Identifying the Issues: Victim Services’ Workers experiences working with victims with Fetal Alcohol Spectrum Disorder

4. Findings and Discussion

4. Findings and Discussion

4.1 Demographics

All Directors were receptive to the research project and agreed to attempt to identify if any victim services workers had experience working with clients with FASD. Several Directors indicated that FASD was not an issue that had been raised by victim services workers. As noted in section 3.3, many of the victim services workers’ who participated in the research worked in regions with high representation of Aboriginal persons. This does not mean that FASD is not an issue for non-Aboriginal persons.

Twelve telephone interviews were conducted averaging thirty minutes each. Interviews were with front line victim services workers, one consultant, and one psychologist who were employed in various parts of the country (seven provinces/territories). Nine participants reported that they had worked with clients who had FASD while employed with victim services. The three remaining participants had experience working with clients who had FASD in other types of social service capacities. Most participants worked with adults only, a few worked exclusively with children, and a few worked with both adults and children. One participant was a volunteer victim services provider, one participant was a consultant for victim services, and the remaining participants were employed by federal/provincial/territorial governments.

The majority of the participants were employed in rural or remote areas and several also worked on circuit where they had to drive or fly to a community that does not have a regular criminal court. Several participants were employed with victim service organizations that offer services to victims from the crisis (police) stage all the way through to sentencing. Other participants provided primarily court-based support preparing witnesses for court and informing victims about the court process.

The results are presented in a format that combines both the individual topics discussed and general themes that emerged. The results section includes the following topics:

  1. the reality of FASD from a victim services perspective
  2. the importance and prevalence of victims who have FASD
  3. knowledge of FASD among participants
  4. providing information to the court
  5. strategies for working with clients who may have FASD
  6. recommendations on what could help victim services’ workers better prepare for clients who may have FASD.

4.2 Experiences with Victims who have FASD

It was apparent throughout the interviews that there are fundamental challenges in addressing FASD from a victim services perspective. Two themes emerged from the discussions that highlight these challenges. There was a lack of opportunity to identify clients who may have cognitive difficulties, and a lack of awareness of FASD within the context of the criminal justice system.

There are several reasons why FASD is difficult to identify. FASD is different from many other types of disabilities because there is often no observable physical or cognitive impairment. This is why FASD is referred to as an invisible disability - the individual often appears to understand what is being said to them and verbal skills appear normal, despite low comprehension. The opportunity to identify individuals who may have cognitive difficulties is often not feasible. Not all victim services offer a seamless service; that is, an ability to assist the client from the first contact with police throughout the court process until a decision is made (court/sentencing). Sometimes, a victim services provider only spends a short period of time with a victim or witness. A couple of participants worked on circuit where they fly or drive to a remote community that does not have a designated court house. The victim services available to victims within these communities are somewhat limited. For example, one participant explained:

It’s usually a half an hour before court starts and it’s not just one trial, it’s several. I might only get ten minutes with each person…

The limited time some victim services workers have with clients makes it very challenging for them to be able to identify if the person appears to have cognitive or learning challenges, let alone FASD. Even victim services workers who work with clients over time (from police stage to post-sentencing) may not be aware the victim has cognitive difficulties unless the workers are familiar with the characteristics associated with cognitive difficulties.

Many victim services workers have been trained in responding to certain types of crimes, for example family violence and sexual assault. They are trained to look at the type of crimes and not the characteristics of particular victims. This further reinforces the challenges in identifying clients with cognitive difficulties.It was clear from participants that there is a significant lack of awareness of FASD within the criminal justice system. If justice professionals are not aware that some individuals within the justice system have cognitive difficulties, then they will not be able to appropriately respond to their unique needs. One participant explained an experience they had in court that highlights the challenge of identifying and addressing FASD in the criminal justice system:

And I tried to warn the Crown that he probably wasn’t going to make a good witness. That you’re going to have to be really direct with your questions, because he doesn’t…I said this is what’s going on for him, he’s not going to deal with abstract questioning very well. And he was a horrible witness, and it was terrible. Because the judge ended up tearing a strip off him.

And it was just terrible because nobody actually came out and asked specific questions to get the information that was needed to be gotten and it never came out. So it made him look guilty and the father look innocent, which wasn’t the case. And then here’s this kid who, for the first time in his life, had spoken out against his abusive father, got a strip torn off him by the judge because he was an unreliable witness. It was just a nightmare.  …the boy was really nervous, so he was kind of coming across as being cocky because he was trying to, I don’t know, appear calm…I don’t know.  …do you realize now these people have no place to go. Because now dad is being let loose. They have none of their clothing, they have nothing, and there’s no place for them to go. And they had taken off and I couldn’t find them. But they were in fear for their lives now because dad got released as a result of the whole process. I just thought the whole system failed this kid.

