Being exposed to alcohol before birth can cause the development of Fetal Alcohol Spectrum Disorder (FASD). The disorder refers to the range of effects—physical, mental, behavioral, and/or learning disabilities. Based on community studies using physical measures, experts estimate FASD might be as high as 2 to 5 out of 100 schoolchildren (or 2% to 5% of the population).

Diagnosing this disorder can be difficult because

• There is no medical test for FASD
• Some symptoms mimic other health conditions

To address this challenge, the Centers for Disease Control and Prevention (CDC) began working in 2014 with national health organizations (Partners) and academic institutions known as Practice and Implementation Centers (PICS). The united approach was to form the Collaborative for Alcohol-Free Pregnancy.

The goal to prevent FASDs was to focus on practice change at the systems level. This innovative initiative targeted implementing alcohol screening and brief intervention (SBI) at primary care settings.

PICs were to collaborate with medical societies and national professional organizations (Partners) to increase their reach to health care providers. 

Evaluating the Effectiveness of Practice Changes

Key strategies needed to be identified that support practice change among health care providers in preventing, identifying, and treating FASDs. So, Westat designed and implemented a cross-site evaluation for CDC grantees. 

Grantees included

• CDC’s newly designed FASD PICs
• National partner organizations to complement and extend the work of the PICs

The cross-site evaluation focused on best practices in

• Collaboration
• Training and practice implementation
• Consistent and science-based messaging
• Practice change, especially from a systems perspective

Westat also monitored and assessed progress across grantee sites over the 4-year evaluation.

What Our Findings Revealed

Westat’s evaluation, completed in 2018, suggests that

• Partnerships are valuable. Partnerships developed tailored materials and implemented innovative virtual trainings to

• Reach health care provider audiences
• Raise awareness about alcohol-exposed pregnancies

• Collaborations are critical. Collaborations with national organizations were a critical strategy to disseminate and develop a cadre of local and national champions (physicians or medical society leaders). These collaborations encouraged the use of alcohol SBI and influenced provider practices.
• Integrating data is key. The inability to integrate alcohol SBI questions in electronic health records was as a barrier to practice change.
• Commitment is essential. Promoting practice change in health systems requires time, resources, and organizational commitment to implement evidence-based interventions, such as alcohol SBI.