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A Closer Look: Q&A with Kathleen Mitchell

Kathy-Mitchell-NOFAS[1]Kathleen T. Mitchell is currently the Vice President and International Spokesperson for the National Organization on Fetal Alcohol Syndrome and a noted speaker/author on Fetal Alcohol Spectrum Disorders (FASD) and Women and Addictions. She founded the Circle of Hope (COH), an international peer mentoring network for women who have used alcohol while pregnant. She discussed this program, as well as the importance of addressing FASD in addiction treatment with us.

Who can screen, assess and diagnose FASD?

Addiction professionals are essential to the prevention of future alcohol-exposed pregnancies.  All professionals can be trained to screen for possible FASD. During the initial assessment, counselors should ask all clients about possible prenatal alcohol exposure. When a patient reports that their mother drank alcohol and likely drank during the pregnancy, then other questions about learning and development should follow. A counselor does not make a diagnosis. A physician, physicians assistant (PA) or a team from a FASD diagnostic center would assess the client and determine the diagnosis. Oftentimes, it is not possible to have a client assessed or diagnosed while in treatment. If a counselor is knowledgable about the behavioral characteristics of FASD, and there was prenatal alcohol exposure, then it would be appropriate for the counselor to assume there may be some learning differences and modify treatment and expectations. The patient should be referred to a knowledgeable physician for an assessment as soon as possible following treatment.

How do you envision FASD screening and education being more effectively integrated into addiction treatment?

The newly revised DSM-V manual will include a new condition related to prenatal alcohol exposure: Prenatal Alcohol Exposure Neurological Disorder (PAEND).  It will be listed as a condition that needs more research. Just having it listed in the DSM should spark more education for clinicians in the addictions and mental health field.

Addiction treatment can integrate FASD into the routine standard of care through some of the following means:

  • Include FASD as a core competency in the curriculum and examinations for all certified and licensed addiction and mental health professionals.
  • Educate all patients (men, women and families) that receive addiction treatment on FASD.
  • Prepare counselors and therapists for the many emotional issues that are experienced by individuals and their families, such as grief, anger towards the birth mother/family, remorse, guilt, shame and blame.
  • Ask women about their alcohol consumption before and after knowledge of pregnancy. If there was exposure, the children should be assessed (and referred to a specialist if possible) for FASD.
  • Include a question about maternal alcohol use in assessments when admitting adolescents and adults into addiction treatment centers. Adolescents and adults should be assessed for possible FASD. Medical directors of addiction centers should be educated about how to diagnose FASD and assess (and refer) for other disorders related to prenatal alcohol exposure.
  • Modify treatment for clients counselors suspect may have a FASD.

Practitioners can contact NOFAS if they are interested in training their staff on FASD identification and treatment.

What resources are in place for children who screen positive for FASD?

FASD is an invisible disorder that is rarely diagnosed. There are FASD diagnostic centers and professionals scattered across the United States. In some communities, it is difficult to locate any provider that is knowledgeable on FASD diagnosis and treatment. A diagnosis can help both children and adults gain understanding and needed services. Please go to the national FASD resource directory at the NOFAS website to locate FASD centers in each state.

Tell us a little about program you founded, Circle of Hope, which supports mothers of children exposed prenatally to alcohol.

You are not alone is the mantra of the Circle of Hope (COH),which was formed in 2004 with a handful of members. Today it has grown to include hundreds of birth mothers from across the world. Members are referred to as “Warrior Moms,” reminding them of their strengths and their important role as their child’s advocate.

The mission of the COH is “to increase understanding and support, and strengthen recovery, for women who drank during pregnancy, and their families.”  The goals are to improve and strengthen the lives of birth families, provide peer support for birth families, and decrease the stigma, blame, and shame that birth families may experience.  Women that contact COH will be connected to a mentor, a woman who has walked a similar path. Members receive periodic COH newsletters, are invited into a private FaceBook site for birth mothers, and are informed about meetings, groups and advocacy opportunities regarding women, substance use and recovery. They become part of an evolving network of women that have become change agents in their communities to support other women and prevent FASD.

For professionals treating a woman who has used alcohol, or other drugs while pregnant, refer them to www.nofas.org/join-the-circle-of-hope/ or email me at NOFAS,

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