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Prevention of fetal alcohol spectrum disorders: educational needs in academia.

ABSTRACT

As many as 4.5 live births per 1000 are affected by fetal alcohol spectrum disorders (FASDs), preventable birth defects with lifelong consequences. Prevention of FASDs is gaining in importance, and recruitment of diverse disciplines in delivering prevention to women of childbearing age is essential. This needs assessment explored to what extent FASD education has been embraced by academic programs and incorporated into curricula. Results (based on 45 programs) suggest that directors are open to FASD education for trainees but with few resources to support it within their own programs. Misunderstandings about their own disciplines' roles vis-a-vis FASD prevention may limit their commitment to incorporating FASD requirements into their programs. Entities interested in facilitating FASD prevention need to be prepared to educate directors about their disciplines' roles in FASD prevention and to make resources available that are neither cost- nor time-intensive. Online resources and clearinghouses of guest lecturers prepared to deliver a variety of contents and methods appear particularly likely to bear fruit.

Keywords: fetal alcohol syndrome, fetal alcohol spectrum disorders, alcohol abuse, alcohol dependence

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Since the term fetal alcohol syndrome (FAS) was coined by Jones and Smith (1973), research has enhanced understanding of the complex consequences of prenatal alcohol exposure. FAS, a diagnosis requiting a specific pattern of facial features, is but one outcome of prenatal alcohol exposure. A much wider range of adverse effects of alcohol on the fetus is described as fetal alcohol spectrum disorders (FASDs). FASDs encompass "the full range, from mild to severe, of disturbances of physical, behavioral, emotional, or social functioning attributable to in utero alcohol damage" (Streissguth & O'Malley, 2000, p. 178). Several factors combine to determine the extent to which an exposed child will evidence symptoms, including how much alcohol is consumed, at what stage in pregnancy alcohol is consumed, and individual, genetic, nutritional, and metabolic factors of mother and fetus (Maier & West, 2001).

Despite increased knowledge related to the dangers of prenatal alcohol exposure and two public health advisory warnings by Surgeons General in 1981 and 2005, 12% of pregnant women report drinking alcohol, and up to 2% report binge drinking in the last 30 days (Food and Drug Administration, 1981; Office of the Surgeon General, 2005; Centers for Disease Control and Prevention, 2009). Commensurately, prevalence estimates suggest that 0.5 to 2 per 1,000 individual are born with FAS every year (Bertrand et al., 2004); estimates for FASDs are three times higher, approximately 4.5 per 1,000 live birth (May & Gossage, 2001).

With regard to the substantial financial burden associated with FAS, annual cost estimates to the nation are $3.6 billion, and lifetime cost estimates are as high as $1.6 million per affected individual (Lupton, Burd, and Harwood, 2004). One cost study specific to Alaska estimated costs for FAS births for 1999 based on 14 FAS births and found the lifetime economic cost for these individuals to the State of Alaska totaled approximately $21 million (McDowell Group, 2001). Since these cost estimates are based on FAS alone, it is expected that the collective costs related to prenatal alcohol exposure are much higher. One measure used to assess the impact of specific health problems is to calculate the population- attributable-risk (PAR), or the proportion of cases for a given condition that may be attributable to etiologic factors. In the case of FASDs, the only cause is prenatal alcohol use. If exposure can be prevented through risk reduction interventions with women, FASDs are completely preventable, making the PAR 100% given that prenatal alcohol exposure is the only cause.

Current knowledge related to effects of prenatal exposure clarifies that medical, allied health, and behavioral health professionals play an important role in primary and secondary prevention of FASDs. They can master this role only if they have an adequate foundation of knowledge and skills related to FASD prevention, diagnosis, and treatment. To provide guidance about FASD-related training needs of professionals and students, the Centers for Disease Control and Prevention (CDC) have identified core competencies that consist of seven primary areas of knowledge and practice behaviors: (a) background and foundational FASD knowledge, (b) screening and brief interventions for women, (c) models of addiction, (d) biomedical basis of FASDs, (e) diagnosis and assessment of FAS, (f) life-long care and treatment strategies, and (g) ethical, legal, and policy issues (FASD Regional Training Centers Curriculum Development Team, 2009). These domains are viewed as crucial to successful prevention, identification, diagnosis, and management of FASDs and recommended for inclusion in the education of students who aspire to become healthcare practitioners. To enhance dissemination of this information, the CDC has funded five FASD Regional Training Centers (RTCs), each charged with developing and implementing FASD curricula for professionals and academic programs and tailored to regional needs.

