Assessing FASD and Complex
Developmental Behavioural
Conditions (CDBC)
Interior HealthInterior Health
Children’s Assessmen...
Fetal Alcohol Spectrum DisorderFetal Alcohol Spectrum Disorder
 Developmental disorder secondary to alcoholDevelopmental ...
Impact on Brain FunctionsImpact on Brain Functions
 Learning deficitsLearning deficits
 Poor Impulse ControlPoor Impulse...
Assessing FASDAssessing FASD
 Interior Health Children’s Assessment NetworkInterior Health Children’s Assessment Network
...
IHCANIHCAN
 IHCAN is funded through PHSA, andIHCAN is funded through PHSA, and
provides assessments for children 0-19 liv...
CDBC AssessmentsCDBC Assessments
 IHCAN completes assessments in 3 differentIHCAN completes assessments in 3 different
ar...
Complex Children and Youth (CCY)
 This is a category designed to catch children who do
not meet referral criteria for FAS...
IH Total FASD Referrals &IH Total FASD Referrals &
Assessments Age 0 -19 from 2006- JulyAssessments Age 0 -19 from 2006- J...
Current FASD waitlist (July 2010)Current FASD waitlist (July 2010)
Region Under 6 6 + Total
EK – E. Kootenay 6 18 24
KB - ...
Ways for schools to support a
referral
 Provide documentation for families to take to
family doctor and/or paediatrician ...
FASD: Canadian Diagnostic Guidelines 2005FASD: Canadian Diagnostic Guidelines 2005
 Diagnosis is complex and requiresDiag...
4 Digit Diagnostic Code4 Digit Diagnostic Code
GrowthGrowth
DeficiencyDeficiency
FAS FacialFAS Facial
FeaturesFeatures
CNS...
FAS Facial FeaturesFAS Facial Features
4 Digit Code & Canadian Diagnostic4 Digit Code & Canadian Diagnostic
GuidelinesGuidelines
 Application of the Code + Cana...
University of Washington guidelines
You will also see diagnoses of:You will also see diagnoses of:
1.1. Static Encephalopa...
REMINDER:REMINDER:
 The different diagnosesThe different diagnoses do notdo not representrepresent
functional differences...
Interdisciplinary Team MembersInterdisciplinary Team Members
Core team members:Core team members:
 Intake CoordinatorInta...
The Interdisciplinary FASD AssessmentThe Interdisciplinary FASD Assessment
Neurobehavioural Assessment:
9 domains
1. Sensory/Motor (“hard and soft signs”)
2. If available, imaging results showing d...
A domain is considered “impaired”
when on a standardized measure:
 Scores are 2 standard deviations or more
below the mea...
The Normal Curve:
Psychology domains: Cognition
 Overall intelligence, verbal intelligence,
nonverbal intelligence
 Common measures:
Wechs...
Cognition
 You are likely to see a broad range of abilities
 A significant minority will be have an
intellectual disabil...
Psychology domains:
Academic Achievement
 Standardized assessment by the psychologist plus
review of school records
 We ...
Academic Achievement
 Academic skills may be relatively intact or
may be very low.
 Math problems are very common.
 Tho...
Psychology domains: Memory
 Includes standardized assessment by the
psychologist plus interview questions to
parent/careg...
Memory
 Many have poor functional memory – however, you
may see a variety of reasons for this.
• Some won’t be able to pa...
Psychology domains:
Executive Functioning
 A set of high-level thinking skills responsible
for organizing and directing t...
Executive functioning:
 Very common area of weakness – however,
standardized tests for children are relatively new and
ar...
Executive Functioning
Our test guidelines mandate:
 Parent and/or teacher report of executive
functions in daily life
 D...
Psychology domains:
Attention and Activity Level
 Another sensitive indicator
 Some standardized testing may be possible...
Psychology domains:
Adaptive functioning/social
communication
 Tests in many of the other areas are intended
to measure w...
Adaptive functioning
 Adaptive behaviour is measured by
parent/teacher report – and also through
clinical interview with ...
Adaptive functioning
 Adaptive behaviour is often very low in this
population, even when intelligence is average
 In int...
Additional domains: sensory/motor
 Psychologist does screening of visual motor
integration, fine motor coordination and v...
Additional domains: language and
social communication
 Psychology testing looks at verbal reasoning
skills
 Consideratio...
Adjunct Assessment: SLP and OT
 Limited resource: approx 40 out of 500
assessments or 1/12
 Need evaluated on a case by ...
Speech Language Assessment
 Standardized testing of core language (receptive and
expressive language) – assessment tools ...
Occupational Therapy Assessment
 Standardized assessment of fine motor skills
and visual motor integration
 Often: Bruin...
Team Deliberation and FamilyTeam Deliberation and Family
ConferenceConference
 After all appointments are completed, the ...
Assessment Goals:Assessment Goals:
 To ascertain if there is a Fetal Alcohol SpectrumTo ascertain if there is a Fetal Alc...
Assessment Summary
 The multidisciplinary team will produce a short report on the
day of feedback (sometimes hand written...
