About Us




August 2004


Building FASD State Systems: second annual meeting

by Sue Green

Each year, approximately 12,000 infants are born in the United States with Fetal Alcohol Spectrum Disorders (FASD) and suffer irreversible life-long physical and mental damage. FASD are national problems that can impact any child, family, or community, but it often lies with each state to provide services and treatments to help its citizens.

In May, the Substance Abuse and Mental Health Services Administration, (SAMHSA), and the FAS Center for Excellence sponsored the Second Annual Meeting of Building FASD State Systems in Kissimmee, Florida. Last year, the first meeting included 155 representatives from 48 states. This year, all 50 states, Puerto Rico and the District of Columbia were represented by 170 individuals.

These meetings are an effort to increase state involvement in preventing and treating FASD, and to bring together state employees and those involved in policymaking that want to move their states forward in these areas. State-specific working groups convened at the meeting to develop five-year goals for building state systems to address FASD in each state. Our contingent, from Washington state, felt especially fortunate to have the depth of knowledge and experience in clinical, policy, and family issues surrounding FASD that we do.Photo of the Washington state Building FASD State Systems group, Susan Astley, Marceil Ten Eyck, Sue Green, Therese Grant, and Julie Gelo.

The Washington state group met the first day with the tasks of developing a five-year goal, identifying the key tasks involved in accomplishing the goal, identifying the major barriers in achieving the goal, and identifying strategies to use to overcome the barriers. The group agreed on the following goal: “To increase communication through a Washington state FASD Web site in order to develop a system of care through integration, coordination and education.” We learned from other states’ representatives and from the work of the FAS Center for Excellence that despite the fact that we have, in comparison with many states, many services in Washington state, we needed to survey what is currently available and make this known to citizens statewide. Then, once we have knowledge of what holes in services must be filled, we can move onto other goals. The states of New York, Mississippi and Florida have each compiled a directory of services, and their working groups shared them with meeting representatives. They also explained how helpful the directories have been to the populations of their states seeking help for individuals impacted by FASD.

After each state group identified its goals, we met in teams of four to six states. Washington state was included in a team with New Hampshire, New York, Pennsylvania, Rhode Island, Vermont and Maine. State goals were shared and common barriers and tasks were identified.

Using this information, the states met again within their own groups and identified three action steps toward developing individual state systems that would work toward their five-year goals and that could be accomplished in the next year. The Washington state group decided to coordinate efforts through the Fetal Alcohol Syndrome Interagency Workgroup (FASIAWG) to:

  1. apply for a grant to develop a Web site, using an agency such as the Fetal Alcohol Syndrome Information Services (publisher of Iceberg) to write the grant. This Web site will be used to disseminate the information gathered about availability of services in Washington state.

  2. use the expertise of the whole group to diagram a Web site and its elements; and

  3. look at other state FASD Web sites for ideas.

During the two-day meeting, there were many excellent presentations that energized the groups to continue their work on preventing FASD. The Washington state contingent is especially excited to begin work on a “one stop” Web site that will encompass information and education resources specifically for the citizens of our state.

Sue Green has been working in the chemical dependency field since 1986, and currently holds the position of Women/Special Services Lead at the Washington State Department of Social and Health Services Division of Alcohol and Substance Abuse.

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The ongoing evolution of a social skills group

By Tony Van Zeyl, M.S., CCC-SLP

In August of 2003, our clinic – a private speech and language clinic – began a weekly after-school “Teen Club” intended to teach teenagers with pragmatic difficulties (including FASD, ADHD, Asperger’s syndrome, and autism) how to use social skills in natural situations. Since that time, we have learned much about serving teenagers, but there is still so much more to learn.