This needs assessment explored to what extent FASD education, as related to CDC's FASD core competencies, has been embraced by academic programs and incorporated into healthcare curricula in university courses in Alaska, the site of one of the CDC FASD RTCs. The Arctic FASD Regional Training Center explored currently-offered FASD-related education in health and allied health programs, interest in FASD information, and preferences about delivery and content.

METHOD

Participants

Academic directors (or designees) of 52 health and allied health programs offered at degree-granting post-secondary education institutions in Alaska were asked to participate in an online survey to assess FASD-related educational needs. Surveyed disciplines covered three healthcare fields: medicine, behavioral health, and allied health programs. Medical programs included physician training programs and nursing programs. Behavioral health programs included psychology, sociology, counseling, social work, human services, occupational therapy, and special education. Allied health programs included health sciences, speech and language pathology, medical assisting, and dental hygiene. Programs ranged across all degree levels (preparatory, certificate, associate, baccalaureate, masters, doctoral). Responses were received from 38 directors representing 45 programs for a program-level response rate of 87%."

Instrumentation

An online survey tool, created in Perseus survey software and self-administered online, required approximately 20 minutes to complete. A set of questions was developed to tap the specific contents of interest. These questions, although independent of one another, can be divided into four areas as described below. A copy can be obtained from the first author.

1. Current FASD-Related Program Activities. Eight questions, three of which were open-ended, asked respondents to detail courses with FASD content and faculty trained to teach FASD content. Answers were recorded on a four-point Likert scale that ranged from 0 (not at all) to 3 (to a very great extent).

2. Relevance of CDC's FASD Core Competencies to Programs. For each of the seven CDC FASD core competencies, three questions were asked regarding the importance of each competency, to what extent it was addressed in a program's curriculum, and degree of interest in receiving assistance from the Arctic FASD RTC in adding or supplementing this information to the program. Questions were presented on a four-point Likert scale that ranged from 0 (not at all) to 3 (very much). Respondents were asked if they were interested in collaborating with the Arctic FASD RTC in adding FASD core competencies to their programs' curricula.

3. Perceptions of Various FASD Resources. Questions assessed the perceived helpfulness of FASD-related resources and program supports to faculty, including courses that could be developed and taught by RTC staff as part of the program. Three sub-sections addressed resources and program support for faculty, resources and program support for students, and the addition of courses as program requirements or electives. For faculty, 12 potentially helpful resources, including guest speakers, websites, publications, video or teleconferences, workshops, and conferences, were listed. For students, 16 potentially helpful resources, including overview lectures, tailored lectures, one or three credit courses, guest speakers, handouts, audiovisual materials, and websites, were listed. For each suggestion, respondents were asked to identify whether these resources would be helpful to the given target group, using a scale that ranged from 0 (not at all helpful) to 3 (very helpful). Finally, respondents were asked whether they would consider adding elective or required courses (one or three credits) with FASD or substance abuse content.

4. FASD Licensure Requirements. Participants were queried about graduates' eligibility to apply for a professional license or certificate. If yes, respondents' support of FASD-related knowledge as a requirement for obtaining or maintaining this license or certification was probed on a scale ranging from 0 (strongly do not support) to 3 (strongly support).

Procedures

Prior to implementation, the needs assessment plan was reviewed and approved by the University of Alaska Anchorage Institutional Review Board. Participants were identified by obtaining publicly available lists of academic directors and coordinators of health and allied health programs at post-secondary institutions in Alaska. Lists were obtained through university websites and online directories at the University of Alaska Southeast, University of Alaska Anchorage, University of Alaska Fairbanks, and Alaska Pacific University. Each program director received a telephone call outlining the scope of the survey and assessing willingness to participate. Interested individuals were sent an email containing an individualized link to the online survey. If directors did not complete the survey upon receipt of the first email, they were sent reminder emails until the survey was completed or the survey period ended. No incentive for participation was provided. Once participants clicked on the survey link, they were taken to the survey website, where they could access the survey only after indicating that they had read and understood the informed consent and agreed to participate.

Statistical Analyses

Two sets of independent variables were developed, one based on academic discipline, the other on geographical region. Of 45 academic directors surveyed, six represented medicine-related programs, 24 represented behavioral health programs, and 15 represented allied health programs. Based upon geographical grouping, 29 academic directors were identified as serving programs in urban areas and 16 representing rural settings. Only descriptive analyses were calculated given the small sample size.

RESULTS

Interest in FASD Education

The interest of academic directors in FASD education was probed based upon their perceptions of what their program did, could, or should offer in the area of FASD education. See Table 1. Academic directors of both medicine programs and rurally-based healthcare training programs strongly endorsed the notion that FASD education belonged within their disciplines but were less interested in adding FASD education or collaborating with an FASD regional training center (RTC) to increase FASD competency. Academic directors from behavioral health, allied health, and urban areas perceived congruence between their training programs' mission and FASD work and indicated greater interest in collaborating with an RTC or adding FASD education.

