PRESENTORS David Gerry, BSc - NAADAC · 2017-01-17 · David Gerry, BSc LivingWithFASD.com Diane...
Transcript of PRESENTORS David Gerry, BSc - NAADAC · 2017-01-17 · David Gerry, BSc LivingWithFASD.com Diane...
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Trying Differently Rather Than Harder: Improving Treatment Outcomes by Accommodating Brain Based Conditions like FASD
PRESENTORS
Seattle, WA September 26 - October 1, 2014
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
David Gerry, BSc
Why Brain Based Conditions like FASD Are Important in Addiction Programs and Practices
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
US Statistics 2012
õ Number of births 3,952,841 (2012)
õ FASD Prevalence rate 2-5% (May 2009) year = õ About 80,000 – 198,000 babies/year born
prenatally exposed õ 51% of pregnancies unplanned (40-60% differs
state by state) õ NIAAA 2012 survey – 71% people drank in past
year 57% in the past month õ About 50% of 2.6m/yr complete treatment
(SAMSHA 2012)
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
ALCOHOL STATS AROUND THE WORLD – W.H.O. 2010
õ Belarus –17.5 litres pure alcohol õ Ireland –11.9 litres õUK – 10.39 litres õUS – 8.51 litres (43rd) õ Canada – 8.26 litres (45th)
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Prevalence of Alcohol Use During Pregnancy in US
õ 7.61% of women drink during pregnancy
õ 1.41% of women binge during pregnancy
Binge drinking rates have not changed
significantly since 1991 (Floyd & Sidhu, 2004)
õ 1CDC 2010
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Embryonic Development & Risk
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
IQ vs Adaptive Functioning
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Choline and the Brain
õ Choline is a dietary nutrient important for all cells to function normally. Choline is required for synthesis of essential components of membranes and is an important building block for neurochemicals in the brain.
õ Sources include many proteins like meat, fish, cheese, nuts avocado etc
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Choline and the Brain
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Level of Activation in Dorsolateral Prefrontal
Cortex
Number of Correct Responses on N-Back
Key: 1-Back (simple task)
2-Back (difficult
task)
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Client Demographics õAge: 19 years to 45 years õ Ethnicity: 9 Caucasian, 10 First Nations
or Métis, 1 Afro-Caribbean õMarital Status: 17 single, 3 common
law, only 1 had been married õ Living Situation: 12 alone, 3 with
relatives, 3 with partner, 2 in FASD Action funded
collaborative homes õ Employment: 1 had a part-time job
12
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Birth Mothers’ Histories
0102030405060708090
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ResidSchool
Dead DV Alc/Fam MH Homeless Specneeds
13
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Clients’ Trauma Histories
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100
Poverty DV PatETOH
FH Legal MomDead
SexTrade
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
28 Children of 12/20 Clients
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FASD confirmedETOH
Behav Dev delay Normal # in Care
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Clinic Results: Mental Health
0102030405060708090
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AnyMHA
DEP Adhd Mood Ptsd Anx Ld
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Video clip of the experience of the effect of receiving an FASD Diagnosis as an adult.
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Psychiatric Training in Fetal Alcohol Spectrum Disorders "Inadequate"
õ http://www.medscape.com/viewarticle/711792 õ 2009 survey with 308 respondents of recent psych. grads õ 40% of respondents reported receiving supervision with a
patient with suspected or confirmed FASDs, õ 70% reported never diagnosing a patient with an FASD, õ 51% reported they had never treated a patient with the
condition. õ 83% reported they had never used any standardized
diagnostic schema at all. õ many respondents mistakenly reported that "it is safe to
drink some alcohol" during the first (6%), second (15%), and third trimesters (30%).
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
DSM-5 AND FASD (R.Densmore 2014)
õ P 86,“Other Specified” Neurodevelopmental Disorder e.g. “Neurodevelopmental disorder associated with prenatal alcohol exposure.”
õ P 783, “Conditions for further study” e.g. “Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure (ND-PAE).”
