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VOLUME 32 • NUMBER 2 • 2020 AOTEAROA NEW ZEALAND SOCIAL WORK
ORIGINAL ARTICLE
THEORETICAL RESEARCH
CORRESPONDENCE TO:
Vanessa Oatley
veeoatley@gmail.com
AOTEAROA
NEW ZEALAND SOCIAL
WORK 32(2), 5–16.
FASD overview: Defi nition,
diagnosis, and prevalence
It is now universally accepted in the
research literature that exposure to alcohol
during pregnancy is the leading cause
of permanent neurological impairment
to the developing brain, and that it has
significant and lifelong impacts (Astley,
2011; Crawford, 2018; Enns & Taylor, 2018).
The term fetal alcohol spectrum disorder
(FASD) is the currently accepted diagnostic
term to capture the broad spectrum of
presentations that can occur as a result
Improving treatment and outcomes for
young people with fetal alcohol spectrum
disorder in the youth justice system:
A social work led response and practice
framework
ABSTRACT
INTRODUCTION: Young people with fetal alcohol spectrum disorder (FASD) in Aotearoa New
Zealand are both primed for, and hindered within the youth justice (YJ) system. This research
provides a fresh perspective on how social workers can take a lead role in ensuring young
people with FASD receive neurodevelopmentally appropriate interventions both within the YJ
system and upon return to their communities.
METHODS: A systematic literature review of secondary data was undertaken to explore
themes, including the connection between the impacts of FASD and risk of contact with the YJ
system; how FASD affects the young person’s ability to navigate the YJ system; best practice
recommendations to ensure just treatment for young people in the YJ system; and the potential
for social work to take a lead role in improving treatment and outcomes for young people with
FASD in the YJ system.
FINDINGS: Key findings include the confirmation of the link between young people with
FASD and the YJ population; consistent best practice recommendations for treatment and
interventions; and a clear positive relationship between the social work mandate and the
implementation of the recommended treatment for young people with FASD who have had
contact with the YJ system.
PRACTICE IMPLICATIONS: Based on the research findings, an FASD-informed practice
framework has been developed as a tool to guide social workers who are working with young
people with FASD in the Aotearoa New Zealand YJ system and beyond.
KEYWORDS: Fetal alcohol spectrum disorder; FASD; youth; rangatahi; youth justice; social work
Vanessa Oatley and Anita Gibbs, University of Otago, New Zealand
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of damage to the central nervous system
due to pre-natal alcohol exposure (PAE)
(Carpenter, Blackburn, & Egerton, 2014;
Cook et al., 2016; Enns & Taylor, 2018). The
term FASD has replaced other commonly
used descriptors such as fetal alcohol
syndrome (FAS), partial fetal alcohol
syndrome (pFAS), and alcohol-related
neurodevelopmental disorder (ARND).
The primary physical, social, cognitive,
and behavioural impairments of FASD are
well documented and largely agreed upon
by researchers and professionals (Mattson,
Crocker, & Nguyen, 2011; Streissguth &
O’Malley, 2000), as is the understanding
that different impairments present at
different developmental stages throughout
the lifespan (Carpenter et al., 2014; Salmon,
2014). These primary impairments are
highly likely to lead to secondary conditions
during the lifespan of those with FASD,
which might include school exclusions,
trouble with the law, mental health issues,
care experience, substance misuse and
suicide attempts (Streissguth et al., 2004).
The task of gaining a firm diagnosis of
FASD is complicated by the myriad of
presenting primary impacts (Chudley,
2018), as well as the similarity of the FASD
phenotype to other disorders such as
attention deficit hyperactivity disorder,
autism, attachment disorder, dyspraxia,
learning difficulties, auditory and visual
processing issues, and conduct disorder
(Brown & Mather, 2014; Gibbs & Sherwood,
2017). Despite these evident hurdles, the
importance of a sound diagnosis of FASD
cannot be overstated. From a public health
perspective, diagnostic misclassification
can lead to inaccurate data collection
regarding the incidence and prevalence of
FASD, thus limiting appropriate resourcing
and reducing reliability of measurement
data based on prevention efforts. From
a clinical perspective, misdiagnosis can
generate inappropriate interventions,
and ignore the potential development of
secondary risk factors (Astley, 2011; Brown
& Mather, 2014).
The best tool for identifying FASD in any
child or young person is an accurate history
of maternal prenatal alcohol consumption
(Chudley, 2018; Cook et al., 2016). In the
absence of a PAE history, a diagnosis
can be assigned when the specific facial
phenotype is evident (short palpebral
fissure—small eyes, smooth philtrum, and
a thin vermillion border on the upper lip):
the presence of this unique facial phenotype
confirms that an individual was affected,
at least in part, by PAE (Astley, 2011). It is
important to note, however, that occurrence
of all three sentinel facial features have been
evidenced in less than 4% of diagnosed
cases of FASD (Clarren et al., 2015).
In Aotearoa New Zealand, there is a clinical
consensus to use the Canadian guidelines
of Cook et al. (2016) in the absence of a
unique national set. Canadian guidelines
require severe central nervous system
impairment in a minimum of three of these
domains: “motor skills; neuroanatomy;
neurophysiology; cognition; language;
academic achievement; memory; attention;
executive function, including impulse
control and hyperactivity; affect regulation;
and adaptive behaviour, social skills or
social communication” (Cook et al., 2016,
p. 193). Diagnosis requires the young
person to undertake a medical examination
(Cook et al., 2016) followed by a
neurodevelopmental assessment utilising a
multi-disciplinary approach with a team of
professionals from a variety of disciplines,
including any of the following: medicine,
psychology, developmental paediatrics,
speech-language, occupational therapy,
education, and social work (Chudley, 2018;
Cook et al., 2016).
Prevalence rates of FASD are a source
of vigorous debate due to the complex
nature of the diagnostic process, the lack
of collected or recorded data, and the
potential for misdiagnosis (Carpenter et
al., 2014). The most recent study out of the
United Kingdom by McQuire et al. (2019)
(n = 13,495) estimated FASD screening
prevalence of between 6% and 7.2%,
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and the most recent American research by
May et al. (2018) (n = 13,146) peaks at 9.9%.