Although few programs included courses with exclusive focus on FASD, programs offering FASD courses were found in behavioral health disciplines in rural and urban settings. Nearly 87% of programs in allied health did not offer courses containing FASD content, yet modal number of courses among those that did was relatively high (3). This compares with behavioral health disciplines, for which 9% did not offer any FASD content in courses but had lower modal number (2) of these courses. Substance abuse courses were offered exclusively in behavioral health programs evenly across rural and urban settings. In programs where graduates are eligible to seek licensure or certification, nearly half the directors indicated support for FASD education requirements for licensure attainment; an even larger percentage supported FASD education requirements for licensure maintenance.

Interest in Adding FASD or Related Courses

Over half of academic directors indicated willingness to encourage students to take a 1-credit course in FASD (56.1%) or substance abuse (53.66%); few were willing to require 1- or 3-credit courses in FASD (2.44% and 3.66%, respectively) or substance abuse (2.44% and 3.66%, respectively). See Table 2. All respondents willing to consider requiring these courses directed behavioral health training programs in rural areas. Allied health, medicine, and urban-based directors affirmed statements related to encouraging students to take FASD or substance abuse courses offered by other programs, indicating little interest in integrating FASD into their own programs.

Perceptions of the Importance of CDC's FASD Core Competencies

Directors perceived all competencies as somewhat important, with little variability across disciplines or regions. See Table 3. Medical program directors rated competencies related to screening and brief interventions for women and to life-long care and treatment strategies slightly lower than other competencies. Allied health program directors rated competencies related to models of addictions and assessment and diagnosis as least important to their profession. Rural directors did not place as much emphasis on assessment and diagnosis as on other competency areas.

Current Coverage of CDC's FASD Core Competencies

Current coverage of topics reflected nearly identical patterns of evaluation. See Table 4. Clearly, for most respondents importance and current coverage appeared inextricably linked. Director ratings suggest that programs are currently covering the topics they deem most important.

Interest in Collaboration Related to CDC's FASD Core Competencies

Interest in collaborating with an FASD regional training center to increase FASD education was directly proportional to ratings of importance. See Table 5. Directors were most likely to indicate willingness to collaborate on topics they deemed most important. Collaboration ratings were consistently lower than importance (or coverage) ratings, suggesting that directors are slightly less open to collaboration than they are convinced of FASD topics' importance Top Resources for Educating Faculty

Program directors ranked resources they considered most beneficial to educating faculty on FASDs. See Table 6. Although resource preferences varied across disciplines and geographies, it appeared that downloadable self-study modules, videos and DVDs, and guest lectures held greatest value. Directors agreed that academic courses were non-viable resources for educating faculty.

Top Resources for Educating Students

Program directors also ranked resources they thought most beneficial to educating students on FASDs. See Table 7. Most helpful resources included short lectures (with tailored content or overviews), expert guest speakers, access to recent publications and websites on FASD. Directors universally designated FASD credit courses as being least helpful for their students.

DISCUSSION

This study explored currently offered FASD education as well as interest in and preferences about FASD education in the context of CDC FASD core competencies among training program directors across Alaska. Results revealed interesting preferences and interests across disciplines and geographies as well as insights about FASD knowledge, perceptions, and misperceptions. Results are discussed in the context of FASD educational practices and preferences, closing with implications for dissemination of FASD information and preparation of providers to provide FASD services.

Openness to FASD Education

Directors of academic programs, especially in medicine and behavioral health, recognized the importance of FASD issues to their programs' missions. Although few programs actually teach courses entirely dedicated to FASD, behavioral health and medical programs tend to include at least some FASD-content related courses, such as courses dealing with diagnostic and assessment issues, prevention, and substance abuse. Allied health programs appeared less convinced of the relevance of FASDs to their missions, with nearly 90% of allied health programs not covering FASD- or substance abuse-related content in any course work. Likely, most outreach work to date has not adequately reached providers such as dentists, dental assistants, medical technologists, and similar specialized supportive healthcare services. This oversight might have important consequences as emerging data underscore these professionals' roles in prevention, identification, and treatment. For example, dentists have an important diagnostic role as they may see dental evidence of FASDs before other providers recognize the disorder in a young child (Itthagarun, Nair, Epstein, & King, 2007; Sant'Anna & Tosella, 2006). Radiology technicians have a role in prevention as they often have immediate access to women of child-bearing age through ultrasound and similar procedures (Bookstein et al., 2005; Kurjak, Azumendi, Andonotopo, & Salihagic-Kadic, 2007; Stoll & Clementi, 2003).

