2020

NewcastleFASD

Youth JusticeMODEL OF CARE

Handbook

THIS PROJECT WAS FUNDED BY THE AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH

NEWCASTLE FASD YOUTH JUSTICE

Preface

Many individuals and organisations kindly contributed directly and indirectly to the production of this resource document.

In 2020 the document was written by Helena H.A. Hodgson (FASD Coordinator, Making FASD History - Newcastle) and Dr. Olivia Hamilton (Research Officer, Making FASD History - Newcastle).

Consultation and contribution from the Making FASD History Team

● Dr. Elizabeth Connor (Program Manager FASD Prevention, Telethon Kids Institute, Western Australia)

● Dr. Rebecca Pedruzzi (Senior Research Officer, Telethon Kids Institute, Western Australia)

● Elvira Johnson (Manager, AOD and Family Services, Mercy Services)

● Dr. Fleur van Dooren (Research Assistant, Telethon Kids Institute, Western Australia)

Model of Care Reference Group Contributions

Consultation was obtained from the following people:

● Magistrate Nell Skinner (Broadmeadow Children’s Court)

● Ruth Marshall (Principal Psychologist, Youth Justice NSW, Department of Communities and Justice)

● Barbara Mannell (NDIS Project Officer, CatholicCare Social Services Hunter-Manning)

● A/Insp Lisa Jones (HR Manager, Northern Region, New South Wales Police Force)

● Jaye Hardy (Broadmeadow Children’s Court Project Coordinator, Department of Communities and Justice, Hunter Central Coast District)

● Leanne Tillock (Assistant Manager, Youth Justice NSW)

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● Rebecca Shiels-Earl (Court Appointed- Outreach Caseworker, Allambi Care)

External Contributions

A number of other people have been involved in providing advice on the Model of Care:

● Dr Kylie Bailey (Senior Clinical Psychologist; Senior Lecturer, University of Newcastle)

● Will Doran (Youth Development Officer, & Chairman, Regional Youth Development Officer’s Network)

● Dubravka Vasiljevic (Multicultural Health Liaison Office for mental health and drug and alcohol clinical services, Hunter New England Local Health District)

● The Australia and New Zealand FASD Clinical Network

● Natalie Kippin, Telethon Kids Institute

● Dr. Hayley Passmore, Telethon Kids Institute

● Prof. Carol Bower, Telethon Kids Institute

● Dr. Rochelle Watkins, Telethon Kids Institute

Strategic Contributions

The following groups are thanked for their guidance and input to the Making FASD History project in Newcastle:

The Making FASD History Project Steering Committee: Dr James Fitzpatrick (Program Lead); Tony Brown (Newcastle site lead); Tony Bidstrup (Newcastle host site lead); Dr John Boffa (Alice Springs site lead); Glenn Pearson (Deputy Director, Aboriginal Health (Telethon)); Louise Gray (NOFASD); Kath Thomas (Community representative).

The authors wish to acknowledge the contributions of the Newcastle Local Drug Action Team in initiating and supporting the Making FASD History project in Newcastle.

This resource has been developed as part of the Making FASD History – Newcastle project. This resource provides information for generalist services to understand the pathway a young person, who may have FASD or other neurodevelopmental disorder, travels in their journey through the justice system.

Acknowledgements

MODEL OF CARE HANDBOOK � 2020

Contents

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1.0 Background .....................................................................................................................................4

1.1 Making FASD History in Newcastle ............................................................................................................ 4

2.0 What is FASD? ................................................................................................................................42.1 Brain anatomy and function ......................................................................................................................... 52.2 Reframing challenging behaviour as a “brain-based” difficulty ......................................................... 5

3.0 Newcastle Model of Care ...........................................................................................................63.1 Aim ..................................................................................................................................................................... 63.2 Objectives ....................................................................................................................................................... 63.3 Development of a Model of Care Document .......................................................................................... 6

4.0 Newcastle FASD Youth Justice Model of Care ....................................................................7

5.0 FASD Across the Lifespan ..........................................................................................................95.1 Observation Across Brain Domains .......................................................................................................... 95.2 Observers Across the Lifespan .................................................................................................................105.3 Strategies Across the Lifespan ..................................................................................................................115.4 Dysmaturity - FASD Chronological Age Vs Developmental Age ......................................................12

6.0 Assessments Across the Life Course ...................................................................................13

7.0 Australian Guide to the Diagnosis of FASD ........................................................................147.1 FASD Diagnosis ..............................................................................................................................................147.2 Information on FASD Diagnostic Assessment for Individuals and Caregivers ...............................15

8.0 Supporting Information ............................................................................................................16

9.0 References .................................................................................................................................... 17

Appendix A: When Can Alcohol Harm the Developing Fetus? ............................................18

Appendix B: Newcastle FASD Youth Justice Model of Care ........................................... 19

Appendix C: Looking for the Indicators of FASD Across the Lifespan .......................... 20

1.0 Background

1.1 Making FASD History in Newcastle

The Making FASD History: A multisite prevention program was a two and a half year fetal alcohol spectrum disorder (FASD) prevention program delivered by the Telethon Kids Institute, in partnership with the Newcastle Local Drug Action Team (LDAT), local auspicing partner Mercy Services (New South Wales), and Central Australian Aboriginal Congress Aboriginal Corporation (Northern Territory), and funded by the Commonwealth Department of Health from December 2017 to August 2020.

The focus of the program was sustainability and building local capacity so that communities can continue to lead FASD prevention activities. Targeted prevention activities in the justice sector in Newcastle were undertaken, including:

● Research exploring the role of service providers and staff in the youth justice sector.

● Development of FASD awareness factsheets for use in the youth justice sector.

● Development of a Model of Care tool for young people with cognitive disabilities including FASD who are involved with the Youth Justice system.

This handbook is designed to provide people working in the youth justice sector and other related sectors with information about FASD, and resources about how and where to refer young people who may have FASD or other neurodevelopmental disorders who come into contact with the Youth Justice system. Information about services and supports is provided at the end of the document.

For further information about the Making FASD History: A multi-site prevention program please visit the Telethon Kids website.

What is a Model of Care?A “Model of Care” broadly defines the way health services are delivered. It outlines best practice care and services for a person, population group or patient cohort as they progress through the stages of a condition, injury or event. It aims to ensure people get the right care, at the right time, by the right

team and in the right place (Agency for Clinical Innovation, 2013).

2.0 What is FASD?

Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disability caused by prenatal alcohol exposure. FASD is a lifelong and often invisible disability that may affect growth, coordination, behaviour, attention span, memory, learning, speech, IQ, reasoning and judgment. FASD may also affect vision and hearing, and can cause cardiac, renal and skeletal problems. People with FASD may have characteristic facial features, such as a smooth philtrum, small eyes and a thin upper lip (Bower & Elliott, 2016) (for more information on FASD see resources provided in Table 4).

