Life History Screen. a. Were you raised by someone other than your biologic/birth parents? Yes No

Transcription

1 Childhood History 1. Childhood History Life History Screen a. Were you raised by someone other than your biologic/birth parents? b. How many living situations (different primary caregivers) did you have while you were growing up (up to the age of 18)? [Prompt: Different people raising you] living situations [Interviewer note: red flag response is more than 2] Is Q1b. A Maternal Alcohol Use 2. Maternal Alcohol Use a. To your knowledge, did your mother ever drink alcohol that caused problems for her or others around her? [Prompt: Can you tell me about this? ] Unknown [Interviewer note: red flag response is yes or unknown] b. Did she drink alcohol when you were young? Unknown [Interviewer note: red flag response is yes or unknown] At least Two Flags? c. Did your mother drink alcohol while she was pregnant with you? [Prompt: If the client doesn t know, ask Has anyone ever said anything to you about your mother s drinking during her pregnancy with you? Is there anyone who knew your mother when she was pregnant with you who might know? Is your birth mother alive? If so, are you in touch with her? ] Unknown [Interviewer note: red flag response is yes or unknown] Education 3. Education a. What s the highest grade in school you completed? grade [Interviewer note: red flag response is 10 th grade or lower] [Interviewer note: graduated high school = 12 th grade, if 3a = less than 12 th grade go to 3b. If 3a = 12 th grade or higher go to 3c] b. If you didn t finish school, why did you leave? Reason: c. Were you ever in special ed or did you get any kind of special help in school? d. What was the subject in school that caused you the most problems? [Math is a red flag response] Criminal History Substance Use 4. Criminal History a. Were you ever in trouble with the law? b. Were you ever arrested? 5. Substance Use a. In what grade (or at what age) did you start using alcohol or drugs? age/grade [Interviewer note: red flag response is before age 12] Page 1 of 8

2 Employment And Income b. Did you start using alcohol or drugs after problems in school began? problems in school [Interviewer note: red flag response is yes] 6. Employment and Income a. What s the longest time you ve worked at the same job? [Interviewer note: red flag response is less than 1 year] b. Have you ever received income from SSI? [Prompt: Supplemental security income (SSI) is a Federal income supplement program designed to help people who have little or no income meet basic needs for food, clothing, and shelter.] Living Situation 7. Living Situation a. As an adult have you ever lived on your own (paying your own rent, etc.)? [Interviewer note: red flag response is no] [If 7a = yes, then go to 7b, if 7a = no go to 8a] b. How long have you lived on your own at any one time? Mental Health months/years [Interviewer note: red flag response is less than 1 year] 8. Mental Health a. Other than a problem with substance use, what kinds of mental health difficulties or disorders have you been told you have? List all: [Interviewer note: red flag response is more than 1 disorder] b. Have you ever tried to commit suicide? At least Two Flags? c. Did you receive childhood mental health services? Page 2 of 8

3 Day-to- Day Behaviors 9. Day-to-Day Behaviors Do you frequently have difficulties with any of the following? 1. Concentrating and paying attention? 2. Understanding what adults were telling you? 3. Remembering things? 4. Following rules and instructions 5. Getting along with others without arguing or fighting 6. Being on time 7. Keeping enough money to last you throughout the month 8. Doing things that later you wish you hadn t done 9. Getting really upset at little things or what people have told you are little things (Being told that you over-react to minor problems) 10. Forgetting or missing appointments 11. Being surprised when you are in trouble Five or Flags? Page 3 of 8

4 Screening Results Eligibility Check and Screening Results Interviewer: Indicate the domains a woman has an overall red flag in by checking the appropriate boxes below. Key Life History Domain Childhood History* Maternal Alcohol Use** Day-to-Day Behaviors*** * A red flag response to Q1b in this domain = a yes for red flag. **2 or more red flag responses out of the 3 questions in this domain = a yes for red flag. ***5 or more yes responses out of the 11 questions in this domain = a yes for red flag. Other Life History Domain Education Criminal History Substance Use Employment and Income Living Situation Mental Health**** ****2 or more red flag responses out of the 3 questions in this domain = a yes for red flag. Screening Results Interviewer: Indicate if woman meets eligibility criteria by checking box below: a. Eligible for Modifications to Treatment flags in all 3 key life history domains; OR flags in 2 key life history domains AND red flag responses in two or more of the other life history domains b. t eligible for Modifications to Treatment Fewer than 2 key life history domains with red flag responses or 2 key life history domains with red flags along with fewer than 2 other life history domains with red flag responses Page 4 of 8

