Justice Committee on March 23rd, 2015

[The Chair, Conservative, Mike Wallace]

Dr. Andrew, you're up first.

[Dr. Gail Andrew]

I think you're right on all those points. For example, in Alberta we have 24 diagnostic clinics. Most of them are funded through the province. The individuals who are seeking assessment do not have to pay. It's covered through our health services. There are a few private centres where you would have to pay privately.

For the current assessment centre that is within one of our youth correction centres, the funding is shared between Health and Justice—they split costs—and so the individual doesn't pay. We do not have as many physicians who have spent their life career, as I have, in this disability. I am an academic professor at the University of Alberta and I'm training, trying to get the next generation in place. With good clear guidelines, which we currently have, through training and mentoring we should be able to produce the next cohort of physicians who could be part of the team. It's a multidisciplinary team, so we need to have the same rigour of training within psychology, the training of speech or language pathologists, occupational therapists, or social workers.

I can speak for the University of Alberta; this has become a huge focus of our work. Across Canada we are fortunate. In the west to have more clinics than the east. We are mentoring more and more clinics as they show interest in being established in the eastern provinces.

[The Chair, Conservative, Mike Wallace]

Dr. Cook.

[Dr. Jocelynn Cook]

A couple of years ago we did a little bit of analysis. We identified 2,000 slots for diagnosis, based on the current capacity at that time, and 3,500 for the demand. So there was a supply-demand issue, as Dr. Andrew suggested.

As for data, if we don't collect data we're not going to have any story to tell. We know enough about the FASD diagnosis, and there are some screening tools. We're starting to get the whole country to collect the same data when they assess their patients for FASD, whether they have it or not, and to say what they recommend in terms of supports and systems.

Justice in the Yukon is interested in collecting some of this standardized data to go into.... I don't know whether it's going to go into our database or not, but they're looking at collecting some of it so that they can see the trends and make some understanding about demand for services, supply of services, and what the patterns are for brain dysfunction. If you have X, Y, and Z, it might be different from A, B, and C, and you might need a different intervention. That is where data comes in.

[Blaine Calkins, Conservative, Wetaskiwin, AB]

That's important. That leads me to my ultimate question. Are we far enough along in the research identification of fetal alcohol spectrum disorder to make a determination that we are going to exempt somebody from a sense of fulfilling justice by providing provisions in the Criminal Code that exempt somebody, whether through section 16 or through a bill like Ryan Leef's? He's a good friend of mine and a great colleague here in the House.

Are we confident enough that the medical system and the whole determination process is good enough that we're going to deny somebody a sense of justice in order to achieve an outcome on behalf of somebody who, through no fault of his own, finds himself in a situation?

[Dr. Jocelynn Cook]

Here's my science answer because I'm not a lawyer. Thankfully, I haven't had any run-ins with justice.

We know individuals have severe neurodevelopmental deficits. We know they don't learn from experience. We know they don't understand consequence. I'm saying this in general terms because there are both ends of the spectrum, and we know that. There are brain tests that show this dysfunction.

We also know, from evidence, that individuals with neurocognitive deficits don't do well in other types of system treatment outcomes, for example substance abuse. They forget to come to group, all of that. That's from U.S. data, so it's a little bit by proxy, which means that we're making a bit of a leap on what makes sense. The interpretation of that within the justice context may be better left to people who understand the justice context, but that's what we know empirically and that's true.

I'm happy to share with you our draft paper that's not published yet on the characteristics of the individuals in our database. That might be helpful. It's the first Canadian data that exists. We're getting ready to submit that for publication. That may show you the depth of impairment and where people are impaired, and that might help.

[The Chair, Conservative, Mike Wallace]

Thank you, Doctor. Thank you for those questions and answers.

The next questioner is from the Liberal Party. Mr. Casey, the floor is yours, sir.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you, Mr. Chair.

Mr. Snow, I'd like to begin with you, but first of all when Madam Boivin asked a question of you she indicated that the private member's bill that I introduced—which borrowed generously from Mr. Leef's and also from the Canadian Bar Association in respect of the consideration of FASD as a recognized disability within the corrections system—was not going to get a chance for debate. That's probably correct, unless there is the political will among any parliamentarian who is in the order of precedence to trade places. That would be the only circumstance under which we would see a debate on Bill C-656 before Parliament, if there were a trade up. Otherwise, we're left with a bill that was introduced, to your great excitement, and then withdrawn.

You indicated in your testimony a couple of things that I want to come back to. One is that the bill introduced by Mr. Leef was a good start and that the perfect should not be allowed to be the enemy of the good. You called upon Minister MacKay to bring the resources of his department to bear to advance this.

Given your call to the minister, and given your identification of the private members' efforts to date as a good start, what improvements would you recommend on the initiatives that have been taken to date? If you had Minister MacKay's ear, and you were to say to him, “This is what you need to do to get as close as possible to perfect”, what recommendations would you have?

[Rodney Snow]

Thank you for that question.

Let me say that I think, as a I listened to the conversation here today and as we learn more, there are probably a lot of ideas that can come out of the work of this committee that might help to answer that question. I haven't had the benefit of sitting in on all the hearings, as you have.

One thing I think is important and that I would encourage is something you picked up in your bill, and that's the provision for external support orders. Everything I have been told by people who work closely in the system is that structure is important. If we can give the judges—who seem to be at the centre of dealing with a lot of individuals with this disability—the ability and the tools to make orders that will allow follow-up work with individuals who have FASD so that there is structure in place and so that can continue, even sometimes after probation is done and people are back in the community, that would be helpful. I think that's one idea. I noticed you have picked that up in your bill.