Aotearoa New Zealand has no established
prevalence data, thus international
prevalence estimates are generally applied
(Connor & Casswell, 2012; Crawford, 2018;
Gibbs & Sherwood, 2017). These estimates
are most likely very low as Fitzpatrick et
al. (2017) points out—higher prevalence
of FASD occurs in communities where
binge drinking, poverty, and geographical
isolation intersect. This creates somewhat
of a perfect storm in Aotearoa New
Zealand—a geographically isolated
country, with clear pockets of poverty
and deprivation, and a binge drinking
culture that continues to pose serious risks
to society (Cheung, Timmins, & Wright,
2015; Mallard, Connor, & Houghton, 2013;
Salmon, 2014).
If we take the lowest range of the United
Kingdom FASD prevalence data of 6% and
apply it to Aotearoa New Zealand, then
around 3,600 children affected by PAE
would be born each year. Given that it is
widely acknowledged that FASD is under-
recognised and PAE is under-reported
(Connor & Casswell, 2012; Crawford, 2018;
Rogan & Crawford, 2014), the final figure
of births affected by PAE in Aotearoa New
Zealand could be substantially higher than
international norms.
Primed for the youth justice system
Young people with FASD are predisposed
to a broad range of difficulties, the
dominant issue for adolescents being the
general impairment in adaptive functioning
that occurs through a combination of
deficits in both executive functioning and
social cognition, and presents as cognitive
and neurodevelopmental sequelae that can
lead to contact with the YJ system and affect
interactions within the system (Bower et al.,
2018; Crawford, 2018; Killingley, 2014).
Deficits in executive functioning such as
impaired memory, and difficulty composing
rational, logical thoughts (Brown & Mather,
2014; Gibbs & Sherwood, 2017; Lynch, 2016)
can manifest as poor judgement, a lack
of understanding of cause and effect, or
actions and consequences, and confusion
over abstract concepts such as ownership
and time (Egerton, 2014; Fast & Conry, 2004;
Gibbs & Sherwood, 2017; McIver, 2010b).
These difficulties can result in offending
behaviour that can seem illogical to the
bystander, and the young person may
struggle to understand the seriousness of a
situation (McIver, 2010b).
Poor impulse control and emotional
lability are also associated with FASD
and can contribute to young people
finding themselves in trouble with the
law (Fast & Conry, 2004; Killingley, 2014;
McIver, 2010b). It does not require much
imagination to conceive of the potential
for criminal behaviour when you couple
an inability to control impulses with poor
habituation, often presenting as rapid
swings in mood (Salmon, 2014). Add to
that a heightened fight or flight response in
high stress situations (Killingley, 2014), a
tendency to sensory overload (Lynch, 2016;
McIver, 2010b) and susceptibility to adverse
psychosocial influences such as peer
pressure (Crawford, 2018; Egerton, 2014;
Hughes & Peirse O’Byrne, 2016; Salmon,
2014) and it is clear that young people with
FASD have increased vulnerability for
involvement in the criminal justice system.
In addition, the propensity to confabulate
associated with FASD can lead young
people to construct fanciful fabricated
stories, sometimes combining real events
with memories or ruminations (Brown &
Mather, 2014) and to be highly suggestible,
tending to acquiesce and adjust their
responses according to external feedback
(Brown, Gudjonsson, & Connor, 2011;
Killingley, 2014). This high level of
suggestibility can result in false confessions
and young people being wrongly convicted
(Killingley, 2014).
Pei, Leung, Jampolsky, and Alsbury (2016)
highlight the double jeopardy for young
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people with FASD where vulnerabilities
such as social stigma; exclusion from
education; and lack of support in health and
welfare systems (Egerton, 2014; Gibbs &
Sherwood, 2017; Hughes & Peirse O’Byrne,
2016; Mattson et al., 2011) are compounded
by adverse environmental factors such as
a history of abuse; disrupted education;
poverty; contact with the state care system
and complex trauma (Bower et al., 2018;
Fast & Conry, 2009; Hughes, Williams,
Chitsabean, Davies, & Mounce, 2012;
Walker, 2018). Added to these, youth with
FASD often have comorbid diagnoses of
mental health issues including depression,
anxiety, ADHD, conduct disorder and
alcohol and drug addiction (Fast & Conry,
2009; Salmon, 2014).
In Aotearoa New Zealand, the intersection
between the FASD population and the YJ
population is largely acknowledged (Gibbs
& Sherwood, 2017; Lynch, 2016; Rogan &
Crawford, 2014; Salmon, 2014); however,
there have been no local prevalence studies
undertaken to date (Lynch, 2016; Rogan &
Crawford, 2014). One of the most commonly
cited studies into the prevalence of FASD
in the justice population was undertaken
by Fast, Conry, and Loock (1999) (n = 287)
in a Canadian youth forensic psychiatric
unit. The study found that 23.3% of the
participants had evidence of FASD. Hughes
et al. (2012) also completed an extensive
report on the prevalence of neurodisability
in young people who offend, and identified
prevalence rates in the range of 10.9–11.7%
(Hughes & Peirse O’Byrne, 2016). A
more recent study by Bower et al. (2018)
undertaken in Western Australia (n = 99)
found that 36% of the young people
assessed had FASD. The three studies
outlined here demonstrate extremely high
ratios of justice system contact for young
people with FASD when compared to the
general population.
Hindered within the YJ system
There are multiple areas of concern
regarding the possible treatment and
outcomes for young people with FASD
within the current Aotearoa New Zealand
YJ system. Firstly, the literature is clear that
there is limited understanding of FASD
across the entire YJ system, including
police, judges, legal professionals, and
social workers (Fast et al., 1999; Gralton,
2014; Lynch, 2016; Townsend, Hammill,
& White, 2015). There is a continued
reliance on traditional assumptions about
young offenders’ behaviour which does
nothing to account for neurodevelopmental
impairments such as FASD (Fitzgerald,
2015; McIver, 2010b). This lack of
knowledge is further exacerbated by a lack
of collaboration between services including
justice, health, social development and
education (Lynch, 2016).
