A modified Delphi study of screening for fetal alcohol spectrum disorders in Australia.
BACKGROUND
There is little reliable information on the prevalence of fetal alcohol spectrum disorders (FASD) in Australia and no coordinated national approach to facilitate case detection. The aim of this study was to identify health professionals' perceptions about screening for FASD in Australia.


METHODS
A modified Delphi process was used to assess perceptions of the need for, and the process of, screening for FASD in Australia. We recruited a panel of 130 Australian health professionals with experience or expertise in FASD screening or diagnosis. A systematic review of the literature was used to develop Likert statements on screening coverage, components and assessment methods which were administered using an online survey over two survey rounds.


RESULTS
Of the panel members surveyed, 95 (73%) responded to the questions on screening in the first survey round and, of these, 81 (85%) responded to the second round. Following two rounds there was consensus agreement on the need for targeted screening at birth (76%) and in childhood (84%). Participants did not reach consensus agreement on the need for universal screening at birth (55%) or in childhood (40%). Support for targeted screening was linked to perceived constraints on service provision and the need to examine the performance, costs and benefits of screening.For targeted screening of high risk groups, we found highest agreement for siblings of known cases of FASD (96%) and children of mothers attending alcohol treatment services (93%). Participants agreed that screening for FASD primarily requires assessment of prenatal alcohol exposure at birth (86%) and in childhood (88%), and that a checklist is needed to identify the components of screening and criteria for referral at birth (84%) and in childhood (90%).


CONCLUSIONS
There is an agreed need for targeted but not universal screening for FASD in Australia, and sufficient consensus among health professionals to warrant development and evaluation of standardised methods for targeted screening and referral in the Australian context. Participants emphasised the need for locally-appropriate, evidence-based approaches to facilitate case detection, and the importance of ensuring that screening and referral programs are supported by adequate diagnostic and management capacity.
Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia. rwatkins@ichr.uwa.edu.au
Rochelle E
RE
Watkins
Elizabeth J
EJ
Elliott
Jane
J
Halliday
Colleen M
CM
O'Leary
Heather
H
D'Antoine
Elizabeth
E
Russell
Lorian
L
Hayes
Elizabeth
E
Peadon
Amanda
A
Wilkins
Heather M
HM
Jones
Anne
A
McKenzie
Sue
S
Miers
Lucinda
L
Burns
Raewyn C
RC
Mutch
Janet M
JM
Payne
James P
JP
Fitzpatrick
Maureen
M
Carter
Jane
J
Latimer
Carol
C
Bower
D001291:Attitude of Health Personnel; D001315:Australia; D003697:Delphi Technique; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration; D011247:Pregnancy; D011795:Surveys and Questionnaires