Transition from care experiences of youth aged 13 to 23 living with fetal alcohol spectrum disorder in Canada: A scoping review

Abstract

Background

Fetal alcohol spectrum disorder (FASD) is a full body, lifespan diagnosis resulting from prenatal alcohol exposure that affects people differently. Children and youth living with FASD are an important sub-population within child welfare services. Yet, knowledge about youths’ transition from care is limited. Policy may be implemented before understanding evidence for supportive programming like ensuring early and consistent prenatal care, remedial education, etc. In 2023, Ontario mandated child welfare transition planning begin at age 13. While youth are valued decision-maker participants, research on the lived experience of child welfare involved youth living with FASD is a gap.

Objective

To map the extant research on the experiences of child welfare-involved youth living with FASD in Canada preparing to leave care. This literature scope may help to minimize or address risks, and identify strengths, during this transition.

Participants and setting

Peer-reviewed Canadian articles in English about child welfare-involved youth with a confirmed history of prenatal alcohol exposure, FASD diagnosis, or both were eligible for inclusion. Child welfare-involved youth from early adolescence to adulthood represent the age captured in included studies.

Method

A systematic scoping review using JBI guidelines was conducted, and four databases (Embase, Medline, PsycINFO, and Social Work Abstracts) searched using a librarian supported search strategy. Reviewers independently completed title/abstract, full-text screening, and data extraction. PRISMA-Scr, descriptive and narrative analysis were used to understand risks and protective factors.

Findings

Six studies met inclusion criteria. A substantial minority of youth experienced comorbidities. Contextual factors were inconsistently described, and several outcomes minimally reported on. Positive outcomes, protective factors, resilience pathways, and youth voices were absent. Four main themes highlighting the complexities of living and planning for youth with FASD were identified. Related policy, research, and child welfare practice implications are discussed.

Conclusions

While this subpopulation must leave care by early adulthood, their experience is missing from the literature. We recommend investing in foundational research on pathways of exiting care, updating policy and practice to ensure youth voices are integrated, and optimizing, standardizing, and tracking protective factors throughout child welfare engagement.