Justice Committee on March 25th, 2015

[The Chair, Conservative, Mike Wallace]

Ladies and gentlemen, let me call this meeting of the Standing Committee on Justice and Human Rights to order.

This is meeting 68, and according to the orders of the day, pursuant to the order of reference of Wednesday, November 26, 2014, the subject matter is Bill C-583, an act to amend the Criminal Code (fetal alcohol spectrum disorder).

We have four witnesses with us today, but the final witness, Ms. Bradley, from the Fetal Alcohol Syndrome Society Yukon, has already presented. We weren't able to get her for the question-and-answer period, so she has kindly rejoined us today.

We have three presentations of approximately 10 minutes each.

Our first presenter, Ms. Ross, is from the Fetal Alcohol Spectrum Disorder Group of Ottawa. By video conference from Edmonton, we have, as an individual, Ms. Pei, associate professor at the University of Alberta. As well, from the Assembly of First Nations, we have Mr. Alexis, Alberta regional chief. Then, of course, from the Yukon, we have Ms. Bradley, also by video conference.

With that, we'll get started.

Ms. Ross, the floor is yours.

[Elspeth Ross, Facilitator, Fetal Alcohol Spectrum Disorder Group of Ottawa]

Mr. Chair, thank you for the opportunity to address the justice and human rights committee today.

My name is Elspeth Ross. I am a parent and a volunteer service and information provider for FASD. I'm talking to you today from the front end of the issue that you are dealing with. I represent the FASD group of Ottawa, which I have facilitated since 1999.

My husband and I have two sons affected by FASD, who are now in their thirties. I serve on committees locally and provincially, and provide a current awareness service by email now through the FASD-Canadian-News.

ln 1992 I was a parent invited to a national symposium on FAS/FAE in Vancouver. We parents came away all fired up and keen to take on organizing FASD, but we can't do it. Our families are often in crisis and we struggle along without help.

The federal government's FASD framework for action makes the same mistake, putting the onus on the community. We don't see leadership from the federal government or a national effort or agenda on FASD in health or justice, or collaboration with the provinces. It's exciting that there is so much research and action going on in FASD now, but we need more in Canada.

The situation is urgent because more women of chiId-bearing age are drinking alcoholic beverages and binge drinking. Damage is done early in pregnancy and 50% of pregnancies are unplanned.

My husband and I had the advantage of knowing in 1991, when our first son joined the family at 19 months, that prenatal alcohol was a factor and that we should look for help. That's unusual.

Tall, good looking, and good talkers, most people affected have average IQ. My sons both graduated from high school, and one from college, and was married. Both work in masonry with an understanding boss.

My second son was caught shoplifting and did community service. He went for a job interview at a store at noon and went back at 2:30 to shoplift from the same store. Does that make sense? The policeman said, “This young man will learn from his mistakes”. That policeman knew about FASD, yes, and tore up the summons.

The same son has got letters from collection agencies for things he does not remember, probably getting on buses without paying. We don't believe any of his stories. He lost an apartment because friends that he met on the street moved in and of course he lost it. Easy victim.

Both sons have to be reminded over and over, and may not show up for appointments. They need clear and simple instructions. Money flows, documents are lost, and forms can't be filled out. There are complications with addictions, health problems with diabetes type 2 and panic attacks. Supervision, structure, services, support, and luck have kept them out of the justice system.

People with FASD have talents and skills, and we build on these to maximize potential with the theme “Being your best with FASD”.

I'm here today to support the issue in Ryan Leef's bill, which would be a great start. We need the addition of court-required external support plans to facilitate reintegration into society. We encourage expanded use of diversion, conferencing, mental health, and community courts, and supports and services to keep people out in the first place.

FASD is a brain disorder and no two people are the same. You see them in the justice system as witnesses, victims, as well as accused, without recognizing them. Eager to please, people with FASD may waive their rights or take responsibility for crimes of others. One mother reports that her son was assaulted and subsequently appeared as a witness. One day on the stand was a gruelling process for someone easily confused. The accused got off and now the young man has no faith in the system for protection, and is marked for daring to testify.