NEWCASTLE FASD YOUTH JUSTICE4

2.1 Brain anatomy and function

Different areas of the brain can be affected by prenatal exposure to alcohol. The degree of damage to the unborn baby will depend on its stage of development at the time of exposure to alcohol because different parts of the brain develop at different times during pregnancy (Brown & Mather, 2014) (see Appendix A: When does alcohol affect the fetus?).

The diagram below demonstrates the different brain function domains that can be affected by prenatal alcohol exposure. People with FASD may present with impairments across these domains (see Table 2: Observation Across Brain Domains, page 9).

Figure 1Brain Domain and Function

2.2 Reframing challenging behaviour as a “brain-based” difficulty

When working with a young person who has FASD, consider reframing their behaviour as the unintentional consequence of compromised brain function, rather than wilful defiance. It can be useful to frame behaviours with the question, “Is it that the child won’t or is it that the child can’t?” (Malbin, 2002). The beliefs that we have about behaviour and the way we frame behaviours can influence our commitment to continue supporting a child with challenging behaviour (McLean, Kettler, Delfabbro, & Riggs, 2012).

5MODEL OF CARE HANDBOOK � 2020

Living& Social

Skills

Focus &Attention

Cognition

Communication

Memory

ExecutiveFunctioning

Sensory& Motor

AcademicSkills

BrainStructure

Note. Adapted from Understanding Fetal Alcohol Spectrum Disorder (FASD) (p.8.), by NHS Ayrshire & Arran, 2019,n.p. https://www.nhsaaa.net/media/7926/understanding-fasd-a5-summary-guide-aug-19-print.pdf

3.0 Newcastle Model of Care

3.1 Aim

The aim of this work was to improve diagnosis and management of young people with FASD and other neurodevelopmental disorders in contact with the Youth Justice System in Newcastle and to reduce the risk of harm to both themselves and others, and break a cycle of reoffending.

3.2 Objectives

1. To determine the patient journey for young people with possible undiagnosed neurodevelopmental disorders (including FASD) involved with the Newcastle Youth Justice System;

2. To build capacity and understanding among justice professionals and custodial staff of the effects of prenatal alcohol exposure; and

3. To publish a Model of Care tool that can be accessed by staff working with young people who are engaged with the justice system.

3.3 Development of a Model of Care Document

In 2019 the Making FASD History team in Newcastle undertook research to inform the development of a Model of Care tool, including a literature review and interviews with key stakeholders in the youth justice sector. Following completion of the research process, we developed this Model of Care tool in consultation with a reference group of key stakeholders in the youth justice space. We sought input from the Australian and New Zealand FASD Clinical Network to ensure that the document conformed to Australian Standards and guidelines. This Model of Care tool is being made available to staff across the youth justice space in Newcastle. It includes:

● Newcastle FASD Youth Justice Model of Care: Designed for generalist services to understand the pathway a young person travels in their journey through the justice system.

● Looking for Warning Signs of FASD Across the Lifespan: Designed for stakeholders to understand how FASD presents across the lifespan, and to raise awareness of service providers and people who can act as observers and identify potential issues. Some strategies have also been included to assist those working with people with FASD.

● Map of FASD Impairments & Indicative Assessments Across the Life Course: This resource is a clinical diagram demonstrating functional impairments and includes the types of assessments indicated at different stages of the life course.

● FASD Diagnosis: Australian Guide to the diagnosis of diagrams.

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4.0 Newcastle FASD Youth Justice Model of Care

The Newcastle FASD Youth Justice Model of Care as shown in Table 1 is designed for generalist services to understand the pathway a young person, who may have a FASD or other neurodevelopmental impairment, travels in their journey through the justice system (see Appendix B for poster).

There are a number of entry points where a young person may have contact with the legal system. These include:

1. Youth on Track – Is an early intervention scheme for 10 to 17 year-olds that identifies and responds to young people at risk of long-term involvement in the criminal justice system. Police and other eligible agencies can refer young people, known to be at medium to high risk of offending, to a support service without requiring a legal mandate. The young person’s engagement in Youth on Track is voluntary (Communities & Justice, 2020).

2. Police – A young person may come to the notice of police within the community. If there is an offence the young person may be sent for youth conferencing or given a charge which would be heard in court before a magistrate.

3. Children’s Court - A young person who has committed an offence appears before the magistrate who determines the course of action related to the offence.

4. Section 32 – May be applied where a young person has a mental health condition, or cognitive impairment.

5. Sentencing – The magistrate may sentence the young person to a community order, or custody. If a cognitive impairment is suspected there are different processes for evaluation.

Young people who may have FASD or other neurodevelopmental disorders who have contact with the youth justice system can fall into the categories of victim, witness, or offender. They may also have contact with the wider justice system in other capacities, such as child protection and family law matters (Telethon Kids Institute, 2020). Staff and others working with young people in the youth justice system should be cognisant of this, as an awareness and understanding of the needs of young people in these scenarios can assist in accessing appropriate services and supports, and reducing the likelihood of re-offending (Telethon Kids Institute, 2020). The general information and principles illustrated throughout the Model of Care Handbook can apply to young people in all categories.

MODEL OF CARE HANDBOOK � 2020

1. YOUTH ON TRACK - YOUTH AT RISK OF JUSTICE INVOLVEMENTDISCRETIONARY REFERRAL

● Schools, NSW Police, Youth Justice NSW, Justice Health and Forensic Mental Health, solicitors, Community Services, Out of Home Care providers, Community Health, Family Referral Service, Headspace and other mental health services.

AUTOMATED REFERRAL ● Computerised Operating Policing System (COPS)

ELIGIBILITY SCREENING ● Eligibility for Youth on Track:

» Have at least one formal contact with police and a number of offending risk factors (discretionary referral) OR » Have at least two formal contacts with police and are at 60% or greater chance of reoffending (automatic

referral) AND » 10 to 17 years old » Have never received a supervised court order » Offend or go to school in one of the seven Youth on Track sites

● If an intellectual disability or cognitive impairment is present the YoT Senior Case Manager makes referrals for further assessment to a paediatrician or clinical support services.

