THE FIRST 1000 DAYS - BASW presentation... · ALCOHOL EXPOSURE IN PREGNANCY STAGES FOETAL ALCOHOL...

THE FIRST 1000 DAYS

Impact of alcohol and other drugs between conception and aged 2 years

Pocket Guides/Presenters

ØWulf Livingston – Chair of the Alcohol and other Drugs Special Interest GroupØBrief introduction to Alcohol and Other Drugs Special Interest GroupØOverview of Pocket Guides ØPresentersØIf anyone is affected by anything in this presentation, please visit Drymester or NOFAS websites or discuss with your GP.

Why the ‘Golden’ First 1000 Days?

ØThe first 1000 days relates to the approximate time between conception and a child’s second birthday.

ØIt’s the period within which we see the most rapid phase of brain growth which sets the foundation for physical, social and emotional development.

ØIt’s a critical window for essential learning:

SeeingTalkingWalkingThinking



ØLearning more about brain plasticity – the ability of the brain to modify/change throughout the life-course

ØImportant to remember that, because of brain plasticity, opportunities exist after the first 1000 days to lesson any deficits in care, during this time.

ØIt’s essential to take a preventative approach protect the brain from the start

The care given to a child in the first 1000 days plays a significant role in their health and development/prevention of ACE’s and is

likely to impact on their life course


ØParental alcohol and substance use following the child’s birth, can also have a negative impact on their development through a lack of:

Appropriate careStimulation

Supervision and safety Emotional availability


ØOther factors that can affect a child’s health and wellbeing during the first 1000 days include:

Poor nutritionSmoking

Poor parental mental healthDomestic abuse

Poverty and poor living conditions

REDUCING Alcohol Exposed Pregnancies IN GREATER MANCHESTERRoisin Reynolds British Association of Social Workers 1 October 2019

FOLLOW & TWEET:@Drymester_GMHSC / #Drymester

Greater Manchester Healthand Social Care Partnership

alcohol exposed pregnancies: THE CHALLENGE

REDUCING ALCOHOL EXPOSED PREGNANCIES


CHIEF MEDICAL OFFICERS’ GUIDELINES – 2016

If you are pregnant or think you could become pregnant, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.

Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.

REDUCING ALCOHOL EXPOSED PREGNANCIES THE CHALLENGE


We asked people IN Oldham…



ALCOHOL USE DURING PREGNANCYA study in The Lancet (2017) estimated 41% of pregnant women in UK drank alcohol while pregnant – the 4th highest in the world



NEW VIDEO CONTENT

RAISING AWARENESSREDUCING ALCOHOL EXPOSED PREGNANCIES


• 4.5 million content views

• Most engaged age group – 25 to 34

• Most used platform to view content – Mobile

• Most engaged target audience – DE

• Gender split: 80% Female to 20% Male


CAMPAIGN RESULTS (AT 10 WEEKS)

RAISING AWARENESS


• Openness and honesty regarding alcohol use

• Unplanned pregnancies

• Multi-agency collaboration

• Early identification

• Support of carers & family

• Need to educate carers, professionals

• Long term appropriate support for children effected with FASD / FAS


CAMPAIGN CHALLENGES

RAISING AWARENESS


alcohol exposed pregnancies: FOETAL ALCOHOL SPECTRUM DISORDERS




ALCOHOL IN THE UTERUS

FOETAL ALCOHOL SPECTRUM DISORDERS

Alcohol crosses placenta and enters

foetus’ blood circulation

Alcohol absorbed by foetus’ tissue

Signs of alcohol consumption detectable in newborn’s first faeces



PERIODS OF FOETAL DEVELOPMENT


3 weeks to full termCentral nervous system

4 weeks to full termEyes

3 weeks to 9 weeksHeart

4 weeks to 9 weeksLower limbs

6 weeks to full termExternal genitalia

4 weeks to 9 weeksUpper limbs

6 weeks to 16 weeksPalate

6 weeks to full termTeeth

4 weeks to 20 weeksEars



ALCOHOL EXPOSURE IN PREGNANCY STAGES


FIRSTTRIMESTER

SECONDTRIMESTER

THIRDTRIMESTER

Alcohol interferes with:

• migration and organisation of brain cells

• formation of Central Nervous System

Alcohol seems to causes more clinical features

Particularly between 10 and 20 weeks

Alcohol greatly affects key part of brain, leading to:

• problems with understanding, reading, maths

• inability to form or retain new memories

MAKE EVERY TRIMESTER #DRYMESTER


REDUCING ALCOHOL EXPOSED PREGNANCIES FOETAL ALCOHOL SPECTRUM DISORDERS

Zygote Embryo Foetus Full Term

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Week 9

Week 16

Weeks20-36

Week 38

Prenatal death Major morthological abnormalities Functional defects and minor morthological abnormalities

central nervous system

heart

upper limbs

eyes

lower limbs

teeth

palate

external genitalia

ears



EFFECTS OF PRE-NATAL ALCOHOL EXPOSURE


PRE-NATAL ALCOHOL EXPOSURE

no effect foetal alcohol effects

foetal alcohol syndrome

death

alcohol-related birth defects

alcohol-related neurodevelopmental

disorders



BREASTFEEDING AND ALCOHOL


• Alcohol in breast milk

• Impact on the baby and its development

• Risk of accidental suffocation


FOETAL ALCOHOL SPECTRUM DISORDERS (FASD)



FOETAL ALCOHOL SPECTRUM DISORDERS (FASD)


Attention deficits

Memory deficits

Hyperactivity

Difficulty with abstract concepts

Inability to manage money

Poor problem solving skills

Educational learning difficulties

Difficulty learning from consequences

Immature social behaviour

Inappropriately friendly to strangers

Lack of control over emotions

Poor impulse control

Poor judgment


FOETAL ALCOHOL SYNDROME


Small head circumference (microcephaly)

Low nasal bridgeUpturned nose

Thin upper lip

Underdeveloped jaw

Flat midface

Small, wide-set eyes

Smooth ridge between upper lip and nose

Underdeveloped upper ears (“railroad

track” ears) Skin folds on upper eyelid (epicanthal folds)


FOETAL ALCOHOL SYNDROME



ASSESSMENT FOR FASD


Different methods

Growth(physical size, head circumference)

Brain

Alcohol

All countries assess: But different countries use:

Face

Different tools


EXECUTIVE FUNCTIONING


2 4 6 8 10 12 14 16 18

Not FASD

FASD


EXECUTIVE FUNCTIONING PROBLEMS: THE ‘managing director’ of the brain


‘Hot’ executive functioning:

Social immaturity

‘Cold’ executive functioning:

Poor peer relations

Naivety / vulnerability

Hyperactivity

Poor impulse control

Poor emotion regulation

Lack of insight into effect of behaviour

Poor learning from past mistakes

Poor working memory

Poor understanding of abstract concepts

Poor planning / organisation

Difficulty sequencing

Repetition of words, gestures (perseveration)

Poor sustained attention / concentration

Inability to work independently


LIVING WITH FASD



alcohol exposed pregnancies: RAISING AWARENESS



#DRYMESTER

REDUCING ALCOHOL EXPOSED PREGNANCIES RAISING AWARENESS


A DIGITAL-LED CAMPAIGN

REDUCING ALCOHOL EXPOSED PREGNANCIES RAISING AWARENESS


alcohol exposed pregnancies: USEFUL INFORMATION



NINE BRAIN DOMAINS AFFECTED BY FASD

REDUCING ALCOHOL EXPOSED PREGNANCIES USEFUL INFORMATION

Executive Functioning

Focus and Attention

• May have trouble with planning, sequencing,

problem solving and organisation • May be impulsive • Difficulty controlling emotions • Challenges with transitions and change • Often repeats mistakes and has difficulty

understanding consequences • Difficulty with abstract ideas/concepts • Difficulty managing time

• Can be easily distracted, over-stimulated or impulsive

• May have difficulty paying attention and be over active

• ‘Can’t sit still’

Sensory and Motor Cognition (Reasoning & Thinking)

• May be unable to make sense of what is

going on around them • May under or over react to sensory input, for

example, light, noise, touch, smell and/or taste and movement

• Difficulty with attention, learning, memory, planning and organisation

• Difficulty with understanding complex ideas • Wide range of IQ

Academic Skills Communication

• May have difficulty in school particularly with

maths, reading, time and money • May have difficulty with comprehension,

organisation and abstract concepts • May have difficulty with age appropriate

tasks • May have normal IQ • Learn better with visual or ‘hands on’

approach

• May speak well but not always understand the full meaning

• Delayed language milestones for age • Difficulty with lengthy conversations • Difficulty following instructions • May be able to repeat instructions but not

able to follow them through

Brain Structure Memory

• Brain and head circumference may be small

• Difficulty with long and short term memory – may seem forgetful

• Difficulty recalling sequences or complex instructions

• Relatively better visual memory • Easily forget steps in normal daily routine • Appear to lie but are really ‘filling in the

blanks'

Living and Social Skills

• May not understand personal boundaries and

have difficulty reading social cues • May be socially vulnerable and easily taken

advantage of. • May have difficulty seeing things from

another’s point of view • Socially and emotionally immature… may

behave younger than actual age


PROBLEMS LINKED TO FASD


“Foetal alcohol spectrum disorders” (FASD) is an umbrella term describing the range of effects that can occur in an individual who was prenatally exposed to alcohol.

