by Becky Richardson

Becky Richardson is foster parten training coordinator with the Hennepin County Children and Family Services Department, Foster Care Unit in Minneapolis, MN. This article is reprinted with permission from the Winter, 1999 Adoptalk, from the North American Council on Adoptable Children. You can reach NACAC at (651) 644-3036.

When pregnant women drink alcohol, the alcohol crosses through the placenta and is mixed into the fetal circulatory system. If it takes three drinks to intoxicate a 150-pound woman, think what three drinks can do to a tiny, one pound baby. Babies who are exposed to alcohol while in the uterus are often damaged, resulting in fetal alcohol syndrome (FAS) or fetal alcohol effect (FAE). Another medical term for this is alcohol-related neurodevelopmental disorder (ARND).

Children who are born affected by alcohol vary considerably in the amount of damage they have sustained. Some may be barely affected, have normal intelligence, and are never diagnosed. Others may have the characteristic look of FAS (thin upper lip, little or no ridge at center of upper lip, wide set eyes, short nose, folds at insides of eyes, low nasal bridge), growth retardation, and severe retardation. Alcohol destroys brain cells so that brains of people with FAS/FAE look like swiss cheese with holes throughout the brain. This means that the normal circuitry of the brain does not work. Children with FAS/FAE may be able to do things one day but not the next. They may be able to understand things in one setting but not another.

Take the following example:

A 10-year-old child with FAS had to cross the street to go to school. The mother spent the summer teaching her child to cross the street safely - look first left, then right, then left again. If no cars are coming, cross the street - quickly, but still walking. Once you are halfway across the street, look again to the right to be sure that no cars are coming. The child learned how to do this and the mother was satisfied that the child could safely cross the street to go to school. However, one day the mother saw the child run into the street without looking to chase a ball. When the mother asked the child why hadn't he looked both ways before crossing the street, the child's response was that he was not crossing the street, just getting a ball.

This child had been unable to make the connection between running into the street after a ball and crossing the street on the way to school. These seemed like two very different activities.

Characteristics of Children with FAS/FAE at Different Ages

Preschool - have sensory integration dysfunction (meaning that they are irritated by too much sensory overload and have trouble calming themselves); tend to exhibit anger or rage; experience attention disorder; behave manipulatively; don't understand cause and effect; are dangerous to selves and family if interested in knives and fire; need 24-hour supervision.

Elementary - exhibit poor social skills; are over-reactive, impulsive, and unpredictable; lack internalized knowledge of right and wrong; blame others for problems; lack empathy; fail at abstract learning (tends to show up in third grade); commit unsafe pranks (can't predict the results of what they do, so do unsafe things without intending to hurt themselves or others); can't transfer information from one setting to another.

High School - are probably in special education classes; participate in high risk behaviors (especially gang activities); may be victim or predator; have difficulty separating fantasy from reality; have strong sense of self-protection, but can't always recognize danger; recover quickly from crisis; are overly influenced by the media and peers; need but resist structure; lack understanding of own limitations; often have family and personal problems.

Adults - have poor problem-solving skills and limited life skills; set unrealistic goals; exhibit little self-control; experience employment and financial problems; are highly volatile and verv manipulative. can't internalize society's values, morals, and laws; are often homeless or unemployed; have unsafe sexual behavior; have mental health issues.

Because of their organic brain damage, many people with FAS/FAF have:

• Poor judgment skills. They seem irresponsible, make poor choices, and seem willful. They are often unable to see beyond the moment and can't think about the future.
• No sense of boundaries. They have little sense of personal or property boundaries, are not respectful of other people and their things, and are inappropriate in their touching.
• An inability to manage their own behavior. They are immature, have little self-control, and say words that have no meaning for the situation.
• Difficulty with abstract reasoning skills. They have trouble with concepts of time, money, and math. Budgeting is a tough skill to learn. It demands planning, thinking about the future, and delaying gratification, all skills that require abstract thinking.
• Poor memory. Things done one day may be forgotten the next. Their knowledge is inconsistent because only some things are remembered.
• Difficulty predicting. Much of behavior is based on being able to predict the outcome. For example, "If I eat this third helping of ice cream, I will feel sick." If people can't think about the consequences of behavior, they are likely to get caught in many tough spots.
• Poor impulse control. People affected by FAS/FAE often lack internal controls, lack intent and foresight, and lack the skills to cover up uncontrolled activities, so they often get in trouble.