Speaking to challenges of adding contents to programmatic curricula, respondents were not enthusiastic about adding required courses on substance abuse or FASDs, though they were willing to endorse these courses for their students as electives. Despite guardedness about adding new courses, a large proportion of respondents overall, and in medicine and behavioral health in particular, were supportive of requiring FASD education as a condition for obtaining, and even more so, maintaining profession-specific licensure or certification. Clearly, program directors understand the need for FASD education, however, as they face realities of overburdened academic programs and curriculum paperwork, they do not want their programs to become responsible for providing this education. Allied health groups, which are least convinced of the value of FASD education, nevertheless recognize that their providers ultimately will face these issues in practice. Thus, they endorse elective courses in FASDs, while being opposed to making programmatic changes.

Patterns of Interest as Related to CDC's FASD Core Competencies

When respondents rated importance, coverage, and interest in developing educational collaborations for the CDC FASD core competencies, interesting patterns emerged. Importantly, most respondents' ratings of importance and current coverage were inextricably linked. Willingness to collaborate around particular core competencies was proportionate to importance (and hence coverage) ratings, suggesting that directors were fairly satisfied with the current levels of coverage of FASD content.

Figure 1, below, shows relative importance rankings of FASD competencies by disciplines and region. This information suggests that misperceptions about FASDs may be present among respondents as ratings of importance do not coincide with the FASD prevention literature. For example, medical program directors ranked screening and brief intervention with women as their least relevant competency. Given that medical providers are at the forefront of interactions with women of child-bearing age and women seeking to get pregnant, the low importance afforded to this competency (relative to others) suggest medical directors do not have a realistic understanding of best avenues for FASD prevention. Similarly, directors of allied health programs failed to appreciate the potential role of their graduates in assessment, diagnosis, and prevention with individuals who evidence alcohol abuse or dependence.

Preferences Related to Training Modalities

Directors' patterns related to training modalities for faculty versus students reflect that they perceive faculty as too busy to attend courses or lengthy presentations. They suggest FASD education targeted at professors be geared toward quick delivery, scientific foci, and online access. Training materials that can be easily digested and used in the classroom also were popular. With regard to resources for students, directors had much agreement, with brief tailored or general lectures being viewed as most useful. Guest speakers were perceived as helpful as were audiovisual materials that can easily be used in classrooms as part of existing curricula. Generally speaking, regardless of discipline or audience, focus appeared to be on rapid delivery with online access and content that can be worked into existing courses. Clearly, directors, while endorsing the importance of FASD, did not perceive the topic to be of sufficient importance to warrant time-consuming coverage. This reality most likely reflects already overloaded curricula and difficult choices about most essential contents for adequate discipline-specific education. Finding room for additional contents likely is perceived as stretching program resources to a degree not compatible with perceived importance or urgency of the topic of FASDs.

[FIGURE 1 OMITTED]

Implications of Directors 'FASD-Related Educational Preferences and Values

Information gathered leads to several important conclusions and recommendations about FASD education. In terms of conclusions, it appears that the importance of FASDs is beginning to be appreciated by most relevant disciplines, though perhaps not to the degree that emergent data would suggest. Allied heath programs, in particular, appear to underestimate the importance of being able to recognize, understand, and intervene with individuals with FASDs or with women at risk of giving birth to children with FASDs. Medical program directors appear to underestimate the importance of graduates' ability to screen and intervene with women and to provide lifelong treatment to individuals with FASDs. Directors of behavioral health programs appear most well-informed. Most likely, given behavioral and neurological consequences for individuals with FASDs, graduates from behavioral health programs have had to deal with FASD-related issues more directly, especially as related to lifetime treatment and early intervention with at-risk women.

Several recommendations reasonably based on this survey are presented below in no particular order of emphasis. All recommendations are equally important to successful FASD prevention, identification, and intervention across a broad spectrum of healthcare settings.

RECOMMENDATIONS

1. Focus educational attempts on helping all health, allied health, and behavioral health program directors recognize the importance of FASD primary and secondary prevention activities within their disciplines. For example, FASD Regional Training Centers can assure that:

a. Medical and many allied healthcare providers understand the value of primary prevention to their special access to women of child-bearing age and women who are planning pregnancies or who are pregnant.

b. Allied healthcare providers recognize that specialized services they provide put them in contact with individuals who potentially have FASDs and may lead to earlier identification and secondary prevention.

c. Behavioral healthcare providers utilize their contacts with high-risk groups for primary and targeted prevention activities, especially with female clients of child-bearing age who are abusing alcohol and who are either contemplating pregnancy or engaging in unprotected sex.

