 Good afternoon and good morning, of course, to those of you who are joining us from the West Coast. In the fall of 1990, the latest year for which we have good statistics, 3,874,000 children entered America's educational system for the first time. In the same year, it's estimated that over a million children were born exposed to alcohol, cocaine, or other drugs. The nation's challenge, our challenge, is to ensure that each of these children gets the same chance to succeed as any other child. Substance exposed children are just like every other child in one key respect. They are each unique, each with his or her own strengths and weaknesses. The purpose of this teleconference today is to discuss ways to discover the uniqueness of each of these children and to stimulate your idea processes about how to unlock their potential. We'll ask questions like what is the responsibility of the school, of the district, of the teacher. We'll hear from educators who have success stories to tell, and we'll hear about some horror stories, but horror stories that have been turned around. Substance exposed children can be rich or poor, they can be of any race, they may be part of a two-parent family, a one-parent family, or a no-parent family. They may live in a rural or an urban setting, but above all, they are children, each and every one unique with their own strengths and weaknesses, and they each deserve the chance to succeed. Now joining us this afternoon will be, to start this afternoon's activities, are two key policy makers in the education community. Betty Castor is the Commissioner of Education for the State of Florida, and Bill Mozilewski is the Director of the Office and Drug Planning and Outreach for the U.S. Department of Education. Welcome to both of you, and Commissioner Castor, we would like to start off with a few comments from you. Thank you, Barbara. The focus of this program, Educating High-Risk Children, is a challenge to educators at every level. Today we will present a range of information and successful practices designed to improve the lives of our nation's substance-exposed children. The Florida Department of Education's involvement with this issue began early in 1988. The Prevention Center was established to address the issues impacting high-risk children. By bringing together state and federal programs, such as drug-free schools, HIV-AIDS prevention, Serve America, Violence and Dropout Prevention, as well as others, we are able to focus on the needs of children and their families, rather than simply meeting the individual requirements of each program. This approach creates opportunities to plan for the future. By looking forward to the future, we knew that schools would be facing tremendous challenges, tremendous challenges in the coming years. The increasing use of drugs, declining economic conditions, and the despair many communities were feeling, created a climate detrimental to the development of healthy, well-prepared children. The Prevention Center developed two resources to help educators prepare for this condition. The first was the Hot Topics publication entitled Cocaine Baby, Florida's Substance-Exposed Children. After receiving 10,000 requests nationwide, we recognized the tremendous need for information. The second resource, Florida's Challenge, Educating Substance-Exposed Children, is a videotape and workbook training package. This package is the basis for today's teleconference. I want to thank the U.S. Department of Education for their continuing support of programs targeting the needs of high-risk children and their families. It is through their support and direction that a nation's challenge is possible. The staff at the Drug Planning and Outreach Office are dedicated to this program. Bill Modzilewski, Director of the Drug Planning and Outreach Office, has joined me. Bill, on behalf of the Florida Department of Education, thank you for your efforts and commitment to this project. Thank you. Thank you, Betty. Mr. Modzilewski. Thank you, Betty. On behalf of the U.S. Department of Education, I want to welcome each and every one of you to what we think will be a very useful and informative session on a critical issue facing numerous communities and school districts throughout the country. How to work effectively with youths who have been prenatally substance-exposed. This teleconference responds to calls by participants at the Educational Summit, held three years ago in Charlottesville, Virginia, for improvement of our educational system. Participants at the summit called for significant and sustained educational improvement for all children. They recognized that nothing less will meet the nation's needs for a strong competitive workforce, successful citizenship, and economic opportunity. An outgrowth of the summit was the development of six national educational goals. Of the six goals eventually developed and embraced by our president and nation's governors, this teleconference will address two. Goal one, that by the year 2000, all children in America will start school ready to learn. And goal six, that by the year 2000, every school in America will be free of drugs and violence and will offer a disciplined environment conducive to learning. It's our hope that all of you will come away from this teleconference with a better understanding of the nature of prenatal substance exposure and of promising classroom strategies for working with children who have special needs. We also hope to dispel some myths regarding these children and show that most children who have been prenatally substance exposed can function and thrive in classrooms, provided the right structure and support is provided. We recognize that we cannot address all of your needs or all of your concerns or answer all your questions in pre-short hours. We want you to know that this is not the end. This is the beginning of a cooperative relationship between several federal agencies, state agencies, and a variety of local agencies to address an issue of critical importance. We believe that the only way this issue can be addressed is by building these cooperative relationships, by sharing information, and by working together. Before turning this back to Barbara, I want to state that your active participation in this teleconference is essential to our collective success. We need your input, your questions, your ideas, and your comments. If you don't have the opportunity to provide them to us today, please don't despair. Send them to us. We want to hear from you. Thank you, Commissioner Casper and Mr. Mozoveski. Now you'll be hearing from both of them again later on in the program. And I am Barbara Rogers. I will be your moderator for the afternoon. We've assembled panels of experts at three sites across the country, in addition to here at WFSU-TV, the public television station in Tallahassee, Florida. The experts are educators, administrators, doctors, and social workers, all with an intense interest in the challenges facing substance-exposed children. In addition, there's an audience at each site. One panel is located in Portland, Oregon at the studios of Oregon Public Broadcasting. Our next panel is in Chicago at the National Television Production Center, a division of public TV station WTTW. The third site with a panel and audience is coming to us from Washington, D.C. from the studios of public TV station WHMM. Well, now it is time for us to begin. The world can be a risky place, and that risk begins at the moment each of us is conceived. Factors such as poor prenatal care or mother's exposure to drugs can have a tremendous impact on infants and children during the most critical years of their development. Phasoconstrictive felicepsin. So what it does is it tends to constrict blood vessels and thereby reduce blood flow. It also does it inside the fetus so that blood flow is affected to various organs of the fetus, including the brain, heart, kidneys, and that, so that it has a tremendous effect on the fetus. It also tends to induce labor so that those babies tend to be born prematurely. In fact, it's not unusual that a mom who uses cocaine may try and induce labor in herself by taking a large dose of cocaine. We get them, though, because they're premature. They come in with the respiratory problems. Their lungs aren't mature, so they can't breathe. We get them because they're a thermal regulation. They have temperature problems. They don't have enough fat on their bodies. They're the real skinny babies. There's no fat on their bodies, so they can't regulate their temperature. We get them because their gut is immature. Their intestines, stomachs, they're immature. They cannot feed, so we have to give them IV fluids or parental fluids, or they're too small to do the suck and swallow, so we may have to feed them by tube. We get them because their nervous system is immature. They may be real, real jittery, so there's a variety of reasons why they come in a lot of times with your premature babies. You can't tell if they're drug-exposed. We know because maybe of the history, but if we did not know if I were to walk in and see a premature baby, I would not be able to tell you that this baby was drug-exposed or not. What we're talking about is the kids that are basically have come through the whole thing with an intact brain, generally good health, but have some of the behavioral and other problems, and there is a lot of bright hope that with really good, thoughtful programs early on that those kids can be turned around and do just fine. So I think if we try to look above our own stereotypes and above our own prejudices and just encourage them the best you can, then I think they've got great potential. Nobody says they can't be road scholars just because they had a slow start in life. Well, now joining us to talk about some of the biological, medical, and developmental aspects is Dr. Ira Chasnoff, and he's joining us from Chicago. He is the president of the National Association of Perinatal Addiction Research, and Andrew Shee, who is here with us in Tallahassee. He is a pediatrician and an expert on what's happening in the rural areas. Dr. Chasnoff, let's start with you. What are some of the problems that you have seen with infants that are born exposed to drugs in utero, and what is the long-term impact on their development? Well, I think what we mainly see was related in the film. There's a high rate of prematurity, growth retardation, difficulties around the time of delivery so that babies do, in fact, have an increased risk for a slow start. But more than just the medical aspect, there's the neurobehavioral that the infant may look fine at birth, have no specific medical complications, but can have jitteriness, irritability, or difficulty relating to its environment. And probably the single most important aspect of this is we see a lot of newborns who have been exposed to drugs prenatally having difficulties with state regulation, the difficulty in controlling their behaviors and responding appropriately. And as we talk about the long-term developmental aspects for these children, we'll find that this impairment of state regulation, the difficulty in regulating behavior, is a theme that will carry through as we look at the children as they grow older. How early would you see some of the problems? I mean, is it possible you were saying sometimes in the beginning you don't see the problem? Is it possible that it wouldn't show up until much, much later and you would think that everything's okay? Sure. Actually, there are studies that look at the children in utero and you can actually see many of the medical problems such as the congenital anomalies are some of the behavioral problems with irritability if you look at the child on real-time ultrasound in utero. Then again, many of the children may look quite fine at birth and not be until two, three years of age. We begin to see the developmental or the behavioral problems. Now, as we track development, what we're talking about here is two different aspects. There's the cognitive development that is the intellectual development of the child and the other aspect is the behavioral. And as we begin to look further at these children and what happens, we find that intellectually most of the children do quite well. As a group, they score in the normal range for intelligence, but they have specific behavioral difficulties. On the other hand, even though the group as a whole scores in the normal range, when you look at individual children, you find that each individual child is at increased risk for developmental failure, that is falling below the standard scores for that child on an individual basis. Okay. Dr. Shee, we tend to think of this as an urban problem, not so much as a suburban and a rural problem, but you've done some work in looking at the rural areas. What do you find? Well, Barbara, in my state in New Mexico, we found that a study showed that somewhere around 50% of women indicated that they had used alcohol at the time they came to a clinic for pregnancy testing. 