title: Challenges and Progress in Building a Comprehensive Statewide System for Fetal Alcohol Spectrum Disorders Prevention in Hawai'i.
abstract: Introduction Fetal Alcohol Spectrum Disorders (FASD) has been a maternal and child public health concern in Hawai'i for over the past decade. Methods A historical assessment of FASD related activities was conducted to map the challenges and progress made in building a comprehensive statewide system for FASD prevention and intervention in an island state. Results Progress has primarily been reflected in increasing the number of individuals receiving FASD education and training, as well as some initiatives in public awareness. The creation of a State FASD Coordinator position was significant in catalyzing support for FASD initiatives and extending collaborative networks with national experts/teams, community-based organizations, and other local agencies to leverage resources in a time of economic strain. Major challenges and barriers included loss of the FASD Coordinator position, reliance on external resources and lack of local capacity for training and education integration into existing practice systems, and inadequate surveillance infrastructure. Discussion Lack of funding and resources were a common factor overall, and impeded the development of a state strategic plan which was needed to guide overall efforts and policies into a more coordinated system to reduce and prevent FASDs in Hawai'i.
authors.affiliation: Department of Psychiatry, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA. onoyej@dop.hawaii.edu.|The Queen's Medical Center, Honolulu, HI, USA. onoyej@dop.hawaii.edu.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Onoye
authors.affiliation: Department of Psychiatry, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA.
authors.forename: Mika D
authors.initials: MD
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology; D005260:Female; D063647:Fetal Alcohol Spectrum Disorders / Q000453:epidemiology / Q000517:prevention & control*; D006254:Hawaii / Q000453:epidemiology; D006291:Health Policy / Q000639:trends; D006801:Humans; D011247:Pregnancy; D015397:Program Evaluation / Q000379:methods / Q000706:statistics & numerical data; D011634:Public Health / Q000379:methods* / Q000706:statistics & numerical data; D036301:Qualitative Research; D018570:Risk Assessment / Q000379:methods
keywords: Fetal alcohol spectrum disorders; Historical; Policy; Prevention; Systems