CAP ConferenceCAP ConferenceThe Importance of Approaching FASD The Importance of Approaching FASD

with a Relational and Strengths with a Relational and Strengths ApproachApproach

Presented by

Stephen de Groot BA, BSW, MSW, RSW

M Y R I A D C O N S U L T A T I O N A N D

C O U N S E L L I N G

Introduction and Brief Introduction and Brief StoryStory

Referral To You…Referral To You…

Preferred Outcomes for Youth Preferred Outcomes for Youth with FASD with FASD • Develop an understanding of who they are and Develop an understanding of who they are and

equate that with seeing themselves as a valuable equate that with seeing themselves as a valuable human being.human being.

• Grows into an adult who feels comfortable with Grows into an adult who feels comfortable with interdependence or ‘successful dependence’ (Ory).interdependence or ‘successful dependence’ (Ory).

• Has understanding, respectful support people in Has understanding, respectful support people in their lives that they use as needed to assist with their lives that they use as needed to assist with areas of difficulty or confusion.areas of difficulty or confusion.

• Is successfully utilizing areas of strength to feel Is successfully utilizing areas of strength to feel competent, and make positive contributions to competent, and make positive contributions to themselves, their families, and their communities.themselves, their families, and their communities.

• Are valued members of society.Are valued members of society.

Introduction to RBSA and Introduction to RBSA and FASD FASD

• Why use a relational approach with youth with FASD?

• Why use a strength-based approach with youth with FASD?

The importance of a relational The importance of a relational focus…focus…• Difficulties following birth…attachment…caring…Difficulties following birth…attachment…caring…

comfort…consistency…etc….comfort…consistency…etc….

• Difficulties or challenges with attaching – sensory-Difficulties or challenges with attaching – sensory-issues…physical and neurodevelopmental sensitivities…issues…physical and neurodevelopmental sensitivities…

• Early childhood – emotional and social challenges and Early childhood – emotional and social challenges and difficulties with self regulation and peer interactiondifficulties with self regulation and peer interaction

• Many children have been violated in relationships that Many children have been violated in relationships that have been confusing, hurtful and unsafe – seriously have been confusing, hurtful and unsafe – seriously compromising and confusing their experiences and compromising and confusing their experiences and understanding of “healthy” and “safe “ relationshipsunderstanding of “healthy” and “safe “ relationships

• Childhood – difficulties with peer attachments – Childhood – difficulties with peer attachments – relationships with younger children or older cohort.relationships with younger children or older cohort.

• Adolescence – challenges with peer relationships .Adolescence – challenges with peer relationships .

The importance of a relational The importance of a relational focus…focus…• Many children live with a great deal of Many children live with a great deal of

stigma and discrimination making stigma and discrimination making relationships with self and others more relationships with self and others more challenging challenging

• Many children with FASD experience Many children with FASD experience neurodevelopmental challenges – can result neurodevelopmental challenges – can result in difficulties and misunderstandings that in difficulties and misunderstandings that may undermine safe and comfortable may undermine safe and comfortable relationships with othersrelationships with others

• Many children with FASD struggle with peer Many children with FASD struggle with peer relationships due to a lack of intrapersonal relationships due to a lack of intrapersonal and interpersonal relational skills for coping, and interpersonal relational skills for coping, adapting, communicating and interactingadapting, communicating and interacting

Relationships and FASDRelationships and FASD• Youth with FASD greatly value Youth with FASD greatly value

relationships with friends, family, relationships with friends, family, educators and other caregivers who educators and other caregivers who really really understand themunderstand them..

• Youth with FASD frequently need to rely Youth with FASD frequently need to rely heavily on others for support, cueing, heavily on others for support, cueing, processing, remembering, and processing, remembering, and interpreting their environments. interpreting their environments.

• For successful outcomes it is critical that For successful outcomes it is critical that these support people form relationships these support people form relationships with youth with FASD that are safe, with youth with FASD that are safe, predictable, and respectful. predictable, and respectful.

Relationships and FASDRelationships and FASD• Youth with FASD may have a history of Youth with FASD may have a history of

being excluded or ostracized by peers being excluded or ostracized by peers who do not understand the differences who do not understand the differences resulting from having FASD.resulting from having FASD.

• A strong desire for friends may leave a A strong desire for friends may leave a youth with FASD vulnerable to being youth with FASD vulnerable to being exploited or coerced into negative or exploited or coerced into negative or risky behaviours.risky behaviours.

• Learning to differentiate between positive Learning to differentiate between positive versus negative friends, and to develop versus negative friends, and to develop social skills to maintain healthy social skills to maintain healthy friendships may be helpful for youth with friendships may be helpful for youth with FASD.FASD.

