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