2. Provide academic FASD education opportunities that do not strain program resources, fit seamlessly into program requirements across departments and disciplines, and address the full spectrum of FASD competencies. For example, FASD Regional Training Centers can:

a. Develop and offer multi- or interdisciplinary courses on specialized FASD contents that can be made available as elective course credits across many disciplines and programs.

b. Become clearinghouses for information about which programs in a state or university have courses with FASD contents that could be used by trainees across other disciplines.

c. Offer online FASD courses that can be made available widely across geographies and disciplines. 3. Make use of preferred strategies and methods for educating faculty and students about FASDs and FASD core competencies. For example, use of the following strategies should be emphasized:

a. Online resources, with separate portals for faculty and students, that span the spectrum from links to other websites, to articles and up-to-date research, to downloadable lecture and lecture notes, to discipline-specific audiovisual materials that can supplement lectures

b. Clearinghouses that can coordinate the availability of guest speakers for short lectures on a variety of topics

Results suggest that directors of training programs are open to FASD education for their trainees but include few resources and program requirements to support such education within their own programs. Misunderstandings about their own disciplines' roles vis-a-vis primary and secondary prevention may limit their commitment to trying to incorporate FASD education into their programs. Entities interested in facilitating FASD prevention thus need to be prepared to educate educators about the role of their disciplines in FASD prevention and to make resources available that are neither cost nor time intensive to academic departments and programs. Online resources and clearinghouses of guest lecturers prepared to deliver a variety of content and methods appear particularly likely to bear fruit.

ACKNOWLEDGMENTS

This project was supported by Cooperative Agreement Number 1U84DD000439 from the Centers for Disorder Control and Prevention (PI--C. Brems). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

We gratefully acknowledge the contributions of Michael Baldwin at the Alaska Mental Health Trust Authority, Mark E. Johnson and Ginger Mongeau at the Center for Behavioral Health Research and Services, and Elizabeth Dang at the Centers for Disease Control and Prevention.

Correspondence concerning this article should be addressed to: Christiane Brems, Ph.D., ABPP, Center for Behavioral Health Research and Services (CBHRS), University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK 99508; email: afcb@uaa.alaska.edu; 907-786-6381; 907-786-6382 (fax)

Additional authors are: Rachel V. Boschma-Wynn, Center for Behavioral Health Research and Services (CBHRS), University of Alaska Anchorage, P.O. Box 241626, Anchorage, AK 995241626; email: asrvw3@uaa.alaska.edu; 907-786-6381; 907-7866382 (fax)

Sarah L. Dewane, Ph.D., Center for Behavioral Health Research and Services (CBHRS), University of Alaska Anchorage, P.O. Box 241626, Anchorage, AK 99524-1626; email: ansld2@uaa. alaska.edu; 907-786-6381; 907-786-6382 (fax)

Alexandra Edwards, M.A., Center for Behavioral Health Research and Services (CBHRS), University of AlaskaAnchorage, P.O. Box 241626, Anchorage, AK 99524-1626; email: anae@uaa. alaska.edu; 907-786-6381; 907-786-6382 (fax)

Rebecca Volino Robinson, Center for Behavioral Health Research and Services (CBHRS), University of AlaskaAnchorage, P.O. Box 241626, Anchorage, AK 99524-1626; email: asrrvl@ uaa.alaska.edu; 907-786-6381; 907-786-6382 (fax)

REFERENCES

Bertrand, J., Floyd, R. L., Weber, M. K., O'Connor, M., Riley, E. P., Johnson, K. A., et al. (2004). Fetal alcohol syndrome: Guidelines for referral and diagnosis. Atlanta, GA: Centers for Disease Control and Prevention.

Bookstein, F. L., Connor, P. D., Covell, K. D., Barr, H. M., Gleason, C. A., Szee, R. W., & Streissguth, S. P. (2005). Preliminary evidence that prenatal alcohol damage may be visible in averaged ultrasound images of the neonatal human corpus callosum. Alcohol, 36, 151-160.

Centers for Disease Control and Prevention. (2009). Alcohol use among pregnant and nonpregnant women of childbearing age--United States, 1991-2005. Morbidity and Mortality Weekly Report, 58(19), 529-532.

FASD Regional Training Centers Curriculum Development Team. (2009). Fetal alcohol spectrum disorders competency-based curriculum development guide for medical and allied health education and practice. Atlanta, GA: Centers for Disease Control and Prevention.