FASD is often labelled as an attachment disorder, ADHD or autism, which are more acceptable conditions. It's complex, with all those occurring, as well as trauma, and being moved around, and mental health problems.

We need to speak out, but many family members won't speak publicly because of guilt and shame, or being blamed for poor parenting, embarrassment, or because they are afraid their children will be targeted. Getting a diagnosis must be made easier. Some won't try for it because they can't get services anyway. People with FASD are usually too high functioning to qualify for developmental services if based on IQ.

What are the protective factors? The researcher Ann Streissguth referred to the following in 1997: early identification and diagnosis, a stable home, supportive environments, and direct involvement with special services. Families need help to provide information and education, so they know it's a disability; support and understanding; help navigating the system; flexibility; patience; perseverance; and hope.

An Ontario stakeholders group in 2008 found that the biggest needs of families was for help with schools, finding respite, transition to adult services, supportive living and employment, diagnostic services, and knowledgeable professionals.

Parents have to educate professionals one at a time. Some of us are joining with families of other developmental disabilities groups, and we've been asked to work with those in the autism community for police training and a registry of people affected.

People with FASD need an “external brain” or scaffolding to help them cope with everyday life, let alone the extra demands of the justice system. This means a parent/caregiver, spouse, mentor, teacher, case worker, and probation officer. Remember us, too, the parents of adults; we often have information and can be allies.

Lawyers, judges, court and probation workers, police officers, social workers, and prison guards all need training and continuing education. A probation officer reports that she must be very specific with instructions and directions and not task her clients with too much in case they get overwhelmed. She would welcome more ideas on what works.

It's now impossible to keep up with all the FASD news and research, and FASD is often being brought up in court cases. Canada has big conferences. The one in Vancouver earlier this month had 600 participants from 13 countries. The pre-conference day FASD and the law event had 20 speakers with suggestions and innovative ideas. You can see many of these on the web.

However, Canada's west and north is where the action is. NeuroDevNet provides research and interventions. The Canada FASD Research Network in eastern Canada only includes New Brunswick, not Ontario. The Ontario government is only beginning to acknowledge FASD—maybe. All over Ontario there are grassroots activities by volunteers. A lawyer recently asked our group to provide counselling to help get a client out of jail, but we couldn't do it without funding.

There are two things this committee can do. Invite the FASD play “Jacob's Story” to come from Kingston to present to you. Ryan Leef was there to watch it when we brought them on February 18. You could also listen to the words of people affected who are speaking out more and more, and I could suggest how to do that.

ln Canada we expect our federal government to lead and act on issues of importance like FASD. This committee has a unique opportunity to make recommendations.

ln conclusion, as you study this issue, I hope you will receive information from all parts of the federal government that deal with individuals with FASD. ln 2006, the government determined that the Public Health Agency of Canada would be the lead agency and coordinate activities. Ask them for information on projects funded and efforts to share best practices, which could be useful for the justice system.

Here are four recommendations.

One, provide funding for research and data collection into all aspects of FASD, especially those relevant to the justice system. Two, coordinate national law enforcement and justice system networks and events for sharing FASD best practices, tied to a curriculum for professionals, as well as continuing training. Three, support efforts to create more diagnostic centres across Canada. And four, recommend the creation and funding of case manager positions to help people with developmental disabilities and FASD.

I'd like to thank you for your attention and I look forward to your report and to the changes that may result from your deliberations.

[The Chair, Conservative, Mike Wallace]

Thank you, Ms. Ross. Thank you for sharing your personal involvement with this issue.

Our next presenter is from Edmonton by video conference, as an individual. We have Associate Professor Pei, from the University of Alberta.

The floor is yours.

[Dr. Jacqueline Pei, Associate Professor, University of Alberta, As an Individual]

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.

[The Chair, Conservative, Mike Wallace]

Thank you very much, Professor.

Now, from the Assembly of First Nations, we have Chief Alexis.

The floor is yours, sir, for 10 minutes.

[Chief Cameron Alexis, Alberta Regional Chief, Assembly of First Nations]

Thank you very much.

Boozhoo. Tanisi. Aaniin.

I want to thank previous speakers, and also to thank the House of Commons committee on justice and human rights for allowing us to participate in this very, very important presentation.

