Occupational Therapy In Health Care
ISSN: 0738-0577 (Print) 1541-3098 (Online) Journal homepage: http://www.tandfonline.com/loi/iohc20
The Knowledge of Rehabilitation Professionals Concerning Fetal Alcohol Spectrum Disorders Stephanie M. Birch, Heidi A. Carpenter, Anna M. Marsh, Kimberly A. McClung & Joy D. Doll To cite this article: Stephanie M. Birch, Heidi A. Carpenter, Anna M. Marsh, Kimberly A. McClung & Joy D. Doll (2015): The Knowledge of Rehabilitation Professionals Concerning Fetal Alcohol Spectrum Disorders, Occupational Therapy In Health Care, DOI: 10.3109/07380577.2015.1053163 To link to this article: http://dx.doi.org/10.3109/07380577.2015.1053163
Published online: 26 Jun 2015.
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Date: 28 September 2015, At: 04:43
Occupational Therapy In Health Care, Early Online:1–11, 2015 C 2015 by Informa Healthcare USA, Inc. Available online at http://informahealthcare.com/othc DOI: 10.3109/07380577.2015.1053163
The Knowledge of Rehabilitation Professionals Concerning Fetal Alcohol Spectrum Disorders
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Stephanie M. Birch, Heidi A. Carpenter, Anna M. Marsh, Kimberly A. McClung, & Joy D. Doll Department of Occupational Therapy, Creighton University, Omaha, NE, USA
ABSTRACT. The purpose of this study was to explore rehabilitation professionals’ knowledge regarding signs and symptoms, prevention, and intervention of fetal alcohol spectrum disorders (FASD). Participants were 111 rehabilitation practitioners (e.g., occupational therapy, physical therapy, and speech-language pathology practitioners) recruited through email using a quantitative online survey design with purposive, snowball sampling. Results showed the majority of participants’ demonstrated accurate knowledge of the signs and symptoms of FASD. Since professionals who received formal education on FASD reported significantly higher feelings of preparedness to identify children with FASD and manage/coordinate intervention plans, this study suggests rehabilitation professionals may be better prepared to treat individuals with FASD if they participate in formal training. KEYWORDS. Developmental disabilities, Fetal alcohol spectrum disorders, Occupational therapy, Physical therapy, Speech-language pathology
Despite the fact that fetal alcohol spectrum disorders (FASD) is preventable, it is the “leading non-genetic cause of mental retardation in the Western World” (Tough et al., 2007, p. 386). FASD is caused by prenatal alcohol exposure and is characterized by a mild to severe range of neurological deficits, which may be accompanied by physical defects such as facial and organ malformations (Lange et al., 2013). Deficits associated with FASD vary based on when and to what amount the fetus was exposed to alcohol (Kalberg and Buckley, 2007). Rehabilitation professionals, including occupational therapists, play a key role in the management of the disabilities associated with FASD and can help individuals with FASD thrive (Astley, 2014). The CDC’s Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis outlines best practices for the diagnosis and care of individuals with FASD, in which rehabilitation professionals are highlighted as core team members for intervention (Bertrand et al., 2004). Address correspondence to: Joy D. Doll, Department of Occupational Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA (E-mail: [email protected]). (Received 28 May 2014; accepted 17 May 2015)
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Due to the variety of deficits associated with FASD, it is often under recognized or mislabeled (Paley and O’Connor, 2011). This is of concern for health care professionals since discriminating between FASD and other similar diagnoses is necessary to provide optimal intervention. Despite the fact that early diagnosis has been identified as important for quality of life, health care practitioners still report discomfort with identification of FAS and FASD (Elliott et al., 2007). Under the fetal alcohol spectrum, fetal alcohol syndrome (FAS) is the only condition with clear diagnostic criteria including facial malformations and microcephaly (Elliott et al., 2007). Consequently, children who exhibit some but not all of the criteria to qualify for an FAS diagnosis may go unrecognized (Bertrand et al., 2004). This lack of recognition may lead to either lack of intervention or intervention that does not cater to the unique needs of individuals with FASD. The brain damage associated with prenatal alcohol exposure, more specifically those with a diagnosis of FAS, requires a comprehensive health team to support the individual throughout the lifespan with early intervention as a critical component to success of individuals (Bertrand et al., 2004). Rehabilitation professionals [e.g., physical therapists (PT), occupational therapists (OT), and speech-language therapists (SLP)] address developmental delays, support educational outcomes, and promote a successful transition into adulthood for individuals with FASD (VargusAdams, 2006). Since rehabilitation professionals play such a significant role in the lifelong management of FASD, these professionals need to have a strong understanding of the signs and symptoms of FASD to ensure intervention matches with the disabilities associated with FASD (Jirikowic et al., 2010). Several studies (Gahagan et al., 2006; Zoorob et al., 2010; Eyal and O’Connor, 2011) have been published concerning physicians’ knowledge and methods of intervention for FASD. In 2006, Gahagan and colleagues, supported by the American Association of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), surveyed AAP members in the United States to identify knowledge of fetal alcohol spectrum disorder. In this study, providers including pediatricians, pediatric subspecialties and residents reported knowledge of FASD but felt unprepared to manage or prevent FASD. Gahagan et al. (2006) reported that only 34% of participants surveyed by the AAP reported that they “felt prepared to manage and coordinate the intervention of children with fetal alcohol spectrum disorders” (p. 657). Zoorob and colleagues (2010) similarly assessed family physicians and residents for their knowledge of FASD. Those providers who had experienced FASD in their medical education curriculum reported higher levels of knowledge and comfortability with the management of FASD. In another study by Eyal and O’Connor (2011), psychiatric residents were assessed and reported that FASD is underrecognized. Overall, across the literature physicians from across different specialties report the need for training on FASD to ensure comfort in the management of the disorder. Despite exploration into the knowledge of physicians, little research has been done regarding health care professionals reported knowledge on FASD beyond physicians. Payne and colleagues revealed that less than 16% of health care professionals identified the essential features of FAS correctly (Payne et al., 2011). In one study, health professionals including nurses, social workers, counselors, therapists, and physical therapists participated in an educational session on FASD with
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a pretest/posttest regarding the fundamentals of FASD (Brimacombe et al., 2008). Reported knowledge of FASD for all participants improved from the pretest to posttest due to the educational presentation (Brimacombe et al., 2008). In another study, 30–40% of physician and residency programs reported a need to incorporate FASD training into their curriculum (Zoorob et al., 2010). The study also found that formal training contributed to participants’ feelings of preparedness to treat individuals with FASD (Zoorob et al., 2010). Furthermore, a study by Payne et al. (2011) indicated approximately 18% of participants felt fairlyto very-prepared to treat patients with FAS after receiving education on prevention of prenatal alcohol exposure and FASD. The findings of Gahagan et al. (2006), Payne et al. (2011), Zoorob et al. (2010), and this study all indicate the need for more formal training across the health care professions in regards to FASD. Since it has been established that the management of FASD requires a teambased health care approach (Denys et al., 2011; Paley and O’Connor, 2011), all health care professionals on the team, including rehabilitation professionals, need to be able to identify and design interventions for supporting individuals with FASD (Substance Abuse and Mental Health Services Administration, 2014). Thus, the purpose of this study was to further investigate rehabilitation professionals’ current knowledge about FAS and FASD; specifically, signs and symptoms, prevention, and intervention. In addition, this study aimed to explore how rehabilitation professionals gained their knowledge regarding signs and symptoms, prevention, and intervention of FASD.
