HOUSE OF REPRESENTATIVES

H.R. NO.

187

THIRTIETH LEGISLATURE, 2019

 

STATE OF HAWAII

 

 

 

 

 

HOUSE RESOLUTION

 

 

Urging the departments of health and human services to adopt the Canadian diagnostic guideline for diagnosis of fetal alcohol spectrum disorder, as published in the Canadian Medical Association Journal.

 

 


WHEREAS, fetal alcohol spectrum disorder is an umbrella term used to describe a broad spectrum of presentations and disabilities resulting from alcohol exposure in utero; and

 

WHEREAS, fetal alcohol spectrum disorder may include physical, mental, behavioral, or learning disabilities, with brain damage being the most serious effect; and

 

WHEREAS, different terms are used to describe fetal alcohol spectrum disorders, depending on the type of symptoms, including fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, and alcohol-related birth defects; and

 

WHEREAS, diagnosing fetal alcohol spectrum disorder is important to help children and adults, and their families, who have the disorder; and

 

WHEREAS, a new Canadian diagnostic guideline released in 2016, supported by the Canada Fetal Alcohol Spectrum Disorder Research Network and published in the Canadian Medical Association Journal, provides recommendations for diagnosing fetal alcohol spectrum disorder, specifically for multidisciplinary diagnostic teams; and

 

WHEREAS, key recommendations from the Canadian diagnostic guideline include: counseling women and their partners about abstinence from alcohol during pregnancy or when planning a pregnancy; screening of all pregnant women and new mothers for alcohol use by trained professionals; and referring individuals for possible diagnosis if there is evidence of prenatal exposure to alcohol at levels associated with adverse brain function; and

 

WHEREAS, one in ten women in the United States report drinking alcohol during pregnancy; and

 

WHEREAS, the diagnostic guideline for fetal alcohol spectrum disorders in Hawaii differs from the Canadian diagnostic guideline; and

 

WHEREAS, the existing practice in Hawaii is to focus on physical features at birth or within the first year when referring children for treatment for fetal alcohol spectrum disorder, rather than the Canadian diagnostic guideline, which recommends referral upon physical or developmental effects whenever there is evidence or suspected prenatal alcohol exposure; and

 

WHEREAS, the current practice in Hawaii is also to confirm prenatal alcohol exposure based on maternal confirmation, which is not always possible, rather than the Canadian diagnostic guideline, which suggests a broader range of ways to confirm possible prenatal exposure to alcohol for purposes of determining a fetal alcohol spectrum disorder diagnosis; and

 

WHEREAS, severe impairment is defined as greater than or equal to two standard deviations below the mean; however, state practice is to require greater than or equal to three standard deviations and require that an individual's intelligence quotient be two standard deviations below the mean for an accompanying intellectual disability to qualify for services; and

 

WHEREAS, individuals with fetal alcohol spectrum disorder often fall above two standard deviations and therefore cannot qualify for services in Hawaii based on their intelligence quotient and functional impairment, compared to the Canadian diagnostic guideline, which does not require a mathematical formula for services; and

 

WHEREAS, adopting the new Canadian diagnostic guideline will improve how clinicians in Hawaii diagnose fetal alcohol spectrum disorder in infants and children, thereby leading to more widespread early intervention and improved prevention efforts; now, therefore,

 

BE IT RESOLVED by the House of Representatives of the Thirtieth Legislature of the State of Hawaii, Regular Session of 2019, that the Departments of Health and Human Services are urged to adopt the Canadian diagnostic guideline for diagnosis of fetal alcohol spectrum disorder, as published in the Canadian Medical Association Journal; and

 

BE IT FURTHER RESOLVED that the Departments of Health and Human Services are urged to consider developmental and physical defects or impairment when making a referral for suspected prenatal alcohol exposure; and

 

BE IT FURTHER RESOLVED that the Departments of Health and Human Services are urged to confirm suspected prenatal alcohol exposure through a variety of ways, as recommended by the Canadian diagnostic guideline; and

 

BE IT FURTHER RESOLVED that the Departments of Health and Human Services are urged to modify the definition of severe impairment from three to two standard deviations from the mean to ensure more infants and children in Hawaii are able to receive needed services; and

 

BE IT FURTHER RESOLVED that the Departments of Health and Human Services are urged to eliminate the standard deviations requirement related to a child's intelligence quotient to ensure infants and children are able to receive needed services; and

 

BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Director of Health and Director of Human Services.

 

 

 

 

OFFERED BY:

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Report Title:

Keiki Caucus; Fetal Alcohol Spectrum Disorder; Diagnostic Guidelines