Children with FASD playing with sensory spaghetti

Social care workers

What does FASD have to do with social care?

Social workers are the primary profession to work with children and young people who are affected by their family’s alcohol and substance use and that they, therefore, require mandatory training in FASD. (Thomas, 2011)                                                                                                  

FASD cases require complex case management and the fact that FASD is not core training may have contributed to the death of a child as described in Two Tragedies. (Badry, 2013; Pringle, 2014)

Without the necessary knowledge and training, a social worker may not understand the significance of asking and recording the right questions.

This can have a significant impact on decisions that are made, which referrals a child receives and can make the process of getting a diagnosis harder.

FASD should be considered in the following areas of Social Work:

  • Pre-birth assessment
  • Initial assessment
  • Disability
  • Fostering and adoption
  • Leaving care
  • Adult Services

Where substance misuse is present in referrals response appears uneven depending on the substance.

Social Work involvement in families where there is alcohol misuse may come to the attention of social services later and follow a different route through the social care system than a family where there is drug misuse. 

These delays in offering support to the family may have further impact on the development and psychological wellbeing of the children and on the family’s ability to function. (Adamson and Templeton) 

Most mothers who misuse drugs also drink alcohol. Therefore, any level of alcohol use must be recorded as it may be impossible to get the correct diagnosis without it in the future for an affected child. (Preece and Riley, 2011)

According to the Chief Medical Officers (2016), there is no Safe level of alcohol use in pregnancy. This means that any pregnancy that was exposed to any amount of alcohol could be affected and it should, therefore, be recorded.

A Message for Social Workers from Joanna Buckard

Which families may have an alcohol-exposed pregnancy?

Research into birth mothers of children with FASD has showed that many were in vulnerable groups:

95%

95% of birth mothers had Mental Health problems

90%

90% experienced physical/sexual abuse

60%

60% were below the poverty line

77%

77% had Post Traumatic Stress Disorder

Without the necessary support, alcohol may have been used as a form of Self-medication. (Astley et al., 2000)

However other research has show that the groups of women most likely to continue drinking alcohol in pregnancy are educated, older mothers.

It is crucial to consider whether there has been prenatal alcohol exposure in all assessments.

Social Workers have the skills to talk about difficult subjects with their clients and this is key to getting the right information.

FASD in Focus - Social Workers

Dialogue and true listening, is an art more than a science and is imperative in trying to build up a picture of life for the family before the child was conceived, during the pregnancy as well as after. (Parton N and O’Byrne P, 2000)

What could be considered?

  • Have questions been asked about prenatal alcohol consumption?
  • Is there any relevant information from other sources i.e. police, etc.
  • How and where are we recording this?
  • What do the family and young person need?
  • How to avoid stigma, blame and remain non-judgemental

Fostering & adoption and FASD

The number of UK children seen with complex behaviour/difficulties where there is a history of exposure to alcohol and/or drugs prenatally appears to be increasing at an alarming rate.

A UK study found that there was a history of prenatal exposure in:

34%

34% of children looked after

75%

75% of medicals for adoption

In 2019 there were 78,150 children that were looked after (Coram BAAF, 2019). Using the above percentages there is a clear need for great understanding within all social care, health and education provision.

Children and young people with FASD are living in a variety of settings including:

  • Long – term fostering
  • Residential care
  • Kinship Care
  • Special Guardians
  • Adoption

However, it is imperative that assessments consider the needs of the young people and also what is available to support the family. There can be a significant risk of parent or carer stress and anxiety/depression if the family haven’t got the support they need as well as FASD training for families. There can also be an effect on other children within the family and the stresses have led to family breakdown in previous situations.

What can help?

  • Support
  • Diagnosis
  • Respite
  • Training
  • School support

There has been a history of presuming a healthy baby does not have FASD. Given that only <10% have facial features, FASD should not be ruled out in young children where there may have been Prenatal alcohol exposure at any level. The child should be noted for follow up.

Adoption Social Workers should:

  • Document any level of alcohol exposure
  • Inform adopters that a child who has been exposed to alcohol, that is meeting milestones may exhibit difficulties later
  • Ensure adopters understand the potential long-term needs of a child who has been exposed to prenatal alcohol

It is also important to consider that within a sibling group, children can be affected differently. If one child suspected of having FASD, they all should be assessed or noted for follow up.

Consider whether there is a history of prenatal alcohol exposure (PAE)

  • No, Mum didn’t drink….’ Bear in mind that the majority of women in the UK drink alcohol and there is no known safe level in pregnancy. Around half of pregnancies are unplanned.
  • How is the young person developing?
  • Other diagnosis? (ADHD, Autism etc)
  • Information from health, school, carers
  • Strengths and Difficulties questionnaire
  • Difficulties with behaviour
  • Reasons for behaviour, struggles…

What about trauma?

New research shows that children with both prenatal alcohol exposure (PAE) and a history of trauma appear to function similarly to children with PAE only.

Those with PAE only tend to have more severe difficulties than children with trauma alone.

Therefore, the difficulties seen in children with both of these exposures seem to be primarily caused by PAE rather than childhood trauma.

Children seen in care, school, or in a medical setting, who have both PAE and a history of trauma, should be thought of more as a child with FASD than a child with a history of trauma.

Strategies designed specifically for FASD may be more effective than those designed for trauma.  (Price, 2019)

What should be considered in the transition to adulthood?

The following assessments should be redone as they show current functional level:

  • CELF
  • WISC
  • Vineland
  • BRIEF

 

This can show the spiky profile of a person with FASD and in some cases shows that their functional ability in some areas can be in the bottom percentiles for their age-range.

People with FASD who have never been diagnosed may previously have been diagnosed with:

  • ADHD
  • Autism
  • Dyslexia
  • Dyspraxia
  • Anxiety
  • Depression
  • Borderline Personality Disorder

 

The appropriate living arrangements should only be made following the functionality assessments. Some people with FASD live:

  • with family
  • in residential Care
  • in a shared-lives setting
  • in a supported Living environment
  • Independently

 

A person with FASD’s abilities should not be assumed.

Where adults with FASD have received poor levels of support they have been vulnerable to:

  • Grooming (CSE, County lines)
  • Mate crime
  • Cuckooing
  • Mental Health
  • Criminality
  • Unemployment
  • Homelessness

 

Any Mental capacity and best interest assessments should be conducted by somebody who has undertaken FASD training.

The aforementioned functional assessments can help to provide insight into support needs.

A UK pilot study (Buckard and Mukherjee, 2016) showed supported adults with FASD in the UK had found their way around some things they struggled with but still faced challenges:

  • ‘I still struggle with money, paying bills’
  • ‘ I used to spend all my money on rubbish, or gamble it, Mum sorts all my money now’
  • ‘I’ve no cooker, just microwave because of my health and safety and the other people here because I might leave the cooker on if I get distracted. I also have a slow cooker which I can do chicken in’
  • ‘Having a bath’s ok now, teeth are still an issue’
  • ‘Sometimes I can go 3-4 days without speaking to anyone, maybe even a week. Except online. ‘
  • ‘I’m lonely’

Supported adults with FASD have the opportunity to live fulfilled lives.

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