The second area of concern is the use of
youth detention or custodial placements.
Without well informed professional
guidance, custodial placements can leave
young people: struggling to understand
the rules, being open to victimisation,
exploitation, and abuse, and susceptible
to the negative influences of their peers
in an effort to fit in (Fast & Conry, 2009;
Gralton, 2014; Lynch, 2016). Likewise, being
held for any duration in police custody or
solitary confinement can aggravate FASD
presentations, particularly from a sensory
perspective with bright lights and small
lock-up rooms causing additional stress
(Lynch, 2016).
The strict sanctions and punitive measures
widely employed in the justice system
present another problematic area as
they are considered to be ineffective for
young people with FASD (Fitzgerald,
2015; Gralton, 2014; Lynch, 2016).
Such approaches assume the brain can
understand the concept of consequences,
along with cause and effect; in short, they
assume the young person with FASD can
learn their lesson when in many cases the
deficits in executive functioning derail
that assumption (Gralton, 2014; Lynch,
2016). Whilst it is essential to ensure young
people are held accountable for harm to
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the victims of their crimes (Lynch, 2016),
critical to the pursuit of this accountability
is tailoring the response to reflect the
presence of neurological impairment (Fast
& Conry, 2009).
The dominant use of diversion and FGCs
in the Aotearoa New Zealand YJ system
poses significant risks for young people
with FASD (Fitzgerald, 2015). Decisions
about diversion and at FGCs are often
made without any legal representation for
the young person, and in the case of FGCs,
there is a reliance on the young person’s
ability to understand what is expected of
them, communicate their needs, avoid the
inclination to confabulate, and effectively
communicate remorse to victims and
families (Lynch, 2016). The preference for
diversion and FGCs over formal court
appearances can in some cases signal
a missed opportunity for engagement,
diagnostic screening, and FASD assessment
(Lynch, 2016).
Language plays a fundamental role in the
legal system both in written and oral forms
and young people with FASD often present
with language deficits (Tavioni-Pittman &
Marsh, 2017). Delayed language processing
and comprehension can leave young people
vulnerable to manipulation and entrapment;
inability to communicate can draw incorrect
assumptions from observers, such as
interpreting short answers or no response as
petulance, or conversely if the young person
with FASD is superficially articulate (Brown
& Mather, 2014). These factors can lead to
false assumptions about overall competence
and reduce opportunities for assistance
(Tavioni-Pittman & Marsh, 2017).
Best practice treatment
recommendations and desired
outcomes
Several key recommendations that could
be adopted to improve treatment and
consequently outcomes for young people
with FASD in the YJ system emerged from
the research.
Many commentators cite a lack of
knowledge of the impacts of FASD as a
barrier to optimal service provision (Bower
et al., 2018; Fitzgerald, 2015; Killingley,
2014; Pei et al., 2016), and suggest a focus
on building a skilled and supported
workforce through training, education,
and professional development, as well as
provision of appropriate resources (Bower
et al., 2018). Raising the profile of FASD
within the Aotearoa New Zealand YJ
system would increase the possibility of
FASD characteristics being identified and
the necessary accommodations being made
(Lynch, 2016; Pei et al., 2016).
Experts in the FASD YJ field argue for
mandatory comprehensive screening for
neurodevelopmental impairment of all
youth in contact with the justice system in
Aotearoa New Zealand (Fitzgerald, 2015;
JustSpeak, 2012; Lynch, 2016). Diagnostic
screening would identify individuals who
are suspected of having FASD and enable
them to be referred for comprehensive
diagnostic assessment. Closely linked to
diagnostic screening is the recommendation
to employ vigorous methods of evaluation
of both the capacity and culpability of
young people with FASD (Fitzgerald, 2015;
Hughes & Peirse O’Byrne, 2016; Longstaffe
et al., 2018). Fitzgerald (2015) contends that
the best way to uphold the interests of both
the community and the victims affected by
youth crime is to identify the true impetus
for the offending behaviour and address
this fully in order to prevent reoffending.
In the case of FASD, evaluations need to be
person-specific, include potential risks and
protective factors, with sentencing linked to
each individual’s capacity and culpability
(Fast & Conry, 2009; McIver, 2010a).
Taking a long-term, individualised view
of the treatment, planning, and support of
young people with FASD in the YJ system
is critical to successful outcomes. Planning
should be strengths based and done in
tandem with the young person
and their parents or caregivers to ensure
client direction, voice, and ownership
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(Longstaffe et al., 2018). Community based
capacity and support networks need to be
developed with the young person in mind
and professional networks of services need
to be coordinated and available outside the
justice setting (Brown, Connor, & Adler,
2012). This wrap-around support and
coordinated service delivery should benefit
not only the young person, but the parents
or caregivers, and the wider community
(Crawford, 2018; Lynch, 2016).
Both the overrepresentation of Māori youth
in justice statistics (Becroft, 2017; Walker,
2018) and a commitment to te Tiriti o
Waitangi call for Aotearoa New Zealand
responses to young people with FASD in the
YJ system to be aligned with a te ao Māori
approach, to recognise the significance of te
reo Māori, and to incorporate Māori models
of practice (Crawford, 2018). Durie (2001)
reminds us that whānau- or caregiver-
based interventions play an essential part
in culturally responsive work with Māori
and that whānau is not limited to blood
relatives, thus individuals with a close
connection to the young person should
also be included in the whānau network
(Crawford, 2018).
Why social work?
In Aotearoa New Zealand, social workers,
across both State agencies and NGOs, work
extensively with youth with FASD, even
when diagnoses may not have occurred.
The research indicates that approximately
50% of children and young people in the
care of Oranga Tamariki are affected by
FASD (FASD Working Group, 2016). It is
highly likely that young people with FASD
who are in contact with the YJ system have
been subject to interventions from social
services throughout their young lives,
with social workers playing a key role in
many of these interactions and holding a
uniquely privileged view across a young
person’s environments (Badry & Choate,
2015). Furthermore, in many cases, the
social worker will have an established
position and relationship in the lives
of young people with FASD and their
families or caregivers (Badry & Choate,
2015; Popova, Lange, Bekmuradov, Mihic,
& Rehm, 2011). It is therefore important
that social workers respond and work
appropriately with youth who have, or are
suspected to have, FASD.