Key Recommendations
Tailored to the individual, but often recommend:
 An individualized learning plan at school (we do no...
Psychology Report
 Comes out several weeks after the team feedback.
 Shared directly with families and medical
professio...
Psychology Report:
A consumer’s guide
Key components of report:
 Reason for Referral
 Identifying/Background information...
Psychology Report:
A consumer’s guide
1. Flip to the summary/conclusions section – look for
the diagnoses as well as an ov...
Case example:
How do you get a “brain 3”?
John Smith example:
- 16 year old
- In utero alcohol, LSD, cocaine and marijuana...
Case example:
How do you get a “brain 3”?
 Overall IQ not meaningful, large discrepancy
between IQ domains – visual skill...
Case example:
How do you get a “brain 3”?
 Memory testing showed visual memory at the 2nd
percentile, verbal memory score...
Case example:
How do you get a “brain 3”?
 Adaptive functioning at the 1st
percentile
 Strengths in communication and co...
Case example:
How do you get a “brain 3”?
 Weaknesses in language reasoning and related
academic problems suggest a langu...
Case example:
How do you get a “brain 3”?
 Multiple impaired domains: cognitive (scatter),
achievement, visual memory, ex...
Case Study: Recommendations
 Strengths based learning program – e.g. good at
mechanics – find a way to build program arou...
Assessment Outcomes
 Better understanding of the child or youth’s learning
profile, challenges, strengths and needs
 Hop...
Designation of students for
Special Education Services
 FASD is most often designated under “chronic health
impairments”
...
From the policy manual:
In some cases, students diagnosed through the Complex Developmental Behavioural
Conditions (CDBC) ...
FASD district partners
 SD 23: Sue Thompson (Central Okanagan) –
sthomson@sd23.bc.ca
250-979-0029
 SD 22 (Vernon): Chery...
Where are services accessed?Where are services accessed?
 Ministry of EducationMinistry of Education
 Ministry of Childr...
Ministry of EducationMinistry of Education
 In B.C., children/youth identified with anIn B.C., children/youth identified ...
MCFD – Keyworker programMCFD – Keyworker program
 Key Worker Agency Program and Parent toKey Worker Agency Program and Pa...
MCFD – continued…MCFD – continued…
 Child and Youth Mental Health (CYMH)Child and Youth Mental Health (CYMH) ––
child/you...
Victoria Foundation Funded PilotVictoria Foundation Funded Pilot
Projects for 2010Projects for 2010
 http://www.victoriaf...
Community Living British ColumbiaCommunity Living British Columbia
 Adults with an FASD may now qualify forAdults with an...
Trouble with the Law/ForensicsTrouble with the Law/Forensics
 Forensic involvement opens service doorsForensic involvemen...
Ministry for Housing and SocialMinistry for Housing and Social
DevelopmentDevelopment
 For some older youth (18+)/adults ...
Interior Health AuthorityInterior Health Authority
 IHA funds Alcohol and Drug counselling forIHA funds Alcohol and Drug ...
Summary – Community Services forSummary – Community Services for
individuals with an FASDindividuals with an FASD
 Withou...
Fasd assessment
Upcoming SlideShare
Loading in …5
×

Fasd assessment

1,404 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,404
On SlideShare
0
From Embeds
0
Number of Embeds
7
Actions
Shares
0
Downloads
9
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Talk about referral form here and hand outs
    We do accept referrals from GPs in outlying areas where it is difficulty to access pediatrics. In areas like the Okanagan we tend to accept referrals primarily from peds and psychiatry. If a referral is from a GP family will be encouraged to get a pediatrician.
  • Full time psychologists work in the Okanagan region (Kelowna) as well as out of Kamloops and Nelson. Other areas are covered by outreach clinics combined with local resources where available, or families travelling to assessment centres. Twice a year psychologists travel to Cranbrook for outreach clinics. We recently added Williams Lake outreach clinics – this is in transition.
  • Now at intake social worker calls to provide screening when IHCAN 1st receives a referral
    Does the family consent to the assessment?
    Are they in crisis
    Inform about the next steps
    – they will be connected with key worker at this stage if they need support with completing intake paperwork and general support with the assessment processes. In some cases key workers are very involved with supporting referrals.
    CCY examples: genetic syndrome, developmental delay w/ behavioural problems; FASD type presentation but unconfirmed alcohol exposure; medical condition + learning problems + social emotional/psychiatric problems
  • (Concern re. asking for “a referral to IHCAN” as opposed to outlining the school’s concerns in multiple domains – think about behaviour, social, academic, cognitive, adaptive, etc.
  • Growth impairment defined as at or below 10th percentile – current and birthweight also included. Growth impairment seems to be the rarest finding (anecdotal).
  • A “brain 2” can sometimes be just as impaired functionally as an individual with a “brain 3” – although in general we are seeing milder symptoms.
