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FASD in Review

Screening and Intervention Programs

White Earth Tribal Council

Intervention Type

FASD Diagnosis and Intervention Subcontractors
(Juvenile Court)

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
Fax: 218-983-3401
E-mail: bobis@whiteearth.com

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.

Methods:

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 FASD initiative.

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 highlights include:

  • 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.