS WERE TRAINED, AND 1,300 FUNDED ORGANIATIONS OFFERED AT LEAST ONE FORM OF MEDICATIONS ASSISTED TREATMENT. THOSE PROGRAMS TRAIN FIRST RESPONDERS, THEY TRAIN PHARMACISTS OR MAKE THEM AWARE OF MULTIPLE PRESCRIPTIONS TO ONE INDIVIDUAL FOR OPIOIDS TO STOP DOCTOR SHOPPING FOR INDIVIDUALS WHICH IS LEADING TO THE DEATHS. ALSO AWARENESS OF WHERE YOU CAN GET YOUR OPIOIDS OUT OF YOUR GRANDMOTHER'S MEDICINE CHEST WHEN YOU VISIT HER AT HER HOME BECAUSE SHE'S IN PAIN OR IF YOU ARE VISITING SOMEBODY IN A NURSING HOME, THEY MAY ALSO HAVE THESE OPIOIDS AVAILABLE, SO AWARENESS AS WELL. ALSO WE FUNDED WITH $1 BILLION ADDITIONAL FUNDING TO THE STATE OPIOID GRANT PROGRAM TO BUILD UPON THE SUCCESS OF THE STATE TARGETED RESPONSE THAT I JUST EXPLAINED TO YOU. CAREFUL ATTENTION WAS TAKEN TO ENHANCE THE CLINICAL FOCUS OF THE GRANT PROGRAM WITH ADDITIONAL LANGUAGE EMPHASIZING THE REQUIREMENTS TO MAKE FASD APPROVE MEDICATION AVAILABLE FOR THE TREATMENT OF OPIOID USE DISORDERS SO THAT WOULD BE NARCAN OR NALOXONE, AND IT WILL BE -- THEY HAVE TO USE THE FDA-APPROVED, PROGRAMS THAT WE FUND. WE ALSO HAVE IMPLEMENTED THE CURES ACT, REQUIRING THE ESTABLISHMENT OF THE INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS QUALITY COMMITTEE, AND OUT OF THAT, WE HAVE COLLABORATED WITH JUSTICE, VETERANS ASSOCIATION, LABOR, HUD, EDUCATION AND SOCIAL SECURITY ADMINISTRATION. AT THE BOTTOM 3, SAMHSA SUCCESSFULLY ACTED ON THESE RECOMMENDATIONS WITH FIVE WORK GROUPS, ESTABLISHING EVIDENCE-BASED TREATMENTS, ADDRESSING POPULATIONS INVOLVING THE JUSTICE SYSTEM, CLOSING THE GAP BETWEEN WHAT WORKS AND WHAT DOESN'TS, INCREASING AFFORDABILITY AND ACCESSIBILITY. I MUST SAY THAT ESTABLISHING EVIDENCE-BASED TREATMENTS IS THE MAIN FOCUS THERE, THE TRAININGS GOING ON THROUGHOUT SAMHSA AROUND THAT. AND OF COURSE HRSA IS DOING MUCH MORE. ALSO WE HAVE A NEW CENTER DIRECTOR AT CCEP AND HER NAME IS JENETTA DAVIS JOYCE, HER BACKGROUND IS THAT SHE WORKED WITH THE PACIFIC INSTITUTE OF RESEARCH AND EVALUATION. HER EXPERTISE IS SCIENCE TO SERVICE AND SHE CAME ABOARD ABOUT TWO WEEKS AGO AND WE WELCOME HER AND SEE WHAT SHE CAN DO IN HER NEW POSITION THERE. WE ALSO HAVE A NEW DIRECTOR OFFICE OF TRIBAL AFFAIRS AND POLICY. THE PREVIOUS PERSON WAS MYRTLE BEETLE. WE NOW HAVE DR. THUNDERCLOUD, WHO'S A PEDIATRICIAN, WHO'S NATIVE AND WHO'S INTERESTED IN VULNERABLE POPULATIONS, SERIOUS MENTAL ILLNESS AND OPIOID ABUSE IN NATIVE COMMUNITIES. SO THOSE ARE THE HIGHLIGHTS THAT SAMHSA HAS RIGHT NOW, AND ACTUALLY WE SPENT $90 MILLION FUNDING TRIBAL COMMUNITIES TO ADDRESS OPIOIDS, SUICIDE PREVENTION, TRAUMA, CHILDREN'S MENTAL HEALTH AND OTHER CRUCIAL AREAS. SO WE DO A LOT IN INDIAN COUNTRY. WE HAVE TWO CONTRACTS THAT ARE FUNDED BY THE CENTER FOR MENTAL HEALTH SERVICES, AND THE CENTER FOR SUBSTANCE ABUSE PREVENTION THAT GO OUT TO SUPPORT TRIBES WITH THE FUNDS THAT WE GIVE THEM TO PREVENT SUICIDE, TO PREVENT YOUTH USE OF ALCOHOL AND ILLICIT DRUGS, AND TO ADDRESS HISTORICAL TRAUMA AS WELL. >> THANK YOU VERY MUCH FOR YOUR UPDATE. WE'RE READY FOR THE NEXT UPDATE. >> SO NEXT IS CAITLIN CROSS-BARNET OF CENTERS FOR MEDICARE. >> SO I'M CAITLIN, I'M FROM CMS. CMS HAS MARKEDLY LITTLE GOING ON AT THE MOMENT WHICH IS SURPRISING SINCE WE COVER NEARLY HALF OF PREGNANCY AND BIRTH KAY FOR WOMEN IN THE UNITED STATES AND COVER A HUGE AMOUNT OF THE CARE FOR CHILDREN WITH DISABILITIES, SO I'M ON A ONE-WOMAN CAMPAIGN TO START WORKING ON THAT. I'M NEW TO THIS COMMITTEE, THIS IS ONLY MY SECOND MEETING SO I'M REALLY EXCITED TO MEET THE FOLKS HERE TO BE ABLE TO NETWORK AND I'M HOPING THAT SOME OF YOU MIGHT BE INTERESTED IN DOING SOME MAYBE LUNCH AND LEARN-TYPE PRESENTATIONS EITHER VIRTUALLY OR IN PERSON WITH SOME OF THE MODEL TEAMS I'M ABOUT TO DISCUSS, BECAUSE I THINK WE COULD REALLY BENEFIT FROM HAVING MORE INFORMATION AND RESOURCES AROUND THIS ISSUE BECAUSE I THINK THESE MODELS ARE VERY WELL SUITED TO ADDRESS FETAL ALCOHOL SPECTRUM DISORDERS MORE BROADLY. SO I HAVE TWO -- WE HAVE TWO MODELS. I DID BRIEFLY TALK ABOUT THEM THE LAST TIME I WAS HERE. THEY'VE BOTH BEEN RELEASED NOW, AND ACTUALLY THE INTEGRATED CARE FOR KIDS MODEL, THE APPLICATIONS ARE DUE ON MONTH. MONDAY, SO WE'LL KNOW KIND OF THE SPECTRUM OF WHO WE HAVE APPLYING ON MONDAY. SO JUST AS AN OVERVIEW, IT'S A CHILD CENTERED LOCAL SERVICE DELIVERY AND STATE PAYMENT MODEL AIMED AT REDUCING EXPENDITURES AND IMPROVING QUALITY OF CARE FOR CHILDREN COVERED BY MEDICAID AND CHIP ESPECIALLY FOR THOSE AT RISK OF DEVELOPING SIGNIFICANT HEALTH NEEDS, WE WANT TO IMPROVE PERFORMANCE ON PRIORITY MEASURES OF CHILD HEALTH. IT IS IMPORTANT TO REALIZE THAT WITHIN CMS, THE CORE SETS DO NOT INCLUDE MEASURES SPECIFICALLY AROUND ALCOHOL AND IT'S PROBABLY ONE OF THE REASONS THAT IT'S NOT MUCH OF AN EMPHASIS AT CMS RIGHT NOW. REDUCING AVOIDABLE INPATIENT STAYS AND OUT OF HOME PLACEMENTS, AND KREE CREATION OF SUSTAINABILITY ALTERNATIVE PAYMENT MODELS. SO WE WILL AWARD IN UP TO EIGHT STATES UP TO $16 MILLION PER AWARD, BUT THAT IS OVER A 7-YEAR PERIOD OF PERFORMANCE, TWO YEARS PREIMPLEMENTATION AND FIVE YEARS OF IMPLEMENTATION. SO THE DESIGN REQUIRES THAT A STATE MEDICAID AGENCY PARTNER WITH A HIPAA-COMPLIANT LEAD ORGANIZATION, SO THAT COULD BE A HOSPITAL SYSTEM OR LARGE MANAGED CARE ORGANIZATIONS. I MEAN, IT COULD BE ANY HIPAA-COMPLIANT ORGANIZATION BUT WE'RE EXPECTING IT WOULD BE SORT OF A LARGER LEVEL SERVICE ORGANIZATION. AND THE TWO OF THEM TOGETHER, EITHER ONE CAN BE THE AWARDEE OF RECORD, SO IT COULD BE THE STATE MEDICAID AGENCY, IT COULD BE THE LEAD ORGANIZATION, HAVE TO CREATE A PARTNERSHIP COUNCIL AND THESE ARE SERVICES THAT ARE REQUIRED TO BE REPRESENTED ON THAT COUNCIL. SO CLINICAL CARE WHICH WOULD BE PROVIDED THROUGH MEDICAID, SCHOOLS AND EDUCATION, HOUSING, FOOD AND NUTRITION, SO FOR INSTANCE, WIC PROGRAMS, SNAP PROGRAMS, EARLY CARE AND EDUCATION, TITLE V, CHILD WELFARE/SOCIAL SERVICES AND MOBILE CRISIS RESPONSE. WE DO FUND THE DEVELOPMENT OF A MOBILE CRISIS RESPONSE SYSTEM IF THERE IS NOT ONE IN PLACE. EVERYBODY HAS SCHOOLS, EVERYBODY HAS WIC, AND SO THE IDEA IS THAT YOU WOULD PULL PEOPLE FROM THOSE ORGANIZATIONS TO THIS COUNCIL. SO IT'S A POPULATION-WIDE APPROACH WITH PERSON AND FAMILY-CENTERED SERVICE DELIVERY. THE IDEA IS TO STREAMLINE ELIGIBILITY AND ENROLLMENT INTO ALL PROGRAMS SO THERE'S SORT OF THE SINGLE POINT OF ENTRY THAT WOULD GET SOMEBODY ALL OF THE SERVICES THEY'RE ELIGIBLE FOR AND HELP WITH SERVICE ACCESSIBILITY. AGAIN IN MOBILE CRISIS RESPONSE SERVICES ARE NOT ALREADY AVAILABLE, WE WILL HAVE TO HELP FUND THEIR DEVELOPMENT OR ENHANCE THEIR DEVELOPMENT IF THEY ARE ALREADY IN EXISTENCE. AND THE SYSTEM IS ALSO DESIGNED TO ENHANCE INFORMATION SHARING. SO TO BUILD INFRASTRUCTURE SO THAT ALL OF THESE SYSTEMS CAN TALK TO ONE ANOTHER AND HAVE A CENTRAL DATABASE OF INFORMATION ABOUT THE CHILD. SO APPLICATIONS ARE DUE JUNE 10TH. WE EXPECT TO ANNOUNCE THE AWARDS IN DECEMBER AND BEGIN WHAT WE CALL THE PRE-IMPLEMENTATION PERIOD IN JANUARY 2020. THAT WOULD ENCOMPASS TWO YEARS OF BEING ABLE TO START COORDINATING THESE COUNCILS, BUILD THE INFRASTRUCTURE, DEVELOP A MOBILE CRISIS RESPONSE PROGRAM, ALL THOSE KINDS OF THINGS, WHICH IS WHY WE HAVE THE FULL TWO-YEAR RAMP-UP, SO CHILDREN OBVIOUSLY WILL STILL BE RECEIVING SERVICES DURING THAT PERIOD, JUST NOT UNDER THE COORDINATED INCK MODEL AND THEN THERE WILL BE A PERFORMANCE PERIOD OF FIVE YEARS WHERE WE EXPECT THEM TO ACTUALLY BE PROVIDING THIS COORDINATED SERVICE SYSTEM AND DEVELOPING THEIR ALTERNATIVE PAYMENT MODELS. SO OBVIOUSLY THERE'S SOME REAL OPPORTUNITY HERE FOR . PREGNANT WOMEN ARE OPTIONAL AS A COVERED ENT THE IT. UNDER THE INCK MODEL, THEY DON'T HAVE TO INCLUDE THEM BUT THEY CAN. THERE'S POTENTIALLY OPPORTUNITY ON PREVENTING FASD AND ALSO WITH THE CHILDREN IN APPROPRIATE DIAGNOSIS AND SINCE ONE OF OUR PRIMARY GOALS IS PREVENTING OUT OF HOME PLACEMENT, ALSO APPROPRIATE BEHAVIORAL HEALTH SERVICES, THE FACT THAT SO MANY KIDS WITH FASD ARE MISDIAGNOSED WITH ADD, A LOT OF KIDS WIND UP IN FOSTER CARE, WE KNOW THAT FOSTER CARE CHILDREN ARE DISPROPORTIONATELY PRESCRIBED ANTIPSYCHOTIC MEDICATIONS INAPPROPRIATELY, REALLY UNDERSTANDING FASD WOULD REALLY HELP US TO BE ABLE TO OFFER BETTER AND MORE APPROPRIATE SERVICES FOR CHILDREN. IN ADDITION -- I LOST MY TRAIN OF THOUGHT. BUT WHEN I THINK OF THE ADDITION, I WILL BRING IT UP AGAIN. OKAY. SO THE MOM MODEL IS THE MATERNAL OPIOID MISUSE MODEL. OBVIOUSLY THAT'S A VERY HOT TOPIC AROUND CMS RIGHT NOW. TECHNICALLY INCK IS ACTUALLY ALSO AN OPIOID USE MODEL FOR ALL THE PRESCHOOLERS USING OPIOIDS. THE IDEA BEHIND THAT IS THAT BEHAVIORAL HEALTH SERVICES WOULD HELP PREVENT OPIOID USE LATER IN LIFE, AND THAT ALSO WE WOULD, OF COURSE, TREAT ANY ADOLESCENT WHO HAD OPIATE USE DISORDER OR ANY SUBSTANCE ABUSE DISORDER AND TRY TO GET THEM APPROPRIATE TREATMENT. IT'S A LITTLE UNCLEAR WHAT EVIDENCE-BASED TREATMENT IS FOR A LOT OF THINGS FOR ADD LE SEPTS AND ADOLESCENTS. SO THE MOM MODEL AIMS TO IMPROVE QUALITY OF CARE AND REDUCE COSTS FOR PREGNANT AND POSTPARTUM MEDICAID BENEFICIARIES WITH OPIOID USE DISORDER AND THEIR INFANTS THROUGH STATE-DRIVEN CARE TRANSFORMATION. THE GOALS ARE TO IMPROVE QUALITY OF CARE AND REDUCE COSTS, INCREASE ACCESS TO TREATMENT, THAT EVIDENCE-BASED CARE IS, A, NOT ALWAYS AVAILABLE TO MEDICAID PARTICIPANTS IN GENERAL, AND B, EVEN WHEN IT IS, THOSE ORGANIZATIONS OFTEN DON'T SERVE PREGNANT WOMEN. THEN TO CREATE SUSTAINABLE COVERAGE AND PAYMENT STRATEGIES THAT THE STATE CAN COVER WITHIN ITS OWN CURRENT INFRASTRUCTURE. THE IDEA IS THAT WE WOULD INTEGRATE MATERNITY CARE, OPIOID USE DISORDER TREATMENT, BEHAVIORAL HEALTH AND PRIMARY CARE, BUT WE KNOW POLYUSE IS COMMON, ALCOHOL USE DISORDER, SO WE AR HOPING TO BE ABLE TO SCREEN AND BE ABLE TO TREAT SUBSTANCE ABUSE DISORDERS MORE BROADLY. BUT AGAIN, THIS IS SOMETHING WHERE I THINK OUR TEAM REALLY NEEDS MORE INFORMATION AND EDUCATION AND HELP. AND WE ALSO KNOW THAT CHILDREN ARE MUCH MORE LIKELY TO DEVELOP NEONATAL -- SYNDROME IF THERE'S A POLYSUBSTANCE USE DISORDER. SO WE COVER THE WOMEN THROUGH LABOR AND DELIVERY AND THEN POSTPARTUM CARE, CONTINUE TO PROVIDE BEHAVIORAL HEALTH AND PRIMARY CARE, OUD TREATMENT AND TRY TO -- NOT SEPARATE THE MOTHER AND THE BABY AS LONG AS IT'S SAFE FOR THEM TO REMAIN TOGETHER, ENCOURAGING SKIN TO SKIN, ROOMING IN, BREAST FEEDING IF THE WOMAN IS NOT USING ILLEGAL DRUGS, OR SOMETHING ELSE THAT MIGHT BE INCOMPATIBLE WITH BREAST FEEDING. BUT MAT IS COMPATIBLE WITH BREAST FEEDING AND WE KNOW& BREAST FEEDING IS REALLY HELPFUL FOR BABIES WHO ARE SUFFERING FROM NAS. SO WANT TO ENCOURAGE THAT. SO WE HAVE ONE YEAR FOR PRE-IMPLEMENTATION IN THIS MODEL, AND THEN THE SECOND YEAR IS WHAT WE CALL THE TRANSITION YEAR BECAUSE WE WILL FUND SERVICES THAT ARE NOT CURRENTLY FUNDED UNDER THEIR MEDICAID PROGRAMS. BY YEAR THREE, WE EXPECT THEM TO HAVE APPLIED FOR WAIVERS OR SPAS WHICH ARE JUST EXCEPTIONS TO WHAT'S FEDERALLY REQUIRED UNDER MEDICAID BUT THE STATE CAN APPLY TO HAVE SOMETHING COVERED USING THEIR STATE FUNDS SO WE EXPECT THEM TO USE THESE MECHANISMS TO BE ABLE TO COVER THESE THEMSELVES. WE WILL BE AWARDING UP TO 12 COOPERATIVE AGREEMENTS, AND WE DO HAVE APPLICATIONS IN BUT WE HAVEN'T ANNOUNCED -- WE'RE IN THE PROCESS OF VERY EARLY REVIEW. SO I DID WANT TO GIVE YOU A LITTLE BIT OF BACKGROUND -- HOW AM I DOING FOR TIME, TATIANA? ONE MINUTE! OKAY. VERY, VERY QUICKLY, WE DID ANALYZE SOME MEDICAID DATA TO LOOK AT DIAGNOSIS AND TREATMENT OF SUBSTANCE ABUSE DISORDER AMONG PREGNANT WOMEN IN THREE STATE MEDICAID PROGRAMS, AND THIS INFORMATION WAS PRESENTED AT ACADEMY HEALTH BUT I HAVE A LITTLE EXTRA PIECE ON FETAL ALCOHOL -- OR ALCOHOL USE THAT I PULLED OUT OF THE DATA. SO THIS WAS JUST A DESCRIPTIVE STUDY WHERE WE LINKED CLAIMS AND BIRTH RECORDS IN THREE STATES FOR THE 12 MONTHS BEFORE WOMEN GAVE BIRTH AND THE 12 MONTHS AFTER. AND CONSIDERED ALL WOMEN WHO GAVE BIRTH TO A LIVE SINGLETON INFANT IN 2014 OR 2015, AND YOU CAN SEE THE SAMPLE SIZE WAS ALMOST 38,000. SO THIS IS THE PREVALENCE OF SUDs AMONG MEDICAID-ENROLLED WOMEN WITH THAT LIVE BIRTH, SO YOU CAN SEE 3.6 HAD A SPECIFIED SUD, 1.7 HAD -- AND THAT WAS BEFORE OR DURING THE DELIVERY MONTH, 1.7 HAD A SPECIFIED SUD NOT DIAGNOSED UNTIL AFTER THE DELIVERY MONTH SO THAT WOULD BE FROM ONE MONTH AFTER DELIVERY THROUGH THE FULL YEAR AFTER BIRTH. SIX HAD UNSPECIFIED SUD AND THEN THE MAJORITY, ALMOST 89%, DID NOT HAVE ANY SUD DIAGNOSIS BUT THAT MEANS MORE THAN 10% OF WOMEN HAD SOME KIND OF SUD DIAGNOSIS. THIS IS THE TIMING IN ENROLLMENT IN MEDICAID. YOU CAN SEE HOW MANY WERE ENROLLED BEFORE AND HOW MANY DURING, AND I DON'T REALLY HAVE TIME TO GO THROUGH THE REST OF THIS RIGHT NOW, BUT IF YOU ARE INTERESTED IN A COPY OF THE POSTER, I CAN SEND YOU THAT. IT DOES NOT HAVE THE ALCOHOL USE DISORDER INFORMATION ON IT. MAY I TAKE 30 SECONDS TO GO THROUGH THIS OR DO YOU JUST WANT ME TO SIT DOWN? OKAY. SO ALCOHOL USE DISORDER WAS THE MOST COMMON SPECIFIC SUD DIAGNOSED. 16% OF THE WOMEN DIAGNOSED WITH ANY SUD BEFORE OR AT DELIVERY WERE DUGGED WITH ALCOHOL USE DISORDER AND 24% OF THE WOMEN DIAGNOSED AFTER BIRTH HAD ALCOHOL USE DISORDER, WHICH MEANS THAT APPROXIMATELY .6% OF PREGNANT WOMEN IN THE THREE STAILT PROGRAMS HAD AUD DIAGNOSED BEFORE DELIVERY AND ANOTHER .4 WERE DIAGNOSED AFTER. SO THE APPROXIMATELY 1% WITH DIAGNOSED AUD IS A VERY LOW ESTIMATE OF ALCOHOL MISUSE BECAUSE IT EXCLUDES NOT ONLY ALL UNDIAGNOSED AUD BUT JUST ALCOHOL USE DURING PREGNANCY OR PROBLEMATIC USE THAT DOESN'T QUALIFY AS AN ALCOHOL USE DISORDER. WHICH IS ONE OF THE DISADVANTAGES OF USING CLAIMS BECAUSE THEY'RE NOT GOING TO REGISTER WHETHER OR NOT WOMEN CONSUMED ANY ALCOHOL. SO THANK YOU VERY MUCH. >> THANK YOU VERY MUCH FOR UPDATES. A LOT OF INTERESTING DATA AND OPPORTUNITIES FOR COLLABORATION. NOW FINALLY, WE'RE GOING TO LISTEN TO HRSA, AND PLEASE WELCOME DON DAWN LEVINSON. >> THANK YOU SO MUCH. GOOD AFTERNOON, I'M DAWN LEVINSON WITH THE HEALTH RESOURCES AND SERVICES ADMINISTRATION, MA TERM AND MATERNAL HEALT H CHEELD HEALTH BUREAU. I SERVE AS THE BEHAVIORAL HEALTH LEAD. I SIT IN OUR DIVISION OF HEALTHY START AND PERINATAL SERVICES BUT I'M REALLY MEANT TO BE A RESOURCE TO THE BUREAU, AND WITHIN THE BUREAU, I PROVIDE LEADERSHIP, COORDINATION, SUBJECT MATTER EXPERTISE AND RECOMMENDATIONS ON BEHAVIORAL HEALTH POLICY PROGRAM AND TECHNICAL ASSISTANCE ACROSS DIVISIONS AND PROGRAMS AND I WORK WITH NATIONAL AND FEDERAL AGENCY PARTNERS, STAKEHOLDERS, AND GRANTEES TO MAKE SURE THAT MENTAL AND BEHAVIORAL HEALTH KNOWLEDGE, TOOLS AND RESOURCES ARE INFUSED ACROSS OUR PROGRAMS. BEFORE I BRING YOUR ATTENTION TO SOME NEW TRAINING RESOURCES THAT I WANTED TO SHARE HERE TODAY, I ALWAYS LIKE TO PUT MCHB'S WORK ON MENTAL AND BEHAVIORAL HEALTH IN THE BROADER HEALTH CONTEXT, AND SO OF COURSE WE ACKNOWLEDGE THAT THERE IS NO HEALTH WITHOUT MENTAL HEALTH. MCHB PROGRAMS FUNDAMENTALLY PROMOTE THE MENTAL HEALTH AND WELL-BEING FOR MATERNAL AND CHILD POPULATIONS ACROSS THE LIFESPAN. AND THIS ALIGNS WITH OUR MISSION TO IMPROVE THE HEALTH OF AMERICA'S MOTHERS, CHILDREN, AND FAMILIES. ESSENTIALLY OUR PROGRAMS DO THE FOLLOWING EIGHT THINGS ALONG THE PUBLIC HEALTH CONTINUUM THAT'S RELATED TO BEHAVIORAL HEALTH. WE PROMOTE, PREVENT, SCREEN, INTERVENE, REFER, TREAT, TRAIN, SUPPORT, AND OUR PROGRAMS ADDRESS MENTAL AND BEHAVIORAL HEALTH ISSUES AT MULTIPLE LEVELS, SUPPORTING PROVIDERS, POLICIES, STATE AND LOCAL SYSTEMS, WORKFORCE TRAINING, PATIENTS AND FAMILIES, AND INNOVATIONS THAT HARNESS TECHNOLOGY-BASED SOLUTIONS. IN THE INTEREST OF TIME, I'M JUST GOING TO FOCUS ON MCHB'S ONE FOCUSED INITIATIVE ON THE PREVENTION OF FASD. FUNDING FOR THIS ACTIVITY COMES THROUGH TITLE V'S SPECIAL PROJECTS OF REGIONAL AND NATIONAL SIGNIFICANCE. MCHB INTEGRATES ITS FASD PREVENTION INTO THE TRAINING AND TECHNICAL ASSISTANCE SERVICES PROVIDED BY THE HEALTHY START INITIATIVE, ELIMINATING DISPARITIES IN PERINATAL HEALTH'S TECHNICAL EPIC CENTER, THE HEALTHY START EPIC CENTER. SO BRIEFLY AS YOU MAY KNOW, THE PURPOSE OF THE HEALTHY START PROGRAM IS TO IMPROVE HEALTH OUTCOMES BEFORE, DURING AND AFTER PREGNANCY, AND REDUCE RACIAL AND ETHNIC DISPARITIES IN RATES OF INFANT DEATH AND ADVERSE PERINATAL OUTCOMES. THE SO I WANTED TO DRAW YOUR ATTENTION TO THIS HANDOUT THAT IS IN YOUR PACKET. IT'S GOT A NICE BURGUNDY COLOR. SO I REALLY WANTED TO HIGHLIGHT FOR THIS GROUP SEVERAL OF OUR NEW RESOURCES, AGAIN, DEVELOPED UNDER OUR INITIATIVE AND FUNDED BY THIS FASD MONEY THAT WAS PUT INTO THE HEALTHY START EPIC CENTER. SO ASTEP STANDS FOR ALCOHOL AND SUBSTANCE EXPOSED PREVENTION PROGRAM. THE ASTEP INITIATIVE FOCUS ON INCREASING KNOWLEDGE AND SKILLS AMONG HEALTHY START AND FEDERAL HOME VISITING GRANTEES, SO OUR MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING PROGRAM, ALSO KNOWN AS MIECHV. IT FOCUSES ON INCREASING THEIR KNOWLEDGE AND SKILLS RELATED TO PREVENTION AND EARLY IDENTIFICATION OF FETAL ALCOHOL EXPOSURE OR OTHER DRUGS THAT IMPACT MATERNAL AND NEWBORN HEALTH OUTCOMES. AND THERE IS A SPECIAL EMPHASIS IN THE ASTEP PROGRAM FOCUSED ON AMERICAN INDIAN COMMUNITIES AND POPULATIONS. SO THE PRODUCTS YOU SEE HERE IN THE HANDOUT CAN BE ACCESSED VIA OUR HEALTHY START EPIC CENTER WEBSITE, WHICH YOU SHOULD HAVE THE LINK TO ON THE VERY BACK. IT'S HEALTHY START EPIC.ORG, AND THEN LOOK FOR THE ASTEP PAGE. SO THESE PRODUCTS HERE FALL INTO THE FOLLOWING THREE BROAD CATEGORIES OR BUCKETS. WE HAVE SELF STUDY RESOURCES, WE HAVE STAFF DEVELOPMENT RESOURCES FOR GROUPS, AND THEN WE HAVE RESOURCES ON SUBSTANCE USE DURING PREGNANCY IN AMERICAN INDIAN AND TRIBAL COMMUNITIES. SO I'LL JUST TAKE A MOMENT TO DESCRIBE THESE RESOURCES FOR YOU IN MORE DETAIL. UNDER THE SELF STUDY RESOURCES, WHICH ARE THE FIRST SET, THIS E-LEARNING COURSE ON ALCOHOL AND OTHER YOU BE SUBSTANCE EXPOSED PREGNANCIES, AS WELL AS A SELF STUDY GUIDE ON STATE LEGISLATION ON SUBSTANCE USE DURING PREGNANCY. UNDER THE -- ON PAGE 2, UNDER THE STAFF DEVELOPMENT RESOURCES FOR GROUPS, THIS INCLUDES SIX STAFF MEETING TRAINING PACKAGES ON VARIOUS TOPICS INCLUDING FASD AND DEPRESSION AMONG OTHERS, AND THEN ALSO ONE GROUP DISCUSSION GUIDE ON OPIOID USE DURING PREGNANCY. I DO WANT TO CALL YOUR ATTENTION TO THE STAFF MEETING PACKAGES BECAUSE I THINK THEY'RE PRETTY COOL. BASICALLY IT PROVIDES IN THE PACKAGE EVERYTHING THAT YOU WOULD NEED FOR A SHORT STAFF DEVELOPMENT ACTIVITY, LIKE UNDER AND HOUR THAT YOU CAN DO WITH YOUR ENTIRE TEAM DURING A STAFF OR OTHER TEAM MEETING. EACH PACKAGE CONTAINS AN AUDIO OR VIDEO PRESENTATION ON THE SUBJECT, QUESTIONS FOR GROUP DISCUSSION, ALONG WITH LINKS TO WEB-BASED AND PRINT RESOURCES FOR FURTHER EXPLORATION. SO EVEN THOUGH THESE MATERIALS WERE