What happened in this instance clearly demonstrates the importance of asking appropriate questions to ensure that witnesses are able to convey the information they need to have presented to a judge. It also alludes to the lack of awareness that justice professionals have in cases where cognitive difficulties couldbe impacting the court proceedings. One participant stated that justice professionals appear hesitant in addressing FASD because:

"…when you’re trying to create awareness about FASD sometimes, it’s like they think you’re saying that these people should be exempt from the criminal process because they have a disability. That’s not what I was saying, but that was how it was perceived."

What was clear from the interviews is that FASD in clients presents significant challenges for workers in all they do whether it is providing information, support, court preparation, referrals and/or follow-up. FASD represents an additional layer of complexity to the realities that their clients are facing.

4.3 Importance and Prevalence of Victims who have FASD

There was a consensus that FASD within the context of victims and witnesses is very important. This is not surprising as we were interested in hearing from people who had experience with FASD. It was stated, however, that FASD is not one of the main issues for participants; FASD is considered a lower priority issue within the broad range of issues faced by victim services workers. For example, responding to victims of domestic violence is a primary concern for participants.

All participants felt that criminal justice professionals at all stages of the criminal justice process should be aware of FASD. One participant explained the importance of criminal justice professionals being aware of victims with FASD:

"…we need to know that the justice system, whether it’s the judiciary, the Crown etc. that they’re aware of this issue…that that’s just something that is part of the knowledge that they have, so that they can do the work that they need to do, keeping that in mind."

Another participant highlighted the importance of working with victims who have FASD, because of the vulnerability of such persons:

"…those that are affected are often also the most vulnerable to continued victimization. It’s a limited contact that we have with people, but when we do, trying to work with people to try to have a safety plan in place so that we can minimize the number of times that they’re in situations where they are at risk again."

All participants hesitated when they were asked how prevalent they think FASD is among their clients. There was a consensus that FASD is under-diagnosed and that in many cases FASD is suspected and not diagnosed. In the words of one participant:

"It [FASD] is much higher than we realize because it’s either misdiagnosed or it’s just not noticed at all." 

One participant indicated that all victim services workers have worked with a client with FASD, but that they do not have the ability to recognize when a client has FASD. The perceived prevalence rate varied and was dependent on participants’ comfort with the behavioural characteristics of FASD.

"Different populations have different social issues going on. And I know for us this [FASD] is one of the big issues within our communities."

Participants were asked to approximate how many persons they worked with had FASD. The perceived prevalence rate of FASD among their caseload ranged from a low of 1% to more than 50% among participants’ case loads. The high perceived prevalence rates were not exclusively restricted to communities that had many Aboriginal persons. Among participants who worked with children and youth, their perceived prevalence rate was between 10-15% of their clients. For example, one participant stated:

"I think it’s more prevalent in some of our youth and older teens, and they’re blaming it on maybe drug usage and other things also."

A couple of participants who work primarily with Aboriginal clients indicated that FASD often overlaps with Post Traumatic Stress Disorder. One participant noted:

"…in a lot of cases, there’s so much post traumatic stress symptoms that it would be hard to tell them apart unless you know what you’re dealing with."

Participants were also asked about the prevalence of working with victims where the accused persons have FASD. Participants who commented on this topic indicated that the prevalence of FASD among accused persons is higher than that among victims and witnesses. Only one participant noted that they had been involved in situations where they had informed victims that an accused person had had FASD so that the victims were aware of how FASD could have impacted upon their behaviour. One common point noted by several participants was that most of their clients know the accused.

"Generally speaking the type of clients that I have in here know the accused, and there isn’t a lot that I could tell them about the accused that they don’t know."

4.4 Knowledge of FASD among Participants

In recruiting for this study, victim services workers who were knowledgeable of FASD, and who had experience working with victims of crime who had FASD (both with and without a formal diagnosis) were sought. All participants were knowledgeable of and familiar with FASD, the diagnostic process, and strategies for working with clients who display characteristics associated with FASD. As one respondent noted:

"I feel comfortable with my understanding of FASD issues, but I think the most important thing that people can realize, for myself that I realize in dealing with these people is that it’s a spectrum disorder, and because of that you can’t just deal with one client like you would deal with another client.  Even within the spectrum disorder like everyone else these people have good days and bad days.  "

Victim services workers gained their knowledge surrounding FASD from a variety of sources. Interestingly, only one participant learned about FASD through their work as a victim services worker. This participant first became aware of FASD during a criminal case where the accused person had FASD, and a physician provided testimony on the impact of FASD on this particular individual. Another participant learned about FASD at an awareness training session on FASD to improve their knowledge of FASD to inform their role as a victim services worker.