Food and Drug Administration (1981). Surgeon General's advisory on alcohol and pregnancy. FDA Drug Bulletin, 11(2), 9-10.

Itthagarun, A., Nair, R. G., Epstein, J. B., & King, N. M. (2007). Fetal Alcohol Syndrome: Case report and review of the literature. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, 103, e20-e25.

Jones, K. L., & Smith, D. W. (1973). Recognition of the fetal alcohol syndrome in early infancy. Lancet, 2, 999-1001.

Kurjak, A., Azumendi, G., Andonotopo, W., & Salihagic-Kadic, A. (2007). Three- and four-dimensional ultrasonography for the structural and functional evaluation of the fetal face. American Journal of Obstetric Gynecology, 196, 16-28.

Lupton, C., Burd, L., & Harwood, R. (2004). Cost of fetal alcohol spectrum disorders. American Journal of Medical Genetics, 127, 42-50.

Maier, S. E., & West, J. R. (2001). Drinking patterns and alcoholrelated birth defects. Alcohol Research and Health, 25(3), 168-174.

May, P. A., & Gossage, J. P. (2001). Estimating the prevalence of fetal alcohol syndrome: A summary. Alcoholism: Clinical & Experimental Research, 25, 159-167.

McDowell Group. (2001). Economic costs of alcohol and other drug abuse in Alaska, Phase two. Report prepared for the Advisory Board on Alcoholism and Drug Abuse, Alaska Department of Health and Social Services. Juneau, AK: McDowell Group.

Office of the Surgeon General, U.S. Department of Health and Human Services. (2005). Advisory on alcohol use in pregnancy. Retrieved March 2, 2010, from http://www.surgeongeneral.gov/pressreleases/sg02222005.html

Sant'Anna, L. B., & Tosella, D. O. (2006). Fetal alcohol syndrome and developing craniofacial and dental structures - a review. Orthodontics and Craniofacial Research, 9, 172-185.

Stoll, C. & Clementi, M. (2003). Prenatal diagnosis of dysmorphic syndromes by routine fetal ultrasound examination across Europe. Ultrasound in Obstetrics and Gynecology, 21, 543-551.

Streissguth, A. P., & O'Malley, K. (2000). Neuropsychiatric implications and long-term consequences of fetal alcohol spectrum disorders. Seminars in Clinical Neuropsychiatry, 5, 177-190.

Christiane Brems, Ph.D., ABPP

Rachel V. Boschma-Wynn

Sarah L. Dewane, MS

Alexandra Edwards & Rebecca Volino Robinson

University of Alaska Anchorage
TABLE 1
Interest in FASD Education

 Behavioral
 Medicine Health Allied Health

 N = 6 N = 24 N = 15

 Mean SD Mean SD Mean SD

Fit of FASD with 3.17 0.75 2.92 1.02 1.80 0.41
Mission

Inclusion of FASD 2.67 0.52 2.42 0.58 1.33 0.49
Educ.

Faculty's Educ. in 2.83 0.98 2.42 0.65 1.93 0.70
FASD

Interest in Add-ing 2.33 1.03 2.83 1.01 2.00 0.65
FASD Educ.

Interest in FASD 2.00 0.89 3.29 1.00 2.07 0.70
RTC Collaboration

% with No FASD 100% 75% 100%
Courses

% with No Courses 0% 9.09% 86.67%
with FASD content (n=5) (n=22)

Modal number of 5 2 3
Courses with FASD (n=5 (n=22)
Content

% with Substance 0% 39.13% 0%
Abuse Courses (n=23) (n=12)

% Supportive
of FASD Educ 60% 47% 42%
for Licensure/ (n=5) (n=15) (n=12)
Certification

% Supportive of 80% 67% 42%
FASD Educ to
Maintain Licensure

 Urban Rural Overall

 N = 29 N = 16 N = 45

 Mean SD Mean SD Mean SD

Fit of FASD with 2.69 0.85 2.38 1.20 2.58 0.99
Mission

Inclusion of FASD 2.07 0.80 2.13 0.72 2.09 0.76
Educ.

Faculty's Educ. in 2.34 0.67 2.25 0.93 2.31 0.76
FASD

Interest in Add-ing 2.66 0.94 2.19 0.98 2.49 0.97
FASD Educ.

