The Canadian guidelines and the interdisciplinary clinical capacity of Canada to diagnose fetal alcohol spectrum disorder

Background: In 2005, the CMAJ published the Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. The intent of this publication was to encourage a more consistent interdisciplinary team approach and diagnostic procedure for FASD diagnoses. That same year, the Canada Northwest FASD Research Network (CanFASD Northwest) determined the locations and capacity for interdisciplinary FASD diagnosis across Canada. Six years later, we wondered how successfully these Guidelines had been in bringing consistency to FASD clinical work.

Method: All clinical programs in Canada that routinely performed FASD evaluations were identified through membership in either our Network Action Team on FASD Diagnosis, professional meetings, organizational memberships, websites, programs lists available from Provincial or Federal offices or by word of mouth. Surveys were sent to all of the programs identified.

Results: A total of 55 clinics had been identified in seven provinces and one territory in 2005 that did FASD multidisciplinary diagnostics. In 2011 only 44 clinics were identified in six provinces and one territory using the same methodology. Survey responses were completed by 89% of these 44 clinics identified in 2011. The Guidelines were well known to all programs and actively referred to by most. Only 46% of respondents had a full staff of professionals on site for diagnosis, however 90% did use the team approach in determining final FASD diagnosis, while 79% used the team to help in developing a treatment plan. Among the clinics reporting, 74% of them used the new diagnostic schema proposed in the Guidelines and another 12% report using both the Guidelines and another system for diagnosis.

Interpretation: The Guidelines have become well known to the medical community. They have contributed to increased consistency in approach and in diagnosis. The variations in clinical ability to fully staff themselves, and the 20% decline in clinic numbers suggest important funding gaps. Many provinces and territories still have no local interdisciplinary programs for FASD diagnosis, and the need across Canada is still many times greater than what is currently available.