14% had used marijuana and 7% had used other drugs. Now, the clinics that we sampled were distributed throughout the state and so really reflected a population of women coming from both the most rural parts of the state of New Mexico as well as some of the urban areas. I think it is a generalizable problem to all communities and will have impact in the rural areas of the country as well. Okay. We have in a separate session, we spoke with Dr. Chasnoff about some specifics that are associated with the development of substance-exposed children. We're going to be taking a look at that tape in just a minute. But while we're waiting for that, Dr. Chasnoff, can you tell us about the effects of alcohol, which Dr. Shee mentioned? What is fetal alcohol syndrome and what is the difference between that and fetal alcohol effects? Well, probably the most important thing to know about alcohol right up front is that fetal alcohol syndrome is the leading diagnosable cause of mental retardation in this country. The full syndrome, fetal alcohol syndrome at birth is diagnosed through three basic criteria. Number one is the child is low birth weight that is born at less than five pounds, eight ounces. Number two, there are central nervous system difficulties, most commonly in the newborn, that's shown through small head circumference, small head size. And number three, the change in the facial structure of babies with fetal alcohol syndrome often look as if the mid-face is pushed in so that there's shortened eyes, a very broad nasal bridge, upturned nose, and the area between the bottom of the nose and the top of the lip called the philtrum is flattened. These are the features of fetal alcohol syndrome. Now, an older child or an adult with fetal alcohol syndrome has the same three criteria that make up the syndrome. That is, it continued poor growth. The central nervous system manifestations are manifest through IQ, that is the average IQ of adults with fetal alcohol syndrome is around 65. And third, the facial features. Now, that's the full syndrome. Fetal alcohol effects is a partial expression of the syndrome. And in fact, those children may look perfectly fine, have none of the medical criteria, in fact, may be functioning in a perfectly normal level cognitively. IQ is perfectly normal. But around two or three years of age, we begin to see the behavioral manifestations. And a child with F.A.E. or fetal alcohol exposure has a very high rate of risk for attention deficit disorder, hyperactivity, short attention span. And certainly these children are extremely high risk for problems in the school system. We're going to hear a little bit more from Dr. Tasnoff in a separate session. We spoke with him about some of the specifics associated with the development of substance-exposed children. So what we begin to look at is the various factors in a child's life that predict, for example, intellectual outcome at three years of age. The first factor we want to look at, of course, is drug exposure. And what we find in our studies in doing some special types of studies is that intrauterine drug and alcohol exposure does in fact predict IQ outcome at three years of age, the IQ being measured on the Stanford Benet. However, we look at other factors, and we can measure, for example, the home environment of the child using the home screening questionnaire, HSQ. Now, what the home screening questionnaire tells us is it gives us a measure of the quality of the care-taking environment for the child. And when we measure that and put it into the equation, we find that the home environment of the child has just as great an impact on IQ outcome of the child at three years of age as does the fact that the child was exposed to drugs in utero. A third factor that we look at is head circumference. Head circumference can serve as a biological marker because we know that in our population children exposed to alcohol and other drugs in utero had small heads at birth on the average, and their heads have continued to be small. Small head, of course, connoting small brain size. Many studies in the past have shown that a child with a small head size at birth is at increased risk for developmental outcome later on. The fourth factor we can look at is behavior of the child. You can measure an aspect called externalization. That really looks at impulsive behavior, hyperactivity, if you will. And the other behavior is we can look at distractibility. What we find when you combine the input or the impact of drug exposure, home environment, the biological marker of small head size, distractible behavior, those factors combine account for 48% of the deviation from normal of the IQ scores in the three-year-old children. We basically get to the point where if you look in your left hand is biology, nature, and in your right hand is the environment, nurture. What we find at birth is that the biological impact of drug exposure probably outweighs the environmental impact. As the child gets older, those scales start shifting. So that by three and four years of age, you have the environmental factors outweighing the fact that the child was biologically exposed to drugs in utero. We have to address the biological factors, but you must begin to address issues for the home, for the mother, for the family. It's when you put all of that together that you're going to be most successful in helping the child. Hey! I believe they're in Chicago where you are. We have a question. Is our caller there? Go right on. Yes. My question is to the doctor. You stated that F-A-E can be detected at about three years, three years old, by behavior problems, correct? Well, not necessarily. It may be that a child, there's a whole continuum, that may be that a child is not going to have difficulties with behavior or cognitive development from alcohol exposure until he gets older and as the developmental tasks and demands become more complex. Okay. Well, how can someone somewhat correct the child not understanding the consequences of the inappropriate behavior? I think as we talk today, we're going to be talking about some of the classroom interventions in one of the later sessions. But clearly, one way to do that is to begin to really understand the child's behavior. We use behavioral logs and work with school systems to look at what the triggers are for a child's behavior and then translating that into intervention points so that we can be proactive rather than reactive to the child's behavior. Thank you. Dr. Shee, would you like to comment at all on what she was saying in terms of the questions about correcting the inappropriate behavior? Well, I think it gets to some other issues around having different kinds of professionals really working to support each other. And I think that in a child of that age, around three, that the medical system can offer some help as well in terms of looking at the child's physical growth parameters, their nutritional needs, for example, and also maybe suggesting things to help the educators and parents with modifying the child's behavior. Once the balance of biology versus environment begins to shift toward the environmental side, a wide range of factors begins to impact the development of every child. Substance-exposed children face special challenges as they grow and explore their new environments. Many substance-exposed children go home with their natural parent. The arrival of a baby is difficult for any new mother, especially if she has a history of drug addiction. The challenges of caring for her baby are compounded by the additional needs of a substance-exposed newborn. What it's like for me, it's scary. I was really scared at first, scared that I would use again and wouldn't be able to be there for. Scared that I can't do it and I can't be a mom and I'm not ready for it. I think that all mothers love their babies, whether they're addicted to drugs or not. They can form a close attachment. I think the problem is that the environment that these children are raised in can definitely make it very difficult for the child to have the types of role models that would be beneficial to the child. I haven't ever seen a mother who didn't love her child. It's just her drug addiction that causes her to put her energies elsewhere other than into appropriate parenting for her child. My kid missed my love and that attention and the caring and stuff. And I know they love me, but I wouldn't give it back to them because that drug wouldn't let me. I love that drug and then love my children. Parents who are chemically dependent often center their lives around drugs, even if they want to quit. They often can't and face tremendous guilt about their addiction. When I was in my using stage, my main focus was getting high. That was it. I wouldn't have time to be a mom. Sometimes today when I think, because I have cravings and things now, to get high, I just look at her and I try to picture where would she be? If she was in her bed crying and I'm in here smoking crack, how could I do that? Because I can't. It's totally impossible for me to do. I can't have both. I can't have crack and I can't have her. I'm going to lose her if I do smoke again. Now, with a baby that is likely to have health problems, be difficult and demanding and often less responsive and emotionally rewarding, parents find it difficult to bond with and meet their child's needs. Strangely enough, sometimes a home that doesn't look cosmetically so good, if there is a lot of interaction between the child and the caregiver, if there is a lot of receptivity to the baby's clues and the mother's clues, it might really be a good growth-promoting home. Conversely, you could have a home that's in a very wealthy neighborhood that is very sterile, where the people are not reading each other's clues, whether they're not paying attention to each other, that may not be a growth-promoting home. Whether children come from wealthy, middle-class or low-income neighborhoods, are raised in white, Hispanic, or African-American homes, or are cared for by foster parents, family members or the natural parents, all children are products of their environments. There are factors within all of these environments that can have a positive or a negative influence on children as they grow older. Drug use, parenting skills, and neighborhood safety all affect a child's level of security and ability to bond. Consequently, children who feel insecure and have difficulty forming attachments are developmentally at risk, physically, intellectually, socially, and emotionally. Now to carry on further discussion about the home and community aspects of this problem, we're going to have some more panel members join us. Diane Malbon, who is a family and educational counselor in private practice, she is going to be joining us from Portland. Bonnie Bernard is a prevention specialist with the Western Regional Center for Drugs-Free Schools and Communities. She is also in Portland. Susie Kirschner, a staff member with the N-A-R-A Residential Treatment Center in Portland. Emma Redman, who is a project director with N-A-P-A-R-E, and that's the National Association of Perinatal Addiction Research, is joining us from Chicago. Judson Hickson, who is a senior associate director of the Midwest Regional Center for Drug-Free Schools and Communities, is also in Chicago. And then, of course, again, Dr. Ira Chasnoff, president of N-A-P-A-R-E in Chicago. And Barbara Bazron, director of CSAP National Resource Center for the Perinatal Prevention of Alcohol and Other Drugs is joining us from Washington, D.C. along with Dr. Andrew Shee, who we heard from earlier, who's a pediatrician who is here with us in Tallahassee. He's with the Department of Pediatrics at the University of New Mexico. And Mike Stone, program consultant, Juvenile Welfare Board of Pinellas County in Tallahassee. Thanks, everyone, for being with us from all around the country. Diane Malben in Portland, let's start with you. How does the mother's drug use and addiction affect the entire family? The effects of drugs and alcohol in families has wide variability. It depends on the type of drugs that are used, the generational impact of the use, and a number of other issues. And as was alluded to earlier, know that no socioeconomic race or gender is immune. In fact, I just wanted to mention also that it looks like, as we talk about mothers using, that fathers use prior to conception is also implicated in some measurable behavioral differences for children. This is early research, I'm aware. And the intent is not to point fingers, but to recognize the problem is much bigger than focusing on women. Could you just sort of give us some general kinds of trends in terms of how the family is affected? Can you just list a few things? Mothers are affected physically, and in fact it's important to bear in mind that the mothers die. In two studies, in one of the studies, by the time the children were five years old, 38% of the mothers had died as a direct result