Results at a glance: Evaluation of the Public Health Agency of Canada’s Fetal Alcohol Spectrum Disorder Program 2017-18 to 2021 22

Program overview

Fetal Alcohol Spectrum Disorder (FASD) is a diagnostic term that describes the impact prenatal alcohol exposure has on the brain and body. People with FASD will experience lifelong challenges with their motor, social and cognitive skills, physical health, and emotional regulation.

The Public Health Agency of Canada (PHAC) is one of many players that address FASD in Canada. Other key players include local public health authorities, provincial and territorial governments, other government departments and many community-based organizations. PHAC’s FASD Program includes grants and contributions funding, policy, and surveillance activities. Its goal is to provide strategic federal leadership and coordination to prevent FASD and promote positive health and social outcomes for those already affected.

To support this goal, the Centre for Health Promotion delivers the FASD National Strategic Projects Fund (NSPF) and leads policy efforts. The fund allocates $1.5 million annually to national projects that support FASD prevention, education and knowledge exchange, capacity building, coordination, as well as FASD data collection and research. Surveillance activities fall under the Centre for Surveillance and Applied Research.

Evaluation approach

The purpose of the evaluation was to provide guidance and information to PHAC on the relevance and effectiveness of the FASD Program.

Methods:

• Document and file review
• Literature review
• Key informant interviews
• Comparative analysis with other jurisdictions
• Financial data review
• Data analysis

What the evaluation found

To date, PHAC has undertaken activities to address FASD that are well aligned with its federal public health role. Despite having ambitious objectives, FASD-dedicated funding is limited. Important gaps remain and some appear to align with the federal public health role in the areas of strengthening surveillance, national strategic planning, stakeholder engagement and collaboration, documenting promising practices, and supporting guideline development and dissemination.

All NSPF funded projects have developed and shared relevant information to raise awareness and improve knowledge at various levels of the four-part FASD prevention model, and appear to be mainly focused on prevention. The public, childbearing or pregnant women and their network, and several professionals, including healthcare professionals, were all target populations of the NSPF funded projects. Most projects had to adapt to the COVID-19 pandemic by shifting toward virtual delivery. The performance data required from funded projects covered mostly outputs and reach, however, some projects were able to demonstrate that participants had acquired awareness and new knowledge. There would be value in collecting additional data to determine project achievements like knowledge, use, or behaviour change.

Some funded projects also helped enhance FASD surveillance data while PHAC’s surveillance activities examined various data sources to establish national FASD surveillance using multiple sources. However, the lack of national FASD prevalence continues to represent a gap, which is further exacerbated by the under-diagnosis and under-reporting of FASD cases.

Recommendations

Recommendation 1: Continue strengthening surveillance efforts with a focus on establishing the building blocks for FASD surveillance, including national prevalence estimates.

Recommendation 2: Strengthen the integration of FASD efforts across PHAC, from awareness and prevention to a response that adopts a social determinant of health and a harm reduction lens which would improve connection with the broader substance use approach.

Recommendation 3: Enhance the FASD program’s performance measurement approach with a focus on impact.