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The Content and Quality of Forensic Mental Health Assessment:
Validation of a Principles-Based Approach
A Dissertation
Submitted to the Faculty
of
Drexel University
by
Tammy D. Lander, M.S., J.D.
in partial fulfillment of the
requirements for the degree
of
Doctor of Philosophy
May 2006
ii
Dedication
To my loving husband, Kevin. From the beginning, you have made my dreams
come true – this instance is no different. It has only been with your support, love, and
devotion that I could even have such big dreams. Honey, you make life fun, romantic,
and extraordinary. Thank you.
iii
Acknowledgements
There is no way to properly express the gratitude owed to those that have aided
my journey through this program. While my attempts to do so are feeble, rest assured
they are also heartfelt. Dr. Kirk Heilbrun contributed knowledge, direction, and a passion
for forensic psychology that I will build on for the rest of my career. Drs. Dave
DeMatteo and Geff Marczyk taught me that brilliance and professionalism can be
accompanied by a mentoring spirit and desire to guide others, along with a great sense of
humor. I would be remiss if I did not mention the contributions of Drs. James Herbert
and Naomi Goldstein who were invaluable members of my committee, as well as passing
on knowledge along the way. Michele Pich and Kristen Loiselle were gracious enough to
agree to aid in my dissertation, even after seeing the pile of reports to be coded. I also
want to use this opportunity to acknowledge those educators associated with both
Villanova Law School and Drexel University. While they are too numerous to list here,
their guidance and contributions were felt throughout my journey. Finally, no listing of
acknowledgements would be complete without touching on those contributions of my
family and friends. Life is always made much easier by those who love you.
iv
Table of Contents
LIST OF TABLES................................................................................................viii ABSTRACT.............................................................................................................x 1. INTRODUCTION ..............................................................................................1
1.1 Legal Issues Associated With Mental Health Assessment .........................3
1.1.1 Competence to Stand Trial................................................................3
1.1.2 Commitment and Restorability .........................................................4
1.1.3 Relevant Pennsylvania Law..............................................................5
1.1.3.1 Competence to Stand Trial..................................................5
1.1.3.2 Involuntary Commitment....................................................7
1.2 The Ethics of Forensic Mental Health Assessment ....................................8
1.2.1 Competence and Integrity of the Evaluator ......................................9
1.2.2 Competence and Integrity of the Evaluation ..................................12
1.2.3 Characteristics of the Report...........................................................15
1.3 Forensic Mental Health Assessment: Empirical Research Evidence ......18
1.3.1 Survey Research..............................................................................18
1.3.2 Research on Report Characteristics ................................................32
1.4 Empirical Study of the Quality of Forensic Mental Health Assessment ..36
1.5 Principles of Forensic Mental Health Assessment....................................38
1.5.1 Identify Relevant Forensic Issues ...................................................39
1.5.2 Accept Referrals Only Within Area of Expertise ...........................39
1.5.3 Decline Referral When Evaluator Impartiality is Unlikely ............40
1.5.4 Clarify the Evaluator’s Role With the Attorney .............................40
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1.5.5 Clarify Financial Arrangements......................................................40
1.5.6 Obtain Appropriate Authorization ..................................................40
1.5.7 Avoid Playing the Dual Roles of Therapist and Forensic Evaluator ........................................................................................41
1.5.8 Determine the Particular Role to be Played Within the
Forensic Assessment if the Referral is Accepted...........................41
1.5.9 Select and Employ a Model to Guide Data Gathering, Interpretation, and Communication ...............................................41
1.5.10 Use Multiple Sources of Information for Each Area Being
Assessed.......................................................................................42
1.5.11 Use Relevance and Reliability (Validity) as Guides for Seeking Information and Selecting Data Sources......................................42
1.5.12 Obtain Relevant Historical Information........................................42
1.5.13 Assess Clinical Characteristics in Relevant, Reliable, and
Valid Ways...................................................................................42
1.5.14 Assess Legally Relevant Behavior................................................43
1.5.15 Ensure that Conditions for Evaluations are Quiet, Private, and Distraction-Free ...........................................................................43
1.5.16 Provide Appropriate Notification of Purpose and/or Obtain
Appropriate Authorization Before Beginning .............................43
1.5.17 Determine Whether the Individual Understands the Purpose of the Evaluation and Associated Limits on Confidentiality ..........43
1.5.18 Use Third Party Information in Assessing Response Style ..........44
1.5.19 Use Testing When Indicated in Assessing Response Style ..........44
1.5.20 Use Case-Specific (Idiographic) Evidence in Assessing Clinical
Condition, Functional Abilities, and Causal Connection.............44
1.5.21 Use Nomothetic Evidence in Assessing Clinical Condition, Functional Abilities, and Causal Connection.................................45
vi
1.5.22 Use Scientific Reasoning in Assessing Causal Connection Between Clinical Condition and Functional Abilities .................45
1.5.23 Do Not Answer the Ultimate Legal Question Directly.................45
1.5.24 Describe Findings and Limits so That They Need Change Little Under Cross-Examination............................................................46
1.5.25 Attribute Information to Sources ..................................................46
1.5.26 Use Plain Language, Avoid Technical Jargon..............................46
1.5.27 Write Report in Sections, According to Model and Procedures...46
1.5.28 Base Testimony on the Results of the Properly Performed
Forensic Mental Health Assessment............................................47
1.5.29 Testify Effectively.........................................................................47 2. THE CURRENT STUDY.................................................................................48
2.1 Hypotheses................................................................................................48 3. METHOD..........................................................................................................50
3.1 Measures ...................................................................................................50
3.1.1 Coding Protocol ..............................................................................50
3.1.2 Expert Rater Questionnaire.............................................................51 4. PROCEDURES.................................................................................................53
4.1 Reports ......................................................................................................53
4.2 Coders and Expert Raters..........................................................................53
4.3 Power Analysis .........................................................................................54 5. RESULTS .........................................................................................................55
5.1 Report Characteristics...............................................................................55
5.1.1 Evaluator Information......................................................................55
5.1.2 General Information.........................................................................56
vii
5.1.3 Sources of Information.....................................................................57
5.1.4 Specialized Forensic Assessment ....................................................58
5.1.5 Psychological Assessment ...............................................................58
5.1.6 Mental State Information .................................................................58
5.1.7 Legal Issues......................................................................................59
5.1.8 Competency Standards.....................................................................61
5.1.9 Competence Conclusions.................................................................64
5.1.10 “Sanity” Conclusions .....................................................................65
5.2 Principles of FMHA..................................................................................66
5.3 Hypotheses................................................................................................67
6. DISCUSSION...................................................................................................73
6.1 Report Characteristics...............................................................................73
6.2 The Quality of FMHA ..............................................................................76
6.3 Limitations ................................................................................................77
6.4 Implications and Future Directions...........................................................78 LIST OF REFERENCES.......................................................................................82 APPENDIX A: CODING PROTOCOL...............................................................87 APPENDIX B: RATER QUESTIONNAIRE.......................................................99 APPENDIX C: PRINCIPLES OF FORENSIC MENTAL HEALTH ASSESSMENT ..................................................................................................101 VITA....................................................................................................................107
viii
List of Tables
1. Essential and Important Elements of Forensic Reports Addressing Criminal Responsibility (CR) and Competence to Stand Trial (CST) (Borum & Grisso, 1996) ..................................................................................20
2. Essential and Important Clinical Elements Within Forensic Reports
Addressing Criminal Responsibility (CR) and Competence to Stand Trial (CST) (Borum & Grisso, 1996) ....................................................21
3. Opinion Elements in Forensic Reports Addressing Criminal Responsibility
(CR) and Competence to Stand Trial (CST) (Borum & Grisso, 1996) ...........22 4. Elements of Forensic Juvenile Evaluations Rated by Psychologists
(N = 82) by Importance (Ryba, Cooper & Zapf, 2003) ...................................25 5. Studies Describing the Use Frequency of Psychological and Specialized
Forensic Tests in FMHA..................................................................................26 6. Examination of Acceptability of Test Usage for Differing Types of
Forensic Questions (Lally, 2003).....................................................................30 7. Components of Community (N = 110) and Hospital (N = 167)
FMHA Reports (Heilbrun & Collins, 1995) ....................................................34 8. Notification of Purpose in Present Sample of Reports (N = 125)....................57 9. Mental State Elements Included in Present Sample of Reports (N = 125)......59 10. Frequencies Associated with Competency to Stand Trial and
Involuntary Treatment in Present Sample of Reports (N = 125) .....................60 11. Competency to Stand Trial Elements in Present Sample of Reports
(N = 125)..........................................................................................................62 12. Commitment Criteria Addressed in Present Sample of Reports (N = 125).....65 13. Frequency of Principle Use Within Reports in Present Sample (N = 125) .....67 14. Correlation Matrix for FMHA Principles Examined in Present
Study (N = 125) ...............................................................................................69 15. Correlations between FMHA Principles and Expert Ratings of Relevance,
Helpfulness and Quality...................................................................................70
ix
Abstract The Content and Quality of Forensic Mental Health Assessment in Pennsylvania:
Validation of a Principles-Based Approach Tammy D. Lander, M.S., J.D.
Kirk Heilbrun, Ph.D.
The expanding practice of forensic mental health assessment (FMHA) has created a need
for more detailed guidelines within the field. Toward that end, Heilbrun (2001) has
described a set of principles developed using relevant legal, ethical, scientific, and
professional authority. The extent to which these principles are currently used in
practice, however, is unclear. Moreover, these principles have not yet been validated
through the use of global expert judgment, an approach with significant precedent in this
area. The current study examined the content of written FMHA reports from
Pennsylvania applying these principles to the reports. In addition, a measure of global
report quality was obtained through a selected group of experts, allowing the status of the
principles to be gauged against the global measure of quality provided by experts. The
results suggest a surprising lack of adherence to standard practice principles within
FMHA. Within the study, those reports that did contain evidence of the use of principles,
even slight, were seen as more relevant, more helpful to the decision-maker, and of
higher quality. Future research and discussion of the legal, ethical, and moral
implications of the impact of FMHA on both legal and mental health systems should be
undertaken with the goal of improving performance of those professionals that choose to
engage in FMHA.
1
CHAPTER 1: INTRODUCTION
The field of forensic psychology has undergone significant advances within the
past twenty years. From the development of empirically validated tools (Grisso &
Barnum, 2000; Monahan et al., 2000; Poythress, Monahan, Bonnie, & Hoge, 1999) to the
creation of specialty guidelines for ethics (Committee on Ethical Guidelines for Forensic
Psychologists, 1991), the field has developed through the demands of the scientific and
legal communities. While attempting to keep up with those advances, the field has
sought to maintain the integrity of the profession while disseminating the knowledge
gained. Numerous articles have been devoted to the goals of specialized training
(Heilbrun & Annis, 1988), certification (Tolman & Mullendore, 2003), and the
development of more detailed practice guidelines (Bow & Quinnell, 2001; Felthous &
Gunn, 1999; Otto & Heilbrun, 2002).
The current discussion about the need for more detailed practice guidelines
centers on the need for higher quality products. In forensic psychology, it is often the
written report that becomes the product in question (Borum & Grisso, 1996; Heilbrun &
Collins; 1995; Melton, Petrella & Poythress, 1983; Petrila, Poythress & Slobogin, 1997;
Reisner, Slobogin & Rai, 1999). The question then becomes how to increase the quality
of forensic evaluations. As with any empirical question, “only a review of normative
practice can indicate the degree to which forensic evaluations meet professional
standards” (Christy, Douglas, Otto & Petrila, 2004, pg 381).
In addition to an examination of current practices, a study of the incorporation of
established standards of practice must be undertaken. Thus far, existing research has
considered the perceptions of forensic mental health professionals regarding appropriate
2
content of forensic evaluations (Borum & Grisso, 1996; Keilin & Bloom, 1986; Ryba,
Cooper & Zapf, 2003). Various texts have suggested principles produced in an effort to
educate the practicing forensic mental health professional (Heilbrun, 2001; Heilbrun,
Marczyk & DeMatteo, 2002; Melton, Petrila, Poythress & Slobogin, 1997). There has
not, however, been an empirical investigation of the extent to which these principles are
used in FMHA.
Finally, there has been some research addressing the quality of reports as rated by
experts (Petrella & Poythress, 1983; Skeem, Golding, Cohn & Berge, 1998). This
research has considered certain principles and their relationship to the quality of the
evaluation, but has encompassed only a few principles. The contribution of these studies
lies in the production of empirical evidence which then supports a number of specific
principles.
In an effort to consider some of these issues, the current study provides normative
data regarding the content and design of forensic evaluations conducted in Pennsylvania,
describes the extent to which specialized forensic principles are seen in reports, and
examines the quality of those evaluations as rated by a panel of experts. Few previous
studies have allowed a comprehensive recording and coding of the content of forensic
evaluation reports; however, the current study considered a detailed view of FMHA
reports in an effort to gauge the nature of current practice. In addition, an examination of
the use of the practice principles described by Heilbrun (2001) in the current field of
FMHA in light of the quality of these reports as rated by experts was undertaken. The
results of these analyses should guide and direct the design of future training and research
in order to improve the quality of future FMHA reports.
3
1.1 Legal Issues Associated With Mental Health Assessment
The use of forensic mental health assessment within a legal context dates back to
the English courts of the late 19th century (Ciccone, 1999; Otto & Heilbrun, 2002;
Philipsborn, 2004). Today, the guidelines associated with specific legal questions are
clearer. The current study examined the relevant legal issues associated with competence
to stand trial, commitment, and restorability.
1.1.1 Competence to Stand Trial
The right of a defendant to participate in his/her own defense is rooted in the due
process clause of the Fourteenth Amendment of the Constitution. This clause provides
defendants with many of the rights associated with fundamental fairness within a criminal
proceeding. The United States Supreme Court (hereinafter “Supreme Court”) has held
that a defendant’s “constitutional rights [are] abridged by his failure to receive an
adequate hearing on his competence to stand trial” (Pate v. Robinson, 1966, pg 386). In a
more recent case, they went on to assert explicitly that “the criminal trial of an
incompetent defendant violates due process” (Medina v. California, 1992, pg 453).
In 1960, the Supreme Court set forth a formal definition of competence to stand
trial in Dusky v. United States. They held that the test of competence includes “whether
he has sufficient present ability to consult with his lawyer with a reasonable degree of
rational understanding – and whether he has a rational as well as factual understanding of
the proceedings against him” (Dusky, 1960, pg 402). Thus, the Dusky standard
articulated two prongs to the competency test – the ability to understand the criminal
process and the ability to assist in one’s own defense. Thus, the Court stated that not
only did the defendant need to understand the formal proceedings associated with the
4
criminal process, but he or she must be able to participate in that process. This standard
has been elaborated to encompass many specific factors such as appreciation of the
charges, appreciation of the potential penalties, understanding of the adversarial nature of
the proceedings, ability to provide relevant information to his attorney, ability to manifest
appropriate courtroom behavior, and ability to testify relevantly (Grisso, 2003; Reisner,
Slobogin & Rai, 1999 – both citing Florida Rules of Criminal Procedure § 3.211(a)).
The 1990s witnessed additional Supreme Court cases relevant to the Dusky
standard: Medina v. California (1992), Godinez v. Moran (1993), and Cooper v.
Oklahoma (1996). In Medina, the Court set the evidentiary standard for competence as a
preponderance of the evidence, while the Godinez court extended the right of competence
to all aspects of the defendant’s participation in the trial, including competence to enter a
guilty plea (Grisso, 2003; Philipsborn, 2004). Cooper reaffirmed the importance of the
defendant’s capacity to waive constitutional rights, while placing the burden on the
defendant to show incompetence (Cooper v. Oklahoma, 1996; Grisso, 2003).
1.1.2 Commitment and Restorability
Occasionally, non-violent defendants adjudicated incompetent to stand trial have
their charges dropped in exchange for their seeking treatment within the civil context
(Melton, Petrila, Poythress & Slobogin, 1997). More typically, however, defendants are
committed to treatment within the mental health system in order to restore competency.
This restoration can include educating defendants about the functioning of the criminal
justice system, and treating symptoms of a mental illness. However, the Supreme Court
has held that this hospitalization is not without time limits. In Jackson v. Indiana (1972),
the Court ruled that initial hospitalization should encompass “a reasonable period of time
5
. . . to determine whether there is a substantial probability that he will attain the capacity
in the future” (Jackson v. Indiana, 1972, pg. 737-38). The Court held that incompetent
defendants could not be detained for treatment “longer than the nature of their disorders
warranted” (Grisso, 2003, pg 77). For the defendant, this translates into an organizational
game of catch. If the disorder cannot be treated, the defendant cannot be tried on
criminal charges. The state must either drop the charges or proceed with commitment
procedures under civil codes. If the disorder can be treated, then the defendant is
committed to a state facility with the purpose of restoring competency.
