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Competency 3: Treatment Strategies for Working with Clients with an FASD

Adults

Ways To Modify Facility Treatment Plans and Staff Expectations

Traditional treatment plans tend not to work with adults with an FASD, because their cognitive and social deficits make it difficult for them to process information or participate in groups. Some experts in the field recommend specific modifications.2,4 Programs that work with various groups of adults with an FASD have found that mentoring, with the one-to-one relationship and the development of a personal bond with a trained individual who has knowledge and experience working with those who have an FASD, can be very effective. This relationship helps the person by:

  • Allowing for the development of concrete and consistent rules that will guide behaviors in specific situations
  • Allowing for the development of personal scenarios for the adult to work out responses and practice through role play

One helpful concept is KISS—Keep It Super Simple. One or two goals written simply is a more understandable and effective plan. Focusing on short-term goals also helps, because persons with an FASD have a hard time with abstract concepts such as the future. It also helps to engage the person from the beginning to develop her own strategies. Clients are the experts on their lives. They often know their strengths and interests and can usually identify problems.

Group participation may be difficult for persons with an FASD. They can become overwhelmed by sensory input from large groups, small spaces causing crowding and touching of others, noise, and visual distractions. In addition, they may not be able to process everything in the discussion and can get lost. Printed material may be helpful but should be written at about a grade 4 level with clear nondistracting page layout.

The cognitive dysfunction seen in FASD also makes group participation difficult. The counselor can assist persons with an FASD, or suspected of having an FASD, by making some accommodations:

  • Explain group expectations concretely and repeat these ideas often.
  • If a person monopolizes conversation or interrupts, use a talking stick as a concrete visual reminder of who should be speaking. Hand the stick to the person whose turn it is to speak and pass the stick to others as appropriate.
  • Give the person time to work through material concretely within the group time so he or she may ask questions or you may check understanding of material. He or she may need extra time to process information.
  • Listen for key themes to emerge slowly through the person’s talk and behaviors.

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