Working with High Risk Women and Children

An Integrated Mother-Child Perspective on FASD

Margaret Leslie Dip.C.S., C.Psych.Assoc.Director, Early Intervention Programs

Mothercraft/Breaking the Cycle

BTC PARTNERS

Mothercraft

Jean Tweed Centre

MotheRisk - Hospital for Sick Children

Children’s Aid Society of Toronto

Toronto Public Health

Catholic Children’s Aid Society of Toronto

St. Joseph’s Health Centre

THE SUSAN STORY

FAMILY HISTORY

BTC mothers reported the following:

• 51% of their mothers had/have substance use problems

• 65% of their fathers had/have substance use problems

• 81% were physical abused -- the perpetrator was most likely their mother or their father’s/mother’s partner

• 83% experienced emotional abuse -- most likely by their mother, or their father’s/mother’s partner

• 67% experienced sexual abuse -- almost 30% of the perpetrators were family members

SUBSTANCE USE HISTORY

BTC mothers reported their average age of first use:• Nicotine aged 13.1 • Inhalants aged 13.1• Alcohol aged 14• Cannabis aged 15.8• Hallucinogens aged 15.8• Amphetamines aged 16.8• Barbituates/sleeping pills aged 18.2• Cocaine aged 19.4• Tranquilizers aged 20• Crack cocaine aged 21.5• Heroin aged 21.8• Antidepressants aged 26.3• Over the counter drugs aged 26.4

EATING DISORDERS

Eating disorders were a problem for 40% of BTC mothers. Of these,

• 47% indicated that their eating disorders were active and ongoing

• 33% reported that they were bulimic

• 29% reported that they were compulsive overeaters

• 16% reported multiple eating disorders

• 16% reported that they were anorexic

SELF-HARM BEHAVIOURS

• 26% of BTC mothers reported that they currently engage in self-harm behaviours, or have engaged in self-harm behaviours in the past

PARTNER ABUSE

• 82% of BTC mothers reported a history of physical abuse

• 43% of BTC mothers reported that their partners are physically abusive

• 29% of BTC mothers reported that their partners are emotionally abusive

• 72%% of mothers reported that their partners are substance users

• 60.4% of mothers reported that they had good/supportive relationships with their partners, but these same partners were responsible for 40% of the physical abuse and 29% of the emotional abuse

EMOTIONAL/PSYCHOLOGICAL PROBLEMS

BTC mothers reported experiencing the following symptoms in the six-month period prior to intake:87% tension, anxiety or nervousness76% depression48.9% fear or phobias42% amnesia34% experienced thoughts that someone was trying to harm

them73% sleeping pattern disturbances67% eating pattern disturbances35% violent thoughts or feelings35% thoughts of suicide21% other emotional/psychological problems43% currently experiencing flashbacks

43% of mothers reported that they had attempted suicide

TREATMENT HISTORY

The majority of BTC mothers (82%)have had previous treatment experience. Of these,

• 49% had been treated in a residential program

• 47% reported previous self-help treatment

• 41.4%% had been treated at detoxification centres

• 28% had attended day programs

• 35% were previously involved in addiction counselling

• 11% had used a hospital treatment program and 9% had been treated with Antabuse/Temposil

POVERTY

The yearly income reported by BTC mothers is:

44.3% Less than $9,999

38.3% 10,000-14,999

4.9% 15,000-19,999

4.9% 20,000-29,999

2.2% 30,000-39,999

2.7% 40,000-49,999

2.7% 50,000 or more

Prevention of the primary disability - FASD

1. Universal Prevention (directed to the general public)

• Public awareness campaigns• Alcohol control policies (incl. increased taxation, responsible

service)• Beverage warning labels

2. Selective Prevention (directed to women of childbearing age who consume alcohol)

• Screening (T-ACE, TWEAK)• Referral• Brief interventions

Prevention of the primary disability - FASD

3. Indicated Prevention (aimed at pregnant women who have significant alcohol use problems) through:

• Access to comprehensive, respectful, flexible and integrated programs, designed to prevent or reduce harms associated with alcohol or other substance use in pregnancy

• Attention to the social and economic conditions which influence prenatal alcohol use, incl.

– Housing stability– Income stability– Food security– Access to primary health care– Access to prenatal care– Access to women-centred addiction treatment programs– Supportive personal relationships free from violence– Social inclusion

Prevention of secondary disabilities

Mental health problems Alcohol/drug problemsDisrupted school experience Trouble with the lawInappropriate sexual behaviour ConfinementProblems with employment Dependent living

Unplanned pregnancies….

Streissguth et al,1996

Protective factors for secondary disabilities

• Living in a stable and nurturant home for over 72% of life• Being diagnosed before the age of 6 years• Never having experienced violence against oneself• Staying in each living situation for an average of more than 2.8

years• Experiencing a good quality home from 8-12 years• Having applied for and been found eligible for Division of

Developmental Disabilities• Having basic needs met for at least 13% of life• Having a diagnosis of FAS (vs. FAE)

Streissguth et al,1996

Prevention of secondary disabilities-- the importance of diagnosis

• Assessment and diagnosis requires a multi-disciplinary approach which integrates prenatal history with the medico-physical and neurodevelopmental/behavioural functioning of the child

• Confirmation of prenatal maternal alcohol use is required for diagnosis

• Diagnosis before age 6 years is a salient protective factor against the development of secondary disabilities

• Diagnosis provides a blueprint for intervention

Intervention……

Through practice modifications Safety Caring Dependability/reliability

Stability Predictability Advocacy/case management

Structure Responsivity/congruence Environmental adaptations

Health Justice/Corrections Children’s Services

Mental HealthEducation Income Support

Education Housing/Shelter

Through policy integrationIntergovernmental

Cross-departmental