METHOD Research Design This study used a quantitative survey design with purposive sampling to understand rehabilitation professionals’ knowledge and current clinical knowledge of FASD. The online questionnaire design was utilized in order to maximize efficiency and meet the needs of busy rehabilitation professionals, in addition to maintaining a cost neutral budget for the study. Participants The target population for this study was licensed rehabilitation professionals within the United States. Rehabilitation professionals surveyed included occupational therapy, physical therapy, and speech language pathology practitioners. Inclusion criteria for participants included that the participant hold an active license currently practicing and met the criteria of being a rehabilitation practitioner as identified previously (i.e. occupational therapy, physical therapy or speech language pathology). Each professional organization for each discipline in each state was contacted to obtain member lists. A list of prospective study participants’ email addresses was generated by obtaining publicly available membership lists of state professional organizations for the three disciplines across the United States that included emails.
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Procedure Prior to implementation, this study was approved by the Creighton University Institutional Review Board (IRB). The prospective participants received an initial email invitation to take part in the survey that included a brief explanation of the study, participation instructions, and a link to the online questionnaire. The email also contained a request to forward the same invitation email to other rehabilitation practitioners which created a snowball sampling method. After three weeks from the initial email invitation, a reminder email was sent to prospective participants. A final reminder email was sent one week prior to the survey closing date. The questionnaire was available for a total of 8 weeks.
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Instrument The questionnaire used in this study was a modification of a survey developed by the Centers for Disease Control and Prevention (CDC) and the American Association of Pediatrics (AAP). The original survey was used to assess the knowledge of FAS and prenatal alcohol-related disorders (Gahagan et al., 2006). Researchers were granted permission, from the original authors and the AAP, to use and modify the questionnaire that had been developed and publishing in the journal Pediatrics, the official journal of the AAP titled “Pediatricians” knowledge, training, and experience in the care of children with fetal alcohol syndrome’ (Gahagan et al., 2006). The modifications of the questionnaire were made by an occupational therapy practitioner with experience with FAS and other prenatal alcohol-related disorders. The original author of the questionnaire and AAP approved these modifications. Modifications to the questionnaire were made to the demographic section in order to gather accurate information regarding professional discipline, practice setting, and years in practice rehabilitation practitioners. Questions that addressed diagnosing FAS and other prenatal alcohol-related disorders were either modified or omitted. All questions regarding knowledge of FAS and other prenatal alcoholrelated disorders were maintained to assess similar knowledge previously assessed in the study by Gahagan of pediatricians and pediatric residents. The modified questionnaire consisted of closed-ended questions regarding knowledge of and where they obtained their clinical knowledge regarding FAS and other prenatal alcohol-related disorders. Other modifications related to when and where participants received education on FAS and other prenatal alcoholrelated disorders that are unique to rehabilitation and differ from physician training. Another significant modification was to use the term FASD rather than FAS and other prenatal alcohol-related disorders due to updates in terminology related to the disorder used by the CDC. All efforts were made to limit modifications to the questionnaire in order to lead to comparison of knowledge between rehabilitation professionals and physicians regarding FAS and other prenatal alcohol-related disorders.
DATA ANALYSIS Results from the survey were analyzed using IBM SPSS Statistics Version 20. Descriptive statistics were computed to determine frequencies and means of
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selected survey responses including demographic information and knowledgebased questions. Correct response rates for knowledge-based questions were analyzed to determine what percent of the surveyed population demonstrated selected knowledge of FASD. One-way analysis of variance (ANOVA) test, including the Brown–Forsythe test, were conducted to compare levels of preparedness of all professions and whether the participant had received any type of formal training in an attempt to answer the research questions. The subsequent post hoc analyses, using HSD Tukey and Games Howell, were performed to determine where significant differences lie between specific formal training groups (i.e., professional education, continuing education, other, or no training received).
RESULTS Researchers sent email requests to 1,264 practitioners and received a total of 111 responses. Participants were asked to forward the questionnaire as a way to recruit more participants for the study. Due to the structure of the online process, an overall response rate is unknown. The final sample size consisted of 96 females, 14 males, and 1 undisclosed participant, with ages ranging from 25 to 71 years (M = 46.6, SD = 11.22). The majority of participants were occupational therapy (n = 48) and physical therapy (n = 37). Additionally, speech language pathology (n = 22), physical therapy assistants (n = 3), and an occupational therapy assistant (n = 1) also participated. Employment ranged from academia (68%), school-based (8.1%), outpatient (7.2%), hospital/clinic (5.4%), private practice (1.8%), community-based (0.9%), and other (8.1%). The number of years in practice ranged from 1 to 44 years, with only 16.2% of participants having been in practice less than 10 years. Table 1 illustrates the number and percent of participants that identified the problems associated with FASD.
