title: Integrating care for individuals with FASD: results from a multi-stakeholder symposium.
abstract: BACKGROUND
  Fetal Alcohol Spectrum Disorder (FASD) has a significant impact on communities and systems such as health, education, justice and social services. FASD is a complex neurodevelopmental disorder that results in permanent disabilities and associated service needs that change across affected individuals' lifespans. There is a degree of interdependency among medical and non-medical providers across these systems that do not frequently meet or plan a coordinated continuum of care. Improving overall care integration will increase provider-specific and system capacity, satisfaction, quality of life and outcomes.
  
  
  METHODS
  We conducted a consensus generating symposium comprised of 60 experts from different stakeholder groups: Allied & Mental Health, Education, First Nations & Métis Health, Advocates, Primary Care, Government Health Policy, Regional FASD Coordinators, Social Services, and Youth Justice. Research questions addressed barriers and solutions to integration across systems and group-specific and system-wide research priorities. Solutions and consensus on prioritized lists were generated by combining the Electronic Meeting System approach with a modified 'Nominal Group Technique'.
  
  
  RESULTS
  FASD capacity (e.g., training, education, awareness) needs to be increased in both medical and non-medical providers. Outcomes and integration will be improved by implementing: multidisciplinary primary care group practice models, FASD system navigators/advocates, and patient centred medical homes. Electronic medical records that are accessible to multiple medical and non-medical providers are a key tool to enhancing integration and quality. Eligibility criteria for services are a main barrier to integration across systems. There is a need for culturally and community-specific approaches for First Nations communities.
  
  
  CONCLUSIONS
  There is a need to better integrate care for individuals and families living with FASD. Primary Care is well positioned to play a central and important role in facilitating and supporting increased integration. Research is needed to better address best practices (e.g., interventions, supports and programs) and long-term individual and family outcomes following a diagnosis of FASD.
authors.affiliation: Community Wellness Department, Native American Health Center, 3124 International Blvd. Ste 214, Oakland, CA, 94601, USA. paulm@nativehealth.org.
authors.forename: Paul
authors.initials: P
authors.lastname: Masotti
authors.affiliation: Children's Hospital of Winnipeg, University of Manitoba, CK253-840 Sherbrook Street, Winnipeg, Manitoba, R3A 1S1, Canada. SLongstaffe@exchange.hsc.mb.ca.
authors.forename: Sally
authors.initials: S
authors.lastname: Longstaffe
authors.affiliation: Healthy Child Manitoba Office, Government of Manitoba, 3rd Floor - 332 Bannatyne Avenue, Winnipeg, Manitoba, R3A 0E2, Canada. holly.gammon@gov.mb.ca.
authors.forename: Holly
authors.initials: H
authors.lastname: Gammon
authors.affiliation: Healthy Child Manitoba Office, Government of Manitoba, 3rd Floor - 332 Bannatyne Avenue, Winnipeg, Manitoba, R3A 0E2, Canada. Jill.Isbister@gov.mb.ca.
authors.forename: Jill
authors.initials: J
authors.lastname: Isbister
authors.affiliation: Manitoba FASD Centre, 633 Wellington Crescent, Winnipeg, Manitoba, R3M 0A8, Canada. bmaxwell@rccinc.ca.
authors.forename: Breann
authors.initials: B
authors.lastname: Maxwell
authors.affiliation: Children's Hospital of Winnipeg, University of Manitoba, CK253-840 Sherbrook Street, Winnipeg, Manitoba, R3A 1S1, Canada. ahdearman@exchange.hsc.mb.ca.
authors.forename: Ana
authors.initials: A
authors.lastname: Hanlon-Dearman
mesh_terms: D032921:Consensus; D003266:Continuity of Patient Care; D019033:Delivery of Health Care, Integrated; D006233:Persons with Disabilities; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders; D006291:Health Policy; D006801:Humans; D033183:Interdisciplinary Communication; D011247:Pregnancy; D011320:Primary Health Care; D011788:Quality of Life; D012947:Social Work