● Referrals to NDIS if required, where diagnosis is present. ● Ineligible young people for Youth on Track are referred to Youth Crime Prevention Command as per the MoU

between Youth Justice NSW and NSW Police for consideration for support under the Rise Up Strategy and or Police Youth Case Management

2. POLICE ● Arrest, warning, caution, youth justice conference, court referral ● Youth on Track referral ● Young person may be known to Department of Communities & Justice and/or in Out of Home Care ● Justice Advocate Support (JAS) in Police Stations. Contact 1300 665 908

3. CHILDREN’S COURTBAIL (Youth Justice supervision or conditions to attend assessment)PLEA/HEARING/SECTION 32/FITNESS TO PLEAD

● Cognitive impairment and mental conditions for which treatments is available in a hospital

SENTENCE ● Sentence can be a caution, youth justice conference,

community based order or control order ● Broadmeadow Pilot Project Court Support Services (assist

the young person in identifying and addressing causes of offending but are not part of the sentence)

» Justice Health Clinician » Specialist Police Prosecutor

» Youth Justice caseworker » Dept. of Communities & Justice out posted case

worker » Education court liaison officer » Children’s court assistance scheme » Youth on track » Allambi Care youth worker » Regular attendance from police youth liaison

officers and school liaison police officers » Civil Youth Lawyer

● Referrals to mental health treatment, drug and alcohol, employment services, anger management, NDIS, health services, PCYC, programs

4. SECTION 32 (S.32) ● Young person has a mental health condition, or cognitive impairment

» Six month community treatment plans » May adopt NDIS plans

https://www.legislation.nsw.gov.au/#/view/act/1990/10/part3/sec325. SENTENCING

YOUNG PERSON IN THE COMMUNITY 1. Lawyer arranges private psychological assessment

YOUNG PERSON IN CUSTODY1. Court requests Psychological report. Youth Justice Psychologist undertakes report

CUSTODIAL ORDERS1. Referral to Youth Justice Psychologist2. Caseworkers apply for NDIS (See procedures)3. If known to NDIS, Youth Justice is informed about services

» NDIS is suspended while young person is in custody

Note. Adapted from Working with Young People who have an Intellectual Disability or Cognitive Impairment (pp. 34 - 36),by the Juvenile Justice NSW, Department of Justice, 2016. Copyright 2016 by The Authors.

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Table 1Newcastle FASD Youth Justice Model of Care

5.0 FASD Across the Lifespan

This information is designed to:

a. Help services and individuals understand FASD across the lifespan and how it may present (see 5.1).

b. Raise awareness in service providers and people who can act as observers and alert clients and their families to the possibility of FASD (see 5.2).

c. Provide strategies for working with people with FASD across the lifespan (see 5.3).

d. Demonstrate the concept of dysmaturity as it relates to FASD (see 5.4). (See Appendix C for poster)

5.1 Observation Across Brain Domains

Table 2Observations Across the Lifespan—Brain Domains Affected by FASD

9MODEL OF CARE HANDBOOK � 2020

EXECUTIVE FUNCTIONING FOCUS & ATTENTION ● Trouble with planning, sequencing, problem solving,

organisation ● Impulsivity ● Challenges with transitions and change ● Repeats mistakes and difficulty understanding

consequences ● Difficulty with:

» controlling emotions » abstract ideas/concepts » managing time

● Easily distracted, over-stimulated or impulsive ● Difficulty paying attention and over active ● Can’t sit still

SENSORY & MOTOR COGNITION ● Unable to make sense of what is going on around them ● Under or over react to sensory input e.g. light, noise,

touch, smell, taste and movement

● Difficulty with attention, learning, memory, planning and organisation

● Difficulty with understanding complex ideas ● Wide range of IQ possible

ACADEMIC SKILLS COMMUNICATION ● Difficulty with:

» school e.g. maths, reading, time and money » comprehension, organisation and abstract concepts » age appropriate tasks

● May have normal IQ ● Learning is enhanced with visual or hands on approach

● May speak well but not understand the full meaning ● Delayed language milestones for age ● Difficulty with long conversations ● Difficulty following instructions ● May be able to repeat instructions but not able to follow

throughLIVING & SOCIAL SKILLS MEMORY

● May not understand personal boundaries and reading social cues

● Socially vulnerable and easily taken advantage of ● Difficulty seeing things from another’s point of view ● Socially and emotionally immature e.g. behaves younger

than actual age

● Difficulty with long and short term memory e.g. seems forgetful

● Difficulty recalling sequences or complex instructions ● Better visual memory ● Steps in normal daily routine are easily forgotten ● Appear to lie but are really ‘filling in the blanks’

BRAIN STRUCTURE AFFECT REGULATION ● Brain and head circumference may be small ● Emotional swings from sad to happy

● Anxiety, depression, panic attacks ● Separation anxiety or attachment disorders ● Inappropriate sexual behaviours

Note. Adapted from Understanding Fetal Alcohol Spectrum Disorder (FASD) (p. 9 & 10), by NHS Ayrshire & Arran, 2019,n.p. https://www.nhsaaa.net/media/7926/understanding-fasd-a5-summary-guide-aug-19-print.pdf; Characteristics across the

lifespan, by NOFASD Australia, n.d. https://www.nofasd.org.au/parents-carers-and-families/characteristics-across-the-lifespan/

5.2 Observers Across the Lifespan

Opportunities arise across the lifespan where families, friends and service providers can be looking out for any irregularities in development or behaviour that might indicate FASD.

If you are one of these observers there are tools available from NOFASD Australia to assist in your observations, in the FASD – A Lifetime Story and FASD – A Check List document (also see Services and Support). These tools should not be used as a diagnostic instrument.

Figure 2Observations across the lifespan

0-5YEARS

● Parents, Grandparents, Aunts, Uncles, Friends, Foster Families

● Midwife , Paediatricians, General Practitioners

● Substance Use in Pregnancy and Parenting Program

● Maternal & Child Health (including multicultural services)

● Aboriginal Maternal & Child Health ● Out of Home Care Services, Case

workers, Carers ● Department of Communities & Justice ● Long Day Care

● Parents, Grandparents, Aunts, Uncles, Friends, Foster Families

● Pre-school Teachers and Staff, Long Day Care

● Primary Schools Teachers, Counsellors and Staff

● Police Youth Liaison Officers ● Out of Home Care Services , Case

workers, Carers ● Department of Communities & Justice ● Paediatricians , General Practitioners

6-10YEARS

11-17YEARS

● Parents, Grandparents, Aunts, Uncles, Friends

● Carers, Foster Families ● High School Teachers, School Counsellors

and Staff ● Police School Liaison Officers ● Out of Home Care Services, Case workers ● Department of Communities & Justice ● General Practitioners , Mental Health

Services ● Police, Youth Conference Conveners ● Solicitors and Magistrate ● Justice Health ● Intellectual Disability Rights Service ● Youth Services

● Family, Friends ● General Practitioners,

Hospitals ● Mental Health Services ● Drug and Alcohol

Services ● Police ● Solicitors and Magistrate ● Justice Health ● Intellectual Disability

Rights Service

18-30YEARS

30+YEARS

50-60YEARS

60-70YEARS

70+YEARS

NEWCASTLE FASD YOUTH JUSTICE10

5.3 Strategies Across the Lifespan

The following table outlines some simple strategies to address FASD across the lifespan.