DEVELOPED SPECIFICALLY FOR HEALTHY START AND HOME VISITING STAFF, WE DO BELIEVE THAT THESE ARE APPLICABLE ACROSS OTHER SOCIAL SERVICE AGENCIES WHO SERVE PREGNANT WOMEN, SO IN THE ABSENCE OF SPECIFIC TARGETED MATERIALS, PERHAPS TO YOUR GROUPS, PLEASE, PLEASE FEEL FREE TO SHARE THESE WITH OTHERS, AND I WILL PROVIDE AN EMAIL SPECIFICALLY SO THAT PEOPLE HAVE THE WEB LINKS BECAUSE WE KNOW -- THIS IS MORE FOR PRESENTATION PURPOSES. AND THEN THE LAST SECTION FOCUSES ON THE RESOURCES IN AMERICAN INDIAN AND TRIBAL COMMUNITIES WHICH INCLUDES TWO VIDEOS FEATURING THE NORTHERN PLAINS TRIBAL HEALTHY START PROJECT IN THE DAKOTAS, A COMPENDIUM OF TRIBAL BEHAVIORAL HEALTH RESOURCES, AND AN INFOGRAPHIC ON THE SOCIAL DETERMINANTS OF SUBSTANCE USE DURING PREGNANCY IN TRIBAL COMMUNITIES. ALSO WE HAVE A FEW OF THE STAFF MEETING PACKAGES ALSO GEARED TOWARD AMERICAN INDIAN AND TRIBAL POPULATIONS. AND LASTLY ON THE HANDOUT, ON PAGE 4, I JUST WANTED TO MENTION THAT WE ALSO HAVE A SERIES, A FOUNDATIONAL WEBINAR SERIES ON FASD, FIVE OF THEM, AND ALSO THESE HAVE BEEN ARCHIVED HERE ON THE HEALTHY START EPIC.ORG WEBSITE. SO AGAIN, I JUST REALLY THINK THIS IS THE PLACE THAT I REALLY WANTED TO PROMOTE THESE RESOURCES AT THIS -- WITH OUR FEDERAL PARTNERS AND COLLEAGUES IN THE FIELD, AND THEN I'M ALSO GOING TO JUST CLOSE TODAY BY MENTIONING IN HRSA WE HAVE THREE NEW JUST-RELEASED FUNDING OPPORTUNITIES TO IMPROVE MATERNAL HEALTH OUTCOMES, AND TO ADDRESS DISPARITIES AND MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY, SO THOSE THREE INCLUDE -- THESE ARE ALL OPEN NOW. THE FIRST IS THE STATE MATERNAL HEALTH INNOVATION PROGRAM, WHICH WILL INVEST APPROXIMATELY 18 MILLION THROUGH NINE AWARDS TO STATES OR A GROUP OF STATES OR AN ORGANIZATION WORKING IN CONCERT WITH THE STATE TITLE V AGENCY. SUCCESSFUL RECIPIENTS WILL RECEIVE $2 MILLION PER YEAR FOR FIVE YEARS TO STRENGTHEN PARTNERSHIPS AND COLLABORATION BY ESTABLISHING A STATE-FOCUSED MATERNAL HEALTH TASK FORCE, IMPROVING STATE-LEVEL DATA SURVEILLANCE ON MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY, AND PROMOTING AND EXECUTING INNOVATION IN MATERNAL HEALTH SERVICE DELIVERY. THE NEXT ONE IS THE SUPPORTING MATERNAL HEALTH INNOVATIONS PROGRAM. THIS ONE WILL INVEST APPROXIMATELY $2.6 MILLION THROUGH 1 AWARD TO SUPPORT STATES AND OTHER STAKEHOLDERS IN REDUCING MATERNAL MORTALITY AND SEVERE MATERNAL MORBIDITY. THIS ENTITY WILL PROVIDE CAPACITY BUILDING ASSISTANCE TO RECIPIENTS OF THE STATE MATERNAL HEALTH INNOVATION GRANTS THAT I JUST MENTIONED, AND OTHER HRSA-FUNDED MATERNAL HEALTH GRANTEES. THEY WILL IMPLEMENT INNOVATIVE AND EVIDENCE-INFORMED STRATEGIES, AND THIS FUNDING WILL ALSO ESTABLISH A NATIONAL RESOURCE CENTER TO PROVIDE GUIDANCE TO HRSA AWARD RECIPIENTS, STATES AND KEY NATIONAL -- KEY STAKEHOLDERS IN IMPROVING MATERNAL HEALTH. AND FINALLY, THE THIRD NEW FUNDING OPPORTUNITY IS CALLED THE ALLIANCE FOR INNOVATION ON MATERNAL HEALTH OR AIM, WHICH YOU MAY BE AWARE OF ALREADY. THERE'S AN EXISTING AIMH ACTIVITY, HOWEVER THIS ONE FOCUSES ON COMMUNITY CARE INITIATIVE. THIS FUNDING OPPORTUNITY IS FOR $1.8 MILLION THROUGH ONE AWARD TO DEVELOP AND IMPLEMENT MATERNAL SAFETY BUNDLES WITHIN COMMUNITY-BASED ORGANIZATIONS AND OUTPATIENT CLINICAL SETTINGS ACROSS THE U.S. AND OF COURSE THE SAFETY BUNDLES ARE KIND OF SETS OF BEST PRACTICES FOR SAFE MATERNITY CARE. THIS INITIATIVE WILL BUILD UPON THE FOUNDATIONAL WORK OF AIMH BY USING A QUALITY IMPROVEMENT FRAMEWORK TO ADDRESS MORTALITY AND MORBIDITY AMONG PREGNANT AND POSTPARTUM WOMEN OUTSIDE HOSPITAL AND OTHER BIRTHING FACILITIES. THESE COMPLEMENT EXISTING NATIONAL EFFORTS SUCH AS THE TITLE V MATERNAL AND CHILD HEALTH SERVICES BLOCK GRANT, THE HEALTHY START INITIATIVE AND THE AIMH PROGRAM TO IMPROVE MATERNAL HEALTH OUTCOMES FOR ALL WOMEN AND, IN TURN, IMPROVE THE HEALTH OF THEIR CHILDREN, FAMILIES AND COMMUNITIES. FOR MORE DETAILS ON THESE FUNDING OPPORTUNITIES, THERE'S GO TO HRSA.GOV AND LOOK UNDER "GRANTS." SO THAT'S REALLY WHAT I WANTED TO PRESENT TODAY. THANK YOU. >> THANK YOU. THANK YOU VERY MUCH. THANK YOU, EVERYONE, FOR PRESENTATIONS. IT WAS IMPORTANT TO HEAR AGENCIES' REPORTS. WE WILL DEFINITELY LOOK AT REPORTS AND SLIDES AND WE WILL HAVE TIME TO DISCUSS AT THE END -- AFTER THE LUNCH AT THE END OF PANEL DISCUSSION TODAY. AS WE SAID, USUALLY IF ICCFASD INVITES EXPERTS IN THE FIELD TO SPEAK TO US TO HELP TO UNDERSTAND ISSUES THAT THE FIELD OF FASD HAS FACED, AND WE NEED TO FOCUS SPECIFIC EFFORTS OF AGENCIES, AND TODAY OUR SPECIAL PANEL IS FOCUSED ON RECOGNITION AND IMPROVING RECOGNITION OF FASD IN DIFFERENT SYSTEMS AND TO HELP US UNDERSTAND HOW WE ALL CAN WORK TOGETHER AND COORDINATE OUR WORK TO IMPROVE THESE SERVICES. WE HAVE SPECIAL MODERATORS FOR THIS SESSION. WE HAVE TRACY KING. SHE MODERATES THE SESSION TOGETHER WITH SALLY ANDERSON. TRACY IS MEDICAL OFFICER AT NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT, AND DR. SALLY ANDERSON IS SPECIAL ADVISOR FOR I.D. SO PLEASE, WELCOME. >> TRACY IS GOING TO DO ALL THE WORK. I DID THE BACKGROUND WORK. >> SO THANKS VERY MUCH. I'M VERY EXCITED TO MODERATE THIS PANEL. I JUST WANTED TO TAKE ONE MINUTE AND KIND OF PROVIDE SOME CONTEXT AND THEN I'LL INTRODUCE THE TWO SPEAKERS THAT ARE GOING TO SPEAK BEFORE LUNCH AND THEN WE'LL COME BACK AND I'LL INTRODUCE THE TWO FOLKS WHO ARE SPEAKING AFTER LUNCH. SO AS ALL OF YOU HAVE BEEN HEARING, THERE ARE CERTAINLY CHALLENGES TO EARLY RECOGNITION AND SCREENING TIMELY IDENTIFICATION OF KIDS WITH FASD. I DON'T NEED TO TELL ANYONE IN THIS AUDIENCE THAT THERE ARE ISSUES AROUND AWARENESS, BUT ALSO THAT THERE ARE LIMITATIONS LIMITATION IN AVAILABLE SCREENING TOOLS AND THERE WILL OFTEN COMPETING DEMANDS AMONG THOSE ASKED TO IMPLEMENT THOSE SCREENING TOOLS. THERE ARE CHALLENGES LINKING SCREENING TO A FORMAL DIAGNOSIS TO SERVICE DELIVERY, AND I PERSONALLY AM INTERESTED IN DOING A BETTER JOB BUILDING AN EFFECTIVE EVIDENCE BASE FOR APPROACHES TO IDENTIFICATION AND INTERVENTION. AT THE SAME TIME, THERE ARE MANY OPPORTUNITIES IN THIS FIELD. AS WE ALL KNOW, EARLIER IDENTIFICATION DOES LEAD TO BETTER OUTCOMES, AND FAMILIES AFFECTED BY FASD DO TOUCH MANY SYSTEMS WHO POTENTIALLY HAVE THE CAPACITY TO PROMOTE EARLIER SCREENING DIAGNOSIS REFERRAL AND SERVICE DELIVERY, AND AS WE'LL HEAR TODAY, THAT OCCURS IN HEALTHCARE EDUCATION, JUSTICE AND SOCIAL SERVICE SETTINGS AMONG OTHERS. WE'RE VERY FORTUNATE WE'RE ABOUT TO HEAR ABOUT SOME INNOVATIVE EXAMPLES OF EFFORTS WITH THESE SETTINGS. SO OUR CHARGE FOR TODAY'S PANEL IS TO SHARE EXAMPLES OF SOME OF THESE SUCCESSFUL AND INNOVATIVE PROGRAMS. AS TATIANA JUST MENTIONED, OUR FOCUS TODAY IS REALLY ON RECOGNITION AND SCREENING PRIOR TO REFERRAL FOR A FORMAL DIAGNOSIS. SO I GUESS MY CHALLENGE TO YOU ALL IS WHAT TO THINK ABOUT WHAT WE COLLECTIVELY AS A GROUP CAN LEARN FROM THESE PROGRAMS AND WHERE WE GO FROM HERE. SO LET ME DO A COUPLE OF BRIEF INTRODUCTIONS. SO WE'RE GOING TO HEAR TWO PRESENTATIONS BEFORE THE LUNCH BREAK. THE FIRST ONE IS GOING TO BE KARNESHA SLAUGHTER JOINING US REMOTELY. SHE'S A HEALTH COMMUNICATIONS SPECIALIST AT THE NATIONAL CENTER FOR BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES AT THE CDC. SHE PROVIDES EXPERTISE TO THE CDC LEARN THE SCIENCE ACT EARLY PROGRAM WHICH WE'RE GOING TO HEAR MORE ABOUT IN JUST A MINUTE, AND KEY AREAS OF MS. SLAUGHTER'S WORK INCLUDE THE DEVELOPMENT AND DISSEMINATION OF TOOLS AND RESOURCES LIKE THE CDC'S MILESTONE TRACKER APP TO REACH THE PROGRAM'S GOALS OF IMPROVING EARLY IDENTIFICATION OF CHILDREN WITH DEVELOPMENTAL DELAYS AND DISABILITIES SO CHILDREN AND FAMILIES CAN GET THE SERVICES AND SUPPORT THEY NEED AS EARLY AS POSSIBLE. OUR SECOND SPEAKER IS DR. YASMIN SENTURIAS, WHO IS A PROFESSOR OF PEDIATRICS AT ATRIUM HEALTH AND AN ADJUNCT PROFESSOR OF PEDIATRICS AT UNC CHAPEL HILL. SHE'S A DEVELOPMENTAL BEHAVIORAL PEDIATRICIAN AND MEDICAL DIRECTOR OF THE DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS AT CAROLINAS CHARLOTTE CLINIC. SHE SERVED ON THE AAP FETAL ALCOHOL SYNDROME PANEL AND IS ONE OF THE AUTHORS OF THE TOOLKIT. SHE HAS WORKED WITH THE AAP NEURAL BEHAVIORAL DISORDERS WORK GROUP TO CREATE GUIDELINES FOR PEDIATRICIANS IN IDENTIFYING AND MANAGING KIDS WITH NEUROBEHAVIORAL DISORDERS ASSOCIATED WITH ALCOHOL EXPOSURE DISORDER, AND SPEAKS TO NATIONAL AS WELL AS INTERNATIONAL AUDIENCES ON THE TOPIC OF FASD. SO WE'RE GOING TO START WITH MS. SLAUGHTER . >> AND I'M GOING TO BE SITTING IN MY CORNER. >> HELLO. MY NAME IS KARNESHA SLAUGHTER, I'M A HEALTH COMMUNICATION SPECIALIST AT THE CENTERS FOR DISEASE CONTROL AND PREVENTION. TODAY I'D LIKE TO TELL YOU ABOUT A PROGRAM FROM CDC THAT OFFERS FREE, PARENT FRIENDLY TOOLS AND OTHER RESOURCES TO HELP PARENTS AND OTHER CARE PROVIDERS TRACK DEVELOPMENTAL MILESTONES AND ACT EARLY ON POSSIBLE DEVELOPMENTAL CONCERNS. LEARN THE SCIENCE ACT EARLY IS A PROGRAM OPERATED OUT OF CDC'S NATIONAL CENTER ON BIRTH DEFECTS AND DEVELOPMENTAL DISABILITIES. ITS MISSION IS TO IMPROVE EARLY IDENTIFICATION OF DEVELOPMENTAL DELAYS AND DISABILITIES, INCLUDING AUTISM, BY PROMOTING DEVELOPMENT AND MONITORING SO CHILDREN AND THEIR FAMILIES CAN GET THE SERVICES AND SUPPORT THEY NEED. THE PROGRAM DOES THIS BY WORKING HARD TO FACILITATE THE INTEGRATION OF PARENT ENGAGED DEVELOPMENTAL MONITORING, USING ITS DEVELOPMENTAL MILESTONE CHECKLISTS AND OTHER RESOURCES INTO FAR REACHING PROGRAM AND SYSTEMS TO SERVICE FAMILIES WITH YOUNG CHILDREN. PROGRAMS LIKE WIC, HOME VISITING, PART C CHILD FIND, EARLY HEAD START, CHILD CARE AND OTHERS. ONE CRITICAL ELEMENT TO INTEGRATE ONGOING PARENT ENGAGED DEVELOPMENTAL MONITORING SYSTEMS AND PROGRAMS IS TO PROVIDE THOSE SYSTEMS AND PROGRAMS AND ALL OF YOU WITH HIGH QUALITY RESEARCH-BASED AND PARENT-TESTED TOOLS AND MATERIALS FOR FREE. THESE TOOLS DO NOT REPLACE DEVELOPMENTAL SCREENING AS RECOMMENDED BY THE AMERICAN ACADEMY OF PEDIATRICS AT VARIOUS AGES, BUT THEY DO STRENGTHEN YOUR DEVELOPMENTAL SURVEILLANCE PRACTICES FOR EVERY HEALTH MAINTENANCE VISIT. THEY ALSO OFFER A PARENT-FRIENDLY WAY TO EDUCATE PARENTS ABOUT WHAT TO EXPECT IN A CHILD'S EARLY DEVELOPMENT AND ENCOURAGES THEM TO NOTICE, TRACK AND CELEBRATE DEVELOPMENTAL PROGRESS. FINALLY, THEY PROVIDE CLEAR, CONCRETE GUIDANCE ABOUT WHAT TO DO WHEN THERE IS A POSSIBLE DEVELOPMENTAL CONCERN. HERE YOU CAN SEE A VARIETY OF TOOLS AND RESOURCES THAT ARE AVAILABLE FROM THE PROGRAM FROM MILESTONE CHECKLISTS AND BOOKLEATHERS WITH TIPS FOR U.S. FOR THING DEVELOPMENT, TO A FREE ONLINE TRAINING FOR EARLY CARE EDUCATION PROVIDERS THAT INCLUDES CONTINUING EDUCATION CREDIT TO A FULL IMAGE LIBRARY OF NEARLY EVERY DEVELOPMENTAL MILESTONE FROM TWO MONTHS TO FIVE YEARS SO PARENTS HAVE A CLEAR IDEA OF WHAT IMPORTANT MILESTONES LOOK LIKE. ALL OF THESE RESOURCES ARE AVAILABLE FREEPRE-PRINTED IN LIMITED QUANTITIES WITH THEIR PRACTICE LOGO AND CONTACT INFORMATION FOR LOCAL PRINTING. CDC MILESTONE CHECKLISTS ARE THE CORE CONTENT OF OUR PROGRAM. A FEW IMPORTANT POINTS TO KEEP IN MIND ABOUT THESE MILESTONE CHECKLISTS IS THAT THEY ARE ADAPTED FROM THE AMERICAN ACADEMY OF PEDIATRICS BRIGHT FUTURES IN CARING FOR YOUR BABY AND YOUNG CHILD, THEY USE PLAIN LANGUAGE AND EVERYDAY EXAMPLES. THE MILESTONES ARE FOR AGES TWO MONTHS THROUGH FIVE YEARS. AND THEY INCLUDE MILESTONES THAT MOST CHILDREN REACH BY EACH AGE, MEANING THEY'RE GREATER THAN THE 50 PERCENTILE. PARENT ENGAGE DEVELOPMENTAL MONITORING TOOLS ARE NOT A SUBSTITUTE FOR DEVELOPMENTAL SCREENING TOOLS AND THEY ARE AVAILABLE AS PART OF CDC'S MILESTONE TRACKER APP, THE MILESTONES BOOKLET, THE ONLINE ACTION IMAGE LIBRARY AND AS PRINTABLE CHECKLISTS. LET'S TAKE A CLOSER LOOK AT CDC'S MILESTONE CHECKLISTS. THIS IS THE PRINT VERSION AND AS YOU CAN SEE, EACH MILESTONE IS CATEGORIZED BY DOMAIN, SOCIOEMOTIONAL, LANGUAGE COMMUNICATION, COGNITIVE OR MOVEMENT/PHYSICAL DEVELOPMENT. PARENTS CAN CHECK OFF THE MILESTONES THAT THEIR CHILDREN ARE REACHING, AND THERE'S ALSO A BOX THAT INDICATES SOME OF THE RED FLAGS THAT ENCOURAGE PARENTS TO TALK WITH THEIR PROVIDER AS SOON AS POSSIBLE AND ASK FOR DEVELOPMENTAL SCREENING. THE CHECKLISTS ALSO INCLUDE TIPS FOR PARENTS TO HELP TO PROMOTE THEIR CHILD'S DEVELOPMENT. AS MENTIONED, THE CHECKLISTS ARE AVAILABLE IN A VARIETY OF FORMATS BUT THE ONE WE ARE MOST EXCITED TO TELL YOU ABOUT IS OUR APP, CDC'S MILESTONE TRACKER. WE HOPE YOU'LL CHECK OUT THIS FREE APP NOW AVAILABLE FOR BOTH USE IN ENGLISH AND SPANISH, AND HELP TO PROMOTE IT AMONG THE FAMILIES YOU SERVE. HERE WE CAN TAKE A CLOSER LOOK AT THE APP WHERE YOU CAN SEE THE OPENING SCREEN TO YOUR FAR LEFT AND BESIDE THAT, THE HOME SCREEN, WHERE PARENTS CAN CLICK TO ACCESS THE MILESTONES, THEY CAN ALSO SEE THE RED FLAGS THAT I MENTIONED PREVIOUSLY FROM THE PRINT CHECKLISTS AND THE TIPS AND ACTIVITIES AS WELL. BESIDE THAT, YOU WILL SEE AN EXAMPLE OF WHAT THE PHOTOS AND VIDEOS LOOK LIKE ON THE MILESTONE TRACKER APP, AND AN EXAMPLE OF ONE OF THE ALERTS THAT INFORM PARENTS THAT IT MAY BE TIME TO ACT EARLY AND ASK FOR DEVELOPMENTAL SCREENING. ON THIS PAGE, YOU'LL SEE SOME MORE RESOURCES FOR PROVIDERS AND PARENTS, THE TIPS FOR TALKING WITH PARENTS ABOUT DEVELOPMENTAL CONCERNS BY AN EXAMPLE SCENARIO ABOUT POSSIBLE DEVELOPMENTAL CONCERNS FOR A CHILD AND ALSO WE HAVE TWO RESOURCES FOR PARENTS WHO MAY BE CONCERNED ABOUT THEIR CHILD'S DEVELOPMENT, GIVING THEM TIPS ON HOW TO TALK WITH THE DOCTOR AND HOW TO HELP THEIR CHILD. I'D ALSO LIKE TO MENTION OUR LEARN THE SIGNS ACT EARLY AMBASSADORS. THESE ARE A GROUP OF PEOPLE WHO ARE VERY WELL CONNECTED IN THEIR STATES AND TERRITORIES. THEY ARE PASSIONATE ABOUT EARLY IDENTIFICATION AND THEY ARE TRAINED TO SERVE AS LEARN THE SCIENCE ACT EARLY AMBASSADORS TO THEIR STATE OR TERRITORY. THEY WORK TO IDENTIFY OPPORTUNITIES TO INTEGRATE LEARN THE SIGNS EARLY INTO STATEWIDE SYSTEMS AND 56% HAVE REPORTED INTEGRATION. WE HAVE 54 AMBASSADORS IN 48 STATES AND THREE TERRITORIES, AND THEY ARE WONDERFUL RESOURCES TO IDENTIFY WHICH MATERIALS ARE BEST USE FOR YOU IN HELPING YOU TO ACCESS THEM. IF YOU'D LIKE TO LEARN MORE ABOUT THE ACT EARLY AMBASSADORS, PLEASE VISIT CDC.GOV/ACTEARLY/AMBASSADORS. IN SUMMARY, CDC HAS MANY FREE RESOURCES AVAILABLE TO HELP PARENTS AND CAREGIVERS AND PROVIDERS MONITOR CHILDREN'S EARLY DEVELOPMENT AND KNOW WHAT TO DO WHEN THERE ARE CONCERNS. THE MATERIALS ARE AVAILABLE IN A WIDE VARIETY OF FORMATS TO MAKE THEM ACCESSIBLE TO AS MANY PEOPLE AS POSSIBLE, AND A IN A VARIETY OF LANGUAGES. THE MATERIAL ARE AVAILABLE IN ENGLISH, SPANISH, VEET VIETNAMESE, SIM SIM PLA SIMPLIFIED CHINESE, -- CAN PROMPT DEVELOPMENTAL SCREENING AND PROVIDE INFORMATION TO HELP IDENTIFY THE 1 IN 6 CHILDREN WITH DEVELOPMENTAL DISABILITIES. ACE MENTIONED ON MY PREVIOUS SLIDE, WE HAVE ACT EARLY AMBASSADORS IN 48 STATES, THREE TERRITORIES AND THE DISTRICT OF COLUMBIA WHOM YOU CAN REACH OUT TO, TO GAIN IDEAS ON WHICH MATERIALS ARE BEST FOR YOU AND HOW TO INTEGRATE THEM INTO SYSTEMS. WE LOVE TO COLLABORATE WITH YOU TO ENSURE THAT EVERY CHILD'S DEVELOPMENT IS CLOSELY MONITORED, THAT CHILDREN WITH FASD, AUTISM AND ANY OTHER DEVELOPMENTAL DISABILITY ARE IDENTIFIED AND CONNECTED WITH SERVICES AS EARLY AS POSSIBLE. AS WE ALL KNOW, THAT IS WHAT IS MOST IMPORTANT. THANK YOU SO MUCH FOR YOUR TIME TODAY. IT WAS A PLEASURE SPEAKING WITH YOU ALL. IF YOU HAVE ANY ADDITIONAL QUESTIONS ABOUT ANYTHING THAT I'VE MENTIONED TODAY, PLEASE FEEL FREE TO EMAIL ME AT KSLAUGHTER2@CDC.GOV. I'M HAPPY TO ANSWER ANY QUESTIONS AT ALL. THANK YOU VERY MUCH. >> THANK YOU VERY MUCH. WE'RE GOING TO SAVE THE DISCUSSION FOR THE END BUT IF ANYONE HAS CLARIFYING QUESTIONS FOR MS. SLAUGHTER? ALL RIGHT. NOW WE'RE GOING TO MOVE TO DR. YASMIN SENTURIAS. >> GOOD MORNING, EVERYONE. AM I TALL ENOUGH FOR THIS? ALL RIGHT. TODAY I WOULD LIKE TO SPEAK MORE ABOUT MIHM PRIMARY CARE AND WHAT ARE WE DOING TO RECOGNIZE CHILDREN WITH FASDs. I WOULD LIKE TO DISCUSS THE CURRENT STATUS RECOGNITION OF INDIVIDUALS WITH FASDs IN PEDIATRIC SETTINGS AND I WOULD LIKE TO DISCUSS SCREENING TOOLS AND GUIDELINES IN CONSIDERATION OF FETAL ALCOHOL SYNDROME SPECTRUM DIAGNOSIS AND I WOULD LIKE TO DISCUSS CHALLENGES AND OPPORTUNITIES IN THIS PARTICULAR FIELD. WE KNOW THESE DISORDERS ARE PREVALENT. WE HAVE HEARD FROM VARIOUS SPEAKERS ABOUT THIS, AND WE KNOW NOW THAT AS MANY AS 1 IN 20 SCHOOL AGED CHILDREN ARE AFFECTED, AND THIS IS CERTAINLY AN ISSUE THAT WE NEED TO TACKLE BECAUSE, THEREFORE, IT IS PRESENT IN EVERY PRIMARY CARE PRACTICE. AND WE KNOW IT IS RELEVANT BECAUSE IT IS THE MOST COMMON PREVENTABLE CAUSE OF INTELLECTUAL DISABILITY AND BEHAVIORAL DISORDERS AND IT HAS LIFELONG EFFECTS WHICH MAKES US REALLY HAVE PEDIATRIC CARE PROVIDERS TAKE THIS SERIOUSLY AND THE EFFECTS ARE MORE SERIOUS THAN OTHER DRUGS OR TERATOGENS. IN 2006, THEY STUDIED FETAL ALCOHOL SPECTRUM DISORDER KNOWLEDGE AND EXE COMPETENCE AMONG PEDIATRICIANS. BASICALLY, THIS IS A LITTLE SKEWED PERHAPS AS TO WHAT PEOPLE ARE SPEAKING ABOUT WHEN THEY SAY WHAT DO YOU MEAN BY IDENTIFYING AND THINGS LIKE THAT, BUT AT THAT POINT, HE SAID -- AND I WAS ACTUALLY SURPRISED ABOUT THIS -- 62% FELT PREPARED TO IDENTIFY AND 50% FELT PREPARED TO DIAGNOSE BUT THEN 34% FELT PREPARED TO MANAGE AND COORDINATE THE TREATMENT OF CHILDREN WITH FETAL ALCOHOL SPECTRUM DISORDERS. AND I WILL TELL YOU SINCE 2006, A LOT OF THINGS HAPPENED. THERE'S SO MUCH EDUCATION THAT HAS HAPPENED, AND WHAT MIGHT BE INTERESTING IS THE SLIDE TO FOLLOW, SO FAST FORWARD 2017, THE AAP STUDY, GRANTED -- YOU KNOW AAP DOESN'T REALLY DO STUDIES, SO BASICALY THIS IS PART OF SOME KIND OF PROJECT THAT INSISTED WE SHOULD DO SOME KIND OF STUDY, AND OUT OF 436 RESPONDENTS, 71%, THE MATH SAYS 306 PEDIATRICIANS WERE INVOLVED, THE OTHERS WERE RESIDENTS, AND OKAY, SO BASICALLY 88.2% SUSPECTED THAT A CHILD IN THEIR PRACTICE COULD HAVE AN FASD WHICH LOOKS LIKE A REALLY IMPORTANT NUMBER, SO PEOPLE ARE RECOGNIZING THIS MAY BE A LITTLE MORE, BUT SIMILAR TO THE PREVIOUS SLIDE, ABOUT 30% FELT VERY COMFORTABLE DIAGNOSING OR REFERRING AN INDIVIDUAL WITH SUSPECTED FASDs, AND I MEAN, BASED ON THE DIFFERENT THINGS THAT WE HEAR, BASED ON EVEN THIS STUDY, PART OF IT HAS TO DO WITH RESOURCES AVAILABLE FOR FAMILIES. YOU KNOW, AND THEN WHAT? SO THIS IS VERY SIMILAR TO A TALK THAT I THINK I PROVIDED TWO YEARS AGO HERE. IT'S SO IMPORTANT TO DISCUSS THE "AND THEN WHAT." AND THE SCREENING AND DIAGNOSIS, THOUGH, CAN BE IMPROVED AND, IN FACT, THE AMERICAN ACADEMY OF PEDIATRICS HAS A FREELY DOWNLOADABLE ONLINE TOOLKIT THAT HAS A SCREENING GUIDE AND A PUBLISHED FLOW DIAGRAM FOR IDENTIFICATION OF CHILDREN, WHICH I WILL SHOW SHORTLY. HOWEVER, THERE ARE NO SPECIFIC SCREENING TOOLS FOR FETAL ALCOHOL SPECTRUM