1.1.3 Relevant Pennsylvania Law
Since the FMHA reports to be examined in the current study reflect evaluations
conducted in the state of Pennsylvania, it is necessary to consider the relevant legal
standards in Pennsylvania. Besides criminal statutes and case law, much of the relevant
law is contained in the Mental Health Procedures Act (MHPA, 1976). The MHPA
specifies FMHA conducted to assist the court in deciding three legal questions: trial
competence, criminal responsibility, and aid in sentencing. In addition, the MHPA
provides guidance for the commitment and treatment of those deemed incompetent to
stand trial, those acquitted by reason of insanity, or following an examination in aid of
sentencing.
1.1.3.1 Competence to Stand Trial. The MHPA defines competence to stand trial as
follows:
Whenever a person who has been charged with a crime is found to be
substantially unable to understand the nature or object of the proceedings against
6
him or to participate and assist in his defense, he shall be deemed incompetent to
be tried, convicted or sentenced so long as such incapacity continues (§7402(a)).
This section continues by stating that once a non-mentally ill defendant is deemed
incompetent to stand trial involuntary treatment can be ordered for a period of up to 60
days (MHPA §7402(b), 1976). For the mentally ill defendant, the civil provisions for
involuntary treatment of the MHPA become applicable. Court-ordered treatment under
the civil provisions provide that commitment should not exceed 90 days (§7306(g)(1)),
unless the disability “is based on acts giving rise to [specific] charges,” e.g. murder,
involuntary manslaughter, aggravated assault, kidnapping, rape, involuntary deviate
sexual intercourse and/or arson, and a finding of incompetency has been entered
(§7306(g)(2)). If the exception applies to the mentally ill defendant, then the court-
ordered treatment can be ordered for a period not to exceed one year.
The MHPA does specify information to be included in the written report, as well
as who should conduct the evaluation. These appear in §7402 as follows:
(2) It [the evaluation] shall be conducted by at least one psychiatrist and may
relate both to competency to proceed and to criminal responsibility for the crime
charged. . . . [§7402(e)(2)]
(4) A report shall be submitted to the court and to counsel and shall contain a
description of the examination, which shall include:
(i) diagnosis of the person’s mental condition;
(ii) an opinion as to his capacity to understand the nature and object of the
criminal proceedings against him and to assist in his defense;
7
(iii) when so requested, an opinion as to his mental condition in relation to the
standards for criminal responsibility as then provided by law if it appears that the
facts concerning his mental condition may also be relevant to the question of legal
responsibility; and
(iv) when so requested, an opinion as to whether he had the capacity to have a
particular state of mind, where such state of mind is a required element of the
criminal charge. [§7402(e)(4)]
1.1.3.2 Involuntary Commitment. The MHPA also contains procedures for court-
ordered involuntary treatment of both those deemed incompetent at some phase of the
trial and those acquitted for lack of criminal responsibility. These provisions allow for
the commitment of those who are “severely mentally disabled” and constitute a clear and
present danger to themselves or others. (MHPA §7304(a)(1), 1976). For those found
incompetent within the trial process, the duration of this commitment is not to exceed 90
days (MHPA §7304(g)(1)) unless they are charged with one of several enumerated
crimes (e.g. murder, voluntary manslaughter, aggravated assault, kidnapping, rape,
involuntary deviate sexual intercourse, or arson). If the incompetent defendant falls into
the second category or the defendant is acquitted by reason of insanity, then the duration
is not to exceed one year (MHPA §7304(g)(1-2), 1976). Additional time may be ordered
by the court under the provisions of MHPA §7305; however, this addition should not
exceed 180 days for the first category and one year for the second category. Further,
those deemed incompetent to proceed with pending charges are entitled to be reexamined
for competency by a court appointed psychiatrist after 90 days (MHPA §7403(c), 1976).
8
This reexamination requires that a report be submitted to the court as well as to the
defendant’s counsel.
The MHPA also allows the use of mental health evaluations to aid in sentencing.
This evaluation is undertaken in an effort to aid the judge with determination of the
disposition (MHPA §7405, 1976). Finally, upon a finding of incompetence, an acquittal
due to lack of responsibility or an aid in sentencing evaluation, the court may be
petitioned for an order directing involuntary treatment pursuant to MHPA §7304 (MHPA
§7406, 1976). This request for involuntary treatment may be made by either attorney, the
defendant, the county administrator, or “any other interested party” (MHPA §7406,
1976).
1.2 The Ethics of Forensic Mental Health Assessment
Besides legal guidelines that serve to govern the professional actions of mental
health professionals, there are ethical considerations that aid evaluators as well.
Depending on the discipline of the evaluator, there are ethical codes and guidelines
associated with most professional organizations. Although differing by profession, these
varying guidelines tend to acknowledge similar ideals. While it would be impossible to
thoroughly examine all possible guidelines that might apply or all possible applications
within the forensic context, a brief examination of three particular professional
organizations is appropriate – the American Psychological Association’s Ethical
Principles of Psychologists and Code of Conduct (APA Ethics Code, 2002), the
American Academy of Psychiatry and the Law’s Ethical Guidelines for the Practice of
Forensic Psychiatry (APPL Ethical Guidelines, 1995), and the Committee on Ethical
Guidelines for Forensic Psychologists’ Specialty Guidelines for Forensic Psychologists
9
(Specialty Guidelines, 1991) produced by the American Psychology-Law Society in
conjunction with APA’s Division 41.
1.2.1 Competence and Integrity of the Evaluator
One of the most important principles of any profession is to foster and maintain
the integrity of that profession. Within the realm of forensic mental health assessment,
this principle can take many forms. From the broad statements of the APA Ethics Code
adopted and enforced by the APA in 2003 and the APPL Ethical Guidelines provided by
the AAPL in 1995, to the more specific guidelines given by AP-LS and Division 41 of
the APA known as the Specialty Guidelines, the message of integrity and professionalism
is paramount. For example, the APA Ethics Code indicates that “Psychologists seek to
promote accuracy, honesty, and truthfulness in the science, teaching, and practice of
psychology” (APA, 2002, p 1062), while the APPL Ethical Guidelines indicate that
forensic psychiatrists “adhere to the principle of honesty and . . . strive for objectivity”
(AAPL, 1995, p 3). The Specialty Guidelines for Forensic Psychologists underscores
this: “Forensic psychologists have an obligation to provide services in a manner
consistent with the highest standards of their profession” (Committee, 1991, p 657).
A prime example of the application of the message of these sentiments concerns
the competence of the mental health professional who seeks to perform forensic mental
health assessments. For instance, the APA Ethics Code contains the following language
concerning skill level and competence of the individual evaluator:
Psychologists exercise reasonable judgment and take precautions to ensure
that their potential biases, the boundaries of their competence, and the limitations
of their expertise do not lead or condone unjust practices. . . . Psychologists
10
provide services, teach, and conduct research with populations and in areas only
within the boundaries of their competence, based on their education, training,
supervised experience, consultation, study, or professional experience (p 1063) . .
. Psychologists undertake ongoing efforts to develop and maintain their
competence (p 1064).
This level of competence needed to provide services is noted in the Specialty Guidelines:
Forensic psychologists provide services only in areas of psychology in
which they have specialized knowledge, skill, experience, and education. . . .
Forensic psychologists are responsible for a fundamental and reasonable level of
knowledge and understanding of the legal and professional standards that govern
their participation as experts in legal proceedings (Specialty Guidelines, p 658) . .
. Because of their special status as persons qualified as experts to the court,
forensic psychologists have an obligation to maintain current knowledge of
scientific, professional, and legal developments within their area of claimed
competence. They are obligated also to use that knowledge, consistent with
accepted clinical and scientific standards, in selecting data collection methods and
procedures for an evaluation, treatment, consultation or scholarly/empirical
investigation (Specialty Guidelines, p 661).
It is also observed in the APPL Ethical Guidelines for Forensic Psychiatrists: “Expertise
in the practice of forensic psychiatry is claimed only in areas of actual knowledge and
skills, training, and experience” (Ethical Guidelines, p 5). This construct should be
applied throughout the evaluation. From maintaining knowledge of the legal issues and
procedures to seeking current awareness concerning methodology and testing, the
11
forensic mental health professional must strive to recognize the limits of their own
knowledge, training, and experience.
A more specific area concerning the role of the forensic mental health
professional involves avoiding dual relationships in the assessment context. This is seen
consistently across different sources of authority. The AAPL Ethical Guidelines provide
that:
Treating psychiatrists should generally avoid agreeing to be an expert
witness or to perform evaluations of their patients for legal purposes because a
forensic evaluation usually requires that other people be interviewed and
testimony may adversely affect the therapeutic relationship (p 4).
Consistent with this, the APA Ethics Code indicates:
A psychologist refrains from entering into a multiple relationship if the
multiple relationship could reasonable be expected to impair the psychologist’s
objectivity, competence, or effectiveness in performing his or her functions as a
psychologist, or otherwise risks exploitation or harm to the person with whom the
professional relationship exists (p 1065).
This is underscored by the Specialty Guidelines:
Forensic psychologists recognize potential conflicts of interest in dual
relationships with parties to a legal proceeding, and they seek to minimize their
effects. . . . When it is necessary to provide both evaluation and treatment services
to a party in a legal proceeding, the forensic psychologist takes reasonable steps to
minimize the potential negative effects of these circumstances on the rights of the
party, confidentiality, and the process of treatment and evaluation (p 659).
12
The avoidance of multiple relationships is an important commonality within the varying
forensic mental health professions. The clarification of role provides the context for the
approach, methodology, and procedures to be used during interaction with the parties
associated with the legal context.
These two examples provide illustrations of the common ground across standards
applicable to different disciplines. Clearly these examples would apply at various states
of the evaluation. It is the forensic mental health professional’s responsibility to remain
diligent in the consideration of these ethical guidelines.
1.2.2 Competence and Integrity of the Evaluation
The different sources of ethical authority also provide guidance concerning the
procedural aspects of the evaluation. For instance, with respect to the notifications of the
limits of confidentiality and informed consent, the AAPL Ethical Guidelines provide:
Respect for the individual’s right of privacy and the maintenance of
confidentiality are major concerns of the psychiatrist performing forensic
evaluations . . . Special attention is paid to any limitations on the usual precepts of
medical confidentiality (p 2).
The Specialty Guidelines elaborate:
Forensic psychologists have an obligation to ensure that prospective
clients are informed of their legal rights with respect to the anticipated forensic
service, of the purposes of any evaluation, of the nature of procedures to be
employed, of the intended uses of any product of their services, and of the party
who has employed the forensic psychologist. . . . Unless court ordered, forensic
psychologists obtain the informed consent of the client or party, or their legal
13
representative, before proceeding with such evaluations and procedures. If the
client appears unwilling to proceed after receiving a thorough notification of the
purposes, methods, and intended uses of the forensic evaluation, the evaluation
should be postponed and the psychologist should take steps to place the client in
contact with his/her attorney for the purpose of legal advice on the issue of
participation. In situations where the client or party may not have the capacity to
provide informed consent to services or the evaluation is pursuant to court order,
the forensic psychologist provides reasonable notice to the client’s legal
representative of the nature of the anticipated forensic service before proceeding.
If the client’s legal representative objects to the evaluation, the forensic
psychologist notifies the court issuing the order and responds as directed. (p 659)
Forensic psychologists inform their clients of the limitations to the
confidentiality of their services and their products by providing them with an
understandable statement of their rights, privileges, and the limitations of
confidentiality (p 660).
The APA Ethics Code states:
When psychologists conduct research or provide assessment, therapy,
counseling, or consulting services in person . . . they obtain informed consent of
the individual or individuals using language that is reasonably understandable to
that person or persons . . . .
When psychological services are court ordered or otherwise mandated,
psychologists inform the individual of the nature of the anticipated services,
including . . . any limits of confidentiality, before proceeding. (p 1065)
14
Psychologists discuss with persons . . . the relevant limits of
confidentiality and . . . the foreseeable uses of the information generated through
their psychological activities (p 1066).
These guidelines underscore the importance of notification and authorization in the
evaluation, as well as the need to inform those being evaluated on the limits associated
with the evaluation.
Another area covered by these sources involves the validity and reliability of the
testing incorporated into the evaluation. The Specialty Guidelines indicate that
psychologists “have an obligation to maintain current knowledge of scientific,
professional, and legal developments within their area of claimed competence. They are
obligated also to use that knowledge, consistent with accepted clinical and scientific
standards . . .” (p 661).
Similarly, the APA Ethics Code provides:
Psychologists use assessment instruments whose validity and reliability
have been established for use with members of the population tested. When such
validity has not been established, psychologists describe the strengths and
limitations of test results and interpretation (p 1071).
Psychologists do not base their assessment or intervention decisions or
recommendations on data or test results that are outdated for the current purpose.
Psychologists do not base such decisions or recommendations on tests and
measures that are obsolete and not useful for the current purpose (p 1072).
While the AAPL Ethical Guidelines do not address reliability and validity directly, the
commitment to high standards within the profession is implied by language concerning
15
the need for honesty and objectivity within the evaluation. Clearly, the use of testing and
procedures that are reliable and valid is the preferred method of any assessment. These
standards apply throughout the evaluation and require that the mental health professional
remain current with the literature so that they can be maintained.
1.2.3 Characteristics of the Report
FMHA reports can have significant effects for the parties involved (Melton,
Petrila, Poythress, & Slobogin, 1997; Skeem & Golding, 1998). Therefore, great care
should be exercised when communicating FMHA results. The ethics authorities cited in
this section speak to this need. The AAPL Ethical Guidelines state that opinions should
reflect “honesty” and an effort “to attain objectivity” (p 3). In addition, the Commentary
associated with this guideline elaborates as follows:
Practicing forensic psychiatrists enhance the honesty and striving for
objectivity of their work by basing their forensic opinions, forensic reports, and
forensic testimony on all the data available to them. They communicate the
honesty and striving for objectivity of their work, efforts to obtain objectivity, and
the soundness of their clinical opinion by distinguishing, to the extent possible,
between verified and unverified information as well as among clinical “facts,”
“inferences,” and “impressions” (p 3).
Consistent with this, the Specialty Guidelines note:
In providing forensic psychological services, forensic psychologists take
special care to avoid undue influence upon their methods, procedures, and
products, such as might emanate from the party to a legal proceeding by financial
compensation or other gains. As an expert conducting an evaluation, treatment,
16
consultation, or scholarly/empirical investigation, the forensic psychologist
maintains professional integrity by examining the issue at hand from all
reasonable perspectives, actively seeking information that will differentially test
plausible rival hypotheses (p 661).
While many forms of data used by forensic psychologists are hearsay,
forensic psychologists attempt to corroborate critical data that form the basis for
their professional product. When using hearsay data that have not been
corroborated, but are nevertheless utilized, forensic psychologists have an
affirmative responsibility to acknowledge the uncorroborated status of those data
and the reasons for relying upon such data (p 662).
When a forensic psychologist relies upon data or information gathered by
others, the origins of those data are clarified in any professional product. In
addition, the forensic psychologist bears a special responsibility to ensure that
such data, if relied upon, were gathered in a manner standard for the profession (p
662).
In addition, the APA Ethics Code indicates that “[p]sychologists base the opinions
contained in their recommendations, reports, and diagnostic or evaluative statements,
including forensic testimony, on information and techniques sufficient to substantiate
their findings” (APA, 2002, p 1071). This call to “test rival hypothesis,” (Committee,
1991, p 661), verify information and use techniques “sufficient to substantiate” findings
underscores the importance of maintaining the integrity of the opinions being offered.
17
Finally, an example of the importance of honesty, competence, and integrity may
be seen in guidelines associated with the report itself. For instance, the Specialty
Guidelines indicate:
Forensic psychologists make reasonable efforts to ensure that the products
of their services, as well as their own public statements and professional
testimony, are communicated in ways that will promote understanding and avoid
deception, given the particular characteristics, roles, and abilities of various
recipients of the communications (p 663).
Forensic psychologists, by virtue of their competence and rules of
discovery, actively disclose all sources of information obtained in the course of
their professional services; they actively disclose which information from which
source was used in formulating a particular written product or oral testimony (p
665).
