A Process Evaluation of the Regional Psychiatric Centre’s Fetal Alcohol Spectrum Disorder Pilot Project: Year 1 (July 2018 - June 2019)

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The University of Saskatchewan’s Centre for Forensic Behavioural Science and Justice Studies was asked to conduct a process evaluation of the Regional Psychiatric Centre’s (RPC) Fetal Alcohol Spectrum Disorder (FASD) Pilot Program, hereafter the FASD Program. The FASD Program was initiated to identify Regional Psychiatric Centre patients with Fetal Alcohol Spectrum Disorder and develop treatment recommendations to facilitate offenders’ community release. To this end, the FASD Program assessed all RPC patients scheduled for community release between July 2018 and June 2019 for FASD, and provided institutional, transitional and community treatment recommendations for all inmate patients.

One of the stipulations of year 1 funding for the FASD Program was an independent evaluation to develop a program model that would be transferable to other Correctional Service Canada (CSC) institutions. In addition to helping the FASD Program formulate a program model to expand to other CSC facilities, this process evaluation aimed to determine the FASD Program model, identify the cognitive profile of inmate participants, identify the strengths and challenges faced by the program, and provide recommendations to strengthen the FASD Program. Data included in the current evaluation are a file review of program documents to identify the program model; diagnosis, FASD screen and treatment recommendations data for inmate participants assessed in the first year of the FASD Program; and interviews with key FASD Program staff and stakeholders.

The purpose of this evaluation is to identify the FASD diagnosis model used by the FASD Pilot Program to enable the development of a program model that could be implemented at other Correctional Services Canada (CSC) institutions to identify and treat patients with FASD. To this end, this evaluation aims to identify the procedures and functioning of the program, the roles and responsibilities in various stages of the program, the prevalence rate of FASD at RPC and cognitive profile of assessed participants, and the treatment recommendations provided by the FASD Program Team.

A mixed-method research design was used in the evaluation of the FASD Pilot Program. Participants of the pilot program were RPC patients with a Statutory Release or Warrant Expiry Date between July 1, 2018 and June 30, 2019. The data used in this evaluation was gathered from various sources including program documents, secondary program data, and interviews with the FASD Program’s staff and stakeholders.

The analytic methods used in this evaluation were a literature review, document review, content analysis of the documents reviewed, a thematic analysis of the interviews conducted with the program staff and stakeholders, and statistical analyses of the assessment data (chi-square statistic, ANOVA test, and independent samples t-tests).

Based on the findings of the evaluation, recommendations are put forward to further support the FASD Pilot Program. The recommendations relate to the various aspects of the program including program management, staffing, training, the screening tools and instruments used in the program, data entry and collection strategy, information sharing, and stakeholder engagement.

Program Management and Staffing

• The program model needs to be documented in a way that reflects the importance of both diagnosis and treatment.
• FASD support team should consist of dedicated full-time staff which involves a psychiatrist, a psychologist, occupational therapists, a Coordinator, an assistant to the Coordinator, social workers, and nursing staff. Adequate number of staff dedicated to the program implementation needs to be ensured.
• In line with the Canadian FASD guidelines, the Program Coordinator should only coordinate the diagnosis and treatment process. To help with the administrative duties, an administrative assistant for the Coordinator needs to be hired.
• The goals of the program should be clarified in staff retreat activities and regular meetings.
• The staff working in RPC should receive more training on the meaning and implications of the FASD diagnosis, the domains of assessments, and the areas of support that the FASD clients need.

• Given the relatively higher accuracy rates of the AYS and QFST in predicting the FASD diagnosis, we recommend using these tools.
• As the accuracy rates of BSC-R, LHS, and FST are relatively lower, we recommend interpreting their results with caution.
• Word Memory Test (Green, 2003) can be added to the battery of standardized neuropsychological assessments to detect if participants are not trying to the full extent of their abilities when completing the assessments.

Data Collection

• The inclusion criteria need to be amended to allow the inclusion of inmates eligible for release in 2 years (rather than 1 year) to ensure that treatment plans can be implemented while patients are still in RPC.
• Program data tracking should be based on the needs of the program (i.e., to measure program effectiveness and efficiency, as well as to respond to changing program needs).
• Data entry should be done either concurrently with diagnosis and treatment, or routinely (e.g., monthly).
• If the FASD Program is expanded to other regional treatment centres (RTCs), a nationwide method of tracking the program data on FASD should be developed and data should be collected consistently across the RTCs.

Information Sharing and Stakeholder Engagement

• To ensure that parole officers can access a copy of recommendations, they should be allowed to access participants’ files via OMS and notified about a released inmate with FASD.
• To enhance the engagement of the stakeholders, the representatives of the community agencies who have key roles in the diagnosis, treatment, and engagement process of the FASD clients need to be included in the clinic meetings.
• Earlier notice about the release date of the patients needs to be given to the project team by the institution to ensure that the required services are made available for the client in the community when they are released.

Limitations

The following limitations should be kept in mind when reviewing the evaluation’s findings:

• There was incomplete diagnosis data for six participants, four of which were transferred out of RPC prior to completing the FASD assessment.
• The statistics presented are based on non-random and small samples for assessed (n = 25) and screened participants (n = 22).
• There is a possibility of social desirability bias in the interview data because the respondents (i.e., staff and stakeholders) may have presented the program in a way to encourage its continuation of the program.
• RPC’s inmate population consists of CSC inmates in the region who require psychiatric assessments/treatment and persons pending trials who need to be assessed for competency to stand trials. Therefore, the findings of the current evaluation are not generalizable to other CSC facilities.