    Brain 2s can grow into Brain 3s (anecdotal) as they age - widening gap in executive functioning, adaptive expectations
  • It may be decided at intake if SLP or OT need to be involved, or the psychologist may decide based on their testing that further testing is warranted in these areas. Limited funding for SLP and OT – about 40 out of 500 assessments (less than 1/12).
    SLP/OT assessment is generally required if these domains are to be evaluated as impaired (psych does screening measures only).
  • Draw attention to cross over of some domains – e.g. adaptive/social
    Note – I have yet to do an assessment where imaging results are available – although there is a hope that this can eventually be part of the diagnostic coding in a bigger way. Not sure how functional/ realistic this is?
  • Note re. Woodcock Johnson and American norms – higher scores less comparable to IQ test to diagnose LDs
  • Limited testing of children under the age of 7 or 8 – which is why “ideal time” for FASD assessment is when the child is 8+
  • Interview questions to validate – ask questions about daily living, self care, hygeine, safety, routines, domestic skills, etc.
  • Pattern – often psych testing finds more deficits than SLP testing – may be aspects of the core tests are too visually based or that the problems tend to be with abstraction and higher level language (anecdotal)
  • Key Worker program – run through MCFD but through contracts to many different organizations – key workers have varying qualifications – sometimes are very helpful, not consistently. Intended to help families understand assessment results and apply recommendations.
  • Report needs to meet multiple needs – so a lot of information, not always accessible to all audiences
    Reporting requirements of our college, needs of school districts for numbers and needs of families/schools to understand the information
  • Note – counterintuitive to the visual verbal discrepancy on IQ testing
  • SD 23 one of the most conservative
  • Window that can include “neurobehavioural” – 2 or more domains (needs to include academics) – not as specific about severity
  • Fasd assessment

    1. 1. Assessing FASD and Complex Developmental Behavioural Conditions (CDBC) Interior HealthInterior Health Children’s Assessment NetworkChildren’s Assessment Network Presentation by:Presentation by: Christy Bryceland, Ph.D., R. Psych.Christy Bryceland, Ph.D., R. Psych. Okanagan Ability CentreOkanagan Ability Centre www.okanaganabilitycentre.comwww.okanaganabilitycentre.com cbryceland@telus.netcbryceland@telus.net
    2. 2. Fetal Alcohol Spectrum DisorderFetal Alcohol Spectrum Disorder  Developmental disorder secondary to alcoholDevelopmental disorder secondary to alcohol exposure in uteroexposure in utero  Specific neurobehavioural pattern +/- physical signsSpecific neurobehavioural pattern +/- physical signs  Identifiable deficits in at least 3 areas, which mayIdentifiable deficits in at least 3 areas, which may include cognition, motor skills, executive functioninclude cognition, motor skills, executive function and/or social skillsand/or social skills  Prevalence is estimated at 9.1 per 1000 birthsPrevalence is estimated at 9.1 per 1000 births Chudley et al., CMAJ, March 1, 2005Chudley et al., CMAJ, March 1, 2005
    3. 3. Impact on Brain FunctionsImpact on Brain Functions  Learning deficitsLearning deficits  Poor Impulse ControlPoor Impulse Control  Social Skills deficitsSocial Skills deficits  Language skills deficitsLanguage skills deficits  Poor abstraction/metacognitionPoor abstraction/metacognition  Math skills deficitsMath skills deficits  Memory/attention/judgment deficitsMemory/attention/judgment deficits
    4. 4. Assessing FASDAssessing FASD  Interior Health Children’s Assessment NetworkInterior Health Children’s Assessment Network (IHCAN)(IHCAN)  We are an assessment team that provides inter-We are an assessment team that provides inter- disciplinary assessments to children with complexdisciplinary assessments to children with complex developmental conditions.developmental conditions.  Children must be referred by a medicalChildren must be referred by a medical professional and there must be significantprofessional and there must be significant suspicion/ confirmation of gestational exposuresuspicion/ confirmation of gestational exposure to alcohol exposure plus impairment in a numberto alcohol exposure plus impairment in a number of domains of functioning (development/of domains of functioning (development/ learning, mental health/behavioural,learning, mental health/behavioural, adaptive/social skills)adaptive/social skills)
    5. 5. IHCANIHCAN  IHCAN is funded through PHSA, andIHCAN is funded through PHSA, and provides assessments for children 0-19 livingprovides assessments for children 0-19 living in the Interior Health Authority catchmentin the Interior Health Authority catchment area.area.  Children referred for FASD or CCYChildren referred for FASD or CCY assessments are seen in 6 sites within theassessments are seen in 6 sites within the health region (Kelowna, Vernon, Kamloops,health region (Kelowna, Vernon, Kamloops, Williams Lake, Nelson and Cranbrook).Williams Lake, Nelson and Cranbrook).