5 Modifications To Treatment Modifications to Treatment Interviewer: Indicate how substance abuse treatment was modified by checking box below. Possible Modifications Impaired executive functioning: Inability to organize stored information, plan future activities, regulate and sequence behavior, make good judgments, and think flexibility when faced with unexpected circumstances. Establish, teach, and model structure and consistency: Be consistent with appointment times, locations, and providers. Schedule multiple brief sessions per week rather than sessions that occur only once a week. Plan changes in routines/transitions carefully, modeling for individual advance risk planning and problem-solving strategies. Teach individual how to set appointment reminders on his or her cell phone. Designate person who will ensure that individual gets to appointments. Designate a mentor/treatment buddy who will respond to individual s calls for advice and support. Role-play likely high-risk situations and methods to handle them. Use a positive, immediate, clear reinforcement system not punishment. If consequences must be implemented, ensure they are immediate, short term, and related to the action that prompted the consequence. Along with telling individuals they are not allowed to do something, also describe what they are allowed to do. Limit changes to the treatment plan. Eliminate interventions that may overwhelm individuals with PAE with impossible challenges that lead to shutting down or acting out (eg, expecting that such individuals will be able to attend to verbal dialog in group treatment, process that information, wait his or her turn to speak, and respond appropriately). Teach individual to keep and use a calendar for daily planning. Teach individual to review and assess his or her own behavior on a daily basis. Impaired ability to think abstractly: Page 5 of 8

6 Difficulty understanding abstract concepts such as time, space, money, quantities, cause and effect, idiomatic expressions, humor, and sarcasm. Remember the person s functional age and abilities, which are lower than chronological age, and set reasonable goals: Use literal, concrete terms when asking a individual to do something (eg, do not say take a hike ). Do not use metaphors or similes. If joking, tell the individual with FASD you are joking; when a peer is joking, tell the individual with FASD know that the peer is joking. Teach the individual to generalize and do not assume a lesson learned in one context will transfer to another. Help the individual understand that he/she thinks literally and therefore needs to check out the meaning of what others are saying and doing before reacting. Use positive reinforcement systems rather than reward and consequence systems because these do not help the persons change their behavior. If consequences are necessary for misconduct, make them brief, immediate, and directly related to what just occurred. Evaluate the individual s ability to manage money and assess the need for a representative payee. Assess the possible need for guardianship for safety. Impaired verbal receptive language processing: Inability to accurately process and understand incoming verbal information in social situations (poor receptive language skills), although verbal expression is adequate and the person may be very social and talkative. Learn person s unique language patterns and present information strategically: Use multiple sensory modes. Use simple step-by-step instructions (written and with illustrations, if possible). Use short, concrete sentences and examples when communicating with person (no abstract ideas/concepts). Verify individual s understanding (ie, ask what does this rule or instruction mean? and how would you follow this rule or complete this task? ). When a rule is broken, respond with I know it s hard to remember everything we are asking you to remember. How can I help you remember that rule when you need to? Role-play and ask person to demonstrate skills (ie, do not rely solely on verbal responses). Revisit important points during each session. Remember the person s functional age in terms of communication Page 6 of 8

7 and vocabulary. Role-play how to decide whether something involves risky behavior and what to say when friends suggest doing something risky. Carefully evaluate the potential effectiveness of group treatment, because this treatment modality is most often completely verbal. If group treatment is used, have the individual sit next to the facilitator for support and follow up each group session with 1:1 review of the important topics covered that day and their relevance to the individual s situation. If group treatment is used, assess frequently to see whether this modality complicates recovery or whether individual therapy should be used instead. Social impairments: Difficulty reading and responding to social cues and body language. Frame treatment expectations and requirements with the perspective that coping capacity and interpersonal skills are likely to be childlike: Role-play various social situations and how the individual might best respond. Role-play social skills and have individual practice with multiple people. Point out misinterpretations of words, body language, and actions of others when they occur. Remind individual that other people having a bad day have nothing to do with him/her. Do not interpret lack of eye contact as lack of motivation. Impaired working, short-term memory: Difficulty remembering information and following sequential verbal instructions. Communicate concretely and repetitively: Communicate rules, instructions, and directions in concrete terms that convey only one idea/instruction at a time (ie, do not state rules or give instructions that involve 2 or more actions/thoughts/steps). Provide support to ensure task completion, modeling appropriate actions. Review rules, instructions, and directions regularly and repeatedly. Teach individual to always carry a notebook and ask providers to write down instructions, appointment times, etc. Use a mentor/treatment buddy to remind individual of important activities. Page 7 of 8

8 Monitor retention of important treatment principles by having individual regularly describe those principles in his or her own words. Impaired coping ability: Inability to respond appropriately to stress or pressure due that may manifest as overreaction or shut-down. Help individual implement/improve effective coping strategies while reducing/eliminating ineffective strategies: Teach staff how to recognize signs that the individual is becoming stressed, including how to intervene appropriately. Teach individual to identify when he/she is getting upset and practice use of effective coping technique(s). Model and have individual practice multiple relaxation techniques, retaining 1 or 2 strategies that are effective. Help individual find extracurricular activities that are calming, fun, easy to access (art, crafts, music, swimming, and walking). Help individual identify 1 or 2 activities that can trigger physical release when emotions become overwhelming (eg, ice cubes on face or wrists, running in place). Praise the individual every time he/she uses coping techniques. Impaired sensory integration: Difficulty modulating incoming stimuli (eg, noise, lights, smells, tastes, tactile sensations). uce all distracting stimuli in the environment to the extent possible: Prefer individual over group therapy in treatment planning. Teach individual to keep living area uncluttered and basic. Keep treatment areas uncluttered and basic. Find ways to reduce auditory distractions during treatment. Avoid fluorescent lights. Page 8 of 8