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FASD in a Correctional Population: Preliminary Results from an Incidence Study

FASD in a Correctional Population: Preliminary Results from an Incidence Study . Addictions Research Centre 23 Brook St., Montague, PEI C0A 1R0. Patricia MacPherson Addictions Research Centre Correctional Service Canada Albert E. Chudley University of Manitoba. Purpose of Talk.

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FASD in a Correctional Population: Preliminary Results from an Incidence Study

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  1. FASD in a Correctional Population:Preliminary Results from an Incidence Study Addictions Research Centre23 Brook St., Montague, PEI C0A 1R0 Patricia MacPherson Addictions Research CentreCorrectional Service Canada Albert E. Chudley University of Manitoba

  2. Purpose of Talk • To review population incidence studies • To review correctional systems incidence • To review research study objectives and methodology • To review preliminary results

  3. Project Team • Co-Investigators • Patricia MacPherson, M.Sc. & Brian Grant, Ph.D, (ARC) • Albert Chudley, MD, University of Manitoba • Clinical Neuropsychologist • Andrea Kilgour, Ph.D, University of Manitoba • Field Staff • Kim Spiers (SMI), Dawn Harmer (Winnipeg Parole) • Data quality/ data management • Charlotte Fraser, MA (ARC)

  4. Secondary Disabilities • A result of the interaction between primary disabilities (behavioural and neuropsychological problems) with adverse environments

  5. Secondary Disabilities • Academic failure • Mental health disorders • Addiction • Sexual deviance • Inability to live independently • Problems with the justice system • Encounters with the law • Confinement

  6. Prevalence • Health Canada • FAS: 1 – 3 per 1000 live births • FASD: 9 per 1000 live births • Rate varies dramatically in special populations • Less than 1 to 190 per 1000 live births

  7. Incidence in Offender Samples • Estimates of incidence in offenders vary, with study limitations • psychiatric referrals • young offenders Streissguth, 1997

  8. 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

  9. Correctional Population • Conry and Fast, 1999 • 287 young offenders remanded to a forensic psychiatric inpatient assessment unit • 23% (3 FAS; 67 FAE) • DOJ BC 2005: probation officer referrals • 48 referrals, 21 assessments: 17 ARND; no FAS • Burd (2003): survey of Canadian correctional facilities • 13 of 148,797 diagnosed cases in Canada; prevalence rate of 0.087 per 1000, below the estimated incidence rate of the American and Canadian population of FAS or FASD of 1-3 per 1000 and 9.1 per 1000

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

  11. 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

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

  13. Potential benefits of a diagnosis • New way to understand difficulties • Paradigm shift in attitudes of guards, case management/ and program staff, judges, parole officers and offender • Open doors for service and provides impetus for development of appropriate services for the affected individual

  14. Potential benefits of a diagnosis • New strategies in the institution and in the community upon release • Peer counselors, mentors, adapted training programs (employment, life skills, education etc.) • Reduce recidivism

  15. Screening Tools • The Alcohol Related Neurodevelopmental Disability (ARNDD) Behavioral Checklist (Burd, 1999) • Administered by specialized clinician • The FASNET Assessment tool (BC FASNET) - 244 items • version had been adapted for Genesis House but is not vaildated • The Fetal Alcohol Exposure Risk Assessment for Adoldescents and Adults (LaDue et al., 1999 ) • - heavily reliant on physical measurements • The Fetal Alcohol Behavior Scale (Streissguth, 1998) • No longer used • The GGPC FASD Screening Tool (Prediger , 2003) • Requires extensive file review for each case; still in development

  16. 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 (60% 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

  17. STONY MOUNTAIN INSTITUTION MEDIUM-SECURITY PENITENTIARY Facility CharacteristicsDate opened: 1876 Security level: Medium As of April 6, 2004Rated capacity: 546 Number of inmates: 506