of their alcoholism. In another study, by the time the children were in early adolescence, 70% of the mothers had died. It's a direct physical effect. Children are affected physically. We've heard Dr. Chasnov talk about some of the obvious physical effects. Please remember that children with fetal alcohol effects are believed to be at greater risk because their handicap is invisible. The emotional effects are myriad. The emotional effects are complicated. Ask your peers what some of the effects are on family systems. Many of us get into our professions from family backgrounds where there's been active alcoholism and we carry with us into our professions many of the issues that are related to that and it impacts us directly. I think this is a hot issue and it's a hot issue partly because we're all affected. The cognitive implications we've mentioned, but please remember that recovery is possible. We've heard about it. We're hearing about PhD candidates who are at fetal alcohol effects. We're hearing about electricians. One of my clients has an IQ of 65 and her child has an IQ of 135. We're talking about intergenerational intervention. Thank you. Okay, Diane, while we're there in Portland, let's talk to Susie Kirschner about whether fetal alcohol syndrome has the same kind of effect on the rest of the family as when a mother is using drugs. Are the father in that particular case? Susie, could you tell us a little about that? Well, when a mother comes home with her child who may, if we're speaking fetal alcohol syndrome, it's quite likely that this may have been shared within the birth setting and so she may come home with that knowledge. She also very likely may not. The majority of the mothers that I work with and see it has not been identified for them. And so what she knows is that she's coming home with a child who perhaps has a poor sucking reflex. So right at the very start, what it's going to mean for that mom is that perhaps even though she had intended to nurse this baby, it's a very difficult phenomena. And so she may turn away from that. What we know from research on nursing is that it has a very positive effect on the development of a child. It has a positive effect in the sense in which it contributes to the bonding, has a positive effect in which it contributes to the language development, which of course is certainly linked to future intellectual and cognitive development. So we have a mother who is first recognizing perhaps and perhaps in a very, very subtle and unconscious way a deficit of her child, which then exacerbates her own sense of poor self-esteem and her own sense that she may be a failure as a mother. I think that it's real difficult to look at this subject and look at it in a positive way if we don't begin at the very moment of birth and understand that as community people we want to give that mother a positive feedback in terms of recognizing as some people identified earlier on and I really appreciate this, recognizing that I have never known in 15, 20 years of working with parents I have yet to meet a mother who did not love her child. There are many things that interrupt the flow of that love and as therapists, as social workers, as educators I think we need to be real respectful of that and we need to proceed from that concept so we can give the mom that support. Along those same lines, Susie, I'm going to have to leave you and go to Chicago now to Emma Redman because along those same lines of trying to intervene and trying to help the mother or the father or whatever the caregiver is who is responsible. Emma, in the inner city environment there are other things that seem to impact on this ability to intervene. Could you talk a little bit about that? And Barbara, just as the problem or nor the people are one-dimensional neither is the way we look at communities and what happens in communities. When we look at substance use, abuse, or addiction it's almost impossible to separate the often overwhelming life issues that families and communities are dealing with such as poverty and such as lack of opportunities and lack of resources and lack of support. But I think we would be doing communities and families and injustice if we only talked about the problems because every community in this country has some strengths and some resources that can be built upon to work with families who are drug involved. And that sort of, Judson, leads us right into you. They're also in Chicago with Emma on how communities are challenged by the problem. Well, Barbara, I think communities are challenged by the problem really in three sorts of ways. One, I think, is that we have to understand that it's everyone's problem. We've got to begin to develop the mindset in our communities that it's not simply the mother that's exposed to the teacher who has the children but really all our children and we have a vested interest in all of their well-being. I think the second kind of challenge to communities is to really look beyond the notion of high-risk children or high-risk families to high-risk environments. We've got to begin to stop pushing the problem at one individual or simply in one place. We've talked in a number of parts of the earlier discussion about the need to talk about the environment as a whole and networks of concern. But I think the third and probably the challenge that's of most importance to the people of this telecast as they think about action planning is that we've got to go beyond individual interventions to develop some community networks and supporting networks, linked collaborative and integrated services. Early intervention, the best way to really begin to attack this problem is not to say what do we do when we get these kids but how do we intervene before the girls become pregnant, the young ladies become pregnant. How do we begin to put in place prenatal support structures where there is that early identification, that monitoring so that we really move to a preventive mode rather than a reactive or an intervening mode. And I think that's got to be a community, a collaborative community effort and a community commitment. And I'll just come back here to Tallahassee and Mike Stone. Is that message not getting out? Are communities not doing enough to get that message out? What do you think, how communities are meeting this challenge? Well, I think it's absolutely essential that we build bridges, that we share information, and that we recognize the importance of funding, prevention, early intervention programs. And I think that's a collective responsibility. And when I talk about building bridges, I'm talking about between the health, social and educational systems, between agencies who are able to respond to a wide range of needs that families have, building bridges to families to understand what their needs are and how we can best work with them in making linkages to communities because they also play an important role in developing informal support networks for kids. When we see kids come into our schools or in whatever form that we interact with kids, there are a lot of things that have happened to that kid in their life, and therefore it's going to require a comprehensive response to meeting those needs to the extent that we do not use the collective strengths that many agencies or people can bring to solving that problem, then we have done a disservice to those children. So we have a collective responsibility to create able, resilient children and families in our communities. You made a perfect segue into Bonnie Bernard, talking about creating resilient children. Bonnie, that's one of the areas that you can address, the resiliency of some of the resiliency factors. Tell us about that. Okay. Basically, looking at resilient children is really based on a body of research that's followed kids. Some, before they were born in utero, have followed kids into their young adulthood, into their middle adulthood, and these studies are all very consistent in terms of finding what works for children and families. And basically, speaking in a simple enough way that we can guide programs, we found three main characteristics that describe kids and their families that succeed. First of all, all the kids that have survived great adversity like poverty, like family dysfunction, like parental alcoholism, mental illness, schizophrenia. Number one, these kids have had a caring adult somewhere in their life. It's best if it's a mother or father or relative early in the child's life in the first year, first two years of the child's life, but the positive message is that it's never too late that caring adults, whether it be in the form of a teacher in the school, a minister, someone from the community, have made a difference and turned around the life trajectory for a child that should have led down to dysfunction and negative outcome to very positive outcome. We also have learned that when kids make it, they usually have received messages from their environment that they have strengths, that they are resilient, that they can bounce back. People have reinforced that in them that they have everything they need to succeed. And lastly, we find that kids that do make it have been given opportunities for participation, both in their family, their home environment to contribute meaningfully in their school and also in their community. And what this is all really getting at is we're talking about really a quality of a caregiving environment for a child and for how we relate to families. The next segment of this teleconference deals with public policy. Now, public policy may seem very remote to the people in the front lines, the teachers, but public policy is going to provide the requirements everyone must follow in providing educational services to substance-exposed children, rather. Now, here are some questions to consider. Should substance-exposed children have to be labeled in order to receive special services? What services are substance-exposed children entitled to? What laws protect the rights of substance-exposed children and ensure that they receive the appropriate services? And finally, how do school districts, states, and the federal government interpret laws to develop policies and programs? And to help us answer some of those questions, we're going to go to Suzanne Miller, who is a researcher with the California State Department of Alcohol and Drug Programs Office of Perinatal Substance Abuse. She is in Portland. In Chicago, Dorothy Boyd, who is a superintendent, Hazel Kress School District, number 152.5, and I'm not sure what the .5 is for there. In Washington, D.C., Leroy Rooker, who is the Director of Family Compliance Office for the U.S. Department of Education. Lillian Dorca, the Attorney Advisor to the Assistant Secretary's Office for Civil Rights. Gail Hool, who is an education research analyst at the U.S. Department of Education Office of Special Education. And here in Tallahassee, we have Betty Castor, who is the Commissioner of the Florida Department of Education. And Bill Modzilewski, who is the Director of the Office of Drug Planning and Outreach for the U.S. Department of Education. And let's start with you, Bill, by talking about is there one policy that schools should adhere to when dealing with this issue? Thanks, Barbara. The quick answer to that is no. There's not one policy. Children's exposed children cover a lot of different areas. And therefore, a person's dealing with this subject need to be aware of not one policy, but of several policies. Immediately following us, you'll hear from three representatives of the Department of Education who will answer questions regarding civil rights, special education, and privacy-related issues. In regards to drug prevention and whether drug-free schools and community acts funds can be used to serve children prenatally exposed to drugs, the use of drug-free schools funds is limited to and for purposes of alcohol and other drug education prevention programs. Examples of programs that would be allowable are mentoring, peer support programs that provide youth with skills to resist taking drugs and student assistance programs that focus on drug education prevention. Schools could also develop programs of family drug abuse prevention, including education for parents to increase awareness about the symptoms and the effects of drug use. At the department, we recognize that this population is not always identified as drug exposed. Schools are encouraged to develop programs that meet the drug prevention and education needs of all children without regard to the presumed cause of the problems they face. Alright, let's go to Washington, D.C. where we have Lillian Dorca, Leroy Rooker, and Gail Hu. Lillian and Leroy, let's talk about some of the specific laws that protect the rights of substance-exposed children. Of course, one is the Family Educational Rights and Privacy Act, and what that law deals with is the protection of education records, and it has three focuses to it as far as parental rights. One is that