How Can You Help?

This all sounds pretty discouraging. What can you do to help these children? The first thing is to get the child diagnosed. If you have a child with some of the behaviors listed above, ask a knowledgeable pediatrician if this child might be affected by alcohol. Remember, too, that many drug-abusing moms are poly-drug users. So a child who was cocaine positive at birth may also be alcohol affected. Early diagnosis will allow you to access treatments that will help your child develop as much and as quickly as possible.

Why Would Anyone Choose to Parent a Child with FAS/FAE?

Good parenting does make a difference for these children. Many children will learn skills on their own, but children affected by alcohol need help to achieve their potential. "In the field of child development, there is a general view that early intervention and a facilitating environment can help to maximize every child's potential, no matter what the problem. However, children without learning disabilities or behavioral problems can thrive without such interventions, whereas children such as those with FAS need interventions to approach normalcy" (Weiner and Morse, in Alcohol Health and Research World, Vol. 18, #1, 1994). If you want to know that you are having a lasting impact on a child, try parenting a FAS child. By getting an accurate diagnosis, coordinating good services and being an active, effective parent you can make a difference in the entire life of an FAS child.

If you are parenting an FAS child, you already know that this is a challenge. It is important that you take care of yourself. Take time outs, use respite, be sure the professionals you use understand FAS/FAE, and talk to others who are parenting FAS/FAE children.

For additional resources about FAS or FAE, please call Ginny Blade, NACAC's parent group coordinator, at 651-644-3036

Parenting Tips for..

Sleeping Problems

• Put infants in cribs when drowsy so they learn to fall asleep there.
• Try white noise in the child's room (a fan or humidifier).
• Establish a calm bed-time routine.
• Develop a list of acceptable activities for children who wake up at night.
• Avoid naps for older children.
• Try heavy bedding or a sleeping bag for older children.
• Try a bed-time snack.

Eating Problems

• Reduce distractions, turn off the TV and radios; don't play, just feed the child.
• Allow plenty of time.
• Recognize that your child may start and stop eating several times during a meal.
• Start with small servings.
• Give your child a chair with arms and a footrest.
• Let your child stand if sitting is difficult.
• Avoid discussing stressful things at meal time - wait until the meal is over.
• Never use food as a reward or punishment.

Sensory Problems

• Avoid crowded spaces and long lines.
• Choose loose, unrestricted clothing.
• Encourage child to wrap self in a blanket, quilt, or sleeping bag.
• Provide a rocking chair, hammock, or bean bag chair to soothe the child.
• Provide sunglasses to reduce glare of the sun.
• Prepare child for physical contact by talking about what is likely to occur.
• Give child words to use when bothered by light, smells, sounds, or touch; for example, "That smell bothers me."
• Develop child's interest in healthy sensory input sports like bike riding, sledding, and hiking.
  Allow child to have own room.

Hyperactivity

• Structure active times so there are fewer chances to get out of control.
• Learn warning signs of out-of-control behavior and intervene before child falls apart.
• Make sure child has a chair with arms and feet that reach the ground.
• Devise a "cue" that parents and teachers can use to remind child to monitor his/her own activity level.
• When a child is overly active, reduce stimulation instead of yelling at the child.
• Recognize the transition required between active times and quiet times.
• Have child sit in front row or have a quiet corner in school.
• Decrease over-stimulating times by giving child quiet, alone space to change for gym or sports.

Discipline

• Provide positive feedback rather than negatives.
• Do not allow your sympathy for the child to interfere with consistent discipline.
• Find activities that help your child feel successful.
• Help child keep organized.
• Reinforce appropriate social skills at home and in school.
• Prepare your child for changes.

