FASD Informed Practice for Community Based Programs developed as a result of recommendations from an  FASD consultation meeting in 2012 where CPNP, CAPC and AHS frontline workers and coordinators recognized the need for practical information and steps to support FASD informed practice. Families who live with FASD often face “multiple issues including poverty, current or past trauma, violence, abuse, previous childhood experiences, dependency, and addiction issues….In depth knowledge about FASD is vital to an effective FASD informed practice.”

Given that services providers’ own values, beliefs and world view are likely to influence work with families dealing with FASD, the document recognizes that “part of informed practice involves self-awareness and an understanding as to how personal values and beliefs influence practice.”

Starting with a detailed outline of FASD, the document then outlines what is involved in FASD Informed practice.  “FASD informed practice includes:

• An awareness that FASD (diagnosed and undiagnosed) is a reality for some participants.
• A strong theoretical and practical understanding of the traits, characteristics, barriers and needs of those affected by FASD.
• A willingness on the part of all staff including administration, reception and frontline workers, to participate in ongoing FASD education and training initiatives.
• Agency policies that accommodate the unique needs of individuals who live with FASD in an effort to make the program fit for participants.
• Reflective practice whereby staff are encouraged to work as a team to debrief and problem solve.
• Service providers’ use of an “FASD lens” to develop strategies and supports on an individual basis according to each participant’s presenting behaviours and assets.
• Trusting relationships between participants and service providers, and a respectful and individualized approach to service delivery that recognizes participants’ strengths.”

The importance of a positive first encounter is stressed. “The first encounter sets a tone for participants and is integral to a positive ongoing relationship.”  Designing service and supports that ensure individual strengths and challenges are considered creates an environment where “participants can experience success, meet expectations of other agencies , and experience a sense of belonging.”

“The most prevalent barriers to FASD informed practice include:

• The lack of understanding of the pervasiveness of FASD especially in marginalized and high risk populations including intergenerational FASD.
• The lack of comprehensive FASD training at all levels (administrative and operational).
• Insufficient resources to accommodate the needs of women who have FASD.
• The misconception that it is too difficult and complicated for workers to have a positive impact on women’s lives when FASD is a factor.
• Stigma and taboos around alcohol use and FASD that can impact staff at all levels.
• Reluctance on the part of staff to participate in dialogue about FASD when there are unresolved personal issues related to FASD.”

The booklet offers suggestions on entering into dialogue around FASD with individual participants and offering supports; approaching the topic of FASD in group settings, particularly in the context of healthy pregnancies; creating agency policies that support FASD informed practice; and taking a strength-based approach in collaborating and partnering with community agencies and services.

Discussion of challenges around participant recruitment and retention stresses the need for building supports such as “reminders, transportation, and hands on assistance with organization”, and suggests the value, ideally, of referees obtaining permission from the potential participant for the service provider to make contact.  “Integrating practices and strategies associated with FASD, trauma informed practice, and harm reduction enhances and encourages retention.”

“Women who have FASD are at greater risk of having their boundaries violated and can become victims of abuse due to difficulty with impulse control and appropriate decision making/good judgment among other FASD related characteristics……Studies indicate that trauma informed practice is effective in supporting women to make positive changes.”  Physical exercise (e.g. laughter yoga and Brain Gym) help in tension release and relationship building.

The Key Principles of Trauma Informed Practice are reviewed, including:

• Trauma awareness and training
• Emphasis on safety and trustworthiness
• Opportunity for choice, collaboration and connection
• Strength-based and skill building

Issues are addressed around safeguarding staff and participants when participants share experience of severe trauma.  There is discussion around introducing culturally appropriate practice as part of a service delivery model “that promotes respect and openness to ongoing learning about diverse cultures.”

The booklet explores how the Harm Reduction model  and the Seven Principles of Harm Reduction can be adapted for work with this particular participant group.  “Support for individuals who have FASD includes reminders, assistance with paper work, transportation and advocacy. Examples of harm reduction strategies/techniques …:

• Reduce isolation: nonjudgmental and supportive programs can provide a safe place for participants to go even if they are currently using.
• Provide access to and support for good nutrition:  have fruit juice and healthy snacks available for participants who drop into the program.
• Support access to needle exchange programs, if available:  this can lead to other positive connections in the community and even a willingness to consider treatment and/or drug maintenance program.
• Support access to birth control… [a range of specific suggestions is given for support workers to utilize in assisting participants in preventing unwanted pregnancies and sexually transmitted infections].
• Reduce the risk of contracting HIV/AIDS, Hepatitis C and other sexually transmitted infections by supporting the use of condoms.
• Support participants to ensure their children are safe if/when they decide to use and/or go out by helping them identify people with whom their children will be safe.
• Assist participants to recognize and remember who in their circles is supportive and who is non-supportive."

A range of strategies are offered for a number of key components in offering individualized support to participants, along with suggestions for service providers in developing reflective practice to provide ongoing review and modification of programs supporting participants with FASD.

There is an extended section on facilitating group sessions, offering practical recommendations and tips for establishing effective group work, including sample worksheets/lesson plans for photocopying and adapting.