These effects may include physical, mental, behavioural, and /or learning disabilities with lifelong implications.

FASD is not a diagnostic term used by clinicians. It refers to specific conditions such as fetal alcohol syndrome (FAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD).

Source: SAMHSA Fetal Alcohol Spectrum Disorders Centre for Excellence. What You Need to Know: Fetal Alcohol Spectrum Disorders by the Numbers. DHHS Pub. No. (SMA)-06-4236. Rockville, MD: Centre for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration 2007

94% had mental health problems

23% had received inpatient care for mental illness

83% of adults experienced dependent living

79% of adults had employment problems

60% of those aged 12 or older had trouble with the law

35% of adults and adolescents had been in prison for a crime

45% engaged in inappropriate sexual behaviour

42% had disrupted school experiences (eg, dropped out)

24% of adolescents, 46% of adults, and 35% overall had alcohol and drug problems


EFFECTIVE WORKING WITH YOUNG PEOPLE


Source: Adapted from C Blackburn, Foetal alcohol spectrum disorders: Focus on strategies; Building Bridges With Understanding Project, SunfieldResearch Institute / Worcestershire County Council, Worcester, 2009, p3; and Yukon Department of Education, Canada, Making a difference: Working with students who have foetal alcohol spectrum disorders, Government of Yukon, 2006

PRINCIPLEChildren with FASD do well when parents / carers and educators talk in concrete terms, especially to children and young people learning English as an additional language or dialect. Refrain from using words with double meanings or idioms, e.g. 'jump on the computer'. The social-emotional understanding of children with FASD is often below their chronological age; therefore it helps to 'think younger' when providing assistance, giving instructions etc. It is also important not to make deficit judgements.

Concrete terms

TEACHING AND LEARNING STRATEGIES

Consistency

Repetition

Simplicity

Specific language

Structure

Supervision

Due to the difficulty that children with FASD experience in generalising learning from one situation to another, it is best to create an environment with few changes. Thus includes consistency of language and routines. Educators and parents / carers should coordinate with each other to use consistent language. Using communication books is an effective way of sharing what's happening and advising on language use and behaviours in classrooms and homes, and to guide everyone to focus on strengths rather than deficits

Children with FASD have chronic , short-term memory problems. They forget things they want to remember, as well as information that has been learned and retained for a period of time. In order for them to commit something to long-term memory, it often needs to be repetitively taught. This can be frustrating for all involved, but sensitivity and positive reinforcement create the best learning environment

Routine Stable routines and consistent visual cues that do not change from day to day make it easier for children with FASD to know what to expect next, and decrease their anxiety, enabling them to learn.

Remember to keep input short and sweet. Children with FASD are easily over-stimulated, leading to 'shutdown', at which point they can take in no more information. When children are living with trauma, this tendency towards 'shutdown' is exacerbated. Break down tasks, and always communicate the task in the positive – e.g. “We walk inside" instead of "Don’t run!"

Say exactly what you mean. Remember that children with FASD have difficulty with abstractions, generalisations and 'filling in the blanks' when given an instruction. Tell them step-by-step what to do. This will help them develop appropriate habit-forming patterns. Keep instructions concise and broken into achievable chunks

Structure is the 'glue' that enables a child with FASD to make sense of the world. If the glue is taken away, things fall apart. A child with FASD achieves and is successful because his or her world provides appropriate structure as a permanent foundation for learning. With these supports in place, a child with FASD can experience success, a vital element in developing self-worth and self-confidence

Due to their cognitive challenges, children with FASD bring a naivety to daily ilife situations. They need constant supervision, as with much younger children, to help them develop habitual patterns of appropriate behaviours, and ensure their safety and wellbeing at all times


UNDERSTANDING FASD



FASD IN CONVERSATION…..

REDUCING ALCOHOL EXPOSED PREGNANCIES FURTHER INFORMATION

https://www.acamh.org/blog/fasd-podcast/

https://www.acamh.org/blog/fasd-podcast/

Contact usIf you have any queries about these guidelines, contact the GMHSC communications team: [email protected]

www.gmhsc.org.uk@GM_HSC

Thank you

Roisin Reynolds: [email protected]

mailto:[email protected]

Neo-Natal Abstinence Syndrome (NAS) – Allison Hulmes

ØNeonatal abstinence syndrome (NAS) is a group ofwithdrawal symptoms seen in new-born babies causedby a sudden withdrawal of substances at birth

ØThe effects are like those experienced by an adult who suddenly stops taking substances

Neo-Natal Abstinence Syndrome

Infants are at increased risk from Mothers who have taken drugs (during pregnancy) such as:

HeroinMethadone

SubutexAmphetamines

CocaineCodeine

Benzodiazepines LSD

Some anti-depressants

How Does NAS Present?

