There is a great deal happening in the arena of fetal alcohol spectrum disorders (FASDs), especially as pertains to policy development. In just the past few years a number of significant policies related to children with FASDs have emerged as the public and legislators have become more aware of the impact of prenatal alcohol exposure on child outcome.
The federal Adoption and Safe Families Act (ASFA) requires that children reported into the child welfare system undergo concurrent planning for alternate forms of permanency placement beginning at 12 months of age if the birth parent(s) are not making significant progress toward drug and alcohol treatment goals. This legislation is grounded in the knowledge that the key period for brain development related to attachment occurs between 6 months and 3 years of life. During this period of time, an infant requires interactive, nurturing and consistent loving care for appropriate “pruning” (weeding out unnecessary neural connections in the brain) to occur. If a child is bouncing around in the child welfare system, or if a caregiver during this time cannot provide consistent care due to addiction or violence or other issues in the family, the child is at high risk for developing an attachment disorder and other mental health problems long term. ASFA provides a legislative focus for ensuring that by one year of age, children are being raised in an appropriate and consistent environment.
The Child Abuse Prevention and Treatment Act (CAPTA) requires that physicians and other health care providers link to child protection services all children birth to three years of age who appear to have been affected by prenatal exposure to alcohol or illicit drugs. The child welfare system is then responsible for ensuring that the child receives early intervention services through the state’s IDEA program. The purpose of reporting the child to the state’s child protection services is not to remove the child from the birth mother’s custody, but to ensure that the child has access to early intervention services. This legislation is based in research that has demonstrated that identification and intervention for children with FASDs prior to six years of age significantly improves the child’s long-term developmental trajectory. States that recently have been moving toward lodging criminal charges against women who have used drugs during pregnancy or states that have developed policies that encourage removal of the child from the family are simply wrong. Children need to be with their mothers if that mother can provide the nurturing support the child must have. Then both mother and child can receive services that ensure best possible outcome.
The American Bar Association’s recent policy recommendation regarding FASDs states that all court officials and lawyers should be educated about the behavior, development, and mental health challenges of individuals with FASDs. The statement goes further in raising the question as to whether prenatal alcohol exposure should be considered a mitigating factor in adjudication and sentencing. This policy recommendation is based in the neuroscience of FASDs that shows that individuals with FASDs have deficits in neurocognitive functioning, self-regulation, and adaptive behaviors. These deficits translate into the question of affected individuals’ ability to understand the consequences of their behavior, to comprehend the reason for the charges against them, and to participate in their own defense.
I’ve been thinking a great deal about these issues lately as our new film, Moment to Moment: Teens Growing Up with FASDs, gets ready to launch. Through this film, we are attempting to take the science of what is known about alcohol use in pregnancy and translate that information into a story format that can educate the public, professionals, and legislators about adolescents with FASDs.
Film can be an excellent medium for this science transfer. Educational research has shown that in order to enhance the public’s readiness to learn, to accept information, and to change behavior or practice, there are four basic requirements. The first requirement is "social validity.” That is, information is presented in a way that it fits with the viewer’s life and values. By watching the stories of adolescents with FASDs, everyone would agree that they want what is best for the children in the film.
The second requirement is that information be "in the moment." That is, it is easily accessible in the moment it is most important. After the stories pull the viewer into caring about the children, the scientific information that can guide assessment and treatment and promote the long term positive outcome of the child is presented. This link of story to science promotes integration of the information into long-term memory, which in turn will influence decision-making.
The third requirement is "ecological validity." The information is delivered within an environment that is appropriate and non-threatening. Seeing a prevention message while watching a film in libraries, classrooms, and other educational environments, viewers are not going to feel personally affronted or threatened by the information.
The final component, "stakeholder participation," is attained because the viewers are given the opportunity to actively integrate the children’s stories with the scientific facts. Viewers feel in control of retrieving the information, which makes them active learners.
Through use of these four educational strategies, we can impact how a message is perceived, accepted, and perhaps how it can move policy and legislation forward. We have to get smarter about bringing science-based information to the public, avoiding hysteria while guiding complex decision-making and policy development. As policies are implemented, states, communities, and systems need to adhere to the scientific principles behind the policies and avoid reactive and punitive approaches that do not serve the best interests of children and families. Good science makes for good policies.