BACKGROUND:In-person, active case ascertainment studies suggest the prevalence of children with fetal alcohol spectrum disorders (FASDs), lifelong disorders caused by prenatal alcohol exposure, in selected communities ranges from 11.3 to 71.4 per 1000 (including diagnosed and undiagnosed FASDs). National, population-based estimates of children with an FASD diagnosis and who are at different stages of a prototypical diagnostic process are limited. METHODS:Data are from the 2022-2024 National Survey of Children's Health (n = 160,640). We estimated the caregiver-reported prevalence of children who had ever been recommended for an FASD evaluation, received an FASD evaluation, and received an FASD diagnosis, overall and by demographic subgroups; Chi-square tests assessed differences by subgroup. RESULTS:Based on caregiver report, 2.4 per 1000 children were recommended for an FASD evaluation, 3.1 per 1000 received an evaluation, and 2.0 per 1000 received an FASD diagnosis. Prevalence varied by several characteristics; for example, the prevalence of children with an FASD diagnosis was higher among those cared for by grandparents or other relations (10.8 per 1000, 95 % confidence interval [CI]: 7.2-16.0) than those cared for by two parents (1.2 per 1000, 95 % CI: 0.9-1.6). Of the 4.6 per 1000 children either recommended for an FASD evaluation, received an evaluation, or diagnosed with an FASD, 20.0 % had all three experiences. CONCLUSIONS:These nationally representative, caregiver-reported estimates for children with an FASD diagnosis are lower than those from active case ascertainment studies, suggesting efforts are needed to improve the screening, evaluation, and diagnosis process for children suspected of an FASD.

BACKGROUND:Alcohol use during pregnancy might be a risk factor for some congenital heart defects (CHDs), but CHD prevalence among children with fetal alcohol spectrum disorders (FASDs) is not well understood. We used two administrative databases to explore CHD prevalence among U.S. children with and without FASDs. METHODS:We limited 2016-2022 Merative™ MarketScan® Multi-State Medicaid and Commercial data to children ≤ 17 years old with ≥ 1 year of continuous enrollment with complete data on mental health and substance use services. CHD prevalence was calculated by FASD status, overall and by age group, using log-binomial prevalence ratios (PRs) and 95 % confidence intervals (CIs). Analyses were repeated after matching on enrollment length, and age and year at the start of enrollment. In the Medicaid sample, we also stratified by demographic characteristics and analyzed severe and non-severe CHD diagnoses separately. Multidimensional bias analysis considered the influence of unmeasured prenatal tobacco exposure. RESULTS:Among 8732,345 children in the Medicaid sample, 5.2 % with FASDs and 1.0 % without FASDs had CHDs (matched cohort PR = 3.4 [CI: 2.8, 4.1]). PRs were similar when stratified by sex and race and ethnicity, and when looking at exclusively severe or non-severe CHDs. Among 10,567,765 children in the commercial claims sample, 3.0 % with FASDs and 0.6 % without FASDs had CHDs (matched cohort PR= 4.6 [CI: 3.3, 6.4]). CONCLUSION:CHDs were more common among children with FASDs compared to those without FASDs in two administrative database samples. Increased provider awareness about CHDs as a potential FASD comorbidity may improve timely CHD care.

BACKGROUND:The United States Preventive Services Task Force recommends annual alcohol screening and brief behavioral intervention (alcohol SBI) with general adult and pregnant populations. Implementation of alcohol SBI in primary care has encountered numerous barriers to adapting procedures and infrastructure to support its routine delivery. This collection of case studies describes the implementation strategies used by 4 academic health system teams that were funded by the Centers for Disease Control and Prevention to implement alcohol SBI within healthcare systems to prevent alcohol-exposed pregnancies. METHODS:We used constructs from the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe planned and unplanned adaptations to implementation strategies, and the SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix to identify key questions, challenges, and recommendations for improving alcohol SBI implementation. Participating systems were 2 regional affiliates of a national reproductive healthcare organization, an integrated non-profit healthcare system, and an urban medical center and its affiliated network of community health centers. RESULTS:Planned adaptations included expanding the target population for brief interventions to include patients drinking at low levels who could become pregnant, modifying workflows and systems to support routine screening, and customizing training content and logistics. Unplanned adaptations included varying site recruitment and pre-implementation awareness-building strategies to enhance local receptivity of systems with decentralized management, and pivoting from in-person to virtual training during the COVID-19 pandemic. Fewer unplanned adaptations were observed for health systems with centralized management structures and practice teams that were fully engaged in implementation planning, training, roll-out, and problem-solving. CONCLUSIONS:Unplanned adaptations were observed across the 4 cases and emphasized the importance of flexible, adaptive designs when implementing evidence-based practice in dynamic settings. Participation of the health system in planning, including decisions to modify electronic health records and workflows, supported adapting to unplanned circumstances to achieve implementation goals.

