❓ WA Parliament Question on Notice regarding the implementation of recommendations from the Education and Health Standing Committee report on Foetal Alcohol Spectrum Disorder (FASD). The response details progress on implementation, funding, and reasons for non-implementation.
AnsweredQoN 1324Legislative Assembly
QuestionView source ↗
I refer to the report from the Education and Health Standing Committee on Foetal Alcohol Spectrum Disorder, released September 2012, and ask: (a) which recommendations have and have not been implemented; (b) of the recommendations that have been implemented, for each one please give details on funding and exact action that has been taken; and (c) of the recommendations that have not been implemented: (i) what is the reason for not implementing them; and (ii) what action will be taken to implement them, including funding and timelines?
AnswerView source ↗
Answered
3 December 2013
Responded by
Minister for Health
Response time
41 days
The Department of Health (DOH) developed a Foetal Alcohol Spectrum Disorder (FASD) Model of Care in 2010, describing best practice, evidenced based strategies across the continuum of care for the prevention and management of FASD.
A Project Control Group, chaired by the DOH with membership from the Drug and Alcohol Office (DAO), Department of Education and the former Department for Communities, now part of the department of Child Protection and Family Support, has overseen the development of a whole of government Implementation Plan and supporting Framework, for the FASD Model of Care.
Currently undergoing final endorsement from the stakeholder agencies, the implementation strategies have been developed through an extensive consultative process and are informed by the recommendations from the 2012 Education and Health Standing Committee (EHSC) Inquiry on FASD.
Once endorsed, each of the pertinent government agencies will be responsible for resourcing their implementation strategies, which during the development process will have been considered and where possible, have incorporated existing initiatives and resources.
The
responses below are the most up-to-date information available.
(a) Recommendations 2, 3, 5, 6, 7, 10, 12, 14, 17, 20 and 22 have been implemented.
Recommendation 4 has not been implemented.
Recommendations
1,
8, 9, 11, 13, 15, 16, 18, 19 and 21 are not the responsibility of the DOH.
(b) Details of funding and actions of recommendations that have been taken:
Recommendation 1:
The Western Australian Government encourages the Federal Government to support the adoption of a FASD Diagnostic tool and the classification of FASD as a disability by June 2013.
DOH Response:
The Commonwealth Government has taken responsibility for the implementation of this recommendation.
Recommendation 2:
The Committee recommends to the Minister for Health that by June 2013 all pregnant and post-partum women are screened for alcohol use with validated screening tools by relevant health care providers.
Women at risk for heavy alcohol use should receive early brief intervention (i.e. counselling).
DOH Response:
As part of the FASD Model of Care Implementation Plan an adopted AUDIT-C (Alcohol Use Disorders Identification Test - Consumption) screening tool is identified as an appropriate tool to screen pregnant and post-partum women for alcohol use and is intended to be rolled out within public antenatal health services and inform other private service providers. The AUDIT-C is a validated questionnaire developed to identify hazardous and harmful alcohol use as well as alcohol dependence.
Whilst the audit tool has not been fully implemented as yet the question of alcohol consumption during pregnancy is being asked more frequently publicly as a result of social marketing campaigns.
The intent of the recommendation is consistent with key directions in the National Maternity Services Plan 2010, the National Evidence-Based Antenatal Care Guidelines and the National Woman-Held Pregnancy Record Project
Recommendation 3:
To protect the unborn child, the Committee recommends to the Minister for Health that the Government prepares guidelines for all health care professionals by June 2013, which should encourage all pregnant women or women attempting to become pregnant to abstain from alcohol.
DOH Response:
The WA Government supports the National Health and Medical Research Council Australian Alcohol Guidelines that for women who are pregnant or planning a pregnancy, not drinking is the safest option.
The DOH is supporting a number of primary prevention initiatives to prevent women drinking alcohol during pregnancy, including partnerships with the Drug and Alcohol Office and social marketing campaigns such as The No
Alcohol
During
Pregnancy
is the Safest Choice
Campaign.
These campaigns and the FASD Model of Care Implementation Plan will inform privately practicing
health care professionals.