TABLE 1. Reported Responses on General FASD Knowledge by Rehabilitation Professionals Correct Response Delayed development Lowered IQ/Intellectual disabilities Behavior problems Birth defects/malformation Prenatal alcohol risk for permanent brain damage Low birth weight Early diagnosis and surveillance may lead to secondary prevention of disabilities Psychiatric (DSM-IV) disorders Long-term emotional disorders Attention deficit hyperactivity disorder Alcohol’s effect on fetal development is clear Young adults with FASD do not usually achieve independence at the expected time (18–21 yr) Addictions Alcohol withdrawal not worst outcome of fetal exposure Higher rates in minorities, including Native Americans
% Correct 100.0 96.4 94.6 94.6 92.8 92.5 91.8 89.2 89.2 85.6 80.2 75.7 72.5 70.3 67.9
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TABLE 2. Percentage Distribution of Participants Who Did or Did Not Receive Education/Training in Knowledge of FASD
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Question Response Ability to recognize features associated with FASD/other alcohol-related disorders Understanding basic biomedical mechanisms that result in FASD Ability to select valid and reliable assessment instruments to screen Ability to identify risk factors/ interventions Ability to perform clinically relevant intervention and management plans Be able to make referrals for further workup when appropriate Ability and appreciation to use interdisciplinary teams evaluations Ability to assist clients in accessing local FASD resources Utilization of techniques for effective communication Demonstration of the ability to provide ethical protections to the patient with FASD Ability to education pregnant women about the effects of alcohol on their babies Ability to screen for women for risky or hazardous drinking
Professional Education (i.e., academic curriculum) CE
Other
No
36.9
18
13.5
31.5
34.2
13.5
15.3
36.9
11.7
12.6
6.3
69.4
27.0 24.3
18.9 17.1
11.7 8.1
42.3 50.5
22.5
11.7
15.3
50.5
19.8
16.2
18.0
45.9
14.4
11.7
18.9
55.0
17.1
9.0
15.3
58.6
30.6
8.1
15.3
45.9
26.1
8.1
18.9
46.8
7.2
3.6
7.2
82.0
Note. CE = Continuing education
Table 2 describes the percentage of distribution of participants who did or did not receive education/training in their professional education. Researchers found that those participants who had received formal training (e.g., professional education or continuing education) on the ability to recognize deficits of FAS and FASD felt more prepared to identify children with FASD and other alcohol-related disorders, F(3, 107) = 13.55, p < 0.001. A Tukey HSD post hoc analysis was used to determine significant differences between formal training groups and levels of preparedness. Results showed that participants who received any type of formal training felt more prepared than those who had received no training at all (p < 0.001). Specifically, 75% of those who participated in formal training felt most prepared to identify children with FASD; while only 20% felt prepared to do the same when no formal training had been received. Table 3 describes the perception of preparedness by participants based on the level of education/training to identify children with FASD and recognize the constellation of features associated with FASD. Table 4 identifies preparedness of rehabilitation professionals to manage and coordinate the intervention plans based on receiving any formal training in the ability to plan and perform clinically relevant intervention and management plans to assist and aid both the patient with FASD and their families.
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TABLE 3. Perception of Preparedness by Participants Based on Level of Education/Training to Identify Children with FASD and Recognize the Constellation of Features Associated with FASD Percent
Formal Training Yes, profession education
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Yes, continuing education
Yes, other
No formal training recalled
Levels of Preparedness Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared
Response 9.8 56.1 29.3 4.9 10.0 65.0 20.0 5.0 6.7 60.0 20.1 13.3 0.0 20.0 34.3 45.7
Prepared vs. Unprepared 65.9 prepared 34.2 unprepared 75.0 prepared 25.0 unprepared 66.7 prepared 33.4 unprepared 20.0 prepared 80.0 unprepared
Researchers also found that those participants who had training on the ability to plan and perform relevant interventions reported being more prepared to manage/coordinate intervention plans of those with FASD, F(3, 72.36) = 24.37, p = 0.01. A Games–Howell post hoc analysis was used to determine significant differences between formal training groups and levels of preparedness. Results TABLE 4. Preparedness to Manage/Coordinate the Intervention Plans for Individuals with FASD Percent
Formal Training Yes, profession education
Yes, continuing education
Yes, other
No formal training recalled
Levels of Preparedness Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared
Response 22.2 44.4 22.2 11.1 21.1 57.9 15.8 5.3 11.1 88.9 0.0 0.0 0.0 19.6 33.9 46.4
Prepared vs. Unprepared 66.6 prepared 33.3 unprepared 79.0 prepared 21.1 unprepared 100.0 prepared 0.0 unprepared 19.6 prepared 80.3 unprepared
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again showed that when comparing the formal training groups versus the no formal training received group, participants who received any type of formal training felt more prepared than those who had received no training at all (p < 0.00). Nearly 30% of participants in this study reported they had suspected a patient of having FASD, yet only 6.7% of all participants had referred a child suspected of having FASD to another professional for confirmation. All participants (100%) felt prepared for managing intervention plans after participating in “other” types of formal training on FASD, while only 19.6% felt prepared without participating in formal training.