Too many times in education, different fads or ideas are touted as the magic bullet for different issues, such as, “whole language reading instruction will help all kids learn to read better;” or, “more testing will improve our nation’s schools;” and so on. That’s not to say that there is anything wrong with the philosophies of these educational fads, but it certainly is a little narrow to think that any one approach will solve some very complex problems. The quickly growing area of social skills training has its share of curriculums and theories that claim to be a magic bullet. We are not dismissing any of those and we are not suggesting we have figured out the way to remedy social skills challenges. Instead, we are offering a picture of what has and has not worked for us.

Below I describe the process that we have undergone in our efforts to teach teenagers how to socialize. Please come to your own conclusions about our process and learn from both our missteps and our successes. I invite you to share any ideas that you may have after reading this by sending an email to tony@cabrooksandassociates.com. We are lifelong learners and are always open to new ideas about how to teach kids how to socialize.

Group makeup

We have grouped teens not by age but by grade. For example we have a group for junior high students and a group for high school students. Our reasoning is based on the idea that the social field is very different in high school when compared to junior high. We have not broken down the groups into smaller years (for example, only a freshman/sophomore group) because we see the older students becoming role models for the younger ones. Our goal is to have groups with as many as 6-8 participants. However, at this point the groups are smaller because we are still in the development stage.

Session time

We decided that an hour was not long enough, so the sessions are 90 minutes long. This length of time allows for a variety of activities in addition to conversation. Also, the group time is ongoing; we do not disband the group after a designated number of weeks. We are finding that parents request breaks for their teens now and again because of different events like job searches, extracurricular activities, family obligations and such.

The evolution of the group

When we began the groups, they were highly structured. Each session began with a very specific schedule that was carefully planned. The schedule would be written on a board and it would be followed closely. After running groups with the same structure for a few months, it was obvious that some changes were necessary. On paper, all of the activities sounded great; in reality, there were some wrinkles.

  1. Rants and raves –

    Each participant shared something good that had happened to them and something not so good during the previous week.

    THE PROCESS: The purpose of this activity was to structure a way for the teens to talk about positive and negative events in their lives. The first time we did this it went VERY well. The guys brought up many different examples, like getting teased on the bus, parents going out of town, and having the highest bowling average on the team. However, after a few weeks group members lost interest in sharing and responses such as, “I don’t know” or “nothing happened this week,” became common. Even with many examples of positive and negative events their interest drifted away, perhaps due to the contrived nature of the activity, or due to challenges with “ranking” activities as a “rant” or “rave,” or maybe just because an adult was suggesting something that they never really bought into. While there were many interesting and lively discussions we eventually decided to move toward something more natural.

    WHERE ARE WE NOW? Currently we begin each session with a few minutes reviewing the week. This is a natural discussion that I usually initiate with, “So what have you guys been up to this week? Why don’t we start with Johnny?” Then each member of the group takes a turn. Over time, and with some prompting, the other members of the group have begun to ask questions of the person talking, too. Sometimes this discussion will last up to 30 minutes, depending on the discourse and what else is planned for the day.

  2. Teaching time –

    Initially we spent 30-45 minutes talking about a specific social skill, such as making eye contact, compromising, talking to adults, etc. This involved role-playing and/or discussion. Sometimes during the teaching time we performed icebreakers or team building activities.

    THE PROCESS: When first putting this together, I drew upon several curriculum elements and therapy ideas. I would introduce the topic to the group at the beginning of the session. The guys were usually respectful during this time in that they would sit and listen quietly. While the information was excellent, they were not in the mood for any more teaching in their day. One group member said, “I’m sick of learning. I have been learning all day long.” This could be dismissed as a “teenage thing to say,” but I interpreted it as: “We have been sitting in classes all day, so if you want to keep our interest, you had better make this seem as different from a class as possible.” Consequently, this section of the group has changed dramatically.