The Commonwealth's "Responding to the Impact of Fetal Alcohol Spectrum Disorders in Australia: A Commonwealth Action Plan" has committed $20 million over 4 years to build on existing initiatives.
Recommendation 5:
The Committee recommends that the Government support the following WA FASD Model of Care recommendations:
a) There should be a collection of data on alcohol use during pregnancy.
Use can be made of existing tools such as the midwife notification form to include documentation of the presence or absence of alcohol consumption in pregnancy.
b) Data linkage ability between sectors to be established to enable the monitoring, sharing and evaluation of data between relevant health professionals and services.
The Government reports back to Parliament on a bi-annual basis on the results of this data collection.
DOH Response:
Work is currently in progress at the National and State levels to assess for alcohol use during pregnancy. The DOH WA is participating in the implementation of the National Maternity Services Plan 2010, endorsed by Australian Health Ministers Advisory Council which includes the National Maternal Data Development Project and the National Woman Held Maternity Record.
Recommendation 6:
In the 2013 budget the Government funds bi-monthly appointments by child health nurses for pregnant women and mothers with children under the age of 4 years who are thought to be drinking alcohol at harmful levels. These child health nurses will provide, at a minimum, a 6 monthly review of these families to the Department of Health. The Government will then report back to Parliament on a bi-annual basis on the effects of these additional appointments.
DOH Response:
All families in WA are offered voluntary access to a Community Health Nurse who provides health screening and surveillance for the early detection of childhood health conditions from birth to school entry. Additional support is provided to families with higher needs and referrals to specialist services are made as appropriate.
The availability and capacity of these child health services will improve in coming years as a direct result of the 2012 Budget allocation of $58.5 million over 4 years to strengthen community maternal and child health services.
Recommendation 7:
The Minister for Health allocates additional funding in the 2013 budget to existing interdisciplinary health teams (such as in antenatal clinics, children's hospitals and child development centres), to improve their ability to diagnose and treat children with FASD and support education and awareness strategies.
DOH Response:
In the last 3 budget years the Government has invested over $100 million to a number of community child health related services which will support children with FASD.
In 2013, the Government also allocated $400,000 over 3 years to provide better care coordination to support children with learning or developmental difficulties and their families in the Fitzroy Valley.
In the 2012 Budget the Government allocated $58.5 million over 4 years to strengthen community maternal and child health services that support and educates parents in the care of children including the effects of alcohol in pregnancy.
In the 2010 Budget $49.6 million dollars of new money over 4 years was committed to child development services in Western Australia.
These services assist children who have developmental delay or a functional difficulty to maximise their life opportunities and includes children with FASD.
In 2009, $11.25 million over 5 years were allocated through the Indigenous Early Childhood Development (IECD) National Partnership to improve access of Aboriginal families to post natal maternal and child health services and $17.12 million to improve Aboriginal women's antenatal, pre-pregnancy and sexual reproductive health.
Recommendation 8:
The Committee recommends that the Government and the Minister for Disability Services support changes to commonwealth and state legislation to better accommodate children and adults with FASD. In particular any reference to disability or intellectual disability to be broadened to include a definition of cognitive impairment as an ongoing impairment in comprehension, reason, judgment, learning or memory, that is the result of any damage to or dysfunction, developmental delay, or deterioration to the brain or mind.
DOH Response:
The Commonwealth Government has taken responsibility for the implementation of this recommendation.
Whilst this recommendation is not the DOH's responsibility the DOH is aware the Commonwealth's "Responding to the Impact of Fetal Alcohol Spectrum Disorders in Australia: A Commonwealth Action Plan" identifies that the new National Disability Insurance Scheme - Disability Care is a key policy development that has capacity to support this recommendation.
People with FASD who have significant reduced functional capacity as a result will be able to make an access request to Disability Care Australia for care and support based on their reasonable and necessary needs.
Recommendation 10:
The Committee recommends that funding be allocated in the 2013 budget for the development of culturally specific prevention, intervention and management strategies for Aboriginal and Torres Strait Islander people who have FASD similar to the current 'Marulu Strategy' in Western Australia.
DOH Response:
There are a number of existing culturally appropriate programs already developed across the continuum of prevention, such as the DAO 'Strong Spirit Strong Future - Promoting Health
y
Women and Pregnancies' project.
