FASD and RBSA Principles
Looking at the Guiding Principles of Relationship Based Strength Approach through an FASD Lens Susan Opie, B.A., B.S.W., M.S.W., R.S.W.
The Relationship Based Strength Approach describes an approach to working with people that is respectful and dignified. It looks at building strong, healthy relationships with individuals; searching for resources an individual has access to in themselves, in their relationships with others, and in their environments; and building on the strengths individuals have to allow themselves to grow to their full potential and to increase protective factors in their lives. This approach has been applied to caregiving and working with diverse groups of people. Individuals with FASD do well when caregivers and others apply the principles of the RBSA approach. Each of the eight guiding principles can be successfully applied to respectful and helpful interactions with individuals with FASD.
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Belief in the dignity and worth of people as valuable human beings.
Canadian society heavily stigmatizes the issue of FASD. The media is full of articles and news reports suggesting that children and youth with FASD fit into various categories of pathology. While it is a reasonable value stance to support healthy pregnancies and healthy children, pathologizing children and youth born with differences due to the teratogenic effects of a substance (i.e. ethyl alcohol) that is legally available for sale and use in Canada makes little sense. If we truly choose a value stance that all human beings are valuable, it makes sense to also choose to value human beings who are different due to cognitive or physical disabilities. A child, youth, or adult with FASD has worth and value regardless of the differences in their brains. A child, youth, or adult with FASD needs an environment that supports these differences and allows them to experience themselves as valuable human beings.
Canadian society stigmatizes women who are birth mothers of children with FASD even more severely than it does their children. Women who have consumed alcohol during pregnancy in sufficient quantities to cause their children to be born with FASD are frequently viewed very negatively as having deliberately harmed their children. Listening to the stories of women with this experience tells a very different story. Women are caught in a web of their own biology, society’s acceptance of consumption of alcohol, which could be reframed as a substance with serious toxic side effects, and the complicated process of addictions. Women who have given birth to children with FASD have had a tragic event occur in their life when their child has a disability, and far too often other tragic occurrences have preceded this one. Birth mothers of children with FASD can be everyone and anyone. Again it makes sense to view this group of women, who have had tragic events happen to them and their children, as valuable human beings.
Belief in the recognition and respect of all people as unique.
Individuals with FASD vary widely in areas in which they have difficulties, and the degree of these difficulties. Many individuals will display difficulties under stress that are not apparent when not under stress. There is no one size fits all approach to understanding FASD or to assisting individuals with FASD in any capacity. Each individual child, youth, or adult is a unique person in their own right as all humans are unique from birth. For a child, youth or adult who has FASD, how issues related to FASD manifest will vary widely from person to person. They will also vary considerably for the same individual from situation to situation, and from environment to environment.
Belief in the necessity of a “secure base.”
Along with having basic needs met, having a sense of security and safety is crucial for optimal development for all children and youth with or without FASD. Long-term prospective research (Ann Streissguth et al.) has shown that protective factors increasing good outcomes for individuals with FASD include “living in a safe and stable environment,” “living in a good quality home for most of life,” and “never having been exposed to violence.” Individuals with FASD often have a very concrete definition of safe environments. They may quickly learn to avoid environments that they deem to be unsafe or unwelcoming. Youth who ‘AWOL’ from placements often cite ‘caregivers yelling’ or ‘receiving consequences’ as reasons to not return to the placement. In the subjective experience of youth with FASD a safe place does not exist in the presence of yelling, loss of privileges, or experiences of punishment. On the other hand youth who are welcomed home unconditionally, offered food, a place to sleep, and clean clothing, and treated with respectful concern for their safety will return to a placement over and over again (Opie, 2006). The same is true of services for adults with FASD or adult services placements for adults with FASD. Adults with FASD are often ‘excluded’ from services because of their own experience of the service or placement not feeling safe to them.
Belief that reality is socially constructed.
Groups of people determine what is viewed as the current ‘reality’ through their attitudes, beliefs, thoughts, life experiences and lens related to culture, faith, and family. The same child, youth, or adult may be viewed by some as “oppositional, defiant, resistant,” by others as “neurodevelopmentally impaired, or cognitively disabled” and by still others as “having a brain that learns, reacts, and cues behaviour differently due to different brain wiring.” In addition to many differently constructed realities that view youth with FASD in different ways, each child, youth, or adult with FASD constructs reality differently for themselves through the lens of how their own brain perceives, interprets, and analyzes the world around them, and then constructs their own subjective view of reality. It may be important to remember that every experience an individual with FASD has had since birth has been filtered through a brain that is different due to prenatal alcohol exposure in a way that is unique to each individual.