    WHERE ARE WE NOW? Compromising, accepting criticism, making eye contact, controlling tone of voice, dealing with teasing, managing anger and being flexible are some of the topics that come up most often. These topics are dealt with directly, usually in response to something that occurs during a session. We will be doing an activity like playing a game, talking or preparing food and a teachable moment will occur. Sometimes it is a positive example; other times it is a negative example. The key for me is to listen carefully and choose my battles wisely. When a teachable moment arises, we pause from our activity and talk briefly about the incident. If it involves heightened emotions – usually due to teasing or a sensitive topic – I will wait until everyone is calm before addressing the skill (which is sometimes the following week). We will often role-play the appropriate way to handle a given situation. Currently, one of the groups is surfing the Internet and learning about social skills through different Web sites about disabilities.

  3. Snack time –

    Since we were meeting from 5:00 to 6:30 p.m., everyone was hungry. We began to prepare a snack or a meal using a microwave and a toaster oven.

    THE PROCESS: The teens love doing this. They plan each “meal” the week before, and each member is assigned an ingredient (for example, for tacos: sour cream, shells, etc.) to bring. The meals/snacks are those we can throw together with few ingredients and little preparation. Within a project where each person has a specific job, the guys flourish and a lot of natural interaction happens. Sometimes the meal is elaborate (pita pizzas) and other times it is a simple snack (chips and salsa).

    WHERE ARE WE NOW? We continue to prepare snacks/meals during the session. Occasionally one of the guys will choose not to participate because of food preferences, but that is rare. It is frustrating for other group members when someone forgets an ingredient, but the consequence of not eating that evening is a powerful motivator for the one that forgot. The hardest part of this activity is generating easy recipes that everyone will like. They have not initiated many ideas themselves, and they don’t always like my suggestions, especially those that are a little offbeat. They didn’t want to even try apples and peanut butter.

  4. Game time –

    Group members chose a game to play from our game closet (like Uno, Sorry!, Monopoly and Scattergories) or I chose a game that specifically promoted social interaction (like Cranium or charades) because team playing was necessary.

    THE PROCESS: This went very well at the beginning. Members were learning new games and playing team-based games together. Eventually, though, we had played all of the games at our clinic that are appropriate for teenagers. The guys really wanted to play video games, but that was out of the question at the time (however, teaching them to play video games in a social way is something that we are considering in the future). Sometimes differences in cognitive or language skills limit the choices that the entire group can play.

    WHERE ARE WE NOW? Game time has evolved into activity time. On a rotating basis, one of the members of the group will bring in an activity for the rest of the group. This has involved members in selecting games and movies. When we watch a movie, a great deal of discussion surrounds the viewing; before beginning, the chooser has to talk about what he liked about the movie without giving away the plot. Due to time constraints, it usually takes several weeks to view an entire movie, much to the group’s dismay. There are usually examples of social skills throughout the movie (tone of voice, the use of sarcasm, dealing with teasing, the use of communication to solve problems, and the like) that we discuss by pausing the movie. When the movie is over, we talk about the movie and sometimes tie it to other movies that we have viewed together.

    Since the summer weather tempts us outside, we are currently planning activities at a nearby park. Also, we have been planning and discussing a group fundraiser so that members can do other activities outside of the clinic and acquire materials. This is still in the development stage.

  5. Email updates –

    Each week I transcribed the session in an email to the teens and their parents. I encouraged the teens to reply with answers to questions posed in the email.

    THE PROCESS: Emails are sent each week, allowing an efficient way for everyone to be informed about weekly activities and announcements. The emails have opened a dialogue between parents and myself, as well as providing them a way to initiate conversation with their teens. The teens were not interested in reading the emails and only answered the questions that I posed when rewards were offered. They viewed my questions as homework, which they felt they had enough of already.

    WHERE ARE WE NOW? I still send the emails and continue to include the teens, but now read them the email at the beginning of each session as a reminder of what we discussed during the previous week. My efforts to have them reply or engage in email dialogues continue to prove unsuccessful.