Table 3Strategies across the lifespan

0-5 YEARS

● Poor sleep: soft music, sing, rocking, frequent holding, low lights, automatic swings, and wrap snuggly ● Poor weight gain: consult a nutritionist ● Chronic ear infections: check hearing & infections ● Developmental delays: consult an occupational therapist ● Speech delays: consult a speech therapist ● Dental problems: consult a paediatric dentist ● Small appetites or sensitivity to food texture: serve small portions that are lukewarm or cool and have some

texture. Allow plenty of time during meals and decrease distractions such as television, radio or multiple conversations

6-10 YEARS

● Sleep problems: shorten naps or cut them out ● Making friends: pair your child with another who is one or two years younger ● Boundary issues: create a stable, structured home with clear routines and plenty of repetition ● Attention problems: establish a routine and use structure. Simplify rooms in the home and reduce noises or

other stimulation ● Easily frustrated/tantrum: remove child from the situation and use calming techniques such as sitting in a

rocker, giving a warm bath or playing quiet music ● Difficulty understanding cause and effect: repetition, consistency and clear consequences for behaviour

are important ● Network of friends, family and professionals who can adapt the environment as needed

11-17 YEARS

● Anxiety and depression: counselling or encouraging participation in sports, clubs or other structured activities

● Victimisation: monitor the activities and discuss dealing with strangers ● Lying, stealing or antisocial behaviour: family counselling, set simple and consistent rules with immediate

consequences ● Network of friends, family and professionals who can adapt the environment as needed

18-70+ YEARS

● Anxiety and depression: counselling or encouraging participation in sports, clubs or other structured activities

● Victimisation: monitor the activities and discuss dealing with strangers ● Lying, stealing or antisocial behaviour: family counselling, set simple and consistent rules with immediate

consequences ● Housing: contact community housing services ● Network of friends, family and professionals who can adapt the environment as needed

Note. Adapted from Living with FASD by National Organization on Fetal Alcohol Syndrome,n.d. www.nofas.org/living-with-fasd/ Copyright by The Authors.

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5.4 Dysmaturity - FASD Chronological Age Vs Developmental Age

Dysmaturity is when a person’s developmental age is less than their chronological age, so they may act and think younger than they are (Malbin, 2010; Streissguth, 1994). It is thought that children will develop and grow according to an accepted chronological schedule and for physical, cognitive, and psychological development to occur at about the same rate. Unfortunately for individuals affected by prenatal alcohol exposure, these assumptions about development can create a poor fit between abilities and the expectations placed upon individuals (see, for discussion, the work of Diane Malbin (2002) - Trying Differently Rather Than Harder: Fetal Alcohol Spectrum Disorders).

The image below demonstrates how a person with FASD might present in terms of their developmental stages across a range of domains. In this example the chronological age of the person is 18 years. However, their social skills are that of a 7 year old, while their expressive language is that of a 20 year old.

Figure 3Dysmaturity

Note. Adapted from Understanding Fetal Alcohol Spectrum Disorder (FASD), (p.11), by NHS Ayrshire & Arran, 2019,https://www.nhsaaa.net/media/7926/understanding-fasd-a5-summary-guide-aug-19-print.pdf

6Comprehension

& socialmaturity

7Social skills

8Money & time

concepts

11Living skills

16Readingability

18Actual

chronologicalage

20Expressivelanguage

DEVELOPMENTALAGE

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6.0 Map of FASD Impairments & IndicativeAssessments Across the Life CourseThis is a clinical diagram which demonstrates the functional impairments that can present with FASD and indicates the types of assessments required at different stages of the life course.

Figure 4Map of FASD Impairments & Indicative Assessments Across the Life Course

Note. Reprinted from NDIA Planning Project, (p. 12), by A. Dudley, T. Reibel, C. Bower, J. Fitzpatrick, 2016,https://www.fasdhub.org.au/siteassets/pdfs/critical-review-of-the-literature-fetal-alcohol-spectrum-disorders-14jun2016.pdf

13MODEL OF CARE HANDBOOK � 2020

7.0 Australian Guide to the Diagnosis of FASD

7.1 FASD Diagnosis

This diagram shows the diagnostic algorithm for Fetal Alcohol Spectrum Disorder (FASD) in Australia.

Figure 5Diagnostic Algorithm for Fetal Alcohol Spectrum Disorder (FASD)

Note. Reprinted from the Australian Guide to the Diagnosis of FASD, (p.6), by C. Bower, and E. Elliott, 2016,https://www.fasdhub.org.au/contentassets/32961d4a5cf94de48ebcf985c34d5456/australian-guide-to-the-diagnosis-of-fasd_all-

appendices_feb2020.docx.pdf

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7.2 Information on FASD Diagnostic Assessment for Individualsand Caregivers

The flow chart below demonstrates the general pathway for diagnosing FASD, illustrating the steps and health care providers involved in this process.

Diagnostic assessment for FASD can be conducted with people of all ages, but is generally conducted with children under 18 years of age. Ideally an individual should have a diagnostic assessment as early as possible. The information in the diagram below is for parents and caregivers. Here, the word ‘child’ refers to a person under the age of 18. However, the information could also be used to explain the FASD Diagnostic Assessment to a person of any age undergoing diagnostic assessment. The number and arrangement of appointments will depend on where a person has their assessment conducted e.g. hospital, community clinic, paediatrician in private practice (Bower & Elliot, 2016, updated 2020, p. 49).

Figure 6What is involved in getting a diagnosis?

15

Note. Reprinted from the Australian Guide to the Diagnosis of FASD, (p.49), by C. Bower, and E. Elliott, 2016,https://www.fasdhub.org.au/contentassets/32961d4a5cf94de48ebcf985c34d5456/australian-guide-to-the-diagnosis-of-fasd_all-

appendices_feb2020.docx.pdf

MODEL OF CARE HANDBOOK � 2020

8.0 Supporting Information

Table 4 below provides details for services, supports, information and training available in the Newcastle area and information and training opportunities for service staff and individuals interested in finding out more about FASD.

Table 4Services, Support, Information & Training

SERVICES & SUPPORT

Justice Advocate from Intellectual Disability Rights Service for support at a police station or court.

