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Recognizing and Serving Children with FAS/FASD from the Bench

Hon. Peggy WalkerHon. Peggy Walker, Juvenile Court Judge, Douglas County (GA) President-Elect, National Council of Juvenile and Family Court Judges

Summary: The author shares advice and 9 lessons learned from 23 years of experience on the bench about recognizing and serving children with FAS and FASD.

Judges make daily decisions about custody, removal to foster care and detention of children and parents alleged to have violated the law. On the surface we see poor communication and problem-solving skills within families; abuse and neglect of children; acting-out behaviors of children; and various forms of theft, financial fraud and forgery by adolescents and adults. As we gain experience, we learn to look beyond the surface and often find the underlying issue of substance abuse. As judges, we must recognize this issue and its impact on the parent, the child, the relationship between the parents, the relationship between the parent and the child, the school, the community and the court.

Substance abuse is the underlying issue in at least 80% or more of the abuse and neglect cases that have come before the Juvenile Court of Douglas County each year for the past 23 years. Of those cases, a third of the parents have a dual diagnosis of substance abuse and some form of mental illness—including postpartum depression, depression, bipolar disorder, anxiety disorder and schizophrenia. Parental substance abuse increases the likelihood of abuse and neglect of children at a rate of four or more times greater than in the general population of children who do not live with substance abuse. Children living in homes with substance abusers, with caretakers suffering from mental illness or with abusive caretakers have a much greater risk for developmental delays, cognitive impairment, health problems, and difficulty with behaviors that affect education and relationships setting children on a course to repeat the behaviors modeled by their parents and caregivers. See the Zero to Three website.

Some of the significant impairments experienced by children who come before the court arise from prenatal exposure to alcohol. There are no systems of screening and assessment in place for fetal alcohol syndrome or fetal alcohol spectrum disorders, leaving the identification of this issue in the hands of judges, attorneys, caseworkers and advocates for children. Training is vital since the vast majority of children who are never diagnosed and never treated repeat the cycle of substance abuse giving birth to the next generation of children adversely affected by alcohol use. See the NCJFCJ website for training opportunities, judicial tools and other resources.

The array of services available actually begins in pregnancy with prenatal care and nutritional support available to indigent pregnant women to support healthy pregnancies and adequate brain development of the child in vitro. These programs are a starting point for screening and educating about alcohol use and damage to children in vitro. Another resource is text4baby, available nationwide in English and Spanish to communicate important messages about healthy pregnancy and education on milestones and development in the first year of life of the infant. These text messages are at no cost to the mother and provide excellent guidance in a form that is always with her. See the Text4Baby website.

The next point of contact is at birth. Screening policies are not consistent across or within states. Screening at birth or at the very least at the first pediatric assessment is needed since hospital social workers can assist in connecting high risk infants to services upon discharge from the hospital. Every state has Part C services under Individuals with Disabilities Education Act (IDEA) to provide developmental screenings and support services for children who need them. The earlier a child is served, the better the outcome because the brain is in its most critical period of development from birth to three. Every experience good or bad wires the brain of a baby for success or for failure in life.

Part C programs support children and families from birth to 24 months (up to 36 months in some states) with a wide range of services from health management, speech therapy, occupational therapy, and other services necessary to support physical, social and emotional development. When a child has developmental issues and reaches the age of 2 or 3 in some states, the child is served through the local school system with early special education services that continue into early adulthood. Those who do not achieve the ability to provide for themselves and become self-sufficient are often eligible for social security benefits and vocational rehabilitation services as adults. See the US Department of Education website.

Sadly, we do not routinely screen children in foster care or parents in substance abuse treatment programs for FAS or FASD even though we know they are at high risk. As a judge, I have served the child who is now the parent, the parent who is now the grandparent, and the grandparent who is now the great-grandparent, where each continues to struggle with substance abuse. I realize that not only do children need these screenings but also we need to screen parents and custodial grandparents.