  18. Why Stony Mountain?

  19. Participant Recruitment • Remand Centre/Headingley 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

  20. Information Sources – Community • 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

  21. 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

  22. Fetal Alcohol Syndrome Facial Photographic Analysis SoftwareSusan Astley, University of Washington

  23. Summary report

  24. FASD Neuropsychological Test Battery

  25. 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

  26. Chudley et. al., 2005. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. CMAJ; 172 (suppl 5)

  27. Four Research Outcomes

  28. Debriefing • All participants : • Received letter from physician stating results • Received certificate of appreciation for participation • With positive neuropsychological findings, letter from psychologist detailing results

  29. Debriefing • If no FASD diagnosis, Research Liaison Officer debriefed participants • If an FASD-related diagnosis is made, the diagnostic team was present for debriefing and will explain results to participant

  30. Disclosure • Participants decided if they want their results disclosed to CSC • Results placed on CSC file • Health care • Psychology • Case management • Used by case management team • Were offered Research Liaison Officer support

  31. 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

  32. Results

  33. Study Sample • 165 offenders were asked to participate over the study period (April 2005-September 2006) • 106 agreed (64%) • 11 withdrew • 4 participants had invalid CNS results • 58 declined • Final Study Sample : 91 participants

  34. Demographics for final sample (n=91) • 66% Aboriginal • 34% Métis • 32% First Nation • 25% Caucasian • 9% Other racial groups (Black, East Indian, Chinese)

  35. Demographics continued • 53% single • 46% common law • Average age 24, SD 2.85 • Range in age between 19-30yrs

  36. Summary of collateral information • Average of 2 per participant (n=194; range 0 – 7) • 61% of collaterals participated (n=118) • 46% participated with maternal alcohol information • 16% participated without maternal alcohol information • 28% unable to contact • 15% no valid contact information • 13% difficult to reach • 10% declined

  37. Summary of maternal information • 77% of offenders provided mother as a contact (n=70) • 69% agreed to participate (n=48) • 16% unable to contact • 7% difficult to reach • 9% no contact information • 3% language barrier • 13% declined

  38. Birth/Hospital Records • All participants agreed to allow access to birth records • 72% of records received • 96% of mothers agreed to release records related to their pregnancy • 63% of pregnancy records received

  39. Summary of Collaterals Participating n=126 * Other includes foster care worker, other professional, friend, or cousin

  40. Reporting on prenatal alcohol exposure Yes=20 Yes=6 Yes=9

  41. Reported Prenatal Alcohol Exposure

  42. Results from diagnostic assessments • 9 offenders diagnosed in one of the FASD categories (10%) • 1 pFAS • 8 ARND • 16 offenders in the ‘Possible’ category (18%) • Not enough information to confirm or rule out a diagnosis

  43. Results from diagnostic assessments • 39 offenders in the “CNS deficits – not alcohol related” category (43%) • 27 offenders in the “Normal” category (30%)

  44. Analysis of palpebral fissure length (PFL) • Two independent raters on photometric software • r= 0.88 (p<.0001) • Physical exam and photometric reports • r=0.74 (p<.0001)

  45. Analysis of palpebral fissure length (PFL) Mean pfl scores across outcomes Report Physical Exam FASD 29.4 +/- 1.3 29.4 +/- 1.3 Possible 29.4 +/- 1.6 29.1 +/- 1.5 CNS-other 29.8 +/- 1.2 30.1 +/- 1.3 Normal 30.0 +/- 1.8 30.3 +/- 1.4

  46. Analysis of palpebral fissure length (PFL) Mean pfl scores across alcohol exposure Report Physical Exam Alcohol (17) 29.2 +/- 1.5 28.6 +/- 1.5 No Alcohol (74) 29.9 +/- 1.5 29.3 +/- 1.5

  47. Analysis of palpebral fissure length (pfl) Mean pfl scores across racial groups Report Physical Exam Caucasian 29.9 +/- 1.6 29.1 +/- 1.7 First Nations 29.1 +/- 1.5 28.8 +/- 1.3 Métis 30.1 +/- 1.3 29.3 +/- 1.6 Other 30.3 +/- 1.4 30.4 +/- 1.2

  48. Average Scores on Behavioural Items 28 questions: max score = 140

  49. Behavioural indicators • Behavioural items on offender self report scale highly intercorrelated; • Cronbach’s coefficient alpha .90 • 17 out of 28 items correlated with FASD diagnosis

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