Fetal Alcohol Spectrum Disorder (FASD)

July 28th, 2016

@HSJCC

Moderator: Trevor Tymchuk , P-HSJCC CKE Chair

HSJCC Webinar

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@HSJCC

Presenter Melody Hawdon Dual Diagnosis Clinician/ Justice Case Manager Canadian Mental Health Association, Sault Ste. Marie

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@HSJCC

FETAL ALCOHOL SPECTRUM

DISORDER (FASD) MELODY HAWDON C.W. B.A. S.W , FASD GRADUATE

PROGRAM CERTIFICATION

DUAL DIAGNOSIS CLINICIAN/ JUSTICE CASE MANAGER.

CANADIAN MENTAL HEALTH ASSOCIATION

EMAIL: MELODY@CMHASSM.COM

PHONE: (705)759-0458 EXT. 229

WEBSITE: HTTP://SSM-ALGOMA.CMHA.CA/

(Tag Archive, 2014) 4

THE F.A.S.D. OFFENDER

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TERATOGEN

• TERATOGEN

• [TUH-RAT-UH-JUH N,

• 1. A DRUG OR OTHER SUBSTANCE CAPABLE OF INTERFERING WITH THE DEVELOPMENT OF A FETUS, CAUSING BIRTH DEFECTS.

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WHAT IS FASD?

Fetal Alcohol Syndrome (FAS) was a terminology first used by medical professionals to describe a cluster of birth defects that were caused by maternal alcohol consumption during pregnancy.

FASD has since been adopted to describe a broader spectrum: o a unique cluster of minor facial anomalies o central nervous system damage o Intellectual disabilities o Medical problems o Behaviour difficulties ( CPRI, December 9 2015)

The prevalence of FASD is estimated to be 1 in 100 people. This means it is believed that more than 330 000 in Canada are affected by FASD. (@2015 CMAJ Guidelines) FASD is the leading known cause of mental retardation and developmental disabilities and is entirely preventable.

(Sutton, 2014)

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EFFECTS ON THE BRAIN

Brain of baby with no exposure to alcohol

Brain of baby with heavy prenatal

exposure to alcohol

(Fetal alcohol syndrome and the brain, 2014)

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FASD DIAGNOSES INCLUDE:

Fetal Alcohol Syndrome (FAS) - Symptoms include small head/body(no longer a factor), facial characteristics, brain damage.

partial Fetal Alcohol Syndrome (pFAS) or Fetal Alcohol Effects (FAE) - Symptoms usually not visible, such as behaviour disorders, attention deficits.

Alcohol-Related Birth Defects (ARBD) - Anomalies such as heart defects, sight/hearing problems, joint anomalies, etc.

Alcohol-Related Neurodevelopmental Disorder (ARND) - Disorders such as attention deficits, behaviour disorders, obsessive/compulsive disorder, etc.

*Not used as diagnosis

*Used as diagnosis in DSM V

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PRIMARY CHARACTERISTICS FASD CAN INVOLVE MALFORMATION OF VARIOUS ORGANS, THE MOST SIGNIFICANT OF WHICH IS PERMANENT ORGANIC BRAIN

DAMAGE. PERSONS WITH FASD MAY HAVE DIFFICULTY ORGANIZING, PLANNING, UNDERSTANDING OR RECALLING A SEQUENCE OF EVENTS, CONNECTING CAUSE AND EFFECT, AND/ OR REGULATING THEIR OWN BEHAVIOURS AND EMOTIONS.

TYPICAL BRAIN BASED, PRIMARY CHARACTERISTICS OF FASD INCLUDE:

• INCONSISTENT MEMORY AND RECALL

• INABILITY TO FILTER OUT ENVIRONMENTAL OR EMOTIONAL DISTRACTIONS AND SENSORY STIMULI

• SLOWER, INCONSISTENT COGNITIVE AND AUDITORY PROCESSING

• DECREASED MENTAL STAMINA

• DIFFICULTY INTERPRETING, AND APPLYING ABSTRACT CONCEPTS (I.E. MANAGING MONEY & TIME)