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DISCUSSION Researchers hypothesized that participants would demonstrate low levels of knowledge of FASD, specifically in the areas of signs and symptoms, prevention, and intervention. Results inferred that participants had a good understanding when it came to identifying basic concepts related to FAS or FASD, but lacked confidence when it came to working with a patient with FASD. Researchers also hypothesized that participants gained knowledge regarding FASD from professional education. This prediction was consistent with the findings that while the majority of participants reported receiving no formal training on FASD, most of those who had received training had done so through professional education. According to survey results, the majority of rehabilitation professionals were able to correctly identify signs and symptoms related to FASD; however, nearly 75% of participants underestimated current prevalence rates of FASD. These findings were consistent with the findings of Gahagan et al. (2006), in which the majority of pediatric medical practitioners (i.e., general pediatricians, pediatric residents, and pediatric subspecialists) were able to identify signs and symptoms, but only half of the participants correctly estimated the prevalence of FAS and other prenatal-related disorders. To increase rehabilitation professionals’ awareness of the prevalence of FASD, integrating FASD into professional education and continuing education should be considered. The current research indicates that a significant amount of children and adults have unrecognized FASD (Lange et al., 2013). Due to rehabilitation professionals being one of the health care professionals with the most direct patient contact of those with FASD, it is imperative that all rehabilitation professionals have the knowledge base to correctly identify signs and symptoms of FASD. Nearly 30% of participants in this study reported they had suspected a patient of having FASD, yet only 6.7% of all participants had referred a child suspected of having FASD to another professional for confirmation. Rehabilitation practitioners report an overall good knowledge of FASD but their lack of comfort in reporting the potential of FASD to the health care team can negatively impact the patient with FASD. Accurate identification of FASD is critical to ensure individuals receive appropriate intervention. Although occupational therapy, physical therapy and speech language practitioners do not diagnose FAS, a comprehensive understanding of the impact of a diagnosis or suspected FAS can enhance clinical reasoning in ensuring designing an appropriate intervention for those with prenatal alcohol exposure. Providers must also be aware of the social complexity of either a diagnosis or a sus-
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pected diagnosis of FAS. Addressing personal biases will also ensure appropriate intervention design. Since nearly 30% of participants in this study reported suspecting a patient of having FASD, but only 6.7% of all participants referred a child suspected of having FASD to another professional for confirmation. Similarly, Gahagan et al. (2006) reported low levels of diagnosing FAS when compared to the pediatric professionals’ reports of recognizing signs and symptoms. The low referral rate found among rehabilitation professionals and low diagnosis rate among pediatric professionals may be related to low levels of formal training or that professional training that occurred during professional education is now outdated. Only 50% of participants in the current study reported receiving formal training regarding when to make physician referrals for further testing for FASD. In addition, nearly 46% of participants reported receiving no formal training on the interprofessional approach to a FASD evaluation and intervention. The literature indicates that an interprofessional approach to care is best practice when working with individuals with FASD (Bertrand et al., 2004). Conceivably, with improved formal training of the interprofessional evaluation process and care for individuals with FASD, rehabilitation professionals may report being more likely to refer a patient suspected of having FASD to a physician. In addition to low referral rates reported, many participants reported feelings of unpreparedness to manage and coordinate an intervention plan for individuals with FASD. Participants’ feelings of preparedness appeared dependent on whether or not they received formal training on FASD. Specifically, rehabilitation professionals who reported receiving formal training on the management and coordination of intervention plans for this population reported higher levels of preparedness with these skills. This finding may indicate that more formal training should be integrated into professional and continuing education in order for rehabilitation professionals to feel prepared to recognize and treat patients with FASD. As a result, more patients are likely to be screened for FASD and receive necessary interventions. This study on the primary rehab practices confirms previous studies that education and training can assist in improved knowledge and confidence can be achieved, as shown in studies with other professions (Payne et al., 2011). Currently there are several places to get CE specific to occupational therapy, including the Centers for Disease Control and Prevention who have funded training through the FASD Practice and Implementation Centers (PICS) and National Partnerships which include the National Organization of Fetal Alcohol Syndrome. Other sources for CE for occupational therapy and other rehabilitation professionals include the FASD Center of Excellence funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Arc Fetal Alcohol Spectrum Disorders Prevention Project. Based on the collective findings of recent studies in the literature and this present study, providing appropriate FASD education and training can help to increase professionals’ knowledge regarding FASD. In particular, with increased knowledge, rehabilitation professionals may more readily recognize individuals with FASD, refer them for further assessment, and improve the quality of care provided to this population. Research supports the concept that appropriate inter-
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vention can help individuals with FASD once the disorder is properly identified (Bertrand et al., 2004; Vargus-Adams, 2006). Thus, it is beneficial to incorporate general knowledge about the recognition of, and intervention for, FASD into formal training, including entry-level and post-professional curricula, as well as continuing education. Researchers suggest that FASD education be the topic of continuing education courses at conferences hosted by rehabilitation professionals’ state and national professional organizations.
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LIMITATIONS This study is limited by the low response rate overall and a high distribution of participants who reported academia as their primary practice setting, which likely influenced the results because these practitioners represent a specific type of practitioner. Further, it is a possibility that despite maintenance of confidentiality for respondents, professionals who are not familiar or comfortable with FASD may have been deterred from participating.
CONCLUSION This study was designed to explore the current knowledge of rehabilitation professionals, including occupational therapy practitioners regarding Fetal Alcohol Spectrum Disorder. These results where then compared with other studies of health care practitioners to determine where occupational therapy practitioners fall in their level of knowledge. Continued efforts to educate all rehabilitation professionals on the prevalence, recognition, and intervention of FASD may help improve practitioners’ feelings of preparedness when working with this population and in-turn improve patient outcomes. Further research is needed to determine how to enhance and address the levels of knowledge and feelings of preparedness among health care professionals, in particular rehabilitation professionals, to develop appropriate and effective educational materials.