the right of a parent to inspect and review records on their children, the right to seek to have those records amended, and also the right to have some control over the disclosure of information from those records, and also another law, the Protection of Pupil Rights Amendment, which provides that schools obtain written permission from parents before minor students are subjected or required to participate in certain Department of Ed funded surveys, and so those are the two primary laws that we administer. Lillian, did you want to add something to that? Well, the Office for Civil Rights of the Department of Education is primarily responsible for enforcing civil rights laws. We're not a funding agency, but an enforcement agency. One of those laws that the Office for Civil Rights is responsible for enforcing is Section 504 of the Rehabilitation Act of 1973, and Section 504 requires that children within educational systems that receive money from the Department of Education are provided a free, appropriate, and public education, which means that handicapped children and let me briefly run through what is a handicapped person. A handicapped person is a person who has a physical or mental impairment that substantially limits a major life activity, such as walking, talking, seeing, hearing, manual dexterity, things of that nature. Children that the second definition of that is a person who has an impairment, a record of such an impairment, and then thirdly, a person who is regarded as having such an impairment. Those last two definitions are particularly relevant when we talk about substance-exposed children. We've begun to see a trend, which is somewhat disturbing where substance-exposed children are automatically labeled because they have a record of coming from that type of environment or because they are regarded simply based on their drug exposure prenatally as having a handicap. This is not in compliance with Section 504. What Section 504 requires is that that child be evaluated on an individual basis to determine how exactly that child's educational needs are to be met. And this is an evaluation conducted by experts in the field. But it's very important not to label those children as, quote, handicapped simply because they are regarded as handicapped with a record of such coming from that type of drug exposed environment. Then, Lillian, let's go to Gail. If it's important not to label them, then how do we get the services to them? Do they have to be labeled in order to receive the services? Well, we certainly do not want to label a child as disabled based on the etiology of their condition. If it is determined by a multidisciplinary process that a child has a disability, then, in fact, they can receive services and they are entitled to receive services. Under public law 94, excuse me, under public law 99457 services are available to young children birth through age two through the Part H program and three to five year old children through Section 619 or the preschool grants program. But we must remember that in order to receive services a child must be evaluated by a multidisciplinary team and it must be determined that the child does have a disability or in some cases in some states is at risk for a disability. This is not a unilateral decision whereby children would be labeled based on prenatal drug exposure. It has to do with the fact that a child has a demonstrated developmental delay or disability. Can you just talk a little more about the kinds of services that are available? Well, under Part H and the 619 program services are individualized for the child and the family. They may need developmental intervention, special education, speech language therapy, physical therapy, occupational therapy. All these services are available through the Part H and the 619 program. What services a particular child or individual receives is going to depend on their evaluation and what the team and parent decide is necessary for the development of the child. Back here in Tallahassee let's go to Commissioner Betty Castor from Florida. How do you feel about that? You're listening to what's going on in California. How have you responded here in Florida? Well, a couple of issues are important to us. Number one, this state has put a premium on starting early. By expanding our early intervention programs and our preschool programs, we now have one of the largest programs in the country. That's important because we can identify those children with special needs early. As a part of that, we have adopted a first start program which is similar to that in other states where paraprofessionals can do home visits and work with mothers especially but other family members as well. I can't stress enough the fact that I think collaboration between agencies is essential. Our public schools are very strategic entities. We have those young people with us for eight hours a day but we are only going to be effective if we can work with the other agencies who deal not only with those youngsters and those young people but their families as well. So we have built collaboration and we've even funded collaborative projects. We've also funded full service schools. Is that word funding again, huh? I'll say it straight up. Funding is essential. We have to pay the people that work with these youngsters and we have to send an example and there's no way to get around the costs associated with these special services. We have located a prevention center in our state office to try to provide technical assistance to schools that are part of a comprehensive plan. We've got to address these situations in all of our schools, in all of our districts and all of our programs. Okay, now you've talked about it. We've talked about the state level. Let's talk about the school district level and go to Dorothy Boyd who is in Chicago. She's a school district superintendent. How are you dealing with it at that level, Dorothy? Well, I'd like to start I'll first with a quote and this quote is from the late Ron Edmonds who was a pioneer in the schools area. He said the following. We can, whenever and wherever we want, successfully teach all children whose schooling is of interest to us. We already know more than we need to do that. Whether or not we do it must depend upon how we feel about the fact we haven't so far. And as a superintendent, it really does my hard good to hear two words linkages and collaboration. It also does my hard good not to hear one sentence and that is the whole responsibility belongs to the school. To hear that it belongs to the family, to the schools and to the community means that we are going to really finally focus upon the child's environment and needs. I've listened to some marvelous speaking done here today and I'm finding that the schools are not alone that we're going to really get some more help. We've started that in our school district. We've linked with the community we've linked with our families and yes it is making a difference. I'm going to say some other things about that later. Okay, thank you a lot Dorothy. We're going to take a short break to let everyone get up and stretch a little. Well most children will spend more than a dozen of the first 18 years of their lives in the educational system. What's in store for our schools when that substance exposed child walks through the door for the very first time? To prepare for these students, schools should examine their current structure, climate and resources. Take a look around, see if there are other teachers that are experiencing similar concerns, if so again pulling together as a team looking at what the schools' problems are in terms of reaching out with students what particular plans have already been in place, what's working, what isn't and going from there in terms of developing new programs or more effective programs. Making a serious commitment to intervention will include everyone on staff starting with the principal. Here at Raleigh we have a child study team or an intervention team and it consists of our school social worker, a school psychologist our referral coordinator for exceptional student education programs, teachers our speech therapist, our guidance counselor, administrators are on it and we also pull in additional help when we feel the need to. Drawing on the resources and talents of a multidisciplinary team educators can make their schools more responsive to the needs of substance exposed children. While joining us now some more panel members in Portland we're going to have Sam Cemento who is the principal of Little Butte Intermediate School in Portland, Diane Malbon family and educational counselor in private practice in Portland you've seen her before and we're going to be talking with her again. Dorothy Boyd who is the superintendent of the school district number 152.5 and we still haven't asked you Dorothy about the .5 in Chicago and Shirley Jackson director of comprehensive school health educational programs the U.S. Department of Education in Washington D.C. Jeff Miller and there's Shirley Jackson Jeff Miller who is the director of prevention center here in Florida at the Florida Department of Education he's joining us here in Tallahassee Nancy Fontaine who is the director of early intervention office at Florida A&M University here in Tallahassee and Fay DeLoach who's a principal with Balzingham Elementary School in Pinellas County Schools District in Tallahassee. Thank you all for joining us. Let's start with you Nancy what factors should be considered in creating an appropriate school environment? I guess I'll start off with a quote it's a very simple quote but profound nothing changes if nothing changes and while it's a really tough job I think for a school to look at and assess how they're serving kids I think they're going to have to do it and I think some of the factors to look at I'm going to name eight of them we've got school climate how the teachers are when they come to school are they ready to do this big task that they have to do or the administrator supportive of it school structure looking at the consistency and the foundation looking at the curriculum is it developmentally appropriate looking at how the curriculum is being introduced is it the single teacher teaching it is it the team approach the community involvement use of resources the school is the school inviting the community in the family involvement getting parents involved can be a tough chore real tough chore can we reinforce the small steps the parent coming in just for a second or two dropping off the child in the parking lot the policies are the policies that are set for the school are those conducive to a child who is a developing child who has some special needs and last but not least is there a crisis intervention plan at the school for there's always a crisis parent coming in who is a drug affected or drug using parent coming in those are some areas I think a school should start assessing. Let's go to Washington D.C. to Shirley Jackson those are a lot of factors that she mentioned Shirley how do those play out in an urban setting in a school district in the school district such as those in Washington D.C. I can't speak for the Washington D.C. public school system but generally in urban school districts as in others when you talk about the environmental factors that our young people face it is clear that the schools are going to have to add another component to the curriculum that in the past they may not have had and that component is pro-social behaviors modeling it teaching children those behaviors that we know are important to their success not only in school but in life many times the teachers will say the children don't know how to do this they don't sit down when I tell them a lot of the kinds of things that teachers expect these children to do they just do not have the backgrounds and they haven't had the experiences to help them to do it all right let's go to Sam Gemento in Portland he's a principal as you listen to Shirley Jackson talking about some of those kinds of things that she called pro-social behavior that we need to add to the curriculum as a principal how do you meet some of the needs of at-risk children do you add some of these things to your curriculum and if so how do you do it well I think yes we do and it's a critical thing that we do it little butte in the school where I'm working is a more rural setting but the needs of the children are not different in terms of the having a curriculum and having experiences be relevant to real life and that would be one of the things that we'd advocate is that when we design experiences provide materials and look at the needs of our children that we put in the context of their immediate real life needs and then anticipate what are children going to need in the future to succeed in adult life so I think that one of the critical ways we can do that is begin to look at our assessment of children when we're interacting with children what is it we're looking for what are we