7 days a week from 9am to 10pmhttps://idrs.org.au/site18/wp-content/uploads/2019/06/About-the-Service.pdf

FASD HUB Service Directory https://www.fasdhub.org.au/services/

HealthShare - Find a professional https://www.healthshare.com.au/

NOFASD Australia - Diagnosis https://www.nofasd.org.au/parents-carers-and-families/fasd-diagnosis/

NOFASD Australia - FASD: A Checklist for parents and carers https://www.nofasd.org.au/wp-content/uploads/2018/05/FASD-checklist.pdf

NOFASD Australia - FASD: A Lifetime Story

https://www.nofasd.org.au/wp-content/uploads/2018/03/FASD-A-Lifetime-Story.pdf

Telethon Kids Institute - Resources https://alcoholpregnancy.telethonkids.org.au/resources/

Australian Institute of Family Studies https://aifs.gov.au/cfca/publications/supporting-children-living-fetal-alcohol-spectrum-disorders-practice-princ

PCYC - Police Citizens Youth Club Rise Up Programs - https://www.pcycnsw.org.au/programs/police-programs/

YAMS - Youth Action Meetings https://www.police.nsw.gov.au/__data/assets/pdf_file/0010/616816/YouthStrategy_D17.pdf

Community HealthPathways (FASD) (for health professionals) https://hne.communityhealthpathways.org/193728.htm

Youth on Track http://www.youthontrack.justice.nsw.gov.au/

INFORMATION & TRAINING

Australian Guide to the Diagnosis of FASD

https://www.fasdhub.org.au/fasd-information/assessment-and-diagnosis/guide-to-diagnosis/

FASD HUB - FASD and Justice Videos https://www.fasdhub.org.au/fasd-information/managing-fasd/what-can-justice-professionals-do/videos/

Telethon Kids Institute - FASD and Justice Videos

https://alcoholpregnancy.telethonkids.org.au/our-research/fasd--justice/professional-development/

Telethon Kids Institute - On-line Continuing Professional Development Module for Lawyers

Contact admin@legalaid.wa.gov.au or phone (08) 9261 6384.

Nate Sheets - Oragon Behaviour Consultation https://www.youtube.com/watch?v=LwxVZXefkr4

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9.0 References

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INFORMATION & TRAINING (cont.)

Dan Dubovsky - FASD Specialist at Substance Abuse & Mental Health Services Administration FASD Centre for Excellence, Washington D.C. Metro Area

Strategies for Improving Outcomes - https://www.fasdoutreach.ca/resources/all/d/dan-dubovsky-strategies-improving-outcomes

Rewards & Consequences - https://www.fasdoutreach.ca/resources/all/d/dan-dubovsky-rewards-consquences

Comparing ODD, ADHD, and FASD - https://www.fasdoutreach.ca/resources/all/d/dan-dubovsky-comparing-odd-adhd-fasd

Malbin, D., Boulding, D., Brooks, S. Trying Differently: Rethinking Juvenile Justice Using a Neuro-Behavioural Model

http://fascets.org/images/uploads/docs/ABA_JJ_newsletter_Trying_Differently_july_2010.pdf

Bower, C., & Elliott, E. (2016, updated 2020). Australian Guide to the Diagnosis of FASD. https://www.fasdhub.org.au/siteassets/pdfs/australian-guide-to-diagnosis-of-fasd_all-appendices.pdf

Brown, J., & Mather, M. (2014). FASD: Parenting a child with an invisible disability: CreateSpace Independent Publishing Platform.

Communities & Justice. (2020). Youth on Track. NSW Government. http://www.youthontrack.justice.nsw.gov.au/

Dudley, A., Reibel, T., Bower, C., & Fitzpatrick, J. (2016). Critical Review of the Literature, Fetal Alcohol Spectrum Disorders. https://www.fasdhub.org.au/siteassets/pdfs/critical-review-of-the-literature-fetal-alcohol-spectrum-disorders-14jun2016.pdf

Juvenile Justice NSW, Department of Justice. (2016). Working with Young People who have an Intellectual Disability or Cognitive Impairment, n.p.

Malbin, D. (2002). Trying differently rather than harder (2nd Ed.). FASCETS Inc.

Malbin, D., Boulding, D., & Brooks, S. (2010). Trying Differently: Rethinking Juvenile Justice Using a Neuro-Behavioral Model. Juvenile Justice Committee Newsletter (5). http://fascets.org/images/uploads/docs/ABA_JJ_newsletter_Trying_Differently_july_2010.pdf

McLean, S., Kettler, L., Delfabbro, P., & Riggs, D. (2012). Frameworks for understanding challenging behaviour in out-of-home care. Clinical Psychologist, 16(2), 72-81. https://doi.org/10.1111/j.1742-9552.2011.00037.x

NHS Ayrshire & Arran. (2019). Understanding Fetal Alcohol Spectrum Disorder (FASD). https://www.nhsaaa.net/media/7926/understanding-fasd-a5-summary-guide-aug-19-print.pdf

National Organization on Fetal Alcohol Syndrome. (n.d). Living with FASD. www.nofas.org/living-with-fasd/

NOFASD Australia. (n.d.). Characteristics across the lifespan. https://www.nofasd.org.au/parents-carers-and-families/characteristics-across-the-lifespan/

Streissguth A. P. (1994). A Long-Term Perspective of FAS. Alcohol health and research world, 18(1), 74–81. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876481/

Telethon Kids Institute. (2020). FASD & Justice. https://alcoholpregnancy.telethonkids.org.au/our-research/fasd--justice/

MODEL OF CARE HANDBOOK � 2020

Appendix A: When Can Alcohol Harm the Developing Fetus?

This diagram shows the stages of fetal development during pregnancy, and the different parts of the body affected and the level of severity, depending on the point in pregnancy.

Figure 7When can alcohol damage the developing fetus?

Note. Adapted from Understanding Fetal Alcohol Spectrum Disorder (FASD), (pp. 5 -6) by NHS Ayrshire & Arran, 2019,https://www.nhsaaa.net/media/7926/understanding-fasd-a5-summary-guide-aug-19-print.pdf

NEWCASTLE FASD YOUTH JUSTICE18

Appendix B: Newcastle FASD Youth Justice Model of Care

19MODEL OF CARE HANDBOOK � 2020

New

cast

le F

ASD

You

th J

ustic

e M

OD

EL O

F CA

REA

you

ng p

erso

n’s

inte

grat

ed jo

urne

y: F

etal

Alc

ohol

Spe

ctru

m D

isor

der

(FA

SD

) 10

+ Ye

ars

●● H

odgs

on, H

. & H

amilt

on, O

. ●●

May

20

20

1. Yo

uth

on T

rack

: Is a

n ea

rly in

terv

entio

n sc

hem

e fo

r 10

to 17

yea

r-old

s tha

t id

entifi

es

and

resp

onds

to y

oung

peo

ple

at ri

sk o

f lon

g-te

rm in

volv

emen

t in

the

crim

inal

jus

tice

syst

em.

Polic

e an

d ot

her

elig

ible

age

ncie

s ca

n re

fer y

oung

peo

ple,

kno

wn

to b

e at

med

ium

to h

igh

risk

of o

� end

ing,

to

a su

ppor

t ser

vice

with

out r

equi

ring

a le

gal m

anda

te. T

he y

oung

per

son’

s en

gage

men

t in

Yout

h on

Tra

ck is

vol

unta

ry (C

omm

uniti

es &

Jus

tice,

202

0).

