Fetal Alcohol Spectrum Fetal Alcohol Spectrum Disorder in a Disorder in a correctional population: correctional population: Preliminary results from an Preliminary results from an incidence study in a incidence study in a federal penitentiary federal penitentiary Brian A. Grant & Patricia Brian A. Grant & Patricia MacPherson Addictions Research MacPherson Addictions Research Centre Centre Albert E. Chudley, University of Albert E. Chudley, University of Manitoba Manitoba Addictions Research Centre 23 Brook St., Montague, PEI C0A 1R0 902-838-5905 [email protected]
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Addictions Research Centre 23 Brook St., Montague, PEI C0A 1R0
Fetal Alcohol Spectrum Disorder in a correctional population: Preliminary results from an incidence study in a federal penitentiary Brian A. Grant & Patricia MacPherson Addictions Research Centre Albert E. Chudley, University of Manitoba. - PowerPoint PPT Presentation
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Fetal Alcohol Spectrum Disorder in Fetal Alcohol Spectrum Disorder in a correctional population:a correctional population:
Preliminary results from an incidence Preliminary results from an incidence study in a federal penitentiarystudy in a federal penitentiary
Brian A. Grant & Patricia MacPherson Brian A. Grant & Patricia MacPherson Addictions Research CentreAddictions Research Centre
Albert E. Chudley, University of ManitobaAlbert E. Chudley, University of Manitoba
Addictions Research Centre23 Brook St., Montague, PEI C0A 1R0
• “Although there is substantial evidence suggesting a link between FASD and crime…. there are no known studies reporting the prevalence of FASD in prisons.”
• 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
• Historical Indicators• Adopted, foster care, developmental
challenges, school disruption, mental health
• Maternal consumption of alcohol• Information collected from the offender,
parole officers, collateral sources
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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
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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
Research Outcome
A Diagnosis in one of the FASD categories
B Does not meet diagnostic criteria but remains a possibility
C No FASD-related diagnosis but other impairments noted
D Normal
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• 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
Debriefing
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• 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
Disclosure
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• 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
Follow-up
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Preliminary Results
Participant Recruitment
• 96 current participants
• 58 declined
• 8 withdrawn
• ~ 59% participation rate
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Demographics for case conference sample
• 64% Aboriginal • 25% Caucasian • 11% Other racial groups
• 51% Single• 49% Married/common law
• Average age 24
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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
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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
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Summary of Collateral Information
Relation % Maternal Alcohol History
No Maternal Alcohol History
Aunt/Uncle 27 7
Sibling 23 11
Father 19 4
Grandparent 15 0
CLW, spouse 7 52
Other* 6 15
Professional 3 11* Other includes step-parent, foster parent, adoptive parent, friend, or cousin
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Average Scores on Behavioural Items
97
79 7667
0
20
40
60
80
100
120
A B C D
Ave
rag
e S
core
26
Average Score on Historical Items
4
1.85
1.070.66
0
1
2
3
4
5
A B C D
Ave
rag
e S
core
27
Reported Prenatal Alcohol Exposure
Drinking Questions
Collateral
(N = 17) %
Mother
(N = 6) %Drink during full pregnancy
35 17
Drink during part of pregnancy
35 67
Drink 2-3 times per week
29 0
Drink 2-4 times per month
12 50
Binge Drinking (> 5 drinks)
41 33
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Reporting on prenatal alcohol exposure
Offender
52%
4%
44%
Yes
No
Unknown
Collateral
50%
23%27%
Mother
85%
15%
Yes=3Yes=17
Yes=6
29
Other Drug Use During Pregnancy
0
10
20
30
40
50
60
Tobacco Prescription Illicit
Offender
Collateral
Mother
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
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Birth/Hospital Records
Maternal pregnancy records
• 77% of mothers agreed to release records related to their pregnancy
• 59% of pregnancy records have been received
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FASD Neuropsychological Test Battery
Wechsler Abbreviated Scale of Intelligence WASI
Wechsler Individual Achievement Test Second Edition Abbreviated
WIAT-II-R
Adaptive Behaviour Assessment System Second Edition
ABAS-II
Wechsler Memory Scale Third Edition Abbreviated WMS-III-A
Wisconsin Card Sorting Test Revised WCST-R
Connors Continuous Performance Test CCPT
Rey Complex Figure Test and Recognition Trial RCFT
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Level of Neuropsychological Deficits Identified in case conference sample
0% 20% 40% 60% 80% 100%
Visuomotor Skills
Attention
Executive functioning
IQ - Cognitive
Language
Memory
Adaptive Behavior
Academic Achievement
No Impairment Moderate Impairment Significant Impairment
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Overall risk and need for offenders with prenatal alcohol exposure identified
0
10
20
30
40
50
High Risk High Need
Perc
ent
Prenatal Alcohol
No Alcohol Exposure
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Overall risk and need for offenders with neuropsychological deficits identified compared to those without
0
20
40
60
80
High Risk High Need
Perc
ent
CNSNo Deficits
*
36
Youth Court History
0
20
40
60
80
100
Youth Court History DisciplinaryReports
Transfer from youthto adult
Perc
ent
CNSNo Deficits
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Adult Court History
0
20
40
60
80
Previous Adult Offence Segregation Reclassified to higherlevel of custody
Perc
ent
CNSNo Deficits
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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