In a similar vein, the APA Ethics Code provides:
Psychologists do not make false, deceptive, or fraudulent statements
concerning their training, experience, or competence; their academic degrees;
their credentials; their institutional or association affiliations; their services; the
scientific or clinical basis for, or results or degree of success of, their services . . .
(p 1067).
The commitment to honesty and integrity within the profession is apparent in the
guidance concerning the communication of FMHA results. Such guidance, however,
applies at all stages of the FMHA process. From the presentation of a curriculum vitae to
18
the attorneys and/or judge to providing the reasoning underlying the opinion, the
importance of ethical standards is compelling.
1.3 Forensic Mental Health Assessment: Empirical Research Evidence
Thus far, the discussion has addressed relevant legal and ethical sources of
authority. This section will describe the contributions of empirical research. Nicholson
and Norcross (2000) described these efforts as attempting to “establish a forensic practice
in which reports and testimony reflect high-quality clinical assessment, document the
examiner’s adherence to the legal and ethical contours of the evaluation, focus on
relevant legal questions and criteria, describe the factual and clinical material that led to
the opinions expressed, and communicate findings in language that is comprehensible to
persons not trained as mental health professional” (p 9-10). There are two main
approaches to conducting research in this area: surveys of the respondents’ perceptions,
and review of work products. Research in each of these areas will be discussed in the
following sections.
1.3.1 Survey Research
Various researchers have surveyed evaluators, attorneys, and/or judges in order to
evaluate what constitutes a quality mental health assessment. There is some consensus
concerning the importance of listing and referencing to multiple sources (Borum &
Grisso, 1996; Bow & Quinnell, 2001; Keilin & Bloom, 1986), valid and reliable
psychological and specialized forensic testing (Borum & Grisso, 1995; Bow & Quinnell,
2001; Keilin & Bloom, 1986; Ryba, Cooper & Zapf, 2003; Tolman & Mullendore; 2003),
and specialized training (Heilbrun & Annis, 1988; Tolman & Mullendore, 2003).
19
The most comprehensive study of the views of forensic psychologists and forensic
psychiatrists was performed by Borum and Grisso (1996). They generated a list of 57
items from the literature and asked forensic mental health professionals to rate each item
as essential, recommended, optional, or contraindicated. These items formed elements of
reports on either competence to stand trial (N = 102 respondents) or criminal
responsibility (N = 96 respondents). The investigators examined consensus (using 70
percent agreement among respondents as the standard) among professionals on these
elements, i.e. in order for an element to be considered “essential,” 70% of respondent
must rate it as “essential.” A rating of important was given to those items that did not
reach 70% agreement, but did warrant examination when essential ratings were combined
with recommended ratings. Table 1 describes their findings with respect to the initial
identification of the defendant and evaluation methods and provides some of the basic
information to be included in a written forensic evaluation according to respondents. In
addition to basic descriptions, forensic evaluations contain both clinical elements and
opinion elements. The investigators constructed a similar list for these areas relevant to
evaluations of criminal responsibility and competence to stand trial (See Tables 2 and 3).
20
Table 1 Essential and Important Elements of Forensic Reports Addressing Criminal Responsibility (CR) and Competence to Stand Trial (CST) (Borum & Grisso, 1996) Consensus reached for both types of evaluations (CR and CST):
Essential Items
Basic identifying information for the defendant
Identification of referral source
Current charges
Statement of purpose of evaluation
Date of evaluation
Date of report
Place of evaluation
List of data sources
Description given to defendant concerning purpose of evaluation
Description given to defendant concerning limits of confidentiality and privilege
Important items
Description of the defendant’s understanding of the evaluation’s purpose
21
Table 2 Essential and Important Clinical Elements Within Forensic Reports Addressing Criminal Responsibility (CR) and Competence to Stand Trial (CST) (Borum & Grisso, 1996)
Consensus reached for both types of evaluations (CR and
CST)
Consensus reached for CR evaluations only
Consensus reached for CST evaluations only
Essential items Psychiatric history Information reviewed in
past mental health records
Understanding of charges/penalties
Current mental status Police information about defendant’s behavior at the time of the alleged offense
Understanding of possible pleas
Information from a formal mental status examination
Information about prior psychiatric diagnoses
Appreciation of consequences of a guilty plea and accepting a plea bargain
Current use of psychotropic medication
Information about presence/absence of substance abuse
Understanding the roles of trial participants
Defendant’s description of events surrounding the time of the alleged offense
Ability to communicate with legal counsel
Ability to consider advice (collaborate with) counse l
Ability to make decisions without distortions due to mental illness
Important items: Consensus reached for CR evaluations only Information from witnesses or other collateral sources
22
Table 3 Opinion Elements in Forensic Reports Addressing Criminal Responsibility (CR) and Competence to Stand Trial (CST) (Borum & Grisso, 1996) Consensus reached for both types of
evaluations (CR and CST) Consensus reached for CST evaluations only
Essential items Opinion about presence or absence of
mental illness/mental retardation (MI/MR)
Opinions about the nature and degree of any deficits in abilities relevant to CST
Opinion concerning the relation between the defendant’s MI/MR and the capacities relevant for the legal question
Important items Opinion about formal MI/MR
diagnosis
Explanation concerning how opinion was reached
Explanation of reasoning for opinion about formal MI/MR diagnosis
Opinion about situational circumstances in which the defendant’s deficits might be more or less likely to compromise the defendant’s trial participation
Explanation of reasoning concerning the relationship between defendant’s MI/MR and capacities relevant to the legal question
Opinion as to whether defendant’s legally relevant mental state deficits might be related to causes other than MI/MR
Contraindicated: Consensus reached for both types of evaluations (CR and CST) Opinions about legal or forensic issues other than those requested by the court
Table 2 provides an examination of the clinical elements to be contained within
reports according to respondents, while Table 3 examines the opinion within those
reports. It is interesting to note that there were no items that reached consensus for
23
Criminal Responsibility evaluations alone. In fact, the investigators noted that the
clinical and opinion elements reflected substantial disagreement between psychologists
and psychiatrists. For instance, one of the most notable differences was on the question
of including an ultimate opinion. This element did not reach consensus within either the
competence to stand trial evaluations (listed as essential by 66.7% of psychiatrists as
compared to only 50.9% of psychologists) or criminal responsibility evaluations (listed as
essential by 58.5% of psychiatrists as compared to 40.4% of psychologists). With respect
to those elements deemed contraindicated, Table 3 demonstrates the consensus on
avoiding additional opinions not requested by the court. While not meeting the standard
for consensus, other elements that yielded a rating of “contraindicated” included
information from the police concerning the defendant’s behavior at the time of arrest, a
report of the defendant’s view of the offense and description of actions, and police views
of the offense.
One might note the overlap between the “essential” items and the content of the
various ethical guidelines discussed earlier. The authors did caution, however, that
standards of practice as defined by experts’ consensus may not be indicative of
appropriate practice when they diverge from those of ethics guidelines (Borum & Grisso,
1996). They point to the explanation of the reasoning underlying an opinion that a
defendant’s cognitive deficits are relevant to the legal question. While this was not seen
as essential within the study, it is required by the Specialty Guidelines.
Ryba, Cooper, and Zapf (2003) employed a similar methodology in examining
juvenile competence to stand trial evaluations. These investigators limited their
participants by discipline (psychologists only) and reduced the number of items to 17. Of
24
these, seven were considered essential using the same 70% agreement as consensus
standard, while nine were considered important (See Table 4). A comparison of Tables
1-4 indicates some consistency across samples, disciplines, and types of FMHA as to the
essential and non-essential but important elements in FMHA. Clearly there are some
elements seen as essential across different types of evaluation.
One of the common elements within these studies is the use of psychological and
specialized forensic testing. Researchers have considered the frequency and type of tests
being utilized (Borum & Grisso, 1995; Keilin & Bloom, 1986; Lally, 2003; Ryba, Cooper
& Zapf, 2003; Tolman & Mullendore, 2003). Table 5 presents a comparison of the test
usage frequency described in these studies.
25
Table 4 Elements of Forensic Juvenile Evaluations Rated by Psychologists (N = 82) by Importance (Ryba, Cooper & Zapf, 2003) Essential items Current Mental Status Understanding of charges or penalties Competence to stand trial abilities Capacity to participate with attorney Mental illness opinion Understanding of trial process Mental illness/mental retardation/immaturity rationale Ultimate opinion Important items Medical history Self-control Legal reference to competence to stand trial Maturity opinion Current status in other settings Causal explanations Psychological testing Forensic testing
26
Table 5 Studies Describing the Use Frequency of Psychological and Specialized Forensic Tests in FMHA*
Psychological Tests Test Keilin &
Bloom (1986)
Borum & Grisso (1995)
Ryba, Cooper & Zapf
(2003)
Tolmon & Mullendore
(2003) WAIS 29/0 a 78/57 b WISC–III/WAIS-III 0/45 a 82 c Unspecified IQ tests 12 c WMS-R 16/0 b 2 c WRAT 0/21 a 4/3 b 24 c MMPI/MMPI-2 71/7 a 94/80 b 74/54 d MMPI–A/2 56 c MCMI 32/17 b 3 c MACI 15 c Rorschach 42/29 a 32/30 b 16 c TAT 38/39 a 8/10 b 12 c Sentence Completion 12/12 a 6/3 b 10 c Bender – Gestalt 12/23 a 12/20 b 15 c Miscellaneous Projective Drawings
6/33 a 4/7 b
Draw-a-Person 6/20 a 6 c HRNB 8/3 b
(table continues)
27
Table 5 (continued) Forensic Assessment Tests Test Keilin &
Bloom (1986)
Borum & Grisso (1995)
Ryba, Cooper & Zapf
(2003)
Tolmon & Mullendore
(2003) PCL-R 8/0 b 63/7 d CAST-MR 0/2 b 45 c R-CRAS 41/10 b 8 c HCR-20 31/2 d VRAG 27/9 d MacCAT-CA 21 c CST 21 c SIRS 12/0 b 5 c ICD-10 2/13 d GCCT 11 c Grisso 11 c CAI 8 c
Note. WAIS = Wechsler Adult Intelligence Scale Revise; WISC–III/WAIS-III = Wechsler Intelligent Scale for Children/Wechsler Adult Intelligence Scale; WMS-R = Wechsler Memory Scale-Revised; WRAT = Wide Range Achievement Test-Revised; MMPI/MMPI-2 = Minnesota Multiphasic Personality Inventory/2; MMPI–A/2 = Minnesota Multiphasic Personality Inventory—Adolescent or 2; MCMI = Millon Clinical Multiaxial Inventory (I&II); MACI = Million Adolescent Clinical Inventory; TAT = Thematic Apperception Test; HRNB = Halstead Reitan Neuropsychological Battery; PCL-R = Psychopathy Checklist-Revised; CAST-MR = Competency Assessment for Standing Trial for Defendents with Mental Retardation; R-CRAS = Rogers Criminal Responsibility Assessment Scales; VRAG = Violence Risk Appraisal Guide; MacCAT-CA = MacArthur Competency Assessment Tool; CST = Competency Screening Test; SIRS = Structured Interview of Reported Symptoms; ICD-10 = International Classification of Diseases (10th ed.); GCCT = Georgia Court Competency Test; Grisso = Grisso’s instruments for assessing understanding and appreciation of Miranda rights; CAI = Competency to Stand Trial Assessment Instrument. * All numbers represent percentages within the individual study a The top number indicates the percentage used within testing of Adults, while the bottom number indicates those used testing Children and Adolescents. b The top number indicates the percentages employed by psychologists, while the bottom number indicates test usage among psychiatrists. c All participants were psychologists. d The top number indicates test usage among diplomates in forensic psychology, while the bottom number indicates usage among general clinicians.
28
It is interesting to note the frequency of specific tests within the study. For
instance, the frequency of use of the MMPI/MMPI-2 within forensic testing seems to
have increased. This may be due to the proliferation of research on the MMPI/MMPI-2,
the increase in availability of the test, or perhaps the acceptance of this test within the
forensic context. The actual reason can not be determined from Table 5 because of the
differing methodologies of the studies; however, the table does speak to the increase in
use of testing in general over time.
Lally (2003) surveyed diplomates in forensic psychology as to their test usage
preferences. The American Board of Forensic Psychology awards the distinction of
diplomate to those professionals who have engaged in over 1000 hours of forensic
psychology within a five year period and have completed 100 hours of specialized
training in forensic psychology. In addition, applicants seeking the diplomate must
submit two work samples to be evaluated and, if approved, complete a three hour oral
examination administered by three diplomates. Lally chose these professionals because
they “appear to represent an ideal sample to query about the acceptability of a test or
technique within the field of forensic psychology” (p 492). Six types of FMHA
evaluation types or issues were considered: mental state at the time of the offense, risk for
future violence, risk for future sexual violence, competency to stand trial, competency to
waive Miranda rights, and malingering. Participants were asked to rate a number of
specific tests as to whether these tests would be considered unacceptable, acceptable, or
acceptable and recommended. As may be seen in Table 6, specific tests are more suited
to aid in the evaluation of a particular forensic issue than others. For instance, the PCL-R
was indicated for use when evaluating violence potential, but not for the evaluation of
29
mental state at the time of the offense, competency to stand trial, etc. In addition, there
seems to be some consensus within the respondents as to the unacceptability of tests. The
use of projective drawings, for example, was seen as unacceptable for all forensic
evaluations.
33
30
Una
cc
Acc
89
72
72
55
66
Mal
inge
ring
(N
= 5
3)
Rec
75
92
51
53
68
Una
cc
64
Acc
95
78
70
63
63
55
Com
pete
ncy
to
Wai
ve M
iran
da
Rig
hts
(N =
40)
Rec
100
70
68
55
63
Una
cc
83
Acc
87
77
69
60
58
50
Com
pete
ncy
to S
tand
T
rial
(N
= 5
2)
Rec
90
73
64
52
50
54
62
Una
cc
62
Acc
95
76
76
52
60
50
Ris
k fo
r S
exua
l V
iole
nce
(N =
42
)
Rec
71
81
55
Una
cc
Acc
67
88
61
90
82
71
53
53
Ris
k fo
r V
iole
nce
(N =
51
)
Rec
Una
cc
81
65
60
Acc
96
94
71
69
58
54
52
Typ
e of
Eva
luat
ion
Men
tal
Sta
te a
t th
e T
ime
of t
he O
ffen
se
(N =
52
)
Rec
60
54
Tab
le 6
E
xam
inat
ion
of A
ccep
tabi
lity
of
Tes
t U
sage
for
Dif
feri
ng T
ypes
of
For
ensi
c Q
uest
ions
(L
ally
, 200
3)
P
sych
olog
ical
Tes
t
WA
IS-I
II
MM
PI-
2
HR
NB
PA
I
Lur
ia-
Neb
rask
a
MC
MI-
III
Sta
nfor
d- B
inet
-
Rev
ised
IFI-
R
Rey
Pro
ject
ive
D
raw
ings
TA
T
Sen
tenc
e
Com
plet
ion
Ror
scha
ch
16
PF
MC
MI-
II
Tab
le c
onti
nues
31
Una
cc
Acc
89
64
53
Mal
inge
ring
(N
= 5
3)
Rec
58
Una
cc
Acc
88
Com
pete
ncy
to
Wai
ve M
iran
da
Rig
hts
(N =
40)
Rec
55
Una
cc
Acc
90
85
77
65
Com
pete
ncy
to S
tand
T
rial
(N
= 5
2)
Rec
56
Una
cc
Acc
91
71
67
62
60
57
Ris
k fo
r S
exua
l V
iole
nce
(N =
42)
Rec
62
Una
cc
Acc
88
73
73
Ris
k fo
r V
iole
nce
(N =
51
)
Rec
63
Una
cc
Acc
94
Typ
e of
Eva
luat
ion
Men
tal
Sta
te a
t th
e T
ime
of t
he O
ffen
se
(N =
52
)
Rec
Tab
le 6
(C
onti
nued
)
Psy
chol
ogic
al
Tes
t R
-CR
AS
PC
L-R
PC
L-S
V
VR
AG
SO
RA
G
Pen
ile
Ple
thys
mog
raph
S
VR
-20
Mac
CA
T-C
A
CA
I C
ST
GC
CT
G
riss
o
SIR
S
TO
MM
V
IP
Not
e. A
ll n
umbe
r ar
e in
dica
tive
of
freq
uenc
y pe
rcen
tage
s. R
ec =
Rec
omm
ende
d; A
cc =
Acc
epta
ble;
Una
cc =
Una
ccep
tabl
e; P
CL
-R =
Psy
chop
athy
Che
ckli
st-
Rev
ised
; W
AIS
= W
echs
ler
Adu
lt I
ntel
lige
nce
Sca
le;
SIR
S =
Str
uctu
red
Inte
rvie
w o
f R
epor
ted
Sym
ptom
s; M
acC
AT
-CA
= M
acA
rthu
r C
ompe
tenc
y A
sses
smen
t T
ool;
Gri
sso
= G
riss
o’s
inst
rum
ents
for
ass
essi
ng u
nder
stan
ding
and
app
reci
atio
n of
Mir
anda
rig
hts;
.MM
PI-
2 =
Min
neso
ta M
ulti
phas
ic P
erso
nali
ty I
nven
tory
-2;
R-
CR
AS
= R
oger
s C
rim
inal
Res
pons
ibil
ity
Ass
essm
ent
Sca
les;
CA
I =
Com
pete
ncy
to S
tand
Tri
al A
sses
smen
t In
stru
men
t; C
ST
= C
ompe
tenc
y S
cree
ning
Tes
t; P
CL
-SV
=
Psy
chop
athy
Che
ckli
st-S
cree
nin
g V
ersi
on;
VR
AG
= V
iole
nce
Ris
k A
ppra
isal
Gui
de;
HR
NB
= H
alst
ead
Rei
tan
Neu
rops
ycho
logi
cal
Bat
tery
; P
AI
= P
erso
nali
ty
Ass
essm
ent
Inve
ntor
y; R
ey =
Rey
Fif
teen
Ite
m V
isua
l M
emor
y T
est;
GC
CT
= G
eorg
ia C
ourt
Com
pete
ncy
Tes
t; T
OM
M =
Tes
t of
Mem
ory
Mal
inge
ring
; S
OR
AG
=
Sex
ual
Off
ende
r R
isk
App
rais
al G
uide
; IF
I-R
= I
nter
disc
ipli
nary
Fit
ness
Rev
iew
-Rev
ised
; S
VR
-20
= S
exua
l V
iole
nt R
isk;
MC
MI-
III
= M
illo
n C
lini
cal
Mul
tiax
ial
Inve
ntor
y (I
II);
VIP
= V
alid
ity
Indi
cato
r P
rofi
le;
TA
T =
The
mat
ic A
pper
cept
ion
Tes
t; 1
6PF
= S
ixte
en P
erso
nali
ty F
acto
r Q
uest
ionn
aire
; M
CM
I-2
= M
illo
n C
lini
cal
Mul
tiax
ial
Inve
ntor
y II
.