2. P

olic

e: A

you

ng p

erso

n m

ay c

ome

to

the

notic

e of

pol

ice

with

in th

e co

mm

unity

. If

ther

e is

an

o� e

nce

the

youn

g pe

rson

m

ay b

e se

nt f

or y

outh

con

fere

ncin

g or

gi

ven

a ch

arge

whi

ch w

ould

be

hear

d in

co

urt b

efor

e a

mag

istra

te.

3. C

hild

ren’

s Co

urt:

A yo

ung

pers

on w

ho h

as c

omm

itted

an

o�

enc

e ap

pear

s be

fore

the

mag

istra

te w

ho

dete

rmin

es

the

cour

se

of

actio

n re

late

d to

the

o� e

nce.

4. S

ectio

n 32

: M

ay b

e ap

plie

d w

here

a y

oung

pe

rson

ha

s a

men

tal

heal

th

cond

ition

, or

co

gniti

ve im

pairm

ent.

5.

Sent

enci

ng:

The

mag

istra

te

may

sen

tenc

e th

e yo

ung

pers

on

to a

com

mun

ity o

rder

, or c

usto

dy.

If a

cogn

itive

im

pairm

ent

is

susp

ecte

d th

ere

are

di� e

rent

pr

oces

ses

for e

valu

atio

n.

Num

ber

of e

ntry

poi

nts

whe

re a

you

ng p

erso

n m

ay h

ave

cont

act w

ith th

e le

gal s

yste

m.

YOU

TH O

N T

RA

CK

YOU

TH A

T R

ISK

OF

JUST

ICE

INV

OLV

EMEN

T

Dis

cret

iona

ry R

efer

ral

●

Scho

ols,

NSW

Pol

ice,

You

th J

ustic

e N

SW, J

ustic

e H

ealth

and

For

ensi

c M

enta

l Hea

lth, s

olic

itors

, Co

mm

unity

Ser

vice

s, O

ut o

f Hom

e Ca

re p

rovi

ders

, Com

mun

ity H

ealth

, Fam

ily R

efer

ral S

ervi

ce,

Hea

dspa

ce a

nd o

ther

men

tal h

ealth

ser

vice

s.

Auto

mat

ed R

efer

ral

●

Com

pute

rised

Ope

ratin

g Po

licin

g Sy

stem

(CO

PS)

ELIG

IBIL

ITY

SC

REE

NIN

G

●

Elig

ibili

ty fo

r You

th o

n Tr

ack:

»H

ave

at le

ast o

ne fo

rmal

con

tact

with

pol

ice

and

a nu

mbe

r of o

� end

ing

risk

fact

ors

(dis

cret

iona

ry re

ferr

al) O

R »

Hav

e at

leas

t tw

o fo

rmal

con

tact

s w

ith p

olic

e an

d ar

e at

60%

or g

reat

er c

hanc

e of

re

o� e

ndin

g (a

utom

atic

refe

rral

) AN

D »

10 to

17 y

ears

old

»H

ave

neve

r rec

eive

d a

supe

rvis

ed c

ourt

orde

r »

O� e

nd o

r go

to s

choo

l in

one

of th

e se

ven

Yout

h on

Tra

ck s

ites

●

If an

inte

llect

ual d

isab

ility

or c

ogni

tive

impa

irmen

t is

pres

ent t

he Y

oT S

enio

r Cas

e M

anag

er

mak

es re

ferr

als

for f

urth

er a

sses

smen

t to

a pa

edia

trici

an o

r clin

ical

sup

port

serv

ices

.

●Re

ferr

als

to N

DIS

if re

quire

d, w

here

dia

gnos

is is

pre

sent

.

●In

elig

ible

you

ng p

eopl

e fo

r You

th o

n Tr

ack

are

refe

rred

to Y

outh

Crim

e Pr

even

tion

Com

man

d as

pe

r the

MoU

bet

wee

n Yo

uth

Just

ice

NSW

and

NSW

Pol

ice

for c

onsi

dera

tion

for s

uppo

rt un

der

the

Rise

Up

Stra

tegy

and

or P

olic

e Yo

uth

Case

Man

agem

ent

CH

ILD

REN

’S C

OU

RT

Bail

(You

th J

ustic

e su

perv

isio

n or

con

ditio

ns to

at

tend

ass

essm

ent)

Plea

/Hea

ring/

Sect

ion

32/F

itnes

s to

ple

ad

●

Cogn

itive

impa

irmen

t and

men

tal

cond

ition

s fo

r whi

ch tr

eatm

ents

is a

vaila

ble

in a

hos

pita

l

Sent

ence

●

Sent

ence

can

be

a ca

utio

n, y

outh

just

ice

conf

eren

ce, c

omm

unity

bas

ed o

rder

or

cont

rol o

rder

●

Broa

dmea

dow

Pilo

t Pro

ject

Cou

rt Su

ppor

t Se

rvic

es (a

ssis

t the

you

ng p

erso

n in

id

entif

ying

and

add

ress

ing

caus

es o

f o�

end

ing

but a

re n

ot p

art o

f the

sen

tenc

e) »

Just

ice

Hea

lth C

linic

ian

»Sp

ecia

list P

olic

e Pr

osec

utor

»Yo

uth

Just

ice

case

wor

ker

»D

ept.

of C

omm

uniti

es &

Jus

tice

out

post

ed c

ase

wor

ker

»Ed

ucat

ion

cour

t lia

ison

o�

cer

»Ch

ildre

n’s

cour

t ass

ista

nce

sche

me

»Yo

uth

on tr

ack

»Al

lam

bi C

are

yout

h w

orke

r »

Regu

lar a

ttend

ance

from

pol

ice

yout

h lia

ison

o�

cers

and

sch

ool l

iais

on p

olic

e o�

cer

s »

Civi

l You

th L

awye

r

●Re

ferr

als

to m

enta

l he

alth

tre

atm

ent,

drug

and

alc

ohol

, em

ploy

men

t ser

vice

s,

ange

r man

agem

ent,

ND

IS, h

ealth

ser

vice

s,

PCYC

, pro

gram

s

PO

LIC

E

●

Arre

st, w

arni

ng, c

autio

n, y

outh

just

ice

conf

eren

ce, c

ourt

refe

rral

●

Yout

h on

Tra

ck re

ferr

al

●

Youn

g pe

rson

may

be

know

n to

Dep

artm

ent o

f Com

mun

ities

& J

ustic

e an

d/or

in O

ut o

f Hom

e Ca

re

●Ju

stic

e Ad

voca

te S

uppo

rt (J

AS) i

n Po

lice

Stat

ions

. Co

ntac

t 130

0 66

5 90

8

SEC

TIO

N 3

2 (S

.32)

●

Youn

g pe

rson

has

a m

enta

l hea

lth c

ondi

tion,

or

cogn

itive

impa

irmen

t »

Six

mon

th c

omm

unity

trea

tmen

t pla

ns »

May

ado

pt N

DIS

pla

nsht

tps:/

/ww

w.le

gisla

tion.

nsw

.gov

.au/

#/vi

ew/a

ct/19

90/10

/pa

rt3/s

ec32

SEN

TEN

CIN

G

YOU

NG

PER

SON

IN T

HE

COM

MU

NIT

Y

1. La

wye

r arr

ange

s pr

ivat

e ps

ycho

logi

cal a

sses

smen

t

YOU

NG

PER

SON

IN C

UST

ODY

1. Co

urt r

eque

sts

Psyc

holo

gica

l rep

ort.