Interest in FASD 3.03 0.98 2.13 1.02 2.71 1.08
RTC Collaboration

% with No FASD 86.21% 87.50% 86.67%
Courses

% with No Courses 42.86% 21.43% 35.71%
with FASD content (n=42)

Modal number of 2, SD = 1.58 3, SD = 2.65 2, SD = 2.41
Courses with FASD
Content

% with Substance 21.43% 23.08% 21.95%
Abuse Courses (n=41)

% Supportive
of FASD Educ 38% 64% 47%
for Licensure/ (n=21) (n=11) (n=32)
Certification

% Supportive of 43% 91% 59%
FASD Educ to (n=32)
Maintain Licensure

* Means based on Likert scale ranging from 1 (not at all) to 4
(to a great extent)

TABLE 2
Interest in Adding FASD or Related Courses

 Behavioral
 Medicine Health Allied Health

 N = 6 N = 23 N = 12

 % yes % yes % yes

Encourage 1-Credit FASD 33% 39% 100%
Course

Encourage 3-Credit FASD 33% 22% 75%
Course

Encourage 1-Credit SA * 33% 39% 92%
Course

Encourage 3-Credit SA 33% 17% 75%
Course

Add 1-Credit Elective FASD 17% 32.61% 8.5%
Course

Add 3-Credit Elective FASD 8.5% 36.96% 4%
Course

Add 1-Credit Elective SA 17% 23.91% 21%
Course

Add 3-Credit Elective SA 8.5% 28.26% 4%
Course

Add 1-Credit Required 0% 4.34% 0%
FASD Course

Add 3-Credit Required 0% 6.52% 0%
FASD Course

Add 1-Credit Required SA 0% 4.34% 0%
Course

Add 3-Credit Required SA 0% 6.52% 0%
Course

 Urban Rural Overall

 N = 30 N = 11 N = 41

 % yes % yes % yes

Encourage 1-Credit FASD 57% 54% 56.1%
Course

Encourage 3-Credit FASD 46% 23% 39.02%
Course

Encourage 1-Credit SA * 54% 54% 53.66%
Course

Encourage 3-Credit SA 43% 23% 36.59%
Course

Add 1-Credit Elective FASD 21% 27% 23.17%
Course

Add 3-Credit Elective FASD 25% 19% 23.17%
Course

Add 1-Credit Elective SA 19.5% 27% 21.95%
Course

Add 3-Credit Elective SA 16% 19% 17.07%
Course

Add 1-Credit Required 0% 8% 2.44%
FASD Course

Add 3-Credit Required 0% 11.5% 3.66%
FASD Course

Add 1-Credit Required SA 0% 8% 2.44%
Course

Add 3-Credit Required SA 0% 11.5% 3.66%
Course

A = su kistance a juse

TABLE 3
Perceptions of the Importance of CDC FASD Core Competencies

 Behavioral
 Medicine Health Allied Health

Competency 1 2.67 1.03 3.04 0.95 2.00 0.65
Competency 2 1.83 0.98 3.08 0.72 2.47 0.92
Competency 3 2.50 0.84 3.21 0.78 1.80 1.21
Competency 4 2.50 0.84 2.92 0.88 2.47 0.99
Competency 5 2.00 1.26 2.96 1.00 1.73 0.80
Competency 6 1.83 0.98 2.96 0.81 2.13 0.83
Competency 7 2.50 0.84 3.25 0.79 2.00 0.93

 Urban Rural Overall

Competency 1 2.76 0.95 2.44 1.03 2.64 0.98
Competency 2 2.97 0.68 2.25 1.13 2.71 0.92
Competency 3 2.66 1.14 2.63 1.15 2.64 1.13
Competency 4 2.83 0.80 2.50 1.10 2.71 0.92
Competency 5 2.72 1.03 1.88 1.09 2.42 1.12
Competency 6 2.83 0.80 2.00 0.97 2.53 0.94
Competency 7 2.76 0.95 2.69 1.14 2.73 1.01

* Means based on Likert scale ranging from 1 (not at all) to 4 (to a
great extent)

TABLE 4
Current Coverage of CDC FAST) Core Competencies

 Behavioral
 Medicine Health Allied Health

 Mean SD Mean SD Mean SD

Competency 1 2.67 0.52 2.54 0.72 1.47 0.74
Competency 2 2.00 0.89 2.63 0.71 1.93 0.70
Competency 3 2.67 0.52 2.54 0.72 1.67 0.98
Competency 4 2.67 0.52 2.50 0.66 1.93 0.59
Competency 5 2.17 1.17 2.42 0.58 1.33 0.72
Competency 6 2.00 0.89 2.17 0.87 1.33 0.49
Competency 7 2.67 0.52 2.38 0.71 1.27 0.70

