Title: FASD in a Correctional Population: Preliminary Results from an Incidence Study
1FASD in a Correctional PopulationPreliminary
Results from an Incidence Study
- Patricia MacPherson
- Addictions Research CentreCorrectional Service
Canada - Albert E. Chudley
- University of Manitoba
Addictions Research Centre23 Brook St.,
Montague, PEI C0A 1R0
2Purpose of Talk
- To review population incidence studies
- To review correctional systems incidence
- To review research study objectives and
methodology - To review preliminary results
3Project 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)
4Secondary Disabilities
- A result of the interaction between primary
disabilities (behavioural and neuropsychological
problems) with adverse environments
5Secondary Disabilities
- Academic failure
- Mental health disorders
- Addiction
- Sexual deviance
- Inability to live independently
- Problems with the justice system
- Encounters with the law
- Confinement
6Prevalence
- 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
7Incidence 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/er
71.pdf
9Correctional 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
10Challenges in the prison environment
- Victimization
- Prison routine / rules
- Wanting to fit in
- Inappropriate sharing of information
- Inappropriate social behaviours
11Challenges 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
12Purpose 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.
13Potential 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
14Potential 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
15Screening 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
16Study 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
17STONY MOUNTAIN INSTITUTION MEDIUM-SECURITY
PENITENTIARY Facility Characteristics Date
opened 1876 Security level Medium As of April
6, 2004 Rated capacity 546 Number of inmates
506
18Why Stony Mountain?
19Participant 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
20Information 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
21Information 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 Software Susan Astley, University of
Washington
23Summary report
24FASD Neuropsychological Test Battery
25Diagnosis
- 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
26Chudley et. al., 2005. Fetal alcohol spectrum
disorder Canadian guidelines for diagnosis.
CMAJ 172 (suppl 5)
27Four Research Outcomes
28Debriefing
- All participants
- Received letter from physician stating results
- Received certificate of appreciation for
participation - With positive neuropsychological findings, letter
from psychologist detailing results
29Debriefing
- 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
30Disclosure
- 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
31Follow-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
32Results
33Study 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
34Demographics for final sample (n91)
- 66 Aboriginal
- 34 Métis
- 32 First Nation
- 25 Caucasian
- 9 Other racial groups (Black, East Indian,
Chinese)
35Demographics continued
- 53 single
- 46 common law
- Average age 24, SD 2.85
- Range in age between 19-30yrs
36Summary of collateral information
- Average of 2 per participant (n194 range 0 7)
- 61 of collaterals participated (n118)
- 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
37Summary of maternal information
- 77 of offenders provided mother as a contact
(n70) - 69 agreed to participate (n48)
- 16 unable to contact
- 7 difficult to reach
- 9 no contact information
- 3 language barrier
- 13 declined
38Birth/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
39Summary of Collaterals Participating n126
Other includes foster care worker, other
professional, friend, or cousin
40(No Transcript)
41Reporting on prenatal alcohol exposure
Yes20
Yes6
Yes9
42Reported Prenatal Alcohol Exposure
43Results 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
44Results from diagnostic assessments
- 39 offenders in the CNS deficits not alcohol
related category (43) - 27 offenders in the Normal category (30)
45Analysis of palpebral fissure length (PFL)
- Two independent raters on photometric software
- r 0.88 (plt.0001)
- Physical exam and photometric reports
- r0.74 (plt.0001)
46Analysis 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
47Analysis 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
48Analysis 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
49Average Scores on Behavioural Items
28 questions max score 140
50Behavioural indicators
- Behavioural items on offender self report scale
highly intercorrelated - Cronbachs coefficient alpha .90
- 17 out of 28 items correlated with FASD diagnosis
51Behavioural indicators offender self report
(top 5 items)
n91
52Behavioral indicators collateral reports
- Items on collateral scale also highly
intercorrelated - Alpha 0.91
- 18 items correlated with FASD diagnosis
53Behavioural indicators collateral report (top 5
items) n90
54Behavioural indicators combined (all reports
n260)
55Reported alcohol use (any source)
- Prenatal alcohol reported by any source was
correlated with alcohol score on 4-digit code
(r0.70, plt.0001) - Mothers use of alcohol when offender was young
was correlated with 4 digit alcohol score
(r0.42, plt.0001).
56Average Score on Historical Items
9 questions max score 11
57Historical checklist items n92
58Overall risk and need for outcome groups
X2(6,91)16.67, plt.01 X2(6,91)17.58, plt.01
59Criminogenic need areas for FASDaffected
offenders (compared to others in study group,
n91)
plt.01
60Characteristics of FASD group
- All had less than grade 10 and 67 (6) had less
than grade 8 education - None had a skill, trade or profession
- All were unemployed at time of arrest and 33 (3)
had no employment history - None had participated in employment programs
prior to incarceration
61Characteristics cont.
- All offenders were rated by intake parole
officers as having poor problem solving abilities
and unable to generate choices - Almost all (n8) were rated as having poor
problem recognition abilities and unaware of
consequences of their actions - All were described as having poor stress
management and poor conflict resolution - Two had a current or prior mental health
diagnosis and four were currently prescribed
medication
62Criminal History
plt.01
63Limitations of the study
- Small n
- Surprising proportion of non-participation
- Ethnic mix at Stony not representative of general
correctional institutions in other parts of
Canada - Current definition of Brain domains in
diagnostic guidelines may limit recognition of
some FASD affected individuals
64Conclusions
- The incidence of FASD is ten times greater in
Stony Mountain Institution compared to the
general population - This is a minimum estimate of incidence as we
followed a conservative diagnostic approach - The photometric analysis highly correlates with
the physical exam - A history of prenatal alcohol exposure is
associated with smaller PFL but this was not
clinically or statistically significant
65Conclusions
- There are no clinically or statistically
significant differences between PFLs and ethnic
groups - There are specific items on the BSC screening
tool that are highly correlated with an
FASD-related diagnosis - Some characteristics of these offenders on the
Offender Intake Assessment may distinguish them
from the rest of the offender population - This study will allow us to develop a reliable
screening tool for the identification of risk for
an FASD-related diagnosis in the offender
population
66Next Steps
- Analysis needs to be completed to determine
sensitivity and specificity of the modified
screening tool, neuropsychological results, etc. - Replicate study at another federal institution to
validate results in order to generalize to the
Canadian offender population
67Addictions Research Centre Correctional Service
Canada Montague PEI