Decoding the FASD Enigma: Application of a New Multidisciplinary Policy Paradigm

In this dissertation, a comprehensive, integrated, multileveled prevention paradigm is proposed to evaluate and/or reform existing FASD policies. There is a variety of evidentiary sources available to policy makers, but there is increasing pressure to utilize more rigorous approaches to analyze the “complex evidence base”. I consider the need for high quality evidence including research and non-research sources, as well as quantitative and qualitative approaches. Findings from my own research, as appropriate for each level’s focus, are also discussed. I begin with the tertiary prevention level which aims to provide individuals affected by FASD continuous interventions throughout their lives so they will “not commit” and can function in the community. However due to the secondary disabilities associated with FASD, these individuals are often found within the criminal justice system. I present a comparison of individuals diagnosed with FASD found within a serious and violent offender population with those who are not diagnosed. I highlight exemplar legal cases where FASD is considered. In addition, I discuss exemplar initiatives and programs addressing the management of affected individuals. The secondary prevention level focuses on interventions to modify those environmental conditions that increase the possibility of maternal drinking. I present an extensive list of risk factors for FASD. Next I reveal four themes of intervention from the literature: screening tools, research, education, and legal strategies. With those in mind, I examine a high risk population using the existing literature on social determinants. The goal of the primary prevention level is to modify the social and environmental conditions that increase the opportunities which create individuals affected by FASD. At this level, the evidence I bring to bear are data which juxtapose medical facility locations and recorded police contacts with intoxicated persons in the same area. My findings suggest an integrated systems approach would be an effective way to identify, validate, implement, and evaluate current FASD policy and practices. By employing this tri-level prevention paradigm, it is possible to address the complexities of FASD, identify the gaps in knowledge and services, and discuss more promising policy and practical initiatives.