The International Federation of Social
Workers (IFSW, 2014) provides this
definition of social work:
Social work is a practice-based profession
and an academic discipline that promotes
social change and development, social
cohesion, and the empowerment and
liberation of people. Principles of
social justice, human rights, collective
responsibility and respect for diversities
are central to social work. Underpinned
by theories of social work, social sciences,
humanities and indigenous knowledge,
social work engages people and
structures to address life challenges and
enhance wellbeing. (para. 1)
There are clear markers within this
international definition that point towards a
natural fit between the social work mandate
and the work required with young people
with FASD in the YJ system.
The obligation to promote “social change
and development, social cohesion, and
the empowerment and liberation of
people” (IFSW, 2014, para. 1) aligns with
the recommendation to raise the profile
of FASD through training and education
(Fitzgerald, 2015; Gibbs et al., 2020;
Longstaffe et al., 2018). The commitment
to uphold the “principles of social justice,
human rights, collective responsibility and
respect for diversities” (IFSW, 2014, para.
1) demands that social workers view FASD
within the recommended human rights,
indigenous rights, and disability rights
frameworks (Townsend et al., 2015).
The presence of “collective responsibility”
(IFSW, 2014, para. 1) within the definition
speaks to the notion of collaboration
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with multi-disciplinary teams, the young
person, and the family or caregivers, from
assessment to diagnosis to treatment
both within the YJ system and across the
lifespan (Astley, 2011; Chudley, 2018; Cook
et al., 2016; Lynch, 2016; McIver, 2010b).
Further, the call to “engage people and
structures to address life’s challenges and
enhance wellbeing” (IFSW, 2014, para. 1)
would clearly benefit young people and
their families who are experiencing the
challenges of living with FASD whilst
simultaneously navigating the YJ system.
The professional mandate of the social
worker demands that they engage with,
advocate for, and appropriately resource
young people to address the challenges
presented by their neurodevelopmental
disability.
In addition, the code of ethics of the
Aotearoa New Zealand Association of
Social Workers (ANZASW, 2015) provides
further indicators to substantiate the
hypothesis that social work would be well
placed to take a lead role in improving
treatment and outcomes for young people
with FASD within the YJ system. The first
ethical responsibility outlined is for a te
Tiriti o Waitangi based society, and the
key aspects as they relate to rangatahi with
FASD and their whānau or caregivers are:
ensuring that, at all times, the imposition
of mono-cultural values and concepts are
avoided; promoting the use of Tāngata
Whenua social work models of practice;
and being actively anti-racist (ANZASW,
2013). Given the overrepresentation of
Māori youth in justice statistics (Becroft,
2017; Walker, 2018) it is self-evident that
social workers working with rangatahi
with FASD and their whānau or caregivers
in the YJ system need to be determinedly
practising to protect the integrity of
Tāngata Whenua.
An ethical responsibility to the wider
community is also part of the social work
mandate (ANZASW, 2013), specifically
the principles of inclusion and choice for
all members of society, with particular
regard for disadvantaged minorities,
including preventing discrimination
based on psychological and physical
abilities (ANZASW, 2013). A further
component of this ethical obligation
addresses the need to promote the fair
allocation of community resources
(ANZASW, 2013), and provides a strong
basis for the argument for increased
diagnostic tools and screening processes,
along with adequately resourced support
systems. The ethical obligation to clients
within the ANZASW code clearly outlines
the responsibility of the social worker
to respect the dignity and worth of each
individual client, to protect the client’s
rights and welfare and to encourage
self-determination (ANZASW, 2013),
all of which underpin one of the key
recommendations for individualised,
inclusive, long-term, strengths-based
practice (Badry & Choate, 2015; FASD
Working Group, 2016; Malbin, 2002).
The above discussion has clearly outlined
the expectations of the social worker,
both by definition and from an ethical
standpoint, as well as highlighted the
existing role that social workers play in
the lives of many families affected by the
impacts of FASD. It is clear that a social
work led response which incorporates
best practice for, and treatment of, young
people with FASD in the YJ system could
ameliorate many of the negative impacts
of the current YJ system and improve
outcomes overall.
Using an FASD-informed practice
framework for social work in the
youth justice system
There is an old adage that proclaims theory
without practice is meaningless, but practice
without theory is blind. It is this sentiment
that provides the impetus for the creation of
a theoretical practice framework (Figure 1)
to scaffold the how to of social work taking
a lead role in improving treatment and
outcomes for young people with FASD in
the YJ system.
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This practice framework is underpinned by
dual theoretical perspectives, the strengths
perspective as prescribed by Saleebey (1997),
and the ecological systems approach as
recommended by Ungar (2014). Employing a
strengths-based theoretical perspective is an
attempt to ameliorate the deficit focus which
is particularly apparent in the YJ system
where young people are often considered
naughty, wilful, and delinquent (Egan &
Craik, 2016). The ecological systems approach
ensures that the response to FASD within
the YJ system focuses on the young person
within their environment (Ungar, 2014).
The social work commitment to te Tiriti
o Waitangi is a fundamental expectation
of all social work professionals and a
critical underpinning principle of this
framework. The partnership founded
in te Tiriti o Waitangi calls for all social
workers to demonstrate indigenous and
bicultural practices in their work. Social
work professionals are provided with
the Kaitiakitanga framework (Tāngata
Whenua Voices in Social Work, 2016)
which informs the assessment of a social
workers competence to work with Tāngata
Whenua. Competency is assessed through
the demonstrated application of three
applied principles—te rangatiratanga; te
manaakitanga; and te whanaungatanga
(Tāngata Whenua Voices in Social Work,
2016). It is beyond the scope of this work
to detail fully the Kaitiakitanga framework
principles, however, it is implied that
the principles are embedded within the
execution of this theoretical practice
framework.
