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Competency 3: Treatment Strategies for Working with Clients with an FASD

Adults

Assessment and Treatment Plan Development

The assessment process for adults with an FASD, or suspected of having an FASD, requires counselors to gather and use information regarding limitations and strengths specific to FASD. In addition, counselors need to use developmentally appropriate assessment tools to assist in identifying needs and planning support. The assessment process should identify skills, areas of vulnerability, and stresses.

Therapist with patient

Adults who have an FASD, including those who have never received an accurate diagnosis, may struggle to meet the demands of a treatment program. They may face particular barriers in treatment due to difficulties with following multiple directions, recalling rules, and applying what they have been told to real-life situations.

A person with an FASD may perform better or worse at different times due to the different areas of the brain affected by prenatal alcohol exposure. He or she may be able to perform a task one day but be unable to do it another day. Malbin describes the personal experience of not being able to rely on one's brain to perform consistently as terrifying.2 The person may appear stubborn or willful but in reality has forgotten how to do the task.3

Due to the organic nature of the brain damage, recently learned skills may not be remembered. Diverse types of support are needed because of constant changes in skill levels and associated memory lapses. The emphasis needs to be on adapting the environment because people cannot change how their brains work. The environment is taken in its broadest sense and includes personal, physical, social, cultural, and institutional components.

Traditional treatment approaches such as 12-Step programs can be particularly challenging for individuals who have an FASD. The programs require a certain level of maturity, self-awareness, and social skills. Participants must be able to process and apply information, and to keep appointments. People with an FASD may forget meetings, not understand what is said at the meetings, or be unable to apply the lessons learned to their lives. Therefore, modifications may be needed, such as:

  • Setting consistent appointment days and times
  • Scheduling short, more frequent sessions and limiting the number of meetings
  • Arranging for someone to get the client to appointments or meetings
  • Limiting the number of treatment plans or steps involved in the treatment plan
  • Establishing goals that are realistic, outcome oriented, and time specific
  • Talking to the individual and family about their goals
  • Breaking steps down and working on one step at a time
  • Reviewing what happens at meetings and processing the information

The treatment plan also needs to include further assessments by medical, mental, and allied health professionals (e.g., pharmaceutical, hearing, speech, occupational therapy, physical therapy, and mental health). Persons with an FASD function at varying levels, so it is important to assess the client’s functioning in various areas, such as mobility, vision, hearing, and speech. Services such as health care, medication, and speech therapy may be needed in conjunction with alcohol treatment to ensure that the client can participate meaningfully in treatment.

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