In 2013, the Government also allocated $400,000 over 3 years to provide better care coordination to support children with learning or developmental difficulties and their families in the Fitzroy Valley.
In August 2013 the Commonwealth's "Responding to the Impact of Fetal Alcohol Spectrum Disorders in Australia: A Commonwealth Action Plan" announced new funding targeted to Aboriginal communities.
Recommendation 12:
The Committee recommends the government invest additional funds in the 2013 budget into FASD prevention campaigns that seek to:
1. Raise public awareness in the general population through campaigns highlighting harmful alcohol use as it relates to the unborn child, and the general health of girls and women;
2. Conduct targeted education for high risk groups through health and community services.
DOH Response:
The DAO runs its
No
Alcohol
During
Pregnancy
is the
Safest Choice
Campaign
.
The DOH supports the DAO,
Alcohol Think Again
campaign to promote that no alcohol during pregnancy is the safest choice.
The DOH has also supported the '
Closing the Gap'
initiative, the '
Strong Spirit Strong Future'
Campaign.
The DOH is not aware of any additional funds being made available for FASD prevention campaigns within the 2013/14 budget.
In August 2013 the Commonwealth's "Responding to the Impact of Fetal Alcohol Spectrum Disorders in Australia: A Commonwealth Action Plan" announced new funding targeted to Aboriginal communities.
Recommendation 14:
The Committee recommends that the Government supports the following WA FASD Model of Care recommendations to reduce unplanned pregnancy:
1. Develop strategies to promote the use of contraception and to improve the consistency of contraceptive use, including contraception prior to discharge from hospital post-natally;
2. Educate men and enlist them as partners in family planning;
3. Develop strategies to promote communication between partners about the use of contraception;
4. Introduce evidence based primary and secondary school drug and sex education.
DOH Response:
The Government supports the above Model of Care recommendations.
The FASD Model of Care Implementation Plan has been drafted by interagency working groups and undergone extensive stakeholder consultations during the process.
This is currently undergoing final sign-off.
Recommendation 17:
The Committee recommends the Government provide additional funding in the 2013 budget to support multidisciplinary and culturally appropriate strategies to address the often complex needs of alcohol dependent mothers and their families.
DOH Response:
In 2013, the Government also allocated $400,000 over 3 years to provide better care coordination to support children with learning or developmental difficulties and their families in the Fitzroy Valley.
There are also existing services f
or
mothers dependent on alcohol, for example, the Saranna Mothers and Children treatment program.
Recommendation 20:
The Committee recommends the Government develop a range of holistic community, education, employment and health services to support individuals and families who are affected by FASD with the Department of Health as the lead agency and report back to Parliament on these by December 2013.
DOH Response:
The DOH WA is aware of the need for a holistic approach and is currently finalising the FASD Model of Care Implementation Plan, developed in partnership with a range of other government and non-government agencies.
The Plan is focused on prevention.
Recommendation 21:
The Committee recommends the Minister(s) support a family case management approach to prevent alcohol abuse in persons and families where there are positive indicators that FASD is present or there are risk factors for FASD.
The Government is to report back to Parliament on this approach by December 2013.
DOH Response:
Whilst this recommendation is not primarily the DOH's responsibility the DOH has a variety of clinical pathways and treatment plans as part of normal business which includes family support and referral to the appropriate agency. Funding for these services is within base budget.
Recommendation 22:
The Committee recommends that by December 2012 the Premier appoint a Minister, to have responsibility for a collaborative intergovernmental approach to the prevention, treatment and management of children and adults with FASD in WA.
DOH Response:
The WA Government Community Services Leadership Group has endorsed and committed to participation in a whole of government approach to the implementation of the FASD Model of Care, which is being led by the WA DOH.
The DOH is not aware of any appointment by the Premier of a Minister to assume responsibility for this collaborative intergovernmental approach.
(c) Recommendations that have not been implemented:
Recommendation 4:
The Committee recommends to the Minister for Health that he direct the Department of Health to review and report back to Parliament by June 2013 on the ethical considerations involved in the analysis of meconium for pregnancy cases where there is a strong suspicion of significant alcohol consumption during pregnancy.