Another key component of the theoretical
practice framework includes the personal
attributes the social worker brings to the
work. The research based personal attributes
necessary to work effectively within the
FASD-affected community have been
summarised as authenticity; acceptance;
persistence; maintaining a hopeful outlook;
being compassionate (Matua Raki, 2019); and
thinking creatively (Badry & Choate, 2015;
Malbin, 2002).
Like other local and international
frameworks for working with individuals
and families with FASD, this FASD-informed
practice framework highlights the role of the
social worker as an agent of change (Bagley,
2019; Gibbs et al., 2020) and identifies four
key skills components for the social worker
to incorporate into work alongside young
people with FASD.
The first key skills component is to generate
a shared understanding of FASD and its
presentations within the YJ system and beyond. A
recurring theme throughout the literature has
been FASD-based knowledge dissemination
(Bagley, 2019; Bower et al., 2018; Fitzgerald,
2015). Implementation of training, education,
and knowledge sharing will increase
awareness of FASD as a neurological
disability with behavioural symptoms, and
contribute to minimising the stigma attached
to FASD, debunking common myths, and
resulting in a better understanding of the
causes of youth offending.
Figure 1. FASD-informed practice framework for social work in the YJ system.
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The second key skills component focuses
on the development and implementation of
diagnostic screening tools and advocating for
formal diagnosis in suspected cases of young
people with FASD within the YJ system. The
research findings clearly identified the
issue of the high numbers of undiagnosed
or misdiagnosed young people with FASD
in the YJ system (Gralton, 2014; Killingley,
2014; Popova et al., 2011) and, despite the
implementation of screening tools being a
key recommendation within the literature
on best practice, Aotearoa New Zealand
currently has none. It is clear that this is an
area that needs addressing with urgency.
Once a suspected case of FASD is reported,
the social worker will likely be required to
advocate for a formal diagnosis for the young
person. In the advocacy role it will be essential
for the social worker to be able to evidence the
reasons why a diagnosis is important as they
may encounter push-back from professionals
who either believe that a confirmed diagnosis
will only increase the impact of stigma (Payne
et al., 2011; Tough, Clarke, & Hicks, 2003) or
see little point in a diagnosis that has either
minimal or no resourcing attached (Crawford,
2018). Ironically, this lack of resourcing is
directly related to the paucity of formally
diagnosed cases of FASD (Astley, 2011).
The third key skills component is to build
relationships and foster collaboration; both
across disciplines and alongside young people
with FASD and their families or caregivers.
This collaborative approach is widely
recommended in the literature (Bagley,
2019; FASD Working Group, 2016; Gibbs
et al., 2020; Lynch, 2016; Matua Raki, 2019)
and places an emphasis on all stakeholders
involved. This is the social worker’s
opportunity to implement a collaborative
case-management approach, coordinating
the various speciality services, along with
input from the young person, family or
caregiver to navigate the critical nexus
between assessment and action (Badry &
Choate, 2015). Employing a collaborative
approach enables the social worker to
build working relationships that ensure
consistency; access collective wisdom to
develop a robust and appropriate plan;
acknowledge young people and families
as experts in their own lives; and more
effectively and appropriately wrap support
around young people with FASD, and their
families (Gibbs et al., 2020).
The final key skills component is developing
individualised, strengths-based, creative
and long term treatment and support plans
with the young person with FASD and their
family or caregivers firmly at the centre. It is
recognised throughout the literature that
the conversation around young people
with FASD remains stubbornly focused on
containment strategies, be they physical,
diagnostic, behavioural, or epidemiological
(Badry & Choate, 2015). This key skills
component redirects that conversation
and bases the planning firmly around the
strengths and challenges of each individual
young person (Badry & Choate, 2015; FASD
Working Group, 2016; Malbin, 2002).
The FASD-informed practice framework aims
to support the social worker to achieve the
desired outcomes: avoiding recidivism by
prioritising rehabilitation and reintegration
(Gibbs & Sherwood, 2017; Lynch, 2016;
Popova et al., 2011); enhancing the wellbeing
and life chances of the young person with
FASD (Ontario Centre of Excellence for
Child and Youth Mental Health, 2016); and
subsequently improving overall community
safety (Fitzgerald, 2015; Lynch, 2016).
It is important to note that the practice
framework is untested and, although based
on international frameworks and evidence-
based best practice recommendations, it
requires field testing and assessment to
ensure praxis can occur.
Conclusion
It has been established that working
with young people with FASD within
the YJ system is complex, cross-sector
work, however, a clear connection has
been drawn between the social work
14 VOLUME 32 • NUMBER 2 • 2020 AOTEAROA NEW ZEALAND SOCIAL WORK
THEORETICAL RESEARCH
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professional mandate and the best practice
recommendations for the treatment of young
people with FASD in the YJ system. This
connection provides sufficient evidence to
conclude that a social work led response
could make a significant positive difference
to the treatment and outcomes for young
people with FASD involved in the YJ system
by assisting young people, their families
or caregivers and other professionals to
navigate the complex terrain that unfolds
as a product of invisible disability (Badry &
Choate, 2015; Gibbs et al., 2020).
In the last 20 years, awareness of FASD
has increased exponentially with the brave
and dedicated work of a number of key
stakeholders: professionals, and families
and caregivers (Gibbs & Sherwood,
2017). Despite this increase in awareness,
FASD remains a highly complex and
underacknowledged issue in Aotearoa New
Zealand (Badry & Choate, 2015) and there
is a clear need for more research in this area
(FASD Working Group, 2016).
In addition to the practical work at the
coalface for social workers, a broader
theme emerged from this research. This
overarching theme captures the need for a
paradigm shift when working with young
people with FASD (Gillen & Dubovsky,
2012; Malbin, 2002; Walker, 2018). If we are
to avoid further injustice for young people
with FASD, we must ensure that each
individual young person is able to engage
in a neurodevelopmentally appropriate way
in the whole YJ process. We must move
away from the focus on the young person
with FASD as the problem, and support
exchanges within the YJ system that consider
the wider internal and external impacts on
each individual young person. Working
towards the fulfilment of these goals is
where social workers can play a lead role to
support young people with FASD in the YJ
system to reclaim a more positive future.