• INABILITY TO CONTROL IMPULSES OR PREDICT OUTCOMES (AS A RESULT OF THEIR OWN OR OTHERS' ACTIONS)

• DIFFICULTY CHANGING MODALITIES (I.E. SHIFTING FROM ONE CONTEXT TO ANOTHER)

• RIGIDITY (UNABLE TO MOVE ON PRIOR TO COMPLETION)

• INABILITY TO SEE ANOTHER PERSON'S PERSPECTIVE OR RECOGNIZE INDIRECT SOCIAL CUES

• ANOTHER COMMON CHARACTERISTIC OF INDIVIDUALS DIAGNOSED WITH FASD IS DYSMATURITY (WIDELY VARYING LEVELS OF MATURITY IN DIFFERENT MODALITIES).

• THE IQ OF PERSONS WITH FASD IS MOST OFTEN WITHIN THE NORMAL RANGE, YET THEY DO NOT HAVE THE ABILITY TO MEET MANY OF SOCIETY’S AGE BASED SOCIAL AND ACADEMIC EXPECTATIONS. SINCE FASD IS NOT USUALLY OUTWARDLY VISIBLE, THE EFFECTS OF DYSMATURITY ON PERSONS WITH FASD CAN BE PUZZLING TO THEMSELVES AND TO THOSE AROUND THEM.

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SECONDARY CHARACTERISTICS

The Secondary Characteristics of FASD are not directly caused by the physical brain injury. Rather, they are the result of a constant misunderstanding of the primary disabilities. Tragically, these misunderstandings all too often result in the marginalization of persons with FASD and their families. Major social issues associated with FASD include:

•Mental Health Disorders •Homelessness •Alcohol and Drug Addictions •Disrupted School Experience •Trouble with the Law, Incarceration •Inappropriate Sexual Behaviour •Problems with Employment •Dependent Living •Early Death

( When Alcohol Abuse Becomes Addiction, 2015)

(The fetal alcohol crisis, 2000)

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PRIMARY CHARACTERISTICS *AGE AND IQ*

• THE AVERAGE INDIVIDUAL HAS AN IQ OF 100 AND AN INDIVIDUAL LIVING WITH FASD HAS AN IQ RANGE OF 29 TO 125.

• THE AVERAGE INDIVIDUAL LIVING WITH FASD HAS AN IQ OF 79.

• IN ORDER TO OBTAIN INTELLECTUAL DISABILITY SERVICES AN INDIVIDUAL MUST HAVE AN IQ OF 70 OR LOWER.

• THEREFORE, THERE ARE SLIM TO NO SERVICES AVAILABLE FOR THOSE WITH FASD.

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ONTARIO SO FAR BEHIND

• In Canada it has been estimated that 1in 100 births, there is a baby being born with F.A.S.D., estimated to be 330 000 people currently living with F.A.S.D in Canada today.

• In Ontario it is thought that there are 130 000 people affected with FASD (Http;//ottawacitizen/author/cobsee,september 22, 2015, Public Largely Ignorant of damage alcohol can cause the unborn babies, says report)

• That means that 1/3 of the people struggling with F.A.S.D. live in Ontario, the only province of Canada that does not have a mandate.

• Out of 28 ministries in Ontario, not one ministry has a mandate for FASD.

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LIVING IN A 3 SECOND WORLD

• SOCIETAL EXPECTATIONS IS THAT A PERSON RESPONDS TO A REQUEST OR VERBAL PROMPT WITHIN 3 SECONDS. (WE FEAR THE SILENCE)

• IN AN FASD MIND, IT CAN TAKE UP TO AN AVERAGE OF 15 SECONDS FOR THEM TO PROCESS ONE QUESTION, COMMENT OR COMMAND.

• DIFFICULTY COMES WHEN A PERSON IS GIVEN MORE THAN ONE REQUEST, QUESTION OR COMMAND AT ONE TIME.

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CLOAK OF COMPETENCE IS THE ABILITY TO APPEAR, OR TO HAVE THE ABILITY TO UNDERSTAND AND COMPLY WITH ANY

GIVEN QUESTION, COMMENT AND OR COMMAND. TO HAVE THE BASIC KNOWLEDGE OF HOW TO PROCEED AND ADHERE TO SOCIETAL, LEGAL AND EXPECTED NORMS.