32
1.3.2 Research on Report Characteristics
A second research methodology involves examination of written FMHA reports.
This approach has the advantage of surveying actual practice, and so can provide more
normative data on FMHA practice.
Petrella and Poythress (1983) compared reports written by psychiatrists with
reports written by psychologists or social workers. They considered reports on
competence to stand trial (N = 120) and criminal responsibility (N = 80). Reports were
rated on thoroughness and quality by legal experts (a judge, an attorney, and a law
professor). For both types of FMHA, the investigators reported that psychologists and
social workers wrote reports that were more thorough and were of comparable quality to
those written by psychiatrists. The dependent measure of thoroughness was measured by
examining the number of times the clinician sought outside information, and by how
many lines were typed within the various sections of the clinician’s notes. For
competency to stand trial evaluations, social workers had, on average, 40% more outside
contacts than psychiatrists, while psychologists had 20% more outside contacts than
psychiatrists. In addition, with respect to typed information, the mean total of clinical
notes was significantly higher for social workers (X = 122.7) and psychologists (X =
144.7) than for psychiatrists (X = 90.8, p = .0001). For criminal responsibility
evaluations, psychologists had 30% more contacts than the psychiatrists sampled and had
significantly more clinical notes (X = 171.6 for psychologists vs. X = 136.2 for
psychiatrists, p = .01). The researchers examination of overall quality did not produce
significant findings when comparing social workers, psychologists and psychiatrists on
competency evaluations; however, when examining criminal responsibility evaluations,
33
psychologists received significantly higher ratings (X = 7.6) in overall quality from the
attorney than psychiatrists (X = 6.5, p < .05). There was no such significant difference
for the ratings given by the judge.
Heilbrun and Collins (1995) used forensic reports written in both community (N =
110) and hospital (N = 167) settings in Florida to examine both evaluator characteristics
and use of specific procedures. They reported that community reports were typically
written by doctoral- level psychologists (50%) or psychiatrists (46%); while hospital
reports were written only by psychologists. A very high proportion (97%) of community
reports were written by licensed professionals, while the majority of hospital evaluators
were supervised (69%), with only 15% of the hospital evaluators having a license. Table
7 describes components of evaluations from the community and the hospital,
respectively.
In a second study, Heilbrun, Rosenfeld, Warren and Collins (1994) explored the
specific question of the type and frequency of third-party information used in FMHA
reports in two states: Virginia (N = 316) and Florida (N = 277). They found that offense
information tended to be consistently utilized within both states, while use of mental
health records varied slightly (68% of Florida evaluations vs. 43% of Virginia
evaluations). In contrast, the researchers noted that victim/witness statements were rarely
cited in reports from either state.
34
Table 7 Components of Community (N = 110) and Hospital (N = 167) FMHA Reports (Heilbrun & Collins, 1995) Setting Report Element Community (N = 110) Hospital (N = 167) Reference to Court Order
91% 97%
Notification of Purpose
30% 97%
Psychological Testing
41% 13%
Use of Mental Status Exam
60% 63%
Third-Party Information – arrest reports
95% 70%
Ultimate Legal Issue 95% 99%
Other researchers have studied FMHA reports in the context of the case
disposition. Hecker and Steinberg (2002) considered juvenile court dispositions (N =
172) in Philadelphia and reported a significant relationship (χ2 (86) = 6.77, p < .001)
between reports that contained a full explanation of recommendations and the likelihood
that the judge would follow that recommendation. The investigators examined the
content areas in the reports, as well as the quality of that content. Content areas included
family history, educational history, criminal history, mental health history drug/alcohol
history, cognitive functioning, personality functioning, and explanation of
recommendations. Ratings given included 0 (meaning content area was absent), 1
(content area was present but insufficient), and 2 (content area was present and
considered sufficient or better). In order to receive a 2, the content area “had to meet or
exceed the criteria recommended by the leading experts as being essential to explaining
that particular aspect of a juvenile’s functioning” (Hecker & Steinberg, 2002, p 301).
35
Some content areas were consistently present (e.g. personality functioning was included
in 100% of reports), while others were seen less often (e.g. offense history was observed
in 29% of reports). The quality of these content areas was rated as generally low,
however. For example, the mental health history content area was rated as “sufficient”
for only 10% of those reports containing mental health history. While all reports
contained personality functioning, only 31% of those were rated as “sufficient” or better.
These results suggest significant problems with juvenile FMHA in thoroughness and
quality, but also suggest that judges are inclined to place more weight on FMHA reports
in which the evaluators’ reasoning is clearly described.
Skeem, Golding, Cohn and Berge (1998) used expert raters to evaluate
competence to stand trial reports in Utah (N = 50). The experts consisted of two
experienced forensic psychologists and the first author. The psychologists had over ten
years of experience working as licensed psychologists and seven years of experience
working chiefly in the field of forensic psychology. The authors found that clinicians
generally provide little information as to their reasoning concerning the relationship
between functional legal impairment and the symptoms of psychopathology. A central
function of forensic mental health assessment is to examine the link between functional
abilities/capacities and such clinical symptoms. The absence and/or poor quality of such
information means that this goal is not being met.
These studies tend to derive conclusions concerning quality from the standards
provided by the literature (Borum & Grisso, 1995; Bow & Quinnell, 2001; Heilbrun &
Collins, 1995; Keilin & Bloom, 1986; Ryba, Cooper & Zapf, 2003; Skeem, Golding,
Cohn & Berge, 1998; Tolman & Mullendore; 2003). One recent study has successfully
36
incorporated the literature into an extensive Coding Protocol in order to examine the
characteristics and quality of juvenile competency to proceed evaluations in Florida
(Christy, Douglas, Otto, & Petrila, 2004). The Coding Protocol was structured,
containing questions in the following sections: General/Sources, Forensic Assessment,
Psychological Assessment, Mental State, Competency Standards, Competency
Conclusions, and Sanity. The authors examined 1,357 reports obtained from the Florida
Department of Children and Families. These reports represent all the youths adjudicated
incompetent to proceed from May 1997 to November 2001. The use of the Coding
Protocol allowed an extensive examination of the content of these reports, including
specific information concerning test usage, diagnosis, and competency standards utilized,
etc. Based on the findings of the study, the authors offered seven recommendations that
mirror some of those provided by Heilbrun (2001). These include: (1) Know the law and
answer the legal questions posed; (2) Possess or develop expertise in the area of
competency assessment; (3) Know the difference between forensic and therapeutic
assessment; (4) Know professional and ethical principles relevant to forensic assessment;
(5) Only use assessment instruments that are relevant to and appropriate for the setting;
(6) Use multiple sources of information and consider response style; and (7) Follow good
general clinical practice by thoroughly reporting details of the assessment and mental
status examination.
1.4 Empirical Study of the Quality of Forensic Mental Health Assessment
While there are many studies that examine the varying aspects of forensic mental
health assessment, there are few that investigate the construct of quality. The first is
Petrella and Poythress (1983), who used measures of both thoroughness and quality. The
37
measure of thoroughness was operationalized using frequency of contact with multiple
sources and comprehensiveness of clinical notes. To assess quality in one phase of the
study, Petrella and Poythress used an attorney, a judge, and a law professor; the second
phase used only a judge and an attorney. These expert raters were asked to rate a series
of questions on nine-point Likert scales, as well as rank order the reports in terms of
quality. Questions included familiarization with legal criteria to be examined, clarity of
clinician’s opinion, factual basis for the opinion, expected clinical characteristics, use of
technical jargon, impression of overall quality, and sufficiency of information upon
which a judge might render a decision. The initial question was whether there was a
difference between medical and non-medical evaluators. They found that reports written
by psychologists were rated as highly, or higher, than those written by psychiatrists.
In another study of quality within forensic mental health assessment, Hecker and
Steinberg (2002) modeled their measures on those used by Petrella and Poythress (1983)
as well as those developed by Heilbrun and Collins (1995). Hecker and Steinberg used a
quality measure from a three-point scale rated by trained coders. This scale ranged from
zero, which indicated that the content area was absent from the report, to two, which
indicated that the content area was present and rated as sufficient or better. The authors
state that to receive a rating of two, the content area in question “had to meet or exceed
the criteria recommended by the leading experts as being essential to explaining that
particular aspect of a juvenile’s functioning” (Hecker & Steinberg, 2002, p 301). Scores
of one indicated that the content area was present, but insufficient.
The literature of forensic mental health assessment has used varying
methodologies to investigate the FMHA process. Each methodology has its limitations.
38
For instance, those that employ survey research must contend with low response rates
and, hence, limited generalizability. Moreover, practices endorsed by those surveyed
may not reflect actual practice. Conversely, investigators who focus on actual work
products are limited as to the generalizability to other settings and types of evaluations.
Research reviewed thus far has tended to focus on a small or limited number of
issues associated with forensic mental health assessment (e.g. use of third-party
information, use of tests). The current study would applied a set of recently described
principles to FMHA reports, with independent ratings of quality applied toward the
validation of these principles to allow for a more complete view of FMHA.
1.5 Principles of Forensic Mental Health Assessment
Until recently, there was no description of “common principles” of forensic
mental health assessment that could be applied across the range of potential types of
evaluations performed. Heilbrun (2001) proposed 29 such principles of FMHA that
encompass the broad range of issues associated with all types of forensic evaluations.
The purposes of this description was (a) to provide a generalizable approach to training;
(b) to facilitate research; and (c) to promote the development of relevant policy and better
practice of the field (Heilbrun, 2001). Subsequently, Heilbrun, Marczyk and DeMatteo
(2002) provided a casebook illustrating the application of these principles to varying legal
questions. These principles have been applied to a case to illustrate how research might
improve FMHA quality (Heilbrun, DeMatteo, & Marczyk, 2004), and have been
examined in their applicability to the forensic assessment of sexual offenders (Heilbrun,
2003) and forensic neuropsychological methods (Heilbrun et al, 2004).
39
The principles described in Heilbrun (2001) are subsumed under four broad areas:
preparation, data collection, data interpretation, and communication. Within these areas,
each principle is discussed with reference to the applicable legal, ethical and professional
standards, as well as pertinent scientific evidence. In addition, each principle is classified
as established or emerging. A principle is determined to be established if it is “largely
supported by research, accepted in practice, and consistent with ethical and legal
standards” (Heilbrun, DeMatteo, & Marczyk, 2004, p 33). An emerging principle is
“supported in some areas, with mixed or absent evidence from others, or supported by
some evidence, with continuing disagreement among professionals regarding their
application” (Heilbrun, DeMatteo, & Marczyk, 2004, p 33). Since the proposed study
would apply those principles toward rating FMHA reports, they will each be summarized
briefly.
1.5.1 Identify Relevant Forensic Issues
This established principle promotes a focus on the “capacities, skills, and
functional abilities that are relevant to the broader legal question” (Heilbrun, 2001, p 21)
rather than the legal question itself. This distinction is important across several
principles; the focus for evaluators should be on the relevant behaviors and capacities that
relate to the legal question rather than the ultimate question to be decided by the court.
1.5.2 Accept Referrals Only Within Area of Expertise
This established principle encourages professionals to acknowledge the
limitations of their training and competence. It is widely accepted that mental health
professionals should provide services only within an area of expertise and consistent with
their experience.
40
1.5.3 Decline Referral When Evaluator Impartiality is Unlikely
This principle reiterates the professional tenet of striving to maintain impartiality
in the assessment process. This principle is considered established when the clinician
acts as evaluator for the court, prosecution, defense, or plaintiff, but emerging when the
professional is acting in a consulting capacity.
1.5.4 Clarify the Evaluator’s Role With the Attorney
This emerging principle addresses the designation of role within the case. The
possible roles include: court-appointed expert, expert for a party within the legal context,
consultant, and fact witness. With each role, specific expectations and procedures will
apply. The clarification of the clinician’s role within the case will aid in defining these
expectations and procedures for both the clinician and attorney.
1.5.5 Clarify Financial Arrangements
This established principle underscores the importance of establishing the fee
arrangement prior to rendering services. An exception to this principle occurs when fee
arrangements are specified by law or policy.
1.5.6 Obtain Appropriate Authorization
This established principle encourages the forensic clinician to obtain a signed
order (if court-appointed) or obtain authorization from the individual being evaluated and
their attorney (if hired by the parties, defense or plaintiff). This authorization is required
under both by ethical and legal standards.
41
1.5.7 Avoid Playing the Dual Roles of Therapist and Forensic Evaluator
This established principle enjoins against assuming two roles within a single case.
For example, the therapeutic role must not be confused with the forensic role when
agreeing to provide services.
1.5.8 Determine the Particular Role to be Played Within Forensic Assessment if the
Referral is Accepted
This emerging principle suggests that clinicians maintain their designated role
throughout a single case. This choice should take place at the beginning of the clinician’s
involvement. This should prevent some potential problems with impartiality and attorney
expectations. An exception to this principle may occur when the clinician moves from
acting as an evaluator to acting as a consultant. This may occur when it is clear from the
results of the evaluation that the attorney will not request a report or testimony. As a
consultant, impartiality is unnecessary; thus, moving from a role requiring impartiality to
one that has no such requirement would not be harmful.
1.5.9 Select and Employ a Model to Guide Data Gathering, Interpretation, and
Communication
This emerging principle examines the significance of utilizing an appropriate
model to guide data collection, interpretation, and communication. Two such models are
examined – the Grisso model and the Morse model. The Grisso model (Grisso, 1986)
incorporates six characteristics of legal competencies: functional, contextual, causal,
interactive, judgmental, and dispositional abilities. The Morse model has three
components: mental disorder, functional abilities associated with the relevant legal
questions, and the causal connection between the first and second components.
42
1.5.10 Use Multiple Sources of Information For Each Area Being Assessed
This established principle emphasizes the importance of examining consistency of
information across sources. The motivations of the individual being assessed in FMHA
may result in distorted accuracy of self- reported information. Comparison across
multiple sources of information can reduce such distortions.