Some participants gained their awareness of FASD through previous employment with the social services and/or the child welfare system. They stated that these experiences exposed them to FASD, so they were able to transfer their knowledge from that setting to their work with victims. Most participants learned directly about FASD through their formal training in the social work field, or by attending workshops or short courses on FASD. These educational training sessions occurred prior to their employment with victim services. A couple of participants noted that they have attended training sessions on mental health (including suicide) and/or developmental disabilities as part of their continued learning within victim services. Furthermore, one participant noted that their victim services organization was currently attempting to have an expert on FASD come to speak to their staff to improve their skills in the area of:

"Helping... being able to communicate most effectively with the kids so that they can integrate the concepts that they’ll need for court purposes."

Overall, the level of knowledge among participants was high, and more importantly, participants were aware of what they did not know, and often asked for training to fill such knowledge gaps.

4.5 Providing Information to the Court

Participants were asked if they had ever, or if they would be willing to, provide information to a court regarding a victim’s FASD or other disability. Participants were also asked if they ever considered encouraging the use of testimonial aids[9] for any of their clients who had FASD. Only a few participants indicated that they had previously spoken with the Crown about a witness having FASD. One participant provided suggestions to the Crown regarding questioning that witness: the participant questioned whether the Crown took those suggestions into consideration.

"I don’t know that he really necessarily took into consideration what I had to say, or even if he knew what that meant, as to how the questioning should go. It wasn’t until it was over that he realized what I was talking about."

Another participant noted that they do not identify disabilities of witnesses, but instead they provide the Crown with the knowledge that a witness may have cognitive challenges. For example, one respondent noted:

"…usually I don’t couch it as just FASD, I’d say look there’s some delays here, and you may have to slow down with the legalese and make it very simple, and don’t ramble on because the attention span may not be there even if they do understand where you’re coming from."

Most participants indicated that they were not comfortable with providing information to the court about whether or not a victim or witness had FASD, recognizing the complexity of the diagnostic process.

"I’m just not qualified to do that."

None of the participants had experience with a case where a testimonial aid was used because the child or adult had FASD. Several participants indicated that defense counsel would argue against the use of testimonial aids for individuals that did not have an official diagnosis of FASD.[10]

"I’m only guessing but I think the Defence would object to that right away because we don’t have any proof, and they’d be all over us. Having said that I’m not aware of anybody ever trying that… "

Another participant noted that even if a person did have FASD they may not be inclined to request a testimonial aid:

"I don’t know that we really use the testimonial aids specifically because they are FASD; it would be more around issues related to the abuse in terms of their fearfulness or, you know, ability to communicate the evidence because they have to see the accused…those sorts of things. "

Also, with respect to requesting the use of testimonial aids, one participant indicated,

"I think the thing that would help us is just to know that if we did request that, we would be honoured in that request."

4.6 Strategies for Assisting Victim who have FASD

Most participants noted that they do not use specific strategies when working with victims who have FASD. Instead, participants identified strategies they employ when working with individuals they perceived to have communication or learning challenges. Examples of approaches participants had used include:

A few participants underscored the importance of these strategies when working with persons with communication or learning difficulties. One participant noted:

"We try as best we can to use plain language, but I think I’m even more cognizant of making sure that what I’m saying makes sense. And checking with people and being aware that people may say that they’re understanding what I’m talking about even if they may not. "

Similarly, another participant noted that:

"…we have to be really careful about making sure that we’re using appropriate language, that’s appropriate to people’s level of comprehension and taking in account that there’s sort of social likeability thing that kicks in, that people will agree with us, or appear to say that they understand things that perhaps they don’t."

One participant highlighted how they assist victims who may have FASD:

"What is there for FAS and post traumatic people is the immediate present, that’s what’s there right now. And you have to take care of those things first. Maybe they’re looking for a way to get something for dinner, and what your concern is, is about how they’re going to behave in the witness box. Well, forget it. Like, you get the dinner thing, like help them with those things and work up towards what they’re going to do in the witness box. You just have to be conscious of what they need and try to find ways to put that stuff around them."

