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FASD Competency-Based Curriculum Development Guide FASD Competency-Based Curriculum Development Guide for Medical and Allied Health Education and Practice Contents Executive Summary Introduction The Curriculum Development Guide: An Overview Model for Developing This Guide How to Use the FASD Curriculum Development Guide Competency I—Foundation Basic biomedical foundation Clinical issues Epidemiological and psycho-social-cultural aspects of FASDs Competency II—Screening and Brief Interventions Populations needing screening Risk factors Screening methods Brief interventions More extensive interviews used to evaluate alcohol consumption during pregnancy Definition of risk drinking Criteria for referral to treatment Competency III—Models of Addiction Past and current models of alcohol use Categories of alcohol use in women States of alcohol use, dependence, and addiction Stages of change in alcohol use Alcohol and co-occurring psychiatric disorders Characteristics of alcohol-dependent families Competency IV—Biological Effects of Alcohol on Fetus Defining amount of alcohol in a drink Alcohol metabolism and pharmacology Neuromorphological birth defects associated with alcohol use Alcohol-induced injuries on developing nervous system Cellular response to alcohol exposure Putative biomedical mechanisms Fetal alcohol exposure effects on neurobehavior Genetic variants and markers Table of Contents FASD Competency-Based Curriculum Development Guide Competency V—Screening, Diagnosis, and Assessment of FAS Framework for FAS diagnosis and services FAS diagnostic criteria Considerations for a referral for an FAS diagnostic evaluation Evaluation of fetal alcohol spectrum disorders Competency VI—Treatment Across the Lifespan for Persons with FASDs Concerns across the life span Providers and approaches to treatment for FASDs Family support services and resources Competency VII—Ethical, Legal, and Policy Issues Ethical issues Legal and policy issues Appendix Terms Used in This Guide Strategies and Resources for Teaching and Evaluation Resources for Cultural Competency Growth Charts FASD Regional Training Centers Contact Information Informational Resources Curriculum Development Team 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. Table of Contents FASD Competency-Based Curriculum Development Guide Executive Summary The Fetal Alcohol Spectrum Disorders (FASD) Competency-Based Curriculum Development Guide for Medical and Allied Health Education and Practice was developed by the FASD Regional Training Centers (RTCs), the Centers for Disease Control and Prevention (CDC), and the National Organization on Fetal Alcohol Syndrome (NOFAS). The purpose of the curriculum development guide is to enhance the knowledge and skills of health care providers to recognize and prevent FASDs. It is for use in developing educational programs and materials in a range of formats based on the needs of learners. The guide is organized by the following types of learning outcomes: Competencies— sets of knowledge, skills, and attitudes that enable a person to perform specific work. Learning goals—broad statements of what a learner should be able to do after instruction. Learning objectives—the specific steps needed to reach the learning goals. Medical and allied health students and professionals who desire to learn about FASDs have a variety of educational backgrounds and skill levels. While the competencies and goals are the same for all learners, the learning objectives have been tailored to meet varying needs and skills. The seven competencies for the curriculum are as follows: I. Demonstrate knowledge of the historical, biomedical, and clinical background of fetal alcohol syndrome (FAS) and other disorders related to prenatal exposure to alcohol, known collectively as fetal alcohol spectrum disorders (FASDs). II. Provide services aimed at preventing alcohol-exposed pregnancies in women of childbearing age through screening and brief interventions for alcohol use. III. Apply concepts and models of addiction to women of childbearing age, including those who are pregnant, to provide appropriate prevention services, referral, and case management. IV. Describe the effects of alcohol on the developing embryo and fetus. V. Screen, diagnose, and assess infants, children, adolescents, and adults for FAS and other prenatal alcohol–related disorders. VI. Provide long-term case management for persons with FASDs. VII. Recognize ethical, legal, and policy issues related to FASDs. Within each competency, specific learning objectives have been designated for three skill levels: Level 1— Medical and allied health students or professionals who need basic background information on FASDs for their education, work, or both. Level 2—Medical and allied health practitioners who need to use the information to provide services. Level 3— Medical and allied health professionals who educate and train other professionals about FASDs. Educators or trainers can select the appropriate goals and objectives with which to develop an educational program based on the level that is appropriate for the participants’ learning needs and current skill levels, along with university or organization criteria. Executive Summary Page i FASD Competency-Based Curriculum Development Guide Introduction Prenatal alcohol exposure is one of the leading preventable causes of birth defects and developmental disabilities. Effective strategies are needed both for diagnosing and treating children with fetal alcohol syndrome (FAS) or other prenatal alcohol–related conditions (known collectively as fetal alcohol spectrum disorders or FASDs), and for identifying women at risk of having an alcohol-exposed pregnancy and intervening to prevent adverse outcomes. Since FAS was identified approximately 30 years ago, significant advancements have been made in diagnosis, surveillance, prevention, and intervention, but a substantial amount of work remains.1 In 1999, Congress directed the Secretary of the U.S. Department of Health and Human Services to convene the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect, coordinated and managed by the FAS Prevention Team in CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD). The Task Force recommended several approaches to enhance FASD prevention, identification, and treatment efforts. One of these recommendations was the development of programs to educate health care professionals about prenatal alcohol–related disorders. As part of the fiscal year 2002 appropriations funding legislation, Congress mandated that CDC, acting through NCBDDD’s FAS Prevention Team and in coordination with the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect, other federally funded FAS programs, and appropriate nongovernmental organizations, would Develop guidelines for diagnosing FAS and other negative birth outcomes resulting from prenatal exposure to alcohol. Incorporate these guidelines into curricula for medical and allied health students and practitioners, and seek to have these curricula fully recognized by professional organizations and accrediting boards. Disseminate curricula to and provide training for medical and allied health students and practitioners regarding these guidelines. As part of the national initiative, in 2002 CDC funded four FASD Regional Training Centers (RTCs) to develop, implement, and evaluate educational curricula for medical and allied health students and practitioners. The RTCs, funded from 2002 to 2008 were2: Midwestern FASD Regional Training Center (a collaboration among Saint Louis University, the University of Missouri-Columbia, and St. Louis Arc) Northeastern FASD Regional Training Center (based at the University of Medicine and Dentistry of New Jersey) Southeastern FASD Regional Training Center (a collaboration among Meharry Medical College, Morehouse School of Medicine, and Tennessee State University) Western FASD Regional Training Center (based at the University of California, Los Angeles) 1 Centers for Disease Control and Prevention (2002). National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect—Defining the National Agenda for Fetal Alcohol Syndrome and Other Prenatal Alcohol-Related Effects.Morbidity and Mortality Weekly Report Recommendations and Reports 51, RR14, 9-12. 2 Contact information for the RTCs is provided in the Appendix. Introduction Page ii FASD Competency-Based Curriculum Development Guide The Curriculum Development Guide: An Overview The RTCs, in collaboration with CDC and the National Organization on Fetal Alcohol Syndrome (NOFAS), developed the FASD Competency-Based Curriculum Development Guide for Medical and Allied Health Education and Practice. It is a tool for developing a range of educational materials and training programs tailored to the needs of students and practitioners in the medical and allied health professions to prevent and treat FASDs. The guide discusses seven competencies—the sets of knowledge, skills, and attitudes that enable a person to perform specific work. These competencies are as follows: I. Demonstrate the historical, biomedical, and clinical background of fetal alcohol syndrome (FAS) and other disorders related to prenatal exposure to alcohol, known collectively as fetal alcohol spectrum disorders (FASDs). II. Provide services aimed at preventing alcohol-exposed pregnancies in women of childbearing age
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