Treatment is Effective Behavioral Health is Essential to Health - PowerPoint Presentation

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Treatment is Effective

Behavioral Health is Essential to Health

Prevention Works

People Recover

Improving the quality of life for

West

Virginians with behavioral health needs

West Virginia Department of Health and Human Resources

Bureau for Behavioral Health and Health FacilitiesSlide2

Fetal Alcohol Spectrum Disorders: Recognition & ResponseSlide3

Cathy Coontz, MA, MS, PSII, NPN Prevention Lead for WV andNational Prevention Network for WVFunded by:

This training is funded by a grant from the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention, and the West Virginia Department of Health and Human Resources, Bureau for Behavioral Health and Health Facilities. Slide4

Learning ObjectivesUnderstand the teratogenic effects of alcohol and supportive cultureLearn

about FASD including terminology; facts; and effects on the body and brainUnderstand primary and secondary disabilities resulting from FASDLearn about prevention, early intervention and treatment strategies for problems associated with FASDSlide5

FASDSimple, but a hard lesson to learn…Mom Drinks, Baby Drinks!Slide6

Why Know About FASD?100% PreventableSlide7

Alcohol and Societal AttitudesAlcohol is often a traditional part of cultureAlcohol is used to celebrate, relax, and socializeStigma attached to receiving treatment.Strong legislative lobbyAvailability and Accessibility

Not illegal for adults Change of societal norms past 30 yearsSlide8

Alcohol AwarenessNorms DiscussionShould restaurants serve pregnant women?

Should doctors talk to women about substance abuse when pregnant.Does it look better for a man to be drunk in public than a woman?Should a woman who use substances during pregnancy be arrested?Slide9

Alcohol is a DepressantAlcohol is a depressant that stops, stunts, or retards the growth of cells.

“A shotgun blast”Slide10

Transmission of Alcohol to the FetusAlcohol is a teratogen, a substance that causes developmental malformations Alcohol passes through the mother’s blood to the baby

Alcohol crosses the placenta and enters the baby’s bloodstream It can then pass into all developing tissues Alcohol may also be transmitted to a baby during breastfeeding causing CNS and brain damage, because the brain continues to develop after birth FASD Center for Excellence-The CourseSlide11

Alcohol and other Drugs“Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.”

—IOM Report to Congress, 1996Slide12

Effects of Prescription Drug AbuseWomen who abuse opiates during pregnancy greatly increase their risk of serious pregnancy complications.poor fetal growth premature rupture of the membranes (the bag of waters that holds the fetus breaks too soon) premature and still birthsSlide13

Drug Exposure Low birth weight babies are premature and often suffer from serious health problems during the newborn period, including breathing problemsThey also are at increased risk of lifelong disabilities Babies exposed to heroin before birth also face an Increased

risk of sudden infant death syndrome (SIDS)Slide14

WV Perinatal Exposure to SubstancesWest Virginia women aged 35 and older reported the highest use of alcohol during the last 3 months of their pregnancy. West Virginia women who had an annual income of $50,000 or more reported the highest use of alcohol during the last 3 months of pregnancy.

(PRAMS, 2009)A 2009 umbilical cord study in eight West Virginia hospitals concluded that almost 20% of babies tested had been exposed to drugs. A newer 2010 study revealed that this number had increased in one hospital to 33% (study includes alcohol and other drugs), compared to a national average of 4%. Stitely, Michael.L

., Calhoun, Byron, MD, Maxwell, Stephan. MD, Nerhood, Robert. MD. Chaffin, David. MD. Prevalence of Drug Use in Pregnant West Virginia Patients. WVMedical Journal. Vol.106. 2010.Slide15

Medication Assisted Recovery During PregnancyMethadone MaintenanceBuprenorphine is increasingly used for treatment also, because of the potential to reduce the severity of Neonatal Abstinence Syndrome ScoresMost babies of opiate abusers show withdrawal symptoms during the 3 days after birth, including fever, sneezing, trembling, irritability, diarrhea, vomiting, continual crying and seizures usually subsiding by 1 week of age

http://www.adoptmed.org/topics/prenatal-opiate-exposure.html Dorothy Minch, MSW Slide16

Timing, Dosage and ExposureThe severity of a baby’s symptoms is related to how long the mother has been using opiates or other drugs and how high a dose she has taken. The longer the baby’s exposure in the womb and the greater the dose, the more severe the withdrawal. Slide17

Alcohol Related Birth Defects Terminology Fetal Alcohol Spectrum Disorders is an umbrella term used to describe the range of effects that can occur in an individual whose mother drank alcohol during pregnancy

