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Addressing Child Welfare and Mental Health Issues for Individuals With an FASD and Their Families. Building FASD State Systems Meeting San Antonio TX June 21-22, 2005. Eileen M. Lally, Ed.D, LCSW Program Manager University of Alaska Anchorage School of Social Work. 4500 Diplomacy Drive #430

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Addressing Child Welfare and Mental Health Issues for Individuals With an FASD and Their Families

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Addressing Child Welfare and Mental Health Issues for Individuals With an FASD and Their Families

Building FASD State Systems Meeting

San Antonio TX

June 21-22, 2005


Eileen M. Lally, Ed.D, LCSWProgram ManagerUniversity of Alaska Anchorage School of Social Work

4500 Diplomacy Drive #430

Anchorage, AK 99508

Phone: 907 786 6720

Fax: 907 786 6735

e-mail: ANEML1@uaa.alaska.edu

web site: www.fsta.uaa.alaska.edu


Dan Dubovsky, MSWFASD SpecialistSAMHSA FASD Center for Excellence

2101 Gaither Rd., Ste 600

Rockville, MD 20850

301-527-6567

dan.dubovsky@ngc.com

www.fascenter.samhsa.gov

1-866-STOPFAS (866-786-7327)


Importance of Accurate Diagnosis

  • A number of adolescents and adults have an FASD, most often undiagnosed and unrecognized

    • These individuals often fail in our traditional treatment programs

      • They say they know what they need to do and don’t follow through

      • They tend to be very verbal

      • They may have average or above average intelligence


Importance of Accurate Diagnosis

  • A number of children and adolescents have an FASD, most often undiagnosed and unrecognized

    • They often appear to be NURMU®

      • Non-compliant

      • Uncooperative

      • Resistant

      • Manipulative

      • Unmotivated

  • Children and adolescents may be, or end up, in foster care

    • Multiple placements are typical

      • Foster and adoptive parents often have not been trained to understand how to parent these children


Importance of Accurate Diagnosis

  • Care givers with an unrecognized FASD are often labeled as neglectful, abusive, sabotaging, or NURMU®

    • They say they know what they need to do

    • They don’t follow through on instructions

      • E.g., treatment, appointments, visits, phone calls

      • Especially when we have given them multiple instructions


Importance of Accurate Diagnosis

  • Care givers with an unrecognized FASD are often labeled as neglectful, abusive, sabotaging, or NURMU®

    • Have difficulty holding jobs

      • In jeopardy with TANF

    • They are in jeopardy of losing subsidized housing

      • They do not follow the rules

        • They don’t pay their rent regularly

        • They don’t keep their apartment clean

      • They may end up homeless


Importance of Accurate Diagnosis

  • Care givers with an unrecognized FASD are often labeled as neglectful, abusive, sabotaging, or NURMU®

    • Children tend to be in multiple placements

    • This is especially important to recognize for child and family serving agencies (e.g., child protective services; foster care; education; public health nursing; mental health)


Issues in Child Welfare for Children and Adolescents With an FASD

  • Many families become involved with child welfare, and child protective services in particular, due to substance use in the family

  • These children and adolescents may be placed in foster homes in which the parents are not skilled in dealing with a child with an FASD

  • They are often disappointed by their birth parents

  • They are at risk for disruptions in placements

  • They are at risk for abuse


Issues in Adoption for Children and Adolescents With an FASD

  • Children who are available for adoption may be “hard to place” due to their behavioral problems

  • Most States do not require an investigation of prenatal alcohol use in birth families

  • If adopted, the parents frequently have much difficulty raising that child

  • The children may be at risk for adoption disruptions

  • The children may be at risk of abuse


Issues in Child Welfare for Parents With an FASD

  • Their children are placed outside the home

  • In order to get their children back, they need to demonstrate the ability to follow through on multiple requirements

    • This is extremely difficult for a person with an FASD

    • We take their inability to follow multiple directions for abuse

  • They appear to be disinterested or neglectful

    • They don’t show up for their appointments on time

    • They don’t complete treatment

    • They don’t go to meetings every day and get a signed statement that they were there

    • They don’t call their children at the designated times

    • They don’t show up for their scheduled visits with their children at the right times.