Accepted 14 April 2020
Published 1 August 2020
References
Aotearoa New Zealand Association of Social Workers.
(2015). The code of ethics of the Aotearoa New Zealand
Association of Social Workers. Retrieved from
https://anzasw.nz/wp-content/uploads/COE-for-website-
chapter-3.pdf
Astley, S. J. (2011). Diagnosing fetal alcohol spectrum
disorders (FASD). In S. A. Adubato & D. E. Cohen
(Eds.), Prenatal alcohol use and fetal alcohol spectrum
disorders: Diagnosis, assessment and new directions in
research and multimodal treatment (pp. 3–29). Retrieved
from http://depts.washington.edu/fasdpn/pdfs/astley-
FASD-chapter2011.pdf
Badry, D., & Choate, P. (2015). Fetal alcohol spectrum
disorder: A disability in need of social work
education, knowledge and practice. Social Work
and Sciences Review, 17(3), 20–32. Retrieved from
https://cwrp.ca/publications/fetal-alcohol-spectrum-
disorder-disability-need-social-work-education-
knowledge-and
Bagley, K. (2019). Responding to FASD: What social and
community service professionals do in the absence of
diagnostic services and practice standards. Advances
in Dual Diagnosis, 12(1/2), 14–26. Retrieved from
https://www.emeraldinsight.com/doi/abs/10.1108/
ADD-05-2018-0007
Becroft, A. (2017). Fulfilling the vision: Improving family
group conference preparation and participation.
Retrieved from http://www.occ.org.nz/publications/
reports/state-of-care-2017-family-group-conferences/
Bower, C., Watkins, R. E., Mutch, R. C., Marriott, R.,
Freeman, J., Kippin, N. R., … Giglia, R. (2018).
Fetal alcohol spectrum disorder and youth justice: A
prevalence study among young people sentenced
to detention in Western Australia. BMJ open, 8(2),
1. Retrieved from https://www.ncbi.nlm.nih.gov/
pubmed/29440216
Brown, J., & Mather, M. (2014). Foetal alcohol spectrum
disorders: Parenting a child with an invisible disability.
Oxford, UK: FASD Trust.
Brown, N., Connor, P. D., & Adler, R. S. (2012). Conduct-
disordered adolescents with fetal alcohol spectrum
disorder: Intervention in secure treatment settings.
Criminal Justice and Behavior, 39(6), 770–793.
Retrieved from https://journals.sagepub.com/doi/
abs/10.1177/0093854812437919
Brown, N., Gudjonsson, G., & Connor, P. (2011).
Suggestibility and fetal alcohol spectrum
disorders: I’ll tell you anything you want to
hear. Journal of Psychiatry Law, 39(1), 39–72.
Retrieved from https://journals.sagepub.com/doi/
abs/10.1177/009318531103900103
Carpenter, B., Blackburn, C., & Egerton, J. (2014). A
brief introduction to fetal alcohol spectrum disorders.
In B. Carpenter, C. Blackburn, & J. Egerton (Eds.),
Fetal alcohol spectrum disorders: Interdisciplinary
perspectives (pp. 3–13). Routledge.
Cheung, J., Timmins, J., & Wright, C. (2015). Patterns and
dynamics of alcohol consumption during pregnancy in
a recent cohort of expectant mothers. Retrieved from
https://superuhub.cwp.govt.nz/assets/documents/
Alcohol%20and%20Pregnancy%20Research%20
Report.pdf
15
VOLUME 32 • NUMBER 2 • 2020 AOTEAROA NEW ZEALAND SOCIAL WORK
ORIGINAL ARTICLE
THEORETICAL RESEARCH
Chudley, A. (2018). Diagnosis of fetal alcohol spectrum
disorder: Current practices and future considerations.
Biochemistry and Cell Biology, 96(2), 231–236.
Retrieved from https://www.ncbi.nlm.nih.gov/
pubmed/28746809
Clarren, S., Halliwell, C., Werk, C., Sebaldt, R., Petrie, A.,
Lilley, C., & Cook, J. (2015). Using a common form for
consistent collection and reporting of FASD data from
across Canada: A feasibility study. Journal of Population
Therapeutics and Clinical Pharmacology, 22(3). Retrieved
from https://www.ncbi.nlm.nih.gov/pubmed/26567605
Connor, J., & Casswell, S. (2012). Alcohol-related harm to
others in New Zealand: evidence of the burden and gaps
in knowledge. New Zealand Medical Journal, 125(1360),
11 - 27. Retrieved from https://www.nzma.org.nz/journal/
read-the-journal/all-issues/2010-2019/2012/vol-125-
no-1360/article-connor
Cook, J. L., Green, C. R., Lilley, C. M., Anderson, S. M.,
Baldwin, M. E., Chudley, A. E., … Canada Fetal Alcohol
Spectrum Disorder Research. (2016). Fetal alcohol
spectrum disorder: a guideline for diagnosis across the
lifespan. Canadian Medical Association Journal, 188(3),
191-197. Retrieved from https://www.ncbi.nlm.nih.gov/
pubmed/26668194
Crawford, A. (2018). Social cognition, executive functioning
and IQ. What are the important influences on adaptive
functioning in children with Fetal Alcohol Spectrum
Disorder? (Unpublished doctoral thesis), University
of Auckland. Retrieved from https://researchspace.
auckland.ac.nz/handle/2292/37651
Durie, M. (2001). Mauri ora: The dynamics of Ma¯ori health.
Auckland: Oxford University Press.
Egan, R., & Craik, C. (2016). Taking action: Change and
intervention. In J. Maidment & R. Egan (Eds.), Practice
skills in social work and welfare: More than just common
sense (3rd ed., pp. 227–243). Allen & Unwin.
Egerton, J. (2014). A step in time: Fetal alcohol spectrum
disorders and transition to adulthood. In B. Carpenter, C.
Blackburn, & J. Egerton (Eds.), Fetal alcohol spectrum
disorders: Interdisciplinary perspectives (pp. 141–157).
Routledge.