My name is Cameron Alexis. I am the regional chief for Treaty 6, 7, and 8 in Alberta, and I lead the work on behalf of the Assembly of First Nations executive in the area of justice. I was an RCMP officer for 23 years.

I am honoured to speak to you today about this private member's bill, Bill C-583, an act to amend the Criminal Code (fetal alcohol spectrum disorder).

The Assembly of First Nations has always stressed the importance of flexibility in sentencing. First nations are overrepresented in the criminal justice system. While our population is approximately 4% of the general population, we make up almost a quarter of the present criminal justice system population and over 50% in the western provinces. This current situation is the result of many factors that this committee is well aware of, including colonization, disposition of lands and culture, the intergenerational impacts of residential schools, and the failure of the child welfare system, to name a few.

Currently, paragraph 718.2(e) of the Criminal Code requires that the particular situation of aboriginal offenders be considered at sentencing and requires that a report outlining the individual's background—also known as the Gladue report, from British Columbia—be provided at pre-sentencing.

Bill C-583 would add a definition of fetal alcohol spectrum disorder, or FASD, to the Criminal Code, as well as other provisions for FASD assessment, evidence provisions, and sentencing considerations for accused with FASD. Adding these new provisions to the Criminal Code would allow judges to identify and consider the effects of FASD in the sentencing of the accused.

Some first nation communities have experienced disproportionately high rates of FASD, and the proposed amendments could provide additional context to sentencing and act as a supportive companion to the statement of purposes and principles of sentencing set out in section 718 of the Criminal Code.

We are concerned that recent amendments to Criminal Code requiring mandatory minimum sentences remove from sentencing judges the discretion to appropriately and effectively determine which sentence can best balance all the fundamental objectives of sentencing. Therefore, to achieve its objectives, the bill would require provisions making the mandatory minimum sentencing provisions subject to the proposed provisions of Bill C-583. Otherwise, the bill would fail to provide judges the required discretion to provide creative sentencing, better reflecting the situation and the capacity limitations of accused persons with FASD.

The current criminal justice system has profoundly failed first nations. It has done so in failing to respect cultural differences, failing to address the system's biases against our people, and denying them an effective voice in the development and delivery of service. The introduction of mandatory minimum sentences furthers this fundamental miscarriage of justice and the failure to respect and uphold aboriginal treaty rights and human rights.

In effect, the justice system is investing in the present system instead of preventative measures and proper supports and services for those suspected of and/or diagnosed with FASD, rights including court-ordered FASD assessments as long as the client is not inhibited by lack of funds for costly diagnoses and also that the courts ensure clients are provided with proper supports that respect their rights and those of their biological mothers. This bill cannot have the needed impact while the unique considerations of first nations, including those with FASD, are subject to non-discretionary sentencing conditions.

We have seen the damaging effects of colonization and the residential school system in our communities. The current criminal justice system has consistently and profoundly failed first nations. Without the proper modifications of this bill, it will ensure that this unfortunate legacy continues.

In closing I just want to add a few quick things.

I want to thank all of you for your valuable interventions. I really thank the speakers before me. I also want to thank Ryan Leef from the Yukon for stepping up on this.

As first nations, we continue to struggle with this, and I know from sentencing circles and restorative justice initiatives that we, by and large, cannot factor in FASD. Our people continue to suffer and correction is not the answer. We need prevention.

I deal with people in my own family and in my own community with this almost on an everyday basis. You have to repeat yourself more than several times to even get your message across. We need a different mechanism, and I support the amendment to this bill.

Respectfully, thank you, members of the committee.

Ish nish. Thank you.

[The Chair, Conservative, Mike Wallace]

Thank you very much, Chief.

Now we're going to go to the question and answer period.

This is a reminder that Ms. Bradley gave her presentation previously, so she's here for questions and answers.

Please, it helps both me and those who are on video conference if, when you're asking a specific question, you let the witness know that the question is for them.

With that, we're starting our question and answer session with the New Democratic Party.

Madame Boivin.

[Françoise Boivin, NDP, Gatineau, QC]

Thank you, Chair.

Thank you to all witnesses here today. It was very enlightening and informative, I must say.

