Over the next few days of 99 Days to FASDay we will continue with sharing information about some early intervention programs which help improve outcomes for children with FASD and their families and caregivers.
It needs to be stated again, the sharing of this information is not an endorsement. Every attempt has been made to share only information from reputable sources. Links are provided for you to conduct your own research.
Today’s information comes from a Report: Prenatal Alcohol Use and FASD : Diagnosis, Assessment and New Directions in Research and Multimodal Treatment, 2011, 64-107, Chapter 4: An Innovative Look at Early Intervention for Children Affected by Prenatal Alcohol Exposure by Heather Carmichael Olson and Rachel A. Montague.
Over the next few days we will share three programs highlighted in the above report which the authors note are scientifically validated parenting interventions that seem especially promising for FASD intervention from a neurodevelopmental viewpoint. These scientifically validated interventions teach positive parenting skills, and methods for dealing with the challenging behavior that is common in FASD.
The first of three featured today is the Families Moving Forward program. It is offered in Seattle, Washington (USA).
The information is taken directly from the noted report (and is found on pages 19 & 20).
The Families Moving Forward (FMF) Program is a positive parenting intervention, developed by Olson and colleagues. The FMF intervention model was designed specifically for the high priority group of families raising children with preschool and school-aged children with FASD, who also have clinically concerning behavior problems.
This is a large segment of families who come into FASD diagnostic clinics or are seen in mental health settings. These children have low adaptive function and very high levels of behavior problems, and their care givers are nearly all highly stressed by the task of parenting children with FASD. These are children with very challenging problems.
The FMF model is a behavioral consultation intervention that combines a positive behavior support (PBS) approach with motivational interviewing and other scientifically-validated treatment techniques. The FMF intervention is specialized for families raising children with FASD, though it is likely useful for children with other neurodevelopmental disabilities.
The FMF intervention is delivered individually to families by clinicians who have received specialized training on the model, and have access to supervision/consultation. There is a manual for the FMF intervention, but the intervention is also flexible enough to respond to the needs of the very diverse population of children with FASD and their families. The FMF intervention can be used for children aged as young as 4 years to as old as age 12 years (at the start of intervention).
The efficacy of FMF services has been tested as home-based counseling delivered from a university setting and later by a community agency, with promising results so far. Delivery in clinic settings has also been tried and is quite feasible. The FMF Program has been designed to be affordable, and is now being disseminated to community agencies that have a special commitment to serving children with neurodevelopmental disabilities or FASD.
In the FMF intervention model, care givers are offered support and education, sustained behavioral consultation that includes coaching on skills, targeted school and provider consultation, advocacy assistance, and connection to community linkages. There is a strong emphasis on emotional support for care givers who must adjust to a disability
that is often unrecognized by social systems, teachers and even health care providers.
Other ‘optional’ treatment elements can be added, such as finding respite care or learning how to explain a FASD diagnosis to a child.
Receiving FMF services does not preclude other services, and the FMF intervention model actually emphasizes links to other community resources.
The FMF Program is a care giver-focused intervention, designed to be used with families experiencing high care giving stress.
Data on the FMF Program were gathered with the intervention offered in biweekly visits, usually each visit about 90 minutes long, occurring over a period of 9 to 11 months. Recent experience suggests a somewhat shorter duration with more frequent visits is feasible, though no outcome data have been gathered. There is a highly collaborative and equal relationship between parent and professional (FMF Specialist).
The entire FMF intervention takes a neurodevelopmental viewpoint:
A first aim of the FMF Program is to help parents “reframe” and understand their child’s neurological impairment and ability to process emotions, changing attitudes in a more positive, realistic direction.
A second aim is to help parents learn skills for how to come up with and use accommodations, such as modifications to the home or classroom.
A third aim is to help parents learn how to set up practical behavior plans to reduce self-selected behavior problems.
These plans rely less on setting up consequences for misbehavior. Instead, behavior plans rely more on parents thinking about the triggers and circumstances surrounding their children’s problem behavior, and how to change them so the child’s behavior problems decrease and the child acts in a more functional way. The idea is for parents to learn how to create behavior plans, so they have strategies to use in the future when new problem behaviors crop up. Parents receive a customized workbook, and do regular home activities to practice new skills and attitudes.
The initial efficacy study compared two groups of families raising children with FASD and behavior problems randomized to receiving: (1) FMF services; and (2) the community standard of care. Families were very diverse in terms of ethnic background, social class, income level, and type of family structure (adoptive, birth, foster; grandparents, single parents, two-parent families).
Immediately after treatment, relative to controls, findings showed the FMF group reported significantly greater family needs met, a greater sense of parenting efficacy, more parental self-care and decreased child disruptive behavior. While not all hypotheses were confirmed, parents reported high satisfaction with treatment, and both parents and clinicians reported good treatment acceptability. Treatment compliance was excellent, with 96% of families completing the basic intervention in this first efficacy trial.
For more information, see the Families Moving Forward website: http://depts.washington.edu/fmffasd