In partnership with the Child & Family Research Institute at the University of British Columbia (UBC), the Department of Justice undertook a study evaluating the prevalence of fetal alcohol spectrum disorder (FASD) in individuals who are incarcerated or on probation in Yukon.
The purpose of this research is to better understand how many individuals in the Yukon corrections system face challenges linked to FASD, mental health and substance-use problems. Information gathered from the study will be used to help inform service delivery in the Whitehorse Correctional Centre (WCC) and in the community.
Individuals who are exposed to alcohol during pregnancy may experience a range of cognitive, emotional, and physical difficulties, and may be diagnosed with fetal alcohol spectrum disorder (FASD). Individuals diagnosed with FASD experience a range of problems in their day to day functioning, and are overrepresented in criminal justice settings. Identifying individuals with FASD in corrections is important for a number of reasons. Persons with FASD often experience brain-based difficulties in areas such as decision-making and problem solving, mental health problems, or problems with addictions. The Department of Justice sought to learn more about how many offenders have these types of problems, to better inform how to meet their needs in the future.
Dr. Kaitlyn McLachlan conducted this study, in collaboration with the Yukon Department of Justice, and the Child and Family Research Institute at the University of British Columbia. A Prevalence Partnership Board provided external oversight for all aspects of study development and conduct. Members included researchers, legal and clinical professionals, and other key stakeholders at the local and national levels. Members included representatives from the Government of Yukon Departments of Justice and Health and Social Services; Yukon First Nations Health and Social Development Commission; Yukon College Northern Institute of Social Justice and Yukon Research Centre; Fetal Alcohol Syndrome Society of Yukon; Department of Justice Canada; Correctional Service Canada; Yukon Chapter of the Canadian Bar Association; and Canadian Centre on Substance Abuse.
Our approach to undertaking this research was extensively reviewed and approved by the Clinical Research Ethics Board at the University of British Columbia. All study procedures were carried out in keeping with ethical standards outlined for research at the University of British Columbia.
The Government of Yukon committed funding, staffing, and internal resources necessary for the successful completion of the study. The University of British Columbia also contributed in-kind resources necessary to secure the data collected from this research in an ethical manner.
From the outset of this project, the research team sought to achieve several important goals. First, we aimed to conduct the project in a manner that would increase local professional capacity for supporting individuals with FASD. The study team was developed using local physicians, psychologists, and research personnel, who received necessary training and support throughout the study.
Second, we wanted to ensure that participants were supported and offered feedback as a result of their involvement in the research. Participants received individualized feedback sessions and written reports summarizing their study participation. Post-study support services were made available to all participants for at least six months following their participation to ensure they had an opportunity to connect with necessary supports, review study findings, or if they otherwise required support as a result of their participation in the study.
As individuals of First Nation heritage are overrepresented in Yukon Corrections, it was anticipated that persons of Indigenous background would be disproportionately impacted by this research. Importantly, FASD occurs in the context of relevant social determinants of health. In Yukon, First Nations communities continue to recover from the effects of colonialist policies, including residential schools, intergenerational impacts that include a loss of cultural identity, weakening of community and family integrity, and disproportionate rates of addictions and poverty. Given these factors, a priority of this research involved engaging with First Nations health partners, primarily through regular communication with the Yukon First Nations Health and Social Development Commission, across all stages of this research. The Commission continues to support the research, as data analysis, interpretation, and communication of study findings is undertaken.
Data was collected over an 18-month period, between May, 2014 and September, 2015. Participants were recruited from custodial and community settings in Yukon, primarily from Whitehorse, though individuals at the Whitehorse Correctional Centre reside across the Territory. Participants were eligible to participate in the study if they were between ages 18 and 40, and supervised on an active legal order through Yukon Corrections. All individuals who met study entry criteria were invited to participate, and the study did not focus on individuals considered to be “at risk” of having FASD.
This study used a prospective case ascertainment design, which involved assessing a wide range of individuals in Yukon Corrections over the 18-month period in order to provide an estimate of the prevalence of FASD in the justice system. In total, 174 individuals were approached, and 66% agreed to participate in the research. Of these, 80 participants completed all aspects of the research, resulting in a 92% retention rate. We estimate that our sample reflects approximately 10% of individuals supervised by Yukon Corrections over the 18-month period that the study was conducted.
After completing an informed consent procedure that was optimized to ensure participants could demonstrate understanding and appreciation of the relevant information necessary to consent to participate in the research, participants underwent an assessment that adhered to the 2005 Canadian Diagnostic Guidelines for evaluating FASD (Chudley et al., 2005). Participants completed a comprehensive research protocol that included medical and psychological evaluations completed by a multidisciplinary team. A clinical coordinator completed thorough file reviews and collateral interviews to collect information about prenatal alcohol exposure. FASD screening instruments were also completed, including the Asante FASD Screening and Referral Tool for Probation Officers and the Brief Screening Checklist, developed by the Correctional Service of Canada. Clinical tools were also administered to help estimate rates of mental health and addictions difficulties in the sample. Following completion of all data collection, the research team held a case conference to determine if a participant met criteria for a diagnosis of FASD.
Eighty participants, including both men and women, participated in the complete study protocol. Prenatal alcohol exposure was confirmed in 25% of participants, and reliably ruled out in another 25% of participants. Information was insufficient to confirm or rule out prenatal alcohol exposure in the remaining 50% of participants. This finding is in keeping with the challenges inherent in undertaking FASD assessments in adults. Results showed that 17.5% of participants were diagnosed with FASD (including 2 cases of partial Fetal Alcohol Syndrome, pFAS, and 12 cases of Alcohol Related Neurodevelopmental Disability, ARND). A diagnosis could not be confirmed or ruled out for a further 13.75% of participants. FASD was ruled out for the remaining 68.75% of participants. Cognitive deficits were observed at high rates in this sample, along with mental health and addiction related difficulties. Comprehensive analysis of the complete dataset, along with findings from the FASD screening tools, is currently underway, in order to better understand the nature and scope of these deficits.
Early findings from this research highlight the high rate of FASD present among justice system-involved adults in Yukon. Results are in keeping with prevalence estimates in other criminal justice-based studies in Canada. For instance, in 2006/2007 the Correctional Service of Canada found a 10% prevalence rate in federally sentenced male offenders (MacPherson, Chudley, & Grant, 2011). In 1999, Conry and Fast similarly found that 23.3% of adolescents admitted to a forensic inpatient unit met criteria for an FASD diagnosis in a study conducted in British Columbia. Early findings also highlighted high rates of both mental health and addictions difficulties in our sample, and high rates of cognitive deficits across all participants, in keeping with early concerns about these difficulties in this population.
The Department of Justice has only received preliminary results at this time and looks forward to evaluating the results as they are worked through and analyzed.
Currently, the findings from this research are being analyzed, with the goal of completing a final report and manuscript submitted for peer-review winter, 2017. As this process unfolds, presentations to local stakeholders will be held to ensure that findings are interpreted and communicated most effectively for the Yukon context. At this time, the Department of Justice is awaiting the substantive research results before determining its way forward with Yukon corrections. The results will be used to inform future program and policy decisions.
This project was developed and implemented with the goal of sharing its methodology and approach with others who may be interested in undertaking similar research in other jurisdictions.
If you have questions about this research or wish to speak to the study’s Principal Investigator, Dr. Kaitlyn McLachlan, please contact Loree Stewart at the Department of Justice at (867) 667-3232.
Policy and Communications Unit
Department of Justice, Government of Yukon