Yout

h Ju

stic

e Ps

ycho

logi

st u

nder

take

s re

port

CUST

OD

IAL

ORD

ERS

1. Re

ferr

al to

You

th J

ustic

e Ps

ycho

logi

st

2.

Case

wor

kers

app

ly fo

r ND

IS (S

ee p

roce

dure

s)

3.

If kn

own

to N

DIS

, You

th J

ustic

e is

info

rmed

abo

ut

serv

ices

»N

DIS

is s

uspe

nded

whi

le y

oung

per

son

is in

cu

stod

y

Plea

se re

fer t

o th

e N

ewca

stle

FAS

D Y

outh

Jus

tice

Mod

el o

f Car

e H

andb

ook

for

refe

renc

ing,

info

rmat

ion

on s

ervi

ces,

sup

ports

and

trai

ning

.

Not

e. A

dapt

ed f

rom

Wor

king

with

You

ng P

eopl

e w

ho h

ave

an I

ntel

lect

ual

Dis

abilit

y or

Cog

nitiv

e Im

pairm

ent (

pp. 3

4 - 3

6), b

y th

e Ju

veni

le J

ustic

e N

SW,

Dep

artm

ent o

f Jus

tice,

201

6. C

opyr

ight

201

6 by

The

Aut

hors

.TH

IS P

ROJE

CT

WAS

FU

ND

ED B

Y TH

E AU

STRA

LIA

N G

OVE

RNM

ENT

DEP

ART

MEN

T O

F H

EALT

H.

1. 2.

3.4. 5.

Note. Adapted from Working with Young People who have an Intellectual Disability or Cognitive Impairment(pp. 34 - 36), by the Juvenile Justice NSW, Department of Justice, 2016. Copyright 2016 by The Authors.

Appendix C: Looking for the Indicators of FASD Across the Lifespan

20

Look

ing

for t

he IN

DIC

ATO

RS O

F FA

SD A

cros

s th

e Li

fesp

anFr

om B

irth

to A

dulth

ood:

Fet

al A

lcoh

ol S

pect

rum

Dis

orde

r (F

AS

D)

●● H

odgs

on, H

. & H

amilt

on, O

. ●●

May

20

20

EXEC

UTIV

E FUN

CTIO

NING

FOCU

S &

ATTE

NTIO

N

●Tr

oubl

e w

ith p

lann

ing,

se

quen

cing,

pro

blem

solvi

ng,

orga

nisa

tion

●

Impu

lsivit

y

●Ch

alle

nges

with

tran

sitio

ns a

nd

chan

ge

●Re

peat

s m

istak

es a

nd d

i� cu

lty

unde

rsta

ndin

g co

nseq

uenc

es

●Di

� cu

lty w

ith:

»co

ntro

lling

emot

ions

»ab

strac

t ide

as/c

once

pts

»m

anag

ing

time

●

Easil

y dist

ract

ed, o

ver-s

timul

ated

or

impu

lsive

●

Di�

culty

pay

ing

atte

ntio

n an

d ov

er a

ctive

●Ca

n’t s

it sti

ll

SENS

ORY

& M

OTOR

COGN

ITIO

N

●Un

able

to m

ake

sens

e of

wha

t is

goin

g on

aro

und

them

●

Unde

r or o

ver r

eact

to se

nsor

y in

put e

.g. li

ght,

noise

, tou

ch,

smel

l, tas

te a

nd m

ovem

ent

●

Di�

culty

with

atte

ntio

n,

lear

ning

, mem

ory,

plan

ning

and

or

gani

satio

n

●Di

� cu

lty w

ith u

nder

stand

ing

com

plex

idea

s

●W

ide

rang

e of

IQ p

ossib

le

ACAD

EMIC

SKI

LLS

COM

MUN

ICAT

ION

●

Di�

culty

with

: »

scho

ol e

.g. m

aths

, rea

ding

, tim

e an

d m

oney

»co

mpr

ehen

sion,

org

anisa

tion

an

d a

bstra

ct co

ncep

ts »

age

appr

opria

te ta

sks

●

May

hav

e no

rmal

IQ

●Le

arni

ng is

enh

ance

d wi

th vi

sual

or

han

ds o

n ap

proa

ch

●

May

spea

k wel

l but

not

un

ders

tand

the

full m

eani

ng

●De

laye

d la

ngua

ge m

ilesto

nes f

or

age

●

Di�

culty

with

long

conv

ersa

tions

●

Di�

culty

follo

wing

instr

uctio

ns

●M

ay b

e ab

le to

repe

at in

stru

ctio

ns

but n

ot a

ble

to fo

llow

thro

ugh

LIVIN

G &

SOCI

AL S

KILL

SM

EMOR

Y

●M

ay n

ot u

nder

stand

per

sona

l bo

unda

ries a

nd re

adin

g so

cial

cues

●

Socia

lly vu

lner

able

and

eas

ily

take

n ad

vant

age

of

●Di

� cu

lty se

eing

thin

gs fr

om

anot

her’s

poi

nt o

f vie

w

●So

cially

and

em

otio

nally

im

mat

ure

e.g.

beh

aves

youn

ger

than

act

ual a

ge

●

Di�

culty

with

long

and

shor

t ter

m

mem

ory e

.g. s

eem

s for

getfu

l

●Di

� cu

lty re

callin

g se

quen

ces o

r co

mpl

ex in

struc

tions

●Be

tter v

isual

mem

ory

●

Step

s in

norm

al d

aily

rout

ine

are

easil

y for

gotte

n

●Ap

pear

to lie

but

are

real

ly ‘fi

lling

in th

e bl

anks

’

