FASD and Early Intervention Jo Nanson, Ph. D.

What happens after screening?  If an infant is found to be positive for prenatal exposure to alcohol of other drugs, what could happen next?  Assumption that all exposed infants are at risk  Unless there is population-based screening, this assumption is unproven

Relationship between exposure and affectedness  Prenatal screening is too new to have any data yet on the relationship between exposure and affectedness  Until there is population-based screening and follow up, the relationship is unknown  Using screening in high risk situations only gives false perspective on this relationship

Early Intervention  Early intervention programs in general provide for three groups of children:  Those at known risk (e.g. Down syndrome, FAS, etc.)  Those at biological risk (e. g. Very low birth weight, term asphyxia)  Those at social risk (low income, mental illness of the parent)

Early Intervention  No data on early intervention in FASD  Animal research suggests that other brain structures and function are improved following early intervention is alcohol exposed animals  In other groups, early intervention is very effective in reducing handicapping conditions

Early Intervention  More is better  Center based programs generally have better outcome than home based programs  More intensive programs have better outcome  Sleeper effects: early intervention is powerful prevention for juvenile delinquency  Few of the youth I see from the courts have had early intervention

Remediation of prenatal alcohol effects Number of slips Klintsova AY., 1998

Early Intervention after maternal screening  Unless FAS is diagnosed at birth, after a positive maternal screen, offering early intervention assumes that the child is at environmental risk.  There is tendency to assume that these children will be apprehended from the birth mother

Guiding Principles  Hope  Respect  Understanding  Compassion  Cooperation

Screening and Child Protection  It is not clear that child protection authorities would always intervene if a maternal screen were positive  Not clear that there are resources to cope if every positive screen were turned over to child protection

Screening and Child Protection  Relationship between health care system and child protection in dealing with positive test results is not clear  Should Child Protection be able to request screening?  Should test results be disclosed without consent?  Should screening occur without consent?

Screening and Child Protection  Debates are currently under way regarding the ethics of disclosing pap screening results to the Cancer Clinic  Using Health data to track school attendance  Implementation of new federal and provincial legislation

Early Intervention Options  Healthy and Home  Follows all neonatal discharges  Uses nurses and lactation consultants  See a variety of home situations  Can refer to other programs  Limited time of follow up

Early Intervention Options  Kids First  Only sees children from high risk areas of the community, based on income levels  Uses a variety of staff  Works only with high risk families  Can follow children for a longer time

Early Intervention Options  Early Childhood Intervention Programs  Long history of working with a variety of children from all risk groups, starting with infants  Sees any child referred regardless of income  Can follow for a long time  Has a waiting list

Early Intervention Options  Head Start  Available to aboriginal children on and off reserve  Only covers a limited number of children  Does not start with infants

Early Intervention Options  Parent aids  Works directly in the home  Works on variety of parenting skills  Focus on the parent not the infant  Can follow for a long time  Often seen as an adversary by high risk parent.

Early Intervention Options  Out of home care  Extended family is preferred to foster care  Often difficult to monitor  Goal is always to return the child home, yet little is done to maintain the parent-child relationship  Foster families and biological parents often have adversarial relationships

Early Intervention Options  Out of home care  Saskatchewan lacks options for fostering families as opposed to children  Foster families are not seen as a resource to the biological family, or vice versa  Saskatchewan lacks family centered addiction treatment

Early Intervention Options  Early intervention may provide secondary prevention by encouraging parents to delay or prevent future pregnancies  May encourage parents to seek drug and alcohol treatment

Summary  Relationship between exposure and affectedness is unclear  Ethical issues remain to be resolved  Relationship between health care and child protection is tenuous

Summary  Early intervention likely reduces the effects of prenatal alcohol exposure  May help the parent to develop a healthier life style before the next pregnancy is attempted  May help parents to space or limit pregnancies to the ones they really want  Every child should be a wanted child !