Fetal Alcohol Syndrome (FAS) occurs in approximately 3 of 1,000 live births in the general population of the U.S. and is the leading known cause of mental retardation. The Midwest Regional Fetal Alcohol Syndrome Training Center (MRFASTC) surveyed 1,000 licensed occupational therapists (OT) of the American Occupational Therapists Association in a six-state Midwest region, including Missouri, Iowa, Nebraska, Kansas, Oklahoma, and Arkansas to assess knowledge and attitudes regarding FAS. Nearly 20% of the OTs responded. Of the respondents, nearly 94% regarded at least 1 drink per day as being 'heavy' in a pregnant woman. There was an increase in the number of respondents who thought it was acceptable to consume 1 drink or more with each advancing trimester of pregnancy. 92% of the OTs indicated a willingness to counsel a mother of a child having FAS, but 96% indicated a poor to fair ability to select valid and reliable assessment instruments for screening a child for FAS. Only 6% of the OT respondents indicated a good-excellent ability to conduct brief interventions on alcohol cessation for women. The data collectively indicate OTs possess similarities to other health care providers, including physicians and psychologists, in the misunderstanding or deficits of knowledge and skills associated with FAS and that they are largely unprepared to provide intervention for women 'at risk' for FAS, or to recognize correctly FAS in children. There is a demonstrated need, and desire, by the practicing OTs for continued education related to alcohol abuse associated with FAS.

Prenatal exposure to alcohol is a leading preventable cause of birth defects and developmental disabilities. Individuals exposed to alcohol during fetal development can have physical, mental, behavioral, and learning disabilities, with lifelong implications. These conditions are known as fetal alcohol spectrum disorders (FASDs). Health care professionals play a crucial role in identifying women at risk for an alcohol-exposed pregnancy and in identifying the effects of prenatal alcohol exposure among individuals. The Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities has funded four universities as FASD Regional Training Centers (RTCs). The RTCs, in collaboration with the CDC and the National Organization on Fetal Alcohol Syndrome, are developing, implementing, and evaluating educational curricula for medical and allied health students and practitioners and seeking to have the curricula incorporated into training programs at each grantee's university or college, into other schools throughout the region, and into the credentialing requirements of professional boards. This article highlights some of the innovative training approaches that the RTCs are implementing to increase knowledge regarding FASDs and the ability of health professionals to identify, treat, and prevent these conditions.

Background Conduct a comprehensive survey of FASD knowledge, skill, and attitudes regarding recognition, diagnosis, treatment, and prevention among family physicians in the Midwest. Methods A 35 question survey on FASD recognition, diagnosis, treatment, and prevention was sent to a random sample of 1,000 active members of the AAFP from Missouri and the 5 surrounding states. Results Twelve percent of participants returned surveys. The mean age was 44 years, 64% were male, 86.3% were Caucasian, and 43.6% were from rural areas. The survey revealed that the great majority of family physicians possess general knowledge about FAS and the effects of alcohol on children, including the importance of early diagnosis and reducing secondary disabilities. However, the survey revealed significant deficits when it came to recognition and diagnosis of FAS, with the great majority of family physicians uncertain about the facial dysmorphology features associated with FAS. In addition, the majority had not made or referred a child for the diagnosis of FAS during the past year, and if they had made the diagnosis, they had not used an evidence-based protocol to do so. Significant barriers to making the diagnosis of FAS were identified, including inadequate training and the belief that better qualified specialists were available to make the diagnosis. Regarding treatment, a significant majority of family physicians had not received any clinical training in the care of children with FAS, and those who had received training felt it was only of fair quality. Regarding prevention, only 12.8% of family physicians asked when seeing a new pediatric patient if the child was exposed to alcohol in utero. Finally, many family physicians reported that education materials on FASD were not available in their area, and many believed the presence of these educational resources would be extremely helpful if they were available. Conclusions While family physicians possess a general knowledge base about FAS, FASD, and alcohol use during pregnancy, significant knowledge deficits exist in the area of prevention, diagnosis, and treatment, and significant barriers make completion of these tasks difficult in practice. Inadequate clinical training in medical school, residency, and continuing education venues may be a prime reason why these deficits occurred.

Fetal alcohol exposure affects approximately 1% to 3% of live births in the United States. Family physicians are in a unique position to reduce the incidence of alcohol-exposed pregnancy. Fetal alcohol exposure can be minimized through 2 general approaches: reducing alcohol consumption or increasing effective contraception among childbearing-aged women who engage in "at-risk" drinking and encouraging pregnant women to abstain from alcohol. Although no safe level of alcohol consumption during pregnancy is established, women who binge drink are more likely to deliver infants with physical and cognitive-developmental anomalies. Screening tools, such as quantity/frequency questions, the TWEAK and the T-ACE, developed specifically for prenatal care, are more useful with women than the CAGE and Michigan Alcohol Screening Test ( MAST). Screening alone seems to reduce alcohol use among pregnant women. Brief interventions, including education about alcohol's effects on the developing fetus, are effective among women not responding to screening. Unfortunately, many barriers exist to effective implementation of alcohol-exposed pregnancy (AEP) prevention in the clinical setting. Designing effective office base systems so the entire burden of implementing AEP prevention activities does fall solely on the family physician is critical.

Background Conduct a comprehensive survey of FASD knowledge, skill, and attitudes regarding recognition, diagnosis, treatment, and prevention among family physicians in the Midwest. Methods A 35 question survey on FASD recognition, diagnosis, treatment, and prevention was sent to a random sample of 1,000 active members of the AAFP from Missouri and the 5 surrounding states. Results Twelve percent of participants returned surveys. The mean age was 44 years, 64% were male, 86.3% were Caucasian, and 43.6% were from rural areas. The survey revealed that the great majority of family physicians possess general knowledge about FAS and the effects of alcohol on children, including the importance of early diagnosis and reducing secondary disabilities. However, the survey revealed significant deficits when it came to recognition and diagnosis of FAS, with the great majority of family physicians uncertain about the facial dysmorphology features associated with FAS. In addition, the majority had not made or referred a child for the diagnosis of FAS during the past year, and if they had made the diagnosis, they had not used an evidence-based protocol to do so. Significant barriers to making the diagnosis of FAS were identified, including inadequate training and the belief that better qualified specialists were available to make the diagnosis. Regarding treatment, a significant majority of family physicians had not received any clinical training in the care of children with FAS, and those who had received training felt it was only of fair quality. Regarding prevention, only 12.8% of family physicians asked when seeing a new pediatric patient if the child was exposed to alcohol in utero. Finally, many family physicians reported that education materials on FASD were not available in their area, and many believed the presence of these educational resources would be extremely helpful if they were available. Conclusions While family physicians possess a general knowledge base about FAS, FASD, and alcohol use during pregnancy, significant knowledge deficits exist in the area of prevention, diagnosis, and treatment, and significant barriers make completion of these tasks difficult in practice. Inadequate clinical training in medical school, residency, and continuing education venues may be a prime reason why these deficits occurred.