DISORDERS, YOU KNOW, WITH METRICS AND ALL THAT HAVE SO FAR BEEN ENDORSED BY THE AAP. THERE IS A PROMISING SCREENING TOOL OUT THERE, BUT IT IS BASED ON A SMALL SAMPLE AND I COULD SHOW YOU IN A LITTLE BIT. WE DO KNOW THERE ARE VARIOUS DIAGNOSTIC SCHEMAS USED BY CLINICIANS IN THE U.S. AND CANADA TO DIAGNOSE THIS. SO WHAT CAN HELP PEDIATRICIANS RECOGNIZE AND MANAGE IT? YOU SIMPLY GOOGLE AAP FASD TOOLKIT, YOU CAN OPEN IT. IT'S A COMPREHENSIVE ONE-STOP RESOURCE FOR CLINICIANS TO SAY, OKAY, WHAT IS FASD, HOW DO I RECOGNIZE IT, WHAT ARE THE RESOURCES FOR DIAGNOSIS, WHAT DO I SAY TO A PARENT. THERE ARE SCRIPTS, DIFFERENT THINGS LIKE THAT, MAPPAGEMENT MANAGEMENT STRATEGIES, EVIDENCE BASED INTERVENTIONS, FURTHER WEB RESOURCES, ET CETERA, BUT THIS IS THAT FLOW DIAGRAM FOR SCREENING. AS I SAID, AND THIS IS PROBABLY TOO SMALL AND TOO BUSY FOR EVERYONE TO SEE BUT AT LEAST IF YOU FOCUS ON THE LEFT-HAND SIDE THAT YOU WILL SEE THAT THE FIRST THING IS THE MEDICAL HOME. FIRST THE PEDIATRIC SAYS, OKAY, I AM DOING A HEALTH MAINTENANCE WITH DEVELOPMENTAL SURVEILLANCE. SO YOU KNOW, THE WELL CHILD CHECKS WHICH MAYBE EVERYBODY IS FAMILIAR WITH. IN THAT PARTICULAR ONE, THERE'S THAT, OKAY, ARE THERE FASD SIGNS OR SYMPTOMS, BY THE WAY, THIS IS A BACK TO BACK GUIDE SO IF YOU'RE GOING TO LAMINATE IT, YOU'LL SEE THE BACK PORTION. IT IS NOT HERE BUT IT IS IN THE TOOLKIT, THE BACK SIDE. SO ARE THERE RISKS, ARE PARENTS CONCERNED ABOUT IT. THERE'S A CHART BUT BASICALLY IT GOES OVER SOME DATA SPECIFIC TO EVALUATING INCLUDING HEIGHT AND WEIGHT WHICH EVERYONE GETS. SOME OF THESE ARE WHAT MIGHT DETRACT FROM WHAT PEDIATRICIANS WOULD DO IS WHEN THEY START TO, OKAY, I DON'T KNOW HOW TO DO THESE, SO ANYWAY, THERE'S SOME GUIDANCE CERTAINLY IN THE TOOLKIT ABOUT THIS, AND OF COURSE IF THERE ARE PARENT CONCERNS ABOUT FASDs, BASICALLY KEEP GOING AND CHECK ON THE CNS ABNORMALITIES SEEN. SO IT KIND OF KEEPS GOING ABOUT DEVELOPMENTAL CONCERNS WHICH, AGAIN, GETS INTO DRK -- IT'S A SCREENING PROCESS, IT'S NOT A SCREENING TOOL. AT THE BACK OF THAT PARTICULAR FLOW CHART OR FLOW DIAGRAM, I FEEL THESE ARE GREAT SCREENING QUESTIONS, BUT WHEN SHOULD PEDIATRICIANS CONSIDER EVALUATING FOR THIS? WHEN THERE ARE DEVELOPMENTAL, COGNITIVE OR BEHAVIORAL CONCERNS. THAT'S ABOUT 25% OR SO OF PEDIATRIC VISITS. COMPLEX MEDICAL CONCERNS WILL ADD ANOTHER FIVE TO 10%, AND GROWTH DEFICITS, AGAIN, THAT WILL ADD. SO I FEEL LIKE WE OUGHT TO SCREEN EVERYBODY. HISTORY OF MATERNAL ALCOHOL OR DRUG USE, THERE'S A PROJECT OF THE AAP SPECIFICALLY DISCUSSING HOW WE CAN DO THIS. A SIBLING DIAGNOSED WITH AN FASD MIGHT BE EASY AND DYSMORPHIC FACIAL CHARACTERISTICS IF THEY ARE PRESENT AND YOU CAN RECOGNIZE. ONE OF THE THINGS THAT IS USED FOR TRAINING RESIDENT PHYSICIANS AND FOR ACTUALLY GENERAL PEDIATRICIANS IN KIND OF OVERALL LOOKING AT SCREENING FOR VARIOUS THINGS IS THE AAP BRIGHT FUTURE KIT. IT'S LIKE A LITTLE BOOK THAT EVERY PEDIATRIC RESIDENT IS HANDED IN THEIR TRAINING, AND FINALLY IN, I THINK, 2016, WE WERE ABLE TO GET SOME SCREENING QUESTIONS RELATED TO PRE-ALCOHOL EXPOSURE, NOT YET FASD, BUT IT IS LIKE KIND OF A BIBLE FOR RESIDENTS AND I FEEL LIKE IT'S HELPFUL THAT WE HAVE SOME OF THESE QUESTIONS THERE, AND THEN I WANT TO SHARE WITH YOU THIS SPECIFIC SCREENING TOOL, THAT WAS CREATED BY VET AND GREEN BAUME ABOUT IDENTIFYING THE BEHAVIORAL PHENOTYPE IN FASD, SO AGAIN, THIS IS A SMALL STUDY AS YOU CAN SEE ON THE LEFT-HAND SIDE, BUT IT HAD 62.5% SENSITIVITY FOR PARTICIPANTS WITH FASD AND 50% FOR PRENATAL ALCOHOL EXPOSURE. SPECIFICITY IS HIGH AND YOU REALLY NEED A SCREENING TOOL TO BE VERY HIGH IN SENSITIVITY SO OBVIOUSLY THERE'S WORK TO DO, AND YOU KNOW, I FIND THAT THERE'S SO MUCH THAT WE WANT EVERYBODY TO BE ACCURATE AND THAT'S WHY IT'S KIND OF A -- IT'S AS S A TOSS-UP BUT SCREENING TOOLS ARE OBVIOUSLY MADE TO CATCH A WIDE NET. SO LET'S NOW TALK ABOUT SOME MORE TRAINING OPPORTUNITIES. I'M TALKING A LITTLE ABOUT CHALLENGES BUT THERE'S SOME OPPORTUNITIES, I JUST KIND OF WANT TO BRING THIS TO YOUR ATTENTION THAT THERE ARE SOME HANDOUTS ABOUT EFFECTS OF PRENATAL ALCOHOL EXPOSURE. THESE ARE ALL AVAILABLE ONLINE, YOU BASICALLY GOOGLE ONE-PAGE HANDOUT AAP FASD. IT MAKES IT INCREDIBLY SIMPLE. GOOGLE IS AN INCREDIBLE SEARCH TOOL. AND YOU CAN SEE ON THE NEXT SLIDE, I WANT TO TALK ABOUT CHALLENGES. THIS MIGHT BE TALKED ABOUT -- ONE OF THE THINGS IS, PEDIATRICIANS ARE STILL NOT UNIVERSALLY SCREENING FOR FASDs. THERE'S STILL A LACK OF CONFIDENCE IN RECOGNIZING AND MANAGING THESE CHILDREN IN THE MEDICAL HOME, AND THAT'S HUGE BECAUSE YOU MIGHT SCREEN BUT YOU CAN'T MANAGE, THEN YOU PROBABLY WON'T SCREEN OR WILL FORGET TO SCREEN EVEN IF YOU SAY SO. THERE'S ALSO A LACK OF FASD CLINICS AND CAN PROVIDE A COMPREHENSIVE EVALUATION BUT AT THE SAME TIME, THERE ARE SOME RESOURCES OUT THERE AND THAT IS THE COOL OF THE TOOLKIT TO KEEP PROMOTING AND PROMOTING THESE RESOURCES. THERE'S A LACK OF EVIDENCE-BASED METHODOLOGIES IN IMPROVED OUTCOMES FOR CHILDREN WITH FASDs. JUST LIKE BEHAVIORAL ANALYSIS FOR AUTISM, WE HAVE AT LEAST FOUR EVIDENCE-BASE INTERVENTIONS FOR FETAL ALCOHOL SPECTRUM DISORDERS THAT THE CDC HAS FUNDED INCLUDING FAMILIES MOVING FORWARD, THE MILE PROGRAM THAT HAS TO DO WITH MATHEMATICS HELP, THERE'S ALSO SOMETHING THAT HAS TO DO WITH SELF REGULATION BUT THESE ARE NOT AVAILABLE TO EVERY STATE OR CITY. THIS IS A BIG ONE. BIAS AND STIGMA ABOUT FASDs AND PRENATAL USE THAT PREVENTS PEDIATRICIANS FROM EVEN DISCUSSING THE DIAGNOSIS AND DISCUSSING WITH FAMILIES. THIS IS DISCUSSED IN SOME WAY IN THE FASD TOOLKIT BUT THERE'S MORE WORK THAT'S BEING DONE BY DR. JONES AND OTHERS ABOUT THIS. AGAIN THE FETAL ALCOHOL SPECTRUM DISORDER -- SOME PEOPLE WILL SAY A WHOLE LOT MORE, FOR EXAMPLE, TRAUMA, BUT NOBODY HAS EVER SAID IN IN THOSE TRAUMA STUDIES, COMPLETELY REMOVE THE ALCOHOL FROM THE TRAUMA. SO WE ARE NOT SURE EXACTLY HOW MUCH THE OVERLAP REALLY IS. SO HERE ARE OPPORTUNITIES. IT IS NOT JUST AMERICAN ACADEMY OF PEDIATRICS THAT'S DOING THIS, THERE ARE SO MANY OPPORTUNITIES THAT YOU HAVE SHARED FROM ALL OVER, FROM ALL THE AGENCIES THAT HAVE PRESENTED. I TALKED A LITTLE BIT ABOUT THE TOOLKIT. DO WANT TO TALK ABOUT THE CHAMPIONS PROGRAM WHICH I AM A PART. I AM THE FASD CHAMPION. IT'S LIKE IN HUNGER GAMES, THERE ARE DISTRICTS. I'M DISTRICT 4, YOU KNOW, SO I JUST WANT TO SHARE THAT WHATEVER DISTRICT YOU ARE, YOU PROBABLY ARE PRESENTING THESE FETAL ALCOHOL WEBINARS WHICH HAS TO DO WITH DIFFERENT COMPONENTS OF WHAT WE NEED TO UNDERSTAND ABOUT FETAL ALCOHOL SPECTRUM DISORDERS, FROM RECOGNITION TO MANAGEMENT. THERE IS A FETAL ALCOHOL ECHO PROGRAM WHICH MAY BE SIMILAR TO WHAT OTHERS ARE TALKING ABOUT. THIS IS BASICALLY TELEMENTORRING ONLINE, CASE-BASED, VERY INTENSIVE WITH PEDIATRICIANS, AND I FEEL THAT THIS IS SORT OF A WAY TO MAKE THEM FETAL ALCOHOL CHAMPIONS. INTO YOU BE SO THERE'S ALSO THE FETAL SPECTRUM DISORDERS CONTINUITY PROJECT THAT HAS TO DO WITH RESIDENTS BEING TRAINED ON THIS. REMEMBER RESIDENTS IN PEDIATRICS ARE REALLY OUR FUTURE AND WE NEED TO HAVE THEM SPREADING THE WORD OUT THERE, AND IF EVERY RESIDENT IN EVERY PROGRAM DOES THIS, CAN YOU IMAGINE WHAT KIND OF PEDIATRICIANS WILL BE HATCHING FROM THIS POINT ONWARD? SO WE ALSO HAVE THESE ONE-PAGE RESOURCES AND HANDOUTS, WE'VE GOT PUBLIC SERVICE ANNOUNCEMENTS AND ALL SORTS OF COLLABORATIONS INCLUDING WITH THE KNOW FAs, ACOG AND OTHER CDC GRANTEES. THE FETAL ALCOHOL -- IN ALL OF THE DISTRICTS, THAT INCLUDING ALL OVER THE UNITED STATES, PUERTO RICO, WE ARE SUPPOSED TO LEAD AND FACILITATE EDUCATION AND TRAINING THE WEBINARS, ET CETERA, WE ARE SUPPOSED TO REINFORCE THE ROLE OF THE MEDICAL HOME IN THE IDENTIFICATION AND CARE FOR CHILDREN WITH FETAL ALCOHOL SYNDROME DISORDERS, WE'RE SUPPOSED TO RAISE AWARENESS AND RESPOND TO QUESTIONS AND ADVOCATE FOR PRACTICE CHANGE. SO WHAT HAVE I DONE AS A CHAMPION? I'VE HELPED CREATE SOME OF THE WEBINARS AND OF COURSE PRESENTED THE WEBINARS, AND WE DO KNOW THERE'S SOMETHING ON SCREENING ASSESSMENT AND DIAGNOSIS, THERE'S NO SCREENING TOOL THERE, NEUROBEHAVIORAL DISORDER ASSOCIATED WITH PRENATAL ALCOHOL EXPOSURE, THERE'S A TREATMENT ACROSS THE LIFESPAN, AND THERE'S SOME DATA. SO WHAT I DO WANT TO TELL YOU IS THIS IS FROM A WEBINAR, SO AFTER AT10ING AFTER ATTENDING THE WEBINAR, WHAT ARE THE PRIMARY FACIAL DYSMORPHIC FEATURES ASSOCIATED WITH FETAL ALCOHOL SYNDROME. THEY NEED TO RECOGNIZE THE NEURAL BEHAVIORAL EFFECTS, EVEN IF THEY ALREADY RECOGNIZE THE FACIAL EFFECTS BECAUSE SO MANY CHILDREN WILL BE MISSED, BUT THERE WAS A 20% PRE/POST-TEST INCREASE OF KNOWLEDGE. THEN THERE'S THE KNOWLEDGE OF THE CRITERIA WHICH IS GREAT, WE ACTUALLY HAVE SOME KNOWLEDGE OF THE CRITERIA FOR NEUROBEHAVIORAL DISORDE ASSOCIATED WITH PRENATAL ALCOHOL EXPOSURE, PRE/POST-TEST INCREASE AGAIN OF 20%, AND A KNOWLEDGE -- IMAGINE IF THEY DID MORE TRAINING. BUT KNOWLEDGE OF APPROACHES AND CARE STRATEGIES, THERE WAS A PRE/POST-TEST INCREASE OF 25%, WHICH IS KIND OF A GOOD START. TO TALK TO YOU A LITTLE BIT ABOUT OTHER OPPORTUNITIES, THERE IS THE NEUROBEHAVIORAL ECHO PROGRAM. ECHO -- THERE'S NO ACRONYM INVOLVED. I'M GOING TO TELL YOU SOMETHING, I'M NOT SURE WHY IT'S CALLED ECHO. MAYBE A LITTLE. BUT ANYWAY, IT'S KIND OF LIKE A WHEEL, REALLY, LIKE A HUB AND SPOKE, A TELEMENTORRING PROGRAM. THE ONLY THING I CAN ASSOCIATE IT WITH ECHO, TELECONFERENCE, YOU CAN HEAR ECHOES, I DON'T REALLY KNOW, BUT IT'S BASICALLY A NEUROBEHAVIORAL HE ECHO, IT ISN'T EVEN FETAL ALCOHOL BUT WE INSERT FETAL ALCOHOL EVERY TIME, I MEAN, IT'S BASICALLY WE'RE TRYING TO PROMOTE FETAL ALCOHOL, BUT WE NEED TO KNOW, CATCH CAST A WIDER NET BECAUSE SOMETIMES THERE'S NO KNOWLEDGE OF ALCOHOL EXPOSURE. IT'S A TELEMENTORRING PROGRAM DESIGNED TO CREATE COMMUNITIES OF LEARNERS BY . BASICALLY WE HAVE PEDIATRICIANS ON THE CALL AND WE HAVE FACULTY, WHICH INCLUDE DEVELOPMENTAL PEDIATRICIANS, MYSELF, THERE'S PEDIATRICIANS, SOCIAL WORKERS, PSYCHOLOGISTS, DR. JULIE CABLE IS THERE. THERE'S DIFFERENT PEOPLE INVOLVED IN TEACHING, BUT VERY IMPORTANTLY, THERE ARE ADVOCATES, PRACTICES THAT ARE INVOLVED, AND THEY PRESENT CASES AND WE SHARE OUR EXPERTISE BUT THEY SHARE THEIR KNOWLEDGE ABOUT WHAT IS GOING ON ON THE GROUND. SO IT'S AN ALL TEACH-ALL LEARN APPROACH, PEOPLE HAVE ASKED A LOT OF GOOD AND EXCITING QUESTIONS, IT'S VERY, VERY HELPFUL, I FEEL. THAT'S THE FEEDBACK THAT I AM HEARING. WE ARE NOT DONE WITH ALL THE STUDIES ABOUT IT, BUT THE OTHER THING, AND I WANT TO SHOW YOU THE RIGHT SIDE, WHICH IS THE FETAL ALCOHOL CONTINUITY PROJECT, IS BASICALLY -- THIS IS FOR RESIDENTS. I DON'T KNOW IF YOU'RE FAMILIAR WITH RESIDENTS AND CONTINUITY CLINICS, THAT'S BASICALLY RESIDENTS IN PEDIATRICS WHILE THEY'RE TRAINING TO BE PEDIATRICIANS, THERE ARE THREE YEARS OF TRAINING, THEY GO -- EVERY WEEK THEY GO TO THEIR CONTINUITY CLINIC, WHICH IS THEY EITHER HAVE SOME KIDS IN THEIR PANEL DOING WELL CHILD CHECKS OR, YOU KNOW, ACUTE VISIT, SICK VISITS, SO THESE RESIDENTS ARE SUPPOSED TO IMPLEMENT, YOU KNOW -- WE ARE SUPPOSED TO IMPLEMENT THIS KIND OF CURRICULUM FOR RESIDENTS TO INTRODUCE THE FUTURE PEDIATRIC WORKFORCE TO KEY COMPONENTS OF FASDs THAT ARE MOST RELEVANT FOR THEM. AND OVERARCHING GOAL IS TO ENGAGE THEM TO PARTICIPATE IN PRIMARY CARE CONTINUITY CLINICS TO RECOGNIZE THE CLINICAL MANIFESTATIONS OF FASDs, AND TO ALSO HAVE AN IMPLEMENTATION OF CARE BECAUSE, AGAIN, WE FEEL THAT IT'S SO CLOSELY INTERLINKED. YOU CANNOT SCREEN WITHOUT KNOWING WHAT TO DO WITH IT. AND UP TO FIVE CONTINUITY CLINICS WILL BE CHOSEN AND BASICALLY FROM JULY TO SEPTEMBER, I THINK WE'VE ADJUSTED THIS A LITTLE BIT TO KIND OF ENCOMPASS MORE PRACTICES. I WANTED TO SHARE SOME DATA. AND THE DATA THAT I HAVE INCLUDES SCREENING FOR PRENATAL ALCOHOL EXPOSURE -- OKAY, THIS ONE IS A REAL AK ACRONYM. IT'S PROJECT SPEAK. SCREENING FOR PRENATAL EXPOSURE TO ALCOHOL IN KIDS, AND WE DO KNOW THAT WHAT WE DID WAS RECRUIT ABOUT NINE PEDIATRIC PRACTICES TO SEE IF THEY WOULD SCREEN BETTER. WHAT WE KNOW IS THE BASELINE RATE FOR SCREENING ARE LOW AND WE DO KNOW ELECTRONIC HEALTH RECORD SYSTEMS ARE GENERALLY NOT CONFIGURED TO SUPPORT SCREENING FOR PRENATAL EXPOSURE TO ALCOHOL. MAKE IT A VITAL SIGN. NOBODY HAS LISTENED TO ME YET SO FAR TO ACTUALLY PUT IT IN, BUT I'LL TELL YOU, WE ARE DOING IT IN OUR PRACTICE AND IT IS BEING DONE BY SOME OF THE OTHER CHAMPIONS AND PHYSICIANS ARE LIKELY TO IMPLEMENT THIS ACCORDING TO THE DATA. I DON'T HAVE THE ACTUAL NUMBERS, I CAN GET IT FOR YOU, BUT IN GENERAL, PHYSICIANS ARE LIKELY TO IMPLEMENT UNIVERSAL SCREENING APPARENTLY BASED ON THOSE NINE PRACTICES WE RECRUITED AND THIS WAS LIKE A SIX-MONTH PROGRAM. SO THE PROJECT ECHO QUALITY IMPROVEMENT METHODOLOGY, WHICH THE ECHO, THE TELEMENTORRING THING I WAS TALKING TO YOU ABOUT, THERE WAS ACTUALLY AN IMPROVEMENT IN DEVELOPMENTAL SCREENING. THIS IS JUST IN A FEW MONTHS. REMEMBER WE DON'T HAVE A LOT OF TIME WHEN WE DO THESE THINGS, PROBABLY ABOUT SIX TO EIGHT MONTHS, AND SO IN THE FEW MONTHS THAT EV WE'VE BEEN GIVING THEM LECTURES AND TALKING ABOUT QUALITY IMPROVEMENT, 20% IMPROVEMENT ALREADY FOR DEVELOPMENTAL SCREENING AND ASSESSMENTS, SO THIS IS PRACTICE CHANGE. 25% IMPROVEMENT REFERRAL FOR FOLLOW-UP ASSESSMENT WITHIN SEVEN DAYS FOLLOWING SCREENING, THAT'S GOOD. SEVEN DAYS. AND 30% IMPROVEMENT HAS BEEN NOTED IN COMMUNICATION WITH FAMILIES REGARDING PATIENT AND FAMILY STRENGTHS, WHICH BY THE WAY IS A BIG -- I FEEL LIKE IT'S A BIG WEAKNESS THAT WE'RE NOT ENCOURAGING PATIENT AND FAMILIAR STRENGTH APPROACH. WE NEED TO BE DOING STRENGTH-BASED APPROACHES FOR, AND SUPPORT SYSTEMS AND PROTECTIVE FACTORS BECAUSE WE DON'T WANT TO BE ALL DOOM AND GLOOM, OTHERWISE THERE'S NO SCREENING. SO CONCLUSION. I HAVE BEEN AN HOUR LEFT, I HEARD? NO, JUST KIDDING, BUT I AM CONCLUDING ANYWAY. FETAL ALCOHOL SPECTRUM DISORDERS ARE PREVALENT WE KNOW AND IMPACTFUL IN PEDIATRIC PRACTICE AND WE KNOW THERE ARE LIFELONG EFFECTS. SO PEDIATRICIANS DO NEED EDUCATION ON FETAL ALCOHOL AND TOOLS TO HELP THEM RECOGNIZE FETAL ALCOHOL SPECTRUM DISORDERS AND PROVIDE MANAGEMENT STRATEGIES BECAUSE AGAIN, MANAGEMENT STRATEGIES, IF YOU BUILD THEM, THEY WILL COME. I KNOW IT'S CONCLUSION SLIDE BUT QUICK ANECDOTE, I HAVE AN FASD CLINIC AND BEYOND FASD CLINIC, I SOUGHT FASD CLINIC PARTNERSHIPS, SO O.T., SPEECH, P.T. I TRAINED THEM, BUT THEN THEY RAN WITH IT. IN ATRIUM HEALTH WHERE I WORK, WE HAVE NETWORKS OF -- IN EVERY STATE, RIGHT, THERE'S O.T., P.T., SPEECH, ARE WE UNDERUTILIZING THEM? ABSOLUTELY. SO TRAINING THEM, TRAINING THE WHOLE NETWORK OF PEOPLE AROUND US, AND NOW THEY KNOW, WHEN A CHILD GETS REFERRED AND THERE'S FETAL ALCOHOL, OKAY, I'M AN O.T., I'M GOING TO DO SOME SELF REGULATION STRATEGIES, ZONES OF REGULATION, I'M A P.T., I'LL HELP THEM WITH PEDIATRIC YOGA. SO WE JUST HAD A BIG SEMINAR AROUND THE SAME TIME YOU WERE DOING THE BIG THING IN CANADA, AND I'M SO SORRY WE MISSED THAT, I WAS WANTING TO GO TO THE ONE IN CANADA WHERE CATHY MITCHELL WAS, BUT WE DID THIS BIG THING FOR OUR FAMILIES IN THE STATE AND FOR PEDIATRICIANS FOR DIFFERENT PEOPLE, O.T.s, P.T.s, AND THIS WILL HOPEFULLY ENCOURAGE PEOPLE TO BE EDUCATED AND TO SCREEN. AND THERE ARE SEVERAL INITIATIVES THAT I JUST SHARED FROM THE AMERICAN ACADEMY OF PEDIATRICS AND PARTNERS THAT CAN BE USED TO IMPROVE RECOGNITIN AND MANAGEMENT OF FETAL ALCOHOL SPECTRUM DISORDERS IN THE MEDICAL HOME. BARRIERS TO DIAGNOSIS INCLUDE STIGMA AND OTHERS. SO THAT'S WHY THAT'S THERE. SO I WANT TO SHARE WITH YOU THESE THINGS AND I HOPE THAT WE WILL KEEP IMPROVING ON SCREENING AND DIAGNOSIS AS WE GO FORWARD. THANK YOU. >> THANK YOU VERY MUCH. I KNOW WE'RE APPROACHING THE& LUNCH HOUR. ARE THERE ANY CLARIFYING QUESTIONS FOR DR. SENTURIAS? ALL RIGHT. I'M GOING TO PASS IT OFF TO TATIANA ABOUT LUNCH, BUT I DO WANT TO CHALLENGE PEOPLE WHEN WE MOVE INTO THE BIGGER DISCUSSION SECTION LATER TO THINK ABOUT, I THINK IN PARTICULAR THESE QUESTIONS ABOUT HOW DO WE MAKE THESE LINKAGES ABOUT THE KIND OF BIGGER PICTURE SYSTEMS TO IDENTIFY KIDS WITH NEUROBEHAVIORAL CONCERNS AND MAKE THAT CONNECTION SPECIFICALLY TO FAS AND FASD. >> THANK YOU, EVERYONE. WE'RE IN TIME FOR LUNCH AND WE'RE ACTUALLY ALMOST ON TIME, SO LUNCH BREAK UNTIL 1:30. WE HAVE A MAP OF THE AREA, THERE ARE A FEW PLACES IN WALKING DISTANCE. CLOSEST PLACE IS IN THE BACK, THEY HAVE DIFFERENT THINGS EVERY DAY. TODAY THEY HAVE -- THERE ARE A FEW PLACES, FEEL FREE TO GET THE MAP, YOU CAN GO AND WALK. SO 1:30, WE'RE GOING TO BE BACK TO CONTINUE THE PANEL. THANK YOU VERY MUCH. I AM GOING TO INTRODUCE THE THREE SPEAKERS FOR THE AFTERNOON. THEN WE'LL TO THOSE THREE PRESENTATIONS AND THEN HAVE AN OPEN DISCUSSION. SO IT IS MY PLEASURE TO INTRODUCE THE THREE SPEAKERS FOR THIS AFTERNOON. THE FIRST ONE IS Dr. MOLLY AND I KNOW I WILL PRONOUNCE IT WRONG, IS IT MILLANS? SORRY ABOUT THAT. SHE IS A CRITICAL EDUCATION SPECIALIST WITH THE EMERY NEUROMEDICINE CLINIC. A LICENSED SPECIAL EDUCATION TEACHER WITH 15 YEARS OF EXPERIENCE WORKING WITH CHILDREN WITH DISABILITIES AND ESPECIALLY THOSE EXPOSURES A SECOND TALK, KEN JONES, WHO IS FROM THE CENTER FOR BETTER BEGINS AT UNIVERSITY OF CALIFORNIA, STUDYING -- ] [ AUDIO ECHO AND INDISCERNIBLE >> SO DOCTOR LYONS --MILLIANS? >> THANK YOU. >> AS DISCUSSED BY OTHERS PREVIOUSLY -- [INDISCERNIBLE] -- WHICH REALLY HAVE AN EXPOSURE ON SCHOOLS, HEALTH PROBLEMS WHICH Dr. JONES IS TALKING ABOUT, POSITIVE NETWORK AND INTERACTION, THEY DO BETTER, STABLE CARE GIVING AND IMPORTANT ACCESS TO INTERVENTION FOR LIFESPAN. I WILL BREAK THIS DOWN IN THREE PIECES, SCHOOL SYSTEM AND REGULATIONS, WHAT HAS BEEN DONE ALREADY IN SCHOOLS AND THEN THE WALL OF SCREENING IN SCHOOLS. WE KNOW THERE ARE THREE PRIMARY REGULATIONS, EVERYTHING FROM THE REHABILITATION ACT, AMERICAN DISABILITY ACT WHICH CLARIFIES THE DEFINITION OF A DISABILITY AND THEN IDEA UPDATED IN 2004, DEALING WITH INTERVENTIONS FOR CHILDREN IN THE SCHOOL SYSTEM. IF WE TAKE A LOOK AT IT, THERE IS A LITTLE BIT OF DIFFERENCE BETWEEN THE TWO REGULATIONS. ONE THING I WANT TO POINT OUT IS BOTH HAVE A SYSTEM CALLED CHILD FIND TO IDENTIFY CHILDREN WITH DISABILITIES AND AT RISK FOR SERVICES. PART B DEALS WITH KIDS FROM 3-21, THROUGH THE 22ND BIRTHDAY AND DOES THE FOLLOWING. AND THEN PART C IS FOR CHILDREN ZERO TO THREE. IF YOU LOOK AT PART C, IT IS A LITTLE DIFFERENT IN THAT IT IS FAMILY-BASED, NOT ACADEMIC OR SCHOOL DRIVEN, IT IS FOR INFANTS AND TODDLERS, HAS COMPONENTS FOR INTERAGENCY COLLABORATION AND CASE MANAGEMENT. BOTH B AND C, DESPITE HAVING CHILD FIND WHICH IS IDENTIFYING CHILDREN WITH DISABILITIES AND IN NEED OF SERVICES, IS IDENTIFIES A NETWORK AND PROVIDES FOR FISCAL SUPPORT. IN SPECIAL ED, YOU HAVE 13 CATEGORIES. THE BIG PART OF THIS IS SCHOOLS ARE