trying to get in the way of information from that child interactions and I think as we begin to look at the issues like cooperation, problem-solving, decision-making we can attune our curriculum and the activities we offer to children more in that direction and I think it's critical too that we address the assessment issue with parents and with school boards so that the kinds of things we're doing with kids in the classroom and the real life things that we're addressing become a part of the assessment component that both school boards and parents hear about during that reporting process okay, Fadalos you are also a school principal so when you're listening to Sam talking about all these things do you think about how they played out in your school have you changed your school curriculum or changed things in your school to meet the needs of these children for sure we have Barbara the first change was with myself I needed a change in my awareness level the second change was as we changed personnel and we had an opportunity to replace these people we needed individuals with broad base backgrounds such as our behavior specialists that we now have a board our assistant principal who has a tremendous background in special education especially autism our guidance counselor thirdly we needed to change the awareness level of our staff so we run ongoing and continuous staff development both from in-house from in our district and from outside so that we're bringing our staff along with us too to meet the needs of the children we're changing how they deliver curriculum there's more attention to problem solving and cooperative learning team effort and thinking skills our behavior specialist brought in a behavior management program because the purpose of that was to quit all the referrals into special education we need to serve these children in the mainstream and so basically what he did with his background he just transferred some techniques from special education right into the mainstream of general education that was so successful that we had to restructure our school because two of the key components that came out of that were bonding these children became a family they became supportive of each other you heard an earlier panel member say that is key for these at-risk children to be successful if they bond with somebody so we restructured we started keeping these children together moving them collectively as a class let's go to Portland now to Diane Malvin how can the school get the home involved in this process we talked about the school restructuring and the superintendent and the district being behind it but we know that a lot has to do with what's going on in that home environment so how do you get the home involved good question again it's a reflection of everything that's been said before training staff, supporting staff, recognizing that staff has needs to support the individual staff member resiliency is not just a factor for children it's a factor for staff burnout is real and burnout prevention and recovery is also important in trainings to think about how to involve parents is to invite them to invite other community members it is a community issue so again to increase staff awareness to increase staff resilience to recognize the needs of the individual staff members to be able to be in a position to work effectively with teachers with the parents and through that to support their reduction of discomfort so that they can invite the parents in and work more effectively with them to reduce the isolation of staff is one way to begin to involve parents in the process we'll come back here now to Tallahassee to Jeff Miller you have worked with children at the middle school level as a middle school principal sometimes this problem is long lasting and it continues on into middle school junior high what did you do at that level to deal with it? Barbara as you've heard the problem is not new and as these students now begin their transition from the early grade levels to the middle and secondary grade levels it's important that schools provide the kinds of support services they need at these levels keeping in mind that many of the prenatally or living environments that for the most part are not conducive to positive learning we need to make sure that we tailor programs to reinforce these efforts unfortunately bigger kids have bigger problems you've heard earlier about our state national commitments and so much school administrators commit and prioritize their efforts no we can't be everything to everybody but what we can do is focus our efforts on programs we know work for instance early identification we need to go ahead and make sure that we can provide services for the kids as quickly as possible this identification should take place at the school level during that school year or even better during the feeder pad in schools redirecting resources no there's not a lot of money out there we know that however perhaps it's the year that we don't spend money on the band uniforms or the labs and we go ahead and try and equip the classrooms to best meet the environments of special needs we also need to provide substitutes for in service for training for teachers scheduling and faculty selection we know what programs work best for kids hand schedule those kids for success and hand pick those teachers best suited to meet their needs school activities keep the kids involved in positive activities at the secondary level at the middle school level advise or advise the programs to offer support at the high school level identify special talent to get those kids involved and finally you heard the commission talk about our full service school concept administrators have to become brokers for social and health services to best meet the needs of our kids and if I can send out a plea to my colleagues across the country as we identify the excellent schools we find a very common element and that's an outstanding principle teachers, students, support staff needs your leadership please help them the efforts of all the people you've heard from up to now are directed at one spot the classroom because it's there where the face-to-face contact between a teacher and a substance exposed child is most often played out today's classroom is changing more rapidly than ever before making sure that change is good for the children especially substance exposed children is a monumental task one that involves all of us assessing the classroom environment is the first step toward making effective change happen there are exciting new concepts being developed as teachers take a look at themselves their students and their classrooms some of the areas teachers are looking at include structure consistent day in and day out activities scheduling do the children know where they should be and what will come next expectations is it clear to each child what is expected of them routines and rituals once there's a structure and a schedule it's time to develop a sense of constancy for the children physical space how is the classroom itself actually set up teaching style how does each teacher relate to the children informally as well as formally beginning the assessment process in your own classroom or in your school is one of the most difficult jobs anyone can start but the payoffs can be tremendous for every student, teacher and administrator at your school classrooms are exciting, dynamic places substance exposed children can and do become important elements in that classroom once they're accepted first as individuals and then as equals to every other student we're going to be talking now with some people about what's going on in the classroom and first we want to go to Carol Cole who is in Portland and Carol tell us how does the classroom teacher address all these factors structure, space and all of that addressing some of the issues that teachers need to look at in terms of a classroom is not necessarily an easy process I think that however it's important to remember that a classroom communicates the organization in a classroom communicates the way things are scheduled or organized in terms of time also communicates to the children you can walk into a classroom and really see what does this environment communicate but in addition I think before we look at really some of the issues around what the classroom communicates in terms of organizational issues we have to look at what kind of a relationship that teacher has with her students and what is the basis then of the the connection is and what we found in our program at Salvin was that we needed to start with a real nurturing relationship with children that meant to understand the children in the context of their temperament their stages of development and their past experiences I think Marcy and Mary can talk more about some of the ways in which the classroom was structured if we're talking about children that are disorganized then how do we manifest organization for these kids? okay we will be coming back Carol a little bit later too Marcy and Mary to talk about that all of you will have different ideas about how to structure or restructure your classroom there's no right or wrong method but here are one teacher's ideas leading a successful learning experience not only for substance exposed children but for the entire class I think some of the things that we have found is environmentally to make your room a very very safe and organized place for the child I think that a teacher that's very very organized that involves themselves with very structured routines and rituals will find that this population works best in that classroom I also think that high respect for children's space to lower the number of people that are rocking in and out of your classroom you know to avoid it until that child can feel secure to keep your classroom if you're going to make major moves in your classroom make sure the children are involved so they don't come into a strange environment if you're going to be out make sure they're involved in that decision that you're not going to be there so that they know what the next thing that's going to happen to them is they're very comfortable with the next decision I think that's the most important in this population because they are so disorganized we're not sure if that disorganization comes from central nervous system damage the withdrawal period when they were very very young and babies were learning to organize themselves in infancy and they were going through withdrawal or the environment that happened later being so chaotic but we do know that when the child feels very stable and secure in the classroom that we have a much more comfortable child now the panelists will be joining us in this section to talk about the classroom and the teacher's role from Portland we have Carol Cole who you heard from earlier she's an administrator for the Los Angeles Unified School Districts Division of Special Education Programs also in Portland Mary Jones who you just heard of that videotape a teacher with the Salvin Learning Center Marcy Blankett Schoenbaum who is a teacher also with the Salvin Learning Center in Tallahassee here we have Martha Fletcher who is the coordinator for the kids project at Quincy Education Center and Cora Royal who is the kindergarten teacher with Lillman Avenue Elementary School in Pinellas County Schools in Tallahassee and thanks to all of you for joining us in this section Mary let's come back to you in Portland we saw you in that videotape and you talked about some of the things that you've been doing in your classroom for a child who was substance exposed and has been living in a chaotic environment what is the classroom experience like for that child on the first day of school this is Mary Jones in Portland I suppose that we'd have to say that each child we've heard it over and over again as individual we may bring a substance exposed child into our classroom and they come from a very organized home they've had good environments from the beginning and they may see the first day of school as something wonderful and pleasurable and they're glad to be there I see we also have children that may have come from multiple placements foster homes, group homes maybe a mother or family that's still involved in drug use and to him school is just one other new place that he has to face or she has to face and for that reason I think that we find children that are hesitant each one of us is hesitant if we had had to have as many changes in our young lives as they had gone through so we look at these children hopefully and I think we've said this a number of times but as individuals and each of them are going to be a little different but the child sees trying to remember that this is a new change for them this is something completely different that they may have experienced before and understanding that change is always scary to any of us Marcy also there in Portland one of the most critical times during the school day is that time when you're