    6. 6. CDBC AssessmentsCDBC Assessments  IHCAN completes assessments in 3 differentIHCAN completes assessments in 3 different areas: FASD, Autism Spectrum Disorders andareas: FASD, Autism Spectrum Disorders and other Complex Developmental Conditions (CCY)other Complex Developmental Conditions (CCY)  We have been completing FASD assessmentsWe have been completing FASD assessments since January 2006since January 2006  Families undergoing IHCAN FASD assessmentFamilies undergoing IHCAN FASD assessment can access the Key Worker Agency Programcan access the Key Worker Agency Program (partnership with MCFD)(partnership with MCFD)
    7. 7. Complex Children and Youth (CCY)  This is a category designed to catch children who do not meet referral criteria for FASD or autism spectrum disorders, but who present with “complex developmental behavioural conditions.”  The same conditions for intake apply: the child must be showing impairment in multiple areas of functioning, and community resources have not been able to address (e.g. complex medical condition+learning challenges)  Need to access community resources first – has a school psychoeducational assessment been completed (if possible)?
    8. 8. IH Total FASD Referrals &IH Total FASD Referrals & Assessments Age 0 -19 from 2006- JulyAssessments Age 0 -19 from 2006- July 20102010 ReferredReferred ~1000~1000 AssessedAssessed ~650~650 Children and YouthChildren and Youth diagnosed with andiagnosed with an FASDFASD ~2/3 or >400~2/3 or >400
    9. 9. Current FASD waitlist (July 2010)Current FASD waitlist (July 2010) Region Under 6 6 + Total EK – E. Kootenay 6 18 24 KB - Kootenay Boundary 2 5 7 OK 1 - South OK 1 11 12 OK 2 – Central OK 3 21 24 OK3 – North OK 2 13 15 OK 4 –S. Arm 1 7 8 OK 5 - Revelstoke 0 1 1 TCS 1 – Merritt 1 5 6 TCS 2 - Kamloops 6 24 30 TCS 3 – Williams Lake 5 18 23 Totals: 27 123 150
    10. 10. Ways for schools to support a referral  Provide documentation for families to take to family doctor and/or paediatrician regarding school’s concerns – be descriptive rather than prescriptive  Assist family in accessing referral – encouraging medical/paediatric referral  Paediatricians decide if it is an appropriate referral for IHCAN
    11. 11. FASD: Canadian Diagnostic Guidelines 2005FASD: Canadian Diagnostic Guidelines 2005  Diagnosis is complex and requiresDiagnosis is complex and requires comprehensive history, physical andcomprehensive history, physical and neurobehavioural assessment – anneurobehavioural assessment – an interdisciplinary approach is necessaryinterdisciplinary approach is necessary  In Canada, we utilize the University ofIn Canada, we utilize the University of Washington Diagnostic Code and CanadianWashington Diagnostic Code and Canadian Diagnostic GuidelinesDiagnostic Guidelines Chudley et al., CMAJ, March 1, 2005Chudley et al., CMAJ, March 1, 2005
    12. 12. 4 Digit Diagnostic Code4 Digit Diagnostic Code GrowthGrowth DeficiencyDeficiency FAS FacialFAS Facial FeaturesFeatures CNSCNS DamageDamage PrenatalPrenatal AlcoholAlcohol 44 SevereSevere SevereSevere SevereSevere High RiskHigh Risk 33 ModerateModerate ModerateModerate ModerateModerate Some RiskSome Risk 22 MildMild MildMild MildMild UnknownUnknown 11 NoneNone NoneNone NoneNone No RiskNo Risk
    13. 13. FAS Facial FeaturesFAS Facial Features
    14. 14. 4 Digit Code & Canadian Diagnostic4 Digit Code & Canadian Diagnostic GuidelinesGuidelines  Application of the Code + Canadian guidelines resultsApplication of the Code + Canadian guidelines results in multiple variations fitting into or being excludedin multiple variations fitting into or being excluded from one of four diagnostic categories:from one of four diagnostic categories: 1.1. Fetal Alcohol Syndrome (confirmed exposure)Fetal Alcohol Syndrome (confirmed exposure) 2.2. Fetal Alcohol Syndrome (without confirmation)Fetal Alcohol Syndrome (without confirmation) 3.3. Partial FAS (confirmed exposure)Partial FAS (confirmed exposure) 4.4. Alcohol Related Neurodevelopmental DisorderAlcohol Related Neurodevelopmental Disorder (confirmed exposure)(confirmed exposure)
    15. 15. University of Washington guidelines You will also see diagnoses of:You will also see diagnoses of: 1.1. Static Encephalopathy (alcohol exposure unknown)Static Encephalopathy (alcohol exposure unknown) 2.2. Neurobehavioural Disorder (alcohol exposed)Neurobehavioural Disorder (alcohol exposed)  These categories are used to diagnose individuals with alcohol-related impairments who are not captured by Canadian guidelines.  This includes individuals for whom we cannot confirm alcohol exposure, as well as those who have milder levels of impairment.  Diagnosis needed to access chronic health designation. Some cases of success for categorizing “neurobehavioral disorder” if evidence of school failure.
