Individuals with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disorder caused by prenatal exposure to alcohol, are overrepresented in criminal justice settings and have complex, forensically relevant clinical needs. This study surveyed 81 forensic clinicians recruited via international professional association listserv postings and social media about their assessment and intervention practices in providing services to clients with FASD and other neurodevelopmental disorders (NDDs), along with their training experiences and needs in this area. Results indicated that the majority of clinicians had forensic experience working with clients who had FASD and other NDDs, although most identified limited relevant training experiences, gaps in their readiness for service provision, and practice barriers in effectively working with these populations. Clinicians also reported seeing fewer clients with FASD relative to other NDDs, and feeling less prepared for forensic practice with this population. Most clinicians endorsed the need for additional training and supports to increase their competency and enhance their practice, such as the development of screening tools, clinical guidelines, and access to experts or specialists for consultation. As awareness about FASD continues to grow in legal contexts, additional research, training, and policy consideration is required to develop and implement evidence-based practice resources for forensic clinicians.

Objectives: A number of commonly used performance validity tests (PVTs) may be prone to high failure rates when used for individuals with severe neurocognitive deficits. This study investigated the validity of 10 PVT scores in justice-involved adults with fetal alcohol spectrum disorder (FASD), a neurodevelopmental disability stemming from prenatal alcohol exposure and linked with severe neurocognitive deficits. Method: The sample comprised 80 justice-involved adults (ages 19–40) including 25 with confirmed or possible FASD and 55 where FASD was ruled out. Ten PVT scores were calculated, derived from Word Memory Test, Genuine Memory Impairment Profile, Advanced Clinical Solutions (Word Choice), the Wechsler Adult Intelligence Scale – Fourth Edition (Reliable Digit Span and age-corrected scaled scores (ACSS) from Digit Span, Coding, Symbol Search, Coding – Symbol Search, Vocabulary – Digit Span), and the Wechsler Memory Scale – Fourth Edition (Logical Memory II Recognition). Results: Participants with diagnosed/possible FASD were more likely to fail any single PVT, and failed a greater number of PVTs overall, compared to those without FASD. They were also more likely to fail based on Word Memory Test, Digit Span ACSS, Coding ACSS, Symbol Search ACSS, and Logical Memory II Recognition, compared to controls (35–76%). Across both groups, substantially more participants with IQ <70 failed two or more PVTs (90%), compared to those with an IQ ≥70 (44%). Conclusions: Results highlight the need for additional research examining the use of PVTs in justice-involved populations with FASD.

Objective: The purpose of this study was to increase the understanding of the Canadian forensic psychiatry system by providing a population-based overview of the Ontario forensic mental health system. Methods: Data were collected on 1,240 accused adults who were subject to the jurisdiction of the Ontario Review Board (ORB) between 2014 and 2015. Archival data were retrieved from annual ORB hearing hospital reports for accused supervised by all nine adult forensic psychiatry facilities across Ontario. Results: The sample included not criminally responsible (NCR; 91.6%) and unfit to stand trial (UST; 8.4%) accused. The majority of the sample was male (85.7%), single (70.1%), unemployed (63.6%), with a high school education (48.8%). Most were on a detention order (78.5%) and almost half were living in the community at the time of the report (48.8%). The majority had prior contact with psychiatric services (83.1%) and/or the criminal justice system (70.6%) before entering the forensic system. A history of elopement (31.5%) and inpatient aggression was high (60.6%). Most had a psychotic spectrum disorder (81.6%) and over half had a substance use disorder (57.2%) in the reporting year. A range of index offences was observed (69.9% violent, 20.3% general, 9.8% sexual), and the majority of the sample (61.0%) had an index offence that resulted in no injury or a minor injury to the victim. Conclusion: The Canadian forensic psychiatry system is comprised of a unique subset of justice-involved individuals. This study provides a detailed examination of accused who are subject to the jurisdiction of the ORB and provides key insight into risk factors associated with offending behaviour in this population. The results of this study will provide a framework for future studies examining the association between mental disorder and violence and the treatment trajectories for those in the forensic psychiatry system.

Big data and analytics are rapidly changing health care and enabling a degree of measurement and quality improvement not previously seen. For a variety of reasons including the limited number of quality indicators in mental health care, psychiatry has been late to the game. Use of technology to measure, monitor, and assess risk and change, would have a significant impact for key stakeholders including patients, care providers, and the community. Analytics offer an opportunity to increase our understanding of the psychiatric populations, target effective programs and interventions, and direct more personalized care at the critical intersection of risk assessment and prediction – risk management. The electronic Hamilton Anatomy of Risk Management (eHARM) aims to harness the capabilities afforded by data analytics to enhance the assessment, monitoring, and management of risk at the clinical interface.

The current article aims to examine the performance of two brief, dynamic risk measuresthe Brockville Risk Checklist (BRC4) and one of two versions of the Hamilton Anatomy of Risk Management [HARM-FV and electronic HARM-FV