1.5.11 Use Relevance and Reliability (Validity) as Guides for Seeking Information and
Selecting Data Sources
This established principle recommends that clinicians choose sources of
information, including collateral interviews, and psychological tests to ensure the overall
accuracy of the assessment. This also promotes greater relevance, an important part of
evidentiary law.
1.5.12 Obtain Relevant Historical Information
This established principle serves as a guide to evaluators in terms of determining
the amount and type of historical information required. While some evaluations may
require more historical information than others, almost all evaluations require some
history of the individual being evaluated.
1.5.13 Assess Clinical Characteristics in Relevant, Reliable, and Valid Ways
This established principle suggests using relevance, reliability, and validity as
guides when choosing which clinical characteristics to evaluate and how best to evaluate
them. Heilbrun (2001) defined clinical characteristics as “symptoms of disorders of
mental, emotional, or cognitive functioning that are recognized in an authoritative source
such as the DSM-IV, regardless of whether they constitute a fully diagnosable disorder”
(p 121).
43
1.5.14 Assess Legally Relevant Behavior
This established principle emphasizes the focus on the capacities and behavior
that are directly relevant to the legal question. Relevance and reliability are suggested as
guides in selecting assessment tools for this purpose.
1.5.15 Ensure That Conditions for Evaluation Are Quiet, Private, and Distraction-Free
This established principle reminds clinicians that environmental factors can play a
role in the validity of the assessment. It is not unusual for the FMHA to take place in a
setting that may not be conducive to the sharing of sensitive information, testing, or
confidentiality (e.g., a correctional facility). These factors should be considered and, if
possible, improved. These issues are balanced with other considerations such as security
and time constraints.
1.5.16 Provide Appropriate Notification of Purpose and/or Obtain Appropriate
Authorization Before Beginning
This established principle takes into account the role being fulfilled for the
conducting of the evaluation. If the evaluator is working under a court order, then
informed consent is not necessary; however, notification of the nature and purpose of the
evaluation, the authorizing entity, and the limits of confidentiality are important. If
retained by a party’s attorney, then the evaluation is voluntary and informed consent is
needed.
1.5.17 Determine Whether the Individual Understands the Purpose of the Evaluation and
Associated Limits on Confidentiality
This established principle reiterates the importance of the notification of purpose
or informed consent. For either of these to be considered meaningful, the person being
44
evaluated must understand them. This principle speaks to the procedures to be used if
this understanding is not apparent.
1.5.18 Use Third Party Information in Assessing Response Style
This established principle examines the importance of using a multi-method
approach to determine response style of the individual being assessed. The
categorization of responses as over- or underreporting is easier when multiple sources of
information are used. This principle also encourages consideration of the consistency of
the individual’s responses with descriptions provided in records and by collateral
observers.
1.5. 19 Use Testing When Indicated in Assessing Response Style
This emerging principle constitutes the ideal that psychological and specialized
testing may be used to assess response style. Some psychological assessment tools have
measures of consistency, e.g. the Minnesota Multiphasic Personality Inventory-2’s
(MMPI-2) F-scale; while some tools are designed to measure malingering specifically,
e.g. the Structured Interview of Reported Symptoms (SIRS).
1.5.20 Use Case-Specific (Idiographic) Evidence in Assessing Clinical Condition,
Functional Abilities, and Causal Connection
This established principle describes the use of information in the specific case to
evaluate the individual’s functioning, both currently and in the past, relative their
potential. This allows for comparisons of abilities and capacities in light of the functional
areas being assessed.
45
1.5.21 Use Nomothetic Evidence in Assessing Clinical Condition, Functional Abilities,
and Causal Connection
This established principle emphasizes the value of using appropriate, empirical
data and testing with the individual being assessed. It is important that these techniques
have normative data, which can allow referencing of group data to the individual.
1.5.22 Use Scientific Reasoning in Assessing Causal Connection Between Clinical
Condition and Functional Abilities
This established principle suggests approaching the evaluation as a testing of
several hypotheses. Upon acquisition from one source, the information can be verified
by another source. In this fashion, accepting and rejecting of hypotheses can aid in the
forming of opinions in a way consistent with the structure of the scientific method.
1.5.23 Do Not Answer the Ultimate Legal Question Directly
This emerging principle considers the long debated question of whether the
evaluator should answer the legal question to be decided by the court. It has been argued
by some that the answer to the ultimate legal question dilutes the scientific nature of the
opinion with other factors such as moral, political, and societal values (Melton, Petrila,
Poythress & Slobogin, 1997). On the other hand, the expectations of the judge and/or
attorneys may be such that an evaluation could be excluded without an ultimate opinion
included (Melton, Petrila, Poythress & Slobogin, 1997). Some suggest that a balance
may be struck in presenting opinions that are primarily focused on functional abilities,
along with the limitations of those findings (Grisso, 2003; Melton, Petrila, Poythress &
Slobogin, 1997).
46
1.5.24 Describe Findings and Limits so That They Need Change Little Under Cross
Examination
This established principle maintains that findings that are thorough in their
description and supported by multiple sources, with the limitations of those findings
explicitly described, will change little under cross-examination. The cross-examination
process can be daunting, but clear, well supported, well documented opinions can make
the process less challenging.
1.5.25 Attribute Information to Sources
This established principle suggests linking information to its source(s) to better
document the basis for the evaluator’s opinions and to help the judge and/or opposing
attorney to understand or re-create the information.
1.5.26 Use Plain Language; Avoid Technical Jargon
This established principle emphasizes that an opinion that cannot be understood
will be less helpful to the fact- finder than one that is clear in its meaning. It is important
for those who will be using the information provided by the evaluator to be able to fully
understand what is being communicated. These individuals may vary in expertise,
experience, or training. To that end, an evaluator should avoid technical jargon, if
possible. When technical terms cannot be avoided, a definition should be provided.
1.5.27 Write Report in Sections, According to Model and Procedures
This established principle suggests that the utilization and application of many of
the other principles is easier to communicate when the organization of the report is in
sections. Suggested sections include (1) referral, (2) procedures, (3) relevant history, (4)
47
current clinical condition, (5) forensic capacities, and (6) conclusions and
recommendations.
1.5.28 Base Testimony on the Results of the Properly Performed Forensic Mental Health
Assessment
This established principle underscores the importance of the overall quality of the
forensic mental health assessment process. A poorly performed assessment could result
in an irrelevant or inaccurate opinion. In order to communicate more efficiently and
effectively, the basis of all evaluators’ opinions should be well-documented and well-
supported within the written report.
1.5.29 Testify Effectively
This principle is described as either established or irrelevant, depending on the
stylistic and substantive aspects of the information provided. When the substance and
style of the forensic mental health assessment is strong, testimony will be effective and
meaningful. When testimony is based on weak substance, then this effectiveness is
minimized. In addition, if the testimony is driven by stylistic variables alone, then this
should be noted and the opinion afforded little weight.
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CHAPTER 2: THE CURRENT STUDY
The first objective of this study was to examine the use of the standard principles
of practice provided by the literature; in particular, the use of those encompassed in
Principles of Forensic Mental Health Assessment (Heilbrun, 2001). These principles had
not been applied to FMHA reports in an effort to analyze such reports. In addition, it was
hoped that such an examination would add to the literature concerning the content of
current report writing.
The second objective involved obtaining an independent measure of the quality of
the written reports using the methodology of Petrella and Poythress (1983). Expert raters
were asked to rate questions similar to those contained in the 1983 study (e.g. appropriate
use of legal criteria, helpfulness of the report to the legal decision-maker, overall quality
of the report).
2.1 Hypotheses
Completion of these objectives allowed for the examination of multiple
hypotheses.
1. There exists a positive relationship between the number of principles
followed in the report and the independent rating of report quality. This was
considered by examining the strength of the correlation between the number
of principles rated as present and the overall independent rating of report
quality. Multiple regression analysis was used to examine the question of
which principles are most strongly related to overall report quality.
2. There exists a positive relationship between the number of principles
followed in the report and the independent rating of report usefulness to the
49
court. This was considered by the strength of the correlation between the
number of principles rated as present and the overall independent rating of
report usefulness. Multiple regression analysis was used to examine the
question of which principles are most strongly related to overall report
usefulness.
3. There exists a positive relationship between the estimated length of the report
and the overall independent rating of report quality. This will be considered
by the strength of the correlation between the recorded length of the report
and the overall independent rating of report quality.
50
CHAPTER 3: METHOD
FMHA reports addressing the issues of competence to stand trial and
hospitalization (N = 125) were obtained from PMHCC, Inc. (formerly The Philadelphia
Mental Health Care Corporation). The name of the defendant, as well as any other
potential identifying information was removed before being copied, thus de-identifying
all reports.
3.1 Measures
The measures used within the current study included a computerized Coding
Protocol (See Appendix A) and a written Rater Questionnaire (See Appendix B).
3.1.1 Coding Protocol.
The Coding Protocol used was a modified version of that developed by Christy,
Douglas, Otto & Petrila (2004). It consists of a multi-sectioned database within
Microsoft Access allowing coders to enter data directly into the database (See Appendix
A). The modifications included the operationalization of principles of forensic mental
health assessment developed by Heilbrun (2001). Not all principles could be rated from
the reports alone (some apply to communication with attorneys, for instance, and others
to expert testimony). A complete list indicating those included and excluded is located in
Appendix C. The protocol utilized ten sections which include (1) Evaluator Information,
(2) General Information, (3) Source Information, (4) Forensic Assessment, (5)
Psychological Assessment, (6) Mental State Information, (7) Legal Issues, (8)
Competency Standards, (9) Competency Conclusions, and (10) Sanity Conclusions. The
Evaluator Information section includes questions examining the role of the evaluator
within the evaluation, as well as their use of a model, and indicated discipline. Due to
51
space constraints within the sections, the Evaluator section also contains coding for
indication of referral source and authorization obtained. The General Information section
addresses the situational factors of the evaluation (e.g. location and conditions of the
evaluation), along with the organization of the report, including length and language use.
This section also contains questions concerning the notification of purpose. The Source
Information section allows for the coding of the use and type of sources used within the
report, as well as some of the areas of history within the report. The Forensic Assessment
section examines the use of specific forensic assessment instruments. The Psychological
Assessment section examines the use of specific psychological assessment tools. The
Mental State section indicates the types of information included with respect to diagnosis
and mental functioning. The Legal Issues section reflects the inclusion of the specific
issue to be examined within the report, along with the relevant legal standards associated
with those issues. The Competency Standards section examines the findings and
opinions of the evaluator with respect to competency focusing on the specific abilities
associated with the construct. In addition, this section examines the use of testing,
interviews, and/or other sources within the description of these findings. The
Competency Conclusions section focuses on the conclusions reached by the evaluator,
including the basis of those conclusions. Finally, the Sanity Conclusions section
examines the opinions offered with respect to the legal question of sanity at the time of
the offense.
3.1.2 Expert Rater Questionnaire.
The expert rater questionnaire was based on the measure used by Petrella and
Poythress (1983). The expert rater was asked a series of three questions in an effort to
52
examine the relevance, helpfulness, and quality of each report. Each question asks the
rater to rate the report on a Likert Scale ranging from 1-9, with lower ratings reflecting a
more negative view on the matter being rated (See Appendix B).
53
CHAPTER 4: PROCEDURES
4.1 Reports.
Reports were randomly sampled by selecting every fifth file in alphabetical order
from the years 2002-2004. Reports were then de- identified in order to maintain
confidentiality, including the identification of the author. The de-identification process
involved the redaction of all names, including defendant, evaluator, and site.
4.2 Coders and Expert Raters.
Coders included two undergraduates trained on the Coding Protocol by the author.
Training consisted of practice with sample reports in order to ensure competence and
comfort with the Coding Protocol. The coding protocol also contained a box which
allowed coders to identify any questions, problems, or concerns they had during coding.
In order to examine inter-rater reliability, both coders were required to code fifteen
identical reports. Analysis of this reliability was conducted by examining the consistency
of each rater on the variables requiring judgment within the protocol using an Intraclass
Correlation (ICC). This analysis produced a rater reliability of r = .94.
Expert raters included a judge, an attorney, a law professor, a psychologist, and a
psychiatrist. These professionals were selected because of their respective reputations
and contributions to the forensic mental health field. Each professional was provided
with 41 reports to rate, 21 of which were rated by all experts and another 20 of which
were rated only by this particular rater. The reliabilities of the expert ratings were gauged
using Cronbach’s alpha (relevance = .69, helpfulness = .72, and overall quality = .82).
54
4.3 Power Analysis
In order to determine the appropriate number of reports needed to establish an
acceptable level of power, a power analysis was undertaken. The main question for the
study concerned the relationship of principle usage within a report to a rating of quality;
thus, a correlational analysis was to be undertaken. The power analysis was conducted
using the Sample Power program and setting the criterion for significance at .05. An
effect size of .25 was used in accordance with Cohen’s conventions, with a medium
effect size (.25) assumed in the absence of previously-collected empirical data on which
to base this estimate. This analysis revealed that a sample size of 120 was needed to
achieve power of .80. After results were obtained using a sample that was slightly larger
than needed (N = 125), the power was calculated as follows: .88 for quality and
helpfulness, .97 for relevance, and 1.0 for report length.
55
CHAPTER 5: RESULTS
The information encompassed within this section include the extensive
descriptive statistics garnered from the Coding Protocol, along with the utilization and
inclusion of principles, and the testing of the main hypothesis. In addition, further
analyses were conducted to examine the strength of individual principles with the
dependent measures.
5.1 Report Characteristics
Both report content and the application of principles in these reports will be
described in this section. This information was coded using the modified Coding
Protocol previously discussed.
5.1.1 Evaluator Information.
The first author listed within each report was generally a psychiatrist (96%, n =
120), with a few listing a psychologist as the first author (3.2%, n = 4). License and
board certification information were not included in any of the reports. All reports were
authorized by the courts; however, only 48% (n = 60) listed the court as the referral
source. A total of 92.8% (n = 116) of the reports were rated as having good impartiality,
while in 7.2% (n = 9) the impartiality was coded as somewhat or mixed. In 21.6% (n =
27) of reports, there was no apparent dual role conflict; however, 77.6% (n = 97)
contained an apparent conflict that was not acknowledged specifically within the report.1
A total of 18.4% (n = 23) used the Morse model and 17.6% (n = 22) used the Grisso
model, while in 23.2% (n = 29) the model used was unclear and 40.8% (n = 51) did not
1 The coding of whether a dual role relationship existed required the judgment of the coder. For example, this dual role relationship was apparent in some reports due to the referral by the writer to their role as prescriber of medication for the defendant. Other indicators included reference to the evaluator’s role on the defendant’s service team or as their primary therapist.
56
use a model at all. In the communication of findings, 43.2% (n = 54) reflected the use of
possible explanations (96.3% of these used to show supporting evidence), 1.6% (n = 2)
reflected the use of competing explanations, and, finally, 1.6% (n = 2) used “most likely”
scenarios.
5.1.2 General Information.
The average length of the reports was 1.98 pages, with 45.6% (n = 57) of the
reports having report length shortened slightly when headings were eliminated by the de-
identification process. The current charges of the defendant were included in 89.6% (n =
112). Of these 112 reports in which charges were cited, a total of 25 (20%) provided
additional details regarding charges, while the remaining 69.6% (n = 87) simply provided
a listing of the charges. In relation to the location and conditions of the evaluation, none
of the reports indicated whether the evaluation took place in a quiet, private, or
distraction free environment and only 4% (n = 5) indicated where the evaluation was
conducted (4 listed an inpatient facility, while 1 described a university hospital).
Regarding technical language used in the reports, 89.6% (n = 112) used no technical
terms, 2.4% (n = 3) used technical terms but defined them, while 8% (n = 10) used
technical terms and did not define them. The use of section headings was seen in 88% (n
= 110) of the reports. For the most part, those section headings used most were Clinical
Functioning (55.2% or n = 69), Competency (50.4% or n = 63) and Conclusions (71.2%
or n = 89). The other headings coded for included Referral, Procedures, and History;
however, the use or absence of these specific headings may be misleading in that other
headings were recorded that reflect similar information, such as Purpose, Identifying
57
Information, Legal Standard, Recommendations. Table 8 indicates the procedures
recorded concerning the notification of purpose.
