Background

FASD in the Criminal Justice System

Fetal alcohol spectrum disorder (FASD) is a common neurodevelopmental disability (NDD)Footnote 2 caused by prenatal alcohol exposure, thought to affect approximately 4% of the Canadian population, or roughly 1.4 million people, with an annual economic impact ranging between $1.3 and $2.3 billion (May et al., 2014, 2018; Popova et al., 2018; Popova, Lange, Probst, Parunashvili, & Rehm, 2017). People with FASD experience a range of difficulties in their cognitive, affective, behavioural, and adaptive functioning, in addition to physical features in a smaller number of cases (e.g., facial dysmorphology) (Cook et al., 2016; Mattson, Bernes, & Doyle, 2019). They also experience high rates of co-occuring mental and physical health concerns, and high rates of additional adversities, including caregiver disruption, experiences of abuse, and contact with the child welfare system (Corrado & McCuish, 2015; Mattson et al., 2019; McLachlan et al., 2016; Pei, Denys, Hughes, & Rasmussen, 2011; Streissguth et al., 2004). As many as 30% to 60% of youth and adults with FASD may have some level of contact with the criminal justice system, with prevalence estimates in forensic and correctional settings ranging from 10% to 36% and far exceeding those of the general population (Bower et al., 2018; Fast, Conry, & Loock, 1999; Forrester et al., 2015; MacPherson, Chudley, & Grant, 2011; McLachlan, Flannigan, Temple, Unsworth, & Cook, under review; McLachlan et al., 2019; Popova, Lange, Bekmuradov, Mihic, & Rehm, 2011; Popova, Lange, Shield, Burd, & Rehm, 2019).

Forensic and Correctional Mental Health Practices

Forensic mental health clinicians are frequently called upon to complete assessments and provide treatment for individuals at various stages of the criminal justice process (Neal & Grisso, 2014; Viljoen, McLachlan, & Vincent, 2010). Given the overrepresentation of people with FASD in both forensic and correctional settings, forensic mental health clinicians are likely to have frequent contact with this population. Further, individuals with FASD may present with a host of complex clinical needs and difficulties that are likely to impact forensic evaluation and treatment outcomes, including complex neurocognitive deficits, comorbid mental and physical health concerns, substance misuse, problems with dependent living, and difficulty maintaining employment (Mattson et al., 2019; McLachlan et al., 2016; Streissguth et al., 2004). FASD has relevance at multiple adjudicative stages, including during arrest and police interview; fitness to stand trial; risk assessment in the context of sentencing and disposition planning; determinations of criminal responsibility; dangerous and long-term offender applications; and, post adjudicative management, intervention, and planning for return to community (Chandler, 2016; Gagnier, Moore, Green, & Hall, 2011; McLachlan, Gray, Roesch, Douglas, & Viljoen, 2018; McLachlan, Roesch, Viljoen, & Douglas, 2014; Mela & Luther, 2013; Roach & Bailey, 2009). However, FASD can be difficult to clinically identify and frequently goes undetected in criminal justice contexts, owing in part to a frequent lack of physical features that distinguish individuals with FASD, variability in the pattern of difficulties and needs experienced from one person with FASD to another, associated stigma, and lack of awareness about the disability among professionals (Astley, 2010; Brown, Helmstetter, Harr, & Singh, 2016; Cox, Clairmont, & Cox, 2008; Mattson et al., 2019).

Existing evidence suggests that knowledge and awareness of FASD in clinicians, criminal justice and legal professionals is variable, and that many lack the appropriate training to work effectively with this population (Bibr, 2018; Brown, Cich, & Singh, 2017; Brown et al., 2016; Caley et al., 2008; Coons, Clement, & Watson, 2017; Cox et al., 2008). Currently, there is limited research examining FASD-related clinical practices, or training experiences or needs, among forensic mental health professionals. This gap in knowledge makes it difficult to know whether forensic clinicians are aware that some of their clients might have FASD, how they identify and work with these individuals in forensic assessment and intervention contexts, and whether they identify a need for additional training or supports to improve practice. As part of a broader study evaluating the professional practices, training experiences, and needs of forensic mental health clinicians in working with clients presenting with a range of NDDs,Footnote 3 the aim of the current report is to summarize findings from this research that are specific to FASD.