# Presentation: 067421

## Hennepin County Fetal Alcohol Specialty Division

A Program of Project Support for screening and intervening with youth with FASD in the juvenile justice system.

- A Program of Project Support for screening and intervening with youth with FASD in the juvenile justice system.

- Presentation by
- Susan S. Carlson, JD
- Building FASD State Systems
- May 10, 2006
- San Francisco, CA

**Notes:**
  Thank you
   How I got involved; like drilling in water; soon you start to make waves
   Powerpoint presentation - guinea pigs
   1/2 hour :  peak your interest in the subject; give basic FAS10; share how those affected are especially at risk to offend;  describe a profile of those affected & issues & recommendations for the juvenile justice system;
  Materials in manual - heavy on research; law needs to be more responsive to what’s happening in research.
Hopefully, time for questions; if not, materials in manual should give u enough resources

## What is the HC FASD Initiative?

- Five year subcontract with HC DOCC and Northrop Grumman-IT Health Solutions
- Build capacity of juvenile courts to identify & provide appropriate interventions for youth with FASD
- HC DOCC is one of five juvenile justice systems in country
- First pilot year screening for FASD in the delinquency system; goal to expand to CHIPS in later years
- Partnership with 4th District Court, U of M FASD Diagnostic Clinic and MOFAS

## Importance of HC Subcontract

- Emphasis on the development of comprehensive systems of care in addressing the treatment of FASD in juvenile justice systems;
- Ability to address screening, identification, diagnosis, treatment and after care;
- Obtain data on incidence of FASD in a juvenile justice system;
- Development of approaches that are sustainable and replicable.

## Major Themes from Needs Assessment

- Lack of FASD-specific services for youth
- No current comprehensive screening or identifying of youth with FASD
- Fragmented system – multiple needs
- Ineffectiveness of traditional correctional/therapeutic interventions for youth with FASD
- Lack of training and/or awareness of FASD by professionals

## Screening for FASD

- All youth ordered to Project Support (Rule 29 Mental Health Clinic) and court ordered to have a FASD evaluation
- Utilize Washington State’s FAS Facial Screening Tool
- Questions regarding birth mother’s alcohol history
- Questions regarding prenatal alcohol history
- Questions regarding youth’s academic deficits, problems with math, IEP, and/or significant behavior problems in school

## Note:  The dotted lines indicate that the court may refer for a FASD diagnostic evaluation based on the criteria.  It depends upon how accurate the screening tool needs to be.  The most accurate screening tool would be the one that follows the solid lines.

- Note:  The dotted lines indicate that the court _may_ refer for a FASD diagnostic evaluation based on the criteria.  It depends upon how accurate the screening tool needs to be.  The most accurate screening tool would be the one that follows the solid lines.

## Mother’s “Problem Drinking”

- Defined as drinking 7 or more drinks per week or 4 or more drinks in one day in the past month
- Sources: self report; juvenile’s report; reliable informant; M being treated for alcohol or drug addiction; M diagnosed with alcoholism; DUI’s; CHIPS (alcohol and/or drug use); birth records

## Referral for FASD Diagnostic Evaluation

- All sites governed by NG Expert Panel’s recommendations
- Automatic referral: Positive facial score; sibling with FASD; youth with previous diagnosis with FASD
- Discretionary:  prenatal alcohol exposure AND IEP, academic deficits, problems with math, or significant behavior problems in school

## NG Expert Panel on FASD Screening in Juvenile Courts

- Expects 10 to 20% youth to get referred based on screening tool
- Courts have flexibility in applying screening tool & making adjustments
- Youth would not get referred if there is no chance of confirmation of prenatal alcohol exposure  (except for those w/previous FASD diagnosis; sibling with FASD; and, positive face screen)

## Preliminary Results

- January 9 – May 8, 2006
-    185  total youth screened
-    8 Automatic referrals (4%)
-    23 Discretionary Referrals (12%)
-    12 Evaluations Completed
-    5 Diagnosed – all pFAS
-   Remaining  19 youth either waiting for FASD    evaluation and/or results of evaluation

