Funded Projects

Building FASD Awareness, Improving Outcomes Together

Project Year

2025

City & State

Topsham, Maine

Program Name

CATCH Implementation

Topic

Substance Use (LHI)

Program Description

THE PROBLEM Significant gaps in awareness of Fetal Alcohol Spectrum Disorder (FASD) persist.  Affecting an estimated 1 in 20 children, an FASD can present with problems in cognition, attention, executive functioning, self-regulation, memory, social and adaptive skills.  Alcohol consumption during pregnancy is often stigmatized, and can be left out of conversations at important touchpoints.  Many pregnant individuals unknowingly put their children at risk.  This disconnect is evident at our local Women, Infants, and Children Nutrition Program (WIC) office, where counselors find few positive prenatal alcohol exposure (PAE) screenings, despite serving pregnant people from counties with high rates of alcohol use during pregnancy. Lack of FASD awareness impacts families in profound ways.  Barriers to effective prenatal education, screenings, and support result in missed opportunities for prevention and incorrect diagnoses for children with FASD.  Affected children face higher rates of foster care placement, juvenile justice involvement, and mental health struggles.  With earlier identification, understanding, and support, children with an FASD can thrive.  The essential nutrient, choline, found in eggs, meats, soybeans, and other foods, is required for healthy fetal brain development, yet is often overlooked during pregnancy.  There is growing evidence that prenatal supplemental choline is an effective neurodevelopmental intervention in cases of PAE and can improve FASD outcomes.  Knowing that choline, with well-established intake recommendations, has an important role in all developing brains, we will partner with WIC to optimize choline intake for all pregnant participants.  PRIMARY SETTING The project will primarily involve the WIC office in Bath, Maine.  The process improvements from this pilot will be extended to the remaining seven statewide sites, including one serving the Passamaquoddy Tribe.    NUMBER OF CHILDREN AFFECTED  Accurate estimates of FASD are hindered by underreporting of PAE and gaps in screening.  Until PAE is better documented allowing FASD to be considered in the diagnoses, the true prevalence of FASD remains unclear.  In Maine, 10% of pregnant people report alcohol use.  The Bath WIC office serves 1,008 children, 259 infants, and 94 pregnant people, providing multiple points of contact for this at-risk population.   PROJECT GOAL Our project goal is to assess and reduce the community health burden of PAE effects among WIC participants, starting in the region of Bath, Maine.  WIC counselors are trusted to connect families with optimal nutrition and other resources.  By expanding WIC counselors' and WIC participants' understanding of the neurodevelopmental disorder, FASD, the need for choline, and the risks of alcohol during pregnancy, we aim to improve:  choline dietary intake for pregnant participants, PAE screening accuracy, and successful connections to resources for those served by WIC.    Timely for multiple reasons, one is the potential for synergy with the Maine Center for Disease Control and Prevention’s current PAE/FASD needs assessment project focusing on medical providers.  PROPOSED INTERVENTION(S) Using surveys to identify knowledge gaps and focus groups to assess attitudes and perceptions about PAE screening, we will collaborate with WIC to make improvements in PAE screening and education provided by WIC.  Pre- and post-assessments will measure knowledge gains.  Envisioned referral process improvements for children with developmental concerns would include a notation regarding presence / unknown/ absence of PAE and a PAE / FASD provider information sheet accompanying the referral when indicated.   ANTICIPATED OUTCOMES For the population served by WIC, we anticipate an increase in recommended choline intake during pregnancy, an increase in the accuracy of screenings for PAE, and an improvement in PAE information sharing at the point of referral for children identified on WIC’s developmental screenings.  Improved PAE screening accuracy will enable children with FASD to be correctly diagnosed and in turn to access services and connect with the FASD community. 

Project Goal

Our project goal is to assess and reduce the community health burden of prenatal alcohol exposure effects among WIC participants* in the Bath, Maine office by 1. increasing the number of pregnant people who consume the recommended amount of the essential nutrient, choline, 2.  increasing the number of referrals (due to better screening) from WIC for pregnant people who are consuming alcohol, and 3. increasing the number of referrals for children with developmental concerns on routine screening who are noted to have positive prenatal alcohol screening (due to improvements in referral process) which will greatly help with accurately diagnosing FASD, when present.   *Bath WIC participants include asylum seekers, known as New Mainers, people of color, people living below the poverty level and people with housing insecurity. 

Project Objective 1

By September 2025, ensure that 90% of pregnant Bath WIC participants are receiving user-friendly information, accessible to people with language/literacy barriers, about choline requirements, dietary sources and options for supplementation.

Project Objective 2

By October 2025, collaborate with Bath WIC to revise the PAE screening and documentation process using FASD United’s 2024 Language and Stigma Guide and local focus group insights, to be able to document trimester-specific PAE information for 75% of pregnant Bath WIC participants, including some with language/literacy barriers.

Project Objective 3

By May 2026, demonstrate that 75% of children referred by Bath WIC for developmental concerns have a notation regarding presence/unknown/absence of PAE and a one page PAE/FASD provider information sheet accompanying the referral when indicated.

AAP District

District I

Institutional Name

Stellar Pediatrics

Contact 1

Andrea Tracy, MD

Contact 2

Lauren Jamele-Townley, DO