    16. 16. REMINDER:REMINDER:  The different diagnosesThe different diagnoses do notdo not representrepresent functional differences or “mild” forms offunctional differences or “mild” forms of FASD; they only represent visible,FASD; they only represent visible, physical features – CNS damage isphysical features – CNS damage is present withpresent with allall six diagnostic categoriessix diagnostic categories
    17. 17. Interdisciplinary Team MembersInterdisciplinary Team Members Core team members:Core team members:  Intake CoordinatorIntake Coordinator  Assessment CoordinatorAssessment Coordinator  PaediatricianPaediatrician  PsychologistPsychologist The team may also include:The team may also include:  Psychiatrist (can replace paediatrician)Psychiatrist (can replace paediatrician)  Occupational TherapistOccupational Therapist  Speech Language PathologistSpeech Language Pathologist
    18. 18. The Interdisciplinary FASD AssessmentThe Interdisciplinary FASD Assessment
    19. 19. Neurobehavioural Assessment: 9 domains 1. Sensory/Motor (“hard and soft signs”) 2. If available, imaging results showing differences in brain structure. 3. Cognition 4. Communication 5. Academic Achievement 6. Memory 7. Executive Function 8. Attention/Activity Level 9. Adaptive Behaviour/Social Communication
    20. 20. A domain is considered “impaired” when on a standardized measure:  Scores are 2 standard deviations or more below the mean  This equates to: a percentile rank of 2nd or lower a standard score of 70 or lower (most measures)
    21. 21. The Normal Curve:
    22. 22. Psychology domains: Cognition  Overall intelligence, verbal intelligence, nonverbal intelligence  Common measures: Wechsler scales – the WAIS-IV, WISC-IV, WPPSI-III  4 Index Scores: Verbal Comprehension, Perceptual Reasoning, Working Memory, Processing Speed (not all within cognition)
    23. 23. Cognition  You are likely to see a broad range of abilities  A significant minority will be have an intellectual disability (IQ below 70)  Others will have even, “average” profiles  Others will have highly uneven profiles, usually with visual-spatial skills better than verbal skills  IQ is not highly predictive of function
    24. 24. Psychology domains: Academic Achievement  Standardized assessment by the psychologist plus review of school records  We can accept recent school testing if we have standard scores  Typically we assess with the WIAT-II (Canadian norms) • Reading • Writing • Math
    25. 25. Academic Achievement  Academic skills may be relatively intact or may be very low.  Math problems are very common.  Those who have language problems are also likely to have poor reading comprehension.  May do better with more concrete skills (word reading, spelling) but have more challenges with abstract skills (comprehension, math reasoning)
    26. 26. Psychology domains: Memory  Includes standardized assessment by the psychologist plus interview questions to parent/caregiver  Testing such as the WRAML-2, NEPSY, Children’s Memory Scale, WMS-III  Measures of: • Visual memory • Verbal memory • Working memory • May include: immediate, delayed, recognition
    27. 27. Memory  Many have poor functional memory – however, you may see a variety of reasons for this. • Some won’t be able to pay attention to what they’re supposed to learn. • Some won’t be able to actively search their memory, but can recognize info in a multiple choice framework. • Problems with working memory are often distinct from problems with short/long term memory.  Those with language problems may have better visual than verbal memory.
    28. 28. Psychology domains: Executive Functioning  A set of high-level thinking skills responsible for organizing and directing the brain’s activities in order to meet long-term goals  Very sensitive  Difficult to assess – use a combination of standardized testing, parent/teacher report, observation, and history  Very difficult area in younger children – harder to do valid and reliable testing
    29. 29. Executive functioning:  Very common area of weakness – however, standardized tests for children are relatively new and are not always sensitive.  Clinical manifestations may include severe problems with safety awareness, inability to learn from consequences, denying wrongdoing even when caught “red handed,” inability to multitask, inability to improvise when something goes wrong, perseveration or “sticky thinking”
    30. 30. Executive Functioning Our test guidelines mandate:  Parent and/or teacher report of executive functions in daily life  Direct testing of: • Inhibition • Working Memory • Planning/cognitive flexibility/ organizing/abstract reasoning (some of these domains covered in other tests, e.g. WISC)
    31. 31. Psychology domains: Attention and Activity Level  Another sensitive indicator  Some standardized testing may be possible, but most crucial information is probably parent and teacher report on formal questionnaires (e.g. Conner’s, Stony Brook) + observation  Teacher reports are very important  Many children and youth seen in the system already have an ADHD diagnosis – if it is considered ‘trustworthy’ then that alone may constitute evidence of impairment
    32. 32. Psychology domains: Adaptive functioning/social communication  Tests in many of the other areas are intended to measure what the child can do under the best possible circumstances (“ideal” testing environment)  Adaptive functioning tests are intended to measure what the child does do in his/her own environment – at school and at home
    33. 33. Adaptive functioning  Adaptive behaviour is measured by parent/teacher report – and also through clinical interview with caregiver  Common measures: Vineland, ABAS, SIB-R (we most typically use ABAS)  Includes real-life communication, self-care, self-direction, home living and social skills  Time, money, safety, social vulnerability are key areas
    34. 34. Adaptive functioning  Adaptive behaviour is often very low in this population, even when intelligence is average  In interpreting questionnaires we have to consider the literacy, analytical skills and possible bias of the informant, particularly parents with FASD – in this case teacher reports are crucial (they are generally helpful collateral information)
    35. 35. Additional domains: sensory/motor  Psychologist does screening of visual motor integration, fine motor coordination and visual perception (Beery VMI) and by interview  Can refer to OT if significant concerns  Sensory concerns are evaluated qualitatively – by interview/observation
    36. 36. Additional domains: language and social communication  Psychology testing looks at verbal reasoning skills  Consideration of “higher level language” and abstraction through some measures of executive functioning  Further assessment by SLP can be recommended
    37. 37. Adjunct Assessment: SLP and OT  Limited resource: approx 40 out of 500 assessments or 1/12  Need evaluated on a case by case basis – can be decided at intake or by psychologist after testing completed  Sometimes OT or SLP assessment has already been completed by community – especially in younger children. We can use this info.