DRIVING FORCE- IS TO APPEAR COMPETENT

COMPETENT- IS TO BE BALANCED, INTELLIGENT AND SOCIAL

THE PROBLEM- IS THAT THEY ACTUALLY DON’T UNDERSTAND THE FULL MEANING OF WHAT IS SAID OR WHAT IS EXPECTED OF THEM

THE JARGON- THEY CAN REPEAT THE WORDS WITH NO OR LITTLE UNDERSTANDING OF THE ACTUAL MEANING

THE MYTH- THE BELIEF IS THAT THE PERSON IS CAPABLE

THIS IS MOST COMMONLY FOUND IN THE POPULATION OF PEOPLE IN THE BORDERLINE TO MILD DISABILITY RANGE OF IQ.

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CONFABULATION

• CONFABULATION IS THE COMMUNICATION OF FALSELY CONSTRUCTED ANSWERS AND INFORMATION BY AN INDIVIDUAL RECOUNTING SOMETHING HE OR SHE GENUINELY BELIEVES TO BE THE TRUTH.

• CONFABULATION IS THE ACT OF HONESTLY LYING, PROVIDING INFORMATION BASED ON INACCURATE MEMORIES WHETHER THOSE MEMORIES WERE PROVOKED BY QUESTIONS OR AROSE SPONTANEOUSLY. (MOSCOVITCH, 1989)

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WHAT TO DO WHEN YOU SUSPECT CONFABULATION

• USE THE GUIDE ON APPROACHING A PERSON WITH FASD (RELAXED BODY)

• NEVER CHALLENGE THEM EVEN IF YOU CATCH THEM IN A LIE, LET THE QUESTION GO AND RETURN TO IT LATER, ASKING THEM IN ANOTHER WAY.

• TRY TO BUILD A RAPPORT AROUND THEIR INTERESTS OR ABOUT AN EASY TOPIC

• TAKE BLAME FOR MISCOMMUNICATION, KEEP THE MISUNDERSTANDING NON-CONFRONTATIONAL.

• LET THE PERSON TELL THE STORY IN THEIR OWN WORDS AND THEIR OWN TIME AND THEN CLARIFY.

• USE PLAIN EVERYDAY LANGUAGE.

• DEAL WITH ONE PIECE OF INFORMATION OR QUESTION AT A TIME.

• CHECK UNDERSTANDING BY ASKING THE PERSON TO REPEAT WHAT YOU SAID, IF HE REPEATS WORD FOR WORD WHAT YOU SAID, CHANCES ARE THEY DIDN’T UNDERSTAND IT. TRY TO HAVE THEM REPEAT IT IN THEIR OWN WORDS (I USUALLY ASK THE SAME QUESTION 3 DIFFERENT WAYS TO MAKE SURE COMPREHENSION IS THERE).

• YOU MAY HAVE TO PROBLEM SOLVE FOR THEM, GIVE THEM THE IDEAS, AND THEN MAKE IT SOUND LIKE IT WAS THEIR IDEA.

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STRATEGIES TO DEAL WITH VULNERABLE PEOPLE (GREY BRUCE FETAL ALCOHOL SPECTRUM DISORDER LEADERSHIP TEAM, LYNDA LEGGE)

• NON-VERBAL COMMUNICATION • PRESENT A NEUTRAL STANCE • AVOID SUDDEN MOVEMENTS • IF PERSON IS AGITATED KEEP DISTANCE, ALLOW TIME TO CALM (IF SAFE) • MODEL CALM BODY LANGUAGE • HELP THEM PROTECT THEIR DIGNITY

• VERBAL COMMUNICATION • SLOW, CLEAR SPEECH IN A CALM TONE • SPEAK DIRECTLY TO THE PERSON • USE LANGUAGE THAT IS DIRECT, CONCRETE AND SIMPLE • AVOID CHALLENGING OR AGREEING WITH DELUSIONS • SAY EXACTLY WHAT YOU MEAN • GIVE PERSON TIME TO PROCESS QUESTIONS/ANSWERS • ASK PERSON TO REPEAT IN OWN WORDS WHAT YOU TELL THEM (ASSESS COMPREHENSION) • REPEAT OR SIMPLIFY INFORMATION IF NEEDED • EMPATHIZE WITH FEELINGS WHEN PARANOID “I CAN SEE YOU ARE AFRAID, HOW CAN I HELP YOU FEEL

SAFER?