õ P 52, DSM-5 actually encourages definition of severity levels of symptoms and how much support is required e.g. Autism
õ - “ADHD is the most frequent presentation of FASD....FASD’s are true clinical masqueraders and ADHD is their most likely disguise!” (O’Malley, 2007)
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Model of Prenatal Alcohol Exposure
Alcohol Pair-fed Control • Liquid diet, 36% calories derived from ethanol
• Nutritional control group
• Control for reduced food intake in Alcohol-consuming females
• Pelleted control diet, fed ad libitum
Pregnant female rats, placed on diet throughout pregnancy Kasia Stepien
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Pregnant Sprague-Dawley dams, placed on diet throughout gestation:
Ethanol Pair-fed Control
Model of Prenatal Alcohol Exposure
Assess offspring:
Kasia Stepien
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Prenatal alcohol exposure increases locomotor (typical) response to amphetamine
Uban et al, 2014, under review
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Figure 1. Diagram describing the spiralling distress/addiction cycle from a psychiatric perspective with the different criteria for substance dependence from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, incorporated at different stages. There are three major components of the addiction cycle: preoccupation-anticipation, binge-intoxication, and withdrawal-negative affect. (Koob & LeMoal, Neuropsychopharamacology, 2001)
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Changes in the brain (neuroadaptation) result in increased value of drug, decreased executive function, decreased reward,
increased stress " transition to addiction Neuropsychopharmacology (2014) 39, 254-262
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
1Washington State Parent Child Assistance Program 2Grant et. al. International Journal of Alcohol and Drug Research 2014
Outcomes for Substance Abuse Treatment Programs For Women in PCAP1 1997-2011, Adapted from Grant2
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Prenatal alcohol exposure & addiction treatment (Grant et al., Addict Med, 2013 – see Table 1)
FASD characteristic Treatment recommendation Difficulties with executive function
Teach how to set appointment reminders on his/her cell.
Concrete- Black or White Thinker
Avoid metaphors, if joking indicate.
Impaired verbal receptive language processing
Remember he/she often express themselves at a much higher level than they understand.
Social impairments Frame treatment expectations & group participation with perspective that coping capacity and interpersonal skills likely much younger than chronological age.
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Summary I õ FASD is a VERY common, invisible brain
based disability, 2-5% of the population. õ 46% of people with a diagnosis of FASD had
alcohol or drug problems õ Laboratory studies show paradoxical or
opposite effects when FASD is a factor in prolonged drug sensitivity.
õ Adaptive Functioning level is a better predictor that IQ for treatment outcomes
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Summary II õHave protein (choline) rich foods and snacks
readily available. õ Inclusion of FASD in DSM V as an appendix
means that many are still very tentative about the extend and breadth of the challenge
õ For more details, please see the NAADAC journal article (Fall 2014) titled “Does your Program or Practice Help….”
FOR MORE INFORMATION: Download new free FASD Life History Screening Tool &
1 hour training with Dr. Joanne Weinberg: http://LivingWithFASD.com/addiction/
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Diane V. Malbin, MSW
Fetal Alcohol/Neurobehavioral conditions: FA/NB Practical Ways We Can We Adapt Treatment Programs to Support People with Brain Based Conditions Like FASD
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
From research to application
Or, What’s the brain got to do with it?
--Thank you, Tina Turner
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Is FA/NB a physical disability? 1. Alcohol, drugs and other teratogens kill cells,
including cells in the brain 2. These causes changes in the physical
structure, neurochemistry in the brain 3. FA/NB is usually invisible, therefore 4. FA/NB is a brain-based physical disability;
behaviors are often the only symptoms
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
If FA/NB is an invisible physical disability
Then Providing accommodations for people with FA/NB is as appropriate, effective, and ethical as providing accommodations for people with other physical disabilities.
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Examples of success
Artist, musician Warehouse person Electrician Boat builder Mechanic Child care worker Animal rescue worker Drummer, dancer BA, BS, MSW, PhD
Office worker Special ed. teacher Addictions counselor Massage therapist Truck driver Husband, wife: Parents Delivery person Parent Adult care worker
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Layers of relevance
õ Policy, accreditation õ Program design, practice õ Personal õ Professional õ Friends õ Family members õ Self õ Children, grandchildren
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
FASCETS Neurobehavioral screening tool
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Definition: Primary neurobehavioral characteristics
Behavioral symptoms of brain structure, function and dysfunction, including strengths.
