Hennepin County Fetal Alcohol Specialty Division

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• Hennepin County Fetal Alcohol Specialty Division
• 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
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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

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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.

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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/therap
  eutic interventions for youth with FASD
• Lack of training and/or awareness of FASD by
  professionals

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Screening for FASD

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

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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.
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Mothers 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 juveniles report reliable
  informant M being treated for alcohol or drug
  addiction M diagnosed with alcoholism DUIs
  CHIPS (alcohol and/or drug use) birth records

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Referral for FASD Diagnostic Evaluation

• All sites governed by NG Expert Panels
  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

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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)

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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

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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

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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 Qs (FASD evaluation) too
  sophisticated for some parents-difficulty getting
  true picture of youths adaptive behavior

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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 youths 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

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For More Information

• Contact Hennepin County FASD
• Program/Project Support
• Juvenile Justice Center
• 626 South 6th Street
• Minneapolis, MN 55415
• Phone [phone]
• Email Susan.S.Carlson_at_co.hennepin.mn.us