Thank you very much.

Thank you to everyone for this opportunity to speak to the committee about this very important issue. I believe you've all received the brief I've written. It provides a lot of the detail and the references. My hope today is to highlight a few key features in that brief and to take it a little bit further.

I'm speaking as both a clinician and a researcher. I work as a researcher with the University of Alberta and the Canada FASD Research Network. I'm also a neuropsychologist who's had the opportunity to work with a number of individuals in the justice system with an FASD. I hope to speak to some specific issues of justice as well as some of the clinical pieces of the puzzle.

I believe you guys have had a number of presentations, and in my brief there's also a discussion about areas of the brain that have been affected and impacted by prenatal alcohol exposure, so I won't revisit that. However, during the question session I'd be happy to address questions and explore some of the ideas around that.

Instead I want to focus today on the portion of my brief that speaks to the risk, needs, and responsivity model. This is identified about midway through my brief. In particular, the risk, needs, and responsivity model is the model that is typically looked at as identifying most faithfully the best approaches to having the best outcome in the justice system. When we employ this model the way it was designed to be employed, we tend to see the best outcomes for any individual across the board.

What is the model? The model starts with risk. How do we assess risk and decide what factors contribute to the risk of somebody engaging in criminal behaviour?

“Needs” is the identification of those criminogenic needs or factors that contribute to why they're involved in the system. Some of those needs might be static or stable, like a history of abuse. Some of those needs may be dynamic or changeable, like being part of a marginalized peer group, lacking a job, or being dysfunctional in their adaptive setting at this time.

“Responsivity” refers to how we respond to those dynamic or changeable needs in a way that creates the potential for change for that individual. Ultimately, when we're talking about the justice system, we're talking about reduced recidivism or reduced likelihood that this person will re-engage with the system.

So that's the model. When it's employed, one of the things we've learned, again with the general population, is that if we have a really good understanding of risk and can then meet the needs that create that risk, we can then match treatment in such a way that it produces the best outcomes. We see a reduction, then, in reoffending when there's an effective match of intervention, sentencing treatment initiatives, and follow-up in the community matching that level of risk and the needs that are presented by that individual. That match is required for good outcomes for an individual.

Now, when I talk about this model, some of the challenges we face in part are in the research world. There's been a large amount of research into risk and what constitutes risk. However, when we start to examine needs and what these needs are, there's less research. Then when we ask what actually works, and what responsivity looks like, there's less research. This is even more true when we start to work with populations that are cognitively diverse or different from the broader population, such as FASD, or fetal alcohol spectrum disorder.

What we are learning is that when we have populations that are more diverse, they may reach a ceiling in terms of that risk factor so that they look very high risk and we can't differentiate that risk anymore to say—within the FASD population, for instance—what the risk looks like, because they all look high risk. So then we respond to them in terms of matching needs with a high-risk offender, which often may mean lengthy sentencing or very intensive treatment approaches. We look at that kind of trajectory

The problem with this is that by not separating the FASD population, we may be providing an intensive level of support to individuals who are actually low risk. Once we examine that cognitively diverse population, and we look at them, we say that they may look high risk compared with the general population, but when we look within that population and actually start researching where they sit, they are not as high risk as we think.

Why is this a concern, you say? We're just giving them more support, more treatment—or often, in cases, a more punitive response. It's a risk because one of the really pronounced features in this model is that when we fail to match risk to our treatment or sentencing response, we can actually do harm and increase the likelihood that an individual will reoffend. If we take somebody who is truly high-risk and give them low-intensity support and treatment or not enough intensive care, there is a likelihood that they're going to get worse. If we take an individual who is low-risk—somebody, say, such as in the shoplifting case we just heard about from our previous speaker—and we say that we want to respond with a high-intensity, punitive sentencing response, we actually see increased recidivism or increased reoffending. So we have done harm and have actually made it worse.

With one-stop shopping—when we use a single-model approach and say that we're going to let the risk come up to the ceiling and are going to respond to this entire population as though they're all really high-risk—we actually create a scenario in which this population may be inappropriately placed within high-intensity services that make things worse for them, increasing the likelihood that they will reoffend and that we will be dealing with them again, which of course is of concern both for that individual as well as for the broader community.

This is crucial to recognize. The choices that we make around sentencing and intervention really can do some significant harm, sending this person back into the system. Providing an assessment that is specialized and that allows us to best understand the needs of an individual will allow us to better differentiate risk, better understand what the criminogenic factors—those needs that are contributing to this criminal behaviour—are, so that we can make sure to target and tailor the response so that it is both of sufficient intensity and of the appropriate type to meet the needs of this individual so that they experience success and that the community is safe.

I'll provide one very brief example of an individual whom I had the opportunity to work with. He was diagnosed with FASD and had entered the system, but there was no knowledge about him by way of specialized assessment. A risk assessment was conducted, he was deemed to be high-risk, was put into high-risk programs over and over again. He was violent, he was aggressive, and he was actually very dangerous to the community at large. At no time was an assessment conducted to determine what his unique pattern of cognitive diversity actually looked like.

They eventually came to me and said: “We don't know what to do. We can't even keep him incarcerated safely.” I went in, worked with him, and conducted an assessment. In the course of that assessment, we were able to identify the fact that the core deficit for this individual was that he was unable to recognize his own regulatory capabilities. Said another way, he was unable to see that he was becoming agitated or triggered. He would seem fine, to everyone he would appear to be fine, and then the next minute he was angry and violent. Nobody understood what was going on.

Through the assessment we were able to identify the fact that he simply lacked the insight and the ability to recognize. The part of the brain responsible to say that the pressure is going up was not working.

What did we do? We said that we could provide a treatment strategy that is responsive to his unique needs as an individual. We put on his arm an ActiGraph, a measurement of his heart rate that allowed us to create a calibrated heart rate over the activity of a day. If his heart rate exceeded that amount—meaning that he was beginning to get angry and agitated—an alarm would go off. This compensated for the failure of his brain to tell him the same information. When the alarm went off, he was then able to separate himself from the situation and engage in some regulation activities to bring his activation level down—he was able to calm down.

He went from aggressive activity every day to none. It was an inexpensive response that allowed him to reduce his offending behaviour substantially. Significant changes occurred, and in the community we were able to redefine and think about how to support him and to put in community supports that were meaningful, based on the fact that now his anger was regulated, or that he had the ability to regulate it.

That required a different level of inquiry, which said that we don't understand these criminogenic needs in a detailed way if we don't look at the brain.

My recommendations to the committee are that we move beyond a one-size-fits-all model of criminal justice. When we're working with cognitively diverse populations such as those with an FASD, it's essential that we look at specialized assessment geared towards informing intervention.

Diagnosis is important, but we need to move beyond diagnosis alone to approaches that also identify intervention approaches that will be the right fit for an individual and allow us to match that individual's needs to our intervention strategies, thereby reducing rather than elevating risk.

Secondly, we need to look at high levels of training that can take place within the system—just as you heard with the previous speaker—to support an assessment, for an intervention approach that recognizes that sometimes we need to shift our approach and respond in unique and creative ways to a population that will be responsive when we do so.

Thank you very much for your time. I look forward to your questions.

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