ACKNOWLEDGMENT The authors would like to thank all of the participants who made this study possible and Dr. Wen-Pin Chang for his mentorship. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. ABOUT THE AUTHORS Stephanie M. Birch, Heidi A. Carpenter, Anna M. Marsh, Kimberly A. McClung, and Joy D. Doll, Department of Occupational Therapy, Creighton University, Omaha, Nebraska, USA.
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REFERENCES Astley SJ. (2014). Twenty years of patient surveys confirm a FASD 4-digit-code interdisciplinary diagnosis afforded substantial access to interventions that met patients’ needs. Journal of Popular Therapeutic Clinical Pharmacolgy, 21(1), e81–e105. Bertrand J, Floyd RL, Weber MK, O’Connor M, Riley EP, Johnson KA, & Cohen DE. National Task Force on FAS/FAE. (2004). Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis. Retrieved from http://www.cdc.gov/ncbddd/fasd/documents/ fas guidelines accessible.pdf Brimacombe M, Nayeem A, Adubato S, DeJoseph M, & Zimmerman-Bier B. (2008). Fetal alcohol syndrome related knowledge assessment and comparison in New Jersey health professional groups. Canadian Journal of Clinical Pharmacology, 15(1), e57–e65. Denys K, Rasmussen C, & Henneveld D. (2011). The effectiveness of a community-based intervention for parents with FASD. Community Mental Health Journal, 47(2), 209–219. Elliott E, O’Leary C, Bower C, & Peadon E. (2007). Impacts of alcohol use in pregnancy: the role of the GP. Australian Family Physician, 36(11), 935–939. Eyal R. & O’Connor M.J. (2011). Psychiatry trainees’ training and experience in fetal alcohol spectrum disorders. Academic Psychiatry, 35(4), 238-240. Gahagan S, Sharpe T, Brimacombe M, Fry-Johnson Y, Levine R, Mengel M, . . . Brenneman G. (2006). Pediatricians’ knowledge, training, and experience in the care of children with fetal alcohol syndrome. Pediatrics, 118(3), e657–e668. doi:10.1542/peds.2005-0516 Jirikowic T, Gelo J, & Astley S. (2010). Children and youth with fetal alcohol spectrum disorders: Summary of intervention recommendations after clinical diagnosis. Intellectual and Developmental Disabilities, 48(5), 330–344. Kalberg WO, & Buckley D. (2007). FASD: What types of intervention and rehabilitation are useful? Neuroscience & Biobehavioral Reviews, 31(2), 278–285. Lange S, Shield K, Rehm J, & Popova S. (2013). Prevalence of fetal alcohol spectrum disorders in child care settings: A meta-analysis. Pediatrics, 132(4), e980–e995. doi: 10.1542/peds.20130066 Paley B. & O’Connor M.J. (2011). Behavioral interventions for children and adolescents with Fetal Alcohol Spectrum Disorders. Alcohol Research and Health, 34(1), 64–75. Payne J, France K, Henley N, D’Antoine H, Bartu A, O’Leary C, Elliot E, & Bower C. (2011). Changes in health professionals’ knowledge, attitudes and practice following provision of educational resources about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorders. Pediatric and Perinatal Epidemiology, 25, 316–327. doi:10.1111/j. 13653016.2011.01197x Substance Abuse and Mental Health Services Administration (2014). Addressing Fetal Alcohol Spectrum Disorders (FASD). Treatment Improvement Protocol (TIP) Series 58. HHS Publication No. (SMA) 13-4803. Rockville, MD: Substance Abuse and Mental Health Services Administration. Tough S, Clarke M, & Cook J. (2007). Fetal alcohol spectrum disorder prevention approaches among Canadian physicians by proportion of Native/Aboriginal patients: Practices during the preconception and prenatal periods. Maternal and Child Health Journal, 11, 385–393. Vargus-Adams JN. (2006). Pediatric rehabilitation. In G. Cooper (Ed.), Essential physical medicine and rehabilitation (pp. 175–190). Totowa, NJ: Humana Press Inc. Zoorob R, Aliyu MH, & Hayes C. (2010). Fetal alcohol syndrome: Knowledge and attitudes of family medicine clerkship and residency directors. Alcohol, 44, 379–385. doi:10.1016/j. alcohol.2009.10.012
ISSN: 0738-0577 (Print) 1541-3098 (Online) Journal homepage: http://www.tandfonline.com/loi/iohc20
The Knowledge of Rehabilitation Professionals Concerning Fetal Alcohol Spectrum Disorders Stephanie M. Birch, Heidi A. Carpenter, Anna M. Marsh, Kimberly A. McClung & Joy D. Doll To cite this article: Stephanie M. Birch, Heidi A. Carpenter, Anna M. Marsh, Kimberly A. McClung & Joy D. Doll (2015): The Knowledge of Rehabilitation Professionals Concerning Fetal Alcohol Spectrum Disorders, Occupational Therapy In Health Care, DOI: 10.3109/07380577.2015.1053163 To link to this article: http://dx.doi.org/10.3109/07380577.2015.1053163
Published online: 26 Jun 2015.
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Date: 28 September 2015, At: 04:43
Occupational Therapy In Health Care, Early Online:1–11, 2015 C 2015 by Informa Healthcare USA, Inc. Available online at http://informahealthcare.com/othc DOI: 10.3109/07380577.2015.1053163
The Knowledge of Rehabilitation Professionals Concerning Fetal Alcohol Spectrum Disorders
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Stephanie M. Birch, Heidi A. Carpenter, Anna M. Marsh, Kimberly A. McClung, & Joy D. Doll Department of Occupational Therapy, Creighton University, Omaha, NE, USA
ABSTRACT. The purpose of this study was to explore rehabilitation professionals’ knowledge regarding signs and symptoms, prevention, and intervention of fetal alcohol spectrum disorders (FASD). Participants were 111 rehabilitation practitioners (e.g., occupational therapy, physical therapy, and speech-language pathology practitioners) recruited through email using a quantitative online survey design with purposive, snowball sampling. Results showed the majority of participants’ demonstrated accurate knowledge of the signs and symptoms of FASD. Since professionals who received formal education on FASD reported significantly higher feelings of preparedness to identify children with FASD and manage/coordinate intervention plans, this study suggests rehabilitation professionals may be better prepared to treat individuals with FASD if they participate in formal training. KEYWORDS. Developmental disabilities, Fetal alcohol spectrum disorders, Occupational therapy, Physical therapy, Speech-language pathology
Despite the fact that fetal alcohol spectrum disorders (FASD) is preventable, it is the “leading non-genetic cause of mental retardation in the Western World” (Tough et al., 2007, p. 386). FASD is caused by prenatal alcohol exposure and is characterized by a mild to severe range of neurological deficits, which may be accompanied by physical defects such as facial and organ malformations (Lange et al., 2013). Deficits associated with FASD vary based on when and to what amount the fetus was exposed to alcohol (Kalberg and Buckley, 2007). Rehabilitation professionals, including occupational therapists, play a key role in the management of the disabilities associated with FASD and can help individuals with FASD thrive (Astley, 2014). The CDC’s Fetal Alcohol Syndrome: Guidelines for Referral and Diagnosis outlines best practices for the diagnosis and care of individuals with FASD, in which rehabilitation professionals are highlighted as core team members for intervention (Bertrand et al., 2004). Address correspondence to: Joy D. Doll, Department of Occupational Therapy, Creighton University, 2500 California Plaza, Omaha, NE 68178, USA (E-mail: [email protected]). (Received 28 May 2014; accepted 17 May 2015)
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Due to the variety of deficits associated with FASD, it is often under recognized or mislabeled (Paley and O’Connor, 2011). This is of concern for health care professionals since discriminating between FASD and other similar diagnoses is necessary to provide optimal intervention. Despite the fact that early diagnosis has been identified as important for quality of life, health care practitioners still report discomfort with identification of FAS and FASD (Elliott et al., 2007). Under the fetal alcohol spectrum, fetal alcohol syndrome (FAS) is the only condition with clear diagnostic criteria including facial malformations and microcephaly (Elliott et al., 2007). Consequently, children who exhibit some but not all of the criteria to qualify for an FAS diagnosis may go unrecognized (Bertrand et al., 2004). This lack of recognition may lead to either lack of intervention or intervention that does not cater to the unique needs of individuals with FASD. The brain damage associated with prenatal alcohol exposure, more specifically those with a diagnosis of FAS, requires a comprehensive health team to support the individual throughout the lifespan with early intervention as a critical component to success of