The most valuable moments of this group have involved teen-directed activities, natural interactions and adult flexibility. When I tried to force a “club” into a rigid structure, the members of the group seemed to sense my anxiety to move on to the next item on the day’s agenda; consequently, they never really got comfortable enough for natural interaction to occur. While many of our teens desire structure and thrive within it, too much structure in the social arena can be a deterrent to learning. I have had to learn to be flexible and allow the teens to take control of the activities. Instead of being a teacher, I have tried to be a facilitator. Of course, there must be a balance of the two, which is exactly where the challenge of working on social skills lies. Our evolution continues.

Tony Van Zeyl, MS, CCC-SLP is a speech-language pathologist who has taught social communication classes to teenagers. Currently, he works at C.A. Brooks & Associates, a private speech and language clinic in Shoreline, Washington, where he facilitates groups for kids with challenges in the area of social skills in addition to providing individualized therapy. For more information about the clinic, visit the clinic website at www.cabrooksandassociates.com, phone 206-546-9595, or email Tony directly at tony@cabrooksandassociates.com.

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Discussion of adolescent therapy groups

by Charles Huffine, MD

As one who has conducted adolescent therapy groups for nearly 30 years, I was gratified to read Tony Van Zeyl’s article about the evolution of his “Teen Club.” Van Zeyl is working with a particularly challenging group of young people in great need of an experience that assists in developing their social skills. He has the special knack of working with this population and engaging them in a process of enhancing their social competencies. In his work Van Zeyl has discovered two critical principles that are key for anyone so brave enough to offer group therapy to teenagers.

The first principle Van Zeyl teaches us is that the best models, research, manuals, structures and treatment breakthroughs can be rendered banal by a real group of teenagers. Untutored teens have a way of refusing to accept what the “experts” say is good for them; when free to express their own preferences, they will come up with some amazing modifications. Van Zeyl is to be commended for his flexibility and willingness to learn from the real experts – the adolescents we work with.

The second principle he demonstrates is that teenagers are individuals first, adolescents second and, way down the line, they are individuals with some specific disability. I believe that adolescence is primarily a social developmental process, and that in those years the norms for social functioning set by the peers around them are the most powerful forces in teenagers’ lives. Adolescents are in a process of adapting to a very rule-bound and hierarchical subculture that requires some skills in reading and adapting to social cues. Sadly, so many of our youth with disabling conditions such as FASD are unable to compete well in this social atmosphere, even in the most primitive or deteriorated of adolescent subcultures. But the rules of engagement, whether our young people can play well or at all, are in their faces daily. Van Zeyl clearly knows this reality and has adapted basically good ideas for working with youth to attend to the “Laws of Adolescence” – staying flexible, adapting to the moment, not over-attending to parents and playing to adolescents’ strengths as they emerge.

It is fascinating to see how Van Zeyl’s groups are moving in the same direction I find my own groups have gone. I think that what this means is that Van Zeyl and I are both attending to the fact that our clientele are adolescents first and youth with mental health challenges second.

Group make-up and time

Both our groups focus on status in school and not specifically age. I ran a junior high school group in years past, but most groups have been for those who are of high school age. My group is also a “rolling group;” new members join when there is an opening. We also have a maximum of eight members. Many “age out”, but some choose to leave because they know when they are done. Continuity of relationships, loyalty to a group and leaving when the peer group you have identified with in-group has departed – these are all a part of what adolescence is about.

Evolution of the group

“Rants and raves,” “Teaching time,” and the structure of discussions

As in Van Zeyl’s groups, the youth I work with also will be good sports for a while, but with passivity and occasional teasing they will make it clear when any structuring I want to impose on them should be jettisoned. My group members also have an aversion to anything that even looks like school. Natural discussions about events a youth is inclined to share with the others – but only in their own way – seems always to work well. That doesn’t mean that group leaders can’t capitalize on teaching moments.

What continues to amaze me is that mixed with my constructive observations and suggestions is the load of outrageous and “inappropriate” suggestions that are all taken with good humor. The members’ goals are to tease the therapist and, in their outrageous humor, to provide an upside down and backward, hidden constructive implication. That is the adolescent way. I find that the teaching times go both ways, and I am constantly learning from the young people I work with.

