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Most clinicians (85%) who had forensic NDD practice experience also had specific experience working with clients who had FASD. Many (56%) had provided only forensic assessment services for this client group; a smaller proportion (25%) provided both assessment and intervention services; and, a very small number (7%) provided only intervention services. Many clinicians indicated that their typical forensic practice did not include clients with FASD for assessment (43%), individual treatment (76%) or group treatment (86%). Among clinicians who had seen clients with FASD in their practice, this population most commonly translated to a very small percentage of their practice or usual caseload (e.g., less than 20%). Clinicians reported variable levels of perceived practice experience for clients with FASD, with 15% describing no experience with this population. Most had experience ranging from “a little bit” to a “fair” amount of experience (79%), and only a small share (7%) felt they had “a lot” of experience working with clients who have FASD (Figure 2). Clinicians who had previously provided assessment services to clients with FASD reported seeing roughly three clients with FASD for assessment in a “typical” or average month of practice, though this frequency ranged widely across practitioners.^{Footnote 6} Clinicians who had previously provided intervention services to clients with FASD also reported seeing roughly three clients with FASD in a “typical” or average month of practice.^{Footnote 7}

Figure 2. Forensic practice experience with clients who have fetal alcohol spectrum disorder – Text version

Figure 2. Forensic practice experience with clients who have fetal alcohol spectrum disorder

Figure 2 is a pie chart with five wedges in different colours. On the right is a legend.

The red wedge (which indicates “no experience”) is 15%

The orange wedge (which indicates “a little bit of experience”) is 42%

The blue wedge (which indicates “some experience”) is 19%

The yellow wedge (which indicates “fair experience”) is 17%

The green wedge (which indicates “a lot of experience”) is 7%

Forensic Assessment. Clinicians reported completing a variety of specific types of forensic assessments for clients with FASD in criminal justice contexts. The most common included evaluations for competence/fitness to stand trial, diagnosis of FASD, assessments of future violence or recidivism risk, and assessments for the purposes of disposition planning in the context of sexual offences (Table 2).

Referrals for forensic assessment referrals came most frequently from judges or were court ordered (89%), followed by public/private defence attorneys and/or lawyers (45%), and prosecution or crown (39%). Just over two-thirds of clinicians agreed (67%) that it was their role and/or responsibility to identify FASD in the context of their forensic practice.

Clinicians characterized a wide range of forensic assessment practices when working with clients who have FASD (Table 3). Common practices that were “always” or “almost always” used included interviews with caregivers, mental health providers, and social workers, and obtaining records from mental health providers, police, and custody/detention centres. Clinicians reported using a range of general psychological tests and tools to assess intellectual and cognitive functioning, mental health and personality, and academic skills. They also described using many forensic assessment instruments (FAIs) including FAIs to assess risk for violence/future offending, and psychopathy.

Clinicians were asked if they had any recommendations about whether courts should receive additional information for cases involving an accused person with FASD. Of those who provided feedback (22%), common recommendations included providing more comprehensive information about FASD (23%), prognosis regarding the likelihood of successful treatment outcomes (14%), and providing additional FASD training for courts/lawyers (9%). Clinicians were also asked what courts could do to better identify people who may have FASD. Of those who provided feedback (19%), common suggestions included listing FASD specifically in the referral question for assessments (29%), providing access/court orders to facilitate obtaining records or access to informants (24%), further FASD-related education for the courts (14%), and requesting court-ordered psychological/neuropsychological assessments (14%).

Forensic Intervention. As previously noted, a smaller proportion of the sample provided forensic treatment services to clients with FASD (31%). Those who did provide treatment services described a range of practice approaches commonly used in forensic and correctional treatment settings, including cognitive behaviour therapy (70%), providing psychoeducational strategies (65%), social skills training (55%), anger management treatment (55%), and treatment for substance abuse (50%). Clinicians also described providing treatment services more often in an individual or one-on-one format for this population, compared to intervention delivered in a group setting.

Practice Barriers. The majority of clinicians reported experiencing barriers in their forensic assessment and intervention practices when working with clients who have FASD. Common barriers included difficulty obtaining records, difficulty in making culturally informed assessments, perceived lack of cooperation from clients, lack of treatment options and/or methods for managing risk, lack of research on best forensic practices for clients with FASD, and lack of funding for sufficient evaluation.

Training Experiences and Needs

Many clinicians had not received formal training about FASD with respect to their forensic practice for: planning/delivering forensic treatment/management plans; offering consultation to legal and other health professionals regarding forensic issues; assessing and/or diagnosing FASD in either youth or adults; assessing adjudicative competence; selecting reliable/valid assessment instruments to screen/diagnose FASD; or, assessing risk for future violence (Table 4). For those who had received FASD training, learning had most commonly focused on recognizing FASD-related clinical signs and symptoms, and less commonly in more specialized areas of practice, such as assessing and/or diagnosing FASD, or providing forensic specific services such as assessing future risk for violence.

In general, clinicians reported feeling that they were not adequately prepared for forensic practice with clients who have FASD, with 22% feeling “not at all” prepared, most (55%) feeling “slightly” to “somewhat” prepared, and only 23% feeling “moderately” to “very prepared.” Many clinicians felt only “slightly” to “somewhat” prepared to complete a range of clinical activities in their forensic practice, including identifying individuals at risk of having FASD in forensic contexts (64%), assessing and/or diagnosing FASD (50%), conducting forensic assessments with clients who have FASD (45%), or managing forensic intervention in this population (58%). Notably, substantially more clinicians felt better prepared (e.g., “moderately” to “very” prepared) to identify clients at risk of having FASD (46%), compared to formally diagnosing FASD in forensic contexts (29%). Similarly, a greater number of clinicians reported feeling better prepared to conduct forensic assessments (45%), compared to managing forensic intervention (22%) for clients with FASD.

All clinicians reported that additional training, resources, and supports were needed to enhance their skills and knowledge in working with individuals who may have FASD in forensic contexts, with two-thirds (67%) of the sample identifying these as “moderately” to “very much” needed. Several specific types of training and practice resources and supports were rated as being “moderately” to “very helpful” in supporting forensic FASD practice, including: evidence-based screening tools and approaches for identifying clients with FASD in forensic settings (75%); clinical guidelines for best practice in diagnosis (73%); having access to a registry of specialists available for consultation (68%); in-depth workshops and/or accredited training opportunities (62%); concise provider and staff information/training on FASD prevention, diagnosis, and intervention (58%); listing of community-based resources (58%); self-study materials (56%); and online training opportunities (55%).

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