1. Detroit Department of Health and Wellness Promotion Fetal and Infant Mortality Review/Fetal Alcohol Syndrome Pilot Project September 21, 2006

2. The FIMR Process Brings a multidisciplinary community team together to review de-identified infant and fetal deaths. Is a two-tiered process  Case Review Team (CRT)  Community Action Team (CAT) Composed of health, social service and other experts Examines the case summary Identifies issues Makes recommendations for community and perinatal systems change.

3. Case Review Team (CRT) Composed of health, social service and other experts Examines the case summary Identifies issues Makes recommendations for community and perinatal systems change.

4. Community Action Team (CAT) Community leaders representing government, consumers, key institutions, and health and human services organizations serve on the CAT to transform recommendations to action. This team reviews recommendations Prioritizes identified issues Designs and implements interventions that may improve outcomes for future families.

5. History of the FIMR/FAS Pilot Project In 2004 two sites-Detroit and Baltimore- were selected by NFIMR to use the FIMR model to look at cases to include:  Women whose children ages zero to three have been diagnosed with FAE/FAS;  Women who drank during pregnancy and had a fetal or infant loss;  Women who drank and died within a year of pregnancy.

6. Development of the FIMR/FAS Case Review Team FIMR/FAS CRT to meet quarterly following the monthly FIMR meeting. In addition to involving several of the FIMR CRT members, invitations were extended to university, public health, Department of Human Services, and other organizations, which have an interest and an expertise in substance abuse, in particular, alcohol.

7. Progress Thus Far Eight meetings have been held. The CRT reviewed 311 records for 2001-2003 where the infants died before their first birthday, and summary information contained reports of alcohol use by 43 women. Eight in depth reviews of deaths where alcohol was a factor were completed.

8. Meeting deliberations have included a discussion of tools used to assess alcohol use such as TWEAK, T-ACE, and Brief Motivation. Recommendations have been made to the Community Action Team known as Infant Vitality Action Network (IVAN). Progress Thus Far, cont.

9. Recommendations have included: When it is known or suspected that alcohol was used during a pregnancy and an infant died, siblings need to be referred to the FAS Diagnostic Clinic. Parents who have suffered an infant loss be followed up with and provided information and education about bereavement services, family planning and risks of alcohol and drug use in subsequent pregnancies, etc.

10. Recommendations, cont. Where a history of protective services/foster care/adoption exists, a system is needed to assure re-referral and follow-up upon subsequent births. Preconception and interconception care education is needed.

11. Future Plans Based on Lessons Learned Include: Consider change from quarterly meeting schedule to at least every other month Move beyond reviews of only cases where alcohol was a factor in an infant death

12. Future Plans Based on Lessons Learned, cont.: More assertively explore opportunities to meet with women who acknowledged alcohol use during pregnancy; may have received treatment; and whose infant may/may not have been born FASE.

13. Future Plans Based on Lessons Learned, cont.: Move recommendations to action via the Infant Vitality Action Network and complemented by the efforts of the Substance Abuse Prevention, Treatment and Recovery community.

14. Thank you! For questions or comments, please contact: Lynn Kleiman, MSW, LMSW Program Manager- Special MCH Projects Detroit Department of Health & Wellness Promotion 1151 Taylor, Room 246 C, Detroit, MI 48202 Phone (313) 876-0733; Fax (313) 876-4658 Kleimanl@health.ci.detroit.mi.us