Background
Evidence-based prevention programs are an important part of preventing future alcohol-exposed pregnancies, but there is currently limited evidence to support the effectiveness of these programs in rural communities. The researchers who conducted this study looked at how a program in Alberta, Canada, offering one-on-one mentoring and long-term home visits to rural and isolated First Nations communities, is suitable in preventing alcohol and drug-exposed births.

The program is known as the Parent-Child Assistance Program (PCAP), and was designed for women who are at risk of using substances, who are pregnant or who are at risk of becoming pregnant, and/or have a child up to 6 months old, with the intention of preventing further alcohol and drug-exposed pregnancies. Currently, there are 30 Alberta PCAP sites that service roughly 500 women. This program has been studied and shown to be effective in urban settings, but less research has focused on its impact on rural and remote communities.

The researchers identified  six important themes:

Preparation

• It is important for PCAP staff to be accepted by the community they are working in, by building relationships and gaining trust of the community members
• Showing a willingness to learn about the community is important in gaining approval
• Knowledge of the community’s history and previous experience with other services will help in choosing a mentor that is suited for the community

 Embarkation

• Once building relationships with clients, staff use a trauma-informed approach to implement harm reduction strategies with women in the program
• By “walking alongside clients”, mentors help them to set goals, teach them to advocate for themselves, and how to balance their lives
• By making connections with other community organizations, mentors are able to refer their clients to appropriate services

 Reflection

• PCAP staff reflect on the impact of the program, noticing positive social and emotional outcomes for clients, through the one-on-one relationship
• Many women found that they were able to form positive relationships with other women, feel more trusting of other service providers, and attend addictions treatment
• Mentors found that some clients had healthy pregnancies as a result of the program, and could transfer their skills and knowledge to improve their parenting

Responsive action

• Providing services in remote and isolated communities proved challenging, as mentors had to travel far to reach the communities and many communities had poor cell phone service
• Mentors also found a lack of services in remote communities, and a need for child care services for women to have a break

 Program adaptation

• PCAP staff found that mentors’ flexibility in participating in activities with clients that were outside of their regular role was important in showing respect
• Staff participating in cultural protocol, ceremonies, and events was also important in strengthening the relationship and showing respect

 Visualization

• To improve the program and outcomes for clients, staff suggested that funding should be extended beyond 3 years
• Improving data collection processes will improve the assessment process for clients, as well as coordinating with other community organizations

Take-home message
The authors of this study showed that a trauma-informed, community-centered approach to FASD prevention can have positive effects for rural Indigenous communities. However, other considerations are important in improving the program and implementing it in other rural Indigenous communities. These considerations include an understanding of how the program functions from the participants’ perspective, mentors’ understanding of the client’s cultural history, and improving data collection and collaboration among services.

Authors: Jacqueline Pei, Elizabeth Carlson, Melissa Tremblay, Cheryl Poth

 Journal: Birth Defect Research