Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep 9;19(1):649.
doi: 10.1186/s12913-019-4378-5.

Protocol for the Yapatjarrathati project: a mixed-method implementation trial of a tiered assessment process for identifying fetal alcohol spectrum disorders in a remote Australian community

Dianne C Shanley  1   2 , Erinn Hawkins  3   4 , Marjad Page  5 , Doug Shelton  6 , Wei Liu  3   4 , Heidi Webster  7 , Karen M Moritz  8 , Linda Barry  9 , Jenny Ziviani  10 , Shirley Morrissey  3 , Frances O'Callaghan  3 , Andrew Wood  11 , Mary Katsikitis  11 , Natasha Reid  3   8
Affiliations

Protocol for the Yapatjarrathati project: a mixed-method implementation trial of a tiered assessment process for identifying fetal alcohol spectrum disorders in a remote Australian community

Dianne C Shanley et al. BMC Health Serv Res. .

Abstract

Background: Fetal alcohol spectrum disorder (FASD) is a highly prevalent neurodevelopmental disorder associated with prenatal alcohol exposure. Early identification can improve functioning for individuals and reduce costs to society. Gold standard methods of diagnosing FASD rely on specialists to deliver intensive, multidisciplinary assessments. While comprehensive, prevalence rates highlight that this assessment model cannot meet demand, nor is it feasible in remote areas where specialist services are lacking. This project aims to expand the capabilities of remote practitioners in north Queensland, Australia, where 23-94% of the community identify as First Nations people. Integrating cultural protocols with the implementation science theories of Knowledge-To-Action, Experience-Based Co-Design, and RE-AIM, remote practitioners with varying levels of experience will be trained in a co-designed, culturally appropriate, tiered neurodevelopmental assessment process that considers FASD as a potential outcome. This innovative assessment process can be shared between primary and tertiary health care settings, improving access to services for children and families. This project aims to demonstrate that neurodevelopmental assessments can be integrated seamlessly with established community practices and sustained through evidence-based workforce development strategies.

Methods: The Yapatjarrathati project (named by the local First Nations community and meaning 'to get well') is a mixed-method implementation trial of a tiered assessment process for identifying FASD within a remote Australian community. In collaboration with the community, we co-designed: (a) a culturally sensitive, tiered, neurodevelopmental assessment process for identifying FASD, and (b) training materials that up-skill remote practitioners with varying levels of expertise. Qualitative interviews for primary, secondary and end users will be undertaken to evaluate the implementation strategies. RE-AIM will be used to evaluate the reach, effectiveness, adoption, implementation and maintenance of the assessment and training process.

Discussion: Co-designed with the local community, integrated with cultural protocols, and based on implementation science theories, the assessment and training process from this project will have the potential to be scaled-up across other remote locations and trialed in urban settings. The Yapatjarrathati project is an important step towards increasing the availability of neurodevelopmental services across Australia and empowering remote practitioners to contribute to the FASD assessment process.

Keywords: Aboriginal and/or Torres Strait Islander peoples; Developmental assessment; Fetal alcohol spectrum disorder; First nations; Implementation strategy; Indigenous communities; Rural and remote areas.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The Integration of Cultural Protocols with Implementation Science Theories
Fig. 2
Fig. 2
The Journey of the Yapatjarrathati Project
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lange S, Rovet J, Rehm J, Popova S. Neurodevelopmental profile of fetal alcohol spectrum disorder: a systematic review. BMC Psychol. 2017;5(1):22–34. doi: 10.1186/s40359-017-0191-2. - DOI - PMC - PubMed
    1. Bower C, Elliott EJ, Zimmet M, Doorey J, Wilkins A, Russell V, et al. Australian guide to the diagnosis of foetal alcohol spectrum disorder: a summary. J Paediatr Child Health. 2017;53(10):1021–1023. doi: 10.1111/jpc.13625. - DOI - PMC - PubMed
    1. Easton B, Burd L, Rehm J, Popova S. Productivity losses associated with fetal alcohol spectrum disorder in New Zealand. NZ Med J. 2016;129(1440):72–83. - PubMed
    1. May PA, Chambers CD, Kalberg WO, Zellner J, Feldman H, Buckley D, et al. Prevalence of fetal alcohol spectrum disorders in 4 US communities. JAMA. 2018;319(5):474–482. doi: 10.1001/jama.2017.21896. - DOI - PMC - PubMed
    1. Reid N, Shelton D, Warner J, O'callaghan F, Dawe S. Profile of children diagnosed with a fetal alcohol spectrum disorder: a retrospective chart review. Drug Alcohol Rev. 2017;36(5):677–681. doi: 10.1111/dar.12519. - DOI - PubMed

MeSH terms