Enns, L., & Taylor, N. (2018). Factors predictive of a
fetal alcohol spectrum disorder: Neuropsychological
assessment. Child Neuropsychology, 24(2), 203–
225. Retrieved from https://www.ncbi.nlm.nih.gov/
pubmed/27830992
FASD Working Group. (2016). Taking Action on Fetal Alcohol
Spectrum Disorder: 2016 - 2019: An Action Plan.
Retrieved from https://www.health.govt.nz/system/files/
documents/publications/taking-action-on-fetal-alcohol-
spectrum-disorder-2016-to-2019.pdf
Fast, D. K., & Conry, J. (2004). The challenge of fetal alcohol
syndrome in the criminal legal system. Addiction Biology,
9(2), 161–166. https://doi.org/10.1080/1355621041000
1717042
Fast, D. K., & Conry, J. (2009). Fetal alcohol spectrum
disorders and the criminal justice system. Developmental
Disabilities Research Reviews, 15(3), 250–257.
https://doi-org.ezproxy.otago.ac.nz/10.1002/ddrr.66
Fast, D. K., Conry, J., & Loock, C. A. (1999). Identifying
fetal alcohol syndrome among youth in the criminal
justice system. Journal of Developmental & Behavioural
Pediatrics, 20(5), 370–372. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/10533996
Fitzgerald, T. (2015). Neurodisabilities and youth offending.
Court in the Act, (71), 18–21. Retrieved from
http://www.districtcourts.govt.nz/assets/Uploads/Court-
in-the-Act/Court-in-the-Act-Issue-71.pdf
Fitzpatrick, J. P., Latimer, J., Olson, H. C., Carter, M., Oscar,
J., Lucas, B. R., … Elliott, E. J. (2017). Prevalence
and profile of neurodevelopment and fetal alcohol
spectrum disorder (FASD) amongst Australian Aboriginal
children living in remote communities. Research in
Developmental Disabilities, 65, 114–126. Retrieved
from http://www.sciencedirect.com/science/article/pii/
S0891422217300975
Gibbs, A., Bagley, K., Badry, D., & Gollner, V. (2020). Foetal
alcohol spectrum disorder: Effective helping responses
from social workers. International Social Work, 63(4),
496–509. https://doi.org/10.1177/0020872818804032
Gibbs, A., & Sherwood, K. (2017). Putting fetal alcohol spectrum
disorder (FASD) on the map in New Zealand: A review of
health, social, political, justice and cultural developments.
Psychiatry, Psychology and Law, 24(6), 825–842.
https://doi.org/10.1080/13218719.2017.1315784
Gillen, P., & Dubovsky, D. (2012). Towards developing a
manual for residential treatment centres to support
individuals with FASD and their families. [PowerPoint
Slides]. Retrieved from https://docplayer.net/3296754-
Towards-developing-a-manual-for-residential-treatment-
centers-to-support-individuals-with-an-fasd-and-their-
families.html
Gralton, E. (2014). Foetal alcohol spectrum disorder (FASD)–
Its relevance to forensic adolescent services. Journal of
Intellectual Disabilities and Offending Behaviour, 5(3),
124–137. Retrieved from https://www.deepdyve.com/
lp/emerald-publishing/foetal-alcohol-spectrum-disorder-
fasd-its-relevance-to-forensic-E9uXa0Ppf2
Hughes, N., & Peirse O’Byrne, K. (2016). Disabled inside:
Neurodevelopmental impairments among young people
in custody. Prison Service Journal (226), 14–21.
Retrieved from https://www.crimeandjustice.org.uk/sites/
crimeandjustice.org.uk/files/PSJ%20226%20July%20
2016.pdf
Hughes, N., Williams, H., Chitsabean, P., Davies, R., &
Mounce, L. (2012). Nobody made the connection:
The prevalence of neurodisability in young people
who offend. United Kingdom: Office of the Children’s
Commissioner. Retrieved from https://yjlc.uk/wp-content/
uploads/2015/03/Neurodisability_Report_FINAL_
UPDATED__01_11_12.pdf.
International Federation of Social Workers. (2014). Global
definition of social work. Retrieved from https://www.ifsw.
org/what-is-social-work/global-definition-of-social-work/
JustSpeak. (2012). Submission on Youth Crime Action Plan.
Retrieved from https://www.occ.org.nz/assets/Uploads/
submissions/Youth-crime-action-plan.pdf
Killingley, J. (2014). Fetal alcohol spectrum disorders and
criminal responsibility. In B. Carpenter, C. Blackburn,
& J. Egerton (Eds.), Fetal alcohol spectrum disorders:
Interdisciplinary perspectives (pp. 199–206). Routledge.
Longstaffe, S., Chudley, A. E., Harvie, M. K., Markesteyn,
T., Neault, D., & Brown, T. (2018). The Manitoba Youth
Justice Program: Empowering and supporting youth
with FASD in conflict with the law. Biochemistry & Cell
Biology, 96(2), 260–266. Retrieved from http://search.
ebscohost.com/login.aspx?direct=true&db=a9h&AN=129
007698&site=ehost-live&scope=site
16 VOLUME 32 • NUMBER 2 • 2020 AOTEAROA NEW ZEALAND SOCIAL WORK
THEORETICAL RESEARCH
ORIGINAL ARTICLE
Lynch, N. (2016). Neurodisability in the youth justice system
in New Zealand: How vulnerability intersects with justice.
2016 Neurodisabilities Forum. Retrieved from
https://ssrn.com/abstract=2869502
Malbin, D. (2002). Fetal alcohol spectrum disorders: Trying
differently rather than trying harder (2nd ed.). Beaverton,
OR: FASCETS.
Mallard, S. R., Connor, J. L., & Houghton, L. A. (2013).
Maternal factors associated with heavy periconceptional
alcohol intake and drinking following pregnancy
recognition: A post-partum survey of New Zealand
women. Drug and Alcohol Review, 32(4), 389–397.
https://doi.org/10.1111/dar.12024
Mattson, S. N., Crocker, N., & Nguyen, T. T. (2011). Fetal
alcohol spectrum disorders: Neuropsychological and
behavioral features. Neuropsychology Review, 21(2),
81–101. Retrieved from https://www.ncbi.nlm.nih.gov/
pubmed/21503685
Matua Raki. (2019). FASD: Essential strategies: A resource
for frontline professionals. Retrieved from
https://www.matuaraki.org.nz/uploads/files/resource-
assets/FASD-EssentialStrategiesFramework-%20web.pdf
May, P. A., Chambers, C. D., Kalberg, W. O., Zellner, J.,
Feldman, H., Buckley, D., … Hoyme, H. E. (2018).