“Snack time” – Food and Adolescents

Food is clearly a big deal for adolescents. What I have found is that providing food, especially teen-friendly food, on special occasions fits the expectations of adolescents that adults should be unconditionally nurturing. Adolescents expect to be free to make their way in the social order, but they definitely want to go home for dinner. Parents have such a key role in making the adolescent process safe and secure, and as group leaders we are seen as extensions of that adult role as mentors. Mentors have some parental-like functions. Nurturing with food is one of these.

“Game time” – fun in a session

What Van Zeyl and I have both learned is that structuring social interactions in games or any formal process gets corny for kids. My experience is that fun and games come in two forms. The first is spirited discussions of movies, video games, music and other popular issues. Adolescents gravitate to such topics, and in that talk there is play for youth and an educational opportunity for adults.

The second form of play in adolescent groups is “tease the adults,” which seems to bond a group in a common activity like no structured game could ever do. The trick of group leaders is to be a cool player where the rules clearly define out excesses of adult control as well as youthful over-indulgence. These unwritten rules also mandate breaking of structures that the youth clearly don’t want and don’t need, and supporting the structures they do want and need. It is always a peer who will pick up on when things are getting out of hand and soften the teasing and play. It is the skill of the adult leaders to handle this with grace and skill.

E-mailing updates

The response to Van Zeyl’s parent updates highlights a rule that is crucial for teens. Teens demand a certain confidentiality in their treatment that is different than what we as adults understand. They don’t mind us tending to their parents; in fact, if we handle it right, it is very helpful to them. But they really don’t want to be a part of that interaction. Any sharing needs to be done without betraying to parents sensitive topics that may come up in-group. Likewise, I am careful to never divulge in the group what I have learned about a teen in an individual session or from parents.

Youth also have different rules for confidences between themselves. What they choose to share with each other is their business. Youth gossip and “dis” each other regularly. That is considered bad behavior and can destroy friendships, but it is also easily forgiven and, at times, even expected as part of adolescent life. Group therapy is a setting where rumormongering can be addressed and youth helped to refine their standards in social interactions.


Group therapy is an excellent treatment modality to help teenagers develop social skills. However, it is rarely a sustainable form of treatment beyond staff-controlled settings such as hospitals or residential programs. Tony Van Zeyl has demonstrated the trick for making it relevant in a school or outpatient setting – let the youth determine the format and content of activities and discussions. He demonstrates beautifully how listening to youth and easing one’s own therapist agenda allows for an evolution of the group to become a relevant and positive factor in their social development. By facilitating and shaping what is an organic process, adults help youth with conditions that impair their socialization to get on board developmentally. With the structure of a time, a place, adult leadership and a set group of youth, even those with severe challenges will find their way in such a process. I am so pleased that Van Zeyl has shared this experience with Iceberg readers.

Charles Huffine has practiced child and adolescent psychiatry in Seattle since 1975. In his private practice he has specialized in the needs of adolescents and their families, and is actively involved with all issues that relate to teenagers. Dr. Huffine also holds a part-time position with the King County Mental Health, Chemical Abuse and Dependency Services Division as the Assistant Medical Director for Child and Adolescent Services.

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FASD resources for the classroom

Alberta Learning, a branch of the government in Edmonton, Alberta, that develops educational curricula for the Canadian province, has developed two new resources on fetal alcohol spectrum disorder (FASD). The first is aimed at helping students learn more about FASD and how it can be prevented. The second offers teachers current information and specific ideas to better meet the learning needs of students with FASD.

There are few FASD prevention resources available to teachers, which is why the September 2004 launch of Teaching for the Prevention of FASD was so important. The goal of this resource is to raise awareness of the effects and characteristics of FASD through learning activities that teachers can incorporate into the Alberta health and life skills, and Career and Life Management (CALM) programs. Teachers are provided with strategies, activities and student information sheets focusing on the prevention of alcohol use and abuse during pregnancy.