NOT MEDICAL PROVIDERS. ELIGIBILITY CATEGORIES ARE FOR EDUCATIONAL PURPOSES AND NOT CLINICAL DIAGNOSES AND YOU CAN BE EXCLUDED FOR A VARIETY OF REASONS, SOCIO, CULTURAL AND OTHER FACTORS. ONE THING THAT IS NOT YET MANDATED BUT ONE THING THE SCHOOL SYSTEMS HAVE PUT IN PLACE IS WHAT IS CALLED A MULTITIER FORM OF SUPPORT. THIS CAN BE INFORMAL AND FORMAL SCREENINGS TO MAKE SURE CHILDREN ARE PROVIDED SUPPORTS BEFORE THEY FAIL AND NEED THE SPECIAL EDUCATION SERVICES. STATES VARY THEIR NAMES WITH ACADEMICS AND BEHAVIOR. YOU AUTOMATICALLY KNOW A CHILD WILL NEED TO GO FOR SPECIAL ED. TIER 1 IS UNIVERSAL, ACCESS TO PROPOSE CURRICULUM, TIER 2 IS INTERVENTION, TIER 3 AND SOME STATES HAVE FOUR TIERS, IS INTENSIVE. THESE ARE BASED ON ACADEMIC BENCH MARKS AND THESE MAY NOT BE CONSISTENT ACROSS STATES ESPECIALLYILY SINCE COMMON CORE IS BEING PHASED OUT AND SOME STATES HAVE MORE INTENSIVE KIND OF BENCH MARKS THAT ARE NOT CONSISTENT. ONE THING FROM A CLINICAL PERSPECTIVE IS THERE IS A DIFFERENCE BETWEEN A CLINICAL AND EDUCATIONAL APPROACH WHEN DEALING WITH CHILDREN WITH DISABILITIES ESPECIALLY WITH DIAGNOSTICS AND THOSE IN NEED OF MEDICAL SERVICES. WE KNOW THAT THE STANDARDS PRETTY MUCH IDENTIFY WHAT IS GOING ON, USING STANDARDIZED AND CRITERION BASED STANDARDS THAT HAVE, IN MOST CASES, GONE THROUGH RIGOROUS EVALUATION IT MAKE SURE THEY ARE SPECIFIC AND ACCURATE. WE KNOW THAT PROBLEMS OF DEVIATION LOOK AT WHAT IS WITHIN A NORMAL RANGE. AND IF AN INDIVIDUAL IS AT RISK RATHER THAN A FAILURE AND PATIENT CENTER, INDIVIDUAL CENTER RATHER THAN HAVING TO BE PUT IN A GROUP OR COMMUNITY. PROFESSIONAL TRAINING GIVEN THE DIAGNOSIS AND IF YOU THINK OF FAS OR FASD, IT IS A CLINICAL APPROACH. YOU ARE DEALING WITH A LICENSED PROFESSIONAL, SOMEONE WHO IS TRAINED TO GIVE A DIAGNOSIS. LOOSELY OPERATIONALIZED, USED AS PREVENTION, SOMETIMES THIS PROCESS CAN TAKE A YEAR AND GO THROUGH 13-WEEK SEGMENTS. PROGRESS IS RELATED IN MEETING ACADEMIC STANDARD OR IF A CHILD SHOWS INDIVIDUAL PROGRESS, WE'RE NOT LOOKING AT TOWARDS NORMAL IN AN OPTIMAL LEVEL OF PROGRESS. HE GO ABILITIES ARE NOT DIAGNOSES AND I WILL REITERATE THAT AND SCHOOLS ARE NOT MEDICAL PROVIDERS. SO I AM GOING TO TALK A LITTLE ABOUT STREAM -- SCREENING. IN TALKING WITH Dr. BOYS, THERE WAS SOME EDUCATIONAL OUTCOME IN SCHOOLS IN MINNESOTA. BUT THIS TWO-YEAR STUDY IN WASHINGTON STATE WAS TO ESTIMATE FAS AND A SCREENING PROGRAM THAT WAS REQUIRED BY AND FOR A SCHOOL SYSTEM AND ACCEPTANCE BY THE COMMUNITY. THEY SET UP A COORDINATING SYSTEM, TRAINED SCHOOL NURSES OR PUBLIC HEALTH TO CONDUCT THE SCREEN. IF A CHILD HAD A POSITIVE SCREEN ON ANY OF THE THREE LEVELS, THEY WERE REFERRED FOR AN EVALUATION. HERE ARE THE OUTCOMES. PREVALENCE WAS ONLY BEING IDENTIFIED IN ONE COUNTY AND THAT IS BECAUSE THEY HAD FULL SCHOOL ACCEPTANCE AND ALMOST ALL FIRST GRADERS WERE SCREENED FROM. THIS, FIVE RECEIVED THE DIAGNOSES, EIGHT DETERMINED BY PRENATAL ALCOHOL EXPOSURE, THREE HAD THEIR INTERVENTIONS ADJUSTED, ONE BY SOCIAL SECURITY SO IT WAS KIND OF HELPFUL. THE COUNTY COULD NOT DO ANY PREVAILANCE BECAUSE NOT EVERY SCHOOL BOUGHT IN TO OR WANTED TO PARTICIPATE IN THE PROCESS. FOR THE FAS DIAGNOSIS, ONE FAMILY SAID THE DIAGNOSIS WAS NOT HELPFUL, ANOTHER WAS ABLE TO EXPAND ITS SERVICES AND 11 DETERMINED ACROSS THE COMMUNITY. THE DIFFERENT REFERRALS THROUGH THE SCHOOL SYSTEMS MADE IT DIFFICULT BUT THOSE WHO DID FOUND IT A BENEFIT TO GET EXTENDED SERVICES AND GUIDE INFORMATION PLANNING. IN 2003, THIS IS LARRY BYRD'S GROUP AND OTHERS, THEY SCREENED 3184 CHILDREN IN NORTH DAKOTA, SOUTH DAKOTA AND MINNESOTA FOR EXPOSURE. THIS WAS A NINE-YEAR STUDY. THE PURPOSE WAS TO USE AN IDENTIFYING TOOL WITH 32 ITEMS AND THEN DETERMINING THE EFFICACY OF THE TOOL. EVERYONE HAD A FOUR-HOUR TRAINING SESSION TO IMPLEMENT THE TOOL AND THEN CHILDREN WITH A CUT STORE OF 20 OR HIGHER ON THE TOOL WERE REFERRED FOR EVALUATION FOR -- A MORE INDEPTH EVALUATION. THEY DID IT DIFFERENT THAN SEATTLE OR THE WASHINGTON GROUP BECAUSE THEY JUST LOOKED AT BEHAVIORAL PROBLEMS AND AT RISK FOR DEVELOPMENTAL AND INTELLECTUAL DISABILITIES. THEY DID NOT LOOK SPECIALLY AT THE CRITERIA NEEDED FOR FAS. AND WHAT THEY FOUND, THEY DID IT IN TWO DIFFERENT WAYS. THEY DID THE IOM AND THEN CLARENS LIST. THE IOM, THEY DETERMINED THIS WAS AN ACCURATE TOOL TO SCREEN KIDS IN NEED FOR FURTHER EVALUATION. IT WAS TIME EFFICIENT AND COST EFFECTIVE. THEY ESTIMATED IT TOOK LESS THAN 15 MINUTES AND COST EIGHT DOLLARS PER KID WHICH IS PRETTY REASONABLE. THEY FOUND THIS APPROACH COULD BE BENEFICIAL AND COMMUNITY HEALTH CENTERS, HEADSTART PROGRAMS. THE LAST ONE I AM GOING TO TALK ABOUT IS MASSACHUSSETTS, AGAIN ANOTHER EARLY INTERVENTION PROGRAM. THEY LOOKED AT THREE PROGRAMS IN MASSACHUSETTS. THIS WAS DONE BY WATSON IN 2011. IT WAS TO BE A 5-YEAR PROJECT BUT DUE TO SITUATIONS IN FUNDING, IT WAS CUT TO A 3-YEAR PROGRAM. THEY WANT TO MEASURE THE FEASIBILITY OF USING THE FAST SCREENING TOOL. THERE IS A PICTURE OF IT RIGHT THERE. AND REALLY WHAT THEY ASKED IS WERE YOU PRENATALLY EXPOSED AND THEY ASKED THE MOTHERS DID YOU DRINK DURING PREGNANCY? TRAINING STAFF TO IMPLEMENT IT AND DEVELOPING MATERIALS ABOUT FAS, AND WHAT THEY FOUND IS IT HAD A 51 PERCENT FEASIBILITY RATE WHICH IS NOT SO HAT BUT WHAT THEY DID FIND WAS THAT IT WAS INCONSISTENT AND A LOT OF SCHOOL STAFF WERE VERY UNCOMFORTABLE ASKING ABOUT ALCOHOL USE DURING PREGNANCY. STAFF DID STATE INCREASED AWARENESS AND WERE ABLE TO DISCUSS MORE ABOUT FAS. SO THAT SAID, WHEN WE TAKE A LOOK AT SCREENING IN CHILDREN WITH FAS, ACCORDING TO THIS STUDY IN 2018, THEY ARE LOOKING AT 21 OR 5 AND THE THAT IS A LOT OF KIDS WITH FAS. EVERY GRADE OR EVERY CLASSROOM WILL HAVE A CHILD AFFECTED BY PRENATAL ALCOHOL EXPOSURE. IN 2018, THERE WERE 57 MILLION KIDS ENROLLED IN PUBLIC SCHOOL. WHEN WE LOOK AT THAT IN 2017, 14 PERCENT WERE ENROLLED IN SPECIAL ED SERVICES. THEY HAVE ALSO BROKEN IT DOWN INTO CATEGORIES AND THERE IS NO MENTION OF FAS. THE ONE STUDY BROUGHT TO MY ATTENTION TODAY, BACK TO DOCTOR BOYS, THEY LOOKED AT -- ONE OF THE FEW STUDIES LOOKING AT KIDS WITH FAS IN SPECIAL EDUCATION. WHEN WE LOOK AT THIS INFORMATION, LOOK AT THE NUMBER OF KIDS, WE KNOW THE RANGE OF THE EFFECTS BUT THERE ARE SOME QUESTIONS WE NEED TO THINK OF. HOW DO WE COLLABORATE WITH THE DEPARTMENT OF ED OR EVEN HEAD START, WE NEED TO START SOMEWHERE BECAUSE ALL THE SCREENING PROGRAMS WE NEED TO LOOK AT RIGHT NOW ARE DEALING WITH YOUNG CHILDREN. SOMETIMES THEY DON'T COME INTO CARE AND SOMETIMES THEY DON'T NEED TO BE SCREENED BUT HOW TO RECOGNIZE KIDS IN SPECIAL EDUCATION AND IT IS NOT JUST ADHD OR OTHER -- IT DOES HAVE SIGNIFICANT HEALTH AND OTHER MEDICAL ISSUES THAT HINDER LEARNING AND WE NEED A NATIONAL FRAMEWORK FOR STATES AND SCHOOL SYSTEMS TO FOLLOW. AND EVEN WITH THE UNIFIED DISTRICT OF L.A., CAN IT BE IMPLEMENTED? LOOKING AT THE STUDIES BASED ON THE INFORMATION, WE HAVE SOME CONCERNS. YES, EVEN IN THE RESEARCH STUDIES THAT YOU HAVE ASCERTAINED ATTAINMENT, THEY HAD VERY FEW RESEARCHERS FOLLOWING IT AND MAKING SURE THE INFORMATION WAS COLLECTED. WE KNOW YOU HAVE CAPTURED A LARGE POPULATION BUT SCHOOLS ARE NOT MEDICAL PROVIDERS AND MAY NOT BE SO WILLING TO BE PART OF IT SINCE FAS IS A MEDICAL DIAGNOSES RIGHT NOW EVEN THOUGH DSM-5 IS RECOGNIZED. PART C, AN INTERAGENCY-COMMUNITY COLLABORATION, SO WE'RE MISSING A BUNCH OF KIDS AT KINDERGARTEN OR MAYBE LATER. SCREENING NEEDS TO BE MORE EFFICIENT, EVEN IF WE'RE NOT MAKING ANY DIAGNOSES, JUST TO INQUIRE IF THERE WAS POSSIBLE PRENATAL EXPOSURE, IT COULD BE DONE BUT THERE WERE ALL THESE CHALLENGES. SCHOOLS WANTED TO BE A PART OF IT AND ALSO THEY ARE VERY DECENTRALIZED IN SOME STATES AND STATES VARY ACROSS THE NATION. SCREENING MAY CONTRIBUTE TO KIDS GETTING THE NECESSARY SERVICES THEY NEED HOWEVER IF YOU LOOK AT A MULTITIER SYSTEM, IF A CHILD IS NOT SHOWING ACADEMIC OR BEHAVIORAL PROBLEMS IN A CLASSROOM, GO YOU MAY NOT BE ELIGIBLE FOR SERVICES EVEN THROUGH THE RTI PROCESS. SO THEN IT GETS TRICKY OF HOW DO WE GET THEM THE SERVICES THEY NEED. EVEN IF IT IS ACCOMMODATION, ACCOMMODATION IS NOT SERVICE AND AGAIN IF THEY DON'T MEET THE DEFICIT, YOU CANNOT SAY THEY DON'T NEED HELP IN THE CLASSROOM. AND WE HAVE TO PROTECT THE INFORMATION AND IN SOME CASES, THIRD-PARTY INFORMATION IF YOU ARE TALKING ABOUT SOMEONE'S BIOLOGICAL MOTHER AND THAT WILL NEED TO BE TAKEN CARE OF. IT WILL INCREASE THE STIGMA BUT CAREGIVERS WILL BE RELUCTANT IF THEIR CHILD IS TO BE TREATED DIFFERENT IN THE CLASSROOM AND THERE HAS BEEN SOME STUDY OF THIS WHICH IS PRETTY INTERESTING. SO YES, I THINK THE DEPARTMENT OF EDUCATION NEEDS TO BE ENGAGED AS WELL AS NATIONAL ORGANIZATIONS, EARLY CHILDHOOD AND ADVOCACY GROUPS. WE NEED MORE ON BOARD TO DO THE NEEDS ANALYSIS TO SEE HOW WILL THIS BENEFIT EDUCATION. HOW DO WE GET OTHERS INVOLVED AND ONBOARD? STRUCTURES TO BE REVIEWED AS WELL AS IMPLEMENTATION. SO HERE ARE SOME OF THE RECOMMEND DATED SUGGESTIONS AFTER LOOKING AT THE LITERATURE, WE NEED TO COLLABORATE WITH SCHOOL-BASED HEALTH SYSTEMS. THERE ARE MEDICAL CLINICS IN SOME SCHOOLS IN SOME AREAS THAT DOES WELFARE AND CAN WE TAG ON TO THAT? CHANGE THE PROCESS TO THE IETP PROCESS. TRAIN SOCIAL WORKERS AND TEACHERS TO ASK THE QUESTION WHEN KIDS COME IN, EVEN WHEN THEY TRANSFER TO A NEW SCHOOL. TRACK THEM THROUGH AN INFORMATION NETWORK SYSTEM AND THAT WAY YOU HAVE SOMEONE TO TALK TO AND CAN REFER THEM TO SUPPORTS AND SERVICES. AND ADD CASE MANAGEMENT SERVICES. AGAIN, I THINK IT WILL BE KEY TO PARTNER WITH THE DEPARTMENT OF ED. THANK YOU. >> THANK YOU VERY MUCH, ANY CLARIFYING QUESTIONS FOR Dr. MILLIANS? YEAH. [ QUESTION OFF MIC ] >> I RUN A GROUP HERE BUT AM ALSO AN EDUCATOR AND ADVOCATE IN IEP MEETINGS SO THIS IS RIFE WITH WHAT WE DO. FIRST THING I WANT TO SAY YOU ARE RIGHT, SCHOOLS ALWAYS EMPHASIZE THEY ARE NOT MEDICAL PROVIDERS BUT AT LEAST IN MARYLAND AND MANY OTHER STATES, ALL SCHOOLS SCREEN FOR HEALTH AND DENTAL WHICH MEANS YOU HAVE TO BE HEALTHY BEFORE YOU CAN GET AN EDUCATION SO I PUT UP THE IDEA OF SCREENING NOT NECESSARILY FOR FASD BUT SCREENING FOR RED FLAGS, DEVELOPMENTAL DISABILITIES WOULD BE APPROPRIATE BECAUSE WE HAVE KIDS GETTING KICKED OUT OF DAYCARE CENTERS IN MARYLAND FOR THIS REASON. SO I GUESS THE THING GOES TO FASD COULD BE A DIAGNOSIS BUT THE REAL ISSUE FOR SCHOOLS IS CAN THE CHILD ACCESS THE CURRICULUM AND WE HAVE SO MANY CHILDREN THAT CAN'T BECAUSE OF THEIR BEHAVIORAL AND DEVELOPMENTAL ISSUES AND THAT IS REALLY THE CRUX. SO IF THEY GET SCREENED, JUST AS LONG AS SOMEBODY SAYS THERE IS A LOT OF DEVELOPMENTAL ISSUES HERE THAT NEED ATTENTION IN THE EDUCATION SETTING, WHY WOULDN'T THAT SUFFICE EVEN WITHOUT A DIAGNOSIS AND THEN THEY WOULD GET REFERRED TO SERVICES? >> I THINK A LOT OF IT COMES FROM THE WAY SCHOOL SYSTEMS INTERPRET. NOW, I DON'T KNOW ABOUT MARYLAND BECAUSE SCHOOL SYSTEMS ARE VERY DIFFERENT BUT A SCREENING, AGAIN, IF YOU ARE AT RISK, SCHOOLS DON'T TAKE AT RISK AND I AM TALKING SCHOOL AGE, NOT DAYCARE CENTERS. BUT SCHOOLS DON'T TAKE AT RISK AS NEEDING SERVICES. THEY HAVE TO SHOW THE DEFICITS IN THE CLASSROOM. NOW I AM IN GEORGIA, I CAN'T SPEAK ON MARYLAND AND I AGREE WITH YOU, I DO THINK SCREENING NEEDS TO BE PART OF IT. WHEN YOU ARE TALKING VISION AND HEARING, UNLESS YOU ALREADY HAVE THE TREATMENT, THEY WILL SEND YOU OUT FOR AN EVALUATION BUT AGAIN I THINK YOU ARE DEALING WITH SOMETHING HERE THAT HAS A STIGMA AND MORE SOCIAL IMPLICATIONS THAT THEY ARE ALMOST AFRAID TO DO IT. IT IS ALMOST LIKE SAYING OH, YOU HAVE BAD TEETH, GO FIX IT AND THEN NO ONE DOES ANYTHING ABOUT IT. >> BUT YOU HAVE SOME SOCIAL OR EMOTIONAL THINGS INTERFERING WITH WHAT IS HAPPENING IN THE CLASSROOM AND CAN SEND THEM OUT FOR SERVICES BUT TEACHERS HAVE -- THERE'S DIFFERENT TOLERANCE FOR THINGS AND THAT IS THE OTHER THING. THAT IS AGAIN WHY I AM SAYING IT IS INCONSISTENT. WE DON'T HAVE CONSISTENT OPERATIONALIZED BASELINE OF WHAT IS APPROPRIATE AND WHAT IS THE RANGE. SOME WILL SAY THAT IS FINE BUT THEN YOU GO TO THE NEXT CLASSROOM AND A DIFFERENT TEACHING STYLE AND THEY WILL SAY OH, NO, THAT IS NOT FINE. SO IT GETS FUZZY AND FLUID TO SEE THE EXPECTATION AND I THINK YOU HAVE A VERY GOOD POINT AND SOMETHING I WRESTLE WITH ALMOST EVERY DAY. AND JUST AN ADD-ON, THE OTIP DOES HAVE A COMMENT THAT THEY INTENDED FOR FASD TO BE INCLUDED UNDER OHI AND THEY ALSO PUT OUT A ISSUE SHEET THAT GIVES INFORMATION THAT YOU CAN GIVE TO SCHOOL SYSTEMS AND THAT IS SOMETHING THAT AGAIN HAS TO BE GIVEN AT THE STATE LEVEL BECAUSE THIS IS THE INFORMATION AND THEN THE STATES DEVELOP THEIR POLICY. SO THE DYSLEXIC COMMUNITY AUTISM COMMUNITY HAVE DONE A GOOD JOB AT GETTING THE WORD OUT. >> HI, OHI IS OF COURSE ONE OF THOSE CATEGORIES BUT SOME PEOPLE HAVE TOYED WITH THE BRAIN DEFICIENCY THAT IS CREATED AFTER THE ZYGOTE IS CREATED, AND CAN THAT BE AT LEAST ONE OTHER CATEGORY YOU CAN TAKE ADVANTAGE OF? >> THE THING WITH BRAIN DEFICIENCY, IT IS NOT BEFORE BIRTH BUT AFTER BIRTH AND I THINK IT AGAIN GOES BACK TO DIAGNOSIS. IT COMES TO -- I TRIED IT ONCE WITH RELATION TO A KID AND THEY SHOT ME DOWN. RIGHT NOW IT IS A MEDICAL DIAGNOSIS. I THINK IF WE GET IT FROM DSM-V, WE CAN DO A LITTLE MORE. AND ALSO GET REFERRED SERVICES WHERE YOU CAN SAY IT IS A MENTAL HEALTH ISSUE AND WE HAVE A CHILD WITH THIS EXPOSURE AND THEN THEY CAN SAY YES, WE CAN GET HIM SERVICES OR ACCOMMODATION. >> AS A FOLLOW UP FOR THAT, NEURODISORDER, WHY NOT SAY DISABLED NERVE CATEGORY BECAUSE THAT IS WHAT IT IS IN THE DSM AND MANY CHILDREN DON'T KNOW THE HISTORY AND DON'T HAVE ALL THE CHARACTERISTICS. IN THIS CASE, YOU ARE NOT EXACTLY LABELING IT AND INTENTIONALLY SIGMATIZEING FAMILIES. I DON'T KNOW, JUST A THOUGHT. >> YES, I AGREE AND A BIG PROBLEM IS WE ARE DEALING WITH SCHOOLS THAT DON'T DO MEDICAL DIAGNOSES BUT USE IT FOR ELLINGABILITY. I E L I GIBILITY. I THINK WE HAVE CLINIC AND EDUCATION NOT INTERACTING WELL AND I THINK WE DO NEED POLICY. SOME OF THIS I CAN'T ANSWER BECAUSE I AM NOT A POLICY MAKER, I AM A CLINICIAN AND I WORK WITH THE SCHOOLS IN ONE SCHOOL IN ONE STATE SO IT IS REALLY HARD TO FIGURE OUT. >> THIS IS A GREAT CONVERSATION, I WOULD LOVE TO MOVE ON AND I SUSPECT THERE WILL BE MORE QUESTIONS AS WE TALK ABOUT ANALOGOUS SITUATIONS AS WELL SO NOW WE WELCOME IN Dr. JONES FOR RECOGNIZING AND SCREENING FAD IN JUVENILE JUSTICE SETTINGS. >> OKAY, MY NAME IS KEN JONES AND I WILL TALK ABOUT RECOGNIZING SCREENING FOR FASD IN THE JUVENILE JUSTICE SYSTEM. ONE OF THEM HAS BEEN BEAUTIFULLY DESCRIBED TODAY BOY MOLLY AND THEN NOT FAR BEHIND, THE JUVENILE JUSTICE SYSTEM. SO WE HAVE A SCREENING PROGRAM AT THE JUVENILE JUSTICE DETENTION FACILITY IN SAN DIEGO, ONE OF TWO IN SAN DIEGO COUNTY AND IT IS A COLLABORATION, THIS SCREENING PROGRAM BETWEEN THE SAN DIEGO COUNTY PROBATION DEPARTMENT, OFFICE OF THE PRIMARY PUBLIC DEFENDER JUVENILE DIVISION AND THE DEPARTMENT OF PEDIATRICS, DISMORPHOLOGY AND TERATOLOGY. SO THE SCREENING PROGRAM WENT THROUGH JULY 2013-16 FROM THE STANDPOINT OF ALL JUVENILES FOR SCREENING WERE REFERRED THROUGH THE PUBLIC DEFENDER'S OFFICE. SO THEY WERE NOT REFERRED THROUGH JUVENILE HALL BUT ALL OF THE KIDS WE SAW WERE SEEN IN JUVENILE HALL. SO WE WENT TO THE JUVENILE HALL TO SEE ALL OF THESE KIDS AND SCREEN THEM. THE PARENT OR GUARDIAN SIGNED THE CONSENT OBTAINED BY THE PUBLIC DEFENDER SO WE HAD TO GET CONSENT FROM THE PARENT OR GUARDIAN TO DO THIS EXAMINATION WHICH I WILL SHOW YOU HERE IN A MINUTE WAS A HUGE PROBLEM. THEN WE HAD TO GET VERBAL ASSENT FROM THE JUVENILE OBTAINED AT THE TIME OF SCREENING. SO THE LADY I TRAINED FOR THIS, A NEONATAL NURSE, A QUICK LEARNER IN DIAGNOSING FAS. AND SHE DID HEIGHT AND WEIGHT MEASUREMENTS, THE WINDOW THAT THE EYE LOOKS OUT OF, THE FILTRUM FROM THE SEPTUM TO THE RED PART OF THE LIP, EVALUATED UP A OF THOSE MEASUREMENTS AND LOOKED FOR THE CHARACTERISTIC PEER FEATURES SEEN IN THIS DISORDER, PALMAR CREASE PATTERNS AND THERE IS A SPECIFIC CREASE PATTERN WE ASSOCIATE WITH PRENATAL EXPOSURE TO ALCOHOL, FINGERS UP TO THE ELBOW AND A HEART MURMUR. THE SCREEN TOOK ABOUT EIGHT MINUTES TO DO. CAROLYN THEN DID A BRIEF PHONE INTERVIEW WITH THE PARENT OR GUARDIAN AFTER THE CHILD WAS SEEN AND IF THE SCREEN WAS POSITIVE, THE ADOLESCENT OR CHILD WAS REFERRED TO THE FASD CLINIC FOR A DIAGNOSTIC ASSESSMENT BY ME. SO THIS IS THE DATA FROM THAT SCREENING THAT WE DID SEPTEMBER 2013 THROUGH JULY 2016 AND YOU WILL SEE THAT THIS -- WE HAD 134 TOTAL NUMBER OF JUVENILES THAT WERE SCREENED AND THAT IS RIDICULOUS BECAUSE THERE ARE HUGE, HUGE NUMBERS WHO WERE ADMITTED TO JUVENILE HALL BUT WE COULDN'T GET THE CONSENT IN SO MANY OF THOSE OTHER CASES. 