Getting it right for children with Fetal Alcohol Spectrum Disorders Bob Fraser

1. Getting it right for children with Fetal Alcohol Spectrum DisordersBob Fraser Children’s Rights and Wellbeing Division Children and Families Directorate Scottish Government www.scotland.gov.uk/gettingitright

2. Getting it right for FASD Prevention Detection and diagnosis Management Ready,steady, baby. Health Scotland

3. FASD • Continuum of conditions – wide ranging implications • Person specific • Subtypes and definitions • partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND), alcohol-related birth defects (ARBD), and fetal alcohol effect (FAE). • Impact of individual symptoms differs throughout childhood • Often difficult to confirm diagnosis • Confused with/ mistaken for/ associated with other conditions • ADHD, Attachment Disorder, Autism, ODD, Trauma, Dyspraxia • Often associated with potentially detrimental social circumstances www.scotland.gov.uk/gettingitright

4. Common Symptoms of FASD Poor problem solving skills Short attention span Impulsiveness Difficulties with Maths and Numeracy Anxiety Poor coordination Inappropriate sexual behaviour Inability to concentrate Poor Memory Hyperactivity in childhood Psychiatric problems Social withdrawal Poor language skills Poor reasoning and judgement skills Stubbornness www.scotland.gov.uk/gettingitright

5. Common Strengths Enjoy working with animals Enjoy school Enjoy making things Like structure and routine Loyal friend Fair and cooperative Artistic Enjoy working with computers Hands on learners Musical Likeable Not malicious Enjoy working with mechanical things Friendly Good with younger children Good long term visual memory www.scotland.gov.uk/gettingitright

6. Care and support can appear complex Health Visiting/ School Nursing General practice Paediatrics SLT/ OT/ Physio Learning disability CAMHS and more………. Parents and carers Teachers Support for learning Educational Psychology Social Work Voluntary/ 3rd sector

7. So, what would be helpful…. • Prevention is best, early identification of need and early intervention if prevention not achieved • Someone to support child and family - Single point of contact • Consistent individual, known to family, identifiable by other practitioners, trusting relationship with family, regular contact with family • Focus on outcomes rather than the condition itself • Involving client - children and families in all aspects of assessment & planning • Considering holistic needs • Focusing on achieving an outcome rather than the process to achieve it • Taking an assets based approach – utilising strengths to address pressures • Good communication between all • Common language for communication between all stakeholders • Common approach to assessment and planning by all practitioners • Single integrated plan • Coordination of the Plan in terms preparation, delivery & management • Timely sharing of relevant and proportionate information

8. Key elements of GIRFEC • The right help, at the right time in the right way • Statutory duties to promote, support & safeguard wellbeing • Common Language of wellbeing SHANARRI– • Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible, Included • Child centred and partnership approach • Building on strengths to address pressures • Taking a whole child approach • Named Person – single point of contact • Sharing of relevant and proportionate information • National Practice Model • Assessment, Planning and Action • Single Child’s Plan www.scotland.gov.uk/gettingitright

9. Named PersonPolicy and CYP (S) Act 2014 • Every child and young person to have available a Named Person until 18 • Work within Universal Services • Most commonly Health Visitors and Promoted Teachers • Point of contact for child, parent, professionals & community • Advising, informing and supporting the child, young person or parent providing help to access a service or support • Maintain the child’s record and record any concerns • Take action, involving others as required, to promote, support and safeguard Wellbeing • Will generally instigate a Child’s Plan when required • Discussing or raising a matter with a service provider or relevant authority www.scotland.gov.uk/gettingitright

10. Midwife CHILD’S BIRTH Health Visitor Named Person Health Board Pre-school Local Authority Primary Head/ Depute / Other 18 years or leaving school if later Depute Head Teacher Guidance / Pastoral Care www.scotland.gov.uk/gettingitright

11. The National Practice Model www.scotland.gov.uk/gettingitright

12. Child’s Plan (Statutory) Lead Professional • Child’s Plan required and Lead Professional identified when • Needs out with the scope or capacity of the normal operation of universal services • Often when two agencies are working together however also when multiple services within one agency are delivering services • Is the person best placed to co-ordinate a Child’s Plan & arrange the review of the Plan • Deciding the Lead Professional will be influenced by • Statutory responsibilities • The kind of help a child or family needs • Previous contact or a good relationship with the child

13. Child’s Plan One Child = One Plan • Include Fetal Alcohol Care Pathway • Child at the centre not the condition or circumstances • Coordinated approach to addressing all wellbeing needs • Outcomes focused • Clear responsibility and accountability within a statutory framework • Include the information required by statutory and non statutory plans – • Coordinated Support Plan CSP, looked after children child’s plan, Carers Support Plan CSP, Individualised Educational Programmes IEP, Health Plans, Child Protection Plans, Social Work Plans………… www.scotland.gov.uk/gettingitright

14. Lead ProfessionalKey responsibilities • To ensure that • Children & families are involved & supported • Agencies act as a team& work together seamlessly • Record the Child’s Plan • Wellbeing needs are clearly identified • Appropriate services are provided • The Plan is monitored • The Plan is reviewed www.scotland.gov.uk/gettingitright

15. What does it mean for Children with Fetal Alcohol Spectrum Disorders • Children and families at the centre • Assessment, planning and action from identification of need • Single coordinating point of contact • Shared language across professional groups and organisations • Single assessment framework • Single plan with clear actions, outcomes, responsibilities and timescales • Prioritization and co-ordination of actions • Reduced duplication in assessment, meetings & reviews • Reduced chance of confusion over responsibilities to address needs

16. Summary GIRFEC is a universal approach that should be applied to all children no matter their condition and/ or circumstances The GIRFEC approach is applied throughout the life of a child & young person Children with FASD will benefit from the application of the approach Child’s Plan and Lead Professional are key components of the approach for children with FASD Key elements of GIRFEC policy are in legislation: Definition of wellbeing Provision of Named Person Service Child’s Plan Enforcement of legislation is likely to be from August 2016 www.scotland.gov.uk/gettingitright

17. Questions/ Comments www.scotland.gov.uk/gettingitright

18. Getting it right for every child in context Scotland – Best place in the world for children to grow up Improving Wellbeing Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible & Included Sustained improvement in outcomes through changes in culture, systems and practice • Key Legislation • PB (JW) Act • CYP Act • ASL Act • SDS Act • CE & R Bill • Carers Bill Reporting /planning on promoting, supporting & safeguarding wellbeing – duties under CYP Act Integration Plans (PB (JW )Act) Policies Specific Policies /Initiatives to support Improvement Overarching/ Enablers Getting it right for every child Curriculum For Excellence Early Years Framework Scrutiny • Early Years – • Parenting Strategy • Play Strategy • Early Years Collaborative • Child and Maternal Health • Universal Pathways • Vulnerable Families • FNP • Review of HV • AHPNDP • Looked after C&YP • We can and must do better, • And many more…….. Single Outcome Agreements/ NPF The Improvement Model Annual Review of NHS Local Delivery Plans • Improved Outcomes • Child • Family • Community • Population

19. Named Person Service Systems Infrastructure People Procedures InformationSharing Supporting InformationSharing Contacting other services Help Support Named person Promote Named Help Child/ Young Person Policies Physical entities Processes Advising Person Informing Protocols Requests for help Helping Safeguard Help Sharing Information