Fetal Alcohol Syndrome is a specific diagnosis with specific criteria, a disorder of permanent birth defects that occurs in the offspring of women who drink alcohol during pregnancy Fetal Alcohol Effects is an outdated term used to describe individuals who had problems associated with prenatal alcohol exposure, but did not have enough of the outward signs to be eligible for the medical diagnosis of FASAlcohol Related Neurodevelopmental Disorder has been widely used to describe the specific damage that prenatal alcohol exposure can have on the central nervous systemSlide18

What is FAS?Medical diagnosis for a permanent condition caused by prenatal alcohol exposureGrowth deficiency in head, height, weight

Special pattern facial featuresSigns of central nervous system damage*Term first identified in international medical literature in 1973 (Jones, K., Smith, D, Recognition of the fetal alcohol syndrome in early infancy. Lancet, 2, 999-1001.)Slide19

Fetal Alcohol: The DiagnosisFetal Alcohol SyndromeTerm first identified in literature- 1973 by Drs. Smith and Jones at the University of WashingtonOne of the diagnoses used to describe birth defects caused by alcohol use while pregnantA medical diagnosis (760.71) in the International Classification of Diseases (ICD)Slide20

Facial CharacteristicsSlide21

“It is not the face that needs the services.”(Streissguth & O’Malley, 2000, p. 178)Slide22

Factors That Impact a FetusWhen and how much a mother drinks while pregnantMother’s genetic make-upBaby’s genetic make-up

Mother’s nutritional level Slide23

Brain DamageSlide24

Alcohol Related Brain DamageAlcohol can damage the developing brain when it crosses the placentaSince the brain develops throughout pregnancy, alcohol exposure at any time can cause brain damageTypes of Alcohol-Related Brain DamageSmall head

microcephaly, usually below the 10th percentile. Damage to or absence of the corpus callosum an area of the brain that contains nerve fibers that bridges the two hemispheres of the brain. MRIs have shown completely missing areas of the brain in individuals with FASDAbnormal cysts or cavities in the brain Neurological problems, such as seizures, tremors, and poor fine motor skills

Patterns of dysfunction on psychometric tests like IQ & PersonalityFASD Center of ExcellenceSlide25

Developmental Delays, Learning Disabilities and Behavioral ProblemsMental RetardationAttention deficits Hyperactivity

Poor Impulse Control Problems in Social Perception Speech and Language Delays or Deficits Poor Capacity for Abstract Thinking Specific Deficits in Math Skills Problems in Memory, Attention, or Judgment Problems Changing Behavior or Response in Different SituationsProblems Anticipating ConsequencesProblems with Cause and Effect Slide26

What we know…There is no proven safe amount of alcohol use during pregnancy.Alcohol can damage the fetus at all stages.People with FASD are everywhere and in all systems of care (diagnosed or not).FASD can occur in all communities.

Fetal alcohol exposure is the leading known cause of mental retardation in the Western world.Slide27

Primary & Secondary DisabilitiesProcessing deficits Managing incoming sensory informationSleeping and eating

Cognition and learning Visual spatial skills, learning, memorySpeed of central processing of informationExecutive functioningSpeech

and languageSlide28

Processing Deficits (Examples)Abstract reasoningGeneralizing information and rulesMemory deficitsTime managementJudgment skillsSocialization and independenceSlide29

Abstract Reasoning (Examples)Missing meaning, humor, and insight in conversationsThinking about the cause and effect of consequencesPredicting an outcomeSlide30

Memory DeficitsPoor short term auditory memorySlow auditory paceDifficulty getting information out of long term memorySlide31

Judgment SkillsAct before they think (Life-Long & Across the SpectrumCause & EffectMay seem noncompliant and willful when in fact they are simply unableSlide32

Socialization and IndependenceNot be able to rely on their own skillsMay have lifelong needs for support and supervision Slide33

Ages and StagesSocially and developmentally younger than their chronological age.People with FAS often can talk the talk but can’t walk the walk.Slide34

Secondary DisabilitiesDisabilities that a person is not born with and are preventable with the right support, interventions, and accommodations.Slide35

“The Fall Out”Mental health issues – 90%Disrupted school experience – 60%Trouble with the law – 60%Confinement – 50%Inappropriate sexual behavior – 49%Alcohol and drug problems – 35% Streissguth, Understanding the Occurrence of Secondary Disabilities August 1996Slide36

FASD & Criminal Justice SystemVICTIMIZATIONKnown predators a problemUnreliable witnessSocial Functioning LowerGang Activity “Patsy” or “fall guy”Brain damage hinders the inability to deal with usual life demandsUnable to resist sexual advances

72% of adolescents & adults with FAS/FAE have been physically or sexually abused. StreissguthSlide37

FASD Comprehensive Service NeedsPediatriciansNeurologist

Pediatric OphthalmologistAudiologistOtolaryngologistMedical Supply ProvidersPsychiatristAllergist