Table 8 Notification of Purpose in Present Sample of Reports (N=125) Indicated as
Procedure Indicated Defendant Response
Indicated as Procedure for
Collateral Source
Indicated Collateral
Source Response
Legal Issue 32.8a (41)b 7.2 (9) 0 0 Limits of Confidentiality
60.0 (75) 52.8 (66) 0 0
Control of Information
59.2 (74) 52.0 (65) 0 0
Written Report 63.2 (79) 52.8 (66) 0 0 Possible Testimony
0 0 0 0
a Numbers in the table indicate percentages. b Numbers in parentheses indicate actual n. 5.1.3 Sources of Information.
The sources relied upon were listed in 20% (n = 25) of the reports, while 8.8% (n
= 11) provided attributions to sources not listed. In addition, 16% (n = 20) provided an
attribution to a source “sometimes.” Regarding interview sources, 95% (n = 119)
involved an interview with the defendant, while only one report listed an interview with a
prior mental health provider and another listed an interview with family members. In
terms of records review, 34.4% (n = 43) referred to a previous mental health record or
evaluation, while 2.4% (n = 3) referred to a jail/detention record review or criminal
record review. A total of 8% (n = 10) were coded as “Other” and included record
reviews such as social history reports, probation officer reports, medical records and the
58
like. A total of 24% (n = 30) used case specific information, 11.2% (n = 14) contained
offense history, 16% (n = 20) included medical/psychiatric history, and 4% (n = 5)
mentioned a history of head injuries. In assessing response style, 11.2% (n = 14) used
third party information and 3.2% (n = 4) used testing information.
5.1.4 Specialized Forensic Assessment.
None of the reports contained specialized forensic testing. One report stated that
malingering testing was attempted, but refused; while another stated that testing for
malingering was done, but did not define or list the tests used. Finally, one report cited
the inclusion of a “Social Database/Assessment” which was not clarified.
5.1.5 Psychological Assessment.
The number of reports using psychological testing was limited. One report used
some version of the Wechsler Adult Intelligence Scale and three others reported using
intelligence testing but did not specify the test used. Four reports stated that
neuropsychological testing was utilized, but did not specify the test. Finally, one report
cited the use of the Drug Abuse Screening Test.
5.1.6 Mental State Information.
This rating domain focused on some of the more common elements of mental
status evaluation. Table 9 illustrates the frequencies of some of these elements. In
addition, 29.6% (n = 37) addressed substance abuse, with 28.8% (n = 36) of these noting
past or present substance abuse. Physical abuse was addressed in a similar way, with
5.6% (n = 7) addressing abuse or neglect and 3.2% (n = 4) noting past or present physical
abuse. While there were no instances of suicidal ideation noted during the interviews,
22.4% (n = 28) reported suicidal ideation, suicidal intent, a suicide plan, a suicide
59
attempt, or a suicidal history, while 7.2% (n = 9) noted a history of such. Similarly,
24.8% (n = 31) contained some note of violence toward others, with 16.8% (n = 21)
commenting on a history of violence toward others and 2.4% (n = 3) reporting presence
of violent intent during the interview. The majority of the reports (83.2% or n = 104)
contained a multiaxial diagnosis consistent with the Diagnostic and Statistical Manual of
Mental Disorders – Fourth Edition (DSM-IV). In contrast, 13.6% (17) contained a non-
multiaxial or partial diagnosis.
Table 9 Mental State Elements Included in Present Sample of Reports (N=125) Orientation (to person, place, or time) 40.8a (51)b Thought form (e.g. illogical, circumstantial, tangential) 32.8 (41) Thought content (non-psychotic) 20.8 (26) Psychotic symptoms 58.4 (73) Speech 44.8 (56) Reading Comprehension 2.4 (3) Auditory Comprehension 12.8 (16) Judgment/Reasoning/Insight 44.8 (56) Response Style (e.g. defiant, guarded, etc.) 33.6 (42) Motor Functioning 10.4 (13) Mood/Affect 45.6 (57) Impulsivity 4.8 (6) Concentration/Attention 17.6 (22) Memory 28.8 (36) Intellectual Functioning 26.4 (33) a Numbers in the table indicate percentages of those reports including this information. b Numbers in parentheses indicate actual n. 5.1.7 Legal Issues.
The legal issues specifically cited by the examiner included Competence to
Proceed (60% or n = 75), Aid in Sentencing (11.2% or n = 14), Other (4.8% or n = 6) or
60
None Cited (24% or n = 30). In order to better evaluate these reports, the coders were
asked to determine from the content of the report what legal issue was being addressed.
These included competence to proceed (76.8%, n = 96), aid in sentencing (18.4%, n =
23), “other” (2.4%, n = 3), and “none” (2.4%, n = 3). Table 10 shows the frequencies of
those elements associated with each of the potential legal issues as applied in
Pennsylvania. In addition to these standards are the frequencies of inclusion of Section
7402(e) requirements such as the diagnosis of a mental condition (88.8% or n = 111), the
capacity to understand the charges (70.4% or n = 88), and the ability to assist in their own
defense (60.0% or n = 75). Section 7402(e) also contains the potential for a requested
opinion on mental condition relating to criminal responsibility (0%) and the capacity to
have a particular state of mind (4.0% or n = 5).
Table 10 Frequencies Associated with Competency to Stand Trial and Involuntary Treatment in Present Sample of Reports (N=125) Specific Citation Application to Case Use of Multiple Sources
to Evaluate Competency to Stand Trial
Understands the Nature or Object of Proceedings
61.6a (77)b 11.2 (14) 0
Participate and Assist in Defense
58.4 (73) 5.6 (7) 0
Involuntary Treatment c Threatens Serious Bodily
Harm to Self 0 0
Threatens Serious Bodily Harm to Others
1.6 (2) 1.6 (2)
Attempted Suicide 0 0 Self Mutilation 0 0
a Numbers in the table indicate percentages of those reports including this information. b Numbers in parentheses indicate actual n. c Use of multiple sources to evaluate section 302 criteria was not assessed
61
5.1.8 Competency Standards.
In addition to the legal issues discussed earlier, the competency standards were
considered according to their specific elements to determine whether such information
was included in these reports. Table 11 illustrates these elements.
62
Mul
tipl
e S
ourc
es
Use
d
0 0 0 0 0 0 0 0 0 0 0 0 0
Exa
mpl
es f
rom
te
sts/
inte
rvie
ws
7 8 5 1 3 3 1 2 2 1 0 2 1
Lef
t B
lank
a
27
46
73
57
64
64
72
72
85
74
86
77
104
Inde
term
inab
le
12
14
7 26
16
15
20
17
32
23
32
15
14
Inco
mpe
tent
3 3 2 6 5 4 5 7 0 3 0 4 1 Com
pete
nce
Indi
cate
d
Com
pete
nt
83
62
43
36
40
42
28
29
8 25
7 29
6
Fre
quen
cy
of
Incl
usio
n
93b
71
52
67
58
57
50
50
39
49
39
42
17
Tab
le 1
1
Com
pete
ncy
to S
tand
Tri
al E
lem
ents
in
Pre
sent
Sam
ple
of R
epor
ts (
N=
125)
App
reci
atio
n of
Cha
rges
Abi
lity
to
Und
erst
and
Ele
men
ts o
f C
harg
es
Abi
lity
to
Und
erst
and
Les
ser
Incl
uded
O
ffen
ses
App
reci
atio
n of
Ran
ge/N
atur
e of
Pen
alti
es
Abi
lity
to
Und
erst
and
Con
sequ
ence
s of
C
onvi
ctio
n A
bili
ty t
o U
nder
stan
d R
ight
s W
aive
d w
/Gui
lty
Ple
a A
bili
ty t
o W
eigh
Con
sequ
ence
s of
Leg
al
Opt
ions
A
bili
ty t
o M
ake
Com
pari
sons
Bet
. Leg
al
Opt
ions
A
bili
ty t
o A
ppre
ciat
ion
the
Lik
elih
ood
of
Bei
ng F
ound
Gui
lty
Abi
lity
to
App
reci
ate
Pun
ishm
ents
Abi
lity
to
App
reci
ate
and
Dis
cern
the
L
ikel
ihoo
d of
Ple
adin
g G
uilt
y A
bili
ty t
o M
anif
est
App
ropr
iate
Cou
rtro
om
Beh
avio
r
Cap
acit
y to
Tes
tify
Rel
evan
tly
Ta
ble
Con
tinu
es
63
Mul
tipl
e S
ourc
es
Use
d
0 0 0 0 0 0 0 0 1 0 0 0 0 0 0
Exa
mpl
es f
rom
te
sts/
inte
rvie
ws
1 3 2 2 2 0 0 0 1 0 1 1 1 1 1
Lef
t B
lank
a
31
41
48
45
73
83
100
88
49
76
104
105
116
116
77
Inde
term
inab
le
23
16
16
15
15
22
23
22
44
11
10
13
9 8 20
Inco
mpe
tent
6 5 4 5 2 0 0 1 5 2 2 1 0 0 3 Com
pete
nce
Indi
cate
d
Com
pete
nt
65
63
57
60
35
20
2 14
27
36
9 6 0 1 25
Fre
quen
cy
of
Incl
usio
n
85
73
67
70
49
40
23
34
71
47
21
20
9 9 45
Tab
le 1
1 (C
onti
nued
)
Com
pete
ncy
to S
tand
Tri
al E
lem
ents
in
Pre
sent
Sam
ple
of R
epor
ts (
N=
125)
Rat
iona
l an
d F
actu
al U
nder
stan
ding
of
Pro
ceed
ings
Abi
lity
to
Und
erst
and
the
Rol
es o
f th
e A
ttor
neys
A
bili
ty t
o U
nder
stan
d th
e R
ole
of t
he J
ury
Abi
lity
to
Und
erst
and
the
Rol
e of
the
Jud
ge
Abi
lity
to
Und
erst
and
the
Pro
cess
of
Ple
adin
g G
uilt
y A
bili
ty t
o S
eek
Out
Inf
orm
atio
n to
Inf
orm
T
heir
Dec
isio
n A
bili
ty t
o A
ppre
ciat
e th
e L
ikel
ihoo
d of
B
eing
Tre
ated
Fai
rly
Abi
lity
to
App
reci
ate
the
Lik
elih
ood
of
Bei
ng A
ssis
ted
by D
efen
se C
ouns
el
Cap
acit
y to
Dis
clos
e In
form
atio
n to
A
ttor
ney
Abi
lity
to
Con
trib
ute
to t
he C
once
pt o
f S
elf-
Def
ense
A
bili
ty t
o M
itig
ate
Inte
nt E
vide
nce
Abi
lity
to
Con
trib
ute
to t
he C
once
pt o
f P
ossi
ble
Pro
voca
tion
Abi
lity
to
Exa
min
e F
ear
as a
Mot
ivat
or
Abi
lity
to
Exa
min
e In
toxi
cati
on a
s a
Mit
igat
ion
Abi
lity
to
App
reci
ate
Ful
l D
iscl
osur
e of
the
F
acts
a T
he C
odin
g P
roto
col
did
not
allo
w f
or t
he d
isti
ncti
on o
f th
ose
repo
rts
deem
ed c
ompe
tenc
y ev
alua
tion
s th
at l
eft
this
ele
men
t bl
ank
from
tho
se r
epor
ts w
ritt
en f
or a
noth
er
lega
l is
sue,
e.g
. Aid
in
Sen
tenc
ing
eval
uati
ons,
whi
ch w
ould
not
con
tain
the
com
pete
ncy
elem
ents
. b N
umbe
rs i
n th
e ta
ble
indi
cate
act
ual
n of
tho
se r
epor
ts i
nclu
ding
thi
s in
form
atio
n.
64
5.1.9 Competence Conclusions.
Although there were a number of reports for which the legal issue was not
specifically cited, the Coding Protocol allowed the examination of competency
conclusions for those reports examining the competency issue. A total of 83.4% (n =
104) of the reports provided an opinion regarding competency. Of these opinions, 76.0%
(n = 95) concluded that the defendant was competent, 11.2% (n = 14) concluded
incompetence, and 12.8% (n = 16) were left blank or could not be coded. These opinions
were offered directly in 24.8% (n = 31) of the reports, while 60.8% (n = 76) used indirect
language and only 2.4% (n = 3) used examples from tests or interviews in their opinion.
The report writers concluded that 1.6% (n = 2) of their conclusions were connected to
mental retardation, with 8.0% (n = 10) related to mental illness and 5.6% (n = 7)
connected to specific symptoms of mental illness. Within 27.2% (n = 34) of the reports,
an opinion regarding restorability was offered. A total of 1.6% (n = 2) of these used
examples from tests or interviews in this opinion. Only one report (0.8%) estimated the
length of time it would take to restore competency. Some 68.8% (n = 86) of the reports
contained recommendations regarding either residential or non-residential treatment, with
8% (n = 10) citing examples from tests or interviews in these recommendations. With
regard to commitment criteria, 62.4% (n = 78) discussed the criteria, with 7.2% (n = 9)
offering an opinion. The reports stated that 53.6% (n = 67) did meet the criteria for
commitment, while 10.4% (n = 13) did not. Table 12 provides additional detail.
65
Table 12 Commitment Criteria Addressed in Present Sample of Reports (N=125)
Commitment Criteria Frequency of Inclusion Mental Illness 6.4a (8)b Mental Retardation 1.6 (2) Harm to Self 1.6 (2)
As Evidenced by Recent Behavior 1.6 (2) Harm to Others 4.8 (6)
As Evidenced by Recent Behavior 4.0 (5) Self neglect or Mutilation 0.8 (1)
As Evidenced by Recent Behavior 0.8 (1) Attempted Suicide 0.8 (1)
As Evidenced by Recent Behavior 0.8 (1) a Numbers in the table indicate percentages of those reports including this information. b Numbers in parentheses indicate actual n. 5.1.10 “Sanity” Conclusions.
The issue of sanity at the time of the offense should be evaluated only when that
question has been formally raised. There was no evidence that this question was raised as
part of any of the evaluation reports reviewed. However, a few reports contained
language that is associated with sanity rather than competence to stand trial. For
instance, 12.0% (n = 15) of reports contained a comment on whether the defendant could
distinguish right from wrong, and 24.8% (n=31) had language concerning whether the
defendant could understand the nature and consequences of his or her actions. It is likely
that such language reflected evaluators’ misperceptions about the competence standard
rather than formal opinions concerning sanity, but the gratuitous (if sanity was not being
evaluated) or incomplete (if it was being evaluated) nature of such comments underscores
an important priority for improvement in such assessment reports.
66
5.2 Principles of FMHA.
Using the Coding Protocol, the principles outlined in Principles of Forensic Mental
Health Assessment (Heilbrun, 2001) were coded as either met (assigned a score of 1) or
not met (assigned a score of 0). The specific variables included in this assignment can be
found in Appendix C. Of the twenty-nine principles described, only twenty could be
rated as applicable to reports in the present study. Six principles could not be determined
from written reports at all. These include declining the referral when impartiality is
unlikely (Principle #3), clarifying professional role with the attorney (Principle #4),
clarifying financial arrangements (Principle #5), avoidance of the dual role of both
evaluator and therapist (Principle #7), basing testimony on properly performed forensic
mental health assessment (Principle #28), and testifying effectively (Principle #29). In
addition, three principles were dropped from examination due to sample specific reasons.
These included accepting the referral only within area of expertise (Principle #2), using
relevance and reliability as guides for seeking information and selecting data sources
(Principle #11), and, finally, ensuring that conditions for the evaluation are quiet, private
and distraction-free (Principle #15). Principle 2 was not rated because almost all reports
were written by psychiatrists, about whom additional information regarding
specialization or specialty training was not available. Principle 11 (psychological testing
when indicated) was eliminated because there was little or no testing completed within
the evaluations examined, while principle 15 was not examined because the conditions of
the evaluations conducted were not included in the reports. The frequencies of those
remaining principles are shown in Table 13.