individuals (Bertrand et al., 2004). Rehabilitation professionals [e.g., physical therapists (PT), occupational therapists (OT), and speech-language therapists (SLP)] address developmental delays, support educational outcomes, and promote a successful transition into adulthood for individuals with FASD (VargusAdams, 2006). Since rehabilitation professionals play such a significant role in the lifelong management of FASD, these professionals need to have a strong understanding of the signs and symptoms of FASD to ensure intervention matches with the disabilities associated with FASD (Jirikowic et al., 2010). Several studies (Gahagan et al., 2006; Zoorob et al., 2010; Eyal and O’Connor, 2011) have been published concerning physicians’ knowledge and methods of intervention for FASD. In 2006, Gahagan and colleagues, supported by the American Association of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC), surveyed AAP members in the United States to identify knowledge of fetal alcohol spectrum disorder. In this study, providers including pediatricians, pediatric subspecialties and residents reported knowledge of FASD but felt unprepared to manage or prevent FASD. Gahagan et al. (2006) reported that only 34% of participants surveyed by the AAP reported that they “felt prepared to manage and coordinate the intervention of children with fetal alcohol spectrum disorders” (p. 657). Zoorob and colleagues (2010) similarly assessed family physicians and residents for their knowledge of FASD. Those providers who had experienced FASD in their medical education curriculum reported higher levels of knowledge and comfortability with the management of FASD. In another study by Eyal and O’Connor (2011), psychiatric residents were assessed and reported that FASD is underrecognized. Overall, across the literature physicians from across different specialties report the need for training on FASD to ensure comfort in the management of the disorder. Despite exploration into the knowledge of physicians, little research has been done regarding health care professionals reported knowledge on FASD beyond physicians. Payne and colleagues revealed that less than 16% of health care professionals identified the essential features of FAS correctly (Payne et al., 2011). In one study, health professionals including nurses, social workers, counselors, therapists, and physical therapists participated in an educational session on FASD with
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a pretest/posttest regarding the fundamentals of FASD (Brimacombe et al., 2008). Reported knowledge of FASD for all participants improved from the pretest to posttest due to the educational presentation (Brimacombe et al., 2008). In another study, 30–40% of physician and residency programs reported a need to incorporate FASD training into their curriculum (Zoorob et al., 2010). The study also found that formal training contributed to participants’ feelings of preparedness to treat individuals with FASD (Zoorob et al., 2010). Furthermore, a study by Payne et al. (2011) indicated approximately 18% of participants felt fairlyto very-prepared to treat patients with FAS after receiving education on prevention of prenatal alcohol exposure and FASD. The findings of Gahagan et al. (2006), Payne et al. (2011), Zoorob et al. (2010), and this study all indicate the need for more formal training across the health care professions in regards to FASD. Since it has been established that the management of FASD requires a teambased health care approach (Denys et al., 2011; Paley and O’Connor, 2011), all health care professionals on the team, including rehabilitation professionals, need to be able to identify and design interventions for supporting individuals with FASD (Substance Abuse and Mental Health Services Administration, 2014). Thus, the purpose of this study was to further investigate rehabilitation professionals’ current knowledge about FAS and FASD; specifically, signs and symptoms, prevention, and intervention. In addition, this study aimed to explore how rehabilitation professionals gained their knowledge regarding signs and symptoms, prevention, and intervention of FASD.
METHOD Research Design This study used a quantitative survey design with purposive sampling to understand rehabilitation professionals’ knowledge and current clinical knowledge of FASD. The online questionnaire design was utilized in order to maximize efficiency and meet the needs of busy rehabilitation professionals, in addition to maintaining a cost neutral budget for the study. Participants The target population for this study was licensed rehabilitation professionals within the United States. Rehabilitation professionals surveyed included occupational therapy, physical therapy, and speech language pathology practitioners. Inclusion criteria for participants included that the participant hold an active license currently practicing and met the criteria of being a rehabilitation practitioner as identified previously (i.e. occupational therapy, physical therapy or speech language pathology). Each professional organization for each discipline in each state was contacted to obtain member lists. A list of prospective study participants’ email addresses was generated by obtaining publicly available membership lists of state professional organizations for the three disciplines across the United States that included emails.
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Procedure Prior to implementation, this study was approved by the Creighton University Institutional Review Board (IRB). The prospective participants received an initial email invitation to take part in the survey that included a brief explanation of the study, participation instructions, and a link to the online questionnaire. The email also contained a request to forward the same invitation email to other rehabilitation practitioners which created a snowball sampling method. After three weeks from the initial email invitation, a reminder email was sent to prospective participants. A final reminder email was sent one week prior to the survey closing date. The questionnaire was available for a total of 8 weeks.
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Instrument The questionnaire used in this study was a modification of a survey developed by the Centers for Disease Control and Prevention (CDC) and the American Association of Pediatrics (AAP). The original survey was used to assess the knowledge of FAS and prenatal alcohol-related disorders (Gahagan et al., 2006). Researchers were granted permission, from the original authors and the AAP, to use and modify the questionnaire that had been developed and publishing in the journal Pediatrics, the official journal of the AAP titled “Pediatricians” knowledge, training, and experience in the care of children with fetal alcohol syndrome’ (Gahagan et al., 2006). The modifications of the questionnaire were made by an occupational therapy practitioner with experience with FAS and other prenatal alcohol-related disorders. The original author of the questionnaire and AAP approved these modifications. Modifications to the questionnaire were made to the demographic section in order to gather accurate information regarding professional discipline, practice setting, and years in practice rehabilitation practitioners. Questions that addressed diagnosing FAS and other prenatal alcohol-related disorders were either modified or omitted. All questions regarding knowledge of FAS and other prenatal alcoholrelated disorders were maintained to assess similar knowledge previously assessed in the study by Gahagan of pediatricians and pediatric residents. The modified questionnaire consisted of closed-ended questions regarding knowledge of and where they obtained their clinical knowledge regarding FAS and other prenatal alcohol-related disorders. Other modifications related to when and where participants received education on FAS and other prenatal alcoholrelated disorders that are unique to rehabilitation and differ from physician training. Another significant modification was to use the term FASD rather than FAS and other prenatal alcohol-related disorders due to updates in terminology related to the disorder used by the CDC. All efforts were made to limit modifications to the questionnaire in order to lead to comparison of knowledge between rehabilitation professionals and physicians regarding FAS and other prenatal alcohol-related disorders.