transitioning from one activity to another how can the teacher structure this down time so that you don't get into problems during that area that's a good question I think first of all it's important to not have it be down time we need to make transitions times activities our children as Mary mentioned have had lots of major transitions in their lives many home placements very very chaotic environments and a lot of the changes that they've experienced have been painful ones so we need to help prepare them for the changes in the school day as well as the other changes that they're encountering in their lives and try to reduce some of the stress that they encounter in the classroom it's important to give children warnings to give them plenty of time when you're changing from one activity to another and to acknowledge their feelings because very often they don't want to change activities and we need to recognize that we need to have very stable predictable environments for our children because they need to feel secure and as a teacher that's our main job is to help them feel secure and help them learn how to cope with the stress that they're encountering okay thank you Marcy now Carol Cole we've heard a lot today about the appropriate curriculum what exactly does that mean well developmentally appropriate curriculum is a body of knowledge that we now know is good for young children the national association for the education of young children has put forth a document that talks about developmentally appropriate curriculum it's curriculum that sees that children will learn better when they act on their environment in a sense what's in if you want something to stay in the head it needs to be in the hands that children are active learners some of the tenants of the developmentally appropriate curriculum is extremely important when we talk about working with children at risk for instance it's known that teachers need to understand that individual children have individual learning styles what we've heard over and over again today is that children prenatally exposed to drugs and other substances or children who come from home environments that are less than supportive really need teachers who understand them in the context of those early experiences that teachers need to be there in appropriate numbers so that they can help children to focus on a task and complete a task that has been known for years and the National Association of again of programs talks about the appropriate number of ratio for adults to children for children ages 4 and 5 is approximately is for 4 and 5 year old 2 adults for every 20 children I think teachers across the country would see that they would be able to do their jobs if in fact there were appropriate adult child ratios in their classrooms okay thanks a lot Carol now it is no secret and if it were you probably know it isn't anymore after listening to everything that people have been saying today that education is no longer just the 3 Rs so how does the teacher fit into all of this this is a challenge for teachers because teachers are trained primarily to be educators however with the children of today many of us are having to be social workers, mothers fathers, nurses and we're trying to take on a variety of roles well now we've got two more people here who are going to talk about some of those roles and some of the things that happen in the classroom Martha Fletcher how can the strategies that you have used with special education be used in the regular classroom programs that integrate facets from both early childhood education and special education will be most successful for children who have been prenatally exposed to drugs with the need for people to consider individual differences the field of early childhood special ed uses two basic prescriptive teaching models one is the ability training which compares the strengths and weaknesses of a child and a task analysis approach where you are breaking down a task into small steps children who need help controlling aggressive behaviors may need the consistent systematic approach of the behaviorist however it's very important for teachers to realize that they need to use an eclectic approach to teaching and adapt what others have found to be successful and modify those practices and teaching styles for the individual learning styles of the children okay now core royal you are a kindergarten teacher some of the things that have been talked about today I understand are easier to use with children who are below the kindergarten age what happens when you get to the kindergarten age what about that okay Barbara I was listening to the different approaches and the different techniques and pre-k we build upon it that's one step and then kindergarten is the next step so we build upon it so whatever techniques that I can use from what I have seen then I will modify it to reach the needs of my students can you give me an example of the kinds of things that you might do okay for instance um the learning styles I could take the learning styles and um if a child learns visually or auditorily then I could I could observe the child and I could focus on the ones that learn visually I could focus on that and the ones that learn auditorily I could focus on that so therefore I wouldn't be using just one style I would be using several techniques so this is sort of what we talked about before in the developmentally appropriate curriculum or task that was sort of what we were talking about before let's go now back to Portland to Mary Jones Mary as a teacher how has your role changed over the past five years well I think over the past five years I have to be honest my role hasn't changed enormously because I've been in the same program but I think if we're talking in general with teachers and how their role has changed in the last five years our classes have become very very different I can only speak for Los Angeles unified school district but certainly the numbers of children Carol mentioned before but the numbers of children that we have to serve have increased greatly not just kindergarten and preschool but all the way up through high school a teacher has to be more if you had 25 children in front of you you could at one point in your life I think go through and know what was happening with all 25 children today if we have 52 children sitting in front of us there's no way that a teacher is going to be able to go through and really work with each and every child we have to look at children that are in for lack of a better word in the very worst position we have to pick our battles and pick our wars and we have to find children that are at risk and help those children as quickly as we can we have to use the services that are provided for us we have to make sure that even though we don't want to put children into special education that we turn to special education and get help from special education from social workers from psychologists, from our support services we have to make sure that administration understands that those of us that are giving direct services to children are going to have to be listened to in a very clear and distinct way we have to understand that the classroom doesn't look like it did 5 years ago, 10 years ago, 15 years ago certainly our parents are working our parents are in sometimes worse financial trouble we don't have as much support from home as we used to have all in all we have a very different classroom than we had 5 years ago Mary you just said something that I'm going to toss there to Marcy who's there with you in Portland you talked about parents working parents not having as much time and a lot of the children who are at risk children are also coming from homes where the parents are at risk parents how do you get the parents who most need to be involved in what's going on in the classroom involved Marcy? I think primarily by being there for them we have to listen to our parents they're our greatest resource and if they know that we truly care about their children I think they'll respond to us as well they're their children's first teachers so we have an awful lot to learn from them in terms of their child's learning style their child's past experiences and we also need to recognize that our role has changed and we can no longer just address curriculum we have to look at the social emotional needs of the child and in a sense to some degree the social emotional needs of the parent if that parent doesn't have food to put on the table that's going to be a greater concern at that moment than whether or not that child is learning how to read and we have to address those basic needs help get resources for the parents and then we can work with the parents in helping the child reach his optimal potential Carol we're going to stay there in Portland and let's go to Carol Cole Carol all of what has been said here it sounds like it's a really overwhelming task for the classroom teacher there's so many things that it seems he or she has to do and so many hats that that person has to wear you and Marcy and Mary have come up with a way to sort of address this without killing that one teacher could you tell us about that I sometimes think that we at times felt very overwhelmed by our task but if you think about children being in some ways a new consumer of our educational services and really starting where the children are and I think what we were talking about today that while more and more children are I'm so pleased that the tone of this conference really addressing children at risk and not just prenatally exposed to drugs and substances children and that while we know prenatal drug exposure is a risk we've got so many more children at risk entering our school system and so it's how do we address those at risk children and clearly it seems that we're talking about children that are disorganized and children that have difficulty with relationships but Carol I really wanted you to talk a little bit about your team approach that you've come up with with you and Marcy and Mary okay one of the things I think that to help teachers however in terms of not becoming overwhelmed is that while we hear all these numbers of so many children impacted what we need to do is find ways to support individual children individual families and provide supports among each other the team approach that was started five years ago incorporated the teachers the assistant teachers part-time psychological help part-time social work help and even the help of a pediatrician what we were able to also acquire or get assurances from administration was stay intact and it did for a few years during the pilot program it's only and I think the research is coming out more and more that it is imperative that staff has time to meet together work together if we're going to be successful in preventing the burnout of working with very demanding children and families so clearly the team approaches the way that we're going to have to go and accessing particularly which is such a short in such shortage in so many of our school systems and that is the mental health services that seem so necessary for serving our families okay thank you Carol and Marcy and Mary now in the end it all comes down to the children how educators respond to them and more importantly how they respond to you will go a long way toward the success or failure of their educational experiences high-risk children have always been in the classroom over the years educators have identified the behaviors of these students and developed effective intervention strategies by drawing on these experiences learning new information and using the resources in the school and district educators can be successful in teaching all high-risk children especially those that have been exposed to alcohol and other drugs like all high-risk students substance exposed children will exhibit a diverse range of behaviors okay now we have an addition to the panel members that you have been hearing from earlier joining us now in Tallahassee are Margaret Ackert coordinator teacher learner connection project Orange County public schools in Tallahassee and George Sherman behavioral psychologist Pinellas County schools in Tallahassee and Margaret since you've just joined us we're going to start out with you how do you assess all of these behaviors that we've been talking about labeling the child Barbara I think while some of the youngsters that are prenatally exposed to drugs may be severely handicapped and need an individualized standardized assessment battery many will have milder handicapping conditions or exhibit little long-term residual effect from their exposure for these children it becomes imperative that the classroom teacher becomes skilled observer of the children's behavior as well as learn to generate and test hypotheses about that behavior then adjustments in the curriculum and adaptations and materials can be made to develop the interventions that are needed for the youngsters applied behavioral