67
Table 13 Frequency of Principle Use Within Reports in Present Sample (N=125)
Principle Percentage Yes N of Inclusion Principle 1: Identify relevant forensic issues 59.2 74 Principle 6: Obtain appropriate authorization 48.0 60 Principle 8: Determine the particular role to be played within the forensic assessment if the referral is accepted
22.4 28
Principle 9: Select the most appropriate model to guide data gathering, interpretation, and communication
36.0 45
Principle 10: Use multiple sources of information for each area being assessed
41.6 52
Principle 12: Obtain relevant historical information 21.6 27 Principle 13: Assess clinical characteristics in relevant, reliable, and valid ways
28.8 36
Principle 14: Assess legally relevant behavior 80.8 101 Principle 16: Provide appropriate notification of purpose and/or obtain appropriate authorization before beginning
24.8 31
Principle 17: Determine whether the individual understands the purpose of the evaluation and the associated limits on confidentiality
3.2 4
Principle 18: Use third party information in assessing response style
11.2 14
Principle 19: Use testing, when indicated, in assessing response style
3.2 4
Principle 20: Use case-specific (idiographic) evidence in assessing clinical condition, functional abilities, and causal connections
24.0 30
Principle 21: Use nomothetic evidence in assessing clinical condition, functional abilities, and causal connections
13.6 17
Principle 22: Use scientific reasoning in assessing causal connection between clinical condition and functional abilities
41.6 52
Principle 23: Do not answer the ultimate legal question 30.4 38 Principle 24: Describe findings and limits so that they need change little under cross-examination
92.8 116
Principle 25: Attribute information to sources 24.8 31 Principle 26: Use plain language; avoid technical jargon 92.0 115 Principle 27: Write report in sections, according to model and procedures
12.0 15
5.3 Hypotheses
The first hypothesis examined the relationship between the number of principles
present in the report and the overall independent rating of quality. The mean number of
principles rated as present in the current study was 7.14 (SD = 2.80). There was a modest
68
but statistically significant correlation between the number of principles present and the
overall rating of report quality assigned by the expert raters (r = .27, p < .01).
The second hypothesis examined the strength of the relationship between the
number of principles present in the report and the overall independent rating of
usefulness to the decision-maker. Again, there was a modest but statistically significant
correlation between the number of principles used in the reports and the independent
ratings of report usefulness (r = .27, p < .01). In addition, the relationship between
principles and independent ratings of relevance was considered. The correlation was
somewhat higher and statistically significant (r = .33, p < .01).
The final hypothesis examined the relationship between the length of the reports
and the independent ratings of quality. There was a stronger and significant correlation
between overall report length and expert ratings of report quality (r = .46, p < .01).
Next, each principle was examined individually to see which were more closely
related to relevance, helpfulness and quality. Due to low frequency, Principle #17 and
Principle #19 were not examined in this analysis. A correlation matrix was produced in
order to identify the best candidates for prediction. The matrix examining the principles
is shown in Table 14, while the relationships of these principles to relevance, helpfulness
and quality are shown in Table 15.
69
27
-.14
-.06
.1
-.17
-.06
-.07
-.24
b
-.26
b
-.16
-.13
-.15
-.08
-.11
-.03
-.09
-.10
.02
26
.06
-.19
a
-.05
-.15
-.17
-.20
a
-.20
a
.01
.03
-.18
a
-.04
-.14
.07
.07
-.08
-.17
25
.14
.45b
.05
.34b
.53b
.33b
.41b
.23b
-.29
b
.50b
.33b
.48b
-.11
.14
.09
24
.02
-.17
.08
-.05
.05
.07
.04
-.06
.16
.00
.01
.02
.05
-.02
23
.16
.06
-.19
a
.12
.11
-.09
.19a
.06
-.06
.15
-.01
.14
-.06
22
-.09
-.36
b
.29b
-.30
b
-.25
b
-.01
-.21
a
-.17
.38b
-.04
-.09
-.15
21
.19a
.18a
.01
.29b
.19a
.19a
.21a
.19a
-.23
a
.08
.38b
20
.16
.32b
-.08
.48b
.29b
.34b
.30b
.23a
-.32
b
.28b
18
.89
.37b
-.01
.32b
.37b
.31b
.45b
.17
-.20
16
.21a
-.48
b
.14
-.39
b
-.33
b
-.17
-.28
b
.09
14
.42b
.31b
-.23
a
.37b
.16
.06
.27b
13
.13
.52b
-.13
.55b
.75b
.27b
12
-.04
.35b
.14
.05
.31b
10
.07
.62b
.05
.45b
9 .25b
.58b
-.24
b
8 -.18
a
-.17
6 .11
Pri
ncip
le
1
1 6 8 9 10
12
13
14
16
18
20
21
22
23
24
25
26
27
Tab
le 1
4 C
orre
lati
on M
atri
x fo
r F
MH
A P
rinc
iple
s E
xam
ined
in
Pre
sent
Stu
dy (
N =
125)
Principles
a S
igni
fica
nt a
t th
e p
< .0
5 le
vel.
b S
igni
fica
nt a
t th
e p
< .0
1 le
vel.
70
Table 15 Correlations between FMHA Principles and Expert Ratings of Relevance, Helpfulness and Quality
Principle Relevance Helpfulness Quality Principle 1: Identify relevant forensic issues .11 -.17 -.18 Principle 6: Obtain appropriate authorization .20a .26b .26 b Principle 8: Determine the particular role to be played within the forensic assessment if the referral is accepted
.09 .14 .13
Principle 9: Select the most appropriate model to guide data gathering, interpretation, and communication
.12 .07 .03
Principle 10: Use multiple sources of information for each area being assessed
.20a .22a .23a
Principle 12: Obtain relevant historical information .12 .30b .33b Principle 13: Assess clinical characteristics in relevant, reliable, and valid ways
.16 .18a .21a
Principle 14: Assess legally relevant behavior .24b -.04 -.05 Principle 16: Provide appropriate notification of purpose and/or obtain appropriate authorization before beginning
.19a .06 .08
Principle 18: Use third party information in assessing response style
.14 .15 .22a
Principle 20: Use case-specific (idiographic) evidence in assessing clinical condition, functional abilities, and causal connections
.02 .06 .02
Principle 21: Use nomothetic evidence in assessing clinical condition, functional abilities, and causal connections
.22a .15 .14
Principle 22: Use scientific reasoning in assessing causal connection between clinical condition and functional abilities
.12 .20a .17
Principle 23: Do not answer the ultimate legal question .04 -.05 -.03 Principle 24: Describe findings and limits so that they need change little under cross-examination
.13 .24b .19a
Principle 25: Attribute information to sources .28b .22a .25b Principle 26: Use plain language; avoid technical jargon -.13 -.18a -.15 Principle 27: Write report in sections, according to model and procedures
-.20a -.11 -.18a
Relevance .64b .67b Helpfulness .64b .85b
Quality .67b .85b a Significant at the p < .05 level. b Significant at the p < .01 level.
These candidates were then entered into a multiple regression analysis examining
each of the three variables separately. Obtaining appropriate authorization (Principle #6),
using multiple sources (Principle #10), assessing clinical characteristics in relevant and
71
reliable ways (Principle #13), using third party information to assess response style
(Principle #18), describing findings and limits so they change little under cross-
examination (Principle #24), attributing information to sources (Principle #25), and using
plain language (Principle #26) were identified as candidates for predictors for all three
variables. For relevance, additional candidates included assessing legally relevant
behavior (Principle #14), providing appropriate notification (Principle #16), using
nomothetic evidence in assessing clinical condition, functional abilities, and causal
connection (Principle #21), and writing reports in sections (Principle #27). For both
helpfulness and quality, addition candidates for prediction include identifying relevant
forensic issues (Principle #1), obtaining relevant historical information (Principle #12),
and using scientific reasoning in assessing causal connection between clinical condition
and functional abilities (Principle #22). The last candidate for prediction for the variable
of helpfulness was the use of plain language (Principle #26), while the final candidate
identified for the variable of quality was writing the report in sections (Principle #27).
The regression of those eleven principles most related to relevance produced a poor fit
(Radj2 = .17, R2 = .25), although the overall relationship was significant (F11,116 = 3.16, p <
.01). The model associated with helpfulness produced an Radj2 of .26 (R2 = .33) with a
significant relationship between the predictors and the helpfulness ratings (F11,123 = 4.94,
p < .01). The final regression analysis produced a similar result with poor model fit (Radj2
= .22, R2 = .29) coupled with a significant overall relationship (F11,123 = 4.17, p < .01). It
is important to note here that these results could be affected by experiment-wise error.
Experimental research requires a balance between Type 1 error, the probability of
rejecting a true null hypothesis, and Type 2 error, the probability of failing to reject a
72
false null hypothesis. The α- level is normally set at .05 in order to decrease the
likelihood of a type 1 error. Efforts to adjust α are undertaken when multiple
comparisons will be conducted within an experiment. Here, the .05 level would have to
be divided by the number of comparisons within the study; thus, the α level would be in
essence non-existent. This would make any significance testing impossible; therefore,
this was not done.
In addition to these results, the correlations between relevance, helpfulness, and
quality were strongly correlated with one another (see Table 14). This would suggest that
all three may be part of a single construct (e.g., “overall quality,” “value”). Alternatively,
it might be that relevance, helpfulness, and quality are conceptually distinct but strongly
related empirically. These are important considerations for future researchers in this area.
73
CHAPTER 6: DISCUSSION
The current study was conducted to examine broad FMHA principles in their
applications to forensic evaluation reports, and consider the relationship between the
presence of these principles and independent expert ratings on the relevance, helpfulness,
and overall quality of reports. There were three hypotheses. The first was confirmed:
there was a significant, positive relationship between the number of principles rated as
present in reports and higher rated quality. The second hypothesis was also confirmed;
the presence of more principles was positively related to expert ratings of the reports’
helpfulness to the judicial decision-maker. The third hypothesis was confirmed as well.
Consistent with previous findings (Petrella & Poythress, 1983), there was a significant
positive relationship between length of report and rated report quality. The confirmation
of these hypotheses indicates that a principles-based approach to forensic assessment is
associated with a product that is higher on the expert-rated dimensions of relevance,
helpfulness, and quality. The strength of these relationships was often only modest,
however, suggesting the importance of future research both replicating these results and
exploring their nuances. Further, there is evidence from the high intercorrelations of the
constructs rated by experts that they may have used a single, larger dimension in their
ratings - or that the dimensions of relevance, helpfulness, and quality are conceptually
distinct b put empirically related. This is an important question for future researchers.
6.1 Report characteristics
Previous research has been limited in the scope of examining the work product of
forensic psychologists. The current study provided a comprehensive coding of forensic
reports in Pennsylvania. This detailed view allowed for the study of the current practices
74
within the field. Since previous research has shown that FMHA reports can have
significant effects for the parties involved (Melton, Petrila, Poythress, & Slobogin, 1997;
Skeem & Golding, 1998), it is important to distinguish between practices that have been
adopted and those that have not. Consistent with previous survey research (Grisso &
Borum, 1996), the majority of the current sample included basic identifying information,
current charges, as well as a referral to sources consulted in the examination. In addition,
the current sample did not identify some of those items rated as essential by previous
research (e.g. a description of the purpose of the evaluation given to the defendant, a
listing of the place of the evaluation).
Previous research has also noted the importance of the use of psychological and
specialized forensic testing (Borum & Grisso, 1995; Keilin & Bloom, 1986; Lally, 2003;
Ryba, Cooper & Zapf, 2003; Tolman & Mullendore, 2003). While the majority of
evidence suggests that testing, when appropriate, can be a useful tool in the examination
of forensic issues, the sample within the current study used almost no testing at all. This
may point to a limitation caused by sampling or, more disturbingly, it may point to a
prevalent disregard for thoroughness within the field. There have been previous
descriptions of forensic evaluations written by psychiatrists as problematic (Felthous &
Gunn, 1999), although the empirical evidence cited throughout this dissertation does not
suggest that other disciplines are necessarily better.
Would the addition of psychological and specialized testing enhance the quality
of forensic assessments? There is evidence that both psychiatrists and psychologists
believe that it would. Borum and Grisso (1995) found that psychological testing was
deemed an essential or recommended component of FMHA for both psychologists and
75
psychiatrists within competency and criminal responsibility evaluations. In addition, they
found no significant differences between the two professions concerning the need for
testing; however, they did find a difference in the frequency of use of testing between
psychiatrists and psychologists. The current study points to the same pattern in its
sample of FMHA.
The jurisdiction clearly has an impact on how FMHA is conducted. For the
current study, Pennsylvania law itself indicated the preference for psychiatrists to conduct
evaluations. Thus, the current study could not examine disciplinary differences between
evaluators. Other jurisdictions would not be so limited. The question of disciplinary
differences and their relationship to principles in evaluation reports should be considered
in other jurisdictions in which there is a meaningful mixture of psychiatrists and
psychologists conducting evaluations and writing reports. In 1983, Petrella and
Poythress challenged the “conventional wisdom” of the day that held that forensic
evaluations performed by psychiatrists were of higher quality than those performed by
psychologists or social workers. They reported results from two separate studies that
found non-medical examiners produced more thorough and higher quality evaluations.
Future studies should re-examine this concept in terms of what differences, if any, exist
now between reports generated by psychologists and those generated by psychiatrists.
The current study was also able to examine the use of third party information
utilized within the reports. Consistent with previous research (Heilbrun, Rosenfeld,
Warren & Collins, 1994), the use of offense information seems prevalent; however, the
use of medical records and other sources is varied, but relatively limited. This absence of
relevant third party information was significantly related to lower ratings of quality. A
76
written report can only be as good as the procedures and sources that go into that report.
This tenet is paramount in the generation of reports used within the legal process.
The current study sought to add to the growing field of knowledge concerning
FMHA. By examining written reports, we can learn a great deal about one of the most
important work products generated by mental health professionals involved in the legal
system. This analysis of the current practices within a field allows the examination of
whether and to what extent research is translated into practice. As with previous studies
of this kind (e.g., Christy, Douglas, Otto, & Petrila, 2004), the recommendations
produced point to a need for better integration of research and practice, as well as more
consideration of how such integration can be achieved.
6.2 The Quality of FMHA
Few researchers have attempted to examine the construct of quality as it relates to
FMHA. The current study replicates (and expands) the Petrella and Poythress (1983)
study examining quality, helpfulness, and relevance. The use of expert raters to
operationalize these constructs allows a meaningful examination of the most important
work product of FMHA. The current study expanded the analysis, using a principle-
based approach. This approach allowed the examination of the prevalence and use of the
recommendations that previous research has suggested. While it is clear that some
principles have been wholeheartedly adopted (e.g. assessing legally relevant behavior,
avoidance of technical jargon) other principles are not being applied on a regular basis
(e.g., determination of understanding of the purpose of the evaluation and the associated
limits on confidentiality, use of testing to evaluate response style). Further study may
need to focus on the implementation of these less frequently applied principles. Perhaps
77
these principles are not taught to a sufficient degree to allow recognition of their
importance, or perhaps evaluators do not have sufficient understanding on how to
implement these principles.
6.3 Limitations
As with all research, the current study contains a number of important limitations.
These include coding and sample specific issues, as well as overall generalizability
issues. One limitation of the current study was the dichotomous nature of the coding of
the principles encompassed with the reports. Each principle was coded as either present
or not present. Future studies should perhaps consider a 3- level rating (e.g., present,
partly present, absent). This would potentially facilitate measurement of the nuances
associated with each principle. It would also allow for the production of more data; thus
allowing for a better chance at capturing significant effects. In addition, a set of broad
principles (as was used in this study) may not be fully applicable to a given specific kind
of forensic assessment. To the extent that principles need to be more specific, there
would be some “theoretical slippage” in their applicability to such specific kinds of
FMHA.
A further limitation of the current study includes the restricted range of relevance,
helpfulness, and/or quality associated with these reports. Had the ranges of these
variables been greater, there would be an increased prospect of higher correlation
coefficients and better regression-based prediction. Within the current study, the sample
size was a liability when trying to gauge the respective predictive capacities of 20
principles. To be within an acceptable participant to predictor ratio (at least 10:1, with
20:1 preferable), the current study would have had to evaluate 200-400 reports. While
78
this was not possible within the current study, further research should allow for such an
examination. This will reduce the risk of capitalizing on chance in identifying significant
predictors.
Finally, the findings of the current study must be considered within the scope of
the limited nature of generalizability inherent in the methodology. The sample used was
limited to those reports obtained from one source in a single jurisdiction. Reports were
written almost exclusively by psychiatrists. As such, these findings may not generalize
well to other jurisdictions, or to other disciplines (e.g. psychologists, social workers).
Future research should expand the focus of the sample in order to better examine these
areas.
6.4 Implications and Future Directions
The field of forensic psychology has struggled with the concept of outcome
research. Does the decision made by the judicial decision-maker constitute the end
result, or should the outcome focus be expanded to incorporate the impact of that
decision and the subsequent direction of the life involved constitute the outcome of
interest? The question of how to define accuracy within the field is one with which
researchers struggle. Is it made up of the extensive and/or thorough nature of the work
product produced or is it made up of the many elements of the evaluation itself, along
with the quality of those elements? Perhaps, as the current study suggests, the answer
lies somewhere in between. The results here indicate that relevance, helpfulness, and
quality may be related, and may reflect a larger meaning (e.g., high quality evaluations
are perceived as both helpful and relevant, and may be more influential in the legal
decision-making process). However, even if this were true, it would not necessarily
79
follow that higher quality evaluations (operationalized in this way) are more accurate. It
would be extremely challenging, both conceptually and practically, to design a study
which measures accuracy in the sense that decisions made consistent with more accurate
evaluations could be shown to have measurably better outcomes. We may never be able
to measure all of the elements involved in a decision-makers process, and certainly
cannot control them, but we can insure that the work product given to that decision-
maker is relevant, helpful, and of high quality.