(Tips are from the pamphlet FAS: Parent and Child by Morse and Weiner, 1993)

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Federal Laws Aim to Remove Barriers

by Steve York

The phrases "reducing time children spend in foster care" and "removing barriers to adoption" no longer belong exclusively to the vocabulary of adoption professionals. In recent years a variety of legislation has been put forth on both the state and federal level to address these very issues. From the so-called "Binsfeld Legislation" in Michigan to Federal laws such as the Multiethnic Placement Act (MEPA) and the Adoption & Safe Families Act (ASFA), legislators also appear to have taken up the challenge to keep children safe, remove barriers that keep them in foster care, and place children with permanent families in a timely manner.

This article addresses two pieces of federal legislation in particular and the resulting policy changes for adoption services in Michigan as outlined in the FIA Services Manual Bulletin #99-16, revised 7/99.

Multiethnic Placement Act (MEPA) of 1994 and subsequent amendments by the Small Business Job Protection Act of 1996 (Section 1808) entitled "Removal of Barriers to Interethnic Adoption."

On August 20, 1996, President Clinton signed the Small Business Job Protection Act of 1996. Section 1808 of the act entitled "Removal of Barriers to Interethnic Adoption" affirms and strengthens the prohibition against discrimination in adoption and foster care placements. This is done by adding to Title IV-E of the Social Security Act, a State Plan requirement to address discrimination, and penalties which apply both to States and adoption agencies who do not comply with the provisions of the Act. In essence, section 1808 of the act states that race, culture, or ethnicity may not be used as the basis to delay or deny a foster or adoptive placement.

Under the Act, States and entities receiving Federal funding which are found to be out of compliance with these State Plan requirements are now subject to specific, graduated financial penalties in cases where a corrective action plan fails to resolve the problem within six months. The penalties imposed by the statute vary according to the State population and the frequency and duration of noncompliance. Estimates put the penalties at less than $1,000 in some states to as high as $7 million to $10 million in others. The penalties for non-compliance in Michigan range from 2% of the state's Title IV-E funding for the 1st violation to as high as 5% for a third violation. The total penalties assessed cannot exceed 5% of the total Title IV-E funding received by the state each year. These financial penalties are not just assessed on a state level. If a private (purchase of service) agency is found to to in violation of Section 1808, that agency may lose its enitire IV-E funding for the fiscal quarter in which the violation occurred.

The message to adoption agencies is clear: Discrimination in foster and adoptive placement decisions, either toward the child or the family, is not to be tolerated. But how does this impact FIA Adoption Services Policy in Michigan? A visible change in the FIA Services Manual is that the "Cross-Racial, Cross-Cultural Parenting Assessment Guide" is no longer to be used as an assessment tool for families willing to provide foster care or adopt transracially. Instead, workers are now asked to assess the ability of a family to meet the specific needs of a particular child. Race may still be one of a number of factors, but it must not be the sole criterion for placement decisions. It is permissible, however, for the adoptive family to express a racial preference and/or to exclude themselves from consideration for placement from a specific racial group because they would not meet the emotional and developmental needs of the child.

When race, color, or national origin is considered in a placement decision, it must be based on concerns arising out of the circumstances of the individual case. The consideration must be narrowly tailored to advance the child's interests, and must be made as an individualized determination for each child and documented in the case record.

According to the FIA Service Manual, Item #732 (page 5), the consideration of race, color, or national origin in the relation of a adoptive family must take into account the following four crucial elements:

1. Delays in placing children who need adoptive homes are not to be tolerated, nor are denials based on any prohibited or otherwise inappropriate consideration;
2. Discrimination is not to be tolerated, whether it is directed toward adults who wish to serve as adoptive parents, toward children who need safe and appropriate homes, or toward communities or populations which may heretofore have been under-utilized as a resource for placing children;
3. Active, diligent, and lawful recruitment of potential adoptive parents of all backgrounds is both a legal requirement and an important tool for meeting the demands of good practice; and
4. The operative standard in adoptive placements has been and continues to be "the best interests of the child." Nevertheless, as noted above, any consideration of race, color, or national origin in adoptive placements must be narrowly tailored to advance the child's best interests, and must be made as an individualized determination of each child's needs in light of a specific adoptive parent's capacity to care for that child.

A grievance procedure to be used when an individual or agency asserts that there has been a violation of Section 1808 is currently in draft form at FIA Central Office and should be ready for implementation in the near future.

(It is important to note that this Act does not apply to Native American children whose placement considerations are addressed in the Indian Child Welfare Act.)