Adapted from Streissguth, 1996
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Primary symptoms 1.Developmental level of functioning 2.Sensory systems 3.Nutrition 4.Language and communication 5.Processing pace: How fast the brain works 6.Learning and memory 7.Abstract thinking 8.Executive functioning 9.Strengths
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Uneven development adult
Actual age of person: 25 Developmental age--------13 Strengths (art, sports)--------------------------------28 Expressive language--------------------------26 Receptive language---11 Reading ----------------------------18 Comprehension ------12
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Primary: Learning strengths
õ Relational: 1:1 õ Visual õ Auditory õHands-on õ Kinesthetic -- see, touch, move õ Experiential -- learns by doing õMultimodal -- uses all senses
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Definition: Secondary behavioral symptoms
Secondary defensive behaviors develop over time when there is a “poor fit”
Defensive behaviors are normal reactions to
pain and are preventable.
Source: Ann Streissguth, 1996
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Secondary behavioral symptoms 1. Fatigued 2. Frustrated 3. Anxious 4. Angry 5. Shut down, avoidant, blaming 6. Poor self esteem 7. Isolated 8. Depressed
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Organized, efficient less energy required for task
Conner, et al 2005
PET Scans: The better the brain is organized, the less energy is required to do the task
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Organized, efficient FAS: Disorganized, less less energy required for task efficient, more energy
Conner, et al 2005
PET Scans: The greater the disorganization, the harder the entire brain works, causing fatigue and irritability
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Definition: Tertiary characteristics formerly known as “Secondary Disabilities”
are the net effect of chronic exhaustion, failure and frustration and are also
preventable
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Tertiary characteristics / problems Trouble at home Trouble at school, dropout Social Services involvement Alcohol / drug-related problems / addictions Justice system involvement
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Poor fit FA/NB Visual learner………........ Slower processing…….. Needs simplicity………... Difficulty organizing…… Concrete…………….........
Technique Verbal instruction Fast paced Complex Requires organizing Abstract
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Good fit FA/NB Visual learner………........ Slower processing……… Needs simplicity………... Difficulty organizing……. Concrete…………….........
Technique Visual cues Slow down, fewer words One or two steps Provide support Hands-on, experiential
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
The Brain - Addiction link Olds and Milner, 1954 Identified the mesodopaminergic limbic
system (brain stem) as being involved in addictive processes
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
ASAM Public Policy Statement of Addiction August 15, 2011
Short Definition of Addiction: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry….
American Society of Addiction Medicine
Or, it is a brain-based condition with behavioral symptoms
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Curious parallel
õ Research: Addictions are brain-based
õ Research: FASD is a Neurobehavioral condition õHow is this reflected in understanding and
practice?
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Why don’t good techniques work?
What does the brain have to be able to do in order for strategies to work?
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
What does the brain have to be able to do in order for strategies to work? Example: Talking
Brain function required: Store information / memory Retrieve information…………… Make links…………………………… Abstract……………………….……… Generalize…………………………… Predict………………………………... Process quickly……………….…
Research on FA/NB has found brain differences: Difficulty with memory Difficulty retrieving information Difficulty forming links Concrete Difficulty generalizing Difficulty predicting Processes slowly
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Remember the Streissguth study? Disabilities: FAS FASD Substance Abuse 21% 32% Mental Health problems 91% 94% School Problems 40% 63% Trouble with the law 51% 68% Homelessness 16% 30% Threatening or violent behaviors 35% 50% One or more 74% 93% Source: Streissguth, et al Secondary Disabilities Study, 1996
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Secondary Disabilities study õNatural history design õ All subjects diagnosed FAS / FASD õ All continued to receive standard services
Power of this study is implicit: High rate does not mean problems are inevitable. It captures the limits of the current paradigm to achieve improved outcomes
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment
A systematic approach to developing person-specific accommodations in all
settings and managing the complexity of FA/NB
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment Setting: _Addictions tx__ Age: _32_ Developmental age: 15_ 1 Task or Expectation