32 OF 34 SCREENED POSITIVE AND WERE REFERRED TO THE CLINIC FOR ME TO EXAMINE. I EXAMINED ONLY 14 OF THOSE 32 OR 44 PERCENT WHICH, AGAIN, IS A PROBLEM, A HUGE AREA THAT IS A PROBLEM AS FAR AS THE STUDY WAS CONCERNED WHICH WE HOPE WE ARE RECTIFYING IN OUR NEXT STUDY. HOWEVER, 12 OF THOSE 14 WHO WERE SCREENED POSITIVE OR 86 PERCENT OF THEM WERE POSITIVE FOR FASD AT THE TIME WE EXAMINED THEM. SO THE OTHER 14 OR THE -- OF THE 32 REFERRALS, 14 WERE EVALUATED. OF THE OTHERS, 5 WERE SCHEDULED BUT WERE A NO-SHOW AND WEREN'T ABLE TO BE RESCHEDULED BECAUSE THEY DIDN'T RETURN THE CALLS, TWO MOVED OUT OF STATE, NO FOLLOW UP. 11 DID NOT RETURN TELEPHONE CALLS AND LOST TO FOLLOW UP. ASSUMPTION FOR YOU AND THIS IS NOT IN YOUR PACKET HERE BUT ASSUME THAT ALL 32 ADOLESCENTS WHO WERE REFERRED WERE EVALUATED BY ME AND IF WILL 86 PERCENT WERE CONFIRMED TO HAVE AN FASD, THEN 28 PERCENT OF THE ADOLESCENTS AT JUVENILE HALL WOULD BE SCREENED AND I THINK THAT IS A PRETTY GOOD ESTIMATE OF WHAT PERCENTAGE OF THEM IN FACT HAVE A DIAGNOSES OF FASD. SO THERE ARE A COUPLE OF PROBLEMS HERE. AND SOME I ALREADY MENTIONED, VERY DIFFICULT TO GET PERMISSION TO SCREENING, AND WE THINK WE HAVE A SOLUTION TO THAT. AND THEN NUMBER TWO, IT WAS A PILOT PROGRAM DONE AT THE JUVENILE HALL AND ONLY 4 4 PERCENT WHO SCREENED FORWARD WERE EVERY EVALUATED IN OUR FASD CLINIC. POINT THAT ONE REQUIREMENT OF THEIR PROBATION BE THAT THE CAREGIVER PERCENT CALL FOR AND ATTEND AN APPOINTMENT AT THE FETAL ALCOHOL SYNDROME DISORDER CLINIC AT MY HOSPITAL. SO WE WANT TO INVOLVE THE PROBATION DEPARTMENT IN THIS. NOW, THE FIELD WAS CHANGED, THE SLOPE OF THE FIELD ALL CHANGED IN JANUARY 2018 WHEN THIS PAPER CAME OUT, PREVALENCE OF FETAL ALCOHOL SPECTRUM DISORDER, ONE OF THOSE FOUR WERE IN SAN DIEGO COUNTY AND WE WERE ABLE TO SHOW THAT THE PROMINENCE OF THIS DISORDER WAS 2.4 PERCENT. NOW, THAT REALLY WOKE UP THE CITY FATHERS AND MOTHERS TO THE INCREDIBLE AMOUNT OR DEGREE OF PROBLEMS THAT EXISTED WITH THIS ORDER AND WHAT HAPPENED WAS THAT THE PROBATION DEPARTMENT ACTUALLY CAME TO US AND SAID WE KNOW YOU HAVE PROBLEMS DOING THE SCREENING TEST, WE WANT TO DO THE SCREENING TEST AGAIN. SO HERE IS THE SCREEN THAT WE PROPOSED IN JANUARY 2019. WE HAD THOUGHT THE SCREEN WOULD START IN MARCH, DIDN'T START TILL MAY BUT WE HAD ALREADY HAD ONE MONTH OF THIS AND YOU CAN SEE WE CAST A VERY BROAD NET AS FAR AS THIS WAS CONCERNED BECAUSE WE WANTED AS MANY KIDS REFERRED TO US FOR SCREENING AS WE POSSIBLY COULD. YOU WILL SMILE A LITTLE BIT HERE BUT IT IS WORKING. THE QUESTIONS, FIRST OF ALL, IF YOU HAD A HEAD CIRCUMFERENCE LESS THAN 10 PERCENTILE, YOU WERE AUTOMATICALLY SENT TO THE CLINIC. IF YOU HAD A HISTORY OF PRENATAL ALCOHOL EXPOSURE, THAT GOT YOU A TICKET AND ANY OF THE OTHER SEVEN DID. LACKING HISTORY OF ALCOHOL EXPOSURE, SIGNIFICANT LEARNING PROBLEMS, HISTORY OF MENTAL HEALTH CONDITIONS, AUTISM, OPPOSITIONAL DEFIANT DISORDER, ADHD OR ADD, MULTIPLE ADMISSIONS TO JUVENILE HALL. SCREEN POSITIVE FOR TWO OR MORE OF THE FOLLOWING SIX BEHAVIORAL PATTERNS. SO TO IDENTIFY THE SCREEN AS POSITIVE, IF THE HEAD CIRCUMFERENCE IS EQUAL TO OR LESS THAN 10 PERCENTILE OR ANY OF THE ITEMS 4-7 ARE CHECKED YES. SO THE NURSE MEASURES THE HEAD CIRCUMFERENCE, TALKS TO THE CHILD AND CAREGIVER TO DETERMINE AS MUCH AS POSSIBLE, GO LOOKS THROUGH THE CHILD'S SOCIAL RECORDS THERE AT JUVENILE HALL PROVIDING INFORMATION ABOUT THE CHILD TO GET FURTHER HELP IN ANSWERING THE QUESTIONS, THE NURSE DETERMINES IF THE CHILD SCREENS POSITIVE OR NEGATIVE AND THEN THERE IS THAT AT THE BOTTOM OF THE FASD SCREENING FORM AND FINALLY THEY ARE COLLECTED BY THE SUPERVISORS WITH CONTACTS WITH FOLLOWING INFORMATION AND THEY ARE IN OUR OFFICE AND THEY INCLUDE NUMBER OF JUVENILES IN DETENTION, THOSE WHERE WERE SCREENED, THOSE WHO SCREENED POSITIVE AND NAMES AND DATES OF BIRTH FOR ALL YOUTHS WHO SCREENED POSITIVE. THEN THE PARENTS OR CAREGIVER WILL BE REQUIRED TO CONTACT CENTRAL SCHEDULING TO GET AN APPOINTMENT FOR THEIR CHILD TO BE EVALUATED AT THE FASD CLINIC AND THAT IS THE SECOND BIG PROBLEM HERE, THAT THEY WERE NOT COMMUNICATING WITH US AFTER THEY WERE SCREENED POSITIVE. SO WE'RE WORKING TO HAVING THE JUVENILE'S PROBATION BE REQUIRED FOR THEM TO CALL FOR AND ATTEND AN APPOINTMENT AT THE FASD CLINIC AT RADY CHILDREN'S HOSPITAL. NOW, I HAVE BEEN WORKING, AS MENTIONED, ON THIS ISSUE SINCE 2013, THE WHOLE ISSUE OF THE JUVENILE JUSTICE SYSTEM SINCE 2013, BUT I HAD SOMEBODY HELPING ME UNTIL TWO YEARS AGO AND NOW I AM WORKING IN EARNEST WITH IT AND I REALIZED AFTER TWO YEARS OF DOING IT THAT THE PERSON HELPING ME WAS DOING A LOT OF THINGS I DIDN'T KNOW WE WERE SUPPOSED TO DO. SO THE BIG ONE OR TWO ARE THE JUVENILE COURT JUDGES AND WE HAVE GOTTEN THE HEAD OF THE JUVENILE COURT JUDGES, THE HEAD JUDGE, TO BUY INTO THIS CONCEPT THAT THE PROBATION DEPARTMENT WILL SET UP AS A REQUIREMENT FOR PROBATION, THAT THE CHILD'S MOTHER OR CAREGIVER BRING THE CHILD TO OUR CLINIC. WE HAVE TO HAVE CONTACT, A BIG CONTACT WITH THE PUBLIC DEFENDER'S OFFICE WHICH WE DO, AND WE NEED TO INVOLVE OURSELVES WITH THE DISTRICT ATTORNEY AS WELL WHICH WE HAVEN'T DONE AND WHICH WE WILL DO IN THE COMING TWO OR THREE WEEKS. THEN THE OTHER BIG GROUP IS THE PROBATION DEPARTMENT. THEY HAVE HUGE POWER AS FAR AS THIS AND THEY ARE A HUGE GROUP OF PEOPLE, I AM SURE, IN ALL OF YOUR CITIES. THEY CERTAINLY ARE IN SAN DIEGO, AND THERE ARE FOUR REENTRY OFFICERS. THOSE REENTRY OFFICERS GET THE LIST OF CHILDREN THAT HAVE BEEN LET OUT OF JUVENILE HALL WHO ARE NOW WARDS, IF YOU WILL, OF THE PROBATION DEPARTMENT AND THOSE FOUR REENTRY OFFICERS ASSIGN EACH ONE OF THOSE CHILDREN TO ONE PROBATION OFFICER. SO THEY REALLY CONTROL THAT CHILD'S LIFE FOR THE LENGTH OF TIME THAT CHILD IS ON BE PROBATION. SO WE'RE MEETING WITH THE FOUR REENTRY OFFICERS NEXT WEEK. THE -- THERE ARE JUVENILE MANDATED SCHOOLS IN SAN DIEGO AND I DON'T KNOW IF THEY ARE IN ALL OF YOUR CITIES BUT I WAS AMAZED TO FIND THIS OUT WHERE THESE ARE SCHOOLS WHERE MOST OF THE KIDS IN THE CLASS ARE IN PROBATION. THEY HAVE BEEN IN JUVENILE HALL OR SOME OTHER REASON THAT HAS GOTTEN THEM ON PROBATION AND WE HAVE TO MAKE CONTACT AND INVOLVE OURSELVES WITH THOSE SCHOOLS. THE PUBLIC HEALTH DISNEY NURSING PROGRAM IS A HUGE THING IN SAN DIEGO AND I SUSPECT IT IS IN ALL CITIES AND THIS IS ANOTHER GROUP WE ARE INVOLVING OURSELVES WITH AND WE FIT IN THERE TOO. AND THEN THE DEPARTMENT OF PURCHASING AND CONTRACTING IN SAN DIEGO COUNTY IS HUGE FOR US BECAUSE THAT IS WHERE THE MONEY IS AND WE NEED MONEY TO RUN THE PROGRAM WHICH WE DON'T OF COURSE HAVE ANY MONEY TO DO. BUT ALL OF THESE GROUPS HAVE TO COME TOGETHER TO MAKE THIS THING WORK AND I AM SURE THERE ARE OTHER THINGS I WILL FIND OUT ABOUT AS WE MOVE FORWARD. SO FINALLY ON THE LAST COUPLE OF SLIDES HERE, I WANT TO TELL YOU ABOUT A GUY BY THE NAME OF ROBERT ALTON HARRIS AND I WANT TO TELL YOU ABOUT THIS MAN BECAUSE IF WE DO NOT DO SOMETHING NOW IN THE JUVENILE JUSTICE SYSTEM, IN JUVENILE HALLS AND AS YOU MAY OR MAY NOT HAVE HEARD, THE SUPERVISORS OF SAN FRANCISCO HAVE JUST DONE AWAY WITH THE JUVENILE HALLS IN SAN FRANCISCO AND BECAUSE THEY THINK, AND I THINK APPROPRIATELY SO, THAT CHILDREN SHOULD NOT BE LOCKED UP AND PUT IN SOLITAIRE CONFINEMENT AND SO FORTH AND SO ON. BUT WHAT IS GOING TO HAPPEN TO THOSE KIDS IS STILL UP IN THE AIR. SO WE MAY NOT HAVE THE JUVENILE HALLS TO DEAL WITH BUT WE WILL STILL HAVE TO DEAL WITH ALL THESE KIDS AND IF WE DON'T DEAL WITH THESE KIDS NOW, WE WILL END UP WITH A WHOLE GROUP OF KIDS LIKE ROBERT ALTON HARRIS. HE WAS BORN IN 195 AT FORT BRAGG, NORTH CAROLINA TO A MOTHER WITH SERIOUS ALCOHOL PROBLEMS. HE HAD RUN-INS WITH THE LAW STARTING AT THE AGE OF 10, HE WAS PLACED NO JUVENILE DETENTION AT 13 YEARS FOR STEALING A CAR. HIS MOTHER ABANDONED HIM AT THE AGE OF 14. HE WAS PLACED NO JUVENILE DETENTION AGAIN AT 14 YEARS FOR STEALING ANOTHER CAR. HE AND HIS BROTHER MURDERED TWO PEOPLE, HELD UP A BANK, STOLE A CAR AND WERE ARRESTED BY POLICE TWO HOURS AFTER THEY MURDERED THE TWO BYES EATING McDONALD'S HAMBURGERS THAT THEY KILLED THEM FOR. THEY WERE ARRESTED AND AFTER THE ROBBERY, CONVICTED AND SENTENCED TO DEATH ON 6/3/79 AND I MET ROBERT ALTON HARRIS IN THE FALL OF 1991 AND I AM JUST GOING TO BRIEFLY TELL YOU BECAUSE IT IS A HIGHLY EMOTIONAL EVENT FOR ME. I WAS CALLED BY THE HEAD LAWYER FOR THE AMERICAN CIVIL LIBERTIES UNION FOR THE DEATH PENALTY AND HE ASKED ME TO LOOK AT THE CHART OF ROBERT ALTON HARRIS TO SEE IF I THOUGHT HE HAD FEET TALL ALCOHOL SYNDROME AND I COULDN'T BELIEVE IT WHEN I LOOKED AT HIS FACE. HERE HE IS ON THE LEFT AS A BOY AND ON THE RIGHT, A FEW WEEKS BEFORE HE WAS EXECUTED, BUT HE HAD THE FETAL CONTROL SYNDROME AND I WENT AND EXAMINED HIM AT SAN QUINTON'S DEATH ROW WHICH WAS ONE OF THE WORST EXPERIENCES OF MY LIFE. WE PLED BEFORE THE GOVERNOR PETE WILSON, HE DENIED OUR REQUESTS. HE WAS PUT INTO THE GAS CHAMBER AT MIDNIGHT. THE DAY HE WAS TO BE EXECUTED, THE LAWYERS AT THE ACLU GOT A STAY AT ONE MINUTE AFTER MIDNIGHT. HE WAS TAKEN OUT OF THE GAS CHAMBER, PUT BACK IN HIS CELL AND TWO HOURS LATER, THE STAY WAS LIFTED BY THE SUPREME COURT OF THE UNITED STATES AND HE WAS EX GO CUTE AND IT WAS THE FIRST EXECUTION IN CALIFORNIA SINCE 1967. SO I AM JUST TELLING YOU ABOUT THIS BECAUSE I THINK THAT IT IS SUCH AN IMPORTANT SITUATION AS FAR AS THIS WHOLE JUVENILE JUSTICE SYSTEM IS CONCERNED. I HAVE NOW SEEN 16 MEN ON DEATH ROW WHO THEIR LAWYERS THOUGHT HAD THE FETAL ALCOHOL SYNDROME OR AT LEAST THEY KNEW THAT THE MOTHER WAS A HEAVY DRINKER. AND SO THEY WANTED TO USE THE DIAGNOSIS OF FETAL ALCOHOL SYNDROME AS A MITIGATING FACTOR IN TERMS OF GETTING THEM OFF DEATH ROW AND INTO JAIL FOR LIFE WITHOUT ABILITY TO BE PAROLED AND I CAN TELL YOU THAT OF THESE 15 CASES, I STILL DO NOT KNOW WHAT IS GOING TO HAPPEN TO SOME OF THEM, BUT WE HAVE GOTTEN FOUR OR FIVE OF THESE MEN PUT ON -- TAKEN OFF DEATH ROW AND NOW ARE STILL IN PRISON FOR HAVING MURDERED SOMEBODY AND THEY HAVE -- THEY ARE NO LONGER ON DEATH ROW BUT WILL SPEND THE REST OF THEIR LIFE IN JAIL. SO I THINK THAT WE HAVE TO BE THINKING ABOUT THAT ALL THE TIME AS WE DEAL WITH THIS JUVENILE JUSTICE SYSTEM AND THIS CONDITION OF FETAL ALCOHOL SPECTRUM. THANK YOU. >> THANK YOU VERY MUCH. ANY CLARIFYING QUESTIONS FOR Dr. BOYS? YEAH, GO AHEAD. >> HOW MANY GIRLS DO YOU SEE IN THE JUVENILE JUSTICE SYSTEM WITH THIS ISSUE? I MEAN, FAR MORE BOYS ARE IN THE SYSTEM BUT I GUESS I AM ASKING PROPORTIONATELY OF THE GIRLS IN THE SYSTEM, HOW MANY OF THEM ARE AFFECTED THIS WAY? >> WELL, I CAN TELL YOU VERY FEW REALLY BUT IN THIS SLIDE, YOU WILL SEE THAT -- I THOUGHT I HAD HOW MANY WERE GIRLS AND HOW MANY WERE BOYS THERE. I THINK THAT I CAN ACTUALLY COUNT THE GIRLS ON ONE HAND THAT I SEE IN THE JUVENILE JUSTICE SYSTEM -- WELL, I HAVE SEEN ONE WOMAN -- I HAVE SEEN TWO WOMEN ON DEATH ROW OUT OF THE 15. >> I GUESS WHAT I AM TRYING TO ASK IS I KNOW THE VAST MAJORITY OF KIDS WHO GO INTO THE JUVENILE JUSTICE SYSTEM ARE MALE BUT OF THE GIRLS IN THE JUVENILE JUSTICE SYSTEM, DO THEY SEEM TO BE PROPORTIONATELY AFFECTED BY FASD OR DO YOU FEEL THEY ARE LESS LIKELY TO -- >> I THINK THEY ARE LESS LIKELY TO COMMIT A CRIME THAT ENDS THEM IN JUVENILE HALL. I THINK IT IS A 50/50 IN TERMS OF WHETHER A WOMAN WHO HAS DRINKS DURING PREGNANCY -- >> YEAH, I GUESS I AM JUST ASKING IF IT DRIVES THEM TOWARDS THE SAME SORTS OF BEHAVIORS. I MEAN, YOU ARE SEEING MAYBE FEWER GIRLS IN THERE BUT ARE THEY SHOWING THE SAME KIND OF LEVEL OF -- LIKE MOST OF THESE PEOPLE YOU SAID WERE THERE FOR MURDER. ARE WE SEEING GIRLS ALSO MURDERING PEOPLE WHEN THEY ARE FASD, THINGS LIKE THAT? >> I WILL MAKE A LITTLE BIT OF A JOKE OUT OF IT IF YOU WILL PERMIT ME.% MY WIFE WHO SAYS THE SAME THING I DO, IS A PEDIATRICIAN LIKE ME, SAYS THAT TESTOSTERONE IS A POISON, WHICH I AGREE WITH. [LAUGHTER] >> DO YOU SEE OTHER MENTAL HEALTH DISORDERS IN THE GIRLS, MORE DEPRESSION OR ANXIETY OR NOT REALLY BEHAVIORAL BUT -- >> YOU KNOW, I DON'T KNOW, THAT IS NOT MY EXPERTISE BUT I THINK THERE IS NO QUESTION THAT THERE IS A MUCH GREATER INCIDENCE OF DEPRESSION, FOR EXAMPLE, IN WOMEN THAN IN MEN BUT I DON'T KNOW ABOUT OTHER MENTAL HEALTH PROBLEMS. BUT YOU KNOW THE WHOLE ISSUE OF DEPRESSION IS ABSOLUTELY A HUGE ISSUE WHERE PREGNANCY IS CONCERNED IN GENERAL. >> THANK YOU VERY MUCH. >> AND NOW WE'RE GOING TO HEAR FROM Dr. CHRIS BOYS IN TALKING ABOUT PREVENTING FASD IN SOCIAL SERVICE SYSTEMS. >> THANK YOU. JUST TO FOLLOW UP ON THE POISON, WE LIKE TO SAY GIRLS GIVE THEMSELVES TUMMY ACHES AND HEADACHES AND BOYS GIVE EVERYONE ELSE TUMMY ACHES AND HEADACHES SO A LITTLE MORE EXTERNALIZING FOR THE BOYS. SO WE WILL TALK ABOUT THE SOCIAL SERVICES IN THE LAST COMPONENT. I AM THE DIRECTOR OF OUR CLINICAL PROGRAM FOR THE PROGRAM AT THE UNIVERSITY OF MINNESOTA. WE DO A LOT OF COLLABORATIVE WORK WITH A COUPLE OF AGENCIES IN THE COMMUNITY, NOT JUST THE DIAGNOSTIC CLINIC, SO WE WILL TALK ABOUT SOME OF THE PROGRAMS WE HAVE DONE IN TERMS OF OUTREACH AND GETTING THE SCREENING COMPONENTS GOING. SO I DO WANT TO TALK A LITTLE BIT ABOUT THE RECOGNITION ON FASD IN MINNESOTA AND THE HISTORICAL OUTREACHES WE HAVE DONE AND SOME OF THE CURRENT THINGS WE HAVE GOING ON AS WELL. WILL THIS ADVANCE THE SLIDES OR IS THIS JUST ON THE... SO THE AWARENESS OF FASD IN MINNESOTA HAS MOVED THROUGH A NUMBER OF YEARS AND HAS A MULTIFACETED APPROACH SO WE HAVE HAD A LONG-STANDING ADOPTION PROGRAM IN MINNESOTA AS WELL AS THE FASD PROGRAM. WE HAVE HAD A STRONG ADVOCACY GROUP WITH MOFAS WHICH HAS DRIVEN A LOT OF THE CONNECTIONS BETWEEN US AND THE COUNTIES AND THE SCHOOL DISTRICT TO KEEP THE SCREENING MECHANISMS GOING. THAT COLLABORATION WAS REALLY REMARKABLE IN TERMS OF OUR IMPROVEMENT IN EDUCATIONAL OUTCOMES WHERE MOFAS WAS FUNDING WHERE A SOCIAL WORKER IDENTIFIED AS MOFAS SPECIFIC AND THEN WERE ABLE TO DO SOME INTERVENTIONS WITH EARLY CHILDHOOD SCREENERS. OUR PROGRAM HAS ABOUT 450 SLOTS FOR FASD AND IN ADDITION, WE HAVE ONGOING RESEARCH PROGRAMS WITH CPAS AND OTHER WORK THAT WE DO REGARDING PSYCHIATRY AND INTERNAL MEDICINE. WE HAVE DONE A LOT OF TRAINING IN SCHOOL DISTRICTS WITH FASD. THEY APPROACH US WITH FAS SPECIFIC MODIFICATIONS AND TRAININGS SPECIFICALLY AROUND THE PROFILE AND THOSE ARE SOME OF THE THINGS WE HAVE DONE. A LOT OF IT IS DRIVEN BY THE PROGRAM WHICH WAS FORMALLY THE INTERNATIONAL ADOPTION CLINIC AND I KIND OF ADVOCATED THAT THERE ARE SOME DIFFERENCES BUT NOT A LOT BETWEEN INTERNATIONAL AND DOMESTIC ADOPTION SO IT SHIFTED TO A MORE REGULAR ADOPTION PLAN. THEY HAVE A DIAGNOSTIC CLINIC WHERE THEY DO A FEW EVALS AS WELL, A SMALL NUMBER. AND WE HAVE A PROGRAM SIMILAR TO WHAT Dr. JONES WAS SPEAKING TO WITH THE COUNTY JUVENILE JUSTICE PROJECT. WE WORKED CLOSELY WITH THE JUVENILE JUSTICE OFFICERS WITH MOSTLY MALES BUT SOME FEMALES AS WELL IF THEY WERE PERMITTED INTO THE SYSTEM AND THERE WAS CONCERN AROUND ALCOHOLIC EXPOSURE, WE HELD SLOTS FOR THEM SO THEY WOULD GET TO US, DO AN EVALUATION, MOSTLY ADJUDICATION IN HOW COMFORTABLE WERE THEY, WHAT WAS THE APPROPRIATE CONSEQUENCE FOR WHAT THEY HAD DONE SO THAT WAS A BIG PART OF IT THAT BLENDED INTO IT. AND IN COLLABORATION, THE SOCIAL WORKERS ALONG THE PROBATION OFFICERS, WE HELD SPOTS IN OUR CLINIC EACH MONTH FOR THE HENNEPIN COUNT SEE SOCIAL WORKERS IN THE FASD PROGRAM IN HENNEPIN COUNTY WOULD GET CHILDREN THROUGH US FOR AN ASSESSMENT AND THEN RECOMMENDATIONS IN TERMS OF PROGRAMMING AND THINGS. SO THAT STILL IS ACTIVE. I HAD SHIFTED A LITTLE BIT AND I CAN SPEAK TO THAT IN A SECOND IN TERMS OF SOME OF THE MORE CURRENT THINGS BUT THAT PROGRAM HAS BEEN REVISITED NOW AND REALLY LOOKING AT WHERE FASD CAN BE LOOKED AT IN TERMS OF ALL THE INTERSECTIONS OF CHILDHOOD SCREENING, PROTECTION, PROBATION AND IN SCHOOL SO TRYING TO BE MORE BROAD BASED IN TERMS OF WHERE CAN YOU PICK OUT THE FASD CONCERNS WITHIN THE INTERSECTIONS THAT THE COUNTY SOCIAL WORKERS WOULD COME ACROSS. AND THEN MOFAS WORKED WITH AN EARLY LEARNING SCREENING PROCESS WHERE THERE WAS A QUESTION ASKED WAS THERE EXPOSURE TO ALCOHOL AND EVEN IF IT WAS NOT YES, AT LEAST GET IT IN THE RECORD AND WE COULD THEN REACT TO IT IF THEY WEREN'T MEETING CRITERIA FOR SERVICES THROUGHOUT THE SCHOOL DISTRICT. SO THAT IS A PROJECT THAT IS ONGOING AS WELL. WITHIN OUR CLINIC, 50 PERCENT OF THE REFERRALS THAT WE GET ARE FROM COUNTY SOCIAL WORKERS IS THEY REALLY -- IN MINNESOTA, THEY REALLY, I THINK, PAY ATTENTION TO THE FASD SIDE OF THINGS, MOSTLY BECAUSE OF EXPOSURE TO MOFAS. MOFAS DOES A LOT OF COUNT TOO -- COUNTY TRAININGS. THEY HAVE 80 OUT OF 100 SCREENINGS WHERE THEY ARE ASKING THE QUESTIONS AND HAVING FASD BE A CONSIDERATION WHEN THE FAMILIES ARE PRESENTING. ONE OF OUR PROBLEMS OR DIFFICULTIES IS JUST ASSESSMENT SLOTS. THERE JUST AREN'T ENOUGH OF THEM. SO TRYING TO THINK AROUND THAT IN TERMS OF IF THERE IS A PRENATAL EXPOSURE CONCERN, WHAT OTHER SERVICES CAN WE GET GOING WHILE THEY WAIT FOR EVALUATION OR FIND DIFFERENT WAYS TO END-RUN THE DIAGNOSTIC BOTTLENECK IN TERMS OF -- OUR PROGRAM HAS 450 OF 550 SLOTS IN MINNESOTA AND THAT WILL NOT COME ANYWHERE CLOSE TO HAVING THE NUMBER OF SPOTS FOR EVALUATIONS WITHIN AN FSE PROGRAM AND WE'RE WORKING PRETTY HARD. I DON'T KNOW THAT WE CAN REALLY UP THAT. THERE IS A LIMIT TO HOW MANY EVALS WE CAN DO EVEN IF WE JUST SHIFT IT TO -- IF WE HAD 1000, THAT DOESN'T -- WOULDN'T BE ENOUGH SO THAT IS THE BOTTLENECK. SO WE HAVE RURAL COUNTY SOCIAL WORKERS WHO SEND KIDS TO US. OUR FEEDBACKS OFTEN INVOLVE THE COUNTY SOCIAL WORKERS SO WE GIVE FEEDBACK, FAMILIES GET UP AND DOWN, OFTENTIMES TRANSPORTED BY SOCIAL WORKERS FROM THE COUNTY AND THEN WE WILL DO A TELEMEDICINE FEEDBACK TO TALK ABOUT WHAT RECOMMENDATIONS WE WOULD LIKE THE FAMILY TO HAVE. SO THAT IS THE COUNTY SOCIAL WORKERS WHO ARE REALLY PRESENT WITHIN THE REFERRAL BASE FOR OUR CLINIC. THEY DRIVE A LOT OF THE REFERRALS AND MOFAS IS WORKING ON HOW DO WE COORDINATE WITH THE COUNTY SPECIFICALLY TO GET THOSE QUESTIONS ASKED AND REALLY MAKE IT MORE OF A FORMAL SCREENING PROGRAM. SO I THINK BETWEEN THE TRAININGS THAT MOFAS DOES, I THINK THAT IS WHERE THE COUNTIES GET A LOT OF THEIR EXPOSURE TO WHY IT IS IMPORTANT TO NEED TO ASK THAT QUESTION AND MOFAS HAS DONE A LOT OF WORK ON PROVIDING GUIDANCE ON HOW YOU ASK THE QUESTION, BOTH WITH THE SCHOOLS AND THE COUNTIES. THAT IS A HARD QUESTION TO ASK AND A HARD QUESTION TO KNOW WHAT TO DO WITH IT SO DOING SOME SPECIFIC TRAINING ON HOW DO YOU INTERVIEW AROUND THAT AND ASK THAT QUESTION, I THINK THAT IS REALLY IMPORTANT TOO, WHERE THE SOCIAL WORKERS ARE MUCH MORE COMFORTABLE ASKING THAT QUESTION AND STILL MAINTAINING RELATIONSHIPS WITH THE FAMILIES. AND IN MINNESOTA, WE'RE PRETTY FORTUNATE IN TERMS OF FORWARD THINKING AROUND FASD AS WELL. FROM THE MINNESOTA DEPARTMENT OF HEALTH, FASD IS LISTED AMONG METABOLIC DISORDERS, NEWBORN SCREENING PROGRAMS AS A CATEGORY FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH NEEDS SO THAT CAN OPEN UP A DOOR FOR SERVICES TO FAMILIES SO IT IS SPECIFICALLY LISTED ON THAT ALONG WITH CF AND THE METABOLIC DISORDER SO I THINK THAT IS AN IMPORTANT PIECE. THERE WAS A BILL BEFORE THE LEGISLATURE AROUND GETTING FASD CATEGORIZED AS A BRAIN INJURY TO JASMINE'S POINT IN TERMS OF WHAT QUALIFIES THE TBI AND THE STATE WAS PRETTY FIRM ON IT AS AFTER BIRTH AND REQUIRED MORE OF A TRADITIONAL DECOMPRESSION OR THEY WEREN'T REALLY GOING WITH THE IDEA OF AN ACQUIRED BRAIN INJURY WITHOUT AN INJURY SO THEY WERE HESITANT TO OPEN UP THE DOOR TO THE TBI SYSTEM. SO IT DID NOT QUALIFY AS A TBI SO WE WILL SEE HOW THAT GOES. IN THE SCHOOL SYSTEMS, WE HAVE WORKED HARD TO GET THE TBI COORDINATORS INVOLVED. IN MINNESOTA, EACH SCHOOL DISTRICT HAS A TBI SPECIALIST AND IF YOU THINK ABOUT THE CLASSROOM INTERVENTIONS FROM A TBI PERSPECTIVE, THAT GETS YOU CLOSER THAN AN EBD OR BEHAVIORAL PIECE SO EVEN THOUGH IT IS NOT CATEGORIZED AS A TBI, IF THE SCHOOL DISTRICT IS WILLING TO BE CREATIVE, YOU CAN DRAW ON THAT TBI COORDINATOR AND GET A LOT OF IDEAS ON HOW DO YOU FOLLOW THAT ON A COORDINATE REHAB EFFORT FOR THE DISORDER AND THAT IS BEEN HELPFUL. IN 2017, GO NEWLY LICENSED FOSTER PARENTS, IT WAS MANDATE THEY RECEIVE AT LEAST ONE HOUR OF TRAINING FOR CHILDREN WITH FASD SPECIFICALLY SO THAT OPENS UP MORE AWARENESS WITH THE SOCIAL WORKERS AND KIND OF THAT BACKDOOR APPROACH SO IF WE TRAIN THE FOSTER PARENTS, THEN THEY WILL ASK THE COUNTY SOCIAL WORKERS FOR SOME OF THOSE THINGS AND THAT IS KIND OF BACK FILLING IN A WAY AND THAT WAS AN IMPORTANT THING FOR THE STATE OF MINNESOTA. THE KIDS IN FOSTER CARE, FASD IS TEN TIMES HIGHER THAN THE GENERAL POPULATION SO IT IS A BIG COMPONENT. AND HOW TO GET THE RECOGNITION OUT THERE, DIFFERENT MODALITIES TO GET PEOPLE THINKING ABOUT IT, A LOT OF