Prevention or Intervention?
© 2003 Teresa Kellerman
At my computer, I write articles to help parents raising children with
Fetal Alcohol Spectrum Disorders (FASD). I also write articles to help
professionals who provide services to these individuals and families. And
I publish web pages that offer accurate and up-to-date information for students
and teachers seeking good-quality information that is easy to
understand.
When I am not at my computer, I am out in the field -
advocating for individuals of all ages in the community, attending school
meetings, facilitating support groups, educating legislators, offering
presentations and seminars to professionals in various social service arenas, in
my home state of Arizona and all over the U.S. The rest of the time I am
supervising and mentoring my son, John, who requires 24/7, medications, good
role models, and a structured environment in order to "succeed." (My
definition of success for my son Chris, who is not affected, is to finish
college, get a decent job, and raise a healthy, happy family without going into
debt. My definition of success for John, who has FAS, is to avoid
imprisonment, addiction, homelessness, parenthood, and accidental
death.)
My closest friends are those who are working in the field
with me. Some have suggested that we spend too much time on intervention
strategies and not enough effort is put into prevention programs. Some
feel the need to choose a specific area, and believe the area of greatest
importance is prevention. I cannot disagree. But I believe that
there is more to the big picture of Prevention than most people can perceive,
that is usually only understood by those in the front lines, the families and
individuals themselves.
To me, every intervention strategy is a
prevention strategy as well. Intervention is prevention.
When I give public presentations, I
include a strong component on prevention, but my main focus is on intervention
strategies. I teach educators and other professionals how to recognize the
facial features and behaviors common in children with FAS, but I also teach them
how to recognize the 90% of the FASD population that do not have the physical
characteristics, do not have a diagnosis, and do not receive adequate
FASD-specific services. And I share with them a multitude of intervention
techniques that might prevent some of the more serious secondary disabilities
that often trouble these individuals in their adult years, such as criminal
behavior, mental health issues, suicide, homelessness, joblessness, risky sexual
behavior, and substance abuse.
The high rate of substance
abuse among adults with FASD (50% for the men and 70% for the women), along with
the life-long struggle with poor impulse control and poor judgment, places this
group of individuals at high risk for producing the next generation of babies born
affected by prenatal exposure to alcohol. All the prevention programs in
the world will not keep the young adults with FASD from engaging in unprotected
sex and alcohol consumption. The only adults with FASD that I know who are
NOT engaging in drinking and sexing are those whose families have successfully
applied intervention strategies that I have published (SCREAMS Model).
I see prevention of FASD as a three-fold process: Primary
prevention focuses on educating the general public about the dangers of drinking
during pregnancy. Secondary prevention focuses on assisting treatment
programs to effectively help women with a substance abuse problem who are
pregnant or who have already had a child exposed and/or affected by
alcohol. Tertiary prevention helps individuals already affected to avoid
the serious secondary disabling effects mentioned earlier. The first two
facets of prevention will be limited or unsuccessful unless we understand the
need for the third, which is ultimately necessary to break the cycle of
generational FASD.
Rather than call for more prevention efforts,
perhaps we need to call for more extensive intervention efforts as the basis for
prevention programs. And while we plan our public education and effective
treatment programs, let us not forget that group that is at greatest risk of all
- those already affected in judgment and self-control, who desperately need our
immediate and continued intervention. And I don't mean just those with a
diagnosis of FAS or who have been identified as FASD. I mean the
thousands, perhaps millions, of persons with the invisible effects that we don't
see because we only look at the obvious effects, full FAS (those with short
stature, the FAS "look," and a lower than normal IQ). We miss those who
look normal and have average or above average intelligence, who might be at high
risk, because of their impaired judgment, of falling prey to addiction, crime,
or victimization in some way. Prevention must include intervention for ALL
individuals. Anything else is a disservice to affected individuals and their families, and
a detriment to the future health of our society.
FAS Community Resource Center