analysis and prescriptive teaching as you've heard earlier are often considered the hallmark of exceptional education and I think what we need to do is make those techniques available on a broader base use for regular classroom teachers these techniques establish a continuous feedback loop for the teacher a sheer he makes seeks to make the individual interventions necessary for the child's progress a portfolio assessment model also provides an organizational structure for documenting teacher observations and collecting work samples over time the utilization of techniques such as applied behavioral analysis or prescriptive teaching and the portfolio assessment model are considered developmentally appropriate for identifying and documenting a child's strengths and weaknesses the advantage to this process is that the child doesn't have to be labeled in order to receive services and so when you've finished with this testing then you're saying you don't put a label on that child no this is an assessment process that gives the teacher the information that she needs to make adjustments in the curriculum or in the materials that she's using within her classroom that empowers her to make moment-to-moment decisions about what child needs to progress rather than setting out an artificial evaluation date that is going to give us information that may not be relevant to classroom and you find that this works better in the classroom setting I think it's more appropriate for the classroom teacher and gives her the kind of feedback that she needs to help the children okay let's go to Portland to Diane Malbon what kinds of assessments can you use what kinds of assessments do you use actually it's very similar I was just delighted to hear the former speaker speaking because I think the whole key to working effectively with children and including assessing I don't think there's going to be one standard assessment tool that can be developed given the range of variability of the children that we're going to be working with I think understanding the potential we could be working with is a degree of organic brain damage is really important in terms of helping us reframe our perceptions of the behaviors if I come to understand that the children have been potentially prenatally exposed to alcohol and other drugs for whom we may not have a diagnosis or even a very clear evaluation if I can rethink my reactions to the children and expand my repertoire of choices around intervening effectively with these children I can go a long way to my own empowerment as a teacher I think it's important to understand as we talk about assessment tools it would begin to think differently about behaviors instead of trying harder it's key to try differently when we look at some of the behaviors that are commonly associated with children who are prenatally drug exposed or alcohol exposed bear in mind that we're talking sometimes about older children and some of these children have been acting out in the absence of identification what we're often seeing with the children who are older is their defensive reaction to being punished for behaviors that they can't help it's normal human beings to attempt to protect themselves from pain children who have not been understood who have been punished when they're trying their best often will act out know that those behaviors that we might be seeing in the fifth and sixth grades which is classic in terms of the point at which the kids often fall apart can be intervened what teachers say after they've been to trainings and understand these kids differently is oh I get it I go back to my classroom I see the kids differently I see the behaviors differently I feel different and the kids act different it's a synergistic effect and it's comprehensive there's no one assessment tool and I agree absolutely that it's a process of evaluation and teachers need support to be able to expand their repertoire okay Diane while you're talking about those behaviors let's go to George Sherman and Cora Royal to talk about how once you've identified those behaviors how do you manage them in the classroom because clearly this is where the teachers sort of start to pull out their hair and say what can I do with this child once he or she is in the classroom in Pinellas County when we were looking at this issue we had several things we wanted to make sure happened and one was that whatever techniques we chose met the needs of all the kids in the classroom not just kids who might get labeled either now or somewhere down the road it didn't work for everybody the second effect that we wanted to look at was which techniques and exceptional education could we put into a regular education classroom that accomplished that Shirley Johnson a kindergarten teacher in elementary was gracious enough to let me experiment in her classroom the first year and we tried over 20 different approaches and we found four that were the most effective meaning they were easy to implement they showed benefit to all the kids in the classroom where they were labeled or not that was increasing the reinforcement density meaning how many times a kid gets rewards out of their environment versus how many times they're punished teaching them linear time the idea that there's a flow of events ensuring teaching them how to pay attention to their own behavior and lastly and most importantly bonding turning that classroom into a family so that those kids develop an emotional attachment not only to one another but to the teacher to the school and to the larger community and Cora would you like to add anything about managing the behavior in the classroom for those same particular techniques that George just listed I've tried them in my classroom and it's a supplement to the behavior I mean using all the time and it works and the main thing is that and the smile on your face says that you got rid of the kid who was driving you crazy right so it says it works yes it really works and that bonding is very important because the at-risk child really needs to feel the sense of belonging as a family and we have established that in our classroom okay well substance exposed children may react to the world around them differently from other children those differences can be classified so that educators can develop effective successful teaching methods as young children move through space and manipulate objects in their environment they learn about themselves in the world many factors influence the development of motor and spatial behavior in children inadequate care in the prenatal and early stages of life may cause children to have fine and gross motor delays young children exposed to drugs prenatally or environmentally are particularly at risk since they are often under stimulated and not supported in the development of motor and spatial skills many children seem uncoordinated at one time or another even adults sometimes feel as if they have two left feet the difference is that compared to their classmates children exposed to alcohol and other drugs are likely to be delayed in the next few weeks language is a highly complex function which develops as a result of the interaction of cognitive, motor and social skills children who were not read to did not have access to books or were not supported in learning new words are likely to have a slow start in language development as teachers assess the language needs of their students the barriers of concern are delays in expressive and receptive language prolonged infantile articulation or baby talk difficulty in understanding directions and an inability to verbalize needs, wants and fears their resulting frustration may lead to shouting, stomping or other inappropriate and aggressive communication behaviors such barriers to effective communication may cause children to remain passive observers rather than active participants in classroom activities learning occurs in a developmental framework it is an ongoing process in which the child constantly organizes and reorganizes experiences within a continuum of stages while children have an unending potential for learning the ability to perceive and explore the environment may be delayed in a child who has been prenatally exposed to drugs children who are easily distracted by sounds, movements or people may be showing signs of cognitive delays the ability to concentrate and visually scan words and pictures may also be impaired many high-risk children have trouble with problem solving become frustrated and in turn give up on challenges quicker than their classmates children sometimes seem to achieve a task one day and then forget the skill the next this sporadic mastery of skills contributes to their frustration with learning they sometimes feel unsafe when their routine has been changed and may withdraw from an activity the early years of life are critical for social and emotional development during this time a secure and dependable environment fosters self-confidence and trusting relationships with the child's adult caregivers but an inconsistent environment that is insensitive to a child's needs such as a home where drugs are the primary focus stimulates fear and suspicion these feelings can manifest themselves behaviorally in the classroom expressing emotions is difficult for anyone especially if they've had a chaotic start in life substance exposed children poor inner control losing their tempers more easily and more often than their classmates these outbursts often contribute to conflicts with other children and undermine their ability to build friendships their peer relationships also suffer because they have trouble empathizing with other children the specific behaviors described in this program should be viewed as separate pieces of a puzzle these behaviors have been highlighted and separated for learning's sake only now it is up to each educator to fit these pieces back together to create the whole picture of a very special child many teleconference participants utilized a break at this point in the program to develop school community team action plans teams composed of administrators classroom teachers student service personnel and local human service agencies can use this instrument to focus on identification of the problem and development of mutual purpose philosophy and mission it also enables groups to assess the strengths or resources available in solving the problem being addressed and to identify issues that still need attention a copy of the school community team action plan is available in the resource guide we're going to go to Jetson Hickson who is in Chicago what school community has done any action planning there well around the Chicago area we've been involved with a number of school community teams and groups of agencies and organizations who have been looking at the issue of substance-exposed infants and working on a wide variety of plans for networking for accessing additional resources for providing training to teachers to other people in the community and also to working with parents prenatal parents before they get pregnant I shouldn't say parents before they get pregnant but young women before they get pregnant young fathers to try and really focus on the prevention aspect generally we try to get people to start thinking in four broad areas if they aren't familiar with the planning process as a way to get started one is looking for broad based involvement and commitment among a wide variety of people in the community if we're really going to have a community based effort we've got to have a wide range of people involved we've got to have the right people involved we encourage people to develop their knowledge and understanding about all of the variety of issues that we've been talking about during this teleconference we need to have access to information and we need to have people who can provide us with a broad range of understanding of that information and not simply just mailing it out we've tried to get people to help organize a well-developed planning process you know Barbara a lot of people can write plans but the question is can you develop a plan that really gets put into action sometimes we find in many school community areas that we spend so much time planning what we want to do we never get around to actually doing it so a well organized planning process is essential and lastly we encourage people to take advantage of a wide variety of technical assistance and training resources that are available the regional centers which the Midwest Regional Center is one is one avenue for that there are a wide number of other resources that people can access at both their state level their local and city levels and at the federal level so we encourage people to think in those four broad areas broad based involvement, identifying information planning process together and seeking out support Portland go ahead with your question yes I would very much like to know the parental involvement in the multi-disciplinary team I realize that the team