DOH Response:
i)
After review of ethical considerations the DOH does not support the screening of meconium.
From an ethical perspective the routine drug testing of meconium could have the impact to further stigmatise a vulnerable group of women for limited gain in regard to the medical treatment of the baby.
Other areas of concern for routine meconium testing relates to informed consent from the parents, the cost of the test and the potential of the breakdown of the patient/healthcare service relationship which directly impacts on the parents willingness to engage with the service.
Service engagement and follow up is very important in regards to babies affected with FASD.
ii)
Not applicable.
A Project Control Group, chaired by the DOH with membership from the Drug and Alcohol Office (DAO), Department of Education and the former Department for Communities, now part of the department of Child Protection and Family Support, has overseen the development of a whole of government Implementation Plan and supporting Framework, for the FASD Model of Care.
Currently undergoing final endorsement from the stakeholder agencies, the implementation strategies have been developed through an extensive consultative process and are informed by the recommendations from the 2012 Education and Health Standing Committee (EHSC) Inquiry on FASD.
Once endorsed, each of the pertinent government agencies will be responsible for resourcing their implementation strategies, which during the development process will have been considered and where possible, have incorporated existing initiatives and resources.
The
responses below are the most up-to-date information available.
(a) Recommendations 2, 3, 5, 6, 7, 10, 12, 14, 17, 20 and 22 have been implemented.
Recommendation 4 has not been implemented.
Recommendations
1,
8, 9, 11, 13, 15, 16, 18, 19 and 21 are not the responsibility of the DOH.
(b) Details of funding and actions of recommendations that have been taken:
Recommendation 1:
The Western Australian Government encourages the Federal Government to support the adoption of a FASD Diagnostic tool and the classification of FASD as a disability by June 2013.
DOH Response:
The Commonwealth Government has taken responsibility for the implementation of this recommendation.
Recommendation 2:
The Committee recommends to the Minister for Health that by June 2013 all pregnant and post-partum women are screened for alcohol use with validated screening tools by relevant health care providers.
Women at risk for heavy alcohol use should receive early brief intervention (i.e. counselling).
DOH Response:
As part of the FASD Model of Care Implementation Plan an adopted AUDIT-C (Alcohol Use Disorders Identification Test - Consumption) screening tool is identified as an appropriate tool to screen pregnant and post-partum women for alcohol use and is intended to be rolled out within public antenatal health services and inform other private service providers. The AUDIT-C is a validated questionnaire developed to identify hazardous and harmful alcohol use as well as alcohol dependence.
Whilst the audit tool has not been fully implemented as yet the question of alcohol consumption during pregnancy is being asked more frequently publicly as a result of social marketing campaigns.
The intent of the recommendation is consistent with key directions in the National Maternity Services Plan 2010, the National Evidence-Based Antenatal Care Guidelines and the National Woman-Held Pregnancy Record Project
Recommendation 3:
To protect the unborn child, the Committee recommends to the Minister for Health that the Government prepares guidelines for all health care professionals by June 2013, which should encourage all pregnant women or women attempting to become pregnant to abstain from alcohol.
DOH Response:
The WA Government supports the National Health and Medical Research Council Australian Alcohol Guidelines that for women who are pregnant or planning a pregnancy, not drinking is the safest option.
The DOH is supporting a number of primary prevention initiatives to prevent women drinking alcohol during pregnancy, including partnerships with the Drug and Alcohol Office and social marketing campaigns such as The No
Alcohol
During
Pregnancy
is the Safest Choice
Campaign.
These campaigns and the FASD Model of Care Implementation Plan will inform privately practicing
health care professionals.
The Commonwealth's "Responding to the Impact of Fetal Alcohol Spectrum Disorders in Australia: A Commonwealth Action Plan" has committed $20 million over 4 years to build on existing initiatives.
Recommendation 5:
The Committee recommends that the Government support the following WA FASD Model of Care recommendations:
a) There should be a collection of data on alcohol use during pregnancy.
Use can be made of existing tools such as the midwife notification form to include documentation of the presence or absence of alcohol consumption in pregnancy.
b) Data linkage ability between sectors to be established to enable the monitoring, sharing and evaluation of data between relevant health professionals and services.