    38. 38. Speech Language Assessment  Standardized testing of core language (receptive and expressive language) – assessment tools such as Clinical Evaluation of Language Fundamentals - 4  Additional testing of “higher level language” and social communication – these measures seem less standardized/more qualitative. Example: Test of Narrative Language. Test of Problem Solving (TOPS) is standardized measure of abstract language
    39. 39. Occupational Therapy Assessment  Standardized assessment of fine motor skills and visual motor integration  Often: Bruininks-Oseretsky Test of Motor Proficiency  May also assess gross motor skills and sensory sensitivities – sensory assessment is more qualitative and thus difficult to quantify severity in our ranking system
    40. 40. Team Deliberation and FamilyTeam Deliberation and Family ConferenceConference  After all appointments are completed, the teamAfter all appointments are completed, the team spends time reporting their findings, agreeing uponspends time reporting their findings, agreeing upon diagnoses and discussing the most appropriatediagnoses and discussing the most appropriate recommendations.recommendations.  The team then sits down with the family and sharesThe team then sits down with the family and shares this information with them and with the supportthis information with them and with the support people they may choose to invite.people they may choose to invite.  We leave it up to families to invite schoolWe leave it up to families to invite school professionals. Sometimes this is more sensitive (e.g.professionals. Sometimes this is more sensitive (e.g. birth mothers) and we may do parts with family onlybirth mothers) and we may do parts with family only even if professionals have been invited.even if professionals have been invited.
    41. 41. Assessment Goals:Assessment Goals:  To ascertain if there is a Fetal Alcohol SpectrumTo ascertain if there is a Fetal Alcohol Spectrum DisorderDisorder  To discover what is making it difficult for thisTo discover what is making it difficult for this child/youth to be successful, and whatchild/youth to be successful, and what interventions we can recommend to assist theinterventions we can recommend to assist the child and family with overcoming barrierschild and family with overcoming barriers  To ensure that recommendations are specific,To ensure that recommendations are specific, reasonable and achievable while focusing onreasonable and achievable while focusing on identified needs and taking into account strengthsidentified needs and taking into account strengths and personal/community resourcesand personal/community resources
    42. 42. Assessment Summary  The multidisciplinary team will produce a short report on the day of feedback (sometimes hand written).  This summarizes diagnosis and key assessment findings as well as key recommendations.  This is the only report signed by all professionals, and is needed to support designation under chronic health (given multidisciplinary guidelines).  We encourage families to share the report with schools but all documentation is owned by families.
    43. 43. Key Recommendations Tailored to the individual, but often recommend:  An individualized learning plan at school (we do not direct schools how to designate children – rather we describe difficulties in a way to facilitate this should schools feel it would be helpful)  Support of the “key worker” – this is a family advocate rather than someone who can work directly with the child or youth. Limited mandate, variable service.  Possible medication recommendations  Possible mental health follow up
    44. 44. Psychology Report  Comes out several weeks after the team feedback.  Shared directly with families and medical professionals. Families are encouraged to provide a copy to schools and if there is sensitive personal information, we may provide a “school version” to facilitate this.  Summarizes findings in much more detail.  Additional specific recommendations for families as well as schools.
    45. 45. Psychology Report: A consumer’s guide Key components of report:  Reason for Referral  Identifying/Background information  Behavioural Observations  Tests used  Results: review of test findings – correspond to FASD domains  Summary and diagnostic conclusions  Detailed recommendations
    46. 46. Psychology Report: A consumer’s guide 1. Flip to the summary/conclusions section – look for the diagnoses as well as an overall description of the concerns – what are the strengths and weaknesses? What is the level of difficulty in different areas? 2. Look at the recommendations – many of these are aimed at schools to assist with developing an IEP/school plan, understanding the child’s learning style and providing appropriate accommodations 3. If desired, you can review test findings in more detail.