One participant noted that their victim services unit had partnered with a family literacy program to adapt the Victims of Crime Protocol[11] to a lower level of literacy that was more concrete and simple.

Several participants provided approaches they use with victims, regardless of whether or not they have a disability:

The one thing that I’ll usually say to people is the judge doesn’t know in his head what you know in your head. And it’s the job of the Crown to get that information from your head out, and so the judge knows what you know. What I find, what people struggle with is they can know so much about the perpetrator but they’re not understanding if it doesn’t get presented in the courtroom, then the judge’s decision is based on what he hears. And he doesn’t always hear everything he needs to hear.

The most important thing is to establish some sort of trust and sort of ongoing relationship in order for anything to happen. Simply somebody who comes in who has been victimized that needs information, number one is to form some sort of bond with them before you try to regurgitate a bunch of, you can go here and this is where you get money and this is where you can get child care.

Participants were asked whether they provide referrals to victims who have FASD, or to victims they suspect have learning or cognitive challenges. Participants indicated that they often provide referrals to clients regardless of whether or not they have a disability. The types of referrals that participants made were based on program availability in their respective communities. Most participants indicated that they provided referrals for counselling.

Several participants indicated that they often ensure the client attend scheduled appointments:

…if the client is going to see a counsellor, for example, I may not just make that referral and leave it at that; I may have the person...or ask the person to come here to my office, and we will go together. It becomes more predictable then if they know every time they come to see me it’ll be at 11:00. And we might have our...so it’s simpler, it’s not a bunch of different places that someone has to go.

Another participant noted that they often ask the police to come to the victim services’ office when a victim who has FASD has to give a statement instead of requiring that individual to provide a statement at a police station:

If someone has to give a statement or give more evidence and it’s not going to be a videotaped statement, then I will try to arrange for the RCMP to come here. Because I think it makes a real difference to have predictable, familiar places.

4.7 Recommendations for Assisting Clients who have FASD

Participants were asked what they would recommend to help provide the best services possible for clients who have FASD. The most iterated suggestion was that training on FASD be provided to all justice professionals. It was repeatedly noted that there is a lack of awareness of FASD within the criminal justice system. To that end, one respondent noted:

"If it were required that every judge, every Crown, every defense attorney, every RCMP member had to have a knowledge of FASD, that would help us greatly. Because sometimes half the battle is just trying to convince somebody that there’s something going on."

Many victim services workers have annual training on various topics. It was suggested by several participants that FASD should be included in the annual training.

Another suggestion was that a kit or DVD be prepared that individuals with disabilities could watch to help them to understand their role in court, and also to show what should be included in a Victim Impact Statement:

"If there was a kind of kit, or DVD that was specifically geared to people with learning disabilities or poor attention spans in the same way there are the same types of kits or audio presentations preparing children to testify.  That would be very useful."

Participants also thought it would be helpful to have a manual for their own use that explained ways to better interact with individuals with learning and communication challenges.

Another suggestion was to let clients do an activity that is familiar to them while talking with them, such as knitting or drawing:

"Once they’re mentally concentrated on something, like an activity of some sort then it’s better to interact with them. So I’d say give them a stress ball or just maybe have them draw something on a piece of paper or I guess…You know that they’re giving them something that familiar to do."

4.8 Discussion

The participants in this study had a high level of awareness about FASD, and noted that there are many other victim services workers who likely do not share that level of awareness. The participants saw FASD as part of a larger constellation of challenges toward providing quality victim services. Participants indicated that the strategies identified for working with clients who have FASD could be used for any client that may have communication or learning challenges.

Agencies have limited resources, workers have limited time for training, and there are competing training needs and priorities. It would be worthwhile to explore a strategy that would ensure that victim services workers are allotted the time to learn about FASD, and how to work with clients who have communication challenges. Such training could be built into other training sessions. Improving knowledge of FASD and other disabilities among victim services workers would assist them in communicating effectively with vulnerable victims of crime, which could result in improved court experiences for all parties.

The use of testimonial aids in Canada for vulnerable adults is not common (see Bala et al. forthcoming). It may be worthwhile to explore further the use of testimonial aids for vulnerable adults and assess Crown and judicial willingness to use aids for some individuals with FASD. It may also be beneficial to explore whether Victim Impact Statements are being completed by a designated support person for vulnerable adults as in R v. C.M.S.

Victims with FASD may be some of the most vulnerable victims of crime; it is incumbent upon criminal justice professionals to better understand how the Canadian criminal justice system may provide the best services possible for all victims of crime, particularly vulnerable victims of crime.