Strategies center on three themes: understanding relationships, dealing with feelings, managing risks and making personal choices. In grades one to three, students focus on building skills to make healthy choices. In grades four through 12, students focus on the same and participate in activities that directly address FASD. For instance, a grade-seven student may be asked to analyze the social factors that influence avoidance or use of a particular substance, whereas a high school student may learn to evaluate choices that can create barriers to achieving and maintaining health.

“This resource is really about broadening students’ understanding of FASD prevention and teaching students how to make healthy choices,” says Greg Bishop, Education Manager for Alberta Learning, and it’s available at just the right time. In September 2002 a new Alberta K–9 Health and Life Skills program, and Senior High School CALM program, were implemented in Alberta schools, and this resource supports these new programs and their emphasis on healthy life choices.

Teaching Students with FASD, which is subtitled Building Strengths, Creating Hope, contains background information and terminology that will help educators understand the current diagnostic definition of FASD, key considerations for planning effective education programs, suggestions for how to build a positive classroom climate and maintain a supportive learning environment, and strategies to assist teachers with programming for students with FASD. An appendix of reproducible blackline masters to use with students, parents and other educators is also included.

Alberta Learning contracted Sandra Clarren, an Iceberg board member, to edit the 1997 FAS resource and act as the contributing writer on the new guide. Many other resources were drawn from to complete this work. The resource has an impressive collection of best practices that teachers can adapt to meet the needs of their students.

Both resources are available for purchase from the Learning Resources Centre, phone (780) 427–2767 or online at www.lrc.learning.gov.ab.ca/. To find free PDF versions of these resources, go to Alberta Learning’s Web site at www.learning.gov.ab.ca/fasd.

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Brewers in Japan will start using warning labels

by Ken and Peggy Oba

”Five major Japanese brewers will voluntarily start to place warning labels on their alcoholic beverages in June of this year. Kirin Brewery and Suntory Ltd. will be placing warning labels on their regular beer, malt beers and specialty drinks in early June. Asahi Breweries have said they will start labeling as soon as possible. Although the labels will only be on beer containers in
the beginning, the five companies have pledged that all alcoholic beverage containers will have the labels in the future.”

This announcement appeared in several Japanese newspapers this spring, including Asahi, Yomiuri and Mainichi, and was greeted with pleasure by those in the FAS Family Information Network who worked with the Japanese Brewer’s Association to heighten awareness about FASD.

The Brewers' Association sponsors the ASK (Human Care) group that investigate issues related to alcohol consumption as alcoholism rates, drunken driving rates, heart disease, cancer, etc. Until the FAS Family Information Network contacted them in 1998, they were unaware of the seriousness of drinking before, during and after pregnancy. The FAS Family Information Network provided many journal studies, textbooks (including both of Dr. Ann Streissguth's books and the 1996 Final Report on the Occurrences of Secondary Disabilities) and the U.S. Congressional Special Reports to Congress on Alcohol and Health, to ASK to help them understand the severity of the problem.

In November 2003, ASK and the FAS Family Information Network consulted together to convene the first Japanese International Conference on Fetal Alcohol Syndrome, which invited both Japanese researchers and Dr. Edward Riley of San Diego State University and Debra Evensen of the national FASD Center for Excellence to participate. It is felt that this conference was one of the turning points in the decision to place the warning labels on alcoholic beverages.

The beverage labels will read, "Consuming alcohol while pregnant or breastfeeding poses the risk of creating developmental problems in fetuses and babies."

The Japanese government also removed 170,000 alcohol vending machines from unattended public places in 2001. This was five years after a massive informational mailing effort to Mr. Naoto Kan, the Japanese Health Minister, by the FAS Family Information Network.

The FAS Family Information Network, directed by Peggy Seo Oba, is a Kansas City, Missouri-based non-profit, whose main work is the international prevention of FASD and the dissemination of information related to FASD


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