Relationships and FASD Relationships and FASD

• Many youth with FASD have difficulty Many youth with FASD have difficulty with appropriate social communication with appropriate social communication and behaviours.and behaviours.

• Youth with FASD may be friendly and Youth with FASD may be friendly and outgoing and make friends easily but outgoing and make friends easily but have difficulty maintaining positive have difficulty maintaining positive friendships.friendships.

• Youth with FASD may be more Youth with FASD may be more successful making friends with successful making friends with individuals younger or older than individuals younger or older than themselves rather than with same age themselves rather than with same age peers.peers.

The Need for a Relational The Need for a Relational Stance…Stance…

• We need to go “over the top” when it We need to go “over the top” when it comes to developing safe, trusting and comes to developing safe, trusting and comfortable attachments with children comfortable attachments with children and youth with FASDand youth with FASD

• We need to keep in mind the need for a We need to keep in mind the need for a secure, safe and significant relationship secure, safe and significant relationship that fosters a sense of confidence, that fosters a sense of confidence, competence and well beingcompetence and well being

• Trusted, effective relationships with Trusted, effective relationships with youth with FASD must be:youth with FASD must be:

•Accepting of differencesAccepting of differences

•Non-judgmentalNon-judgmental

•UnconditionalUnconditional

•HonestHonest

•CaringCaring

FASD Lens: FASD Lens: Belief in the dignity and worth of youth Belief in the dignity and worth of youth as valuable human beings.as valuable human beings.• Media reports often pathologize individuals Media reports often pathologize individuals

with FASD.with FASD.

• Well meaning others often pathologize Well meaning others often pathologize families living with FASD.families living with FASD.

• Despite differences in their brains, youth Despite differences in their brains, youth with FASD are valuable members of our with FASD are valuable members of our society with strengths to contribute.society with strengths to contribute.

• Youth with FASD need an environment that Youth with FASD need an environment that supports these differences and allows youth supports these differences and allows youth with FASD to experience themselves as with FASD to experience themselves as valuable human beings.valuable human beings.

FASD Lens: FASD Lens: Belief in the respect and recognition of Belief in the respect and recognition of all all Youth as unique.Youth as unique.• Youth with FASD are born unique Youth with FASD are born unique

individual human beings.individual human beings.

• How FASD manifests in each How FASD manifests in each youth with FASD is unique to that youth with FASD is unique to that specific individual.specific individual.

• Life events through childhood and Life events through childhood and youth have further shaped each youth have further shaped each youth with FASD into a unique youth with FASD into a unique individual.individual.

FASD Lens: FASD Lens: Belief in the necessity of a “secure Belief in the necessity of a “secure base”.base”.

• Having basic needs met, and a Having basic needs met, and a sense of safety and security are sense of safety and security are critical for all youth.critical for all youth.

• Long-term prospective research Long-term prospective research (Streissguth et al. 1997, 2004) (Streissguth et al. 1997, 2004) indicates protective factors for indicates protective factors for individual with FASD include: ‘living individual with FASD include: ‘living in a safe and stable environment,’ in a safe and stable environment,’ ‘living in a good quality home for ‘living in a good quality home for most of life,’ and ‘never having most of life,’ and ‘never having been exposed to violence.’been exposed to violence.’

FASD Lens: FASD Lens: Belief that reality is socially Belief that reality is socially constructed.constructed.

• Youth construct their own understanding of Youth construct their own understanding of

situations through the lens of how their brain situations through the lens of how their brain works, perceives, processes, leading to potentially works, perceives, processes, leading to potentially very different understandings of caregivers.very different understandings of caregivers.

• Caregivers and community members may Caregivers and community members may negatively construct youth with FASD as ‘bad, lazy, negatively construct youth with FASD as ‘bad, lazy, oppositional, violent . . .’ or more positively as oppositional, violent . . .’ or more positively as neurodevelopmentally differences or having a neurodevelopmentally differences or having a brain that experiences the world differently.brain that experiences the world differently.

• Ideally, having FASD would mean ‘differences’ that Ideally, having FASD would mean ‘differences’ that can be valued as part of human diversity, versus can be valued as part of human diversity, versus differences that are feared and negatively labeled.differences that are feared and negatively labeled.

FASD Lens: FASD Lens: Belief that all youth are resilient, Belief that all youth are resilient, have strengths and the capacity to have strengths and the capacity to grow.grow.

• Youth with FASD learn, grow and mature. Youth with FASD learn, grow and mature. However, they may do so at a different rate than However, they may do so at a different rate than other youth.other youth.

• Youth with FASD often learn what we are actually Youth with FASD often learn what we are actually teaching versus what we think we are teaching. teaching versus what we think we are teaching.