NutritionistFeeding SpecialistHigh-Risk Infant and Follow Up ClinicFAS Diagnostic Clinic

Lab and x-ray servicesSurgeonsPulmonologistRespiratory TherapistOccupational TherapistSpeech/Language TherapistSensory Integration Therapist

Mental Health therapist/Family Support *In addition education, social, legal, and financial service providers are utilized.Slide38

Examples of Physician ServicesPre-conceptual CounselingPrevention of Drug-Exposed Pregnancies

Counseling Pregnant Women who Use(d) Alcohol & Other DrugsFramework for FAS Identification, Diagnosis and Treatment/InterventionSlide39

Providers are Powerful Allies in Continuum of Substance Abuse Services

Prevention

Intervention

Treatment /

Recovery

Universal, Selected & Indicated:

Drug Exposed Pregnancy Prevention

Brief Interventions with Pregnant Women & Adolescents

SBIRT

Provide primary case monitoring

Diagnosis

Referral

Treatment

(Out-Patient, Residential, Medication Assisted Recovery)

Community SupportsSlide40

Research Says…

“Healthcare providers loathe to discuss substance use with prenatal patients. Obstetricians and midwives are reluctant to confront patients in prenatal care about substance-abuse issues.” (Join Together Online, Indiana University October 2008)Slide41

More research…“It is important to screen and identify every patient for substance abuse. Following diagnosis, physicians need to assess patients’ readiness to change their behavior…guiding progress through the stages of recovery.”

(Booker T. Bush, MD American College of Physicians 2006)Slide42

Provider ResourcesACOG/CDC Drinking & Reproductive Health Laminated Screening Instrument for Providers

Resource Information Patient Handouts that can be Downloaded and PrintedContinuing Medical Education CreditsSlide43

Simple Strategies that Work!ConcreteConsistencyRepetitionRoutineSimplicitySpecificStructureSupervision

8 Magic Keys Deb Everson & Jan Lutke 1997Slide44

Educational & Environmental StrategiesOrganizing the Physical SpaceReinforcing Routines and Assisting with TransitionsMaking Learning Accommodations

Assisting Social Development and Improving Behavior Slide45

Birth-5 RecommendationsEarly identificationIntervention with birth and/or foster/adoptive parentsEducation of parents regarding physical and psychosocial needs of an infant or child affected by FASDCareful monitoring of physical development and health

Safe, stable and structured homeAssignment of a case manager for coordination of services and support to parentsPlacement of child in preschoolRespite care for caretakersSlide46

Ages 6-11 RecommendationsSafe, stable and structured home or residential placementCareful and continued monitoring of health issues and existing problemsAppropriate

educational and daily living skills placementHelp caretakers establish realistic expectations and goalsCaretakers support groupPsychological, educational and adaptive evaluations on a regular basisUse of clear, concrete and immediate consequences for behavior

Respite care for caretakersCase manager role expands to include liaison between parents, school, health care and social service providersSlide47

Adolescent RecommendationsEducation of caretakers and patients regarding sexual development, birth control options and protection from sexually transmitted diseasesPlanning and implementation of adult residential and vocational training and placementAppropriate mental health interventions as needed

Respite care for caretakersCaretakers support groupSafe, stable and structured home or residential placementShifting of focus from academic skills to daily living and vocational skillsCareful monitoring of social activities and structuring of leisure timeWorking towards increased independence by teaching to make healthy choices (taught at the child’s level)Slide48

Adult RecommendationsGuardianship for fundsSpecialized residential and/or subsidized livingSpecialized vocational training and job placementsMedical couponsAcceptance of the person’s “world”

Acknowledgment of the person‘s skills and limitationsAdvocates to ensure the above occursSlide49

Person Centered… Strength Based ServicesGive people with FASD longer to answer, develop, and achieveReteach skills in every environment they will be used – don’t assumeMove from what’s wrong with them to what is going on for themSlide50

What professionals can do today?Modify the environment.Modify expectations.Think younger or think “stage not age.”Think perpetual innocence.

Make the world make sense.Rethink, reteach, respect.Slide51

Final Thoughts…See People Not Problems Remember that expectations have to be realistic and appropriate to each person with FASD and not a generalization about FASDServe as a professional and community resourceSlide52

For Additional Informationwww.ocali.org/topic/fasdwww.fascenter.samhsa.govwww.cdc.gov/ncbddd/fasd/index.html

www.nofas.orgniaaa.nig.gov/aboutNIAAA/Interagency/pagesSlide53

Contact InformationCathy Coontz, MA, MS, PSII, NPN Prevention Lead for WV andNational Prevention Network for

WVDivision on Alcoholism and Drug AbuseBureau for Behavioral Health and Health Facilities350 Capitol Street, Room 350Charleston, WV 25301Cathy.E.Coontz@wv.gov