FASD: A Social Work Perspective. Liam Curran Principal Social Worker Disability Voluntary Services

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1 FASD: A Social Work Perspective Liam Curran Principal Social Worker Disability Voluntary Services

2 What is Social Work? The definition of Social work is centred on the social context of people s s lives and the right of individuals to make decisions for themselves The key concepts from the definition include problem solving, change, empowerment rights and social justice, as these are the focus of professional Social work practice.

3 Why an Issue for Social Work? mental illness 60% early school leavers 60% trouble with the law 60% institutionalization (psychiatric, drugs- or alcohol addiction treatment, prison) 50% Inappropriate sexual behavior 50% alcohol or drug addiction 30% dependent living 80% of those over age 21 (Streissguth et al. CDC, 1996)

4 Professional Conflict Recognizing FASD can challenge the basic tenets of our profession. We want to believe that people need to take responsibility for their actions, learn from experiencing the consequences of their actions, and need to make their own determinations for their lives. That is the basis of our approaches in parenting, education, treatment, and corrections. That does not work for people with an FASD due to the way their brains process information. Accepting that means that we must change our approach change our practice?

5 Seeing things differently! at the heart of all compliance issues is a competency issue. We have to move from seeing behaviour as non-compliance to seeing it as non-competence competence (Jan Lutke)

6 Why? Look at her mom she drank and took cocaine for the first five months of her pregnancy and how it affected her. She lost so much Theresa, grandmother of Kaitlin (Manitoba, CA.)

7 Universal Protectors Living in a stable and nurturing home for 72% of life. Staying in a living situation for average of longer than 2.8 years. Having a diagnosis by 6 years. Accessing Developmental Disability Services. Full FAS diagnosis. Never exposed to violence/victimized. Basic needs are met for 13% of life. Experiencing good quality home from years. (Ann Streissguth)

8 Primary behaviours are presenting behaviours. These primary behaviours may include: impulsivity distractibility suggestibility immaturity being socially or developmentally younger than chronological age slower brain processing rate/pace memory problems inconsistent performance clear strengths in some areas (e.g., art, music interpersonal skills, computers) difficulty generalizing, forming links and making associations difficulty abstracting and predicting outcomes over- and under-sensitivity to stimuli

9 Children with FASD have challenges with and yet society demands. slow cognitive pace immaturity, acts younger than age memory problems, often needs reteaching learn by doing difficulty transitioning need more time rapid responses grouped by age remember after just one lesson abstract learning multiple transitions one timeline for everyone

10 Challenging a person with FASD for behavior resulting from fetal brain damage is like challenging a blind person for not seeing where they are going.

11 Behavioural and learning patterns in Children with FASD(s) Infants - Often poor adaptation to sensory stimuli - Problems with increased or decreased muscle tone - Sleep disturbances common - Motor development difficulties are often observed

12 Behavioural and learning patterns in Children with FASD(s) Cont. Preschool - May be slow to acquire and understand language - May have motor deficits or delays - Difficulty in regulating mood and emotions - Inability to securely attach to reliable, supportative caregiver

13 Video

14 Current Irish Estimates CSO birth rates level of 2008 suggested the following estimates (Mongan et al 2009): Up to 150/year born with FAS Up to 676/year born FASD Using Stade (2009) Canadian Research on Public Health Budget Irish Estimated Cost: Individual Yearly cost 13,820 Individual lifetime cost (0-65) 898, would equate to annual 741,097, Liam Curran M.Sc 9/13/2010

15 Your Response to an FASD What to do when a child has been identified with Fasd Explain the disorder to carers and its effect on behaviour. This might include difficulty in understanding how words relate to practical action, and the concept of cause and effect. Children may also ask a the same questions over and over or make the same mistakes every day, in spite of being taught otherwise, because they have difficulty in learning from experience. Provide guidance on how to deal with behaviours and how to teach children differently. This includes modelling behaviours, rather than telling, to give children something to copy. Reward systems can also be useful, as can structuring activities into short chunks of time so the child does not lose concentration. Children with Fasd can be hyperactive so introducing frequent exercise breaks between tasks to give the child opportunities to run about and release energy can also help.

16 Assessments The Adolescent and Children s s Trust ( Tact) carries out multi-disciplinary assessments of children thought to have Fasd, which include psychometric tests, facial photography and paediatric input. Social workers can also make use of a toolkit from Sunfield Research Institute, designed to improve practice, which includes a range of free information sheets. Teresa Whitehurst, a research at Sunfield Research Institute, says if social workers are more aware of Fasd they can help flag it as a possibility to carers..

17 Behaviour 3 familiar areas of Child Care Services Societal Interpretation Reframed Interpretation Inappropriate humour Touching other children Intentionally rude Intentionally inappropriate Poor Social Skills, wants friends but doesn t t know how to make or keep them Unable to understand abstract concept of boundaries acting a developmental age Lying Minimizing, denial, manipulation Unable to grasp abstract concept of lying- wants to do the right thing but doesn t know how- so makes up answers to fill in the gaps

18 T-ACE Questionnaire Tolerance How many drinks does it take to make you feel high? Tolerance ( Score 2 points for more than 2 drinks. Score 0 for 2 drinks or less) Annoyance Have people annoyed you or criticised your drinking? (Score 1 point if Yes) Annoyance Cut Down Have you ever felt you ought to cut down your drinking? ( Score 1 point if Yes) Eye Opener Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hang over? ( Score 1 point if yes) High Risk Score 2 points or more Maximum Score 5 points

19 Findings Unanimous regarding harm to Unborn Where concern exist need for formal assessment that combines both medical & social philosophies of harm reduction Services are ad hoc and disjointed Addiction services routed in a patriarchal model Poor Screening for alcohol/drug use Complex challenge of fetal rights Vs rights of mother to be.

20 What respondents said Child protection has a huge role, it s s a role that should be there throughout the entire pregnancy and not just when the child is born MH 13 It probably would be a maternal issue, and if you can help the mother to help herself then the baby should be fairly safe after the baby is born MH 11

21 risk is not destiny. There is hope for children, an alternative to the cycle of school failure, gang activity, and drug abuse, if we are ready to make the investment. (Chasnoff 2010)

22 Alberta ( 3.7mil pop) 12 FASD Service Networks that promote prevention of FASD and provide people affected by FASD and their caregivers with comprehensive supports that encourage them to reach their full potential at home, school, work and in their communities; 20 FASD assessment and diagnostic clinics, available in hospitals and other medical centres; videoconference learning opportunities for families, caregivers, professionals and organizations in communities across Alberta, with new sessions beginning September 29; and resources for Albertans to assist with increasing public awareness and education in their communities including; posters, fact sheets, booklets, postcards and the latest Taking Action on FASD newsletter.

23 The Call A National FASD Diagnostic & Assessment Clinic Multidisciplinary team assessment and diagnosis for children, infancy to 18 years, who have confirmed or suspected prenatal alcohol exposure. Make recommendations that facilitate the child's access to appropriate community-based intervention programs within Primary Care Team or specialist therapy provision etc. FASD education is bedded into all professional undergraduate training

24 Summary FASD permeates all sections of our society & our services Fetal brain damage is a life time disability FASD Children become FASD Adults FASD requires us to think differently to original tenets of our professional ethos The FASD child can succeed if we are prepared to accommodate

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