American Academy of Pediatrics 2014 Educational Webinar Series Wednesday, August 27, 3:00 3:30 pm ET FETAL ALCOHOL SPECTRUM DISORDERS (FASDs): COMMUNICATION, CARE COORDINATION, AND CO-MANAGEMENT PRESENTED BY PHILIP MATTHEIS, MD, FAAP IRA J. CHASNOFF, MD
FASDs Series Overview Access recorded sessions at www.aap.org/fasd Myths, Media and Medical Home Detection, Discovery, and Diagnosis Roles, Referrals, and Reimbursement Communication, Care Coordination, and Co- Management
There is no specific treatment for FASDs As a spectrum disorder, the related problems fall across a wide range of type and severity, which direct decisions about needed support Co-existing emotional trauma, fetal exposure to other toxins, traumatic brain injury, and other associated conditions make for unique individual patterns of disability
Comprehensive treatment requires a sequence of clinical products: Diagnosis of FASDs condition Problem List with Recommendations Case Management best for treatment decisions, ideally from a consistent medical home (all of this from trauma-informed perspective)
Diagnosis - various routes and protocols: Can be done by local clinical team, with consult to tertiary FASDs clinic for complex cases (see AAP FASDs Toolkit for details and guidance www.aap.org/fasd) Or referral for diagnosis can follow screening by the local medical home
Problem List with Recommendations: Problems may include obtaining FASDs diagnoses (directly, or by referral) Problems include impact of physical/emotional trauma, which requires trauma-informed assessment (again, either directly if expertise available, or by referral to appropriate resources) Referral for therapeutic and functional supports is most effective when coordinated by medical home to manage and organize priorities
Case Management (as with most chronic conditions) is the primary support for FASDs conditions, (therapy details vary by individual needs) is often the most effective and durable route to services over lifespan of client, and may be the most consistent need Communication with a medical home for the client should be a central item on problem list for tertiary clinic or developmental consultant Client lifespan may require a series of handoffs with age (anticipated by addition to the problem list) Selection of primary case manager often shifts with changing needs and age of the client
Case #1: History 5 months old male infant with history of Failure to Thrive 23 year old mother who found out she was pregnant at 3 months gestation 4Ps Plus screen: drank one quart of beer/liquor per day in three months prior to knowledge of pregnancy
Case #1: Diagnosis ND:PAE Alcohol exposure: 1 quart / day x 3 months Growth: history of failure to thrive at 2 months with current growth parameters at 15 th percentile Facial features: normal Neurodevelopment: Sleep irregularity Delayed motor development (poor head control, not able to roll either way, poor suck, generalized hypotonicity) No spontaneous babbling Highly sensitive to light, sound, movement crying and irritability
Case #1: Problem List Poor feeding with history of failure to thrive Delayed motor development Delayed speech/language development Sensory processing disorder Poor maternal/infant interaction Inadequate immunizations Maternal alcoholism
Case #1: Case Management Mother enrolled in residential treatment program w/ child Early intervention (IDEA) referral for assessment and treatment: OT, PT, S/L, Developmental Therapy General pediatric care, including catching up with immunizations and monitoring growth and development Report to DCFS as required by CAPTA legislation
Case #2 5 year old boy in foster care after child protection services removal due to witnessing domestic violence between biologic parents related to mother s continued alcohol abuse Parents agree about mother s use of alcohol during pregnancy Pregnancy and Birth otherwise uncomplicated Child has no abnormal medical conditions Developmental milestones reported to be normal, but local assessment finds significant social and language delays Child has had very limited social experience outside of home Parents agree that father has physically assaulted mother, explained as his necessary response after she drinks too much Parents deny need for therapy for either domestic violence and anger control, nor for substance abuse
Case #3 14 year old girl in suburban Kentucky presents with adopted mother for evaluation of reasons for academic performance History includes heavy use of drugs and alcohol in pregnancy Methamphetamine and alcohol positive at birth; child was removed and placed in foster care from hospital, later adopted by foster parents, with normal development and social experience Early academic readiness and performance within normal limits Difficulties with homework and more sophisticated academic challenges emerging in high school
FASDs: Communication, Care Coordination Questions and Answers