• Many youth with FASD have incredible resilience Many youth with FASD have incredible resilience and demonstrate amazing ‘survival skills’ or the and demonstrate amazing ‘survival skills’ or the ability to persevere against amazing obstacles.ability to persevere against amazing obstacles.

• Youth with FASD always have areas of strength Youth with FASD always have areas of strength that can be utilized to develop plans at home and that can be utilized to develop plans at home and school, and later to develop plans for living as school, and later to develop plans for living as adults or engaging in productive work activities.adults or engaging in productive work activities.

FASD Lens: FASD Lens: Belief that all youth want what is Belief that all youth want what is good for them and have a desire good for them and have a desire to change.to change.• Youth with FASD have plans, goals, and Youth with FASD have plans, goals, and

desires. desires.

• Spending time with a youth, Spending time with a youth, reallyreally listening listening to them, and working to understand what to them, and working to understand what they are saying helps to understand the they are saying helps to understand the underlying needs and goals a youth has.underlying needs and goals a youth has.

• Youth with FASD may have difficulty following Youth with FASD may have difficulty following through with stated goals, and need through with stated goals, and need additional support to be successful; or they additional support to be successful; or they may change goals frequently and require may change goals frequently and require caregivers and others to be flexible.caregivers and others to be flexible.

FASD Lens: FASD Lens: Belief in the significance of promoting Belief in the significance of promoting Empowerment and Self-determination.Empowerment and Self-determination.• Youth with FASD may have grown up not Youth with FASD may have grown up not

understanding their own strengths and understanding their own strengths and limitations, and may have been punished over limitations, and may have been punished over and over because of their brain’s inability to and over because of their brain’s inability to comply with society demands.comply with society demands.

• Recognizing and validating a youth’s own Recognizing and validating a youth’s own perceptions and knowledge of their experiences perceptions and knowledge of their experiences mitigates some of their negative experiences.mitigates some of their negative experiences.

• When caregivers can assist youth to understand When caregivers can assist youth to understand the choices open to them, they can make their the choices open to them, they can make their own choices and self-determine a life plan and own choices and self-determine a life plan and direction that has meaning for them.direction that has meaning for them.

FASD Lens: FASD Lens: Belief in the importance of Belief in the importance of Purpose and Goal-directedness.Purpose and Goal-directedness. • Youth with FASD may view the world in concrete Youth with FASD may view the world in concrete

ways.ways.• Having clearly stated goals, with concrete steps Having clearly stated goals, with concrete steps

or tasks to lead to those goals can help youth or tasks to lead to those goals can help youth with the often difficult task of follow through.with the often difficult task of follow through.

• Make goals, and the steps to achieve them, Make goals, and the steps to achieve them, more visual and concrete helps youth to follow more visual and concrete helps youth to follow through and successfully reach goals.through and successfully reach goals.

• Experiences of success help to mitigate feelings Experiences of success help to mitigate feelings of incompetence and low self-esteem that occur of incompetence and low self-esteem that occur when youth with FASD have faced repeated when youth with FASD have faced repeated ‘failures’ to comply with unrealistic ‘failures’ to comply with unrealistic expectations.expectations.

Got Strengths?Got Strengths?

The Desperate Search for the The Desperate Search for the

““Not-So-Obvious”Not-So-Obvious”

““Common Sense”?Common Sense”?

• Despite caring and nurturing intentions, Despite caring and nurturing intentions, children with FASD exist in a system that is children with FASD exist in a system that is focussed on deficits, dysfunction, risk, focussed on deficits, dysfunction, risk, disability, problems, pathology, disorder disability, problems, pathology, disorder which also takes an individual focus on which also takes an individual focus on treatment and “dealing with” the individualtreatment and “dealing with” the individual

• Unfortunately the system is often risk, not Unfortunately the system is often risk, not strengths focussedstrengths focussed

• It can be difficult to see the strengths of It can be difficult to see the strengths of children who have so many emotional, children who have so many emotional, cognitive, social and behavioural challenges cognitive, social and behavioural challenges

Barriers to youth Strengths.Barriers to youth Strengths.

Psychobiomedical Focus

Pathology

Disability

Impairment

Damage

Disorder

Risk

DeficitsMy Strengths?

Abnormal

Problem

Dysfunction

Deficiencies

Multiple Diagnoses

Blame

Potential Barriers to the youth and the youth’s Potential Barriers to the youth and the youth’s story.story.

File Information

Negative Social History

Labels

Stereotypes & Generalizations

Experts

Theories

Assumptions

Our Story

DSM Diagnoses

My StoryStory?

Getting to know the youth and the youth’s Getting to know the youth and the youth’s story.story.