## Diagnosis & then what?

- Specific & concrete recommendations from the diagnostic team
- Individual treatment plan (team approach with all providers) to help youth & family
- Assist youth & family with getting eligible services (i.e. DD, SSI, etc.)
- Training about FASD for those who provide services and FASD-specific case assistance
- If done before adjudication, can be used to assist parties in appropriate dispositions

## Challenges

- Prenatal alcohol exposure history difficult has been difficult to obtain, but not impossible if good relationship with bio mother obtained
- At-risk population – difficult to get cooperation (i.e. paperwork, transportation & compliance issues)
- Adaptive Behavior Q’s (FASD evaluation) – too sophisticated for some parents-difficulty getting true picture of youths’ adaptive behavior

## Challenges continued

- Lengthy time from screening to FASD evaluation
- Youth who are lower functioning in an at-risk environment with little outside support
- Training of all in the system about FASD and the HC FASD program

## Successes - Case History

- 16 year old African American/Caucasian Male
- Lives with Biological Mother & Stepfather
- Number of Legal Issues: truancy, shoplifting, disorderly conduct & assault charges

## Case History continued

- 1st Contact with Court – 2003 for 5th degree assault; plea bargained to DOC; placed on probation, Project Support, & Psychological Evaluation ordered
- Project Support found the following concerns: education issues; family problems; aggressive acting out; antisocial affiliation

## Case History continued

- Project Support made community referrals, closed case & referred to PO to complete monitoring
- Psychological Evaluation findings: Youth has IEP for EBD; ADHD; has history of sensory-reactive problems; severe temper tantrums as young child; NO QUESTIONS ON PRENATAL ALCOHOL EXPOSURE; Recommended 30 day psychological evaluation

## Case History continued

- Youth had in-patient psychological evaluation
- Mother admits “to using some alcohol and occasionally used marijuana” before she knew she was pregnant
- Easy baby, but holy terror as toddler – kicked of 2 day cares for behavior problems
- Youth has exceptional intellectual abilities, with reading & spelling scores above average

## Case History continued

- Psychological Evaluation recommendations:  therapeutic foster home for consistency & structure; individual therapy to focus on anger management; continued behavioral interventions in school; “youth is likely to learn best from consequences”

## Case History continued

- Since 2004 in-patient psychological evaluations, interventions attempted: therapy, medication, in-home family therapy, group home placement, residential treatment center, & in-patient CD treatment
- Continued offenses: domestic assault, obstruction of legal process
- Other:  terminated from in-patient CD treatment on 12/1/05 because of suicide threats & out of control behavior

## Case History continued

- December 2005 – Probation and out of home placement committee requested advice of FASD program; Youth was screened in detention center & program recommended he have a FASD diagnostic evaluation due to exposure history, IEP & continued behavior problems (negative on FAS facial score)

## Case History continued

- Received FASD evaluation; diagnosed with Pfas (all of facial features, no growth deficiency, neurocognitive deficits in the following areas:  executive functioning, processing speed, emotion regulation, ADHD, and adaptive behaviors)
- Youth has Full Scale IQ of 119 & has strengths in perceptual,reasoning, working memory, listening comprehension, visual motor functioning

## Case History continued

- February 2006 – Youth was ordered to an adult FASD foster home with waiver for youth 16 & older;
- In-home family therapist received FASD training by Diane Malbin-working with mom & youth in dealing with diagnosis
- Upon admission, SSI & CADI waivers applied for which will pay for youth’s continued placement until age 18
- Visited home in March –, had behavior problems at first, but has settled in & is doing very well;  loves this new placement & wants to stay, learn auto mechanics, get his GED & possibly go into the military

## For More Information 

- Contact:  Hennepin County FASD
- 	           Program/Project Support
-     Juvenile Justice Center
- 	626 South 6th Street
- 	Minneapolis, MN 55415
- 	Phone:  612-596-1887
- 	Email: Susan.S.Carlson@co.hennepin.mn.us