INTRODUCTION:Alcohol use during pregnancy can cause birth defects and developmental disabilities. From 2018 through 2020, 13.5% of pregnant women reported current drinking. The US Preventive Services Task Force recommends evidence-based tools (eg, AUDIT-C and SASQ) for implementing screening and brief interventions to reduce excessive alcohol use among adults, including pregnant people, for whom any alcohol use is considered excessive. METHODS:We used DocStyles 2019 data to conduct a cross-sectional analysis to examine current screening and brief intervention practices that primary care clinicians conduct among pregnant patients; clinicians' confidence levels in conducting screening, brief interventions, and referral to treatment; and the documentation of brief interventions in the medical record. RESULTS:A total of 1,500 US adult medicine clinicians completed the entire survey. Among the respondents who conduct screening (N = 1,373) and brief interventions (N = 1,357) in their practice, nearly all reported implementing screening (94.6%) and brief interventions (94.9%) with their pregnant patients for alcohol use, but fewer than half felt confident about conducting their screening practices (46.5%). Two-thirds (64%) reported using a tool that met the criteria recommended by the US Preventive Services Task Force (USPSTF). Over half documented brief interventions in electronic health record notes (51.7%) or designated space (50.7%). CONCLUSION:Pregnancy presents a unique opportunity for clinicians to incorporate screening into routine obstetric care and encourage behavior change among patients. Most providers reported always screening their pregnant patients for alcohol use, but fewer used evidence-based USPSTF-recommended screening tools. Increased clinician confidence in screening and brief intervention, the use of standardized screening tools tailored to pregnant people, and maximal use of electronic health record technology may enhance the benefits of their application to alcohol use, which ultimately can reduce adverse outcomes associated with alcohol use during pregnancy.

Background:In 2014, the Centers for Disease Control and Prevention funded a four-year partnership effort between university and health care professional associations (HCPAs) to reach health care providers (HCPs) nationally in six health disciplines and engage them to adopt evidence-based practices for the prevention, identification, and treatment of fetal alcohol spectrum disorders (FASDs). The aim of this project was to evaluate partnerships for their (1) structure and formation, (2) collaboration process, and (3) outcomes with regard to resources and strategies developed for FASD prevention and management. Methods:We used quantitative and qualitative data from quarterly progress reports, a semi-annual collaboration survey, and annual interviews with each discipline's members. Results:Partnerships in each discipline varied in the number of members and organizations, expertise in the discipline, and access to HCPs. Assigned partnerships with limited researchers' expertise in the discipline or the inability of HCPAs to reach priority audiences created challenges in the development and dissemination of resources. Two partnerships showed challenges in the collaboration process regarding understanding respective responsibilities, sharing similar ideas, and resolving disagreements despite efforts at facilitated discussion. Messaging and resource dissemination by HCPAs and the use of provider champions developed through HCPAs' national network emerged as promising approaches to engage HCPs. Conclusion:Circumstances under which partnerships are formed can facilitate or challenge collaboration and outcome efforts. Discipline-specific partnerships between researchers and HCPAs provide a model for evidence-based resources to be developed and disseminated widely for adoption by HCPs in their practice.

Opioid use disorder (OUD) poses a significant public health concern impacting maternal and infant outcomes. In 2018, the Centers for Disease Control and Prevention (CDC) partnered with the Association of State and Territorial Health Officials (ASTHO) to develop the Opioid use disorder, Maternal outcomes, and Neonatal abstinence syndrome Initiative Learning Community (OMNI LC) to identify and disseminate best practices and strategies for implementing systems-level changes in state health departments to address OUD affecting pregnant and postpartum persons and infants prenatally exposed to opioids. In 2019, the OMNI LC incorporated a field placement approach that assigned temporary field placement staff in five select OMNI LC states to provide important linkages, facilitate information sharing, and strengthen capacity among state and local health departments and other partners supporting maternal and child health communities affected by the opioid crisis. Using an implementation science framework, the field placement approach was assessed using five implementation outcome measures: appropriateness, acceptability, implementation cost, sustainability, and feasibility. Written responses from the participating OMNI LC states on these implementation outcome measures were analyzed to (1) highlight key strategies used by field placement staff, (2) assess the implementation of the OMNI LC field placement approach within the context of implementation science, and (3) identify implementation barriers. This report describes the implementation of a temporary field placement approach and suggests that this approach could be replicated to enhance state and local capacity to respond to the opioid crisis or other high-consequence events.

