B2 Awareness, Prevention, Training and FASD Diagnostics at NorWest CHCs_Maureen Parkes & Anita Jean

CFPC Conflict of Interest

Disclosure of Commercial Support Presenter Disclosure Presenters:

Maureen Parkes Anita Jean

Relationships with commercial interests: • • • •

Grants/Research Support: Speakers Bureau/Honoraria: Consulting Fees: Other:

None None None None

Awareness, Prevention, Training and FASD Diagnostics at NorWest CHCs Maureen Parkes, FASD Coordinator Anita Jean, Manager, Health & Social Programs

Every One Matters.

Learning Objectives ∗ Sharing of our experience to illustrate the development of an FASD program. ∗ How to expand with little additional funding. ∗ How to develop programs and services by layers. ∗ Building community engagement to enhance partnerships and awareness. ∗ How the CHC environment is ideal for FASD diagnostics.

Goodness of Fit with Conference ∗ Best practice to keep people healthy in our efforts to raise awareness that “there is no safe amount of alcohol during pregnancy”. ∗ Working upstream with partners to prevent the incidence of FASD. ∗ Working with partners at the local level, as well as regionally and provincially. ∗ Finding the best fit for what the CHC can contribute.

NorWest CHCs ∗ NorWest CHCs is a primary care model ∗ We serve people who have a higher risk of poor health. ∗ People who are having difficulty finding health care because of language, cultural barriers, poverty or isolation. ∗ We consider the social, emotional and financial needs of our clients, since these factors affect a person's health.

How do we provide care? Collaborative or “Team” Care REGISTERED NURSE & PRACTICAL NURSE

PHYSICIAN NURSE PRACTITIONER

FOOT CARE NURSE

THERAPIST

CLIENT COMMUNITY HEALTH WORKER

DIETITIAN

TELEMEDICINE NURSE COORDINATOR

FASD COORDINATOR

EARLY CHILDHOOD EDUCATOR

NorWest CHCs Continued… ∗ Our team features family physicians, nurses, nurse practitioners, counsellors, dietitians, nutrition workers, community health workers, early childcare educators, and support staff. ∗ We have provided health care in Thunder Bay for over 24 years. ∗ We are funded through the North West Local Health Integration Network (NWLHIN), with no dedicated FASD funding. ∗ We provide primary health care to approximately 14,000 clients at 3 sites in the District of Thunder Bay.

Humble Start for FASD Programs ∗ In 2001 we responded to the request by community members to assist with the development of an FASD Coalition with approximately 20 partner agencies. ∗ We initially secured $117,000 of Ontario Trillium Funding over three years. ∗ We create awareness by having a yearly event since inception.

Community Development Approach

∗ Developing Partnerships and enhancing community capacity. ∗ Mobilizing local resources (FASD Coalition) and training FASD resource people in agencies serving individuals with FASD. ∗ Experience with clients gained through 2 funded proposals for alternative programming. Maintain this experience with the community kitchen.

Community Development Approach

∗ Respond to caregiver needs and to clients served. A parenting program was modified to a caregiver program. ∗ Grounded in the needs of the community (piloting a peer lead support group).

Development of Diagnostic Capacity

∗ Since 2004, referrals had been made to the FASD diagnostic clinic at St. Michael’s Hospital. ∗ In 2007 we recruited two physicians and two NP’s on site, to start the diagnostic process in Thunder Bay allowing patients to have initial intake in Thunder Bay and not needing two trips to Toronto, Ontario. ∗ We slowly transitioned to completing the full assessment and diagnostic clinics on site.

Development of Diagnostic Capacity

∗ 2009-2014 we have assessed approximately 156 clients and diagnosed 131 with FASD. ∗ We receive approximate 5 referrals per week from the region.

Milestones ∗ Being invited by the FAS/E Support Network of British Columbia for training in a program funded by Health Canada. ∗ The Coordinator can prepare clients for referrals, building a relationship with Diagnostic Clinics. ∗ Partnership with St. Michael’s FASD Diagnostic Clinic.

Milestones ∗ Building credibility to secure year-end funding to train and expand the diagnostic team.

Adding On Within Your Agency ∗ Environmental scan of community resources. ∗ Choose people who have good communication skills and are compassionate. ∗ Utilize current resources to provide a variety of services. ∗ Not always necessary to pull people in full time, may utilise several key players part time.

Adding On Within Your Agency cont., • Non clinical staff are the key when providing non diagnostic supports and services.

• Provide training especially in communication and psycho/social needs of this population.

• Look at the population needs in your community/region and ensure services meet their needs.

Community Resources ∗ Community resources are our greatest asset. ∗ By early engagement with key partners, providing education and supporting clients. ∗ Ask what can the agency do to help support the client in not only receiving a diagnosis but continue to engage in services. ∗ Treatment plans with agencies are helpful.

Community Health Centre Based Resources ∗ FASD Coordinator ∗ Community Health Workers ∗ Program Assistants ∗ Nutrition Worker ∗ Community Health Nurse ∗ Aboriginal Community Health Worker who provides culturally sensitive programming ∗ CHW provide free income tax services and offer support in filling out variety of forms

Community Case Management ∗ Role is to provide intensive case management for clients with an FASD diagnosis or pre-diagnosis. ∗ Community based resource for clients, families, health care providers and other community partners. ∗ Support clients in receiving medical care in the clinic and in the community. Attend appointments with the client. ∗ Home visits, ID replacement, money management, housing, and facilitate peer led FASD support group.