Other high risk populations include children whose parents are incarcerated and adolescents with status and delinquent offenses. Without diagnosis and treatment, these adolescents are at high risk of entering the criminal justice setting as adults. One of the stunning findings in Georgia was an assessment of children in 2006 committed to the custody of the state for delinquent behavior that found 99.8% of them had a parent or sibling with an alcohol or other drug abuse problem.

There is also a greater risk of suicide among those with FASD, suggesting that through diagnosis and treatment we can reduce risk for suicide. Suicide during the span of the court’s jurisdiction does occur and is devastating to the children, the family, attorneys, caseworks and court personnel who struggle in the aftermath of the loss, grief and guilt they experience.

As judges and advocates, we can learn the factors and traits that indicate alcohol use during pregnancy. We can identify resources in the community. We can ask for screenings and assessments. We can choose assessors with adequate training and skills and reject those whose services are not adequate. We must reject any assessment based solely on self-reporting as a hallmark of substance abuse is denial of the problem. Assessments create a road map for reunification, but we need to prioritize the steps and make case plans, custody orders and probation orders as understandable as possible. Judges can hold agencies, custodians, foster parents, service providers, attorneys and advocates accountable for ensuring assessments are done in a timely manner, that quality work is provided to guide the case, that the recommendations are incorporated into a case plan that becomes a court order, and that the plan is followed and services are utilized. Judges can and should make a “no reasonable efforts to achieve permanency” order to get the attention of the agency responsible for serving children and families. As judges, we can ask questions and reset cases when the information is not provided in a timely manner to give us guidance in forming the best plan for a child and family. We must continue to convene stakeholders, train them and set standards for them to achieve excellence in serving our children and families.

Children who have FAS or FASD carry a very high burden of care, meaning that the degree of disabilities they exhibit, the number of appointments and specialists they need, and the structure and care they must have require a very high degree of positive parenting and organizational skill often lacking in the families who seek to reunify with their children. Parental fitness assessments are vital to establish at the beginning of the case if parents have the potential to parent children with serious disabilities. All children need permanency, but children with disabilities need stability and consistency as soon as possible. The longer they linger in foster care the greater the damage to them.

9 Lessons Learned from 23 Years of Experience on the Bench

  1. Denial of the use of alcohol during pregnancy is common. A better way of gathering the information is to ask the mother what her habits were regarding alcohol before she knew she was pregnant.
  2. Alcohol is commonly used with other drugs of choice.
  3. The length of addiction of the mother and her age are indicators for exposure of the children, meaning the longer she has been addicted and the older she is the greater the likelihood that her children have prenatal exposure.
  4. Daily use of alcohol by the mother’s partner is a red flag risk indicator.
  5. Other red flags are estrangement from family and friends, failed relationships, homelessness, poor employment history, and criminal history for substance abuse and multiple forms of theft or burglary.
  6. A child who has experienced chronic abuse and neglect and/or a child who has significant developmental delays must be screened for FAS and FASD.
  7. Evaluations by pediatricians and Part C providers often miss indicators of exposure and some diagnoses because they lack the training to screen for FAS and FASD.
  8. FAS and FASD indicators may not manifest until a child is two years of age so early screenings where a child is on target gives us a false sense of security that the child has no disabilities. Periodic screening throughout the court’s jurisdiction help identify emerging problems and connect children to support services.
  9. The medical, physical and developmental, social and emotional needs of children with prenatal exposure to alcohol and other drugs are often overwhelming to even the most skilled caregiver. Recovering parents need a strong support system to parent their developmentally disabled children while maintaining their sobriety. The best way to test the parents’ ability to provide for their children is to have them co-parenting with the foster family to attend all appointments and therapies to determine their capacity to learn and to meet the needs of these children who will benefit greatly from support services.

Author biography:

Judge Peggy Walker has served full time as Juvenile Court Judge of Douglas County for the past fifteen years. She is president-elect of the National Council of Juvenile and Family Court Judges.

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