The opioid crisis has impacted vulnerable populations, specifically pregnant and postpartum women, and infants prenatally exposed to substances, including infants with Neonatal Abstinence Syndrome. Lack of access to clinical and social services; potential stigma or discrimination; and lack of resources for provision of services, including screening and treatment, have impacted the health of these populations. In 2018, using a systems change approach, the Association of State and Territorial Health Officials (ASTHO) and the Centers for Disease Control and Prevention (CDC) convened an Opioid use disorder, Maternal outcomes, Neonatal abstinence syndrome Initiative Learning Community (OMNI LC) that included other federal agencies, national clinical and nonclinical organizations, and 12 state leadership groups. The purpose of the OMNI LC was to determine areas of focus and identify strategies and best practices for implementing systems change to improve maternal and infant outcomes associated with opioid use disorder (OUD) during the perinatal period. Activities included in-person convenings with policy goal action plan development, virtual learning sessions, intensive technical assistance (TA), and temporary field placements. The OMNI LC partnering agencies and state teams met bimonthly for the first year of the initiative. At the in-person convening, state teams identified barriers to developing and implementing systems change in activity-specific action plans within five areas of focus: financing and coverage; access to and coordination of quality services; provider training and awareness; ethical, legal, and social considerations; and data, monitoring, and evaluation. State teams also identified stakeholder partnerships as a necessary component of strategy development in all areas of focus. Four virtual learning sessions were conducted on the areas of focus identified by state teams, and ASTHO conducted three intensive TA opportunities, and five states were identified for temporary field placement. To successfully address the impact of the opioid crisis on pregnant and postpartum women and infants, states developed innovative strategies focused on increasing support, services, and resources. Moving forward, state teams will participate in two additional in-person meetings, continue to identify barriers to the work, refine and customize action plans, and set new goals, to effect broad-ranging systems change for these vulnerable populations.

Since 1999, the rate of opioid use disorder (OUD) has more than quadrupled, from 1.5 per 1,000 delivery hospitalizations to 6.5 (1), with similar increases in incidence of neonatal abstinence syndrome (NAS) observed for infants (from 2.8 per 1,000 live births to 14.4) among Medicaid-insured deliveries (2). CDC's response to the opioid crisis involves strategies to prevent opioid overdoses and related harms by building state capacity and supporting providers, health systems, and payers.* Recognizing systems gaps in provision of perinatal care and services, CDC partnered with the Association of State and Territorial Health Officials (ASTHO) to launch the Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community (OMNI LC). OMNI LC supports systems change and capacity building in 12 states.† Qualitative data from participating states were analyzed to identify strategies, barriers, and facilitators for capacity building in state-defined focus areas. Most states focused on strategies to expand access to and coordination of quality services (10 of 12) or increase provider awareness and training (nine of 12). Fewer states focused on data, monitoring, and evaluation (four of 12); financing and coverage (three of 12); or ethical, legal, and social considerations (two of 12). By building capacity to strengthen health systems, state-identified strategies across all focus areas might improve the health trajectory of mothers, infants, and families affected by the U.S. opioid crisis.

Alcohol, tobacco, marijuana, and other substance use by adolescents can have a serious impact on their health and well-being according to the American Academy of Pediatrics (AAP, 2016). School social workers (SSW) are trained to conduct assessments and interventions with adolescents and families to improve their functioning and academic performance (National Association of Social Workers [NASW], 2003). Also, substance abuse prevention, identification, brief intervention, and referral to treatment are supported by the profession's standards for working with adolescents (NASW, 2003). For SSW interested in incorporating these services into their work, this practice highlights column describes the importance and principles of conducting adolescent screening, brief intervention, and referral to treatment (SBIRT) for substance use. Highlights are drawn from Substance Use Screening and Intervention Implementation Guide: No Amount of Substance Use Is Safe for Adolescents (hereinafter, AAP Guide), a guide developed through a cooperative agreement between AAP and Centers for Disease Control and Prevention (CDC) (AAP, 2016).