The Government reports back to Parliament on a bi-annual basis on the results of this data collection.
DOH Response:
Work is currently in progress at the National and State levels to assess for alcohol use during pregnancy. The DOH WA is participating in the implementation of the National Maternity Services Plan 2010, endorsed by Australian Health Ministers Advisory Council which includes the National Maternal Data Development Project and the National Woman Held Maternity Record.
Recommendation 6:
In the 2013 budget the Government funds bi-monthly appointments by child health nurses for pregnant women and mothers with children under the age of 4 years who are thought to be drinking alcohol at harmful levels. These child health nurses will provide, at a minimum, a 6 monthly review of these families to the Department of Health. The Government will then report back to Parliament on a bi-annual basis on the effects of these additional appointments.
DOH Response:
All families in WA are offered voluntary access to a Community Health Nurse who provides health screening and surveillance for the early detection of childhood health conditions from birth to school entry. Additional support is provided to families with higher needs and referrals to specialist services are made as appropriate.
The availability and capacity of these child health services will improve in coming years as a direct result of the 2012 Budget allocation of $58.5 million over 4 years to strengthen community maternal and child health services.
Recommendation 7:
The Minister for Health allocates additional funding in the 2013 budget to existing interdisciplinary health teams (such as in antenatal clinics, children's hospitals and child development centres), to improve their ability to diagnose and treat children with FASD and support education and awareness strategies.
DOH Response:
In the last 3 budget years the Government has invested over $100 million to a number of community child health related services which will support children with FASD.
In 2013, the Government also allocated $400,000 over 3 years to provide better care coordination to support children with learning or developmental difficulties and their families in the Fitzroy Valley.
In the 2012 Budget the Government allocated $58.5 million over 4 years to strengthen community maternal and child health services that support and educates parents in the care of children including the effects of alcohol in pregnancy.
In the 2010 Budget $49.6 million dollars of new money over 4 years was committed to child development services in Western Australia.
These services assist children who have developmental delay or a functional difficulty to maximise their life opportunities and includes children with FASD.
In 2009, $11.25 million over 5 years were allocated through the Indigenous Early Childhood Development (IECD) National Partnership to improve access of Aboriginal families to post natal maternal and child health services and $17.12 million to improve Aboriginal women's antenatal, pre-pregnancy and sexual reproductive health.
Recommendation 8:
The Committee recommends that the Government and the Minister for Disability Services support changes to commonwealth and state legislation to better accommodate children and adults with FASD. In particular any reference to disability or intellectual disability to be broadened to include a definition of cognitive impairment as an ongoing impairment in comprehension, reason, judgment, learning or memory, that is the result of any damage to or dysfunction, developmental delay, or deterioration to the brain or mind.
DOH Response:
The Commonwealth Government has taken responsibility for the implementation of this recommendation.
Whilst this recommendation is not the DOH's responsibility the DOH is aware the Commonwealth's "Responding to the Impact of Fetal Alcohol Spectrum Disorders in Australia: A Commonwealth Action Plan" identifies that the new National Disability Insurance Scheme - Disability Care is a key policy development that has capacity to support this recommendation.
People with FASD who have significant reduced functional capacity as a result will be able to make an access request to Disability Care Australia for care and support based on their reasonable and necessary needs.
Recommendation 10:
The Committee recommends that funding be allocated in the 2013 budget for the development of culturally specific prevention, intervention and management strategies for Aboriginal and Torres Strait Islander people who have FASD similar to the current 'Marulu Strategy' in Western Australia.
DOH Response:
There are a number of existing culturally appropriate programs already developed across the continuum of prevention, such as the DAO 'Strong Spirit Strong Future - Promoting Health
y
Women and Pregnancies' project.
In 2013, the Government also allocated $400,000 over 3 years to provide better care coordination to support children with learning or developmental difficulties and their families in the Fitzroy Valley.
In August 2013 the Commonwealth's "Responding to the Impact of Fetal Alcohol Spectrum Disorders in Australia: A Commonwealth Action Plan" announced new funding targeted to Aboriginal communities.