File Information

Negative Social History

Labels

Stereotypes & Generalizations

Experts

Theories

Assumptions

Our Story

DSM Diagnoses

My My StoryStory

Neurodevelopmental Uniqueness

Dreams

Experiences

Values

Goals

Opinions

Strengths

Resiliencies

Culture

Sensitivities

Knowledge

Many Programs and Helpers Many Programs and Helpers emphasize importance of a Strengths emphasize importance of a Strengths Focus. BUT…Focus. BUT…• Youth are often described with, by or in context of Youth are often described with, by or in context of

the FASD diagnosis – and/or with combination of the FASD diagnosis – and/or with combination of multiple diagnoses.multiple diagnoses.

• Sometimes all issues of challenge or struggle are Sometimes all issues of challenge or struggle are viewed or interpreted solely through the FASD viewed or interpreted solely through the FASD lens. lens.

• Youth are described as and/or represented by Youth are described as and/or represented by what their limitations are (can’t, won’t, will never)what their limitations are (can’t, won’t, will never)

• Files are often set up as leading with negatives, Files are often set up as leading with negatives, problems, deficits, pathology, dysfunction, problems, deficits, pathology, dysfunction, disabilities, etc. over strengths.disabilities, etc. over strengths.

• Strengths section of file is considerably smaller, if Strengths section of file is considerably smaller, if existent at all.existent at all.

Many Programs and Helpers Many Programs and Helpers emphasize importance of Strengths emphasize importance of Strengths Focus. BUT…Focus. BUT…• Mandatory and compulsory file/assessment Mandatory and compulsory file/assessment

“strengths” sections often sparsely represented. “strengths” sections often sparsely represented.

• When focus on strengths – often two or three key When focus on strengths – often two or three key strengths identified. strengths identified.

• Sometimes general list of strengths presented Sometimes general list of strengths presented and drawn on for youth.and drawn on for youth.

• Some “strengths-focussed” programs place youth Some “strengths-focussed” programs place youth in environments which may seriously undermine in environments which may seriously undermine strengths development or interfere with strengths development or interfere with demonstration of strengths capacities.demonstration of strengths capacities.

• Many youth are not invited or present at their Many youth are not invited or present at their own planning/case meetings.own planning/case meetings.

• Many youth do not have goals (that are important Many youth do not have goals (that are important to them, or that they se value in) in the case plan. to them, or that they se value in) in the case plan.

What can we do?What can we do?• Make Relationship Focus a PriorityMake Relationship Focus a Priority• Utilize a Relational and Strengths Utilize a Relational and Strengths

Based Approach Based Approach (see supplemental HO)(see supplemental HO)

• Understand the importance of safety Understand the importance of safety (consistent, predictable, anticipated) (consistent, predictable, anticipated) and significance in relationshipsand significance in relationships

• Know your youth – predicting and Know your youth – predicting and preventing crisis situations. preventing crisis situations. Understand that relationships are Understand that relationships are critical for shaping and developing critical for shaping and developing the capacities of individuals with the capacities of individuals with FASDFASD

What can we do?What can we do?• Make Strengths Focus a PriorityMake Strengths Focus a Priority• Understand potential for “negative” focus of rigid Understand potential for “negative” focus of rigid

FASD lensFASD lens• Be cautious – Realistic (ongoing) and accurate Be cautious – Realistic (ongoing) and accurate

assessment of limitationsassessment of limitations• Consider the reality we may be perpetuating – At Consider the reality we may be perpetuating – At

Risk vs. At Potential Risk vs. At Potential • Suspend assumptions about what you think youth Suspend assumptions about what you think youth

is capable ofis capable of• Provide opportunities for youth to teach you Provide opportunities for youth to teach you

about areas of strength and potential about areas of strength and potential • Involve the youth as much as and to the extent Involve the youth as much as and to the extent

possible in planning possible in planning • Ensure that the youth has goals (in the plan) that Ensure that the youth has goals (in the plan) that

are important to themare important to them• Endorse a consistent search for strengths – then Endorse a consistent search for strengths – then

build on and mobilizebuild on and mobilize

In the most concrete and In the most concrete and practical terms…practical terms…• Ask these questions:Ask these questions:

– How come the youth is not at this meeting?How come the youth is not at this meeting?– What goals are important to the youth?What goals are important to the youth?– What goals does the youth see the value in?What goals does the youth see the value in?– What do you like about this youth?What do you like about this youth?– What is this youth good at?What is this youth good at?– What does this youth do well?What does this youth do well?– What does this youth like? What is it about that?What does this youth like? What is it about that?– Who does this youth like? What is it about them?Who does this youth like? What is it about them?– Where are the strengths…in this file, assessment, Where are the strengths…in this file, assessment,

report?report?

Strengths and Loose Change…Strengths and Loose Change…

Questions or Comments…Questions or Comments…

THANK YOU!THANK YOU!