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Fetal Alcohol Spectrum Disorder in Children & Adults: Interventions for Families & Caregivers
Fetal Alcohol Syndrome continuing education counselor CEUs

Section 6
Model of Advocacy

CEU Question 6 | CEU Test| Table of Contents | Addictions
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed three aspects of clients diagnosed with FASD as they enter adulthood.  These three aspects of adult FASD clients included:  financial affairs; social skills; and depression.

In this model, an FASD client chooses an advocate who will act on his or her behalf.  An advocate is an active mediator between the client and the environment.  This advocate helps interpret the child to the world and the child to him or herself.  The advocate is also a key figure in preventing or ameliorating the secondary disabilities that can change the life trajectory of FASD clients.

On this track, we will examine three concepts of the Advocacy Model. These three concepts of the Advocacy Model include:  appropriate candidates; inferring needs from behaviors; and identifying limitations and strengths. This track may make a good training tool for a client seeking an advocate. So consider playing it during a future session or discussing the content with an FASD client or relative.

Three Concepts of the Advocacy Model

Concept #1 - Appropriate Candidates
The first concept of the Advocacy Model that we will discuss is appropriate candidates for the position of the advocate. Parents are natural advocates, although with biological mothers, I feel that sometimes their sobriety is a major factor in the degree to which they can reasonably attend to the advocacy needs of their children. Other family members can also be strong advocates. In some instances, fathers are very effective advocates for children whose mothers have succumbed to alcoholism. In other instances, grandparents have assumed an advocacy role for their grandchildren. 

Teachers and other school personnel also serve as good advocates, but some of the most dedicated advocates are associated with the criminal justice system.  These are professionals from various disciplines who realize that they have people with FASD in their care and that the institutional or service delivery system is not effectively serving them.  Because the needs of clients with FASD are complex, they can seldom be met by a single advocate. 

Advocates must work within the community and with other services providers to orchestrate an appropriate network of services. In short, anyone can be an advocate, but the necessary and sufficient conditions for effective advocacy are an understanding of FASD, a genuine affection for the client, a capacity for creative problem solving.

Kelly, age 6, was adopted by Brad and Valerie at birth, but her biological mother, Stephanie still retained visiting rights. At the age of two, Kelly had been diagnosed with FASD. The following year, I suggested setting up an Advocacy Model for Kelly to alleviate her transition to school.  Stephanie, the birth mother, immediately wanted to be her advocate. She stated, "She’s my real daughter!  How could they know her better than me?"  Although I was impressed with Stephanie’s enthusiasm, I did not trust that she could correctly interpret Kelly’s needs because she continued to have alcohol abuse problems. 

I suggested to Brad and Valerie that both of them become Kelly’s advocates as they are most in tune to her needs.  Stephanie, however, became irate.  I stated to her, "You gave up your daughter for adoption because you knew you could not take care of her in your condition. You made a responsible decision based on your own self-knowledge. Think of Kelly now. Do you think you are in any better condition to care for her?" 

Stephanie stated, "I just want to be a part of her life!" I suggested that Brad and Valerie consider including Stephanie in a few of their family events. Think of your Stephanie. How can you assess if he or she is not fit to advocate for an FASD client?

Concept #2 - Inferring Needs from Behaviors
The second concept of the Advocacy Model is inferring needs from behaviors. Clients with FASD are not very self-reflective, especially with regard to their own limitations. It is extremely difficult for them to evaluate when they need help or to ask for assistance. Advocates learn to untangle the acts of frustration from the incidents that provoke them. Although the inclination is to focus on punishing or extinguishing the act of frustration itself, the effective advocate needs to understand the setting in which the undesirable behavior occurred. 

3 Questions that Can Help Advocates Assess the Situation
-- (1) Was the setting too distracting or over-stimulating?
-- (2) Was the task too demanding or complex? 
-- (3) Was someone making the person with FASD feel inadequate, put on the spot, or trapped? 

Yolanda, age 31, was the aunt and advocate of Michael, age 8, an FASD client. One day at school, Michael had what the substitute teacher described as "a fit."  The teacher stated, "I gave an assignment to the rest of the class which they were fine handling, but Michael became a little monster and began howling and banging his head on the desk! I’ve never seen such a spoiled child!" 