Recommendation 12:
The Committee recommends the government invest additional funds in the 2013 budget into FASD prevention campaigns that seek to:
1. Raise public awareness in the general population through campaigns highlighting harmful alcohol use as it relates to the unborn child, and the general health of girls and women;
2. Conduct targeted education for high risk groups through health and community services.
DOH Response:
The DAO runs its
No
Alcohol
During
Pregnancy
is the
Safest Choice
Campaign
.
The DOH supports the DAO,
Alcohol Think Again
campaign to promote that no alcohol during pregnancy is the safest choice.
The DOH has also supported the '
Closing the Gap'
initiative, the '
Strong Spirit Strong Future'
Campaign.
The DOH is not aware of any additional funds being made available for FASD prevention campaigns within the 2013/14 budget.
In August 2013 the Commonwealth's "Responding to the Impact of Fetal Alcohol Spectrum Disorders in Australia: A Commonwealth Action Plan" announced new funding targeted to Aboriginal communities.
Recommendation 14:
The Committee recommends that the Government supports the following WA FASD Model of Care recommendations to reduce unplanned pregnancy:
1. Develop strategies to promote the use of contraception and to improve the consistency of contraceptive use, including contraception prior to discharge from hospital post-natally;
2. Educate men and enlist them as partners in family planning;
3. Develop strategies to promote communication between partners about the use of contraception;
4. Introduce evidence based primary and secondary school drug and sex education.
DOH Response:
The Government supports the above Model of Care recommendations.
The FASD Model of Care Implementation Plan has been drafted by interagency working groups and undergone extensive stakeholder consultations during the process.
This is currently undergoing final sign-off.
Recommendation 17:
The Committee recommends the Government provide additional funding in the 2013 budget to support multidisciplinary and culturally appropriate strategies to address the often complex needs of alcohol dependent mothers and their families.
DOH Response:
In 2013, the Government also allocated $400,000 over 3 years to provide better care coordination to support children with learning or developmental difficulties and their families in the Fitzroy Valley.
There are also existing services f
or
mothers dependent on alcohol, for example, the Saranna Mothers and Children treatment program.
Recommendation 20:
The Committee recommends the Government develop a range of holistic community, education, employment and health services to support individuals and families who are affected by FASD with the Department of Health as the lead agency and report back to Parliament on these by December 2013.
DOH Response:
The DOH WA is aware of the need for a holistic approach and is currently finalising the FASD Model of Care Implementation Plan, developed in partnership with a range of other government and non-government agencies.
The Plan is focused on prevention.
Recommendation 21:
The Committee recommends the Minister(s) support a family case management approach to prevent alcohol abuse in persons and families where there are positive indicators that FASD is present or there are risk factors for FASD.
The Government is to report back to Parliament on this approach by December 2013.
DOH Response:
Whilst this recommendation is not primarily the DOH's responsibility the DOH has a variety of clinical pathways and treatment plans as part of normal business which includes family support and referral to the appropriate agency. Funding for these services is within base budget.
Recommendation 22:
The Committee recommends that by December 2012 the Premier appoint a Minister, to have responsibility for a collaborative intergovernmental approach to the prevention, treatment and management of children and adults with FASD in WA.
DOH Response:
The WA Government Community Services Leadership Group has endorsed and committed to participation in a whole of government approach to the implementation of the FASD Model of Care, which is being led by the WA DOH.
The DOH is not aware of any appointment by the Premier of a Minister to assume responsibility for this collaborative intergovernmental approach.
(c) Recommendations that have not been implemented:
Recommendation 4:
The Committee recommends to the Minister for Health that he direct the Department of Health to review and report back to Parliament by June 2013 on the ethical considerations involved in the analysis of meconium for pregnancy cases where there is a strong suspicion of significant alcohol consumption during pregnancy.
DOH Response:
i)
After review of ethical considerations the DOH does not support the screening of meconium.
From an ethical perspective the routine drug testing of meconium could have the impact to further stigmatise a vulnerable group of women for limited gain in regard to the medical treatment of the baby.
Other areas of concern for routine meconium testing relates to informed consent from the parents, the cost of the test and the potential of the breakdown of the patient/healthcare service relationship which directly impacts on the parents willingness to engage with the service.
Service engagement and follow up is very important in regards to babies affected with FASD.
ii)
Not applicable.
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