Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694573882579.pdf (Australia)
Associate Professor Carmela Pestell School of Psychological Science, M304 The University of Western Australia 35 Stirling Highway, Crawley WA 6009 Adjunct Professor James Fitzpatrick School of Psychological Science, M304 The University of Western Australia 35 Stirling Highway, Crawley WA 6009 Dr Kirsten Panton School of Psychological Science, M304 The University of Western Australia 35 Stirling Highway, Crawley WA 6009 CRICOS Provider Code 00126G Committee Secretary Senate Standing Committees on Community Affairs PO Box 6100 Parliament House Canberra ACT 2600 Dear Committee, We represent members of the National Consortium Steering Committee for the Commonwealth funded Fetal Alcohol Spectrum Disorder (FASD) Models of Care project (H1617G038).
The overarching aim of this project was to develop and implement local models of care and expand sustainably funded FASD diagnosis and therapy service models across the country, with parties joining from Western Australia (WA), Northern Territory (NT), South Australia (SA), Tasmania (TAS) and Victoria (VIC)1.

Additionally, the development of a Graduate Certificate in the Diagnosis and Assessment of FASD was funded through the FASD Diagnostic Services and Models of Care project.
The implementation of the Graduate Certificate is part of a longer-term goal to increase diagnostic capacity within Australia and New Zealand.

To our knowledge, it is the only course of its kind in the world.

The aim of the course is to provide clinicians with the specialist knowledge and clinical skills required to participate in team-based diagnosis and assessment of FASD.
1 Consortium sites include: • • • • • • • • PATCHES Metro (WA) PATCHES Outreach (WA and NT) PATCHES Justice (WA and NT) Goulburn Valley Health Service (VIC) Danila Dilba (NT) Central Australia Aboriginal Congress (NT) FASD Tasmania Child Development Unit, Women’s and Children’s Health Service (SA) Effective approaches to prevention, diagnosis and support for Fetal Alcohol Spectrum DisorderSubmission 23 For this submission we will be addressing reference items d) and n), specifically in relation to the provision of training through the Graduate Certificate.
Our response will highlight the importance of courses like the Graduate Certificate in ensuring that clinicians are appropriately educated and trained in FASD.

Our hope is that clinicians who complete the course will not only be better trained to diagnose and assess FASD but will also be enthusiastic advocates for FASD in their local community, especially in rural and remote areas.
Reference items: (d) provision of diagnostic services in Australia including capacity, training, integration and diagnostic models in current use; (n) the effectiveness of the National FASD Action Plan 2018-2028, including gaps in ensuring a nationally co- ordinated response and adequacy of funding; Diagnostic services capacity and training There has been significant progress in Australia in regard to diagnostic rigor, with the release of the Australian Diagnostic Guide for the Diagnosis of FASD in 20162.
It has been recognised that there are ethical issues with not diagnosing FASD3, including the development of secondary medical and psychological issues4.

A FASD diagnosis provides an opportunity for individuals and their families to better understand behaviours associated with FASD, and gain access to further support and management for FASD.
Given the complex diagnostic criteria - which requires confirmation of prenatal alcohol exposure and neurodevelopmental impairment in at least 3 (out of 10) domains - ideally a FASD diagnosis is made within a multidisciplinary team2.

Typically, this will involve multiple assessments (spread over 1-2 days) followed by a multidisciplinary case-conference5, with a team that includes (but is not limited to) a Paediatrician or Physician, Neuropsychologist, Speech Pathologist and Occupational Therapist.
Despite this approach being considered as the gold-standard of assessment and diagnosis, there are currently very few FASD diagnostic services around the country.

Partly, this can be attributed to a lack of appropriately trained clinicians to assess and diagnose FASD.

Surveys continue to show evidence of a knowledge gap in clinicians and the general public regarding FASD6,7.
The importance of providing appropriate training for clinicians to diagnose and assess FASD spans across all priority areas of the FASD Action Plan8 and is clearly linked to a number of the specific objectives.

The FASD Action plan notes the importance of increasing FASD knowledge in frontline professionals on screening and diagnostic skills.
Currently, many of the training opportunities available to clinicians address the diagnostic features of FASD, though to have a more comprehensive understanding of FASD from a multidisciplinary perspective, a more nuanced approach is required.