ØSigns and symptoms of NAS can be different for every baby and can range from mild to severe

ØMost happen within 3 days (72 hours) of birth, some may happen right after birth or not until a few weeks after birth

ØSymptoms can last from 1 week to 6 months after birthØA baby with NAS may need more specialised medical

care and perhaps medication to help manage the symptoms

Do remember that most babies with NAS who get treatment get better in 5 to 30 days once they have

withdrawn from the substance

ØBody shakes (tremors), seizures (convulsions)ØOveractive reflexes (twitching) and tight

musclesØExcessive crying or having a high-pitched cryØPoor feeding or sucking or slow weight gainØBreathing problems, including fast breathingØFever, sweating or blotchy skinØTrouble sleeping and lots of yawningØDiarrhoea or vomitingØStuffy nose or sneezing

How Does NAS Present?

Engaging Dads

ØFathers’ attitudes and behaviours can impact significantly on mothers and babies during pregnancy and birth

Ø It’s important to remember that during the first two years of babies’ lives, most fathers are around

ØExpectant and new mothers rely on their partner above anyone else and are more likely to receive support from them than from any other person, including medical staff

ØMothers feel more capable and confident about breastfeeding when their partner is supportive

ØSensitive and supportive Father involvement following the birth relates to a range of positive outcomes in babies and toddlers.

ØThe influence of fathers on infant language development is equal to that of mothers, so the role of father’s in ensuring babies and toddlers have the best environment to develop and flourish, is crucial

Disengaged father-child interactions, as early as the third month of life, have been found to predict behaviour problems in children when they

are older

InterventionsSocial Work InterventionsØIntervention is focused on maintaining parents/partners in

substance use services ØSupporting positive parenting skills and strategiesØIt is important to be very clear about the factors that offer

protection to children from parental substance use and identify a trusted adult in the family support network, who can model good parenting and provide some practical/emotional support

ØThese measures can have a positive impact in reducing parental stress and promoting the best environment for a child’s development and well-being to flourish.

Interventions

Brief Interventions

ØUses motivational interviewing techniques to facilitate behaviour change, along with core skills of open questions, affirmation, reflection and summary

ØIt’s time limited and purposefulØIn pregnant women, brief interventions have been shown

to modestly improve rates of alcohol abstinence

Video – Parents in Recovery

InterventionsMotivational Interviewing (MI)

ØAt its simplest, MI is a helping conversation about change, one in which social workers regularly engage

ØMI is used by suitably trained social workers to guide parents/carers in making positive behaviour change, either pre or post birth

ØOne of the most important reasons that many parents make positive changes to their alcohol and/or substance use, is pregnancy and child-birth

Ø In a social worker/service user relationship, this is achieved through arranging a conversation, so that the service user effectively talks themselves into change, by resolving ambivalence and finding their own important reasons for change

ØEmpathy, compassion and collaboration are key for motivational interviewing practitioners

ØThe earlier that positive behaviour change happens, the better the long-term outcomes for a baby/toddler

Interventions

Gro-Brain – brain-based parenting for long-term emotional health

ØGro-brain interventions are targeted at the key first 1000 days in a child’s life to increase the opportunities for optimal health and brain development across the life-span

ØThe Gro-Brain is a parenting course and can be undertaken pre or postnatally.

ØIt can be delivered as a group or as a one to one with parents or carers

ØThe tools and resources are visual and interactive and suitable for a variety of learning styles

ØThe course can be delivered by anyone

Key Messages

ØDON’T be judgemental - Women don’t use alcohol/other substances in pregnancy because they want to harm their baby

• They may not know they’re pregnant• They may not know the most current advice

• They may be under pressure socially or from others, including partners

• They may be coping with difficult life experiences and stressors

ØDO integrate care and support for parents and children from different services – multi-agency working is essential.

Key Messages

ØDO ask questions at the earliest possibility about both parents’ alcohol/substance use and ASSESS and RECORD this. DON’T assume anyone else will, it might prove key at a later stage if considering an FASD diagnosis

ØDO be aware of the impact a fathers/partners problematic alcohol/substance use can have on a mum and the safety of the child

ØDO be aware of the protective and resilience factors that could support positive parental behaviour in relation to substance use. They will almost always be there and shouldn’t be overlooked

Key Messages

ØDO approach every interaction with parents with empathy, respect and an understanding of substance use in a wider context. This is key to removing the stigma many parents fear

ØDO remember that a respectful, helping conversation that effects positive behaviour change can happen in just a few minutes

ØDO work in partnership with parents, families and key agencies throughout the first 1000 days

THE FIRST 1000 DAYS - BASW presentation... · ALCOHOL EXPOSURE IN PREGNANCY STAGES FOETAL ALCOHOL...

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