DATA ANALYSIS Results from the survey were analyzed using IBM SPSS Statistics Version 20. Descriptive statistics were computed to determine frequencies and means of
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selected survey responses including demographic information and knowledgebased questions. Correct response rates for knowledge-based questions were analyzed to determine what percent of the surveyed population demonstrated selected knowledge of FASD. One-way analysis of variance (ANOVA) test, including the Brown–Forsythe test, were conducted to compare levels of preparedness of all professions and whether the participant had received any type of formal training in an attempt to answer the research questions. The subsequent post hoc analyses, using HSD Tukey and Games Howell, were performed to determine where significant differences lie between specific formal training groups (i.e., professional education, continuing education, other, or no training received).
RESULTS Researchers sent email requests to 1,264 practitioners and received a total of 111 responses. Participants were asked to forward the questionnaire as a way to recruit more participants for the study. Due to the structure of the online process, an overall response rate is unknown. The final sample size consisted of 96 females, 14 males, and 1 undisclosed participant, with ages ranging from 25 to 71 years (M = 46.6, SD = 11.22). The majority of participants were occupational therapy (n = 48) and physical therapy (n = 37). Additionally, speech language pathology (n = 22), physical therapy assistants (n = 3), and an occupational therapy assistant (n = 1) also participated. Employment ranged from academia (68%), school-based (8.1%), outpatient (7.2%), hospital/clinic (5.4%), private practice (1.8%), community-based (0.9%), and other (8.1%). The number of years in practice ranged from 1 to 44 years, with only 16.2% of participants having been in practice less than 10 years. Table 1 illustrates the number and percent of participants that identified the problems associated with FASD.
TABLE 1. Reported Responses on General FASD Knowledge by Rehabilitation Professionals Correct Response Delayed development Lowered IQ/Intellectual disabilities Behavior problems Birth defects/malformation Prenatal alcohol risk for permanent brain damage Low birth weight Early diagnosis and surveillance may lead to secondary prevention of disabilities Psychiatric (DSM-IV) disorders Long-term emotional disorders Attention deficit hyperactivity disorder Alcohol’s effect on fetal development is clear Young adults with FASD do not usually achieve independence at the expected time (18–21 yr) Addictions Alcohol withdrawal not worst outcome of fetal exposure Higher rates in minorities, including Native Americans
% Correct 100.0 96.4 94.6 94.6 92.8 92.5 91.8 89.2 89.2 85.6 80.2 75.7 72.5 70.3 67.9
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TABLE 2. Percentage Distribution of Participants Who Did or Did Not Receive Education/Training in Knowledge of FASD
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Question Response Ability to recognize features associated with FASD/other alcohol-related disorders Understanding basic biomedical mechanisms that result in FASD Ability to select valid and reliable assessment instruments to screen Ability to identify risk factors/ interventions Ability to perform clinically relevant intervention and management plans Be able to make referrals for further workup when appropriate Ability and appreciation to use interdisciplinary teams evaluations Ability to assist clients in accessing local FASD resources Utilization of techniques for effective communication Demonstration of the ability to provide ethical protections to the patient with FASD Ability to education pregnant women about the effects of alcohol on their babies Ability to screen for women for risky or hazardous drinking
Professional Education (i.e., academic curriculum) CE
Other
No
36.9
18
13.5
31.5
34.2
13.5
15.3
36.9
11.7
12.6
6.3
69.4
27.0 24.3
18.9 17.1
11.7 8.1
42.3 50.5
22.5
11.7
15.3
50.5
19.8
16.2
18.0
45.9
14.4
11.7
18.9
55.0
17.1
9.0
15.3
58.6
30.6
8.1
15.3
45.9
26.1
8.1
18.9
46.8
7.2
3.6
7.2
82.0
Note. CE = Continuing education
Table 2 describes the percentage of distribution of participants who did or did not receive education/training in their professional education. Researchers found that those participants who had received formal training (e.g., professional education or continuing education) on the ability to recognize deficits of FAS and FASD felt more prepared to identify children with FASD and other alcohol-related disorders, F(3, 107) = 13.55, p < 0.001. A Tukey HSD post hoc analysis was used to determine significant differences between formal training groups and levels of preparedness. Results showed that participants who received any type of formal training felt more prepared than those who had received no training at all (p < 0.001). Specifically, 75% of those who participated in formal training felt most prepared to identify children with FASD; while only 20% felt prepared to do the same when no formal training had been received. Table 3 describes the perception of preparedness by participants based on the level of education/training to identify children with FASD and recognize the constellation of features associated with FASD. Table 4 identifies preparedness of rehabilitation professionals to manage and coordinate the intervention plans based on receiving any formal training in the ability to plan and perform clinically relevant intervention and management plans to assist and aid both the patient with FASD and their families.
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TABLE 3. Perception of Preparedness by Participants Based on Level of Education/Training to Identify Children with FASD and Recognize the Constellation of Features Associated with FASD Percent
Formal Training Yes, profession education
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Yes, continuing education
Yes, other
No formal training recalled
Levels of Preparedness Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared
Response 9.8 56.1 29.3 4.9 10.0 65.0 20.0 5.0 6.7 60.0 20.1 13.3 0.0 20.0 34.3 45.7
Prepared vs. Unprepared 65.9 prepared 34.2 unprepared 75.0 prepared 25.0 unprepared 66.7 prepared 33.4 unprepared 20.0 prepared 80.0 unprepared
Researchers also found that those participants who had training on the ability to plan and perform relevant interventions reported being more prepared to manage/coordinate intervention plans of those with FASD, F(3, 72.36) = 24.37, p = 0.01. A Games–Howell post hoc analysis was used to determine significant differences between formal training groups and levels of preparedness. Results TABLE 4. Preparedness to Manage/Coordinate the Intervention Plans for Individuals with FASD Percent
Formal Training Yes, profession education
Yes, continuing education
Yes, other
No formal training recalled
Levels of Preparedness Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared Very prepared Somewhat prepared Somewhat unprepared Very unprepared
Response 22.2 44.4 22.2 11.1 21.1 57.9 15.8 5.3 11.1 88.9 0.0 0.0 0.0 19.6 33.9 46.4
Prepared vs. Unprepared 66.6 prepared 33.3 unprepared 79.0 prepared 21.1 unprepared 100.0 prepared 0.0 unprepared 19.6 prepared 80.3 unprepared
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again showed that when comparing the formal training groups versus the no formal training received group, participants who received any type of formal training felt more prepared than those who had received no training at all (p < 0.00). Nearly 30% of participants in this study reported they had suspected a patient of having FASD, yet only 6.7% of all participants had referred a child suspected of having FASD to another professional for confirmation. All participants (100%) felt prepared for managing intervention plans after participating in “other” types of formal training on FASD, while only 19.6% felt prepared without participating in formal training.
