1. YOLANDA ROSS, LBSW LEAH DAVIES, LMSW CENTRAL TEXAS AFRICAN AMERICAN FAMILY SUPPORT CONFERENCE MARCH 27, 2015 Prenatal Alcohol Exposure: Lifelong Impacts

2. Welcome and Thank you for coming! FASD Pregnancy Choice? Addiction Mental Health Disability Health Alcohol Development Support Knowledge

3. Yolanda’s Story

4. ALCOHOL USE AMONG PREGNANT WOMEN Understanding FASD

5. Women and Alcohol Studies show that women with alcoholism are up to twice as likely as men to die from alcohol-related causes such as suicide, accidents, and illnesses. Alcohol becomes more highly concentrated in a woman’s body. Women who drink heavily are more prone to liver disease, heart damage, and brain damage than men. The code of silence around women and substance abuse and women is harming women and their babies.

6. The Numbers  1 in 13 pregnant women drink (CDC, 2012)  47% of Texas pregnancies are unintended (PRAMS, 2009)  Approximately 68% for women aged 19 and younger  44.3 % of Texas women report drinking any alcohol before pregnancy (PRAMS, 2009)  5.7 % reported drinking any alcohol during the 3 rd trimester  34% of pregnant adolescents (age 12-14) report using one or substance in past 30 days (Salas-Wright, 2015)  Most commonly used: Alcohol (16%)  Most likely to report alcohol use during pregnancy in 2012 CDC MMWR report:  White  Between the ages of 35 and 44  College graduates  Employed

7. Drinking while pregnant? Women may be unaware that they are pregnant Women may know other women who drank during pregnancy and who have children who appear outwardly to be healthy Women may use alcohol to cope with difficult life situations such as: poverty, violence, isolation, despair or depression Women may be struggling with addiction. STIGMA

8. FASD is not about the face, it’s about the brain! Wattendorf, D. MAJ, MC, USAF, and Muenke, M, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland. Am Fam Physician. 2005 Jul 15;72(2):279-285.

9. Prevalence Experts estimate that an FASD may occur in approximately 2-5% of all live births. (May. P et al., 2014). The chart below reflects national prevalence estimates for new cases of each of the listed health issues Spina Down Childhood Diabetes FASD Bifida Syndrome Cancers (Type 1) Thus, of the 380,000 or so infants born in Texas in 2011(DSHS), approximately 7,600-19,000 may have been born with a disorder within the FASD spectrum*.

10. Characteristics of FASD Due to Brain Damage Impaired executive function Developmental delay Mental Health Issues  Attention deficits  Increased stress response Increased activity Sleep disturbances Decreased visual focus Decreased/increased response to noise or stimulation Delayed speech development Possible intellectual disability Learning difficulties

11. FASD and well-being... Oppositional Defiant Disorder (ODD) ADHD, ADD Bipolar disorder Intermittent Explosive Disorder Autism Spectrum (including Asperger’s Syndrome) Reactive Attachment Disorder Traumatic Brain Injury Antisocial Personality Disorder Conduct Disorder Borderline Personality Disorder Depression

12. Logic Model Because FASD is a brain-based disability, seen mostly in behaviors... Then providing accommodations for people with an FASD or other neurocognitive impairment is as appropriate, effective and important as providing accommodations for people with other physical disabilities

13. PREVENTION INTERVENTION So what should we do?

14. Prevention is key! Screening Brief Intervention (if positive) Referral to Treatment (if necessary)

16. Shift in Thinking From believing the individual with an FASD… To understanding the individual possibly… Won’t Can’t AnnoyingFrustrated, challenged LiesFills in the blanks IrritableOverstimulated Trying to get attentionNeeds contact, support InappropriateDisplays behaviors of a child, is developmentally younger IS the problemHAS a problem Adapted from Malbin, 2002

17. Developing Accommodations Identify what was going on just before behavior = the need Adapt teaching and/or environment, carefully monitor progress Ask: What can I do to help meet this child in his/her need?

18. So what works? Hannah’s experience MHMRA of Harris County Early Childhood Intervention (ECI) Pasadena Independent School District (PISD) NOFAS University of Washington The Council on Alcohol and Drugs Houston (Cradles Project) K.I.N.D.E.R. Clinic through Memorial Hermann Hospital (No longer in existence) No Place Like Here

19. Strategies for Success Stable routine Limit (but provide,) choices and instruction Celebrate successes (even small ones) Teach social skills and emotions Provide supports in school (to individual, teachers, and classmates.) Repetition! Consistency Use concrete language and explanations Teach self-advocacy

20. What doesn’t work Rewards or punishments that will happen “in the future.” Independence as a goal. Viewing inability to follow through as a lack of motivation. Zero Tolerance policies. Approaches that rely heavily on verbal processing – like MI. “We must move from viewing the individual as failing if s/he does not do well in a program to viewing the program as not providing what the individual needs in order to succeed.” —Dubovsky, 2000

21. For more information The Texas Office for Prevention of Developmental Disabilities http://www.topdd.state.tx.ushttp://www.topdd.state.tx.us Leah Davies: leah.davies@hhsc.state.tx.usleah.davies@hhsc.state.tx.us The CDC http://www.cdc.gov/ncbddd/fasd/index.html http://www.cdc.gov/ncbddd/fasd/index.html The FASD Center for Excellence (SAMHSA) http://www.fasdcenter.samhsa.gov/ http://www.fasdcenter.samhsa.gov/

22. Questions/Thoughts

23. There is also no safe time during pregnancy to drink and no safe kind of alcohol. We urge pregnant women not to drink alcohol at any time during pregnancy.” – Centers for Disease Control and Prevention, 2011

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