THAT DRIVEN BY US. IF YOU DON'T HAVE A STATE ORGANIZATION DRIVING THAT WITH ADVOCACY, I THINK IT WOULD BE REALLY HARD. NOBODY WOULD HAVE PRESENTED THAT BILL TO THE STATE IF MOFAS WASN'T PRESSING IT SO I THINK WE'RE PRETTY FORTUNATE IN TERMS OF PROOF ALLIANCE, MOFAS, WHO JUST CHANGED THEIR NAME LAST YEAR IS WE'RE GETTING PRETTY USED TO PROOF ALLIANCE. WELL, I JUST SAID THAT. BUT IN TERMS OF RECOGNITION, THE SCREENING SIDE OF THINGS, TO GET THE COUNTY WORKERS, EVEN IF NOT AT EARL CHILDHOOD, WHEN KIDS PRESENT TO SOCIAL SERVICES, TO GET THE SOCIAL WORKERS TO BE THINKING IS THIS AN INTENTIONAL ISSUE, IS IT OPPOSITIONAL BEHAVIORAL ISSUE, CAN IT BE CONSIDERED TO BE AN FASD COMPONENT? BECAUSE THERE IS A LOT OF CROSSOVER BECAUSE THESE KIDS HAVE NEGLECT, INCONSISTENT PARENTING, ALL OF THESE THINGS THAT COME INTO PLAY BUT TO GET PEOPLE TO THINK ABOUT IT AS AN FASD-DRIVEN COMPONENT I THINK IS REALLY IMPORTANT. HAVING PROBATION AND JUVENILE JUSTICE AND THE CPS WORKERS CROSSING OVER BETWEEN THERE WITH THE MORE TRADITIONAL CHILDREN'S MENTAL HEALTH SOCIAL WORKERS IS REALLY IMPORTANT ESPECIALLY IN HENNEPIN COUNTY WHICH IS THE SECOND BIGGEST COUNTY IN MINNEAPOLIS AND THE ONE THAT WE KIND OF BRANCH OUT FROM. BUT THERE ARE SOME DIFFERENCES BETWEEN THE MET RO AND RURAL, YOU HAVE THE TWO SOCIAL WORKERS AND THE COUNTY WORKERS AND SO IT DOESN'T TAKE MUCH TO GET THAT TO SPREAD OUT WITH PEOPLE TRYING TO BE CREATIVE WITH PROGRAMMING SO IT SEEDS A LOT AND CAN REALLY MOVE OUT FROM THERE. THE OUTREACH TRAININGS THAT HAVE BEEN DONE HAVE BEEN REALLY IMPORTANT ALSO. I THINK WHAT WE HAVE FOUND, CENTERING AROUND THE STATES DOING THE COUNTY TRAININGS, YOU GET ONE COUNTY LOOKING FOR A DIFFERENT CONTINUING EDUCATION PIECE, YOU TALK TO ONE COUNTY AND SAY WHAT DID YOU DO AND THEY SAID OH, WE DID THIS FASD THING AND THEN TRANSFERRED TO THE COUNTY SO IT IS BRANCHING OUT BY WORD OF MOUTH, TOO. FOR THIS POPULATION, OFTENTIMES FAMILIES ARE MOST COMFORTABLE WITH THE SCHOOL DISTRICT OR SCHOOL PEOPLE SO THEIR COUNTY SOCIAL WORKER, DEPENDING ON THE WORKER, CAN BUILD THOSE RELATIONSHIPS BUT HAVING THE SCHOOLS INVOLVED CAN REALLY MAKE IT MORE COMFORTABLE FOR THE FAMILIES TO RECEIVE SOME LEVEL OF SERVICES IF WE HAVE CLOSE RELATIONSHIPS WITH THE SCHOOL, THE EDUCATIONAL SPECIALISTS, THEY CAN TALK TO THE SCHOOL AND SAY MAYBE THIS IS SOMETHING YOU NEED TO BRING UP WITH YOUR SOCIAL WORKER AND THE CAN BE INVOLVED WITH TRUANCY OR BEHAVIORAL ISSUES SO I THINK THOSE SYSTEMIC QUESTIONS OR ISSUES CAN BE POSED AND WORK AROUND THAT WAY. SO CLOSING THE LOOP IS REALLY IMPORTANT IN TERMS OF THE COUNTY SOCIAL WORKERS. IF A QUESTION IS POSED TO THEM, IF THEY CAN CALL US OR WE HAVE INFORMATION WITH THE SCHOOLS WHERE THE SCHOOL CAN TALK TO THE COUNTY SOCIAL WORKER THAT HEY, MAYBE YOU CAN THINK OF IT IN TERMS OF THIS WAY, CAN YOU GET A TBI WAIVER, MAYBE NOT BUT THERE ARE SOCIAL SERVICES THAT YOU CAN GET FOR OTHER THINGS AND SO WE TRY TO CLOSE THAT LOOP. A LOT OF THIS IS SEEDING, I THINK. WE'RE PRETTY FORTUNATE TO HAVE MOFAS AS AN ADVOCACY GROUP AND THEY ARE WORKING TO -- I THINK THIS PROJECT IN HENNEPIN COUNTY IN TERMS OF ALL THE DIFFERENT INTERSECTIONS WHERE FASD CAN BE THERE IN TERMS OF PROBATION, EARLY CHILDHOOD, CPS AND REALLY PAY ATTENTION TO WHERE CAN THEY START TO SEE FASD FOR COMPLEX KIDS AND FAMILIES AND I THINK THAT WILL BE THE EYE OPENER, TOO. THAT HAS BEEN GOING ON 18 MONTHS TO 2 YEARS AND JUST NOW THEY ARE STARTING TO THINK HOW CAN THEY QUANTIFY THAT A LITTLE MORE AND MAKE IT MORE PROGRAMMATIC. HENNEPIN COUNTY HAS BEEN PRETTY GOOD WITH THEIR JUVENILE JUSTICE PROGRAMS AND THEN THE ONE THAT WAS OUTSIDE THE NORTHRUP-GRUMMAN PROGRAM WITH STREAMLINING SERVICES SO HENNEPIN COUNTY IS STARTING TO SEE BENEFITS OF THAT. ONE OF THE BOARD MEMBERS FOR MOFAS IS THE SENIOR ASSISTANT ATTORNEY SO THAT HELPS WITH THAT. SO THE QUESTIONS, SHE WAS NOT INVOLVED WITH MOFAS BUT GOT INVOLVED WITH MOFAS AFTER WE GOT TO THE DISTRICT ATTORNEY AND THINGS. SO AGAIN, IT IS HOW YOU NEGOTIATE THE LOOP TO GET THESE THINGS GOING AND HAVE CONNECTION WITH THE JUVENILE JUSTICE PROGRAM. SO THAT IS WHERE WE ARE AT WITH MINNESOTA WITH TRYING TO GET MORE SCREENINGS DONE AND THINKING OF THE THINGS DIFFERENT FOR THE SYSTEMS INVOLVED WITH THE FAMILY. SO I CAN TAKE QUESTIONS NOW OR SIT DOWN AND WAIT FOR QUESTIONS. >> AND YOU HAVE A NATIVE AMERICAN POPULATION YOU SERVE? >> YES, I DON'T KNOW THE NUMBERS BUT WE HAVE A VERY SIGNIFICANT POPULATION OF NATIVE AMERICAN FAMILIES WHO COME TO OUR CLINICS SPECIFICALLY. WE WORK PRETTY CLOSELY WITH A COUPLE OF SPECIFIC TRIBAL GOVERNMENTS IN TERMS OF WADER, RED LAKE, TAKSU AND THEY HAVE QUESTIONS THERE AND TEND TO TRUST US. I KNOW THERE IS ALWAYS AN ISSUE EVEN WITH A UNIVERSITY PROGRAM GOING INTO THE COMMUNITY AND TRYING TO BUILD THE TRUST. >> ARE YOU FINDING THAT THE INDENTS OF FASD ARE HIGHER IN THAT POPULATION THAN GENERAL? >> I HAVE A HARD TIME ANSWERING THAT BECAUSE MY LENS IS ONE THAT I MADE AND IT SPANS ACROSS A LOT -- YOU KNOW, IN THE SUBURBAN AFFLUENT COMMUNITIES, IT IS THERE, TOO SO I DON'T KNOW. WE DON'T SEE THE WHOLE COMMUNITY SO EVERYONE WHO PRESENTS TO ME HAS AN FAS CONCERN SO IT IS REALLY HARD TO ANSWER THAT. THE THOUGHT IS IT IS MORE GENERALLY, WE THINK IT IS BUT YOU KNOW TRYING TO GET MORE SERVICES GOING -- >> OR THERE ARE MORE BEHAVIORAL ISSUES IN THE ALCOHOL WITH THE WOMEN AND SO FORTH -- >> WHAT I ALSO KNOW IS IF YOU MAKE IT LEVELS OF SDS VERSUS ETHNICITY, I HAVE A HUNCH THAT, YOU KNOW, SES, REGARDLESS OF THIS ETHNICITY IN TERMS OF FAMILY STRESSORS AND MENTAL HEALTH AND CHEMICAL DEPENDENCY, THAT IS IMPORTANT ALSO BUT THEN I THINK TRYING TO GET THOSE CONNECTIONS IN TO THE NATIVE AMERICAN COMMUNITIES, IT IS HARDER. THERE IS A GROUP OF GRANDPARENTS OF NATIVE AMERICANS AND APPARENTLY THE WORD IS -- [INDISCERNIBLE] -- [LAUGHTER] -- AND I AM LIKE REALLY, THAT IS WEIRD THAT THEY TRUST YOU BUT -- >> I HAVE -- [INDISCERNIBLE] -- TWO CONTRACTS AND THE INCIDENT DENTS OF SUICIDE AMONG NATIVE YOUTH, MANY OF THEM HAVE F IT -- FAX OR F ITASB AND I DON'T KNOW HOW TO GET AT IT, IF NATIVE WOMEN DRINK MORE OR NOT BECAUSE THERE IS NO REAL -- >> THAT IS MY SENSE, TOO. I THINK PEOPLE WOULD ASSUME -- I HAD A FUNNY COMMENT FROM A DAD IN MY CLINIC WASN'T IN THE FASD PROGRAM BUT HE TALKED ABOUT WHEN HE WAS DOING HIS ROUTE THERE WERE JUST AS MANY ALCOHOL BOTTLES IN THE RECYCLING BINS IN AFFLUENT NEIGHBORHOODS THAN ON THE RES SO IT SPANS ALL OVER. >> I KNOW IT VARIOUS -- >> THAT IS THE HARDEST PART. >> WE HAVE OTHER QUESTIONS FROM THE AUDIENCE. >> YOU MENTIONED TRAINING FOR -- >> SORRY, COULD YOU IDENTIFIED YOURSELF SO EVERYONE KNOWS WHO YOU ARE? >> SORRY, ALISON MISSION, WORKING ON BEHALF OF MY COLLEAGUES WHO DO RESEARCH IN PRENATAL ALCOHOL EXPOSURE AND THINKING ABOUT IT IN THE CHILD WELFARE SYSTEM. SO THE FOSTER PARENTS JUMPED INTO MY HEAD AND YOU MENTIONED IT ON THE PARENTING SIDE BUT WHAT TO LOOK FOR A ASSUMING THEY ARE NOT ALL GETTING THE DIAGNOSIS IN THE CASE FILE. DOES IT INCLUDE THOSE PIECES AS WELL? >> SO I HAVEN'T SEEN THE WHOLE TRAINING PROTOCOL IN TERMS OF THE CURRICULUM THEY ARE USING BUT IT IS BOTH BEHAVIORAL MASS STRATEGIES FOR KIDS THAT HAVE FASD AND THEN WHAT THE BEHAVIORS REPRESENT AND I THINK IT IS GOOD TRAINING FOR FOSTER PARENTS BECAUSE THERE IS A CROSSOVER OF A LOT OF STRATEGIES THAT IS NEEDED BY THESE KIDS AND OTHERS WHO MAY NOT HAVE THE DIAGNOSIS. SO THIS IS A GOOD APPROACH FOR THESE KIDS IF YOU ARE THINKING CLASSIC PRESENTATION AND THEN IF YOU HAVE THIS PRESENTATION, THESE ARE THE STRATEGIES WE USE REGARDLESS. >> IT IS INTERESTING TO THINK ABOUT IT AS THAT BACK DOOR INTO THE SCREENING, RIGHT, AND THEN THEY CAN REQUEST IT WHICH COMES AT IT FROM A DIFFERENT ANGLE -- >> TO ME THAT IS UNIMPORTANT, KIND OF THE UNINTENDED BENEFITS WAS THAT, IN TERMS OF IT GOT THE FOSTER FAMILIES THINKING I HAVE BEEN DOING THIS 20 YEARS AND I HAVE A LONG LIST OF KIDS THAT HAVE COME THROUGH MY HOME THAT WILL SHOULD HAVE BEEN CONSIDERED FOR THIS. >> GREAT, THANK YOU. >> I WANTED TO RESPOND SPECIFICALLY TO THE FOSTER CARE QUESTION AND THANK YOU FOR YOUR TALK. I AM YASMIN SENTRIYAS FROM -- [INDISCERNIBLE] I WANT TO KNOW IF IT IS REALLY STRONG AND HELP CAN BE GIVEN TO FOSTER CARE FAMILIES IT, THERE WILL BE A LOT OF PROGRAMS TO PROMOTE THAT IN PRIMARY CARE. SAY WE HAD FOSTER CARE COMMUNITY CAPTIVE FOR THIS, THERE IS GOING TO BE A WHOLE LOT MORE THAN THE 20 PERCENT I THINK THAT WE THINK -- >> YEAH. >> AND I KNOW FOR SURE THAT SOME OF THE PEOPLE WHO HAVE ADVERTISED ABOUT OUR CLINIC ARE FOSTER CARE FAMILIES AND THEY ARE OUT THERE PROMOTING. >> THERE IS A SECOND PART OF THAT LAW SO IT IS ALL NEWLY LICENSED FOSTER PARENTS HAVE TO HAVE THAT ONE-HOUR TRAINING. THE LAW ALSO MANDATED THAT FAS HAD TO BE AN OPTION FOR THE CONTINUING TRAINING SO IT HAD TO BE PUT ON THE LIST OF OPTIONS SO SUBSEQUENTLY THEN IT, THEY DON'T NEED TO CHOOSE IT BUT IT DIDN'T USED TO BE ON THE LIST OF POTENTIAL TRAININGS AS FOSTER PARENTS DO THEIR RESEARCH AND THINGS LIKE THAT. SO IT MANDATED FOR NEWLY LICENSED AND THEN OPTIONS FOR FOSTER PARENTS WHO HAD BEEN PARENTS LONGER. >> IN MINNESOTA, DO YOU HAVE CLASSES IN THE SOCIAL WORK AT UNIVERSITIES ABOUT FASD SO THAT THEY BECOME AWARE AS SOCIAL WORK STUDENTS? >> I DON'T BELIEVE SO. I GUESS I AM NOT WELL VERSED AGAIN ON THE TRAINING PROGRAM OF THE SOCIAL WORK PROGRAM. THEY HAVEN'T APPROACHED US AS ALL. I DON'T DO ANY OF THOSE TRAININGS AND ESSENTIALLY FASD AT THE UNIVERSITY RUNS ATLANTA OUR PROGRAM BUT I DON'T THINK THEY WOULD BE DOING IT IF WE DIDN'T -- >> NO, BUT YOUR DATA IS AMAZING AND THAT IS ANOTHER PLACE TO INTRODUCE THE SUBJECT. >> YEAH. >> AND THE OTHER THING IS I HAD HEARD ABOUT YOUR FOSTER PARENT TRAINING AND IN THE STATE OF MARYLAND, IN ORDER TO BE A LICENSED CHILDCARE PROVIDER, PEOPLE ARE REQUIRED TO TAKE TRAININGS FOR SPECIAL NEEDS CHILDREN AND OF COURSE FASD IS ONE OF THEM AND THIS WOULD BE A GREAT TRAINING. DO YOU HAVE A SIMILAR PROGRAM IN MINNESOTA BECAUSE WE ALSO NEED CHILDCARE -- >> YEAH, AND AGAIN, I AM NOT REALLY WELL VERSED ON TRAININGS FOR DAYCARE AND EARLY CHILD PROVIDERS. HAVING IT ON THE DEPARTMENT OF HEALTH LIST AS A DIAGNOSES THAT FALLS UNDER CHILDREN AND YOUTH WITH SPECIAL HEALTH NEEDS, I THINK THAT PROBABLY HELPS KEEP IT, YOU KNOW, ON THE RADAR SCREEN FOR THE EARLY EARLY CHILDHOOD PROVIDERS WOULD BE MY GUESS. [QUESTION OFF MIC ] >> I DO IT, YEAH. SO WE CATCH IT -- I DO ONE IN PSYCHIATRY FOR THE PSYCHIATRY RESIDENTS AND FELLOWS AND THEN NOT EVERY YEAR BUT MOST YEARS I WILL DO IT AT A COUPLE DIFFERENT LEVELS WITHIN. SO WE'RE -- WE DO IT KIND OF BY MORE OF TRAINING PROGRAMS HONESTLY SO INTERNAL MEDICINE WILL CALL ME AND -- [ QUESTION OFF MIC ] >> NOT THE FIRST AND SECOND YEARS, CORRECT, IT IS MORE AT THE RESIDENCY LEVEL THAT I GET INVOLVED -- NO, NO. MARY JOE SPENCER, HER DAUGHTER IS IN MEDICAL SCHOOL AND AS IS THE BOARD MEMBER WHO IS THE ASSISTANT DISTRICT ATTORNEY, BOTH OF THEIR KIDS ARE IN MED SCHOOL AT UOM AND THEY DID TALK ABOUT THAT IT WAS MENTIONED, DISCUSSED SOMEWHERE WITHIN THEIR ACTUALLY MEDICAL SCHOOL TRAINING WHEN THEY WERE 1ST OR 2ND YEAR MED STUDENTS. WE DIDN'T TOUCH WHERE THAT CAME IN BUT BOTH OF THOSE NEW MED STUDENTS, THEY TALKED TO THEIR PARENTS THAT PEOPLE AT LEAST DISCUSSED IT IN ONE OF THEIR LECTURES. SO MAYBE NOT ALL THE FAS RULES WITHIN THE MEDICAL SCHOOL BUT -- >> DO WE HAVE TIME TO TALK ABOUT THINGS OR -- >> SO WE'RE MOVING INTO THE OPEN DISCUSSION PERIOD SO I WAS GOING TO SAY IF THERE ARE OTHER QUESTIONS SPECIFICALLY FOR Dr. BOYS, BUT THIS IS MEANT TO BE THE OPEN DISCUSSION FOR THE ENTIRE PANEL. >> I DO HAVE ONE QUICK QUESTION, PLEASE, JUST IN THE COMMUNITY, THE PARENTS OF WELFARE WHOSE CHILDREN HAVE IT AND MIGHT THEMSELVES HAVE IT -- >> YEAH, I THINK IT CERTAINLY IS -- THERE'S A CYCLE THERE OF, YOU KNOW, DEPENDENCY AND I DON'T KNOW THAT WE REALLY -- WE DON'T ASK SPECIFICALLY IN TERMS OF HAS THE PARENT EVER BEEN DIAGNOSED WITH FASD? MY SENSE IS THAT, YOU KNOW, IF THE CYCLE HAS NOT BEEN BROKEN BY A KID BEING REMOVED FROM THAT FAMILY, WHEN WE ARE WORKING WITH BIOLOGICAL PARENTS, CERTAINLY THAT IS SOMETHING THAT COMES UP. WE HAVE A LOT OF GENERATIONAL FAMILIES IN OUR PROGRAM. SO I AM 15 YEARS INTO MY POST-TRAINING CAREER. I TOOK MY POST-DOC POSITION IN 2004 AND I NOW HAVE KIDS OF KIDS, KIDS I SAW AS TEENAGERS AND NOW THEY ARE BRINGING THEIR CHILD IN OR GRANDPARENTS WHO ARE BRINGING THEIR GRANDKIDS IN. SO IT IS NOT UNUSUAL A. I KNOW A GREAT MANY OF FAMILY MEMBERS NOW IN PODS SO TO SAY. >> I ASK FOR SPECIFICS IN CERTIFICATE OCCASION AND WHY THE CONCERN WAS I CAN SEE CHILDREN GO THROUGH SYSTEM AND THEY MAY NOT RECEIVE SERVICES BUT I ALSO CAN SEE HOW THE CHILD WELFARE SYSTEM AND JUSTICE IN SITUATIONS WHERE PARENTS -- [INDISCERNIBLE] -- AND THESE PARENTS WHO CANNOT MAINTAIN A PLAN, GO ONE YEAR AFTER ANOTHER REAL INCONSISTENT ASK THEY TRY AND THEN THIS IS WHY THE PARENTAL RIGHTS ARE TERMINATED. BUT THEN THEY STILL CANNOT MAKE IT AND SUFFER BOTH SIDES SO JUST WANTED TO SAY THERE IS SOME WAY TO THINK ABOUT THIS ASPECT. >> I THINK ONE OF THE THINGS WE HAVE RUN INTO ON THE CHILD PROTECTION SIDE OF THINGS IS WE HAVE HAD REALLY GOOD LUCK HAVING CPS WORKERS BE PROACTIVE IN TERMS OF WE WILL CONTACT CPS OR THEY WILL BE INVOLVED AND WE WILL TALK TO THEM AND SAY THIS IS AN A CHRONIC DISEASE FOR THE PARENTS, THEY HAVE CHEMICAL DEPENDENCY ISSUES, THEY ARE TRYING HARD AND USE THAT AS A WAY TO GET A SAFETY NET FOR THE FAMILY. EARLIER IN MY CAREER, IT SEEMED LIKE CPS WOULD TAKE THE KID AND BE FAIRLY PUNITIVE WHERE WE HAVE HAD MORE CONVERSATIONS OF LISTEN, THIS IS A WELL-INTENTIONED PARENT WHO DOESN'T HAVE THE RIGHT SOURCES AND CAN WE THINK ABOUT CPS CARRYING THAT INTO THE KIDS IN THE SERVICE. BEING COMFORTABLE HAVING THAT CONVERSATION WITH CHILD PROTECTION NOT SAYING THERE ISN'T AN ISSUE HERE, JUST SAYING IT MAY NOT BE NEGLECT, IT COULD BE THAT THIS PARENT IS STRUGGLING WITH THIS AND LET'S GET THAT SERVICE AS WELL AND THEN MAYBE IT WILL BE A SHORTER OUT-OF-HOME PLACEMENT AND THEN HE CAN REDEFINE IT. SO WE HAVE HAD GOOD LUCK WITH COMMUNICATION THAT WAY AND SOMETIMES IT JUST HAS TO BE A REMOVAL AND THAT HAPPENS BUT SOMETIMES THERE IS SOMETHING IN BETWEEN. >> I JUST WANTED TO SAY THAT THERE IS A MAJOR SHIFT GOING ON RIGHT NOW AT THE CHILDREN'S BUREAU AND OUR LEADERSHIP IS FOCUSING ON TRYING TO KEEP THE CHILDREN SAFELY IN THEIR HOMES AND PROVIDING WHATEVER SERVICES ARE NEEDED TO BE ABLE TO ACCOMPLISH THAT, WHETHER THEY NEED COUNSELING OR IF THEY NEED HOUSING OR FOOD OR WHATEVER IT IS, TO FIND WAYS TO KEEP CHILDREN SAFELY IN THEIR HOMES RATHER THAN PUTTING THEM IN FOSTER CARE. AND THE OTHER THING I KEEP THINKING ABOUT THIS WHOLE DAY IS THAT WHEN I LOOK AT THE DATA FROM THE CHILDREN'S BUREAU, NOW, WE DO A SURVEY, A FOLLOW UP SURVEY OF THE YOUTH WHO LEAVE FOSTER CARE AND YOU FIND, YOU KNOW, IT IS OUT OF WAC IN COMPARISON TO THE GENERAL POPULATION. MORE OF THEM ARE UNEMPLOYED, MORE OF THEM HAVE DRUG OR ALCOHOL PROBLEMS, MORE OF THEM IN JAIL, MORE OF THEM -- YOU KNOW, ALL THESE KINDS OF THINGS AND I AM LOOKING AT THEM AND SAYING OH, MY GOD, THEY LOOK LIKE FASD KIDS. AND SO THAT -- I MEAN, WE DON'T REALLY KNOW FOR SURE WHAT THE NUMBERS ARE. SOMEBODY DID AN INTERNATIONAL STUDY AND CAME UP WITH THE NUMBER OF 16.9 PERCENT OF THE CHILDREN IN OUT-OF-HOME CARE WORLDWIDE HAD AN F.M. ASD. SO WE DON'T REALLY HAVE SOMEBODY WHO HAS DONE A SOLID STUDY LIKE IN ONE PARTICULAR PLACE AND WE KNOW THERE ARE CERTAIN PROBLEMS WITH GOING ALL OVER THE PLACE AND GRABBING DATA BUT THAT IS WHAT THEY FOUND AND I HAVE TALKED PERSONALLY WITH SOCIAL WORKERS WHO THINK THAT IS A GROSS UNDERESTIMATE. AND IF YOU LOOK AT HOW MANY -- I COULD DO AN ANALYSIS OF HOW MANY OR THE PORTION OF KIDS FOR WHOM ALCOHOL OR OTHER DRUGS WAS A FACTOR, THERE IS AN ITEM IN THE FCARS, ADOPTION AND FOSTER CARE REPORTING SYSTEM WHERE THE STATES SEND US THEIR DATA AND THERE IS AN ITEM IN THERE ON THE CIRCUMSTANCE SURROUNDING REMOVAL WHICH MOST STATES TAKE TO MEAN WHY DID YOU REMOVE THIS CHILD FROM THE HOME. IT IS NOT REALLY WHAT IT MEANS AND YOU CAN CHECK MORE THAN ONE BUT IT IS REALLY HUGE WHERE THE NUMBER THAT THEY CHECK OFF ALCOHOL AND OTHER DRUGS. IT IS REALLY HUGE. AND SO THEN YOU WANT TO PAIR THAT UP WITH THE FACT THAT A VERY LARGE NUMBER OF KIDS THAT ARE COMING INTO FOSTER CARE ARE AGE 1 OR YOUNGER SO IT SEEMS LIKE THIS IS JUST A LOGIC PROCESS AND IT IS HIGHLY LIKELY THAT A LOT OF THEM WERE PRENATALLY EXPOSED. >> THIS IS A GREAT DISCUSSION AND I WANT TO MAKE CLEAR TO FOLKS THAT WE WOULD LIKE TO DISCUSS THE ENTIRE PANEL INCLUDING Dr. BOYS. I KNOW Dr. JONES HAD ADDITIONAL COMMENTS AND THEN I KNOW THERE IS ONE IN THE AUDIENCE... >> I JUST WAS STRUCK WHEN YOU WERE TALKING ABOUT CPS, HAVE YOU ALL DONE ANY TRAININGS OR ANY WORK WITH A PERSON WITH FAS WHO HAVE CHILDREN BECAUSE THERE ARE A LOT OF CHILDREN BORN WITH FASD WHO THEN HAVE CHILDREN AND THEIR CHILDREN MAY NOT HAVE THE FETAL ALCOHOL SECRETARY TRUM DISORDER BUT THE PARENT OBVIOUSLY IF THEY HAVE NOT HAD DIAGNOSES OR INTERVENTION IS AT RISK FOR HAVING A CHILD TAKEN AWAY AND OBVIOUSLY THE KIND OF HELPS AND SUPPORT THAT YOU WANT TO GIVE FOSTER FAMILIES WITH CHILDREN WITH FASD. IS THAT ON YOUR RADAR? >> I WOULD SAY OFFICIALLY WE HAVEN'T LOOKED AT THAT AT ALL. JUST FROM AN ANECDOTAL CLINIC PERSPECTIVE, IT CERTAINLY COMES INTO PLAY IN TERMS OF CONSIDERING -- WE TRY TO MAKE EVALUATIONS OF THE PARENTS AS WELL SO IT IS MORE OF A FAMILY ASSESSMENT SO TRYING TO MAKE SURE THAT -- IF A FAMILY PRESENTS TO US AND WE CAN IDENTIFY A CHEMICAL DEPENDENCY ISSUE, WHETHER THE CHILD HAS FASD OR NOT, WE TRY TO GET THE FAMILY SERVICES TO SUPPORT THAT. WHEN THEY FIND US, THERE IS SOME PROCESS LAIN AS THEY DON'T FIND US ON THEIR OWN. YOU WILL PRESENT TO A CLINIC BECAUSE SOMEONE SHEPHERDS YOU THERE BUT NOT LIKELY TO PRESENT ON THEIR OWN. AND NOT SURE HOW WE -- OTHER THAN COUNCILMEMBER PROGRAMS, -- THE CHEM PROGRAMS, START TO TRAIN THE CHEMICAL DEPENDENCY COUNSELORS ON THAT TYPE OF PROGRAM. A LOT OF ASPECTS TO IT AND THINGS TO COVER. >> I THINK MAYBE SIX, FOUR YEARS AGO -- DAN TALKED ABOUT A SCREENING TOOL IN CLINICAL SETTINGS FOR WOMEN WHO WERE IN THERE FOR SUBSTANCE ABUSE WENT DEEPER TO FIND OUT WHETHER OR NOT THAT INDIVIDUAL ALSO HAD AN FAS OR FASD WHICH SPEAKS TO WHAT YOU ARE TALKING ABOUT, THAT THE PARENT OF THE CHILD THAT IS IN THE JUVENILE SYSTEM BEING TREATED ISN'T ABLE TO TAKE CARE OF THAT CHILD BUT IT WAS NEVER CAUGHT THAT PARENT HAD AN FASD AND I DON'T KNOW IF -- I KNOW IT WAS USED AROUND BUT WE HAD IT IN A SENSE AND TRYING TO PROMOTE IT AND TALK ABOUT IT WITH REGARD TO THE PROGRAM. >> I THINK THIS TOOL IS INVOLVED