Use of Ontario Telemedicine Network ∗ Initially clients were seen by the diagnostic team face to face in Toronto . ∗ Transitioned to into use of OTN with St. Michael’s Hospital from our site with the addition of CHC medical staff. ∗ We are now able to offer initial interviews and consultations with clients in Northern Ontario with the FASD coordinator via OTN.

Primary Health Care ∗ Half the clients being seen have no primary health care providers, we accept these clients for primary care. ∗ All clinic staff have training in FASD and can gear primary health care to this population. ∗ We complete approximately 30 applications a year for Ontario Disability Support Program.

Increasing Community Capacity ∗ Yearly FASD Awareness Day since 2002. ∗ This includes a variety of speakers and for minimal cost open to community agencies and evening sessions for parents, clients and supports. ∗ Featured a live theatre production at an awareness event. ∗ Awareness Day event a 4 local Liquor Control Board of Ontario (LCBO) liquor stores in the city.

FASD Programs ∗ Bi-weekly community kitchen that focuses on hands on food preparation component and life skills components. ∗ Bi-monthly community outings to develop social skills and promote safe activities. ∗ Peer lead support group running once monthly up to 30 clients invited with a core group of 6 that attend.

FASD Education ∗ 8 Week Education Program for Parents; Caregivers; Family Members and Friends. ∗ 4 Day Intensive FASD Training program to Child and Youth Worker students at our Community College. ∗ Regular education session about the dangers of drinking while pregnant to all grade 10 students in the Catholic School Board.

Community Partnerships ∗ Children’s Aid Society ∗ Dilico Anishinabek Family Care ∗ Children’s Centre Thunder Bay ∗ Confederation College ∗ Northern Ontario School of Medicine ∗ School Boards ∗ Addiction Services ∗ And so on………….

Four Levels of Prevention – Public Health Agency of Canada - Adapted Policies That Decrease Alcohol Consumption

Level 4 Postpartum Support Postpartum support for new mothers to help maintain & initiate changes to support development of child.

Postpartum = Preconception

Level 1 Raising Awareness Involves broad awareness building and health promotion efforts media campaigns

Prevention of FASD

Fetal Alcohol Spectrum Disorder (FASD) Prevention: Canadian Perspectives- Multiple Approaches to FASD Prevention (2008)

Level 2 Brief Counselling with Girls & Women of Childbearing Age Discussion of alcohol use and risks with all women of childbearing years

Level 3 Specialized Prenatal Support Specialized holistic support of pregnant women with alcohol & other health/social problems

Prevention

∗ Primary care model allows us to provide on site birth control to clients ∗ Off site programs also screen and offer birth control to all women ∗ All women are screened for alcohol use who are planning to become pregnant or at risk of becoming pregnant

Prevention is also Education ∗ All disciplines can take the opportunity within their fields to education others on FASD ∗ A 2012 meeting of Ontario nurses has lead to a interest group providing a variety of education to nurses in all areas on prevention, diagnosis and how to provide the best care to this patient population

Where Else Are Services Being Provided ∗ Screening and identification of at risk clients are done at a variety of programs and settings. ∗ Mobile teams that go to rural communities can refer. ∗ NP’s work at a variety of locations in the city such as youth corrections, homeless shelters, detox centre and high risk neighbourhoods. They are trained to identify possible clients and refer to the diagnostic clinic.

Suitability of CHC Environment ∗ Do not bill for services, salaried staff, EMR. ∗ Range of providers under one roof (MDs, NPs, RNs, CHWs, Therapists, access to a Psychiatrist for consults). ∗ Points of access via the Mobile Health Services and Outreach sites. ∗ Can do diagnostics, support and programming under one roof. ∗ Key partnerships – OTN sites, GAAPS, school boards, child protection agencies, correctional facilities, detox & shelter. ∗ Community development approach grounded in the determinants of health.

Strategy Development ∗ Occurred at three points: ∗ When we received the initial funding in 2002, as part of a community consultation process. ∗ In 2010, after we mapped out strategies from funding sources and considered our capacity. ∗ In 2014, when we looked at what we wanted to achieve and to build our case for dedicated funding.

Outcome Evaluation ∗ Conduct a pre/post evaluation after every program or training event to measure the outcome (self reported skills, knowledge, behaviour change, satisfaction with program or training). ∗ Outlined the process for diagnostics, streamlined and quantified the time required by type of provider for funding requests. ∗ Would like to research client outcome from the diagnostic process.

Challenges ∗ Need to maintain our commitments to our funder in terms of active clients, number of service encounters, without any dedicated funding for FASD activities such as diagnostics. ∗ Not able to provide the range of services. Our community kitchen is for clients within a narrow spectrum of individuals with FASD. ∗ We are still learning from program delivery. Peer lead support group changes to be implemented (more visual).

Thank you for your interest!

Maureen and Anita mparkes@norwestchc.org ajean@norwestchc.org NorWest CHCs - Thunder Bay Site Thunder Bay, ON P7C 3J6 Telephone: 807.622.8235 Toll Free: 1.866.357.5454 Website: www.norwestchc.org