Issues That Might Interfere With the Ability to Succeed in Systems of Care

  • Memory problems

  • Language processing problems

    • Especially verbal

  • Problems with attention

  • Self esteem issues

  • Lack of support


Issues That Might Interfere With the Ability to Succeed in Systems of Care

  • Desire to “belong”

  • Desire to “fit in”

  • Inability to process multiple directions

  • Literal thinking

    • Take conversations exactly as spoken

    • Difficulty with the sense of time


Issues in Mental Health for Individuals With an FASD and Their Families

  • A significant percentage of people with an FASD have co-occurring mental health disorders

    • A number of mental illnesses have a strong genetic link

    • About 50% of those with mental illness use substances

    • Those illnesses with high rates of co-occurring substance use are ones with a strong genetic link


Issues in Mental Health for Individuals With an FASD and Their Families

  • Most of the time, the FASD is not recognized as a co-occurring disorder

    • It is not considered a mental health disorder by the American Psychiatric Association

    • It cannot be treated by a mental health professional and get reimbursed

    • The person may get a psychiatric diagnosis based on symptomatology

      • If this is not an accurate diagnosis, the treatment may not be helpful


Issues in Mental Health for Individuals With an FASD and Their Families

  • We utilize our typical treatment approaches

  • The individual “fails” in treatment

  • That failure is viewed as a lack of motivation on the part of the individual

  • Families are viewed as enmeshed and enabling


Profile of 80 Birth Mothers of Children With FAS(Astley et al 2000)

  • 96% had one to ten mental health disorders

    • 77%:PTSD

    • 59%:Major depressive episode

    • 34%:Generalized anxiety disorder

    • 22%:Manic episode/Bipolar disorder

    • 7%:Schizophrenia

  • 95% had been physically or sexually abused during their lifetime

  • 79% reported having a birth parent with an alcohol problem


Likely Co-occurring Disorders With FASD

  • Attention-Deficit/Hyperactivity Disorder

  • Substance use disorders

  • Schizophrenia

  • Delusional disorder

  • Depression

  • Bipolar disorder

  • Oppositional Defiant/Conduct Disorder

  • Reactive Attachment Disorder

  • Separation Anxiety Disorder

  • Posttraumatic Stress Disorder

  • Traumatic Brain Injury


Likely Misdiagnoses for Individuals with FASD

  • ADHD

  • Oppositional Defiant Disorder

  • Conduct Disorder

  • Adolescent depression

  • Bipolar disorder


Likely Misdiagnoses for Individuals with FASD

  • Intermittent Explosive Disorder

  • Psychotic disorders

  • Autism

  • Asperger’s Syndrome

  • Reactive Attachment Disorder

  • Traumatic Brain Injury

  • Antisocial Personality Disorder

  • Borderline Personality Disorder


Comparing FASD, ADHD and Oppositional Defiant Disorder


Comparing FASD, Adolescent Depression and Adolescent Bipolar Disorder


Typical Treatments Must Often Be Adapted for Those With an FASD

  • For those with a fetal alcohol spectrum disorder, prevention interventions must be adapted due to:

    • Difficulty with verbal receptive language processing

    • Difficulty with multiple directions and multiple tasks

    • Difficulty processing information on one’s own

    • Difficulty following through on one’s own

    • Modeling the behavior of those around them

    • Difficulty in group situations

      • Do better one-to-one


Friendly

Likeable

Verbal

Helpful

Caring

Determined

Have points of insight

Good with younger children*

Not malicious

Strengths of Persons With an FASD

Dubovsky, Drexel University College of Medicine (1999)


Strategies for Improving Outcomes for Individuals With an FASD

  • Be aware of language used

    • Use literal language

    • Use person first language


Use Literal Language

  • Do not use metaphors or similes

  • Do not use idiomatic expressions

  • Think about how what you say could be misinterpreted


Person First Language

  • “He’s a child with FAS” not “he’s an FAS kid”

  • “My son has FAS (or an FASD)” not “my FAS son”

  • “I’m working with a mother with FAS” not “I’m working with an FAS mom”

  • “She has mental retardation” not “she is mentally retarded”

  • “He has a developmental disability” not “he is developmentally disabled”

  • “He has schizophrenia” not “he is a schizophrenic”

  • No one “is” FAS; people may have FAS


Notions to Keep in Mind

  • Both prevention and treatment are key in addressing FASD

  • Successful treatment is one key to effective prevention

    • Those at highest risk of giving birth to a child with an FASD are women who have already given birth to a child with an FASD

    • Providing these women with successful treatment approaches can reduce the incidence of FASD

  • When an intervention does not work, it is essential to examine for whom it doesn’t work and why it doesn’t work for that person at that time

    • Remember the paradigm shift


“We must move from viewing the individual as failing if s/he does not do well in a program to viewing the program as not providing what the individual needs in order to succeed.”

—Dubovsky, 2000

Paradigm Shift


Notions to Keep in Mind

  • Developing comprehensive systems to address FASD can improve outcomes as FASD crosses all systems

    • Collaboration among agencies and systems is essential

    • Acknowledgement of turf issues

    • Pooling of resources

  • FASD is a human issue

    • Addressing FASD is a matter of life or death for some


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