Using the Health Promoting School Approach as As an Intervention strategy in dealing

with Fetal Alcohol Syndrome

Rubin AdamsWestern Cape Education Department

Fetal Alcohol Syndrome

Fetal alcohol syndrome was first described Fetal alcohol syndrome was first described independently by Lemoine and colleagues in independently by Lemoine and colleagues in France in 1968, and by Jones and Smith in the France in 1968, and by Jones and Smith in the US in 1973 US in 1973

Fetal alcohol syndrome in South Africa

• A US-South African collaborative study has revealed very high prevalence rates of fetal syndrome (40-80 per thousand) in some communities in the Western Cape Province• The rates are even greater if children with fetal alcohol neurodevelopmental disorder are included (up to 500 per 1000 in some schools)

Fetal alcohol syndrome

A specific pattern of malformation, which includes:A specific pattern of malformation, which includes:

Confirmed history of maternal alcohol abuse during Confirmed history of maternal alcohol abuse during pregnancypregnancy

Prenatal and postnatal growth retardation (including Prenatal and postnatal growth retardation (including length and/or weight)length and/or weight)

A specific pattern of minor anomalies of the faceA specific pattern of minor anomalies of the face

Neurocognitive deficitsNeurocognitive deficits

Background

• 1657 Liquor was first introduced to indigenous people • Liquor was traded for cattle and labour• It evolved into the tot system that became a form of labour control• 1928 Liquor Act prohibited the majority of Africans from drinking “European” liquor this act was repealed in 1962

Demographic Factors

• Low levels of education 4.4 years • Unemployment rate 40%• Married 12.9%• Average income R100 per week• Single 29 %• Living together 58,1%• Alcohol consumption 16 drinks per week mostly weekends• Low levels of religiosity

Schools• 13 Schools • Two types *smaller farm schools * bigger township schools• Classrooms are overcrowded ( learner- teacher ratio : 50 : 1)• Support Services are limited • LD learners (FASD) included in mainstream

Health Promoting Schools

A Health Promoting School is a school that is constantly strengthening its own capacity as a centre for learning, living and working.

(WHO, 1986)

HPS Principles“SPECS”

• Re-orientate Services•Build Healthy School Policies• Create Supportive Environments• Strengthen Community Action• Develop Personal Skills

HPS Principles applied in a home setting

•Services (Accessing support from formal services eg. Social, Health)•Policies (House rules)•Environments (Psychosocial/Physical)•Community Action (Enlisting support from family and friends)•Skills (Parenting Skills)

Intervention Rationale

• Mothers/ Caregivers are the only permanent support in children’s lives, teaching them skills could potentially have a long term benefits for children• Parenting skills could only be meaningful if it also address systemic factors•Therefore: Intervention need to address systemic issues unique to South African conditions

Interventions

• Family – Parenting, alcoholism, domestic violence, communication,

emotional issues, conflict management, creating an enabling environment, self-efficacy, teaching independence.

Baseline Assessment• Family Behaviour Questionaire• Spousal Risk Assessment Guide

• Criminal History• Psycho-social adaptation• Assault history on spouse

• Mental Pain Scale• Children’s Self-Efficacy Scale

• Enlisting resources• Academic achievement• Self-regulated learning• Leisure time, Skills and extra curricular activities• Self-regulatory efficacy• meeting other’s expectations• Social self efficacy• Self-assertive efficacy• Enlisting parent and community support

Parent Interventions

• Group sessions 1 hour per week evenings 2 Groups Farm and Urban

• Interactive approach • Agenda setting: Parents• Focus: Skills

Enlisting support from partner/familyChanging psycho/social environment

Limitations

• This study represented a pilot phase • Alcoholism limited support services• Low literacy levels/• Poor emotional vocabulary• Lack of financial support• Logistical issues transport• Timeslot- after work• No Aftercare for children

Learnings

• Persons struggling with dependency may experience difficulty in transferring and retaining skills.

• The sustaining of long term training material incentives

• Need for psychological support• Religiosity provides a support structure for

sustained behaviour change• Persons that have stopped drinking- benefits more

from training

Conclusions• Despite these limitations, preliminary data indicate that HPS model is appropriate for children with FASD from impoverished environments in SA.• The strength of this approach is that concurrently addresses systemic issues at multiple levels impacting on learning• It is extremely difficult to measure the extend of transfer and eventual impact