Over the past several years, the staff at Santa Maria has benefited from training with nationally recognized FASD (Fetal Alcohol Spectrum Disorders) specialist Dan Dubovsky. FASDs are a group of conditions that can occur to an unborn baby when an expectant mother drinks alcohol during her pregnancy. Although sometimes recognized at birth by physical characteristics, Dan realized that very few clinicians understood or recognized this disability in adults. The behavioral, intellectual and neurological problems that are lifelong were the factors that most engaged Dan with his research. He believed that typical substance use treatment programs fail individuals that present with FASDs. He also believed that there were many undiagnosed individuals who had suffered victimization and resultant trauma; were unable to live independently; were caught up in the criminal justice system because of their central nervous system damage; and suffered from addictions to alcohol and other substances. In short, he felt that many clients accepted into traditional treatment centers were affected by these disorders, but remained undiagnosed.
While leading a SAMSHA funded center, which has since been defunded, Dan created a screening instrument for FASD diagnosis and developed treatment modifications specific to substance use disorder treatment. He selected ten agencies nationwide to be a part of the implementation and continuous training for staff to identify affected clients and develop best practices for directing treatment to adults that presented on the spectrum. SMH was one of those ten agencies.
There are several characteristics of individuals with FASDs, including behaviors that appear willful and oppositional. Immediate working memory is impaired and often instructions that have more than two steps are impossible for an affected person to carry out. Their abstract thinking is debilitated, so for example, if the consequence of breaking a policy on Tuesday is delayed until Friday, the individual is unable to connect the consequence to the original behavior. In addition, these clients don’t do well in a group setting.
By understanding the limitations, the staff soon learned that there were very definite modifications that must be met for treatment to be effective. When clients can’t respond, staff must change the methods. Client handbooks need to be amended, policies reconsidered. Through their continued training, SMH staff learned that one of the most important characteristics of a success for these clients includes modeling of appropriate behavior in all things. An example of this would be modeling a bedtime routine for the mother and her young children. Affected clients learn best by showing them the steps and having staff or trained volunteers work next to them as they create habits. It is also crucial for the clients to be told what they have done well, something that has not been standard in their lives. A good goal is for that positive reinforcement to happen five times a day. Building confidence and self-esteem makes for a positive focus system of care, something that builds achievement.
After the center closed, SMH continued with Dan’s training, the only program nationally to persevere. Nadine Scamp, CEO of SMH says, “This is one of the most important facets of our admissions. We can’t tailor effective treatment without identifying those affected.” Whenever Dan can get to Houston, he works with all staff in person to keep their knowledge front of mind and in practice. For the past six years, he has also led quarterly staff coaching calls over the phone and assists the team as they continue to implement the screening protocol. He says it is crucial that all staff are involved in training, especially the front line employees who work directly with the clients. It is important that staff look to changes in their own behavior that will reach clients.
Some important statistics showed that at times as many as 53% of the clients at Bonita House screened positive for FASDs. With this specialized training, SMH clients were successfully completing treatment at a rate of 75% when the national average hovered around 50%. In addition at the six month follow up with the clients who completed treatment, it was revealed that 93% continued their abstinence.
This is just one more evidenced-based practice that guides and informs our staff. We thank Dan Dubovsky for his kind and compassionate work with our team.