Background: Women continue to drink alcohol during pregnancy despite Surgeon Generals' Advisory statements and educational efforts about the dangers. Purpose: This focus group research study examined women's knowledge and beliefs about alcohol consumption and its risks during pregnancy along with related perceptions of social influences and information sources in order to inform future messaging. Methods: The study included 20 focus groups of 149 reproductive-age women segmented by age, pregnancy status, and race/ethnicity. Results and Discussion: Women acknowledged the risks and consequences of drinking alcohol during pregnancy, but many held common misconceptions. Some women continued to drink during pregnancy or expressed intent to continue drinking until pregnancy confirmation. Findings indicated that women's partners, families, and friends influence women's decisions to drink or abstain from alcohol. In addition, health care providers and the Internet act as important sources of health information for women but sometimes do not adequately educate them about the risks of alcohol use and pregnancy. Translation to Health Education Practice: Considerations for messaging and educational materials related to alcohol use and pregnancy include providing clear and consistent messaging (especially from health professionals), focusing on social support strategies, and utilizing electronic media.The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Alcohol use among women of childbearing age is a leading, preventable cause of birth defects and developmental disabilities in the United States. Although most women reduce their alcohol use upon pregnancy recognition, some women report drinking during pregnancy and others may continue to drink prior to realizing they are pregnant. These findings emphasize the need for effective prevention strategies for both pregnant and nonpregnant women who might be at risk for an alcohol-exposed pregnancy (AEP). This report reviews evidence supporting alcohol screening and brief intervention as an effective approach to reducing problem drinking and AEPs that can lead to fetal alcohol spectrum disorders. In addition, this article highlights a recent report of the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect that describes effective interventions to reduce alcohol use and AEPs, and outlines recommendations on promoting and improving these strategies. Utilizing evidence-based alcohol screening tools and brief counseling for women at risk for an AEP and other effective population-based strategies can help achieve future alcohol-free pregnancies.

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.

Hurricane Katrina caused immense upheaval and disrupted many lives. Among those affected were pregnant women. A public service announcement, website content, and a fact sheet were developed to inform pregnant women about the issues that could potentially affect their health and that of their babies. The aim of these products was to provide health messages that captured the attention of the intended audience amid the challenging environment of an emergency situation. Message dissemination methods-television, radio, and websites-were carefully selected, because using a combination of outlets is often helpful in reaching the widest audience possible.

Fetal alcohol syndrome (FAS) results from maternal alcohol use during pregnancy and carries lifelong consequences. Early recognition of FAS can result in better outcomes for persons who receive a diagnosis. Although FAS was first identified in 1973, persons with this condition often do not receive a diagnosis. In 2002, Congress directed CDC to update and refine diagnostic and referral criteria for FAS, incorporating recent scientific and clinical evidence. In 2002, CDC convened a scientific working group (SWG) of persons with expertise in FAS research, diagnosis, and treatment to draft criteria for diagnosing FAS. This report summarizes the diagnostic guidelines drafted by the SWG, provides recommendations for when and how to refer a person suspected of having problems related to prenatal alcohol exposure, and assesses existing practices for creating supportive environments that might prevent long-term adverse consequences associated with FAS. The guidelines were created on the basis of a review of scientific evidence, clinical expertise, and the experiences of families affected by FAS regarding the physical and neuropsychologic features of FAS and the medical, educational, and social services needed by persons with FAS and their families. The guidelines are intended to facilitate early identification of persons affected by prenatal exposure to alcohol so they and their families can receive services that enable them to achieve healthy lives and reach their full potential. This report also includes recommendations to enhance identification of and intervention for women at risk for alcohol-exposed pregnancies. Additional data are needed to develop diagnostic criteria for other related disorders (e.g., alcohol-related neurodevelopmental disorder).

Prenatal alcohol exposure can lead to serious birth defects and developmental disabilities. A need exists to develop effective strategies for both children with fetal alcohol syndrome (FAS) or other prenatal alcohol-related effects and for women at high risk for having an alcohol-exposed pregnancy. Since the syndrome was identified approximately 30 years ago, advancements have been made in FAS diagnostics, surveillance, prevention, and intervention, but a substantial amount of work remains. Collaborations among partners in federal state, and local agencies, academia, clinical professions, school systems, and families are critical to developing and implementing successful efforts related to FAS and fetal alcohol effect (FAE). In 1999, Congress directed the Secretary of the U.S. Department of Health and Human Services to convene the National Task Force on FAS and FAE (the Task Force). CDC's National Center on Birth Defects and Developmental Disabilities, Fetal Alcohol Syndrome Prevention Team, coordinates the Task Force and manages its operation. Since the Task Force was chartered in 2000, Task Force members, with input from multiple partners, have convened to deliberate and determine the Task Force mission, goals, and priority concerns to be addressed. This report describes the structure, function, mission, and goals of the Task Force and provides their first recommendations. An explanation of how the Task Force recommendations were generated and the Task Forces next steps are also reported.