1. Fostering FASD Research Capacity in Under-served, Under-represented Communities Developing FASD Interventions for Aboriginal Women Suggestions for an Urban-Based Approach

2. 1. Why do we need an urban-based approach for Aboriginal women? 2. What things should we consider when developing FASD interventions that would work well with Aboriginal women in urban settings? 3. What are our suggestions? Urban-Based Approach

3. Urban FASD Interventions: Bridging the Cultural Gap Between Aboriginal Women and Primary Care Physicians Paul Masotti, Karen Szala-Meneok, Peter Selby, Jennifer Ranford, and Alison Van Koughnett JFAS Int 2003;1:e17 October 2003 Developing a Fetal Alcohol Spectrum Disorder Intervention for Aboriginal Women in Urban Settings: A Primary Care Office-Based Approach Paul Masotti, Gideon Koren, Karen Szala-Meneok, Cornelia Wieman, & Peter Selby CIHR – Institute of Aboriginal Peoples’ Health Proposal. June 4, 2004. (Results Pending) Urban-Based Approach

4. Alcohol Consumption and FASD in Aboriginal Communities Demographic Changes (migration to urban centres) Cultural Gap in Urban-Based Primary Care Primary Care Offices as Points of Access Why do we need an urban-based approach for Aboriginal women?

5. What things should we consider when developing FASD interventions that would work well with Aboriginal women in urban settings? Bridge the cultural gap between Aboriginal women and non-Aboriginal primary care physicians - Consider the needs/characteristics of urban Aboriginal women - Consider the needs/characteristics of non-Aboriginal primary care physicians’ practice patterns and offices Collaborate with all appropriate stakeholders - Aboriginal women, Aboriginal organizations, primary care physicians, office staff, mental health and addictions professionals Focus on improving the relationship between non-Aboriginal physicians and Aboriginal women.

6. What are the characteristics of an office-based intervention that would work well with urban Aboriginal women and non-Aboriginal primary care physicians? Aboriginal Women Ability to identify ‘at risk’ women Women feel the encounter is culturally sensitive, respectful and non-threatening Accessible to women (time and place) Consider the women’s family situation (e.g., daycare needs) Primary Care Physicians Easily adopted, flexible, and aligned with standard office procedures Perceived as effective and valuable in addressing an important public health issue Compatible with clinical practice approaches Not be resource intensive Fee-for-service reimbursement should be considered appropriate

7. Suggested Approach 1.Facilitate/Develop a research relationship with Aboriginal organizations 2. Begin with a intervention model that has worked in other populations 3. Introduce a structured approach to evaluating and adapting the model 4. Active participation from stakeholders in developing the intervention and instruments - Key informant interviews, stakeholder specific focus groups, combined stakeholder focus groups, and implementation analysis (lessons learned, unintended consequences, and suggestions for improvement). - Stakeholders: Aboriginal women, Aboriginal organizations, primary care physicians & office staff, mental health & addictions professionals, and pilot test volunteers. 5. Pilot test and conduct an implementation analysis of the intervention and instruments

8. Our Suggestion Develop a Culturally Appropriate Office-Based Brief Alcohol Intervention

9. What is a Brief Alcohol Intervention? Brief interventions for heavy alcohol use derive from motivational interviewing and cognitive behavioural therapy modes. They usually consist of one or more short client-centred counseling sessions that focus on changing behaviour. Core Characteristics 1)Identifies ‘at risk’ people 2)Assesses drinking behaviours 3)Provides information on the harmful effects of drinking above recommended levels 4)Employs a method of delivery that facilitates the decision of ‘at- risk’ persons to adopt healthier drinking behaviours 5)Monitors changes or progress

10. Fostering FASD Research Capacity Who would benefit? Non-Aboriginal researchers & Aboriginal organizations - Bi-directional capacity-building takes place Primary care physicians and other health services providers Physician – patient relationships Aboriginal mothers and children