FASD is a complex disorder which requires an in-depth understanding of how the diagnostic features of FASD fit within the wider neurodevelopmental picture.
It is important for differential diagnoses to be carefully considered, including the impact of other teratogens and other physical or psychosocial postnatal exposures (e.g.

trauma).

2 Bower, C., & Elliott, E. J.

(2016, on behalf of the Steering Group).

Report to the Australian Government Department of Health: “Australian Guide to the diagnosis of Fetal Alcohol Spectrum Disorder (FASD)”.

3 Helgesson, G., Bertilsson, G., Domeij, H., Fahlström, G., Heintz, E., Hjern, A., .

.

.

Rydell, A.-M. (2018).


Ethical aspects of diagnosis and interventions for children with Fetal Alcohol Spectrum Disorder (FASD) and their families.

BMC medical ethics, 19(1), 1.

4 Streissguth, A., Bookstein, F., Barr, H., Sampson, P., O’Malley, K., & Young, J.

(2005).

Scientific news ientific news adverse life outcomes associated with fetal alcohol syndrome-the benefits of early diagnosis.

5 Reid, N. (2018).

Fetal alcohol spectrum disorder in Australia: What is the current state of affairs?
Drug and alcohol review, 37(7), 827-830.

6 Peadon, E., Payne, J., Henley, N., D'antoine, H., Bartu, A., O'Leary, C., .

.

.

Elliott, E. J.

(2010).

Women's knowledge and attitudes regarding alcohol consumption in pregnancy: a national survey.

BMC public health, 10(1), 510.

7 Mukherjee, R., Wray, E., Hollins, S., & Curfs, L. (2015).

What does the general public in the UK know about the risk to a developing foetus if exposed to alcohol in pregnancy?

Findings from a UK mixed methodology study.


Child: care, health and development, 41(3), 467-474.

8 Department of Health (2018).

National Fetal Alcohol Spectrum Disorder Stategic Action Plan.

Canberra: Australian Government Department of Health.
Senate inquiry into FASD 2 Effective approaches to prevention, diagnosis and support for Fetal Alcohol Spectrum DisorderSubmission 23 Broader implications of improved training in clinicians includes increased FASD awareness in the current workforce which can advocate for FASD within their local communities and local diagnostic service.
This meets the specific prevention objective of Increase community knowledge and awareness about the harms and consequences of drinking during pregnancy or when planning a pregnancy.

Additionally, more thorough training for clinicians will also help to fulfil the objective outlined in Support and Management, which the objective was to support, parents, carers and families and in education and employment settings.
To provide adequate management post-assessment and/or diagnosis, clinicians need to have adequate baseline knowledge of FASD interventions and management strategies.

Current initiatives Diagnostic services Within the FASD National Consortium group, there has been a steady incline in clients assessed and subsequently diagnosed with FASD utilising the multidisciplinary team approach, indicating success with this model.
However, some sites experienced greater difficulty in launching this diagnostic service, due to difficulties in finding appropriately trained clinicians and/or clinicians who felt comfortable with the FASD diagnostic process.

In a 12-month period the Consortium of clinics1 has provided 429 diagnostic episodes (Jul-Dec 2018; 140 assessments; Jan-Jun 2019; 289 assessments) with an average yield of 50% diagnosed with FASD.
Education and training There have been several initiatives to promote FASD education and training at a local and national level.

NOFASD – the peak national body representing the interests of individuals and families living with FASD – provides a range of workshops which can be tailored to the specific audiences.

Though, one of the most accessible resources are the FASD Hub e-learning modules, which were released in 2016 to supplement the diagnostic guide2.
This free online tool has been invaluable for clinicians to gain a broad understanding of what is required for a FASD diagnostic assessment, and general principles for referral, screening and ongoing management.

Additionally, Professor Fitzpatrick was the founding chair of the Australian and New Zealand FASD Clinical Network, whose purpose is to coordinate, expand capacity and standardise approaches relating to FASD referral, diagnosis and management in Australia and New Zealand.
Within the FASD National Consortium Steering Group, each site was required to deliver 4 Community Education Sessions and 4 Training Clinics per year.

