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Clare Stiles - Health Visitor, NHS Shetland

Fetal Alcohol Spectrum Disorder (FASD) Training

Fetal Alcohol Spectrum Disorder training is an online programme which allows access to it from work and from home. I had originally looked briefly at this package at work with a particular child in mind. The training increased my knowledge of the physical anomalies that can occur, such as dysmorphic facial features and "tram-track" ear shape, along with more occasional defects such as cleft palate.

The package is arranged in such a way that it is possible to dip in and out and to work through as much or as little as the practitioner desires, so in a short time I was able to identify that FASD could be a possibility for a few children on my caseload. I was particularly interested in the behavioural aspects that can occur with the condition, as these particular children had been difficult to settle, but I did not have enough time during my working hours to read the material in sufficient depth. I therefore decided to continue the training package at home and found the materials absolutely fascinating.

The increase in knowledge I developed as result of completing this training package has enabled me to identify further children who may have been affected by this. As a health visitor, being alert to the possibility of the presence of the condition will allow me to refer children who may be affected to services promptly and appropriately.

As the training programme points out, there is no cure for to condition but early therapy for any developmental delays with occupational therapy, physiotherapy, speech and language therapy and educational support can lessen the impact of the condition for the child.

It is therefore important for me in my role as health visitor to refer children as early as possible for interventions in order to ultimately improve their educational and life chances, thus increasing their chances of entering employment as an adult, contributing to society and reducing mental health problems later in life.

NES funded a course for the island boards to attend training based on the strengths based approach which is used within the Family Health Nurse (FNH) programme. The FHN programme is designed to give additional support to teenage mothers and requires that the practitioners have a specific number of cases in order to maintain skills.   As none of the island boards have sufficient numbers of teenage pregnancies to use this programme, NES developed the course to allow us to learn the approach and adapt to our own situations.

In Shetland, we have used this to develop a small team who use the approach to provide an intensive antenatal programme for young vulnerable pregnant teenagers and additional support after the birth of the baby.

I have also used this approach for a young couple who were experiencing difficulties due to recovering for years of drug abuse and petty criminal activity. Although they were not teenagers, they were vulnerable and keen to change for the sake of their unborn baby. Their previous experiences with the health services, social services and criminal justice system had been negative and self-esteem issues were evident, through working with the strengths-based approach, the couple were able to begin to identify their own strengths, those of their child and even those of the professionals working with them. I observed an incredible growth in both parents in their self-esteem and sense of self-worth, and their ability of communicate with their child, identify the child's needs and respond accordingly.

After initially providing an intensive programme of support for this couple, I now feel able to reduce the support offered as this couple are now providing loving and nurturing care for their child. The child is showing all the signs of feeling safe and content, and there are clear signs of bonding and attachment. This stable base will allow the child to develop emotionally and physically and hopefully attain full potential. The father is currently seeking employment outside the home, for the first time in years.

I will continue to use this approach with families I identify as vulnerable. I feel that the initial intensive work required by this approach can result in an improved outcome for the child and family and ultimately a reduction in requirement for services, such as health visiting, later in the child's life.

I also intend to use a strengths based approach in team building and have designed a teaching programme to share my learning with relevant staff within the Child Health Department.