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Earth Tribal Council
White Earth Tribal Council
FASD Diagnosis and Intervention Subcontractors
Project Contact Information
White Earth Tribal Council
Bobi Spaeth, FASD Program Manager
P.O. Box 348
White Earth , MN 56591
Phone: 218-983-3286, ext. 1434
Project Summary Statement
Brief Overview of Objectives:
The White Earth FASD Project screens, diagnoses, and provides interventions to dependent
children, ages 0-7, who are in protective custody of the White Earth Tribal Court,
primarily in the foster care system.
The primary objective in Option Year 3 (OY3) was to screen all children coming through
the court; however, the project began seeing more cases closed out in court prior
to the completion of screening. Sixteen children were lost in the process from screening
to intervention. In addition, children diagnosed were lost during the period of
time when interventions were being provided. Many actions were taken to increase
the number of children making it all the way through the process. Despite these
attempts, it is now apparent that this challenge with these court-ordered cases
will continue in option year 4.
During OY3, the courts also began ordering early developmental screenings, which
contributed to the completion of more timely and efficient FASD screenings. It is
suspected that higher numbers of completed developmental screenings accounted for
the placement of fewer children in positive monitor status (children age 0-3 who
screen positive for prenatal alcohol exposure but are asymptomatic for an FASD)
and many more children screening positive and thus being identified earlier.
Along with the screening of children came an alarming increase in the number of
children screening positive for drugs only with developmental delays. Minnesota
FASD diagnostic clinics require confirmed prenatal alcohol use for a referral for
an FASD diagnostic evaluation. Children who screen positive for drugs but not alcohol
are referred to other agencies for services. Accordingly, the project does not refer
children without confirmed prenatal alcohol exposure for FASD diagnostic evaluation.
Accomplishments and Discussion:
One of the great assets of the White Earth FASD project has been its diagnostic
clinic located within the boundaries of the White Earth Reservation. The White Earth
Diagnostic Clinic originated with funds provided by the Minnesota Organization on
Fetal Alcohol Spectrums (MOFAS) but for the majority of OY3 was funded through state
Medicare reimbursement dollars. The clinic is fully functional with pediatrician
and psychology services provided in-kind by Indian Health Services and two school
psychology students that complete the testing.
The project has been fortunate in having its own clinic in the community. There
are limited to no wait times, and families do not have to travel great distances
to complete the evaluation process. The White Earth Diagnostic Clinic is open every
other month and evaluates four to five children annually that are referred by the
White Earth FASD project.
Providing interventions to the target population is critical to ensuring that children
have successful outcomes. Although the number of children diagnosed with an FASD
has been small low, children diagnosed with an FASD did receive interventions. In
addition, some children were receiving interventions through other systems prior
to the FASD diagnoses. When this occurred, the FASD program and the existing service
provider collaborated to ensure that the FASD recommendations were met.
The FASD Task Force is responsible for oversight of the FASD subcontract and the
FASD OJJDP grant. In option year 3, the challenge was to look at ways to strengthen
task force involvement. With representation from the Health Department, Indian Child
Welfare and the White Earth Court, an executive committee was established to increase
leadership and direction from key stakeholders while optimizing the use of their
time. For example, in the process of sustainability planning, it was important to
obtain input from leadership regarding how to proceed and ensure their consensus
regarding post-subcontract goals and outcomes. This was accomplished through individual
meetings between the project director and each executive committee member.
The intent for option year 4 is to bring executive committee members together and
to facilitate their collaboration for the future of the FASD initiative. Task force
subcommittees established during option year 2 continued to meet in OY3: Early Intervention,
Intervention and Diagnostic. In option year 4, a Sustainability Subcommittee will
be established to ensure successful and timely implementation of the sustainability
plan. In OY 3, the project increased its focus on sustainability of the FASD initiative.
Discussions took place with executive committee members, particularly the Director
of the Health Department in which the FASD subcontract is housed. These discussions
were critical to begin the development of a working sustainability plan. As a result
of these discussions, a decision was made to ask for assistance from the SAMHSA
Native American Center for Excellence (NACE) to work on bringing key project partners
together to openly discuss the future of the FASD initiative.
NACE, the SAMHSA FASD Center for Excellence and the White Earth FASD Project Director
began collaborating to address sustainability. This initial work led to a plan to
gather the tribal agencies currently involved in the FASD initiative or with potential
for future involvement in the process of screening, diagnosing and/or providing
interventions to children for the purpose of collaboration on sustainability. A
sustainability planning meeting was scheduled for option year 4 (October 4, 2011)
with NACE and SAMHSA FASD Center for Excellence staff co-facilitating the training
and discussion. The goal of the October 4 meeting will be to bring all of the tribal
leaders together to focus on FASD and to formulate and agree on an action plan to
guide planning toward full sustainability after the end of the FASD subcontract.
White Earth Tribal Court, Indian Child Welfare and Health Department leaders have
added the FASD initiative to their full rosters of activities. Efforts to increase
collaboration among executive team members will increase in option year 4 when it
will be even more critical to have a clear direction and plan for sustaining the
One of the methods that have been critical in every option year is providing the
necessary training and support to project staff. Due to high turnover, there is
a need to train and re-train staff on FASD screening. In addition, White Earth has
an Office of Juvenile Justice and Delinquency Prevention (OJJDP) grant that provides
FASD services to youth between the ages of 8 and 18 in the juvenile justice system.
Training provided through this grant is open to FASD subcontract staff as an in-kind
service. MOFAS has also provided training in-kind to diagnostic staff, who benefit
from keeping abreast of new developments in the field of FASD.
An initiative was launched in option year 2 to key partners Indian Child Welfare,
Tribal Substance Abuse and Oshki Manidoo, a tribal inpatient treatment facility
for youth. Initial screening trainings were provided for these sites in option year
2, but the intent in option year 3 is to make this an annual event with a particular
focus on new staff. Project staff conducted a group training for Indian Child Welfare
staff, but most training was provided on an individual basis. Other option year
- Screening staff began utilizing the support staff for assistance in completing more
timely referrals to clinics once a positive screen was established. Great emphasis
was placed on providing ongoing support to the case manager with weekly clinical
and administrative supervision.
- Greater attention was paid to how staff proceeded with gathering prenatal alcohol
confirmation. Prior to OY3, less effort was applied to locating and speaking to
the biological mother. Most information was obtained through Indian Child Welfare
records or by the verbal confirmation of the worker. In OY3, procedures were changed
that made it mandatory for workers to make active efforts to locate and speak to
the biological mother when appropriate. The goal in OY4 will be to further support
staff in this effort and provide them with motivational interviewing techniques
to assist them in having such a sensitive conversation with mothers that enabled
them to get the needed information regarding prenatal exposure to alcohol.