Discussion and Conclusions

Findings from the current study provide an important snapshot of the practices, training experiences, and training and support needs of forensic mental health clinicians providing services to individuals with FASD in various criminal justice contexts. While the majority of forensic mental health clinicians reported at least some experience working with clients who may have FASD, many did not regularly practice with this population. Further, clients with FASD tended to reflect a very small proportion of typical clinician caseloads, and relatively few clinicians provided forensic intervention services to this population despite their pronounced clinical needs (Brown et al., 2015; Mattson et al., 2019; Pei et al., 2011). These low rates may be driven by several factors, including not having adequate training or access to effective tools to support the identification of individuals with FASD in practice (e.g., they may see more clients with FASD than they realize); not routinely practicing with this population given limited training, perceived competency, or other barriers (e.g., insufficient time or funding allotted); or individuals with FASD not being detected and flagged for referral to forensic mental health services (Bibr, 2018; Brems, Boschma-Wynn, Dewane, Edwards, & Robinson, 2010; Eyal & O’Connor, 2011; Gahagan et al., 2006; Popova et al., 2019). Indeed, many clinicians characterized themselves as inadequately prepared for forensic practice with clients who have FASD, and most felt that their formal training either during professional school or in the context of postgraduate training had been limited. These findings are similar to other FASD practice surveys of various clinicians and both legal and health professionals (Bibr, 2018; Brown et al., 2017, 2016; Caley et al., 2008; Coons et al., 2017; Cox et al., 2008; Sarrett, 2017).

The current results strongly support the need to develop additional FASD training opportunities, resources, and supports geared toward forensic mental health clinicians. Clinicians strongly endorsed a range of possible FASD-focused resources and training opportunities they felt would be helpful in strengthening their forensic practices. Helpful training modalities may include developing modularized curriculum components to increase training in key areas (e.g., graduate programs and internships) and online and/or face-to-face continuing education courses and workshops tailored to forensic practice. In addition, clinicians highlighted the value of having access to evidence-based screening tools and approaches, as well as practice guidelines to support their forensic work with clients who have FASD.

Findings from this study suggest that forensic mental health clinicians may not be providing services to clients with FASD at rates consistent with their estimated proportions in forensic and correctional settings. Although several clinicians with substantial FASD-related expertise were identified, most felt ill-equipped to practice effectively with this population. Findings highlight the need to ensure that appropriate training opportunities are provided for clinicians, in addition to sufficient time and resources allocated to both assessment and intervention processes, to support best practice. This will be particularly critical as FASD awareness continues to grow among criminal justice and legal professionals, that coupled with potential policy shifts, may result in increased FASD-related referrals for forensic assessment and treatment.