    47. 47. Case example: How do you get a “brain 3”? John Smith example: - 16 year old - In utero alcohol, LSD, cocaine and marijuana in first 14 weeks of pregnancy – stopped when she knew she was pregnant - mom is adopted and believes she may have FASD herself - History of learning problems as well as attachment disruption - Has ADHD diagnosis – tried meds but couldn’t tolerate side effects - School avoidant in the last year (so school reports less available) – choosing to attend shop class only - Viewed as bright and capable and previous academic testing revealed low average to above average skills (Woodcock Johnson) but weak visual motor skills - Has been identified as having LD in writing – some accommodations provided
    48. 48. Case example: How do you get a “brain 3”?  Overall IQ not meaningful, large discrepancy between IQ domains – visual skills are 75th percentile, verbal 16th , working memory 5th , processing speed 1st  Significant academic problems – history of written output challenges, on testing reading is average, but written math and spelling/writing are below 1st percentile  VMI 9th percentile, fine motor 4th percentile (note OT assessment would have been helpful, but not available on outreach in small community)
    49. 49. Case example: How do you get a “brain 3”?  Memory testing showed visual memory at the 2nd percentile, verbal memory scores scattered from below average to average  Executive functioning: reported difficulties in all areas – testing shows weak scanning as well as working memory/cognitive flexibility and multi- tasking, and poor inhibition (not all testing is low)  Very compliant and focused during testing – ADHD not outwardly visible – now qualifies for inattentive subtype
    50. 50. Case example: How do you get a “brain 3”?  Adaptive functioning at the 1st percentile  Strengths in communication and community use  Weaknesses in health and safety, home living, self care, self direction, social and leisure
    51. 51. Case example: How do you get a “brain 3”?  Weaknesses in language reasoning and related academic problems suggest a language-based learning disability  Also a specific LD: Disorder of Written Expression, complicated by fine motor/visual motor challenges and problems with visual scanning  Meets criteria for ADHD, inattentive subtype
    52. 52. Case example: How do you get a “brain 3”?  Multiple impaired domains: cognitive (scatter), achievement, visual memory, executive functions, attention and adaptive meet the “severe” criteria  No findings of growth impairment or facial features  Diagnosis is 1134 or Alcohol Related Neurodevelopmental Disorder  For John who appears high functioning and has generally average to high average cognitive (especially visual strengths) – this is truly an “invisible disability”
    53. 53. Case Study: Recommendations  Strengths based learning program – e.g. good at mechanics – find a way to build program around strengths  Visual and hands-on learner  Reduce verbal demands  Adjust for slower processing speed  Adaptations for written output challenges  Recognize and support memory impairment  Structured, predictable environment – lots of support as “external brain”
    54. 54. Assessment Outcomes  Better understanding of the child or youth’s learning profile, challenges, strengths and needs  Hopefully impacts to school planning and provision of supports  Limited access to intervention programs outside of school context (not like ASD programming)  In adulthood, may have access to disability services such as Persons With Disabilities funding or Personal Supports Initiative through Community Living BC  Family may be eligible for Disability Tax Benefit
    55. 55. Designation of students for Special Education Services  FASD is most often designated under “chronic health impairments”  IHCAN covers 16 different school districts and each has their own policy and interpretation of assessment information with regards to designation of students under Ministry of Education guidelines  A diagnosis seems to be a requirement (not just a description of challenges) and needs to include medical assessment (multidisciplinary)
    56. 56. From the policy manual: In some cases, students diagnosed through the Complex Developmental Behavioural Conditions (CDBC) Network as children and youth with complex needs may be included in this category. Regionally, the CDBC Network has been established to assess children and youth with complex needs, including children and youth who may have fetal alcohol spectrum disorder (FASD). A clinical diagnostic assessment by the CDBC Network or by qualified specialists (psychiatrist, registered psychologist with specialized training, or medical professional specializing in developmental disorder) is required. The assessment must include and integrate information from multiple sources and various professions from different disciplines that indicates the student with FASD or the complex developmental behavioural conditions is exhibiting an array of complex needs, with two or more domains being impacted (social emotional functioning, communication, physical functioning, self determination/ independence, and academic/intellectual functioning). See: http://www.bced.gov.bc.ca/specialed/special_ed_policy_manual.pdf
    57. 57. FASD district partners  SD 23: Sue Thompson (Central Okanagan) – sthomson@sd23.bc.ca 250-979-0029  SD 22 (Vernon): Cheryl Turner cturner@sd22.bc.ca 250-549-9240  For other partners see: http://www.fasdoutreach.ca/about-us/district- partners/district-partners
    58. 58. Where are services accessed?Where are services accessed?  Ministry of EducationMinistry of Education  Ministry of Children and Family DevelopmentMinistry of Children and Family Development (Keyworker, CYSN, CYMH, Probation)(Keyworker, CYSN, CYMH, Probation)  Adults- CLBC, Mental HealthAdults- CLBC, Mental Health  Ministry of Housing and Social DevelopmentMinistry of Housing and Social Development  Interior Health AuthorityInterior Health Authority  Community AgenciesCommunity Agencies
