The IAD Hub was developed to support health and allied health care providers across all settings—primary care, specialty care, public health, mental health, and beyond—with the most current tools and resources to improve early identification, diagnostic decision-making, and referral coordination.

Whether you are starting a conversation about alcohol use in pregnancy or navigating a complex referral, the IAD hub is your one-stop access point to evidence-based, Canadian-specific FASD resources.

Identification of possible FASD involves identifying people who have prenatal alcohol exposure (PAE) and are exhibiting behaviours that may be associated with FASD. Professionals can then refer them to the appropriate FASD diagnostic services.

Established prenatal alcohol exposure (PAE) is often a requirement for referral to a specialized diagnostic clinic.  There is currently not a standardized, validated identification tool for FASD, although the diagnostic criteria (facial features, significant brain domain impairment and prenatal alcohol exposure) are well-established. Clinicians rely on informal intake conversations, clinical observation, or the use of tools designed for other conditions (e.g., Attention Deficit Hyperactivity Disorder, anxiety, trauma, adverse childhood experiences) as well as possible or confirmed prenatal alcohol exposure. Clinics may be able to access PAE information from friends or family or from birth, medical and/or social services records.

• ASSIST: The Alcohol, Smoking and Substance Involvement Screening Test. (English).
  A 8-item questionnaire used to screen for substance use across a variety of substances.·
• T-ACE: Tolerance, Annoyed, Cut Down, Eye-Opener. (English).
  A 4-item questionnaire to determine at-risk drinking.
• TWEAK: Tolerance, Worry, Eye-opener, Amnesia, K/Cut down. (English).
  A 5-item, 7 point questionnaire used to assess at-risk drinking.
• AUDIT-C: brief alcohol consumption screener. (English).
  A 3-item, 12 point self-report questionnaire used to assess at-risk drinking.

Navigating Conversations about Alcohol Use During Pregnancy

Current resources and advice emphasize the importance of experience in navigating conversations about alcohol and pregnancy, which can be sensitive and complex. Mentors with more experience can be helpful for those with less experience. Having frequent conversations with all families is a good way to reduce the stigma associated with alcohol use during pregnancy and normalize the conversation.

Conversations about alcohol and pregnancy should be in plain language, where information is presented in multiple ways (e.g., graphs, diagrams, videos, statistics). Offer a choice to the individuals/families about how they would like to receive education and information, and with whom—including in-person and virtual options depending on personal preference and comfort.

• Effective referral ensures timely diagnosis and appropriate supports and services for individuals affected with Fetal Alcohol Spectrum Disorder (FASD).
  However, referral pathways are fragmented across Canada.
• Different clinics have different eligibility criteria, documentation requirements, and wait times.
• Families and individuals may struggle to understand where to go, what to expect, and how long the process will take; in many cases, support in navigating these systems may fall to clinicians.

The first step in referral for an FASD diagnosis is understanding the eligibility criteria/requirements for the clinic or pathway which may include:

• Region (e.g., clinics may only accept referrals from their local community)
• Age (e.g., clinics may be child or adult only)
• Individual who is referring (e.g., clinics may accept self-referral, rely on service providers, or have their own referral process)
• Service or programming (e.g., some referrals require involvement in a relevant program that may help prepare for assessment and promote coordinated, wraparound approaches)

Clinics may use referral forms that are publicly available, or may need to be contacted directly by phone or email. Referral pathways differ depending on clinic, network and area of Canada, but history and information are important first steps in the assessment process.

Diagnosing Fetal Alcohol Spectrum Disorder (FASD) is a critical step in ensuring individuals receive the care, support, and understanding they need to thrive. The diagnostic process involves a comprehensive assessment of neurodevelopmental functioning, physical features, and prenatal alcohol exposure (PAE) history, guided by nationally recognized criteria. This section provides health care providers with the tools and resources to navigate the complexities of FASD diagnosis across age groups from infancy to adulthood.

Effective management of Fetal Alcohol Spectrum Disorder (FASD) extends beyond diagnosis and requires coordinated, compassionate, and long-term support tailored to each individual’s unique needs. That means consideration of before, during and after diagnosis, including (but not limited to) what can be done while individuals are on the waiting list, how to ease the confusion and fatigue that may come from the emotionally taxing process for individuals and families, and collaborative planning for clear next steps after diagnosis.

Welcome to the Fetal Alcohol Spectrum Disorder (FASD) Identification, Assessment and Diagnosis Learning Hub! This hub offers flexible, self-directed learning for health and allied health care professionals at all levels of experience, including training, webinars and additional reading to help build core competencies in FASD care.