2 Brain has to
3 Primary symptoms FA/NB
4 Devel. Age (est.)
5 Secondary behaviors
5 Strengths
6 Accommodations
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment Setting:_Addictions tx_ Age: 32_ Developmental age: 15 1 Task or Expectation
2 Brain has to
3 Primary symptoms FA/NB
4 Devel. Age (estimate)
5 Secondary behaviors
5 Strengths
6 Accommodations
Cognitive behavioral technique (language)
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment Setting:_Addictions tx Age: 32_ Developmental age: 15
1 Task or Expectation
2 Brain has to
3 Primary symptoms FA/NB
4 Devel. Age (estimate)
5 Secondary behaviors
5 Strengths
6 Accommodations
Cognitive behavioral technique (language)
Analyze abstract
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment Setting:_Addictions tx Age: 32_ Developmental age: 15 1 Task or Expectation
2 Brain has to
3 Primary symptoms FA/NB
4 Devel. Age (estimate)
5 Secondary behaviors
5 Strengths
6 Accommodations
Cognitive behavioral technique (language)
Analyze abstract
Concrete Literal
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment Setting:_Addictions tx Age: 32_ Developmental age: 15 1 Task or Expectation
2 Brain has to
3 Primary symptoms FA/NB
4 Devel. Age (estimate)
5 Secondary behaviors
5 Strengths
6 Accommodations
Cognitive behavioral technique (language)
Analyze abstract
Concrete Literal
14
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment Setting:_Addictions tx Age: 32_ Developmental age: 15 1 Task or Expectation
2 Brain has to
3 Primary symptoms FA/NB
4 Devel. Age (estimate)
5 Secondary behaviors
5 Strengths
6 Accommodations
Cognitive behavioral technique (language)
Analyze abstract
Concrete Literal
14 May not finish tasks, argues
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment Setting:_Addictions tx Age: 32_ Developmental age: 15 1 Task or Expectation
2 Brain has to
3 Primary symptoms FA/NB
4 Devel. Age (estimate)
5 Secondary behaviors
5 Strengths
6 Accommodations
Cognitive behavioral technique (language)
Analyze abstract
Concrete Literal
14 May not finish tasks, argues
Artistic Hands-on learner
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment Setting:_Addictions tx Age: 32_ Developmental age: 15 1 Task or Expectation
2 Brain has to
3 Primary symptoms FA/NB
4 Devel. Age (estimate)
5 Secondary behaviors
5 Strengths
6 Accommodations
Cognitive behavioral technique (language)
Analyze abstract
Concrete Literal
14 May not finish tasks, argues
Artistic Hands-on learner
Art, drama, music, relationship, role modeling
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment Setting: Addictions tx Age: _32_ Developmental age: 15
1 Task or Expectation
2 Brain has to
3 Primary symptoms FA/NB
4 Devel. Age (estimate)
5 Secondary behaviors
5 Strengths
6 Accommodations
Cognitive behavioral technique (language)
Abstract, analyze
Concrete, literal
14 May not finish tasks, argues
Artistic, hands-on learner
Art, drama, music, relationship, role modeling
Communicate
Process language
Slow processing pace
12 Anger, frustration
Determinedcreative
Art, drama, music, poetry
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com
Application: Functional Neurobehavioral Assessment Setting: Addictions tx Age: 32 Developmental age: 15
1 Task or Expectation
2 Brain has to
3 Primary symptoms FA/NB
4 Devel. Age (estimate)
5 Secondary behaviors
5 Strengths
6 Accommodations
Cognitive behavioral technique (language)
Abstract, analyze
Concrete, literal
14 May not finish tasks, argues
Artistic, hands-on learner
Art, videos, relationship, role modeling
Communicate
Process language
Slow processing pace
12 Anger, frustration
Determinedcreative
Art, drama, music, poetry
Apply new knowledge
Store, retrieve and generalize
Memory problems, difficulty generalizing
16 Defensive Relational Teach in different settings, use mentor
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Addictions treatment? õ Cognitive-behavioral? õ Language based? õ Require the ability to reflect, recall,
analyze, integrate, reframe and generalize?
õ Post-tx require the ability to organize, plan, initiate, prioritize, inhibit impulses?
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Treatment opportunities 1. Intake, history, neurobehavioral screen 2. Identify strengths, challenges 3. Simplify. Adapt treatment plans
1. Fewer objectives 2. Fewer words 3. More concrete, visual, relational
4. Educate client, family, sponsor
Diane Malbin, MSW FASCETS.org
David Gerry, BSc LivingWithFASD.com David Gerry, BSc LivingWithFASD.com
Questions?
David Gerry, BSc Diane V. Malbin, MSW
LivingWithFASD.com FASCETS.org
Phone: (250) 889-1429 PO Box 69242
Portland, Oregon 97239 Phone/FAX: (503) 621-1271
[email protected] [email protected]
FOR MORE INFORMATION: Download new free
FASD Life History Screening Tool & 1 hour training w/ Dr. Joanne Weinberg: http://LivingWithFASD.com/addiction/