    59. 59. Ministry of EducationMinistry of Education  In B.C., children/youth identified with anIn B.C., children/youth identified with an FASDFASD maymay qualify for additional supports inqualify for additional supports in their educational settingtheir educational setting  http://www.bced.gov.bc.ca/independentschools/bc_http://www.bced.gov.bc.ca/independentschools/bc_  www.fasdoutreach.cawww.fasdoutreach.ca
    60. 60. MCFD – Keyworker programMCFD – Keyworker program  Key Worker Agency Program and Parent toKey Worker Agency Program and Parent to Parent Support Groups funded by MCFDParent Support Groups funded by MCFD (Ministry of Children and Family(Ministry of Children and Family Development) and contracted out to variousDevelopment) and contracted out to various private agency around the provinceprivate agency around the province  http://www.mcf.gov.bc.ca/fasd/kw_support.htmhttp://www.mcf.gov.bc.ca/fasd/kw_support.htm
    61. 61. MCFD – continued…MCFD – continued…  Child and Youth Mental Health (CYMH)Child and Youth Mental Health (CYMH) –– child/youth with an FASD may qualify forchild/youth with an FASD may qualify for counselling and support if they have additionalcounselling and support if they have additional mental health concernsmental health concerns  Child and Youth with Special NeedsChild and Youth with Special Needs (CYSN)(CYSN) – may provide supports if child/youth– may provide supports if child/youth has an FASD and an intellectual disabilityhas an FASD and an intellectual disability
    62. 62. Victoria Foundation Funded PilotVictoria Foundation Funded Pilot Projects for 2010Projects for 2010  http://www.victoriafoundation.bc.ca/web/files/Sept2009_Fhttp://www.victoriafoundation.bc.ca/web/files/Sept2009_F  Gateway Program at the John Howard Society (South CentralGateway Program at the John Howard Society (South Central Okanagan)Okanagan)  Pacific Community Resources Society (Vancouver-to-Pacific Community Resources Society (Vancouver-to- Chilliwack)Chilliwack)  Women’s Health Research Institute (Vancouver area)Women’s Health Research Institute (Vancouver area)  Alberni Valley FASD Community Action Group (PortAlberni Valley FASD Community Action Group (Port Alberni)Alberni)  Fetal Alcohol Spectrum Disorder Society of BC (AsanteFetal Alcohol Spectrum Disorder Society of BC (Asante Centre, Vancouver)Centre, Vancouver)
    63. 63. Community Living British ColumbiaCommunity Living British Columbia  Adults with an FASD may now qualify forAdults with an FASD may now qualify for life-long supports IF they have significantlife-long supports IF they have significant impairment in adaptive functioning (below theimpairment in adaptive functioning (below the 0.1 percentile)0.1 percentile)  Supports may include supported living,Supports may include supported living, respite, employment support, skillrespite, employment support, skill development, homemaker support anddevelopment, homemaker support and development of support networksdevelopment of support networks  http://www.communitylivingbc.ca/individuals-famhttp://www.communitylivingbc.ca/individuals-fam
    64. 64. Trouble with the Law/ForensicsTrouble with the Law/Forensics  Forensic involvement opens service doorsForensic involvement opens service doors  Specialized programs for youth who commitSpecialized programs for youth who commit sexual and violent offensessexual and violent offenses  General and specialized mental health servicesGeneral and specialized mental health services for eligible youthfor eligible youth  Community treatment and supervision ofCommunity treatment and supervision of youth who have received a conditionalyouth who have received a conditional dischargedischarge
    65. 65. Ministry for Housing and SocialMinistry for Housing and Social DevelopmentDevelopment  For some older youth (18+)/adults with anFor some older youth (18+)/adults with an FASD and an inability to work full time,FASD and an inability to work full time, financial support may be available via MHSDfinancial support may be available via MHSD through the Persons with Disabilities or PWDthrough the Persons with Disabilities or PWD  http://www.hsd.gov.bc.ca/PUBLICAT/bcea/pwd.hhttp://www.hsd.gov.bc.ca/PUBLICAT/bcea/pwd.h
    66. 66. Interior Health AuthorityInterior Health Authority  IHA funds Alcohol and Drug counselling forIHA funds Alcohol and Drug counselling for youth. Many of the counsellors have receivedyouth. Many of the counsellors have received specific training regarding necessaryspecific training regarding necessary modifications when treating youth with anmodifications when treating youth with an FASDFASD  Developmental Disability Mental Health –Developmental Disability Mental Health – trained youth mental health therapiststrained youth mental health therapists (generally youth also have an intellectual(generally youth also have an intellectual disability to qualify)disability to qualify)
    67. 67. Summary – Community Services forSummary – Community Services for individuals with an FASDindividuals with an FASD  Without additional diagnoses or forensicWithout additional diagnoses or forensic involvement, individuals with an FASD do notinvolvement, individuals with an FASD do not generally qualify for specialized services in BCgenerally qualify for specialized services in BC  In our region, there are no services that work directlyIn our region, there are no services that work directly with the person affected by FASDwith the person affected by FASD  The Key Worker Agency Program is the onlyThe Key Worker Agency Program is the only provincial program for FASD and its mandate is toprovincial program for FASD and its mandate is to work with families and other professionalswork with families and other professionals

    ×