Uncovering Maternal Alcohol History: A Stigma-Free Approach

1. STAMPING OUT STIGMA: ESTABLISHING THE MATERNAL ALCOHOL HISTORY OF THE BIRTH MOTHER THROUGH INTERVIEWS AND INVESTIGATION WILLIAM J. EDWARDS, DEPUTY PUBLIC DEFENDER OFFICE OF THE PUBLIC DEFENDER LOS ANGELES COUNTY, CALIFORNIA For training purposes only. Not for distribution without the express permission of author. 01/2017

2. For training purposes only. Not for distribution without the express permission of author. 01/2017

3. For training purposes only. Not for distribution without the express permission of author. 01/2017

4. Specific MEASURES of Alcohol Consumption During Pregnancy • In the United States, England and Canada 20-32% of pregnant woman drink during pregnancy.  • In some European Countries the rate has been found to be as high as 50% ( Study by MAY et al. 2013).  For training purposes only. Not for distribution without the express permission of author. 01/2017

5. Maternal Risk of the Fetus. • Maternal risk of the fetus involves interactions of environmental, biological, familial, cultural customs, historical, social, medical, psychological and psychiatric history ( i.e. depression). Other maternal factors include lack of prenatal care, hormone status, nutritional, socioeconomic status, oxidative stress level, age ,parity and years of drinking. We must consider all these maternal risk factors and INVESTIGATE the quantity, frequency and timing of (QFT) of the alcohol consumption of the birth mother. For training purposes only. Not for distribution without the express permission of author. 01/2017

6. Risk of Developmental Disability • KEEP in mind that Drinking throughout all trimesters increases the odds of having a child born with a developmental disability by 65% over that of a non-drinking birth mother.  • Drinking during only the first-trimester increase the odds 12 times. For training purposes only. Not for distribution without the express permission of author. 01/2017

7. Maternal Alcohol Exposure Documentation and confirmation of prenatal alcohol exposure can be extremely challenging. • Stigmatizing. Stigma isolates people and discourages the birth mother from coming forward for treatment, intervention services and full disclosure of maternal alcohol drinking. • Complicated if mother is still using, especially if at high rates. For training purposes only. Not for distribution without the express permission of author. 01/2017

8. Maternal AlcoholExposure (cont.) • Alcohol use might need to be obtained from other reliable informants. • Often little or no maternal history is available if the client was adopted (either in the US or from a foreign country) or was in foster care. For training purposes only. Not for distribution without the express permission of author. 01/2017

9. Maternal Alcohol Exposure (cont.) • Beyond stigma, birth mothers may wish to conceal PAE because they fear that revealing such information could result in potential loss of parental rights for siblings who have not reached adulthood. If the legal professionals who conduct the interviews is insensitive to these issues, minimization and denial of PAE may result in erroneous conclusions, which will make FASD diagnosis difficult if not impossible.” See Prenatal Alcohol Exposure: An Assessment Strategy for the Legal Context, Brown, Burd, Grant, Edwards, Adler and Streissguth, International Journal of Law and Psychiatry, 2015. For training purposes only. Not for distribution without the express permission of author. 01/2017

10. Maternal Alcohol Exposure (cont.) • Keep in mind that stigma falls into three areas: Blame directly towards the mother. Second stigma towards the child and family. Finally, stigma linked to negative stereotypes about the life path destined for youth with FASD and perceptions that they will fail in school and encounter trouble with the law. • The length of addiction of the birth mother and her age are indicators for exposure of the children. For training purposes only. Not for distribution without the express permission of author. 01/2017

11. MOTHER’S HISTORY For training purposes only. Not for distribution without the express permission of author. 01/2017

12. Risk Factors forMaternal Alcohol Use • Previous child with FAS. • Maternal substance use, polysubstance use • Alcohol use prior to pregnancy. • Single woman. • Smoking. • History of physical and/or sexual abuse. • Mental illness. • Partner or mother’s alcohol use. For training purposes only. Not for distribution without the express permission of author. 01/2017

13. Mother’s History • Keep in mind that the mother may have been involved with other toxic substances such as glue sniffing, drugs and may not have considered alcohol her “drug of choice.” Her medical records may reflect drug use but not the concomitant alcohol use which is usually present. • Some women may not realize there is no safe kind of alcohol, for example, thinking wine/wine coolers don’t count. For training purposes only. Not for distribution without the express permission of author. 01/2017