IN EVERY STATE. I DON'T KNOW WHAT HAPPENS TO THIS BUT THE IDEA WAS JUST TO CONDUCT SCREENING OF INDIVIDUALS WITH FAS AND NOT NECESSARILY WOMEN, MEN AND WOMEN IN SUBSTANCE ABUSE TREATMENT PROGRAMS TO IDENTIFY PEOPLE, AND ONE OF THE PROFESSIONALS VERY ACTIVE IN SOCIAL WORK AND FAS AND IN WASHINGTON STATE, COMES WITH SPECIFIC RECOMMENDATIONS ON HOW EXPANSE ABUSE CAN BE MODIFIED TO BETTER MEET THE NEEDS OF PEOPLE WITH FETAL ALCOHOL SPECTRUM DISORDERS SO IT IS NOT JUST THE SUBSTANCE USE BUT CHILDREN WITH FASD WHO KNOW THEY ARE WORSE COMPARED TO OTHER CHILDREN AND HAVE THIS EXPECTATION. THEY MAY NOT HAVE PROBLEMS THEMSELVES BUT WITH THE RECOMMENDATION OF LOOKING AT THE -- [INDISCERNIBLE] WHICH DOESN'T ALLOW THEM TO GO THE SAME WAY THROUGH A CHILD WELFARE SYSTEM WHERE THEY CANNOT MAKE RECOMMENDATIONS FOR WHICH THEY CAN'T UNDERSTAND. >> I THINK HIS CONCERN WAS THE TREATMENT WOULD NOT BE SUCCESSFUL UNLESS IT WAS MODIFIED BECAUSE THE PERSON DIDN'T HAVE FAS OR FASD. >> I JUST WANTED TO MAKE A COMMENT SO I WILL TRY TO BE QUICK. FIRST OF ALL, I WAS VERY HAPPY TO HEAR INFORMATION ABOUT EDUCATION INCLUDING THE DEPARTMENT OF EDUCATION, INCLUDING FASD AS PART OF OTHER HEALTH IMPAIRED THAT THE INTENT WAS THAT IN FACT PEOPLE WHO WERE ON THE -- I WAS THE EDUCATION PERSON ON THE CBC TASK FORCE RELATED TO EDUCATION AND THE LAW THAT WAS PUBLISHED IN 2004 AND IN FACT, WE REALLY DID GET THIS KIND OF HIDDEN IN SOME LETTERS AND THE INTERPRETATION AND THAT INTERPRETATION DIDN'T, YOU KNOW, BECOME PUBLIC IN A WAY THAT MOST PEOPLE COULD READ IT OR ACCESS IT. SO THAT IS A REALLY IMPORTANT THING NOW THAT THAT INFORMATION HAS BEEN DUG OUT BECAUSE THE INTENT WAS ALWAYS THAT FASD BE CONSIDERED PART OF OHI UNLESS THERE WAS ANOTHER CATEGORY THAT THE CHILD WAS -- YOU KNOW, SHOULD HAVE BASED ON THEIR NEEDS. SO THAT IS VERY IMPORTANT AS AN ISSUE AND CHANGES THINGS. AND FOR THOSE OF YOU PAYING ATTENTION TO THE SUPREME COURT, THE SUPREME COURT RULED IN THE LAST FEW YEARS IN THE CASE -- AND UNANIMOUSLY, THEY ALL AGREED ON IT, BIG DEAL, AND TWO YEARS AGO, A CASE CALLED ANDREWS VERSUS THE COUNTY OF DOUGLAS WAS PASSED AND IT IS A HUGE SHIFT FOR SPECIAL ED AND TURNS THE LAW UPSIDE DOWN OR THE INTERPRETATION OF THE LAW AND REQUIRES THAT CHILDREN IN SPECIAL ED MUST MAKE PROGRESS AND IF THEY ARE NOT MAKING PROGRESS, THE LAW IS NOT BEING MET. >> I WILL MAKE ONE COMMENT FROM THE CLASSIFICATION SIDE OF THINGS. AIM SCHOOL PSYCHOLOGIST BY TRAINING AND THEN I BECAME A NEUROPSYCHOLOGIST BUT THAT STILL IS MY FOCUS AND ONE OF THE THINGS I REMIND SCHOOLS OF ALL THE TIME WHEN THEY SAY FASD ISN'T ON THE LIST FOR OIH, WELL, IT IS AN ICD9 OR 10 MEDICAL DIAGNOSIS. SOCIAL MEDICATION DOESN'T LIFT OUT EVERY DIAGNOSIS FOR THE CATEGORY. IT IS BASED ON ICD9 AND 10 CLASSIFICATIONS SO WE REMIND THEM ALL THE TIME YOU CAN USE IT IF YOU CHOOSE TO. IF YOU ARE EXPRESSING YOU HAVE BEHAVIORAL OR LEARNING CONCERNS AND THAT IS A DIAGNOSIS, YOU CAN USE THAT. WE HAVE WORKED HARD TO TRY AND GET THE SCHOOLS TO USE OTHER HEALTH DISORDERS VERSUS EBD BECAUSE I THINK IT KEEPS A MORE PROACTIVE REHABILITATION MINDSET THAN DRIFTING INTO THE BEHAVIORAL SIDE OF THINGS WHICH IS A LITTLE POTENTIAL DOWNFALL BETWEEN HAVING THE FAS AND DSM. IF IT IS A KEY PSYCHIATRIC DISORDER, IT IS KEY IN TERMS OF HOW YOU THINK OF INTERVENTIONS IN THE CLASSROOM, PROCESSING SPEED AND DISREGULATION VERSUS EBD-TYPE BEHAVIORS AND I WOULD ARGUE PROBABLY ON THE EBD SIDE, THEY SHOULD THINK ABOUT THAT AS WELL BUT KEEPING IT ON THE EBD SIDE IS HELPFUL SO THEN IT BECOMES A PSYCHIATRIC DIAGNOSIS VERSUS A MEDICAL DIAGNOSES WHICH MAKES IT A BEHAVIORAL PROBLEM WHICH PEOPLE JUST THINK YOU CAN SOLVE, JUST BEHAVIOR BETTER, RIGHT? SO THAT IS NOT ACCURATE BUT OFTEN WHAT WE HEAR IN THE SCHOOL AS A COMMENT ON THE OHD SIDE. IT ALREADY COUNTS FOR OHD AND YOU DON'T NEED ANYTHING MORE SO HAVING IT WRITTEN DOWN ON THE SPECIAL EDUCATION SIDE IS IMPORTANT BUT IT IS ALREADY THERE AND HAS A MEDICAL CLASSIFICATION. >> AND FROM A PRACTICAL IMPACT ON IT, I TRY, WHEN I GET KIDS ELIGIBLE, I REALLY PUSH FOR OHI AND WHAT THEY DO IN GEORGIA IS YOUR ELIGIBILITY CLASS -- CLASSIFICATION DOES NOT GUIDE YOUR SERVICE OR STRUCTURE INDIVIDUALLY. YOU CAN GET THEM ANYTHING BUT IT DEPENDS ON THEIR NEEDS. FASD DOESN'T GET OFTEN REGULATED IN CLASSES SO IT IS IMPORTANT TO LOOK AT THE INDIVIDUAL CHILD AND DO THE EDUCATION ON FAS AND SAY THIS IS NOT A BEHAVIOR, HE IS NOT CHOOSING TO DO THIS AT THIS POINT, THAT WHATEVER IS NOT TRIGGERING SO THAT HE CAN FUNCTION, IT GETS NUANCED. >> WITH REGARD TO ESD AND THE PSYCHIATRIC REALM, ADHD AND AUTISM ARE BOTH DEVELOPMENTAL DISORDERS AND BOTH IN THE DSM SO I THINK WHILE THERE COULD BE A CONCEPTION THAT THIS COULD MAKE IT MORE THEATRIC, THERE IS A MORE PSYCHOLOGICAL COMPONENT TO THINK ABOUT BECAUSE RECOGNIZE THAT PEOPLE DON'T NECESSARILY THINK OF IT THAT WAY, DSM VERSUS NOT BUT I THINK IT IS POSSIBLE -- [INDISCERNIBLE] -- >> OKAY, GO I THINK IT IS TIME FOR BREAK. LET'S TAKE A SHORT BREAK. WE HAVE BREAK AND THEN CONTINUE DISCUSSION, YES? OKAY, TEN MINUTES' BREAK, WILL THAT BE ENOUGH? >> TEN MINUTES INSTEAD OF 20? >> YES, I SUGGEST 10 IF EVERYONE AGREES. OKAY, LET'S MEET BACK AT 3:15. >> WE HAD GREAT DISCUSSION, TIME IS MOVING QUICKLY SO IT LOOKS LIKE SEVERAL PEOPLE WANTED TO ASK QUESTIONS AND THAT WILL GIVE EVERYONE WHO WOULD LIKE, AN OPPORTUNITY TO SPEAK. BUT IT SOUNDS LIKE WE HAVE HAD GREAT DISCUSSIONS OUTSIDE SO MAYBE NEXT TIME WE SHOULD GIVE EVERYONE ADDITIONAL TIME TO COMMUNICATE OUTSIDE. SO LET'S GO BACK TO THE DISCUSSION AND THANK YOU VERY MUCH, FOR A GREAT PANEL, AND TO EACH PRESENTER, IT WAS EXCELLENT AND GREAT, WE CAN SEE THE IMPORTANT POINTS WHICH YOU INDICATED IN YOUR SLIDES, INDICATING BOTH THE DIFFICULT CHALLENGES AND AREAS WHICH NEED ATTENTION AND ALSO SOME SOLUTIONS AND WILL DEFINITELY BE LOOKING AT THIS. SO ALSO TO REMIND, THIS MEETING IS VIDEOCAST. WE DID HAVE DIFFICULTY AT BEGINNING TECHNICALLY, WE ARE FINE BUT THERE HAD BEEN TECHNICAL ISSUES SO I JUST DON'T KNOW PEOPLE WHO WERE REMOTE BUT I.T. IS SAYING THEY WILL HAVE A WAY TO FIX IT ON THE FINAL VIDEO CAST SO EVERYONE CAN SEE IT. SO IF SOMEONE MISSES US, YOU COULDN'T SAVE YOUR SPOT OR HEAR WELL, IT SHOULD BE DONE FOR THE ARCHIVE. SO WE'RE GOING BACK TO DISCUSSION AND I KNOW YOU HAVE BEEN PATIENTLY WAITING? >> I DIDN'T WANT TO DERAIL THE PREVIOUS TOPIC BECAUSE I WAS INTERESTED IN SHIFTING OVER TO SORT OF A MORE GENERAL QUESTION ABOUT THE ROLE OF GENDER IN DIAGNOSIS AND LET ME TELL YOU SOME OF THE THINGS THAT TRIGGERED MY THOUGHTS ABOUT THIS. SO FIRST OF ALL, YOU WERE TALKING ABOUT EXTERNALIZING VERSUS INTERNALIZING BEHAVIORS AND I KNOW THOSE ARE PRESENT IN OTHER THINGS SUCH AS ADHD AND THAT MEANS THAT ADHD IS UNDER DIAGNOSED IN GIRLS AND SOMETIMES OVERDIAGNOSED IN BOYS AND ALMOST ALL OF THE TREATMENTS FOR ADHD THAT HAVE A STRONG NEIGHBORHOOD BEHIND THEM HAVE ONLY BEEN TESTED IN BOYS AND THEN YOU WERE TALKING ABOUT TESTOSTERONE IS A POISON AND OF COURSE WE KNOW WHEN YOU LOOK AT DIFFERENCES WITHIN, THEY TEND TO BE GREATER THAN THOSE UNSEEN, MOST BOYS A EXPOSED TO TESTOSTERONE AND ARE NOT KILLING PEOPLE AND ARE PEACEFUL AND WILL HAVELY AND I THEY NEVER KILLED ANYBODY. VOUCH AND THEN THE OTHER THING YOU WERE TALKING ABOUT WAS FOR OLDER CHILDREN IN PARTICULAR, ONE OF THE BIG TARGETS FOR CHANNELS FOR SCREENING HAPPENS TO BE THE JUVENILE JUSTICE SYSTEM. BUT IF IT IS MOSTLY BOYS ENTERING THE JUVENILE JUSTICE, HOW DO WE DIAGNOSE GIRLS AND% MAKE SURE THEY GET THE SERVICES THEY NEED. SO THOSE ARE THE KEY POINTS I WAS THINKING ABOUT BUT WANT TO HEAR IDEAS MAKING SURE GIRLS ARE TREATED EQUITABLY IN THE SYSTEM REGARDLESS. >> I THINK THE JUVENILE JUSTICE SYSTEM WAS AN ENTRY POINT BECAUSE IN MINNESOTA, ANY WAY, SUSAN CARLSON, WHO IS THE FORMER FIRST LADY WHO IS ALSO A JUDGE IN THE HENNEPIN COUNTY COURTS, SHE SAW THAT AS A CONCERN, THE LINK TO PRENATAL EXPOSURE. I THINK TO ADDRESS KIND OF ACROSS THE BOARD, IT IS THE EARLY SCREENING SO IF WE FOCUS ON THE EARLY CHILDHOOD PIECE, A LOT OF WHAT THE EARLY CHILDHOOD DOES AT LEAST IN MINNESOTA, WHAT SOME OF THE PURPOSE WAS TO GET IT DOCUMENTED SO THAT DOWN RANGE, YOU COULD COME BACK TO IT. ONE OF THE BIG ISSUES WAS IF YOU ARE THINKING ABOUT EXPOSURE, FINDING IT IN THE RECORDS AND GETTING IT DOCUMENTED WAS HARD. IT IS HARD TO GET RECORDS AND BE CONSISTENT SO TO HAVE IT IDENTIFIED EARLY BY HAVING PEOPLE ASK THE QUESTIONS AND EARLY CHILDHOOD SHOULD PRESENT ALL KIDS ARE SCREENED FOR EARLY CHILDHOOD PIECES SO THAT SHOULD COVER IN TERMS OF AT LEAST ASKING THE QUESTION OF BOTH GENDERS. >> WON'T MOST OF THE QUESTIONS RELATE TO EXTERNALIZING BEHAVIORS, THOUGH? >> IN EARLY CHILDHOOD? THE SCREENERS WE TRY TO GET INTO WEREN'T FOR THOSE PRESENTING FOR SERVICES, JUST FOR SCHOOL. SO AUTOMATICALLY ASKING THE QUESTION, ALMOST LIKE DIVISION IN HEARING MENTALITY AND I FORGOT WHO REFERENCED THAT, HAVING ALL THE PRE-SCHOOL SCREENERS ASK THE QUESTION WAS THERE CONCERN FOR EXPOSURE AT ANY POINT AND A DOCUMENT BASED ON HOW PARENT ANSWER SO IT WASN'T IN TERMS OF PRESENTING FOR A PROBLEM BUT JUST -- >> RIGHT, BUT IF DIAGNOSTIC TOOLS ARE BASED AROUND ACTING OUT, BEING VIOLENT, DOING -- >> I WON'T SAY THAT IS TRUE. >> I AM LITERALLY JUST ASKING, I AM NOT -- [OVERLAPPING SPEAKERS] >> THE DIAGNOSTIC PIECE IS TRYING TO GET AT ANXIETY AND DEPRESSION AS WELL AND TRYING TO COVER BOTH SIDES OF THAT HONESTLY. I DON'T THINK THE FOCUS HAS ALWAYS BEEN ON THE EXTERNALIZING PIECE. THIS HE GET PEOPLE'S ATTENTION MORE SO HAVING THE QUESTIONS BE MORE GENERAL, I THINK IS GOOD AND THEN JUST FROM A CLINICAL PSYCHOLOGICAL PERSPECTIVE IN HOW DO YOU IDENTIFY THE MORE WITHDRAWN KIDS OR IN ONE THING THAT I THINK PEOPLE ARE DOING A BETTER JOB OF UNDERSTANDING IS ANXIETY IN CHILDREN PRESENT AS AGITATION ESCALATION AND DOESN'T ALWAYS PRESENT AS NAIL BITING AND RUINATION. THAT AGITATED BEHAVIOR IS LIKELY TO BE DUE TO ANXIETY VERSUS A -- [INDISCERNIBLE] SO I THINK GETTING PEOPLE TO THINK ABOUT IT IN THOSE TERMS, WE DON'T MISS EX TERM -- EXTERNALIZING GIRLS BUT I THINK WE DO TEND TO MISS THE INTERNALIZING GIRLS AND BOYS. >> I THINK THAT IS FANTASTIC. I THINK AS A PEDIATRICIAN, WE SHOULD BE ASKING AT THE SIX-WEEK CHECK WHEN THE MOTHER -- IT IS A BEAUTIFUL BABY AND EVERYTHING IS WONDERFUL ABOUT HER BABY, SOMEHOW THE PEDIATRICIAN NEEDS TO ASK A BUNCH OF QUESTIONS ABOUT HER PREGNANCY, ONE OF WHICH WILL GET AT THE ISSUE OF WHETHER SHE DRANK ALCOHOL DURING HER PREGNANCY. IT SHOULD NOT BE DID YOU DRINK ALCOHOL DURING YOUR PREGNANCY BUT IT GETS AT THAT. NOT BECAUSE THAT CHILD NEEDS HELP, BOY OR GIRL AT THAT POINT, BECAUSE THAT BABY IS JUST A BEAUTIFUL BABY, BUT IN MY EXPERIENCE, THE TIME THAT WE START SEEING KIDS WHO HAVE BEEN AFFECTED BY ALCOHOL TO REALLY START TO HAVE PROBLEMS IS MORE LIKE THREE YEARS OF AGE AND I THINK THAT AT THAT POINT, YOU DON'T ASK OR YOU DON'T GET AT THE QUESTION BECAUSE SHE IS GOING TO ANSWER NO, I DID NOT DRINK ALCOHOL DURING MY PREGNANCY AT THREE YEARS OF AGE WHEN HER CHILD IS STARTING TO BE DELAYED AND HAVING PROBLEMS, BUT IT IS IN THE CHART. AND I THINK THAT IS GOING TO BE BOYS OR GIRLS SO YOU ARE LOOKING AT IT PERSPECTIVELY. WHEREAS IF YOU ARE LOOKING AT IT RETROSPECTIVELY, YOU WILL FIND MORE BOYS. I THINK THERE ARE WAYS TO FIND GIRLS WITH THIS AS WELL BUT I THINK IT NEEDS TO BE TAKEN IN THIS APPROACH'S WAY. >> I HAVE A COUPLE OF COMMENTS ALONG THE LINE OF WHAT YOU ARE SAYING IN TERMS OF PEDIATRICIANS ASKING THOSE QUESTIONS. AND YOU KNOW, I AM TOTALLY ON THE RESEARCH SIDE, CLINICAL RESEARCH, BUT IN TERMS OF POLICY, WHAT WOULD IT TAKE TO PUT THAT INTO MEDICAL TRAINING, TO IMPLEMENT IT IN TERMS OF STANDARD SCREENINGS? I MEAN THIS IS WHAT WE ALWAYS SEEM TO HAVE A PROBLEM WITH, IS TRANSLATING THE RESEARCH FINDINGS AND BEING ABLE TO EFFECT POLICY. AND THEN JUST ONE OTHER QUESTION AND THIS GOES ALONG WITH THE SCHOOL SYSTEM OR JUST A COMMENT, RATHER, BEFORE I WENT BACK TO SCHOOL TO GET MY DEVELOPMENTAL PSYCHOLOGIST DEGREE, I WAS A SCHOOL PSYCHOLOGIST AND I COULD TELL YOU WE RECEIVED NO TRAINING AT ALL IN ANYTHING LIKE THAT. I MEAN, WE WOULD -- WE COULD SAY THIS BEHAVIOR SUGGESTS THIS OF ATTENTION DEFICIT. WE DON'T DIAGNOSE, AS YOU SAID AND THEN REFERRAL TO A PEDIATRICIAN BUT YOU KNOW SO BEHAVIOR, DEPRESSION, THAT SORT OF THING WE WERE TRAINED TO PICK UP ON BUT NOT FACIAL FEATURES INDICATIVE OF WHAT YOU ARE LOOKING FOR. SO AGAIN, BACK TO THE SCHOOL SYSTEM, OUR TRAINING, ARE THESE PROFESSIONALS THAT HAVE CONTACT WITH THESE CHILDREN ALL THE TIME AND WE WOULD TEST CHILDREN. MOST OF THE TIME IT WAS 1ST GRADE AND ABOVE BUT SOMETIMES IF THE CHILD WAS HAVING PROBLEMS, WE WOULD GET THEM EARLIER. >> FROM THE STANDPOINT OF THE FIRST QUESTION YOU ASKED ABOUT POLICY AND GETTING LECTURES, ET CETERA, YOU ARE NOT GOING TO CHANGE THE UNIVERSITY OF CALIFORNIA SAN DIEGO OR THE UNIVERSITY OF MINNESOTA AND TELL THEM WHAT TO TEACH IN THEIR CLASSES, I GUARANTEE THAT. SO BASICALLY WHAT YOU NEED TO DO ARE THINGS SUCH AS PERSUADE THE PEOPLE THAT MAKE UP THE TESTS THAT ALLOW YOU TO BECOME A PEDIATRICIAN TO HAVE ON THEIR TEST, QUESTIONS ABOUT THE FETAL ALCOHOL SYNDROME AND IT WILL NOT TAKE LONG FOR THEM TO RECOGNIZE THAT THEY HAVE TO LEARN ABOUT THIS DISORDER IF THEY ARE GOING TO PASS THE TEST AND THEREFORE BE ABLE TO GET THEIR BOARDS IN PEDIATRICS. SO THOSE KINDS OF THINGS ARE, I THINK, WHAT YOU NEED TO DO TO CHANGE POLICY ABOUT THOSE KINDS OF THINGS BUT YOU ARE NOT GOING TO BE ABLE TO TELL THE MEDICAL SCHOOLS WHAT THEY ARE GOING TO TEACH. THEY ALREADY THINK THEY KNOW ALL ABOUT -- >> AND HOW WOULD YOU DO THAT EVEN IN TERMS OF THE TESTING, HOW WOULD YOU BE ABLE TO GET THAT ONBOARD? >> NO, I DON'T THINK THAT WOULD BE SUCH A DIFFICULT THING. >> YOU DON'T? >> I DEFINITELY DO NOT. >> WOULD IT BE SOMEONE LIKE YOU? >> IT WOULD BE SOMEONE LIKE YOU OR ME. >> OR MAYBE EVEN THE TEXTBOOK -- WELL, THEY DON'T DO TEXTBOOKS ANYMORE, OR SOME DO BUT ON CHILD DEVELOPMENT, THERE IS A PREPARING ON FASD AND MAYBE GET THAT MORE ELEVATED, PUT INTO THE CURRICULUM THROUGH THE BOOKS. >> I WAS A MEMBER OF THE AMERICAN BOARD OF PEDIATRICS CONCEPT DEVELOPMENT TEAM, YOU KNOW, FOR DEVELOPMENTALAND BEHAVIORAL PEDIATRICS ISSUES AND IT WAS IN THERE BUT THERE ARE SO MANY OTHER THINGS YOU HAVE TO SHUFFLE THROUGH SO YOU CAN SAY YES, THIS IS ONE OF THE COMPONENTS BUT THE OTHER COMPONENT IS GOING THROUGH THE GRADUATE MEDICAL EDUCATION, THE ONE OVERSEEING ALL MEDICAL AND RESIDENCY EDUCATION AND TRYING TO IMPLANT IT THERE. I DO KNOW THAT FOR THE AMERICAN BOARD OF PEDIATRICS, FETAL ALCOHOL IS SOMEWHERE THERE IN THE CONTENT SPECIFICATION SO IT IS NOT REALLY A REACH TO TALK TO EVERY SINGLE PROGRAM ABOUT THIS. SO THE ONLY THING IS HOW TO IMPLEMENT AND WHO DOES THE LECTURE BECAUSE IF ALL IT IS IS ABOUT THE FACE, THEN IT DOESN'T BASICALLY TEACH FOR ALL THE ASPECTS THE PEDIATRICIAN WILL NEED AND THERE IS, THEREFORE, THE NEED TO HAVE THE PEDIATRIC PATIENT AND THE CONTINUITY CLINIC THAT I WAS TALKING TO YOU ABOUT COULD BECOME THE MODEL. IF THE DATA SUPPORTS IT, IT POTENTIALLY COULD REACH LARGER BODIES, THE ACG AND GRADUATE MEDICAL EDUCATION, AMERICAN BOARD OF PEDIATRICS AND THEREFORE DISSEMINATION MAY BE POSSIBLE AND MAY MAKE IT MANDATORY THAT THERE IS ONE FULL OF FETAL ALCOHOL BUT THE ENTIRE- THING FROM DIAGNOSIS TO MANAGEMENT. >> AND I THINK SIMILAR TO WHAT YASMIN SAID, THE SAME SHOULD BE APPLIED TO OTHER ASSOCIATIONS, POTENTIALLY GO TO OTHER ASSOCIATIONS FOR INCLUSION IN EXAMINATIONS SO THIS POTENTIALLY WOULD -- [INDISCERNIBLE] >> BUT I THINK THAT IS HOW IT HAPPENED FOR ACOG, AMERICAN COLLEGE OF OBSTETRICS AND GYNECOLOGY. IT WASN'T TILL THEY WROTE IT INTO THE BOARD WITH SUCH A GENERAL STATEMENT THAT IT WAS THOUGHT MUCH ABOUT. PARENT WERE STILL BEING TOLD OH, YOU CAN PROBABLY HAVE A LITTLE BIT OF ALCOHOL SO IT WASN'T TILL THE ACOG BOARDS, THEN THEY HAD A MUCH MORE DEFINITIVE STATEMENT. THAT IS MY RECOLLECTION OF HOW ACOG GOT ONBOARD BECAUSE FOR A LONG TIME, THEY WERE NOT ONBOARD WITH THE STATEMENT PRENATAL ALCOHOL USE WAS HARMFUL. >> I HAVE A QUESTION ON THIS AND THEN A FOLLOW UP QUESTION BUT THAT CAN WAIT. I WAS DOING GO MY TRAINING IN IMMEDIATE YACHT TRICKS AND PEDIATRIC RESIDENTS AND I MUST AGREE THAT IT MAKES ME NERVOUS FOR PEOPLE TO THINK THAT IS A RELIABLE AND POTENTIALLY CONSISTENT WAY OF DOING GO IT BECAUSE ANYONE WHO HAS BEEN IN A PEDIATRIC OFFICE RELATIVELY RECENTLY KNOWS THERE IS A LIMITED AMOUNT OF TIME AND, YOU KNOW, PAGES AND PAGES OF THINGS THAT PEOPLE ARE SUPPOSED TO BE BE SCREENING FOR. I KNOW THAT -- I REMEMBER WHEN I WAS STARTING IN GENERAL PEDIATRICS, WE HAD THIS DISCUSSION OF IF YOU WERE TO IMPLEMENT ALL THE RECOMMENDATIONS, IT WOULD BE A 7-HOUR VISIT. SO AGAIN, I DON'T DISAGREE THAT TRAINING PEDIATRIC RESIDENTS IS CLINICAL AND IMPORTANT AND WILL CONTRIBUTE BUT IT DOES MAKE ME A LITTLE NERVOUS TO SAY THAT IS ONE PIECE OF IT. AND I HAVE KIND OF ANOTHER QUESTION BUT I ALSO KNOW THERE ARE IT OTHER QUESTIONS. CAN I MAKE MY OTHER POINT AND THEN -- SO I THINK WHAT I WAS THINKING ABOUT AS I WAS LISTENING TO THE PANELISTS WAS THAT ALMOST EVERYONE TALKED ABOUT THE STRUCTURAL BARRIERS BETWEEN SYSTEMS, RIGHT, THAT IS COMMUNICATE AND COORDINATE WITH EDUCATIONAL SYSTEMS AND HARD FOR THEM TO COMMUNICATE AND SHARE DATA WITH AND COLLABOATE WITH JUVENILE JUSTICE SYSTEMS AND PEOPLE ARE FINDING WAYS TO MAKE IT WORK BUT PEOPLE WHO MAKE IT WORK SEEM TO BE RELYING ON PERSONAL RELATIONSHIPS WHICH SEEMS LIKE A LOVELY BUT NOT NECESSARILY SCALABLE APPROACH TO COORDINATING BETWEEN SYSTEMS, RIGHT? SO I GUESS, YOU KNOW AND AS SOME OF YOU KNOW, I HAVE BEEN THINKING ABOUT SCREENING MORE BROADLY RECENTLY AND WE HAVE JUST BEEN REALLY STRUCK ABOUT HOW THERE ARE SO MANY THINGS YOU COULD SCREEN FOR IN A CLINICAL SETTING AND PROBABLY THE BEST WAY TO MAKING SURE THAT SCREENING IS MAKING A DIFFERENCE IS THROUGH OUTCOME OR SOCIAL UTILIZATION BUT THAT ONLY WORKS IF YOU CAN COMMUNICATE BETWEEN STAFF AMONG SYSTEMS. SO I GUESS MY EXISTENTIAL QUESTION IS HOW CAN WE MAKE THIS MORE STRUCTURAL? HOW CAN WE MAKE MORE EFFECTIVE COORDINATION BETWEEN THESE SYSTEMS SO IT DOESN'T RELY ON, YOU KNOW, A JUDGE BEING INTERESTED IN BEING ON THE BOARD, OR A CONCERNED SOCIAL WORKER SHEPHERDED SOMEONE TO OVERCOME THE SYSTEMIC BARRIERS BETWEEN HEALTHCARE AND SOCIAL SERVICES? [ INAUDIBLE ] >> BUT I WOULD ARGUE A LOT OF THAT TECHNOLOGY SAYS IF YOU HAVE THE DATA, YOU COULD ACT BUT YOU CAN'T GET THE DATA BECAUSE OF PRIVACY CONCERNS OR REGULATORY CONCERNS. LIKE I COULD THINK OF TEN PROJECTS WHERE I KNOW THE DATA EXISTS IN THE EDUCATIONAL SYSTEM AND TECHNOLOGIES EXIST TO MATCH THE DATA BUT NO ONE CAN DO IT BECAUSE THERE IS NO WAY TO MATCH