Executive Summary

Individuals with fetal alcohol spectrum disorder (FASD), a common neurodevelopmental disability (NDD)Footnote 1 caused by prenatal alcohol exposure, face high rates of criminal justice system contact and are overrepresented in correctional and forensic settings. As a result, forensic mental health clinicians, who frequently provide assessment and treatment services in criminal justice system contexts, are likely to see youth and adults with FASD in their practice. Existing evidence suggests that awareness of FASD among clinical and criminal justice system professionals is variable. Evidence also suggests that many lack the appropriate training, knowledge, and skill to work effectively with this population, potentially leading to missed diagnosis and other adverse legal and social outcomes As forensic mental health professionals play an increasingly important role in providing assessment and intervention services for individuals with FASD, it is critical to understand their FASD-related knowledge, professional practices, and training needs. The current study sought to evaluate the professional practices of forensic mental health clinicians regarding FASD, with the overall goal of informing best practices and identifying needs for the development of potential training, tools, and resources.

In total, 81 forensic mental health clinicians completed an online survey about their forensic practices and training experiences related to FASD. The sample was international in scope, with 27% of clinicians responding from Canada. Most forensic clinicians (93%) indicated that they had some level of practice experience with clients who had neurodevelopmental disorders (NDDs). Of these, many had at least some experience with clients who had FASD (85%), though these clients formed only a small part of their usual caseloads. A sizeable proportion (15%) had no practice experience with this client population. Clinicians who had completed forensic assessments with clients who had FASD indicated that assessments occurred in a variety of forensic contexts. The most commonly reported contexts were: fitness to stand trial; diagnosis; future violence/recidivism risk; and disposition planning. Fewer clinicians had provided forensic intervention for clients with FASD. Those who had experience in this area described using a range of therapeutic approaches, including cognitive behaviour therapy, psychoeducational strategies, social skills training, anger management programming, and substance abuse treatment.

Most clinicians had experienced barriers in their forensic assessment and intervention practices in working with clients with FASD, including: difficulty obtaining records; making culturally-informed assessments; having a lack of treatment options and/or methods for managing risk; and, a lack of research linking best forensic practices for clients with FASD. Many clinicians had not received formal education or training about FASD, and generally reported feeling inadequately prepared for forensic practice with this population. The majority endorsed the need for additional training, resources, and supports to enhance their forensic practice for clients with FASD, such as evidence-based screening approaches and tools, clinical guidelines for best practice in diagnosis, in-depth workshops and/or accredited training opportunities.

The study’s findings offer important insights into the practices and experiences of forensic mental health clinicians who provide services to clients with FASD. Critically, clinicians identified important gaps in their training, knowledge, and competence to practice in forensic contexts with individuals who have FASD.