Addictions Research Centre 23 Brook St., Montague, PEI C0A 1R0

1. Fetal Alcohol Spectrum Disorder in a correctional population:Preliminary results from an incidence study in a federal penitentiaryBrian A. Grant & Patricia MacPherson Addictions Research CentreAlbert E. Chudley, University of Manitoba Addictions Research Centre23 Brook St., Montague, PEI C0A 1R0 902-838-5905 addictionsresearch@csc-scc.gc.ca

2. Project Team • Patricia MacPherson, Addictions Research Centre (ARC) • Brian Grant, (ARC) • Ab Chudley, University of Manitoba • Fred Boland, Queens University • Charlotte Fraser (ARC) • Staff:

3. Expression of Neurological impacts • Adaptive behaviour – • meets standards of personal independence and social responsibility • Language – words not fully understood • Attention • Reasoning – do not learn from experience, problem solving, judgement • Memory - confabulation • ALARM – from Conry & Fast (2000)

4. Secondary Disabilities • Result from the environment; potentially preventable • Academic failure • Mental health disorders • Addiction • Sexual deviance • Inability to live independently • Problems with the justice system

5. Prevalence • Health Canada • FAS: 1 – 3 per 1000 live births • FASD: 9 per 1000 live births • Consistent with U.S. estimates • Rate varies dramatically in special populations • Less than 1 to 190 per 1000 live births

6. Correctional Populations • Conry and Fast, 1999 • young offenders remanded to a forensic psychiatric inpatient assessment unit • 23% (3 FAS; 67 FAE) • Streissuth et. al. (2004) • 60% of FASD affected adolescents & adults had contact with the law

7. Boland et al., (1998). • “Although there is substantial evidence suggesting a link between FASD and crime…. there are no known studies reporting the prevalence of FASD in prisons.” • http://www.csc-scc.gc.ca/text/rsrch/reports/r71/er71.pdf

8. Challenges in the prison environment • Victimization • Prison routine / rules • Wanting to fit in • Inappropriate sharing of information • Inappropriate social behaviours

9. Challenges for Corrections • How to identify affected individuals • Number of offenders with FASD • How to adapt current programs • How best to accommodate • Management in the institution and community • Reducing risk of re-offending; keeping the community safe

10. Purpose of CSC Research • Determine incidence • Identify scope of the problem • Appropriate resource allocation • Develop targeted interventions • Develop a screening instrument • Identify offenders for further assessment • Integrate into intake assessment process.

11. Study Sample • Offenders processed by Winnipeg Parole Office • 30 and under; • Over 18 month period • New admissions transferred to Stony Mountain Institution • Aboriginals are over-represented in our sample (40% vs. 17%) • Everyone is asked to participate • Statistical methods will be used to generalize to CSC population • Women are not purposely excluded, SMI is a male facility

12. Participant Recruitment • Remand Centre/Headingly Correctional Centre: • Parole officer conducts preliminary assessment with newly sentenced offenders • Explains that research assistant will be coming to see them • Research Assistant: • Explain the study to offenders both verbally and in writing • Audiotapes consent interview • Obtains signed consent

13. Community Information • 28 Behavioural Indicators • Judgment, distractability, mood swings, hyperactivity, financial, consequences. • Historical Indicators • Adopted, foster care, developmental challenges, school disruption, mental health • Maternal consumption of alcohol • Information collected from the offender, parole officers, collateral sources

14. Information Sources - Institution • Medical Intake Interview • FASD Facial Photographic Analysis Software • Physical exam • Facial measurements, about 10 minutes • Neuropsychological testing • IQ; executive functioning; visual and auditory memory; social adaptive functioning

15. Diagnosis • Case Conference to determine outcome • Doctor • Psychologist • Research Liaison Officer • Information from all sources will be compiled • Checklists (community) • Medical records • Medical intake interview • Photometric report • Physical/neuropsychological evaluations

16. Four Research Outcomes

17. Debriefing • If no FASD diagnosis, Research Liaison Officer will debrief participants • Letter from Dr. Chudley stating results • Certificate of appreciation for participation • If positive neuropsychological findings, letter from psychologist detailing results • If FASD diagnosed, Dr. Chudley will be present for debriefing and will explain results to participant

18. Disclosure • Participants can decide if they want their results disclosed to CSC • Results placed on CSC file • Health care • Psychology • Case management • Used by case management team • Will be offered Research Liaison Officer support

19. Follow-up • Once a year for two years • Those diagnosed with FASD • Brief Questionnaire (approximately 10 minutes) • Adjustment • Views on participation in study • Value or benefit of their experience with the Research Liaison Officer

20. Preliminary Results Participant Recruitment • 96 current participants • 58 declined • 8 withdrawn • ~ 59% participation rate

21. Demographics for case conference sample • 64% Aboriginal • 25% Caucasian • 11% Other racial groups • 51% Single • 49% Married/common law • Average age 24

22. Summary of collateral informationCase conference sample • Average of 2 per participant (range 0 – 7) • 45% participated with maternal alcohol information • 17% participated without maternal alcohol info • 28% unable to contact • 10% declined

23. Summary of maternal informationCase conference sample • 83% of offenders provided mother as a contact • 63% agreed to participate • 18% unable to contact • 14% declined • 5% language barrier

24. Summary of Collateral Information * Other includes step-parent, foster parent, adoptive parent, friend, or cousin

25. Average Scores on Behavioural Items

26. Average Score on Historical Items

27. Reported Prenatal Alcohol Exposure

28. Reporting on prenatal alcohol exposure Yes=17 Yes=3 Yes=6

29. Other Drug Use During Pregnancy

30. Birth/Hospital Records • All participants agreed to allow access to birth records • 71% of records received • 13% hospital did not have records • 9% offender did not know where born • 4% records were destroyed • 3% offender not born at the hospital that he indicated

31. Birth/Hospital Records Maternal pregnancy records • 77% of mothers agreed to release records related to their pregnancy • 59% of pregnancy records have been received

32. FASD Neuropsychological Test Battery

33. Level of Neuropsychological Deficits Identified in case conference sample

34. Overall risk and need for offenders with prenatal alcohol exposure identified

35. Overall risk and need for offenders with neuropsychological deficits identified compared to those without *

36. Youth Court History

37. Adult Court History

38. Conclusion • 75 offenders assessed to date • Data collection ongoing • Analysis will assist CSC to determine • Incidence of FASD • Characteristics of offenders with confirmed PAE • Characteristics of offenders with significant CNS impairment • Factors that identify offenders who are at risk for FASD