 Urban Rural Overall

 Mean SD Mean SD Mean SD

Competency 1 2.07 0.84 2.44 0.89 2.20 0.87
Competency 2 2.45 0.69 2.06 0.93 2.31 0.79
Competency 3 2.17 0.89 2.44 0.89 2.27 0.89
Competency 4 2.28 0.59 2.44 0.81 2.33 0.67
Competency 5 2.00 0.89 2.06 0.85 2.02 0.87
Competency 6 1.83 0.89 1.94 0.77 1.87 0.84
Competency 7 1.90 0.90 2.31 0.79 2.04 0.88

* Means based on Likert scale ranging from 1 (not at all) to 4
(to a great extent)

TABLE 5
Interest in Collaboration Related to CDC FASD Core Competencies

 Behavioral
 Medicine Health Allied Health

 Mean SD Mean SD Mean SD

Competency 1 2.83 1.47 3.13 0.90 2.20 0.77
Competency 2 2.17 1.17 3.08 0.93 2.07 0.80
Competency 3 2.50 1.22 3.04 0.91 1.67 0.98
Competency 4 2.50 1.22 2.96 0.91 2.27 0.88
Competency 5 2.33 1.37 3.04 0.86 2.27 0.80
Competency 6 1.83 1.33 2.88 0.80 2.13 0.83
Competency 7 2.50 1.22 3.21 0.98 2.07 0.80

 Urban Rural Overall

 Mean SD Mean SD Mean SD

Competency 1 2.90 0.94 2.56 1.15 2.78 1.02
Competency 2 2.79 0.98 2.31 1.08 2.62 1.03
Competency 3 2.55 1.18 2.44 1.09 2.51 1.14
Competency 4 2.79 0.94 2.44 1.03 2.67 0.98
Competency 5 3.03 0.78 2.06 1.00 2.69 0.97
Competency 6 2.79 0.82 1.94 1.00 2.49 0.97
Competency 7 2.86 1.06 2.50 1.10 2.73 1.07

* Means based on Likert scale ranging from 1 (not at all) to 4 (to a
great extent)

TABLE 6
Top Resources for Educating Faculty

 Behavioral
 Medicine Health Allied Health

1 Downloadable Guest Speakers Downloadable
 Self-Study invited to Self-Study
 Modules or Online classes) Modules or
 Tutorials Online Tutorials

2 Access to Recent Videos or Access to
 Publications / DVDs Website about
 Videos or DVDs FASD

3 Independent Study Access to In-Services,
 Opportunities Website about Workshops,
 FASD Conferences

4 Access to Recent Access Guest Speakers
 Publications to Recent invited to
 Publications classes)

5 In-Services, In-Services, Video- and
 Workshops, Workshops, Teleconference
 Conference/ Conferences Videos or DVDs
 Video- and
 Teleconferences

 Urban Rural

1 Guest Speakers Videos or DVDs
 (invited to
 classes)

2 Downloadable Access to Recent
 Self-Study Publications
 Modules or
 Online Tutorials

3 Access to Downloadable Self-
 Website about Study Modules or
 FASD Online Tutorials /
 Access to Website
 about FASD

4 In-Services, Guest Speakers
 Workshops, (invited to classes)
 Conferences

5 Videos or DVDs Video- and
 Teleconferences

TABLE 7
Top Resources for Educating Students

 Behavioral
 Medicine Health Allied Health

1 1-Hour Tailored Expert Guest 1-Hour Tailored
 Content Lecture Speaker Content Lecture

2 Downloadable Access to
 Self-Study Website About 1-Hour Overview
 Modules or Online FASD Lecture
 Tutorials

3 Handouts for Use Audiovisual Expert Guest
 by Instructors Materials (e.g., Speaker
 videos, DVDs)

4 Audiovisual 1-Hour Tailored Audiovisual
 Materials (e.g., Content Lecture Materials (e.g.,
 videos, DVDs) videos, DVDs)

5 Access to Recent Access to Recent 1-Credit FASD
 Publications Publications Course
 / 1-Hour Overview /
 Lecture 1-Hour Overview
 Lecture

 Urban Rural

1 1-Hour Tailored Expert Guest
 Content Lecture Speaker

2
 Expert Guest 1-Hour Tailored
 Speaker Content Lecture

3 Audiovisual Audiovisual
 Materials (e.g., Materials (e.g.,
 videos, DVDs) videos, DVDs)

4 1-Hour Overview Access to
 Lecture Website About
 FASD

5 Downloadable Access to Recent
 Self-Study Publications
 Modules or /
 Online Tutorials 1-Hour Overview
 Lecture
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Author:Brems, Christiane; Boschma-Wynn, Rachel V.; Dewane, Sarah L.; Edwards, Alexandra; Robinson, Rebecca
Publication:Journal of Alcohol & Drug Education
Date:Apr 1, 2011
Words:6110
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