Advocating Against the Tide Child Welfare Social Worker's Interventions in Cases of Fetal Alcohol Spectrum Disorders (FASDs)

Background & Purpose:

After half-a-centuary of research, a large body of literature clearly documents the impact of fetal alcohol spectrum disorders (FASDs) on the child welfare services (CWSs). Despite significant prevalence rates of FASDs, ranging from 17 to 40% in Western societies, very limited research has documented the role of Child Welfare Social Workers (CWSWs) in responding to children living with an FASD. The US legislator under CAPTA (2010) mandates that children living with or suspected of having an FASD should receive a Plan of Safe Care. Current evidence on how CWSWs intervene with children living with FASDs is limited and, when available, it is often portrayed poorly in terms of mandated statuatory duty. This study sought to explore CWSWs’ perspectives on responding to the multiple and interlocking needs when assessing children living with or suspected of an FASD.

Methods:

The study utilized the qualitative approach of constructivist grounded theory (ConGT). Data were collected from 18 participants including CWSWs, foster parents, and allied health professionals working directly within CWSs. All professionals were registered within their profession and all foster parents were registered caregivers. Of the 18 participants, 11 were females, and 6 were males. Interviews were transcribed verbatim and coded thematically using Dedoose qualitative software over four stages of coding at initial, focused, theoretical and conceptual levels.

Results:

The study offers a grounded theory of ‘advocating against the tide’. This grounded theory is supported by four conceptual categories of (1) professional positioning (hierarchical dismissal and devaluing of CWSWs when seeking to plan safe care), (2) intellectual haze (a lack of specific knowledge to guide FASD assessment and care planning), (3) broaching difficult conversations (addressing the sensitive ethical issues of prenatal alcohol and maternal versus fetal rights) and (4) disabling the enabler (not able to deliver plans of safe care).These categories demonstrate that CWSWs face systemic barriers when intervening with caregivers where FASDs are a presenting concern. Further, this study identified that CWSWs are in critical need of policy, procedures and protocols on FASDs in order to respond adequately to this vulnerable cohort of children receiving CWSs. Thus, a simple multistep intervention model that supports evidence-based practice is purposed.

Conclusion:

A ‘system' approach' is required to support the mandated role of CWSWs in offering a plan of safe care for children with or suspected of having an FASD. The development of specific, standardized, and focused FASDs education modules is needed at all levels of CWSs and social work education. This could be achieved by the integration of FASDs within a social model of disability which offers CWSs and CWSWs a clear pathway to successfully manage all FASDs presenting in CWSs.