THE DATA WITH A WAY TO DO IT, RIGHT? >> I AGREE WITH YOU WITH THAT SPECIFIC CONCERN. REALLY PEDIATRIC RESIDENTS ARE FACED WITH SO MANY THINGS TO TACKLE BUT THERE IS A MANDATORY ONE-MONTH ROTATION FOR DEVELOPMENTAL PEDIATRIC SITUATIONS. PEOPLE REMEMBER THIS AND BECOME SO SHOCKED THAT THEY NEVER THOUGHT ABOUT IT BEFORE AND HOPEFULLY THAT SHOCK VALUE TRANSLATES INTO SOMETHING AND IT IS NOT JUST SYSTEMATIC AND NOT YOUR JOB OR MAYBE MY JOB, TOO, TO GET IT OUT THERE BUT TO CHAMPION THE AREA AND MAKING IT SO IMPACTFUL FOR PEDIATRICS ROTATIONS THAT IT TRANSLATES TO SOMETHING, SAY, 20 PERCENT OF RESIDENTS AND THAT WOULD MAKE A DIFFERENCE. >> I WOULD LIKE YOU TO SPEAK A BIT ON THAT. >> I THINK YOU PERFECTLY SEGUED TO WHERE I WAS GOING. I FREQUENTLY DO HOME VISITING AND RIGHT NOW MANY ARE STRUGGLING WITH THE OPIOID CRISIS AS EVERYONE IS AND THEY ARE SEEN AS A SILVER BULLET, IF YOU GIVE THEM HOME VISITING, THEY WILL GET TO THESE THINGS. NONE OF THEM ARE TRAINED IN HOW TO APPROACH THE CONVERSATIONS AND FREQUENTLY WHEN THEY HAVE SCREENING TOOLS, NO ONE HAS EVER TOLD THEM HOW TO DO THAT. AS A GRADUATE STUDENT MYSELF, HAVING TO ASK A HEADSTART MOM, HAVE YOU EVER BEEN SO DRUNK OR HIGH THAT YOU COULDN'T TAKE CARE OF YOUR KIDS AND I REMEMBER THINKING WHO LETS ME ASK THIS QUESTION TO PEOPLE AND THERE IS A CONVERSATION I AM HEARING THAT THERE IS A NEED TO HAVE APPROPRIATE TOOLS BUT ALSO THE TRAINING OF PEDIATRICIANS AND IF WE ASK DID YOU DRINK WHEN YOU WERE PREGNANT, YOU ARE NOT GOING TO GET WHAT YOU NEED AND FROM THE MOMENT VISITING SIDE, YOU CAN HAVE A TOOL AND CHECK IT OFF BUT YOU HAVE TO BE ABLE TO IMPLEMENT THAT IN A WAY AND I AM WONDERING WHAT ALL OF THE FOLKS IN THE ROOM THINK OF THE IMPLICATIONS ARE LOOK FOR TRAINING AND DO REREALLY NEED TRAINED CLINICIANS TO DO THESE TRAININGS AND IN CASE IT IS NOT SUSTAINABLE IN THESE SYSTEMS TO GET THE FAMILIES AND KIDS WHERE THEY NEED TO BE. SO HOW DO WE COME TOGETHER ON THAT? DO WE START YOUNGER IN TRAINING? I AM THINKING ABOUT MED SCHOOL BUT, YOU KNOW, PSYCH 101 AS YOU GET YOUR ASSOCIATE DEGREES PROGRAMS, CDA PROGRAMS, WHERE DO WE BUILD SOME OF THIS ABILITY TO SCREEN FOR PEOPLE WHO ARE NOT GOING TO BE MEDICAL PROFESSIONALS IN THAT SENSE? >> YEAH, I HAVE A -- WHAT IS SORT OF A SIMPLE NAIVE QUESTION BUT IT KIND OF BLENDS WHAT YOU JUST MENTIONED AND SOMETHING THAT IS STUCK IN MY MIND, KEN, WITH WHAT YOU SAID AND THEN A LARGER QUESTION. YOU MENTIONED THAT MAYBE SIX WEEKS AFTER BIRTH IS A REALLY GOOD TIME TO TRY AND COLLECT THAT INFORMATION ABOUT POTENTIAL ALCOHOL USE DURING PREGNANCY AND I KEEP COMING BACK THAT, YOU KNOW, BEING NIAAA AND IT ALL BEING ABOUT THE DATA, THAT ONE PIECE OF DATA WOULD BE SO HELPFUL IN SO MANY PLACES ABOUT ALL OF WHAT WE'RE TALKING ABOUT AND WOULD BE HELPFUL IN EVEN LAYERING, KNOWING THAT WE ARE TALKING ABOUT THE SAME THING WITH THE FETAL ALCOHOL EXPOSURE. IT IS A TWO-PART QUESTION AND YOU MENTIONED OBVIOUSLY YOU ARE NOT GOING TO SAY HEY, DID YOU DRINK DURING PREGNANCY BUT WHAT WOULD THE QUESTIONS BE ASKED THAT COULD CAPTURE THAT A AND COULD IT BE AS SIMPLE AS PUTTING THAT ONE ELEMENT IN THE ELECTRONIC HEALTH RECORDS AT SIX WEEKS? I ASSUME SIX YEARS IS NOT A TIME YOU ARE DOING A WHOLE LOT OF OTHER THINGS SO I GUESS THAT IS MY QUESTION. >> I TOTALLY AGREE WITH YOU. I THINK IT WOULD BE FABULOUS TO HAVE THAT INFORMATION IN THE LEGS TON NICK MEDICAL RECORDS AND I DON'T -- IN THE ELECTRONIC RECORD. THE MOTHER WITH THAT BEAUTIFUL BABY IS NOT FEELING ANY KIND OF A THREAT WITH ANSWERING QUESTIONS ABOUT HER PREGNANCY ASK I THINK THERE ARE PRETTY GOOD VALID, ALMOST PEAK OR VALIDATED WAYS TO ASK THOSE QUESTIONS THAT DO NOT CREATE A LOT OF THREAT TO A WOMAN, PARTICULARLY WHEN SHE IS HOLDING ON TO THAT BEAUTIFUL BABY. SO I DON'T THINK IT WOULD BE THAT BIG OF A DEAL. AND I KNOW YOU HAVE BEEN INVOLVED WITH THEM AS THE AMERICAN ACADEMY OF PEDIATRICS A LOT AS HAVE I BUT I THINK THEY ARE REALLY COMING AROUND TO THIS IDEA AT THIS POINT. I CAN REMEMBER THREE YEARS AGO WHEN THEY WERE SAYING NO, WE ARE NOT GOING TO HAVE PEDIATRICIANS ASK WOMEN QUESTIONS ON THEIR FIRST WELL-BABY CHECK ABOUT WHETHER THEY DRANK ALCOHOL DURING THEIR PREGNANCY OR TRYING TO GET AT THAT BUT I THINK RECENTLY I HAVE BEEN HEARING A DIFFERENT STORY FROM THEM. SO I REALLY THINK THAT SORT OF WE'RE AT A BIT OF A TIPPING POINT AS FAR AS THIS CONCERNED AND I AM RELATIVELY OF THE MYSTIC ABOUT BEING ABLE TO DO THAT ONE THING YOU ARE BRINGING UP. >> AND CAITLYN, FOR MEDICAID, SOMETIMES THINGS START THERE. IS THAT SOMETHING WE HAVE ANY CHANCE OF THINKING ABOUT? AND NOT TO PUT YOU ON THE SPOT BUT -- [ OFF MIC ] [ INAUDIBLE ] AND SOME STATES DO DO IT AND A LOT MORE STATES SAY YOU HAVE TO USE IT -- [INDISCERNIBLE] [ INAUDIBLE ] >> EPIC IS ONE OF THE MOST HORRIBLE THINGS THAT HAS EVER HAPPENED TO ME, THE ELECTRONIC MEDICAL RECORD. ON THE OTHER HAND, IT REALLY DOES LACK ALL KINDS OF THINGS THAT ALLOW YOU TO KNOW THINGS THAT WE NEVER KNEW BEFORE, WE COULD NEVER BRING BACK THAT OCCURRED AT A FIRST VISIT, FIRST WELL-BABY VISIT AT SIX WEEKS OF LIFE. SO I THINK THAT THE EMR HAS CREATED A SITUATION THAT WOULD MAKE THIS NOT SO DIFFICULT. [ OFF MIC ] >> YES, CORRECT, YOU CAN'T ROUTINELY OR RE RELIABLELY LINK THE MOM'S RECORDS WITH THE OTHER PLATFORM. >> BUT THE FOCUS HERE IS NOT THE MOTHER. WHEN THIS BABY AT TWO YEARS OF AGE STARTS TO ACT OUT, WE HAVE IN HIS OR HER RECORD THAT HIS OR HER MOM SAID AT SIX WEEKS THAT SHE -- OR I HATE TO USE A THE WORDS THAT SAY SHE DRANK ALCOHOL DURING PREGNANCY BUT IT HAS BEEN IDENTIFIED IN THE BABY'S RECORD WHO THE NEURODEVELOPMENTAL PEDIATRICIAN IS NOT THUMBING WHERE SHE IS TRYING TO FIGURE OUT WHAT CAUSED THIS BABY TO BE HAVING PROBLEMS. >> YOU ARE ASSUMING THAT MOM BROUGHT THE BABY IN FOR IT THE APPOINTMENT -- >> I AM ASSUMING THAT -- WOMEN, YOU KNOW, IN MY EXPERIENCE, AND THAT IS REALLY A BAD THING TO SAY BUT MY FEELING IS THAT MOST PEOPLE, MOST MOMS BRING THEIR KIDS IN FOR WELL-BABY CHECKS AT SIX WEEKS OF AGE. >> BUT THE ONES WHO DON'T ARE PERHAPS THE ONES MOST LIKELY TO HAVE REAL ISSUES. >> WELL, I AM NOT DISAGREEING. I WILL NOT DISAGREE WITH YOU ON THAT AND IF YOU DON'T MIND, I WOULD LIKE TO BRING UP A THING THAT RELATES TO THAT A LITTLE BIT. >> IT SOUNDS AS IF THERE IS TWO DIFFERENT ISSUES. ONE IS HOW TO IT GET THE OPPORTUNITY TO HAVE IT IN THE MEDICAL RECORDS WHEN YOU HAVE A YOUNG CHILD TO RECORD THE ALCOHOL USE BUT AT THE SAME TIME, THE CONVERSATION WITH MOTHERS -- [INDISCERNIBLE] SO WE HAVE TWO DIFFERENT WAYS AND OPPORTUNITY, I THINK. >> AND WE CAN'T SEPARATE MOMS AND CHILDREN. I MEAN, THE BABY COMES FROM THE MOTHER -- >> BUT IF THEY WERE TO COME IN FOR THIS PARTICULAR SUBJECT, I WOULD SAY GO AHEAD AND THEN WE WILL COME BACK TO YOU. >> I DID WANT TO MAKE ONE FOLLOW UP POINT AND THEN I WILL STOP. SO ONE THING THAT I HAVE KIND OF BEEN HEARING IN THIS CONVERSATION, AND I THINK BECAUSE KEN IS SPECIFICALLY TALKING ABOUT, YOU KNOW, COLLECTING DATA AT SIX WEEKS AND OTHER PEOPLE HAVE BEEN TALKING ABOUT COLLECTING DATA IS THAT IN MY WORK RELATED TO THE TASK FORCE TOPICS, IT HAS REALLY COME UP THAT PEOPLE TEND TO SPECULATE BUT NOT TO ACTUALLY STUDY POTENTIAL HARMS. AND SO I THINK WE'VE TALKED A LOT ABOUT WELL, YOU KNOW, I ASSUME -- WE USED TO ASSUME THERE WOULD BE HARM FROM ASKING THIS QUESTION AND NOW WE ASSUME DIFFERENT THAT THERE ARE NOT HARMS OR NOT BENEFITS AND I THINK ONE OF THE REAL BARRIERS TO GENERATING EVIDENCE ABOUT THESE RECOMMENDATIONS IS THAT THEY ARE STILL LIVING IN THE REALM OF SPECULATION AND NOT EVIDENCE. SO WHAT WE REALLY DISCUSSED FROM THE OTHER SIDE IS THAT IF WE ARE, YOU KNOW, EITHER STUDYING OR FUNDING PEOPLE TO STUDY THESE QUESTIONS ABOUT SCREENING, IS THAT WE HAVE TO REQUIRE THAT PEOPLE NOT ONLY LOOK AT POTENTIAL BENEFITS BUT LOOK SYSTEMATICALLY AT POTENTIAL HARMS AND I THINK THAT WILL REALLY HELP BECAUSE WITHOUT THAT KIND OF EVIDENCE, PEOPLE TEND TO DISAGREE ABOUT WHAT THE POTENTIAL HARMS MIGHT BE. >> ONE BIG AREA THAT WE ARE NOT HAPPY -- AND THIS IS Dr. JONES SAYING THAT YES, WE HAVE EPIC AND ALL THOSE ELECTRONIC MEDICAL RECORDS. THE BIRTH HOSPITALS ARE ACTUALLY REQUIRED TO ASK ABOUT DRUGS FOR SOME REASON AND THEN THERE REALLY IS NOTHING ABOUT ALCOHOL AND I HAVE SEEN IT TIME AND TIME AGAIN. THE RECORDS, YOU KNOW HOW IT IS PRINTED, DRUGS, WHATEVER, HIV, DIFFERENT THINGS LIKE THAT BUT THERE IS NOTHING ON ALCOHOL. NOW, IT IS STARTING TO COME IN BUT IT IS JUST NOT IN EVERY HOSPITAL BUT IF YOU PUT IT IN EVERY HOSPITAL BIRTH RECORD, IT WILL ACTUALLY COME THROUGH BELIEVE IT OR NOT WHETHER THE ACTUAL BIRTH MOTHER IS INVOLVED. SO THIS COULD BE AN OPPORTUNITY FOR US TO FLAG IN SOME WAY OR USE WHATEVER CODES THEY HAVE USED OR SEE WHATEVER IS FROM THAT RECORD. >> I WOULD LIKE TO JUST MAKE A QUICK STATEMENT ABOUT THE ALCOHOL USE DISORDER AND I THINK IT DEPENDS ON HOW YOU PHRASE IT AND I BELIEVE THAT IS WHAT IS IN THE MEDICAID DATA AND NOT HOW MUCH THEY USE. SO MANY PEOPLE ARE NOT DIAGNOSED WITH ALCOHOL -- >> THAT WAS THE POINT I WAS GOING TO MAKE, 1 PERCENT DIAGNOSIS, ONLY SLIGHTLY HALF OF THEM ARE DIAGNOSED BEFORE THE BABY IS BORN EVEN THOUGH THEY ARE ENGAGED IN CARE AND IT DOESN'T COVER BINGE DRINKING WHICH CAN HAVE A BIG IMPACT, IT ONLY ASKS ABOUT DIAGNOSED ALCOHOL DISORDER SO A REALLY CRUDE TOOL AND PROBABLY GETTING AT ONLY THE MOST SEVERE CASES AND NOT ONLY TO SAY IT IS THAT IT IS NOT HELPFUL BUT THE TIP OF THE ICEBERG. >> I WANT TO POINT OUT THERE ARE ALSO A LOT OF CHILDREN ADOPTED INTERNATIONALLY SO WE DO NOT HAVE ANY CONFIRMATION OF WHETHER THEIR MOTHERS DRANK OR NOT. THEY FIT ALL THE CRITERIA FOR THE NEUROBEHAVIORAL DISORDERS BUT THERE IS NO CONFIRMATION SO THAT IS NOT A QUESTION THE PEDIATRICIAN CAN ASK BUT LOOKING BACK ON IT AND WHAT I HAVE LEARNED AND HEARD FROM ALL THE OTHER PARENTS, IF THERE WERE ALSO A SERIES OF QUESTIONS AT SIX WEEKS OR TWO YEARS OR WHATEVER ABOUT SOME OF THE -- I WANT TO SAY MORE SUBTLE BEHAVIORAL THINGS LIKE BEING ABLE TO SLEEP THROUGH THE NIGHT, BEING ABLE TO TAKE A NAP, A LOT OF LITTLE THINGS THAT, YOU KNOW, YOU ARE TOLD AT THE BEGINNING THESE ARE ALL DIFFERENT BUT WHEN YOU GET A GROUP OF FASD PARENTS TOGETHER, YOU ALL FIND OUT YOU HAD THE SAME KIND OF IRRITABILITY AND THOSE KINDS OF QUESTIONS PUTTING OUT THERE ABOUT SOME OF THE SELF-REGULATION BEHAVIORS CAN BE JUST AS USEFUL. AS FAR AS HAVING IT IN THE RECORD, THAT WOULD BE CRITICAL BECAUSE THERE ARE TWO ISSUES THAT COME UP AS THE CHILDREN GROW. ONE IS IF THEY DO FIND IT HELPFUL, THEY GO TO JUVENILE JUSTICE OR DETENTION HALL AND THEY ARE GIVEN ALL KINDS OF PSYCHOTIC DRUGS WHICH DON'T DO ANYTHING. IF IT IS IN THE RECORD, THEN IT COULD GO WITH THEM AND I DON'T KNOW IF YOU KNOW BUT MANY OF THESE YOUNG FASD PEOPLE ARE ON LIKE SEVEN DRUGS FOR LIKE DEPRESSION, ET CETERA. THAT IS HORRIBLE. ALSO WHEN THEY GET TO BE ADULT, IF THEY HAVE A DIAGNOSIS RECORDED ON FILE, THEY COULD BE ELIGIBLE FOR DISABILITY SERVICES AND THEY HAVE TO HAVE THAT, TO BE ABLE AT THE AGE OF 21 TO GET DISABILITY SO BY NOT HAVING THAT, THEY ARE NOT GOING TO GET IT. AND AS FAR AS BIRTH, THE STATE OF COLORADO, I BELIEVE, PASSED A LAW THAT SAID WHEN THEY REPORT THE DRUG OR ALCOHOL USE AT BIRTH, IT WILL BE AUTOMATIC REFERRAL TO CHILD PROTECTIVE SERVICE, NOT REMOVAL FROM THE HOME, BECAUSE THEY WANT TO ENCOURAGE THE DOCTORS TO DO IT. HERE IN THE STATE OF MARYLAND, THERE ARE CERTAIN HOSPITALS THAT THE WOMEN WITH SUBSTANCE ABUSING TO BECAUSE THEY KNOW THEY WILL NOT GET REPORTED. SO THAT IS ANOTHER THING TO CHANGE THE CONVERSATION. >> Dr. JONES? >> I JUST WANTED TO BRING UP SOMETHING THAT HAS NOT BEEN DROUGHT UP EXCEPT INDIRECTLY HERE TODAY AND I THINK WE REALLY NEED TO WATCH OUT AS WE'RE SITTING AROUND, TALKING, THAT WE DO NOT MAKE THIS DISORDER A DISORDER OF THE LOWER CLASS, UNEDUCATED, HEAVILY-DRINKING WOMEN. BECAUSE I THINK ALL OF YOU ARE PROBABLY AWARE OF THE FACT THAT FOR BOTH MEN AND WOMEN, THE PEOPLE THAT DRINK THE MOST ARE THE PEOPLE FROM UPPER CLASS AND HIGHLY EDUCATED GROUP. SO I THINK THERE IS ABSOLUTELY NO QUESTION THAT A HUGE NUMBER OF PEOPLE, WOMEN, WHO ARE DOCTORS, WHO ARE LAWYERS, WHO ARE BUSINESS WOMEN, WHEN ARE SOCIAL WORKERS, WORK A FULL DAY, TEN-HOUR DAY, THEY COME HOME, THEY HAVE A GLASS OF WINE. AND AS THEY ARE MAKING DIFFERENT, THEN THEY SIT DOWN WITH THEIR HUSBAND FOR DINNER AND HAVE ANOTHER GLASS OF WINE AND, YOU KNOW, THERE IS 9 PERCENT OF WOMEN IN THIS COUNTRY THAT DON'T FIND OUT THEY ARE PREGNANT UNTIL THE END OF THE FIRST TRIMESTER. THE AVERAGE IS 6-8 WEEKS. SO THERE ARE A LOT OF WOMEN LIKE THAT WHO ARE DRINKING IN A RISKY FASHION FOR THE FIRST SIX TO EIGHT WEEKS OR THE FIRST 1 WEEKS OF THEIR PREGNANCY WHO ARE FROM UPPER-CLASS, WEALTHY HIGHLY EDUCATED PEOPLE AND I FEEL LIKE WE THINK THAT IT'S -- I SORT OF GOT THE FEELING AND MAYBE I WAS THE ONLY PERSON THAT GOT THE FEELING THAT WE WERE FOCUSED ON A LOT OF PEOPLE WHO WERE UNDER EDUCATED PEOPLE FROM THE LOWER-CLASS AND THAT IS NOT ALL THE PEOPLE THAT ARE HAVING KIDS WHO ARE PREGNAT -- PRENATALY EXPOSED TO ALCOHOL. I THINK THAT THOSE KIDS ARE NOT AS HARD OFF AS THOSE WITH LESS RISKY BEHAVIOR. THEY READ TO THE CHILD, TAKE THE CHILD TO THE OPERA, THEY LOVE THAT CHILD, DO ALL KINDS OF WONDERFUL THINGS FOR THE CHILD AND THAT CHILD MAYBE ENDS UP IN A PRIVATE SCHOOL IN THE SUBURBS AND EVEN GETS INTO COLLEGE BUT HAS LOST 15, I DON'T KNOW HOW MUCH THAT CHILD HAS LOST BUT LOST SOMETHING IN TERMS OF THEIR COGNITIVE ABILITY AND THEIR EXECUTIVE FUNCTIONING, ET CETERA, AND I THINK WE HAVE TO REALIZE THAT AND I AM NOT SAYING TO FOCUS ON IT, BUT WE HAVE TO KEEP THAT IN MIND AS WE ARE THINKING ABOUT THIS DISORDER. IT IS NOT A DISORDER OF THE LOWR CLASS, IT IS AN EQUAL OPPORTUNITY DISORDER >> AND I WANT TO COMMENT THAT IS ACROSS THE BOARD FOR ALL DRUGS, I WOULD SAY. >> SURE. >> I WANT TO ALSO SAY THAT JUST ON A PERSONAL LEVEL, WE HAVE A YOUNG MAN WHO IS LIVING WITH US RIGHT NOW AND I WILL NOT SAY HIS LAST NAME BECAUSE YOU MAY RECOGNIZE HIS LAST TIME. HIS PARENTS HAVE QUITE A BIT OF MONEY BUT HE WAS HAVING A LOT OF DIFFICULTIES WITH ALCOHOL. HE HAD A LOT OF TROUBLE AS A KID, GO WENT TO THE SAME PRIVATE SCHOOL THAT MY KIDS WENT TO AND THEY KNEW HE HAD SOME KINDS OF PROBLEMS BUT NOBODY COULD FIGURE IT OUT. BUT TALKING WITH HIM MORE AND MORE, I LEARNED MORE ABOUT HIS FAMILY'S STYLE OF DOING THINGS AND HE WAS TELLING ME THAT HIS MOM LOVED TO HAVE THESE DINNER PARTIES AND HE USED TO CALL THEM DRINKING PARTIES. AND HE SAID IT WAS SO IMPORTANT, SO MUCH A PART OF THE CULTURE, YOU KNOW IT, IT WAS VERY SUAVE AND GREAT FOR PEOPLE TO STAND AROUND WITH SOME EXPENSIVE DRINK IN THEIR HAND AND, YOU KNOW, HE WENT THROUGH SCHOOL, HE WENT THROUGH LAW SCHOOL, BUT HIS PARENTS WERE ALWAYS DISAPPOINTED BECAUSE THE PARENTS HAD GONE TO HARVARD BUT THEIR SON WASN'T ABLE TO DO THAT. SO I MEAN I FEEL LIKE I HAVE SEEN THIS CLOSE-UP AND HE EVEN FEELS THAT BEING IN THE SORT OF UPPER-MIDDLE TO UPPER-CLASS IS A DISADVANTAGE BECAUSE THERE IS A LOT OF PRESSURE TO DRINK. IT IS PART OF THE CULTURE. >> ALL RIGHT, WE HAVE TIME FOR A CONCLUSION. >> YOU KNOW, IT WAS INTERESTING AND I APOLOGIZE, I HAD TO DUCK OUT FOR A BIT OF THE MEETING, OTHER DUTIES CALLED BUT JUST LISTENING TO THE RICHNESS OF THE DISCUSSION AND THE THOUGHTFULNESS IN THE MULTIPLE PERSPECTIVES IS REALLY IMPRESSIVE. AND WHERE WE STARTED, WE HAD A CLOSED SESSION THIS MORNING JUST KIND OF TO GET TOGETHER FOR A FEW MINUTES AND YOU KNOW ONE OF THE THINGS IS WHERE CAN WE MAKE THE MOST IMPACT. PUTTING THIS GROUP OF FEDERAL ENTITIES AROUND THE TABLE, GETTING INPUT FROM ALL THE PEOPLE WHO DEAL WITH THIS WHO ARE NOT IN THE FEDERAL GOVERNMENT, WHERE CAN WE CAPITALIZE ON WHERE WE CAN MAKE THE MOST IMPACT. AND YOU KNOW AS YOU ALL HAVE PRESENTED THINGS, AND I UNDERSTAND THERE WERE RECOMMENDATIONS ON SLIDES THAT I AM ANXIOUS TO GO BACK AND LOOK AT, BUT WE WELCOME NOT JUST AT THE MEETINGS BUT THROUGHOUT THE YEAR OF SUGGESTIONS OF WHAT IS PRIMETIME NOW BUT REMEMBERING ALWAYS THAT PEOPLE WHO ARE SERVING OUT THERE ARE NOT THE PEOPLE AROUND THE TABLE. SO I THINK EVERYONE COMES WITH DIFFERENT PERSPECTIVE AND REALLY IMPORTANT IDEAS AND I WANT TO MAKE SURE THAT THE CONVERSATION, EVEN WHEN WE'RE NOT IN THE ROOM TOGETHER CONTINUES. TATIANA, DO YOU WANT TO... >> A COUPLE OF THINGS I WANTED TO SAY. FIRST I WANTED TO SAY THANK YOU SO MUCH FOR PARTICIPATING. THESE WERE EXCELLENT PRESENTATIONS AND I KNOW EVERYONE IS VERY BUSY BUT I UNDERSTAND HOW MUCH COMMITMENT IT TAKES TO COME HERE AND PREPARE A PRESENTATION AND PARTICIPATE AS YOU HAVE. THANK YOU. BUT ALSO JUST TO, BECAUSE I AM NEW, I WENT TO SEVERAL PREVIOUS MEETINGS WHICH ARE VIDEOCAST BECAUSE ALL OF OUR MEETINGS ARE VIDEOCAST AND AVAILABLE FOREVER SO I WAS REALLY IMPRESSED BECAUSE THE QUALITY OF PRESENTATIONS, EVERY TIME, JUST OUTSTANDING. AND I LOOK HOW MANY PEOPLE WATCHED AND IT IS NOT REALLY WHAT I WOULD EXPECT. SO I JUST EXPECT, IF YOU WANT TO WATCH, IT WILL GIVE YOU SOME IDEAS ABOUT THE GAPS AND JUST VERY GOOD PRESENTATIONS AND VERY GOOD DISCUSSIONS. SO I SUGGEST IF YOU CAN, IF YOU ARE INTERESTED, YOU CAN GO BACK AND WATCH AND ALSO TO DISSEMINATE AND SEND US LINKS BECAUSE IT WOULD BE HELPFUL MAYBE TO SOMEONE ELSE IN YOUR AGENCIES WHO WOULD LIKE TO HEAR THIS. AND ANOTHER POINT WHICH I WANTED TO MAKE, ACTUALLY IS SOMETHING THAT SOMEONE TOLD ME WHO PRESENTED HERE, WHAT HE SUGGESTED, HE SAID THAT THIS MEETING IS NOT JUST OPPORTUNITY FOR US TO LEARN AND DECIDE WHAT ACTIONS NEEDS TO BE TAKEN, AND NOT JUST THE PUBLIC TO SEE WHAT WE'RE DOING BUT ALSO TO GOVERNMENT AGENCIES AND TO IT OTHER ORGANIZATIONS TO GET TOGETHER AND I THINK THIS IS GREAT OPPORTUNITY FOR US TO SEE WHO IS INTERESTED, WHO IS WORKING IN THIS FIELD AND WE CAN CORROBORATE, COMMUNICATE BETWEEN US BUT ALSO WE HAVE REPRESENTATION FROM THE PUBLIC AND WE ALSO AT SOME POINT WANT TO MAKE MORE TIME TO BE ABLE TO HEAR MORE AND SPEAK MORE AND DISCUSS MORE WITH EVERYONE ELSE TO THIS. >> WOULD ANYBODY LIKE A FINAL COMMENT BEFORE WE ADJOURN? I KNOW IT HAS BEEN A LONG DAY BUT IT HAS BEEN A REALLY RICH CONVERSATION AND AGAIN, THANK YOU AND THANK YOU NOT ONLY TO THE PRESENTERS FOR THE DISCUSSION BUT ALSO STAYING ENGAGED THE ENTIRE DAY. I WAS IMPRESSED. I CAME BACK AFTER MY OTHER MEETING AND PEOPLE WERE JUST AS ENGAGED AS THEY WERE THIS MORNING SO THANK YOU. ANYONE? >> THANK YOU FOR COMING. I JUST WANTED TO SAY THIS MEETING, REALLY ON BACK SIDE WAS VERY MUCH PREPARED BY SPECIAL ADVISORS AND I KNOW IT IS REALLY NOT A NECESSARY ROLE FOR A SPECIALIST TO DO THE LITTLE THINGS AND PREPARE SOME OTHER THINGS BUT OTHER THINGS BECAUSE NO ONE WAS HERE TO HELP AND I REALLY APPRECIATE THAT. [APPLAUSE] >> AND WITH THAT WE'RE ADJOURNED