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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.

Counselor sitting down with a family and discussing aftercare options

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.

The 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 12-Step-based meetings.

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.

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