An indigenous framework of the cycle of fetal alcohol spectrum disorder risk and prevention across the generations: historical trauma, harm and healing

ABSTRACT

Objective: To build on Evans-Campbell's [2008. “Historical Trauma in American Indian/Native Alaska Communities: A Multilevel Framework for Exploring Impacts on Individuals, Families, and Communities.” Journal of Interpersonal Violence 23 (3): 316–338. doi:10.1177/0886260507312290.] multilevel framework of historical trauma and health by focusing on the cycle of fetal alcohol spectrum disorders (FASD) in the socio-cultural, historical, and interpersonal context of trauma shared by American Indian and Alaska Native (AI/AN) peoples.

Methods: We analyzed qualitative data from focus groups with seventy four urban AI/ANs who were 15 years of age and older. Community-based participatory research methods were used for data collection and analysis. Our study explored knowledge and attitudes about FASD, perspectives on FASD risk factors, and culturally relevant approaches to FASD prevention and healthcare.

Results: According to our study's participants, efforts to address FASD among urban AI/ANs should align with and emerge from community values, promote healing, consider the broader context that influences behaviors, and reflect the community's understanding that FASD risk behaviors are inextricably linked with historical and contemporary trauma.

Conclusion: Effective, multiple-level FASD prevention approaches for AI/ANs may include prioritizing Indigenous culture, supporting intergenerational cohesion, focusing on non-stigmatic healing of traumas, and authentically engaging community knowledge. This work draws on community and cultural strengths in an effort to reduce the occurrence of substance-exposed pregnancies, and encourages transformational changes in systems that serve AI/AN peoples to promote a healthy and thriving community and future generations.

KEYWORDS:

• American Indian/Alaska Native (AI/AN)
• fetal alcohol spectrum disorders (FASD)
• patient engagement
• psychological trauma
• historical trauma

Acknowledgments

This work would not be possible without the dedication and courage of the Elders and Natural Helpers of the Future Generation Collaborative who served as research assistants. We are honored by the wisdom and experiences shared by all participants. We are also grateful to Alexa Weinstein for editorial contributions and support in this work. Funding for this project was provided by Multnomah County Health Department. We wish to express our gratitude to the Future Generations Collaborative and CityMatCH and the Prevention of Substance-Exposed Pregnancies Collaborative, who provided expert technical assistance and guidance in the beginning phases of this work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by CiyMatCH, with funding from the Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities (NCBDDD). CityMatCH initiated a Practice Collaborative, with an aim to reduce the number of pregnancies that are exposed to alcohol and other substances within U.S. urban areas. The Prevention of Substance-Exposed Pregnancies Collaborative (PSEP) was an 18-month technical assistance grant led by CityMatCH. The two main goals of the PSEP were to: (a) Increase awareness and knowledge about the risks of alcohol and other substance use during pregnancy and their associated adverse effects among providers who serve women of reproductive age; and (b) Enhance capacity of health care providers and public health professionals to deliver screening and intervention services to women of reproductive age who engage in risky substance use including alcohol, and refer to treatment, as appropriate.