I thank you, Ms. Ross, first of all because of all the work you do. I think it's very important, and sharing your story helps us to understand.

I will keep in mind what you said about how we need more diagnostic centres. I look at the legislation, which in quotation marks is not necessarily even “in front of” Parliament anymore. I think this is important because we're in discussion mode, and we'll make recommendations. Sometimes, maybe it's my age, I get impatient because I think we were all pretty much aware of the situation, but I always learn something and so I'll keep that positive. At the same time, I don't think we'll be able to move it as far forward in this legislature as I wish we could.

However, the point on more diagnostic centres is a very important one because if, at some point in time, we do have a piece of legislation that comes into force, has an impact on the Criminal Code, and changes different things, it will be all fine and dandy but there are a lot of courthouses in this country. It's a big country, and if all the centres for diagnosis are in certain areas, there will be a lot people who will not be able to benefit from this situation. I'm a strong believer that justice should be rendered the same way for everybody.

I think in your testimony, there was some emphasis made by Professor Pei—I hope I say your name right, but believe you me, the way anglophones say my last name, I'm sorry, but not that much.

Anyways, Professor Pei, you were talking about moving beyond a one-size-fits-all system and the fact that we need more diagnostic centres. I am addressing my question maybe to you. How many of those exist in Canada?

Second, the more I hear about FASD, the more I wonder if section 16 of the code in any shape or way could find application because 16.1 says the following:

No person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that renders the person incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong.

I am curious to hear your view on the matter.

For Chief Alexis, thank you very much for the points you made, which were very, very important, because I was also going to say that mandatory minimum sentences defeat the purpose of Bill C-583. I understand from your recommendation, and I'm sure the other members on the panel today would agree with you, that Bill C-583 or whatever shape it will come back in during a new legislature should give precedent to this over any mandatory minimum sentencing.

Those are my questions.

[The Chair, Conservative, Mike Wallace]

Okay, I think the first question is for Professor Pei.

[Françoise Boivin, NDP, Gatineau, QC]

How many centres do we have in Canada?

[Dr. Jacqueline Pei]

I'm not certain how many there are. I can tell you that in Alberta, where there are the most centres by far, there are 24. In Whitehorse—and we have representation from Whitehorse here—I think they have a pediatric team and a newly developed adult team, so there are a couple in Whitehorse. There are three in B.C. that I can think of, one in Saskatchewan, and maybe two in Manitoba. I'm just flying by the seat of my pants on that. There are maybe one or two in Ontario through the Sick Kids Hospital.

The Yukon is well ahead in terms of territories setting a precedent, but what we're talking about is maybe three per province on average, nowhere near the number required to meet the needs of the population—not even close. For that reason, I might suggest that it would be lovely to see more of these centres, particularly as we move forward.

But if we look at assessment practices, and say that we need to at least be looking at more specialized assessment practices to begin with, those services are more readily accessible. We want to move towards diagnostic centres, but in the absence of those centres, it doesn't mean there aren't folks in the community who are equipped and trained to provide specialized assessment that may lead to diagnosis.

Diagnosis is crucial. We know that. It's important for us to track numbers and to convey a certain understanding. But diagnosis alone does nothing to support the way we respond to the unique needs of an individual, because individuals with FASD can be incredibly diverse. So, we need to look at specialized assessment that moves beyond diagnosis to inform intervention initiatives. That means talking to community providers—

[Françoise Boivin, NDP, Gatineau, QC]

Excellent. Thank you.

[The Chair, Conservative, Mike Wallace]

Did you want the chief to answer too?

[Françoise Boivin, NDP, Gatineau, QC]

Yes. I first wanted her answer on section 16 of the Criminal Code, though. I understand it's very diverse but it could affect the possibility of a person to have mens rea when committing an infraction.

[Dr. Jacqueline Pei]

That's a great question. It's a very difficult one to answer, and there's not a whole lot of research yet that really informs that.

What we do know and understand about the brain is that while understanding may be reduced or diminished, and while there are components of the brain, like inhibitory control and self-regulation, that may be operating at a much lower level developmentally than we would like for an adult, a lot of these individuals do understand right and wrong. Sometimes the NCR, the not criminally responsible, system actually provides a level of treatment intensity that is not an appropriate fit.