14. Mother’s History (cont.) • Or they may not realize there is no safe time to drink during pregnancy, from conception (just before they found out they were pregnant) to birth. For example, they may say no because they quit when they found out they were pregnant. • NOTE: Alcohol exposure to the fetus during the first trimester poses the greatest risk for physical changes to brain, body and organ development. i.e. birth defects. The central nervous system (brain) is sensitive to damage throughout pregnancy. For training purposes only. Not for distribution without the express permission of author. 01/2017

15. Mothers Psychiatric History • DOES the birth mother suffer from a mental illness or has she ever been seen by a psychiatrist? • Is there a history of mental illness in the family? • The mother may have a mental illness and cannot afford the prescribed medication and may “self-medicate” with alcohol. For training purposes only. Not for distribution without the express permission of author. 01/2017

16. USE OF DECLARATIONS BY BIRTH MOTHER For training purposes only. Not for distribution without the express permission of author. 01/2017

17. DECLARATION ONVERA .__________. I, Vera .__________., declare as follows: • I am the birth mother of Robert .__________. I was 15 years of age when I became pregnant with R. • When I was 13 years of age I started drinking alcoholic beverages that included mixing whiskey with ale. I would also drink beer by itself. For training purposes only. Not for distribution without the express permission of author. 01/2017

18. Vera (cont.) • I never had any prenatal care until about six months along in my pregnancy. I did not know I was pregnant with Robert until I was about four months along. • During the first four months of pregnancy, I would drink every other day up to four times a week. I would drink mainly whiskey and mix it with beer. I would sometimes consume up to a 2 pint of whiskey every time I drank alcohol. • I would drink until I became intoxicated. For training purposes only. Not for distribution without the express permission of author. 01/2017

19. Vera (cont.) • I would consume up to four drinks every time I drank alcohol. I also would smoke cigarettes. • I would consume alcoholic beverages up to 16 days per month during the first 4 months of pregnancy. • Once I found out I was pregnant I continued to drink occasionally during the remaining term of my pregnancy. I declare under the penalty of perjury that the above is true and correct. For training purposes only. Not for distribution without the express permission of author. 01/2017

20. WHAT HAPPENS WHEN THE MOTHER WON’T TALK? For training purposes only. Not for distribution without the express permission of author. 01/2017

21. David’s Prenatal Exposure asDocumented by Family Member T • During their relationship, [T] has observed the birth mother consume large quantities, three to four 8 oz glasses, of alcoholic beverages (whisky). • She has seen the birth mother drink as little as one glass, but has also seen her drink as much as four glasses per day and considers her to be a “binge drinker”. • During the birth mother’s pregnancy, which was a surprise, her large consumption of alcohol and other drugs remain the same. For training purposes only. Not for distribution without the express permission of author. 01/2017

22. David’s Prenatal Exposure asDocumented by David’s Father • The birth mother and father used to drink a lot of beer and whiskey, but mainly whiskey. • Their consumption was estimated to be approximately 6 six-ounce glasses a day on the low side, to as much as 3 pints or more per day. • The pregnancy, although not planned, was a welcome surprise. Prior, during and after her pregnancy, Katherine’s drinking remained the same. For training purposes only. Not for distribution without the express permission of author. 01/2017

23. CLIENT HISTORY For training purposes only. Not for distribution without the express permission of author. 01/2017

24. Client’s History • Previous Diagnosis May Have Been Incorrect or Incomplete • Antisocial personality disorder. • ADHD/ADD - placed on Ritalin. • Speech and language handicaps. • Learning disabilities. • Behavioral problems, ODD, RAD, Conduct Disorder and/or Mood Disorder. For training purposes only. Not for distribution without the express permission of author. 01/2017

25. Birth Records • Look at the weight, height (length) and head circumference of the child. Examples: • In one case my client was born with cocaine in his system and a social worker was called to interview the mother. • In another case my client was hospitalized because he had lost so much weight at birth-”Failure To Thrive.” For training purposes only. Not for distribution without the express permission of author. 01/2017

26. Client’s Educational Records • All academic and attendance records. • Special education records including eligibility and placement reports (many kids qualify for more than one category). • All IEP reports (goals and accommodations). • (Investigate the parent’s failure to follow up with the IEP meetings to request the required services for the client). • Was there any IQ testing completed. For training purposes only. Not for distribution without the express permission of author. 01/2017

27. Juvenile Court/Juvenile Delinquency Records • Get all juvenile delinquency records. • All social services reports, psychological records. • If the client was incarcerated you will need to get all educational records, social histories. For training purposes only. Not for distribution without the express permission of author. 01/2017