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STRATEGIES TO DEAL WITH VULNERABLE PEOPLE • ENVIRONMENTAL CONSIDERATIONS

• DECREASED DISTRACTIONS, NOISE AND OTHER STIMULI

• MINIMIZE THE NUMBER OF PEOPLE IN THE AREA

• DESIGNATE ONE PERSON TO DO THE TALKING

• PROVIDING SUPPORT • ASSURE THE PERSON THAT YOU WANT TO HELP THEM

• ACKNOWLEDGE FEELINGS BY NAMING THEM I.E. FEAR, ANXIETY, AGITATION

• BE PATIENT AND NON-INTIMIDATING

• GAIN TRUST BY ASKING ABOUT THEM, THEIR FAMILY, ARE THEY HURT

• TELL THEM WHAT YOU ARE DOING BEFOREHAND: I.E. “WE NEED TO TAKE YOU IN THE CAR”

• FOR MORE ASSISTANCE CONTACT:

• CENTRAL ACCESS – INFORMATION & REFERRAL SERVICE • 705-749-5989 / TOLL FREE: 1-855-366-1466 / E-MAIL: INFORMATION@CMHASSM.COM

• CRISIS SERVICES • 705-759-3398 / TOLL FREE: 1-800-721-0077

• CMHA – COURT SUPPORT PROGRAM • 705-759-0458 X234

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REFRAMING AND STRATEGIES FOR F.A.S.D AND THE COURTS

• Failure to appear to court (or late for court).

• New charges, failing to appear for prints, same type of charges as first one.

• Non-compliance.

• Disturbance in court room.

• Lack of understanding of court procedures.

• Fitness and N.C.R. may be factors.

• Include a team of supports for the person at each court appearance. This could be family/friends and agency services.

• Have finger prints done at the courthouse, or arrange transportation to local police station to have them done immediately.

• Reframe the “non-compliance” into “not able”, with bail conditions and/or court orders. Can be customized to the understanding of individual.

• Have them attend the specialized court if possible.

• Request any and all assessments to be completed to better understand the persons disability and limitations. 20

COURT APPEARANCE REMINDERS

• Use a full 8x10 paper with an unusual colour that stands out.

• Try to use clear and simple words and information.

• Give as much direct information needed to make the person successful in getting to the court appearance.

• Let as many supports or family members know of the date, so they may help get the person there on time. 21

BILL C-583 • An act to amend the Criminal Code to include FASD

as a mitigating factor in a person legal defense, under the court of law.

• Having the court legally recognize

• A full definition of FASD to be added into the criminal code section C.C -672. section 1 (a-g).

• An assessment can now be done, asked for by defense and or the courts, C.c-672.2. ( www.parl.gc.ca)

• Main goal for the bill to pass;

1. A definition of FASD in criminal code

2. Allow court to accept evidence that a person accused of a crime has FASD, and or suspected to have FASD.

3. Determine the contribution , if any FASD had on the offence. (Canfasd.ca)

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REFRAMING AND STRATEGIES FOR F.A.S.D AND CORRECTIONS

• Either excels in jail or struggles greatly.

• Regularly victimized.

• Tend to see more emotional and behavioural issues.

• Will respond to other inmates requests and or ideas.

• More conduct codes of violations.

• Suicidal ideations and or suicide attempts.

• All Corrections and facility staff should be made aware of diagnosis.

• House in the safe unit, PC or smaller cell block area, not in remand or bigger general population areas.

• Put in areas with more supervision.

• Include healthcare into correctional plan.

• Refer to outside counselling and support agencies.

• Connect with spiritual or religious advisors.

