> Competency 5: Continuing Care of Families Affected by FASD > 5b. Treatment Plan Development
Competence 5: Continuing Care of Families Affected by FASD
Continuing Care for Clients with an FASD or Possible FASD, Continued
Treatment Plan Development
In developing a treatment plan for a person with an FASD, the addiction professional
needs to consider comprehensive ongoing service requirements. These include service
requirements that refer to both a severe mental illness and a substance use disorder.
Integrated dual disorder treatment has been shown to work effectively.
Clinicians need to know the effects of alcohol and drugs and their interactions
with mental disorders. They also need the knowledge and skills to directly provide
services for both mental illness and substance disorders at the same time or be
able to collaborate with the mental health system. The coordination of these systems
enhances the quality of services by removing barriers that impede access to needed
services. Community health centers and other primary health providers also play
critical roles in substance abuse treatment and mental health treatment.
At the beginning of treatment planning, addiction professionals need to anticipate
aftercare options, as it may be difficult to find the necessary services in the
local community. A person with an FASD may need more sustained contact with aftercare
resources than usual to enhance skill development, fulfill employment goals, or
develop alternative social supports. Aftercare plans need to include provisions
for counseling or relapse
prevention groups, as
well as other practical matters such as housing concerns or legal issues.
Ideally, one professional within the treatment program or affiliated with some other
community agency will be responsible for monitoring aftercare activities. If aftercare
services are not reasonably accessible, treatment programs can direct clients to
tape or book libraries, Internet sites, or other types of self-directed support
activities. However, the treatment provider should work with the individual’s
family or caregiver to arrange such activities. Persons with an FASD will require
more structure and assistance than normal for the program to be effective.
Programs will need to make use of linkages to facilitate aftercare for people with
an FASD. In some cases, a halfway house or other sober living arrangement may be
an option. These living arrangements provide support and structure over a longer
period of time, which is particularly beneficial for people with an FASD.
Americans with Disabilities Act (ADA) requires that halfway houses and sober houses be adaptable for people with
disabilities, but that is not always the case. The treatment provider should investigate
whether accommodations will be made for a client with an FASD before sending her
to an aftercare facility. If the person is not going to an aftercare facility, treatment
providers should make housing a priority and find out from the community network
or other systems serving the person whether appropriate housing is available.2
In working with individuals with an FASD, providers must systematically address
what has been learned in the program and how it will be applicable in the next stage
of treatment or aftercare. Persons with an FASD have trouble applying what they
learn to different situations. Providers cannot assume that the lessons learned
in treatment will be applied in aftercare. Techniques used in treatment, such as
role playing, can be used to rehearse what will happen during aftercare, such as
Someone with a cognitive impairment may find it extremely difficult to understand
and complete all 12 steps, but exposure to even a few steps can help recovery. Versions
of the 12 steps have been adapted for persons with reading limitations and
mental retardation (although
not all 12-Step members or groups agree on these modifications). In working with
individuals with an FASD, providers must systematically address what has been learned
in the program and how it will be applicable in the next stage of treatment or aftercare.
For persons with mental retardation, the presence of a facilitator may be very helpful,
even though facilitators are not normally part of 12-Step meetings.