The Adoption and Safe Families Act of 1997 (ASFA) with respect to Interjurisdictional Adoptions

The ASFA of 1997 also amended the Social Security Act, Title IVE, Section 471 (a) (23) (1). It prohibits the delay or denial of an adoptive placement of a child when an approved adoptive family is available but resides outside the jurisdiction (county or state) which has responsibility for handling the case of the child. The same financial penalties as described above for MEPA can be applied to states and entities receiving Title IVE funding if they are found to be in violation of Section 471 (a) (23) (1).

Approved adoptive families from jurisdictions (counties or states) other than the child's county of commitment or county of residence who express interest in adopting a child are to be considered for adoption when the child has no identified family. Some workers have told MARE verbally and in writing that it "is against our agency policy to place children out of state," or that "I would never place MY children out of state." Such statements are in direct contrast to what is required by Federal law. As with MEPA, any placement decisions that are made based on geographic considerations must also be individualized, case-specific, and well-documented.

According to the FIA Services Manual, Item #732 (page 6a), individuals are to be granted an opportunity for a fair hearing if the individual alleges a violation of Section 471 (a) (23) (1), or if their request for a hearing was not acted upon with reasonable promptness. Within 15 days of receipt of a request for a hearing, the local FIA office with supervisory responsibility for the child must prepare form FIA-3050, Hearing Summary, and send to Bureau of Administrative Hearings.

Contrary to what some may think, MEPA and ASFA do nothing to undermine the "best interest" criteria or the worker's authority in making placement decisions. If, in fact, a permanent home is in the "best interest" of the child, these Federal laws and resulting adoption policy changes only strengthen that criteria by attempting to remove barriers to permanency. These laws should also encourage child professionals to continually scrutinize and improve their efforts in recruiting appropriate families from their communities who are representative of the children waiting in foster care.

There are over 500 children waiting for adoption in the September '99 MARE Book - a new record. Whether through Federal or State legislation, adoption policy, or our personal "best practice" methods, let us continue to identify and remove the barriers to timely adoptive placements. These children are depending on us - and they have waited long enough.

MEPA Grievance Procedures

The Multiethnic Placement Act of 1994 as amended by the Interethnic Adoption Provisions of the Small Business Job Protection Act of 1996 (MEPA) and Title VI of the Civil Rights Act of 1964, prohibit discrimination in foster care and adoptive placements on the grounds of race, color, or national origin.

Any foster care or adoptive applicant or approved foster care/adoptive parent who has reason to believe that he/she has been denied or delayed the placement of a child because of race, color or national origin may file a grievance.

• Filing a grievance must be in writing, contain the name, address and phone numbers of the person filing it, and briefly describe the nature of the complaint and the circumstances of the alleged discrimination.
• A grievance must be filed within ten (10) working days of the occurrence of the alleged act of discrimination. This requirement may be waived if extenuating circumstances exist which justify an extension.
• The written grievance must be filed with the Adoption Program Office at the Michigan Family Independence Agency (MFIA), P.O. Box 30037, Lansing, Michigan, 48909. The agency director of the local agency, which is alleged to have violated MEPA will receive a copy of the grievance.
• An informal conference will be held to review the facts of the allegation, by the Adoption Program manager or designee, within ten (10) working days of receipt of the written complaint. An extension of the time limits may be granted if agreed upon by both parties. Complainant shall be notified in writing of the location, date, and time of the conference. Complainants who are unable to attend a conference in person due to their location must be offered a teleconference.
• The Adoption Program manager or designee will informally review the facts of the complaint and notify the complainant of conclusions in writing within ten (10) working days of the conference/teleconference.
• The complainant may appeal the decision of the agency. The appeal must be in writing and sent to the Office of Affirmative Action at the Michigan Family Independence Agency, P.O. Box 30037, Lansing, Michigan, 48909, within ten (10) days of the receipt of the decision.
• The Office of Affirmative Action will investigate the complaint and may convene a meeting with the complainant. The Office of Affirmative Action will issue a written answer within ten (10) days. An extension of the time limits may be granted if agreed upon by both parties.

This procedure does not impair the right of an individual to file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services, or the Michigan Department of Civil Rights.