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DISCUSSION Researchers hypothesized that participants would demonstrate low levels of knowledge of FASD, specifically in the areas of signs and symptoms, prevention, and intervention. Results inferred that participants had a good understanding when it came to identifying basic concepts related to FAS or FASD, but lacked confidence when it came to working with a patient with FASD. Researchers also hypothesized that participants gained knowledge regarding FASD from professional education. This prediction was consistent with the findings that while the majority of participants reported receiving no formal training on FASD, most of those who had received training had done so through professional education. According to survey results, the majority of rehabilitation professionals were able to correctly identify signs and symptoms related to FASD; however, nearly 75% of participants underestimated current prevalence rates of FASD. These findings were consistent with the findings of Gahagan et al. (2006), in which the majority of pediatric medical practitioners (i.e., general pediatricians, pediatric residents, and pediatric subspecialists) were able to identify signs and symptoms, but only half of the participants correctly estimated the prevalence of FAS and other prenatal-related disorders. To increase rehabilitation professionals’ awareness of the prevalence of FASD, integrating FASD into professional education and continuing education should be considered. The current research indicates that a significant amount of children and adults have unrecognized FASD (Lange et al., 2013). Due to rehabilitation professionals being one of the health care professionals with the most direct patient contact of those with FASD, it is imperative that all rehabilitation professionals have the knowledge base to correctly identify signs and symptoms of FASD. Nearly 30% of participants in this study reported they had suspected a patient of having FASD, yet only 6.7% of all participants had referred a child suspected of having FASD to another professional for confirmation. Rehabilitation practitioners report an overall good knowledge of FASD but their lack of comfort in reporting the potential of FASD to the health care team can negatively impact the patient with FASD. Accurate identification of FASD is critical to ensure individuals receive appropriate intervention. Although occupational therapy, physical therapy and speech language practitioners do not diagnose FAS, a comprehensive understanding of the impact of a diagnosis or suspected FAS can enhance clinical reasoning in ensuring designing an appropriate intervention for those with prenatal alcohol exposure. Providers must also be aware of the social complexity of either a diagnosis or a sus-
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pected diagnosis of FAS. Addressing personal biases will also ensure appropriate intervention design. Since nearly 30% of participants in this study reported suspecting a patient of having FASD, but only 6.7% of all participants referred a child suspected of having FASD to another professional for confirmation. Similarly, Gahagan et al. (2006) reported low levels of diagnosing FAS when compared to the pediatric professionals’ reports of recognizing signs and symptoms. The low referral rate found among rehabilitation professionals and low diagnosis rate among pediatric professionals may be related to low levels of formal training or that professional training that occurred during professional education is now outdated. Only 50% of participants in the current study reported receiving formal training regarding when to make physician referrals for further testing for FASD. In addition, nearly 46% of participants reported receiving no formal training on the interprofessional approach to a FASD evaluation and intervention. The literature indicates that an interprofessional approach to care is best practice when working with individuals with FASD (Bertrand et al., 2004). Conceivably, with improved formal training of the interprofessional evaluation process and care for individuals with FASD, rehabilitation professionals may report being more likely to refer a patient suspected of having FASD to a physician. In addition to low referral rates reported, many participants reported feelings of unpreparedness to manage and coordinate an intervention plan for individuals with FASD. Participants’ feelings of preparedness appeared dependent on whether or not they received formal training on FASD. Specifically, rehabilitation professionals who reported receiving formal training on the management and coordination of intervention plans for this population reported higher levels of preparedness with these skills. This finding may indicate that more formal training should be integrated into professional and continuing education in order for rehabilitation professionals to feel prepared to recognize and treat patients with FASD. As a result, more patients are likely to be screened for FASD and receive necessary interventions. This study on the primary rehab practices confirms previous studies that education and training can assist in improved knowledge and confidence can be achieved, as shown in studies with other professions (Payne et al., 2011). Currently there are several places to get CE specific to occupational therapy, including the Centers for Disease Control and Prevention who have funded training through the FASD Practice and Implementation Centers (PICS) and National Partnerships which include the National Organization of Fetal Alcohol Syndrome. Other sources for CE for occupational therapy and other rehabilitation professionals include the FASD Center of Excellence funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Arc Fetal Alcohol Spectrum Disorders Prevention Project. Based on the collective findings of recent studies in the literature and this present study, providing appropriate FASD education and training can help to increase professionals’ knowledge regarding FASD. In particular, with increased knowledge, rehabilitation professionals may more readily recognize individuals with FASD, refer them for further assessment, and improve the quality of care provided to this population. Research supports the concept that appropriate inter-
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vention can help individuals with FASD once the disorder is properly identified (Bertrand et al., 2004; Vargus-Adams, 2006). Thus, it is beneficial to incorporate general knowledge about the recognition of, and intervention for, FASD into formal training, including entry-level and post-professional curricula, as well as continuing education. Researchers suggest that FASD education be the topic of continuing education courses at conferences hosted by rehabilitation professionals’ state and national professional organizations.
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LIMITATIONS This study is limited by the low response rate overall and a high distribution of participants who reported academia as their primary practice setting, which likely influenced the results because these practitioners represent a specific type of practitioner. Further, it is a possibility that despite maintenance of confidentiality for respondents, professionals who are not familiar or comfortable with FASD may have been deterred from participating.
CONCLUSION This study was designed to explore the current knowledge of rehabilitation professionals, including occupational therapy practitioners regarding Fetal Alcohol Spectrum Disorder. These results where then compared with other studies of health care practitioners to determine where occupational therapy practitioners fall in their level of knowledge. Continued efforts to educate all rehabilitation professionals on the prevalence, recognition, and intervention of FASD may help improve practitioners’ feelings of preparedness when working with this population and in-turn improve patient outcomes. Further research is needed to determine how to enhance and address the levels of knowledge and feelings of preparedness among health care professionals, in particular rehabilitation professionals, to develop appropriate and effective educational materials.
ACKNOWLEDGMENT The authors would like to thank all of the participants who made this study possible and Dr. Wen-Pin Chang for his mentorship. Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper. ABOUT THE AUTHORS Stephanie M. Birch, Heidi A. Carpenter, Anna M. Marsh, Kimberly A. McClung, and Joy D. Doll, Department of Occupational Therapy, Creighton University, Omaha, Nebraska, USA.
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