We are faced with a system where you may be putting somebody with an FASD who understands right and wrong but can't inhibit or control his or her behaviour with somebody who has experienced a schizophrenic episode where they absolutely had no idea of what reality was or was not.

[The Chair, Conservative, Mike Wallace]

Thank you.

[Dr. Jacqueline Pei]

So the treatment fit would not be there.

[Françoise Boivin, NDP, Gatineau, QC]

Thank you.

[The Chair, Conservative, Mike Wallace]

Thank you, professor.

You've run out of time. I'm sorry, Madam.

We will get back to you, Chief, with another question.

The next question is from Mr. Dechert of the Conservative Party.

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

Thank you, Mr. Chair, and thank you to our guests today.

I want to start with Dr. Pei. You talked a lot about prevention strategies in your opening remarks, and I want to explore the issue of prevention, and the awareness of the general population about the dangers of FASD.

When we last convened, we heard from some experts that there appears to be increased binge drinking among young women generally in our society, and that may be one factor leading to FASD.

My first question is whether you know if the incidence of FASD in Canada is increasing, going down, or remaining stable over time.

Second, do you think Canadians are generally aware of FASD? What suggestions would you have to increase awareness among all Canadians, especially women, of the dangers of FASD, so that one would hope that over time this can be reduced?

Perhaps I could hear from each of the witnesses on that question.

[The Chair, Conservative, Mike Wallace]

You want to start with the professor though?

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

Yes, thank you.

[Dr. Jacqueline Pei]

Whether or not the incidence of FASD is increasing is a difficult question to answer. The short answer is yes, in that our numbers are getting higher. Is that because the incidence is increasing or because we're measuring it better and we're seeing diagnostic clinics where we're capturing it? I don't think we've gotten to a point of prevalence or surveillance yet that allows us to say we've diagnosed it at a level across the country and we can say that with any kind of confidence. Similarly there is no evidence that it's getting worse. There are patterns of drinking that we're concerned about, but there is nothing yet to say that we're seeing real change. Until our surveillance...and I know there are work and projects initiated right now and we're hoping to capture that better so we can begin to measure that more effectively.

In terms of prevention and your question about Canadians' awareness of FASD, there certainly are some prevention campaigns around. You will see them in some provinces and different bars. There are commercials out there that talk about not drinking when you're pregnant. My one thought is that when we look at risk factors that contribute to alcohol consumption and pregnancy, we're often looking at issues of women who are marginalized, women who are struggling with mental health issues like depression, and women who are isolated. There are significant features that women are dealing with. For those reasons, in addition to increasing public awareness around health practices and pregnancy—and I know that we don't say what not to do, but say let's be healthy together—we're talking about being positive with women. We also need to look at professionals who work with women who are pregnant, planning to be pregnant, or even could become pregnant, and how to have supportive conversations with women about how to take care of themselves and how to feel comfortable having that conversation about having sex. What are you doing to protect yourself? What are you doing to monitor your alcohol? What are you doing to watch for pregnancy? Those are the kinds of things that the professionals in our communities need to be more comfortable with so they can have those conversations with the women in their communities, all women.

[The Chair, Conservative, Mike Wallace]

Ms. Bradley, would you like to answer the second question?

[Wenda Bradley, Executive Director, Fetal Alcohol Syndrome Society of Yukon]

Yes, thank you.

I agree with what Dr. Pei has been saying.

The thing that we found out here by way of conversation, more than any research that's been done, is that there is not easily accessible testing available without someone having to jump through a lot of hoops, if that's a way of putting it. We initiated a study with the University of Alaska in Anchorage and have put up two dispensers for pregnancy tests, one in the college and one in a local bar. There will be two put up in Dawson City in two local bars as well.

They're doing research to see what kind of messaging, or messaging with available tools, is to be used to help women make a more positive choice for themselves. If they are in a bar and drinking and they see this message, then maybe they can check it out right away discreetly and not have any other hoops to go through before that. Then they can make their own choices. I think that's a good question. I think we have to be able to provide accessibility for women to care for themselves.