Although the original teacher had been informed of Michael’s condition and could usually explain instructions to him in a simple manner, the substitute did not know how to handle the situation. 

Yolanda was called in and immediately explained the situation to the teacher. Yolanda stated, "My nephew does not process information the same as the other children. If you give him too many instructions, he becomes frustrated." Yolanda then explained the exercise to Michael so that the substitute could witness proper procedure for instructions with an FASD client. 

Think of your Michael.  How might his or her advocate respond to an emergency call from a school?

Concept #3 - Identifying Limitations and Strengths
In addition to appropriate candidates and inferring needs from behaviors, the third concept of the Advocacy Model is identifying limitations and strengths. The discrepancy between what FASD clients expect of themselves and their own level of performance can create constant frustration.  Thus, they often overrespond to insignificant remarks to criticism and become hypersensitive to failure. Advocates help to counteract the negativity and low self-esteem that accumulate from day after day of failing to meet expectations. 

When a client balks at a task, a good advocate can reevaluate the situation and let the client select a chore he or she would really like to do. Advocates also examine the general level of problem relative to the client’s abilities and attention span.  By restructuring the number of steps, the number of distractions, and the by involving the client in the decision –making process, advocates prompt successful outcomes.

Julia, age 48, was the adoptive mother of Kim, age 16.  Once Kim had started to high school, she wanted to go to the mall and hang out with teenagers her age. Julia, her advocate, knew immediately that the mall would not be an appropriate place for a teen with FASD.  However, she did not want to hamper Kim’s independence.  Julia stated, "I know that Kim’s success has to be measured through an alternative means, but I can’t seem to figure out how to do that but still let her act like a typical teenager." 

I stated to Julia, "But treating Kim like a ‘typical teenager’ is not in her best interests. It is important that she is able to measure her success, but not through the general outlets of adolescence."  Kim, who loved to play the piano and had a talent for it, joined her mother in frequent recitals. This weekly event helped Kim lead a fulfilling life under the care and supervision of her advocate. 

Think of your Kim.  How could the advocate help him or her to understand their limitations and strengths?

On this track, we discussed three concepts of the Advocacy Model.  These three concepts of the Advocacy Model included:  appropriate candidates; inferring needs from behaviors; and identifying limitations and strengths.

On the next track, we will examine three concepts for preparing an FASD client for school.  These three concepts include:  school cooperation; school advocates; and nine steps to effective advocacy.

Peer-Reviewed Journal Article References:
Acuff, S. F., Soltis, K. E., Dennhardt, A. A., Borsari, B., Martens, M. P., Witkiewitz, K., & Murphy, J. G. (2019). Temporal precedence of self-regulation over depression and alcohol problems: Support for a model of self-regulatory failure. Psychology of Addictive Behaviors, 33(7), 603–615.

DiBello, A. M., Carey, K. B., & Cushing, V. (2018). Using counterattitudinal advocacy to change drinking: A pilot study. Psychology of Addictive Behaviors, 32(2), 244–248.

Flannigan, K. R., Coons-Harding, K. D., Turner, O., Symes, B. A., Morrison, K., & Burns, C. (2020). A survey of measures used to assess brain function at FASD clinics in Canada. Canadian Psychology/Psychologie canadienne. Advance online publication.

Moxley, D. P., & Freddolino, P. P. (1990). A model of advocacy for promoting client self-determination in psychosocial rehabilitation. Psychosocial Rehabilitation Journal, 14(2), 69–82.

Wedding, D., Kohout, J., Mengel, M. B., Ohlemiller, M., Ulione, M., Cook, K., Rudeen, K., & Braddock, S. (2007). Psychologists' knowledge and attitudes about fetal alcohol syndrome, fetal alcohol spectrum disorders, and alcohol use during pregnancy. Professional Psychology: Research and Practice, 38(2), 208–213.

Online Continuing Education QUESTION 6
What are three concepts of the Advocacy Model? To select and enter your answer go to CEU Test

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