Belief that all people are resilient, have strengths and the capacity to grow.
FASD is a medical diagnosis that implies a certain level of brain-based impairment. While an understanding of these issues is important to ‘knowing an individual,’ it does not imply that these youth have no areas of resiliency or strengths. In fact the opposite is true. Individuals with FASD often show remarkable resiliency. Areas of brain difference that cause individuals to interpret their environment and interactions with others differently may mean that their lived experience of situations is very different than it would be for others. In some cases situations may be less traumatizing, or an individual may not remember events that would disturb someone who did remember the same event. Individuals with FASD often start each day as if it were a new day. While this may complicate learning from mistakes, it often leads to a resiliency grounded in a willingness to forgive themselves and others.
Individuals with FASD always have areas of strength that can be mobilized; many have areas of outstanding strengths. Common areas of strengths include art, music, poetry or song writing, journaling, working with animals or people, computers, mechanics, spirituality, and being kind, empathic and helpful to others. Supporting areas of strength and empowering people with FASD to utilize their strengths is likely even more important than it would be for any person. Building on strengths can help individuals with FASD work towards seeing themselves as valuable, competent human beings with something important to contribute to their community, and thus help to break down barriers, misunderstandings, and stereotypes about individuals with FASD.
Belief that all people want what is good for them and have a desire to change.
It is difficult for many people to see youth and adults with FASD wanting what is good for them. If individuals with FASD are displaying issues that have arisen secondary to their brain differences, the person’s behaviour may appear extremely risky. Youth or adults who use alcohol or drugs, engage in risky sexual behaviour, resolve interpersonal conflicts violently, attempt to meet their needs for economic resources through criminal activities, or are easily cued by others into risky behaviours can appear to be out of control. Youth and adults with FASD may have overall goals for their lives that are unrealistic, and this may further support the idea that these individuals do not know what they need.
As with all people, building a great relationship with individuals with FASD, and really listening to what they say, can help us to better understand the subjective inner reality of the person with FASD. As we come to know an individual we may find the person in fact does want what is good for them, and they do want to change. Youth and adults with FASD may struggle with following through on the goals they set for themselves, and may have difficulty making good choices in the moment, but they are often frustrated with themselves later when they find themselves suffering the same consequences over and over.
It is a misperception that children, youth or adults with FASD cannot learn or change. However, many individuals with FASD learn very differently from others. It is important to explore how a person learns as we get to know them, and that we support the person’s desire for growth and change in ways that fit with their learning strengths.
Belief in the significance of promoting self-determination and empowerment.
Self-determination and empowerment are core values of humanism for all people. Many children, youth, and adults with FASD have experienced negative feedback from other individuals and systems in their lives. They have experienced ‘failure’ and ‘rejection’ because they are different and others have not understood these differences. Children, youth and adults with FASD far too often have not grown up understanding their own strengths and limitations, and have frequently been punished over and over for the inability of their brain to comply with demands from society. Overcoming the harm individuals with FASD have suffered occurs best in an environment that acknowledges the individual’s perceptions and knowledge about their own experience. Helping a person to reframe experiences of failure to misunderstandings by systems can help rebuild a sense of value and worth of self. Youth and adults with FASD need others to help them to understand what choices exist, and what the outcome of those choices might be. This allows youth and adults to make choices that allow a person to self-determine a life plan that has meaning for them.
Belief in the importance of Purpose and Goal Directedness.
Many children, youth, and adults with FASD see the world in very concrete and tangible ways. They may have difficulty with tasks that require sequencing and planning, and with consistently following through on goals they have set for themselves. Having a clear concrete goal, with clear concrete steps to achieve that goal can be very helpful. Putting goals and activities or steps into a visual format by writing it down or putting it in a pictorial form can make real and concrete a process to work towards change that otherwise might be very abstract and difficult to see or understand. Checking off steps completed or accomplished, and reminding individuals of all the steps that have been realized can make the abstract notion of change more concrete. Like all youth and adults, effort without reward does not make much sense to individuals with FASD. Helping them see where they are going, and how much they have accomplished makes efforts meaningful for an individual with FASD.