is very important from the standpoint of people trained in certain evaluative tools but parents are the responsible person with their child and I would like to know how you're going to evolve them to a greater degree than now in those teams and in that process and what do you think the role of doctors should be in becoming more politicized to fight for the rights of parents because of all of their knowledge because of all of the things that the doctors know about the fetal alcohol syndrome and the drug being born addicted to drugs okay you have two parts to that question I think the first part of that question we can probably get answered right there in Portland Marcy and Carol and Mary you have developed a team so could you perhaps help her with how you get parental involvement going in those interdisciplinary teams in our program we certainly think that the parents are a key component of our team I think that one of the things that we've heard about children prenatally exposed to drugs and alcohol is that there's no typical profile of impairments I think what we need to understand is that there's also no typical profile of a parent who is raising that child whether that is a biological parent whether it's a foster parent whether the child is in relative care and that we need to work with that parent individually one of the strategies that I find helpful for myself when I was in the classroom was just the following that while I may have a great deal of information about young children in general I have no information about a particular child and that that parent or the caregiver is really that child's expert and that when we start to deal about, deal with developing a homeschool partnership what we need to understand is that that parent is looking to us to see that they have some expertise about that child and people in schools need to confront their own attitudes about those caregivers before we will really be successful in incorporating them in the team Okay, thanks a lot. Dr. Shee, how about that? Do you think that you as a doctor should be up there in the capitals wherever those capitals are lobbying those legislators to get them to pay more attention to these issues so that there are more resources made available? Well, I think that the legislative process can be very valuable to helping the multidisciplinary team do its work but I want to address one thing about the questioner and physicians. I think that one of the primary relationships that have to happen is that of trust and that trust is a process that takes time. So a family that's very involved in alcohol or other drug use does not necessarily trust health providers or other service providers initially providers have to hang in there with that family believe that they have a very strong emotional bond to the child that they are going to work with and then develop a system that enables that trust to grow so that families begin to take more control over decisions for their child as their progress in treatment proceeds and that providers have to be politicized, if you will to create the support mechanisms that help the family achieve that process understand that relapse may happen and support them through the relapse process and not let go of the family and the child. We have a call now from someone in California, could you tell us perhaps where you're calling from and what your question is? Hi, I'm Sandy Landry from the Orange County Department of Education here in California and we want to know how would you recommend that educational staff teachers, school nurses support staff and even community agency staff be encouraged and supported towards effective teaming which would focus on the child's strengths and family rather than on hanging labels of drug or substance exposed. Okay, how about Nancy? How would you like to feel that question? I think you raised a good issue and I think it's something that in assessment we don't usually do. I think we tend to concentrate on the child's weaknesses or the areas that she needs improvement. I know Bonnie Bernard talked about risk and resiliency factors and we have to identify and get a full range of those factors in terms of the child's strengths or those resiliency factors. In the home, the family, the community, it's peer group as well as the school and that interdisciplinary team cannot just be made up of school personnel it has to be made up of community personnel as well so that those resources can all talk amongst themselves on, okay these are the kinds of behaviors or these are the kinds of strengths that we need to look at and then develop a prescriptive plan to fit the individual needs of the child and his or her family. Sam Temento in Portland, you also wanted to add something on this subject about how do you go about building these teams? Again, just to concur with what folks have just said to us that the restructuring of schools is critical so that in fact the efforts and practices we've been describing can occur. The other thing I'd point out is that from the school perspective we need to start realizing that if we're going to work with kids on an individual basis, look at the personal nature of learning and establish that relationship in our schools, we're going to have to direct our attention toward the child and make it a child-centered curriculum as opposed to a subject content focus curriculum because too often what happens to classroom teachers is they get entrapped in this issue of having to teach this and having to teach that and having to divert attention and efforts away from the child in an effort to meet some believed prescribed goal. Okay, let's go now to Chicago where we have a question from an audience member there. Go ahead, Chicago. This is for Dr. Chasnoff. How does treatment for the mother fit into getting the child ready for school? I think as we work with children we've learned that the child certainly does not exist in isolation. If we try to create an environment in the school in the early intervention programs that is going to provide sustenance for the child, we have to also be sure that our interventions are consistently followed through with in the home. And if the home is continuing to have problems of substance abuse then that's not going to happen. One of the key things the school district has to do is to link in to drug treatment programs. And as we look at healthcare, as we look at drug treatment, as we look at early education, we have to realize that any one part of that puzzle is not going to be successful at all. A study we just completed, just in the last two weeks, was a four year study funded by NIDA. And what we found in that study in reviewing 192,000 cases of drug of pregnancies across the country that of all the women found to have been diagnosed as using drugs, only 25% of their newborns were recognized. What this told us was that physicians, the pediatricians taking care of those mothers had not taken a history had not evaluated the child thoroughly and had not even talked to the obstetrician. So even within the healthcare system we are not communicating. So a place to start is in the school where trust does exist and build those bridges from the school out into the treatment community. That way you'll get the mother involved and hopefully the father involved in the situation and you'll be much more successful in your programs. Okay, we have a pediatrician here in Tallahassee. Dr. Xi, I assume you could be in that case where you were not taking the history, but you wanted to comment on that. Well, I think particularly relative to the issue of services in rural communities, there are studies that show that people who are addicted to various substances on the advice of their doctor will modify their behavior. We know in New Mexico that pregnant women who know they're pregnant already begin changing their use of alcohol and other drugs. So I think that everybody in the community physicians and education specialists can say to the parent, you know it's really important for your child's learning abilities for you to reduce or stop using your drugs and it sets a better model for your child. So even at a very what seems like a very simple intervention may have a significant impact on a lot of families. And sometimes it's the simple things that we don't think about first. That's right. Let's go to Portland where there is another question. Hi. I wanted to make a comment about the use of language and how compartmentalized things can be in different disciplines and go back to the notion of if some of these behaviors in the children are a function of central nervous system damage and some of them are not what are ways we can begin to talk about the confusing behaviors that we see without terming everything willful misconduct or seeing it as a function of either the child's willful misconduct or the professional or the parents inability to manage behaviors that often it's a gap that exists I've heard teachers describe it to me where if they are not effective if a behavior in one of their children is difficult that when they go and seek help from their peers or they go and seek help for it they're stuck feeling a burden of shame that parents often feel too about not being able to quote manage a behavior. Are there some alternatives in terms of language in terms of principles differently that would provide a little relief for both teachers and parents and other professionals? I guess I would respond to that by saying that we need to take that developmental word that we've been hearing and make that the perspective that we use when we look at our children. We need to examine the behaviors that we're observing take the work samples that we get from our children and put them onto a developmental continuum. And now we're beginning to look at children not from the point of view of whether they're misbehaving but beginning to look at where they are in their growth stage. And by taking that growth stage we can identify next steps. The other thing is expanding in our view of curriculum beyond the notion of what might be in a prescribed set of curriculum goals and again from the point of view of how functional is it in a youngsters that we expand to what we expect from our children. So it's the idea of looking at kids from a developmental perspective as opposed to just judging it as good or bad or right or wrong. Okay, now let's go to Barbara Basron in Washington D.C. I believe you have some comments and I'm not sure whether they're on this particular topic or some of the other things that we were talking about earlier. Dr. Basron. Respond to the question that was addressed earlier by a member of the audience regarding where they may locate resources that could be helpful to them as they plan for the education of children within their classroom. At the CSTAP National Resource Center for the Prevention of Perinatal Substance Abuse we do provide a variety of services that one might find very helpful. We have a GIS system, the Perinatal Research Education Management Information System that contains information on programs that have been shown to be effective around the country. It also has information on finance and funding on state legislation and contains a bulletin board of activities that can be helpful. We also have a calendar of events that can alert professionals in the field to upcoming conferences and training opportunities that might be available to them. The Resource Center, in addition to having the management information system that can be accessed either by telephone or you can get by computer and modem or you can get that information also through our information and referral line. All of these services are free of charge. Well, we hope this teleconference has energized you, it seems to have given you some good solid information on meeting the challenges of educating substance-exposed children. We know that all of you didn't get your questions in but I hope you'll continue to talk after we've left this today. I want to thank all of the participants, all the panelists, all the audiences at all of the sites and to thank all of you who are watching. Your caring, your humor, your knowledge and your persistence are the things which will turn what's been portrayed as a huge crisis into an even bigger story. Thanks for watching. I'm Barbara Rogers. Good afternoon. There is no typical profile of a high-risk child who has been prenatally or environmentally exposed to drugs. Each must be seen and respected as an individual with particular strengths and vulnerabilities. The sources of a child's behavior must be understood for teachers to develop specific interventions geared to the individual child. Rather than labeling children as crack or cocaine babies educators should view these children as individuals each with their own unique characteristics. These traits develop from the medical impact of their mother's drug use, their different home and community environments and the positive and negative experiences of their young lives.