• Use strategies for vulnerable persons.

• * Mental Health Watch*

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THE COST TO HOUSE AN INMATE • It costs approximately $120, 000 a year to house a

young offender for one year in the Ontario Correctional system.

• It costs approximately $82, 000 a year to house an adult inmate in the Ontario Provincial system.

• It costs approximately $68 000 for males and $115, 000 for females, housed in the Federal penitentiary system.

( Lakeland Centre for FASD, www.lcfasd.com/transition-program-description)

• Total cost for youth with FASD in Corrections in 2011/2012 is approximately $17.5 million.

• Total cost for adults with FASD in Corrections in 2011/2012 is approximately 356.2 million.

Svetlana Popova, et al., “Cost Attributable to Fetal Alcohol Spectrum Disorder in the Canadian Correctional System. “International Journal of Law and Psychiatry , In Press, 2015)

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Estimated Number of Youth/Adults with FAS/FASD in Custody in Canada in 2011/2012.

Svetlana Popova, et al., “Cost Attributable to Fetal Alcohol Spectrum Disorder in the Canadian Correctional System. “International Journal of Law and Psychiatry , In

Press, 2015)

Adults in Custody

• 39 087

• Estimated cases of FAS/FASD 3870

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Youth in Custody

• 1676

• Estimated cases of FAS/FASD 278

COUNTING PENNIES

ONTARIO WORKS • Single male gets $681.00 a

month

• Total income for one year

• $8172.00

ONTARIO DISABILITY SUPPORT PLAN

Single male gets $1110.00 a month

Total income for one year

$13 320.00

ONTARIO PROVINCIAL JAIL

• Single male in jail for 12 months

• Total cost for incarceration

• $82 000.00

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REFRAMING AND STRATEGIES FOR F.A.S.D AND PROBATION AND PAROLE

• Failure to make appointments.

• Breach probation order, usually the first condition of not meeting with Probation and Parole within the first 48 hours.

• Does not complete community service order.

• Recharged with another crime, similar to original charge.

• Probation could attend the sentencing court date, and meet with client there.

• Work with other social service agencies to collaborate on next appointment.

• With permission Probation Officer attend person’s home or community appointments.

• Book appointments that are back to back with other agency appointments.

• Use visual orders, clear simple terms.

• Only review, IN-DEPTH, up to three of the probation orders at a time.

• Call the day before their appointment and the day of the scheduled appointment.

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PROBATION ORDER • Put all conditions into easy to read and easy

to understand language.

• Use as many actual pictures and visual cues as possible.

• Be direct and concrete with the expectations and what the consequence will be.

• Make sure Probation and or legal system has viewed the conditions for any discrepancy.

• Go to all probation appointments with person.

• Try to review only 3 conditions each visit and continue to rotate the conditions reviewed each meeting.

• If possible give a copy of the visual order to all supports and legal advisors that may come into contact with this person. This may include Probation Officer, Police, Lawyer and family members.

• Have the person post this on fridge or beside phone for easy and constant reminder.

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VISUALS AND ICONS OF REMINDERS OF

COURT CONDITIONS

• Visual reminders.

•Small to be placed in wallet and or pocket of coat.

•Concrete and direct.

•Make extra copies, incase misplaced or lost and to give to other providers.

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MAAMWESYING AND MEDICAL ALERT, WORKING TOGETHER

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AND THAT’S A WRAP!!

PLEASE FEEL FREE TO ASK ANY QUESTIONS YOU MAY HAVE…

THANK YOU SO MUCH FOR HAVING ME ATTEND 31

REFERENCES

• Canadian Government Ministry of Community Safety and Corrections Services

• Canadian Government Ministry Of the Attorney General

• FASD ONE, Fetal Alcohol Spectrum Disorder and Justice, fasdjustice.ca/whatworks

• Lakeland Centre for FASD, www.lcfasd.com/transition-program-description Svetlana Popova, et al., “Cost Attributable to Fetal Alcohol Spectrum Disorder in the Canadian Correctional System. “International Journal of Law and Psychiatry , In Press, 2015)