BRAI

N ST

RUCT

URE

AFFE

CT R

EGUL

ATIO

N

●Br

ain

and

head

circ

umfe

renc

e m

ay b

e sm

all

●

Emot

iona

l swi

ngs f

rom

sad

to

happ

y

●An

xiety,

dep

ress

ion,

pan

ic at

tack

s

●Se

para

tion

anxie

ty o

r atta

chm

ent

diso

rder

s

●In

appr

opria

te se

xual

beh

avio

urs

OB

SER

VA

TIO

NS

0-5

YEAR

S

OB

SER

VER

S

●Pa

rent

s, Gr

andp

aren

ts, A

unts,

Un

cles,

Frie

nds,

Fost

er F

amilie

s

●M

idwi

fe , P

aedi

atric

ians

, Gen

eral

Pr

actit

ione

rs

●

Subs

tanc

e Us

e in

Pre

gnan

cy a

nd

Pare

ntin

g Pr

ogra

m

●

Mat

erna

l & C

hild

Hea

lth (

inclu

ding

m

ultic

ultu

ral s

ervic

es)

●

Abor

igin

al M

ater

nal &

Chi

ld H

ealth

●

Out o

f Hom

e Ca

re S

ervic

es, C

ase

work

ers,

Care

rs

●De

partm

ent o

f Com

mun

ities

&

Justi

ce

●Lo

ng D

ay C

are

STR

ATE

GIE

S

●Po

or sl

eep:

soft

mus

ic, si

ng,

rock

ing,

freq

uent

hol

ding

, low

light

s, au

tom

atic

swin

gs, a

nd w

rap

snug

gly

●

Poor

wei

ght g

ain:

cons

ult a

nu

tritio

nist

●Ch

roni

c ear

infe

ctio

ns: c

heck

he

arin

g &

infe

ctio

ns

●De

velo

pmen

tal d

elay

s: co

nsul

t an

occ

upat

iona

l the

rapi

st

●Sp

eech

del

ays:

cons

ult a

spee

ch

ther

apist

●De

ntal

pro

blem

s: co

nsul

t a

paed

iatri

c den

tist

●

Smal

l app

etite

s or s

ensit

ivity

to

food

text

ure:

serv

e sm

all p

ortio

ns

that

are

luke

warm

or c

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nd

have

som

e te

xtur

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llow

plen

ty o

f tim

e du

ring

mea

ls an

d de

crea

se

dist

ract

ions

such

as t

elev

ision

, ra

dio

or m

ultip

le co

nver

satio

ns

OB

SER

VER

S

●Pa

rent

s, Gr

andp

aren

ts, A

unts,

Un

cles,

Frie

nds,

Foste

r Fam

ilies

●

Pre-

scho

ol Te

ache

rs a

nd S

ta� ,

Lo

ng D

ay C

are

●

Prim

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choo

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ache

rs,

Coun

sello

rs a

nd S

ta�

●

Polic

e Yo

uth

Liaiso

n O�

cer

s

●Ou

t of H

ome

Care

Ser

vices

, Cas

e wo

rker

s, Ca

rers

●

Depa

rtmen

t of C

omm

uniti

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Ju

stice

●

Paed

iatri

cians

, Gen

eral

Pr

actit

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rs

STR

ATE

GIE

S

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eep

prob

lem

s: sh

orte

n na

ps o

r cu

t the

m o

ut

●

Mak

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frien

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air y

our c

hild

wi

th a

noth

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ho is

one

or t

wo

year

s you

nger

●

Boun

dary

issu

es: c

reat

e a

stabl

e,

struc

ture

d ho

me

with

clea

r ro

utin

es a

nd p

lent

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epet

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●

Atte

ntio

n pr

oble

ms:

esta

blish

a

rout

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and

use

struc

ture

. Sim

plify

ro

oms i

n th

e ho

me

and

redu

ce

noise

s or o

ther

stim

ulat

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●

Easil

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stra

ted/

tant

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: rem

ove

child

from

the

situa

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and

use

calm

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tech

niqu

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ch a

s sitt

ing

in a

rock

er, g

iving

a w

arm

bat

h or

pl

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iet m

usic

●

Di�

culty

und

erst

andi

ng ca

use

and

e� e

ct: r

epet

ition

, con

siste

ncy

and

clea

r con

sequ

ence

s fo

r be

havio

ur a

re im

porta

nt

●Ne

twor

k of f

riend

s, fa

mily

and

prof

essio

nals

who

can

adap

t the

en

viron

men

t as n

eede

d

6-10

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-17YE

ARS

OB

SER

VER

S

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rent

s, Gr

andp

aren

ts, A

unts

, Unc

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nds

●

Care

rs, F

oste

r Fam

ilies

●

High

Sch

ool T

each

ers,

Scho

ol C

ouns

ello

rs

and

Sta�

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lice

Scho

ol Li

aiso

n O�

cer

s

●Ou

t of H

ome

Care

Ser

vices

, Cas

e wo

rker

s

●De

partm

ent o

f Com

mun

ities

& Ju

stice

●

Gene

ral P

ract

ition

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Men

tal H

ealth

Se

rvice

s

●Po

lice,

Yout

h Co

nfer

ence

Con

vene

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licito

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nd M

agist

rate

●

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ce H

ealth

●

Inte

llect

ual D

isabi

lity R

ight

s Ser

vice

●

Yout

h Se

rvice

s

STR

ATE

GIE

S

●An

xiety

and

depr

essio

n: co

unse

lling

or

enco

urag

ing

parti

cipat

ion

in sp

orts

, clu

bs

or o

ther

stru

ctur

ed a

ctivi

ties

●

Vict

imisa

tion:

mon

itor t

he a

ctivi

ties a

nd

disc

uss d

ealin

g wi

th st

rang

ers

●

Lyin

g, st

ealin

g or

antis

ocia

l beh

avio

ur:

fam

ily co

unse

lling,

set s

impl

e an

d co

nsist

ent r

ules

with

imm

edia

te

cons

eque

nces

●

Netw

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f frie

nds,

fam

ily an

d pr

ofes

siona

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o ca

n ad

apt t

he

envir

onm

ent a

s nee

ded

OB

SER

VER

S

●Fa

mily

, Frie

nds

●

Gene

ral P

ract

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ers,

Hosp

itals

●

Men

tal H

ealth

Ser

vices

●

Drug

and

Alco

hol S

ervic

es

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lice

●

Solic

itors

and

Mag

istra

te

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stice

Hea

lth

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telle

ctua

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bilit

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hts S

ervic

e

STR

ATE

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●An

xiety

and

depr

essio

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unse

lling

or

enco

urag

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parti

cipat

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in sp

orts

, clu

bs

or o

ther

stru

ctur

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ctivi

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●

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imisa

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mon

itor t

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ctivi

ties

and

disc

uss d

ealin

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th st

rang

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●

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g, st

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antis

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l beh

avio

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ily co

unse

lling,

set s

impl

e an

d co

nsist

ent r

ules

with

imm

edia

te

cons

eque

nces

●

Hous

ing:

cont

act c

omm

unity

hou

sing

serv

ices

●

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ork o

f frie

nds,

fam

ily an

d pr

ofes

siona

ls wh

o ca

n ad

apt t

he

envir

onm

ent a

s nee

ded

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ARS

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sup

ports

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trai

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