[Sean Casey, Liberal, Charlottetown, PE]

We heard at an earlier meeting from Wenda Bradley, Fetal Alcohol Syndrome Society of the Yukon, and Dr. Cook just referred to the work that's being done in the Yukon. We didn't get a chance to ask any questions of Ms. Bradley so I'm going out on a bit of a limb here, Mr. Snow, to ask you whether you are familiar with the Yukon study that is presently in progress, and what you anticipate it will add to the conversation.

We're going to give Dr. Andrew a shot at that one as well, but from a local perspective is there anything you can offer, or do you want to hand the floor to Dr. Andrew?

[Rodney Snow]

I'm happy to hand it to Dr. Andrew.

[Sean Casey, Liberal, Charlottetown, PE]

Dr. Andrew, you had your hand up.

[Dr. Gail Andrew]

Yes. I've been very fortunate to work with the Yukon government on this particular project. There is a project within the jail itself to provide diagnostic assessment of individuals. It's not mandatory so we do get their consent.

We're looking at actually validating some screening tools that could potentially be very useful across all of the justice systems to identify individuals who may have an FASD. We're looking at their brain profiles in detail. We're looking at additional substance abuse issues, mental health issues, and we're looking at recommendations post-release from serving their sentence. We're looking at what their brain profile tells us that we need to put in place to support that individual after they leave so they don't go through that revolving door.

It's an in-depth study. There is a service component. We're helping these individuals, but we're also collecting valuable data that will give us the profile of individuals who are currently in the justice system.

The Yukon has also just established an adult clinic where they are going to be seeing individuals, hopefully, before they ever set foot in the justice system. With this diagnostic information that will be strength and challenge based, we can look at what are the wraparound support systems in the community that individuals will need to prevent them from ever encountering the law, such as housing, community participation, and what they need in terms of funding so they aren't hungry and homeless.

We have learned through the literature that there is importance in trusting relationships and mentors. That's where the communities in the Yukon are really grasping this big picture of what we need to do, not just for diagnoses but the bigger piece of prevention.

I'm the clinical consultant. I mentioned I do a lot of training and teaching. I've been involved in training both of those teams, and via Telehealth I am their clinical consultant in helping interpret the brain dysfunction.

[Sean Casey, Liberal, Charlottetown, PE]

Professor Popova, when you testified before committee, you gave us a lot of numbers. I want to know if I have this one right and whether you could tell us a little more about it.

You indicated that the cost to the correctional system in Canada, if I heard you correctly, was $378 million for FASD. Have I quoted you correctly, and can you tell us anything more about that number?

[Dr. Svetlana Popova]

Yes, it's correct. We recently estimated that the cost of corrections was associated with $378 million per year, annual cost. We were not able to estimate the cost associated with police and corrections because the data actually doesn't exist.

I think more importantly I would just reiterate that based on justice statistics in Canada, data and epidemiological data, we estimated that youths with FASD were 19 times more likely to be incarcerated than youth without FASD in any given year in Canada.

We also estimated—it's presented in one of my slides—that the total annual cost of corrections among adults was more than $356 million, and among youths it was approximately $17.5 million. There was a gender difference. Of course, males accounted for the largest proportion of this cost based on the male-female gender ratio that we obtained from Statistics Canada.

[The Chair, Conservative, Mike Wallace]

Thank you very much, Professor, for those questions and answers.

Our next questioner, from the Conservative Party, is Mr. Dechert.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Thank you, Mr. Chair.

Thank you, ladies and gentlemen, for joining us and sharing your expertise.

Dr. Cook, I just want to mention that my father was an obstetrician and gynecologist, and practised for over 40 years in the city of Hamilton. I very much appreciate the work that you and your colleagues do in research and caring for people.

You mentioned in your comments that a significant number of women of child-bearing age are drinking, and you also mentioned some other drugs and how they might also impact. Is the incidence of FASD increasing over time? Is it decreasing, staying the same?

[Dr. Jocelynn Cook]

That's a really good question. Is the incidence of FASD increasing? Is awareness of FASD increasing so that women are disclosing their alcohol use more? Are we diagnosing more so that we can say there's more FASD?

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Are you diagnosing more?

[Dr. Jocelynn Cook]

Yes. In Canada we have many more diagnostic clinics than we did in the past. They're continuously opening in different places. Quebec has its first one now; it's exciting. We are diagnosing more.

We're trying to change the stigma around alcohol use in pregnancy so there's not the shame and blame context. We're hoping that women are becoming more comfortable talking about alcohol use. We're doing a lot of education so that everybody understands the potential implications of alcohol use during pregnancy. We're working a lot with health professionals and front-line workers so that they know how to talk to women about alcohol use, because there's an art to that and there's a relationship piece to that.

I don't know. Dr. Popova has done a lot of work on prevalence in Canada. We know different populations have a higher incidence. We know about child welfare, as Dr. Andrew suggested. We know justice. We know some isolated communities. There are lots of other factors for that.

I don't know the answer to that. I'd like to think it's decreasing, but the prevalence of women drinking during pregnancy is not decreasing.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Okay. I think Dr. Popova wants to comment as well.

[Dr. Jocelynn Cook]

I think the incidence of women drinking dangerously during child-bearing age is increasing.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

You do think the drinking is increasing.

[Dr. Jocelynn Cook]

Yes, the drinking is increasing, and the pattern.

[Bob Dechert, Conservative, Mississauga—Erindale, ON]

Yet there's advertising. Generally you see it on bottles of alcohol, on bottles of beer and wine. Sometimes you see it in bars and restaurants. There's a notation on a menu or on a sign in the bar that there's a danger in doing this. Is there a need for more of that kind of advertising and public education about the dangers of drinking during pregnancy?