• WWW.CADFP.ORG

• Youtube

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REFERENCES

• CAMH STORIES. (2012). RETRIEVED FROM HTTP://WWW.CAMH.CA/EN/HOSPITAL/ABOUT_CAMH/NEWSROOM/CAMH_IN_THE_HEADLINES/STORIES/PAGES/BREAKING-THE-CYCLE-OF-FETAL-ALCOHOL-SPECTRUM-DISORDER.ASPX

• CMAJ GUIDELINES@2015 FETAL ALCOHOL SPECTRUM DISORDER: A GUIDELINE FOR DIAGNOSIS ACROSS THE LIFESPAN.

• CPRI CHILD AND PARENT RESOURCE INSTITUTE, ONTARIO MINISTRY OF CHILDREN AND YOUTH SERVICES, POWER POINT

• FASD CENTER. (2015). RETRIEVED FROM HTTP://WWW.SAMHSA.GOV/PROGRAMS-CAMPAIGNS/FETAL-ALCOHOL-SPECTRUM-DISORDERS-FASD-CENTER

• FETAL ALCOHOL SPECTRUM DISORDER - CAMPAIGN DESIGN - BLUEGATOR CREATIVE. (2013). RETRIEVED FROM HTTP://BLUEGATORCREATIVE.COM/FETAL-ALCOHOL-SPECTRUM-DISORDER-CAMPAIGN-DESIGN/

• FETAL ALCOHOL SYNDROME AND THE BRAIN. (2014). RETRIEVED FROM HTTP://PEAKMEMORY.ME/2014/05/24/FETAL-ALCOHOL-SYNDROME-AND-THE-BRAIN/

• SANTIAGO, S. (2006). SCIENTISTS OPEN A NEW WINDOW ON FASD RESEARCH. RETRIEVED FROM HTTP://WWW.NATIVEJOURNAL.CA/PAGES/2006 SECTIONS/*2006.09.SECTIONS/2006.09.HEALTH.HTML

• SILHOUETTE PREGNANT WOMAN STOCK VECTORS, ILLUSTRATIONS & CLIPART. (2015). RETRIEVED FROM HTTP://WWW.DREAMSTIME.COM/ILLUSTRATION/SILHOUETTE-PREGNANT-WOMAN.HTML

• SUTTON, K. (2014). TREAT FETAL ALCOHOL SYNDROME NATURALLY. RETRIEVED FROM HTTP://SIMPLEREMEDIES.NET/HOME-REMEDIES/TREAT-FETAL-ALCOHOL-SYNDROME-NATURALLY/

• TAG ARCHIVE. (2014). RETRIEVED FROM HTTPS://FASDPREVENTION.WORDPRESS.COM/TAG/FASD-AWARENESS-DAY/

• THE FETAL ALCOHOL CRISIS. (2000). RETRIEVED FROM HTTP://FATHERSFORLIFE.ORG/HEALTH/FAS.HTM

• WHEN ALCOHOL ABUSE BECOMES ADDICTION. (2015). RETRIEVED FROM HTTP://WWW.BMS.CO.IN/WHEN-ALCOHOL-ABUSE-BECOMES-ADDICTION/

• (1996). RETRIEVED FROM HTTPS://LH3.GOOGLEUSERCONTENT.COM/2IE9JQVOSD2NVFQKAMU3PET717RZFNQDOTNZO_FPD2VP8CBWRNM3VOUX-ZK3MKIJYPDGXW=S170

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5TH ANNUAL International Fetal Alcohol Spectrum Disorder AWARENESS DAY • An educational and informative conference on FASD, hosted by Peel

HSJCC • Presenters: Judy Pakozday (Registered Nurse) and David Boulding (PhD, B.C.

Lawyer) • Date and Time: Friday, September 9, 2016 (9:00 a.m. to 3:00 p.m) • Location: Mississauga Grand Banquet & Convention Centre • Registration: $40/person • Register online: www.bit.ly/FASDpeel or contact Judy O’Shea (judy@cdrcp.com)

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For more information about the Provincial HSJCC and to join the mailing list, visit:

www.hsjcc.on.ca

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