Prevalence of fetal alcohol spectrum disorders in
4 US communities. JAMA, 319(5), 474–482.
https://doi.org/10.1001/jama.2017.21896
McIver, L. (2010a). Fetal alcohol spectrum disorder in
the Youth Court: Part 2. Court in the Act, (51), 6–8.
Retrieved from http://www.districtcourts.govt.nz/youth-
court/newsletters/court-in-the-act/
McIver, L. (2010b). Fetal alcohol spectrum disorder
in the Youth Court: Undiagnosed and unrecognised.
Court in the Act, (50), 12–13. Retrieved from
http://www.districtcourts.govt.nz/youth-court/newsletters/
court-in-the-act/
McQuire, C., Mukherjee, R., Hurt, L., Higgins, A., Greene,
G., Farewell, D., Kemp, A., & Paranjothy, S. (2019).
Screening prevalence of fetal alcohol spectrum disorders
in a region of the United Kingdom: A population-based
birth-cohort study. Preventive Medicine, 118, 344–351.
Retrieved from http://www.sciencedirect.com/science/
article/pii/S0091743518303323
Ontario Centre of Excellence for Child and Youth Mental
Health. (2016). Best practices to support youth with
FASD in residential settings. Evidence In-Sight.
Retrieved from http://www.excellenceforchildandyouth.
ca/resource-hub/best-practices-support-youth-fasd-
residential-settings
Payne, J., France, K., Henley, N., D’Antoine, H., Bartu, A.,
O’Leary, C., … & Bower, C. (2011). Changes in health
professionals’ knowledge, attitudes and practice
following provision of educational resources about
prevention of prenatal alcohol exposure and fetal
alcohol spectrum disorder. Paediatric and Perinatal
Epidemiology, 25(4), 316–327. https://doi.org/10.1111/
j.1365-3016.2011.01197.x
Pei, J., Leung, W. S. W., Jampolsky, F., & Alsbury, B. (2016).
Experiences in the Canadian criminal justice system for
individuals with fetal alcohol spectrum disorders: Double
jeopardy? Canadian Journal of Criminology & Criminal
Justice, 58(1), 56–86. Retrieved from http://search.
ebscohost.com/login.aspx?direct=true&db=a9h&AN=112
352455&site=ehost-live&scope=site
Popova, S., Lange, S., Bekmuradov, D., Mihic, A., & Rehm,
J. (2011). Fetal alcohol spectrum disorder prevalence
estimates in correctional systems: A systematic
literature review. Canadian Journal of Public Health/
Revue Canadienne de Sante’e Publique, 102(5),
336–340. http://www.jstor.org.ezproxy.otago.ac.nz/
stable/41995627
Rogan, C., & Crawford, A. (2014). Building a community
of care through diagnosis of fetal alcohol spectrum
disorders in Aotearoa New Zealand. In B. Carpenter,
C. Blackburn, & J. Egerton (Eds.), Fetal alcohol
spectrum disorders: Interdisciplinary perspectives
(pp. 174–182). Routledge.
Saleebey, D. (1997). The strengths approach to practice. In
D. Saleebey (Ed.), The strengths perspective in social
work practice (2nd ed., pp. 49–57). Longman.
Salmon, J. (2014). The experiences and views of individuals
with fetal alcohol spectrum disorder: A New Zealand
approach. Nova Science Publishers.
Streissguth, A. P., Bookstein, F. L., Barr, H. M., Sampson, P. D.,
O’Malley, L., & Young, J. K. (2004). Risk factors for
adverse life outcomes in fetal alcohol syndrome and fetal
alcohol effects. Journal of Developmental & Behavioural
Pediatrics, 25(4), 228–238.
Streissguth, A. P., & O’Malley, K. (2000). Neuropsychiatric
Implications and long term consequences of fetal alcohol
spectrum disorders. Seminars in Child Neuropsychiatry,
5(3), 177–190. Retrieved from https://www.ncbi.nlm.nih.
gov/pubmed/11291013
Ta¯ngata Whenua Voices in Social Work. (2016).
Kaitiakitanga Framework. Retrieved from https://swrb.
govt.nz/about-us/news-and-publications/publications/
Tavioni-Pittman, M., & Marsh, C. (2017). Neurodisability
and therapeutic justice. Neurodisability and Therapeutic
Justice Symposium. Retrieved from https://www.adls.
org.nz/for-the-profession/news-and-opinion/2017/7/21/
symposium-on-%E2%80%9Cneurodisability-and-
therapeutic-jurisprudence%E2%80%9D/
Tough, S. C., Clarke, M., & Hicks, M. (2003). Knowledge
and attitudes of Canadian psychiatrists regarding fetal
alcohol spectrum disorders. The Canadian Child and
Adolescent Psychiatry Review [La revue canadienne
de psychiatrie de l’enfant et de l’adolescent], 12(3),
64–71. Retrieved from https://www.ncbi.nlm.nih.gov/
pubmed/19030527
Townsend, C., Hammill, J., & White, P. (2015). Fetal alcohol
disorder, disability and the criminal justice system.
Indigenous Law Bulletin, 8(17), 30–33. Retrieved from
http://www.austlii.edu.au/au/journals/ILB/2015/19.pdf
Ungar, M. (2014). Working with children and youth with
complex needs: 20 skills to build resilience. Routledge.
Walker, J. (2018, October). Barriers to engagement: Enabling
full participation in the justice system for young people.
Paper presented at the Justice for Young People
Conference, Adelaide, Australia. Retrieved from
http://www.districtcourts.govt.nz/youth-court/publications/
barriers-to-engagement-enabling-full-participation-in-the-
justice-system-for-young-people/
