TB Testing for Clients

Goal - why is this important to us?

Fetal Alcohol Spectrum Disorders (FASD) are life-long neurodevelopmental conditions that frequently go undiagnosed or are misdiagnosed as ADHD or personality disorder. At Dawn Farm, identifying prenatal alcohol exposure (PAE) early allows us to tailor treatment, avoid misinterpreting brain-based memory and executive function deficits as "willful resistance," and connect clients to specialized diagnostic and community resources.

Ingredients - what do I need to get started?

• This SOP

• Client chart in Apricot

• Episode Intake 

• Local FASD Diagnostic Referral Directory (e.g., regional neuropsychological testing services, Michigan Medicine FASD/genetics clinic resources)

Timeframe - about how long will this take?

Screening takes 5-10 minutes during intake; processing a referral takes 5-10 minutes.

Contacts - who do I need to let know?

• Primary Therapist and/or assigned RSS

• Program Coordinator to assist with any accommodations needed for learning or behavioral support. 

• Receiving Diagnostic Clinic / External Specialist (when placing a referral)

Steps - what do I do?

Section 1: Intake Screening Protocol

• Administer Assessment: During standard biopsychosocial intake, review medical, developmental, and family history for reported or suspected prenatal alcohol exposure (PAE).

• Identify Behavioral & Cognitive Indicators: Screen for consistent patterns of:

  • Persistent memory deficits (inability to retain daily instructions despite effort).

  • Extreme executive dysfunction (difficulty planning, tracking time, or organizing belongings).

  • Difficulty linking cause to effect or learning from repeated consequences.

  • History of unsuccessful standard treatment attempts due to cognitive overload.

• Document Findings in Apricot: Record confirmed or suspected PAE and observed cognitive vulnerabilities in the Episode intake psychological summary notes.

Section 2: External Referral Process

• Determine Need for Referral: Initiate a diagnostic or neuropsychological referral if the client requires formal FASD diagnosis for disability support, housing accommodations, or specialized legal advocacy.

• Obtain Release of Information (ROI): Complete the MDHHS-5115 Universal Release Form specifically naming the target diagnostic center or neuropsychology clinic.

• Document and Track:  Document that the referral happened and then continue to track as they receive services. 

Section 3: Synopsis of Adapted Clinical Care

Once suspected or identified, adapt standard care to support the client's neurodevelopmental needs:

• Communication: Use direct, concrete language. Avoid abstract metaphors. Give one instruction at a time and ask the client to rephrase it back rather than asking "Do you understand?"

• Environmental Support: Provide external executive function tools, including visual schedules, written checklists, and predictable daily routines.

• Reframing Behavior: Shift focus from punitive consequences to proactive cueing. Treat repeated oversights as memory/processing deficits rather than non-compliance.

Follow-up - what loose ends do I need to wrap up?

If the client tests Positive (or have in the past):

1. Instruct the Client Complete follow up testing with either Packard Health or their own medical provider. Typically this is a chest x-ray.

2. If the results from follow up show that their TB is positive, but inactive (a.k.a. Latent):

a.) know the person is not contagious.  

b.) staff will want to refer them back to Packard or their doctor for preventative care and   a 4 month medication regimen.  

c.) continue to look for a persistent cough 

3. In the future the client will be asked to fill out a brief questionnaire annually with Packard or their doctor to see if they need another chest X-Ray.

If the client test Positive & Active:

1. Instruct the client to Immediately follow up with their medical provider as soon as they receive this diagnosis for instructions and care.

2. Immediately make a note in the client’s Apricot file 

General Information about Fetal Alcohol Spectrum Disorder (FASD) :

What is TB? 

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria becomes sick. As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease. If not treated properly, TB disease can be fatal. www.cdc.gov.

How is it Spread? 

TB bacteria are spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, speaks, or sings. People nearby may breathe in these bacteria and become infected.

TB is NOT spread by:

• shaking someone's hand

• sharing food or drink

• touching bed linens or toilet seats

• sharing toothbrushes

• kissing