For the Community Education Sessions, each site completed over 140 sessions since July 2017 to over 4500 thousand participants which represent key stakeholders in the community (e.g.

parents/carers, allied health, Department of Education).
Feedback from these sessions indicate that most participants have found the information presented in these sessions to be useful and applicable for future practice.

These briefer education sessions are key for providing foundation knowledge about FASD, which in turn better equips community members, families, clinicians and other stakeholders for disseminating knowledge about this condition and the impact of prenatal alcohol exposure.
They can also help improve diagnostic confidence in medical and allied health professionals and stimulate the development of additional diagnostic opportunities.

Though, the complex nature of FASD lends to more comprehensive training opportunities being available for clinicians who are looking to actively work in this field in the future.
Recommendations Increasing diagnostic service capacity can be facilitated by supporting networks or consortia of diagnostic clinics, to enable standardisation of clinical processes, and peer to peer training opportunities.

Continuation of funding for coordinators within the existing FASD diagnostic clinic consortia will enable the gains made through this model to be sustained.
Senate inquiry into FASD 3 Effective approaches to prevention, diagnosis and support for Fetal Alcohol Spectrum DisorderSubmission 23 The key barriers for clinicians engaging in further training and education in FASD are accessibility and cost.

To help fill this need, in early 2019 the Graduate Certificate in the Diagnosis and Assessment of FASD was launched through the University of Western Australia by Professor’s Fitzpatrick and Pestell after considerable development of materials.
The course is delivered mostly online, allowing flexible delivery of course material.

Many of the regions that need more clinicians trained in FASD are often least able to access workshops and training clinics (e.g.

rural towns).

The Graduate Certificate provides an avenue for clinicians to build their skills and become more confident in assessing and diagnosing FASD.
This includes the provision of foundational material on FASD, assessment tools relevant to each discipline, and ethical and cultural considerations for diagnosis.

The course builds on the e-Learning modules and other community workshops by utilising a multilayered approach to teaching9, which provides a good opportunity for students develop a deeper understanding of FASD.

The interactive lecture format allows for students to discuss the content with clinicians across varied disciplines.
There has been large interest in the course to date with over 80 unique expressions of interest, including 31 formal applications made in the last 12 months.

These students were represented across varied disciplines including Nursing (13.3%), Occupational Therapy (6.67%), Paediatrics (6.67%), Psychology (33.33%), Speech Pathology (33.33%) and Social Work (6.67).
Students applied from Western Australia (64.52%), Northern Territory (12.91%), Queensland (12.91%), New Zealand (6.45%) and New South Wales (3.23%).

The students who have completed the coursework components of the unit have indicated that the course was beneficial for furthering their understanding of the complexity of FASD and has enabled them to feel more confident in supporting and managing clients with FASD in the future10.
However, one of the major barriers identified by prospective students is the cost, as the course is not HECS/HELP supported, and there are currently limited scholarships available to students.

Consequently, to help meet the goals of the FASD Action Plan, we highly recommend that the Australian Government commits to subsidising course costs to help propel FASD diagnostic efforts across the country, particularly in rural and remote regions.
This may involve: • Providing additional scholarship opportunities for clinicians looking to further their skills.

This could include a combination of: 1.

Whole course scholarships 2.

Scholarships for travelling to other clinics for the practical components.

This will be particularly valuable for students studying in remote or rural areas.

3.
3.

Subsidising unit costs To conclude, the training of multidisciplinary clinicians in FASD will be integral for sustaining prevention, screening, assessment, diagnosis and management efforts going forward.

We believe that supporting activities that promote training and education is necessary for the success of the 2018-2028 FASD Action Plan.

9 Akbar, M. (2016).

Digital technology shaping teaching practices in higher education.

Frontiers in ICT, 3, 1.


10 Further assessment-of-fetal-alcohol-spectrum-disorders-fasd information and Alumna Story available at https://www.uwa.edu.au/study/courses/graduate-certificate-in-the-diagnosis-and- Senate inquiry into FASD 4 Effective approaches to prevention, diagnosis and support for Fetal Alcohol Spectrum DisorderSubmission 23