Building Your Team

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Building Your Team

 

FAS and other FASDs often involve physical, neurologic, and neurobehavioral manifestations that have lifelong consequences for affected individuals. Similar to other children with special health care needs, individuals with FASDs require a comprehensive evaluation for diagnosis and the development of a treatment plan. Despite the inability to cure FASDs, outcomes can be improved with prompt recognition of the condition and implementation of therapy. Because FASDs affect all aspects of the child’s life, therapeutic plans, as much as possible, should involve the child, the family, health care providers, educators, and other individuals who impact the child’s day-to-day life.

Ideally, an FASD team consists of a general and/or developmental pediatrician, geneticist, psychologist, social worker, educational specialist, occupational therapist, and speech-language pathologist. Since these resources are not universally available, the composition of the particular FASD team will vary depending on the resources available in a given geographic region and each child’s needs. 

In managing FASDs, patient-specific issues must be addressed by matching the patient needs to certain skills and expertise. Most importantly, true teamwork with efficient and effective multidisciplinary care is best provided when orchestrated through the medical home attuned to effective, cooperative, and consistent communication and care coordination.

  • A medical home provider will need to evaluate the individual, including his or her strengths and challenges in regard to the impact an FASD has had on their lives and health. The medical home is often the first link to the interdisciplinary FASD team, providing the best possible care and support for the child and his or her family.
  • Build your FASD team(s) around the individual patient's care coordination plan and consultation needs with medical specialists.
  • Additional examples of complex needs often relate to growth, development, and nutrition. Failure to thrive and short stature may need to be evaluated by a gastroenterologist or endocrinologist, and may require guidance from a nutritionist.The management of a child with an FASD commences with a diagnostic evaluation consisting not only of making the diagnosis, whenever possible, but of facilitating the family’s understanding of the individual's unique medical and neurobehavioral profile and coordinating ongoing care. The FASD diagnostic process can be viewed as part of a continuum of care that helps identify and facilitate the appropriate health care, education, and community services for both the child and family. Continuous communication and explanation of processes with the family is essential. While there is no cure, an FASD team providing consistently coordinated and clearly communicated care offer the essential support needed by patients who are living with FASDs and their families from infancy through adulthood.
The following are common examples of specialty professionals who might serve on an FASD team or may be appropriate referrals in the diagnostic or treatment planning phases.

Type of Professional   Skills/Expertise Needed
Primary care pediatrician or developmental-behavioral pediatrician These clinicians often lead the medical home for children with FASDs by integrating their history and physical and neurologic examinations with the clinical reports from other disciplines. They provide feedback to the family about the evaluation and ensure appropriate referrals to medical/educational/developmental specialists. Frequently, these clinicians are the only ones who review all of the child’s physical, social, and environmental aspects. These clinicians may also provide ongoing medication monitoring.
GeneticistCompletes a physical examination, with particular emphasis on differential dysmorphic etiologies as well as possible comorbid conditions. This examination may be conducted by telemedicine with appropriately equipped clinics.
Psychologist/
neuropsychologist
Conducts neurocognitive/psychological evaluation that may involve evaluation of cognition, executive function, socio-emotional function, adaptive skills, academic achievement, and self-regulation within the context of the child’s family/community. Psychologists may also diagnose and provide treatment for affective disorders secondary to an FASD diagnosis, including depression and/or anxiety disorders. 
Neurologist Examines any central nervous system abnormalities and manages neurological issues.
Social workerServes as a family advocate for services and resources, provides or facilitates indicated counseling services and community resources, and conducts an assessment of the individual and the family’s strengths and challenges.
Early intervention servicesProvide families with children from birth to 36 months of age with appropriate developmental monitoring, services, and supports to assist in maximizing the child's development.
Educational specialist and/or school function evaluatorPerforms an assessment of the individual’s academic abilities and achievement.
Family therapistAddresses coping skills needs of the individual as well as the entire family.
Occupational therapistEvaluates the individual’s fine motor, gross motor, and adaptive functioning as well as sensory integration.
Speech-language pathologist   Assesses an individual’s receptive, expressive, pragmatic and written language skills.
Child protective services (CPS)Some children will be referred through CPS. However, when any aspect of exam or history suggests abuse or neglect, CPS should be contacted. Issues of alcohol should be discussed with all CPS case workers involved with the child both for diagnostic purposes and documenting history.
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