The current study sought to examine how broadly-derived principles have been
applied in practice. The results suggest that the level of practice in the field does not yet
come close to conforming to such principles. Further principle-based research should be
conducted in order to examine both general and specific standards within FMHA. In
particular, other studies should concentrate on how these standards are informing FMHA
procedure and product. The current study allowed for the construct of quality to be
examined comprehensively in terms of both the content and principles employed within
written reports. These are two areas that have been addressed on a very limited basis
using empirical research. There has been limited study of the process of FMHA and its
associated work products.
While quality within the field is important, it is important to note what the current
study did not find. The results discussed here point to a lack of utilization of basic
standards within FMHA. These standards are not only encapsulated in Heilbrun (2001),
but are evident in legal and ethical standards as well. Previously discussed guidelines
encompass the ideals of integrity, professionalism, knowledge of legal standards, and
avoidance of dual roles. Legal standards were also not being adhered to within the
80
current study. The reports examined were written in Pennsylvania where §7402 of the
MHPA outlines specific criterion to be included within the report. Even these elements
were not included. It has been demonstrated that FMHA reports have a significant effect
on the parties involved (Melton, Petrila, Poythress, & Slobogin, 1997; Skeem & Golding,
1998), If the current study is indicative of the current quality of FMHA, what must that
mean for those parties?
Consistent with the findings of others (e.g., Christy et al., 2004), the current study
found that FMHA evaluations are lacking in many important respects. Many evaluators
fail to cite the relevant legal issue, fully describe the evaluation techniques used, consult
third party information, or describe the causal connections between the relevant legal
criteria and clinical condition. This can no longer be attributed to the absence of practice
standards. These standards have been discussed in multiple sources in the literature
(Christy, et al., 2004, Heilbrun, 2001; Heilbrun, Marzyck, & DeMatteo, 2002, Melton, et.
al., 1997). The current study did show that those reports adhering to a more principle-
based approach of FMHA were seen as more relevant, more helpful, and of higher
quality. This would suggest that relying on the literature standards when conducting
FMHA can only better serve the consumers of FMHA. As both Christy et al. (2004) and
Nicholson and Norwood (2000) concluded, a significant gap exists between “what should
be (both legally and clinically) and what is” (Christy et al., 2004). The present results
suggest that there are important and clear ways in which the practice of FMHA can be
improved.
Efforts to improve FMHA may require additional training or certification in order
to insure that those performing FMHA are cognizant of the relevant literature and
81
practices. In addition, further research and development of practice guidelines that “have
teeth” should be considered. Some of the current guidelines are only aspirational in
nature and contain no consequential action for non-adherence. Considering the impact
that FMHA has on, not only the parties involved, but the legal and health systems of
communities across the nation, the field must be more responsible in the work being
produced. Quality, however defined, should be a goal toward which individual
evaluators, courts, attorneys, and the legal and metal health systems should aspire.
82
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87
Appendix A: Coding Protocol
88
Ev
alu
ato
r In
form
ati
on
1 /
10
Dis
cip
lin
e U
se o
f a
Mod
el
P
sych
olo
gis
t M
ors
e M
od
el U
sed
P
sych
iatr
ist
Gri
sso
Mo
del
Use
d
S
oci
al W
ork
er
Un
clea
r
Oth
er
(Sp
ecif
y)
No M
odel
Use
d
Boa
rd C
erti
fied
A
pp
rop
riat
e A
uth
oriz
atio
n O
bta
ined
L
icen
sed
F
rom
Co
urt
F
rom
Def
end
ant
Du
al R
ole
Con
flic
t F
rom
Def
endan
t's L
egal
Guar
dia
n
N
o C
onfl
ict
Dua
l R
ole
Ack
now
ledg
ed
R
efer
ral
Sou
rce
D
ual
Ro
le A
pp
aren
t b
ut
no
t A
ckn
ow
led
ged
C
ou
rt
If
Du
al
Role
exis
ts:
Def
ense
Att
orn
ey
N
oti
fica
tion g
iven
to d
efen
dan
t P
rose
cuti
ng a
ttorn
ey
L
iste
d a
s pote
nti
al c
onfl
ict,
but
U
ncl
ear
def
endan
t not
info
rmed
E
xpla
nat
ion
for
Rea
son
ing
M
ost
M
ost
Support
ing
Dis
con
firm
ing
D
oes
rep
ort
ref
lect
the
use
of:
E
vid
ence
E
vid
ence
P
oss
ible
ex
pla
nat
ion
s
Com
pet
ing e
xpla
nat
ions
"M
ost
lik
ely"
sce
nar
io
T
one
of R
epor
t
No
, o
r
Som
ewhat
Y
es, or
Lar
gel
y N
o
or
Mix
ed
Lar
gel
y Y
es
Doe
s re
port
ref
lect
im
par
tial
ity
89
Gen
era
l In
form
ati
on
2 /
10
Est
imat
e of
wh
ole
pag
es i
n r
epor
t, i
n i
ncr
emen
ts o
f .2
5
In
dica
te h
ere
if t
he r
epor
t le
ngth
est
imat
e w
as d
ecre
ased
due
to
head
ings
, etc
.
Are
cu
rren
t ch
arg
es i
ncl
ud
ed w
ith
in t
he
rep
ort
?
No
Yes
, lis
ted
on
ly
Yes
, ap
pli
ed l
egal
sta
nd
ard
to
Sec
tion
Hea
din
gs U
sed
N
o S
ecti
on H
eadin
gs
Use
d
Pla
ce o
f E
valu
atio
n
If
use
d, d
o th
ey r
efle
ct (
chec
k a
ll t
hat
ap
ply
):
R
efer
ral
I
n-P
atie
nt
Un
it
P
roce
du
res
Det
enti
on
Cen
ter/
Jail
His
tory
Eval
uat
or'
s O
ffic
e
C
linic
al F
unct
ionin
g
A
tto
rney
's O
ffic
e
C
om
pet
ency
U
nid
enti
fied
Concl
usi
ons
O
ther
(S
pec
ify
)
Oth
er(s
):
Con
dit
ion
s of
Eva
l.
Yes
N
o
Un
clea
r N
ot
Men
tioned
U
se o
f P
lain
Lan
guag
e
Qu
iet
No
tec
hn
ical
ter
ms
use
d
P
riv
ate
Tec
hn
ical
ter
ms
use
d a
nd
def
ined
Dis
trac
tio
n f
ree
Tec
hn
ical
ter
ms
use
d,
no
t d
efin
ed
Not
ific
atio
n o
f P
urp
ose
Indic
ated
as
In
dic
ated
def
end
ant
Ind
icat
ed a
s p
roce
du
re
Ind
icat
ed c
oll
ater
al
pro
cedure
r
esponse
fo
r co
llat
eral
re
sponse
L
egal
iss
ue
L
imit
s of
confi
den
tial
ity
Who c
ontr
ols
info
rmat
ion
Wri
tten
rep
ort
Poss
ible
tes
tim
ony
90
Sou
rces
In
form
ati
on
3 /
10
Sou
rces
of
Info
rmati
on
Lis
ted
?
Yes
N
o
Sou
rces
of
Info
rmat
ion
Use
d
(Che
ck a
ll t
hat
appl
y)
R
ecord
s R
evie
w /
Pap
er S
ou
rces
In
terv
iew
Sou
rces
Arr
est
repo
rt/a
ffid
avit
cri
min
al i
nves
tiga
tor
revi
ew
In
terv
iew
/ob
serv
atio
n o
f d
efen
dan
t
Det
enti
on
cen
ter/
jail
med
ical
rec
ord
rev
iew
I
nte
rvie
w w
/ fa
mil
y m
ember
/guar
dia
n
M
enta
l H
ealt
h R
eco
rd/E
val
uat
ion
Rev
iew
In
terv
iew
w/
pd/d
ef a
tty
C
rim
inal
Rec
ord
Rev
iew
In
terv
iew
wit
h d
eten
tion/j
ail
off
icer
Sch
oo
l/A
cad
emic
Rec
ord
s R
evie
w
Inte
rvie
w w
ith d
eten
tion/j
ail
med
ical
sta
ff
D
epo
siti
on
Rev
iew
In
terv
iew
w/
pri
or
mh p
rovid
er/c
ase
mgr
O
ther
1
Inte
rvie
w w
/ vic
tim
Oth
er 2
In
terv
iew
w/
oth
er w
itnes
s
Att
rib
uti
on t
o S
ourc
es (
bes
ides
in
itia
l li
stin
g)
Yes
S
om
etim
es
No
Y
es
No
Not
Men
tion
ed
Is
thir
d p
arty
in
form
atio
n u
sed
to
asse
ss r
esp
onse
sty
le?
I
s te
stin
g in
form
atio
n u
sed
to
asse
ss r
esp
onse
sty
le?
I
s ca
se s
pec
ific
in
form
ati
on
use
d?
D
oes
th
e re
port
con
tain
off
ense
his
tory
?
Do
es r
epo
rt c
on
tain
med
ica
l/p
sych
iatr
ic h
isto
ry?
D
oes
rep
ort
co
nta
in h
isto
ry o
f h
ead
in
juri
es?
91
Fore
nsi
c A
sses
smen
t
4 /
10
C
om
pet
ency
Ass
essm
ent
Inst
rum
ent
Str
uct
ure
d I
nte
rvie
w o
f R
eport
ed S
ym
pto
ms
(SIR
S)
C
om
pet
ency
Ev
alu
atio
n I
nst
rum
ent
Mil
ler
Fo
ren
sic
Ass
essm
ent
of
Sy
mp
tom
s T
est
(MF
AS
T)
In
terd
isci
pli
nar
y F
itnes
s In
teri
ew
Vic
tori
a S
ym
pto
m V
alid
ity
Tes
t (V
SV
T)
C
om
pet
ency
Scr
eenin
g T
est
Tes
t o
f M
emo
ry M
alin
ger
ing
(T
OM
M)
T
rial
Com
pet
ency
Inst
rum
ent
Co
mp
reh
ensi
on
of
Mir
and
a V
oca
bu
lary
G
eorg
ia C
ourt
Com
pet
ency
Tes
t C
om
pre
hen
sion o
f M
iran
da
Rig
hts
M
acA
rth
ur
Co
mp
eten
ce A
sses
smen
t T
oo
l -
Cri
min
al A
dju
dic
atio
n
Com
pre
hen
sion o
f M
iran
da
Rec
ognit
ion
R
og
ers
Cri
min
al R
esp
on
sib
ilit
y A
sses
smen
t S
cale
s F
un
ctio
n o
f R
igh
ts i
n I
nte
rro
gat
ion
O
ther
92
5 /
10
AA
MR
Ada
ptiv
e B
ehav
ior
Sca
le
Vin
elan
d A
dapt
ive
Beh
avio
r S
cale
Oth
er A
dapt
ive
Beh
avio
r/D
evel
opm
enta
l
Ben
der
Ges
talt
/Ben
der
Lur
ia N
ebra
ska
Bat
tery
(p
arti
al/c
ompl
ete)
Hal
stea
d R
eita
n B
atte
ry
(par
tial
/com
plet
e)
Oth
er n
euro
psyc
h
Str
uctu
red
diag
nost
ic i
nte
rvie
w(s
) (D
ISC
/SC
ID)
Con
nors
' Sca
les
Dru
g A
buse
Scr
eeni
ng T
est
(DA
SI)
Alc
ohol
Dep
ende
nce
Sca
le (
AD
S)
Dru
g H
isto
ry Q
uest
(D
HQ
)
Sub
stan
ce A
buse
Sub
tle
Scr
eeni
ng
Tes
t (S
AS
SI)
Add
icti
on S
ever
ity
Inde
x (A
SI)
WA
IS/W
AIS
-R/W
AIS
-III
/WA
SI
(Wec
hsle
r)
WIS
C/W
ISC
-R/W
ISC
-III
(W
echs
ler)
Sta
nfor
d B
inet
Oth
er I
Q
Woo
dcoc
k-Jo
hnso
n A
chie
vem
ent
Tes
t
Wid
e R
ange
Ach
ieve
men
t T
est
(WR
AT
)
Oth
er A
chie
vem
ent
Bri
ef S
ympt
om I
nven
tory
(B
SI)
Bri
ef P
sych
iatr
ic R
atin
g S
cale
(B
PR
S)
Agg
ress
ion
Que
stio
nnai
re
Psy
chop
athy
Che
ckli
st -
Rev
ised
(P
CL
-R)
Psy
chop
athy
Che
ckli
st -
Scr
eenin
g
Ver
sion
(P
CL
-SV
)
Mas
sach
uset
ts Y
outh
Scr
eeni
ng
Inst
rum
ents
-2 (
MA
YS
I-2)
Mil
lon
Inst
rum
ents
- A
dult
(M
CM
I I,
II,
III
)
Mil
lon
Inst
rum
ents
- Y
outh
MA
CI
MM
PI-
A
MM
PI/
MM
PI-
2
Per
sona
lity
Ass
essm
ent
Inve
ntor
y (P
AI)
16
PF
Jesn
ess
Inve
ntor
y
Sym
ptom
Che
ckli
st (
SC
L-9
0)
Oth
er o
bjec
tive
per
sona
lity
Ror
scha
ch
The
mat
ic A
pper
ceti
on T
est
(TA
T)
Dra
w A
Per
son/
Hou
se T
ree
Per
son
Inco
mpl
ete
Sen
tenc
e B
lank
Oth
er p
roje
ctiv
e pe
rson
alit
y
Psy
chol
ogic
al A
sses
smen
t
93
Men
tal
S M
enta
l S
tate
In
form
atio
n
6 /
10
O
rien
tati
on (
to p
erso
n, p
lace
, tim
e)
S
ubst
ance
Abu
se a
ddre
ssed
Sui
cida
l id
eati
on/i
nten
t/pl
an/a
ttem
pt/h
isto
ry
addr
esse
d
Tho
ught
for
m (
illo
gica
l; c
ircu
mst
anti
al;
tang
enti
al)
Pas
t or
pre
sent
not
ed
His
tory
rep
orte
d
Pre
senc
e of
sui
cida
l ide
atio
n/pl
an/i
nten
t at
int
ervi
ew
T
houg
ht c
onte
nt (
nonp
sych
otic
)
Abu
se/n
egle
ct a
ddre
ssed
Psy
chot
ic S
ympt
oms
(hal
luci
nati
ons,
del
usio
ns,
ill
usio
ns)
Pas
t or
pre
sent
not
ed
Vio
lenc
e to
oth
ers
addr
esse
d
His
tory
rep
orte
d
Spee
ch
Pre
senc
e of
thr
eat
to o
ther
s at
int
ervi
ew
R
eadi
ng C
ompr
ehen
sion
A
udit
ory
Com
preh
ensi
on
Ju
dgm
ent/
reas
onin
g/in
sigh
t
Non
-mu
ltia
xial
dia
gnos
is o
ffer
ed
Mu
ltia
xial
dia
gnos
is o
ffer
ed
R
espo
nse
styl
e (d
efia
nt, g
uard
ed, h
ones
t, c
oope
rati
ve)
S
peci
fy:
Axis
I
M
otor
fun
ctio
ning
A
xis
II
M
ood/
affe
ct
Ax
is I
II
Im
puls
ivit
y
Axis
IV
C
once
ntra
tion
/att
enti
on
Axis
V
(G
AF
)
Mem
ory
In
tell
ectu
al f
unct
ioni
ng
(s
epar
ate
from
IQ
tes
ting
)
94
Leg
al
Issu
es
7 /
10
C
om
pet
ence
to
C
rim
inal
A
id i
n
P
roce
ed
Res
po
nsi
bil
ity
Sen
ten
cin
g
Oth
er
Leg
al
issu
e sp
ecif
icall
y c
ited
by e
xam
iner
Leg
al
issu
e in
ferr
ed b
y y
ou
Com
pet
ency
Sta
nd
ard
s S
pec
ific
Cit
atio
n
Ap
pli
cati
on
to
Cas
e
Use
of
Mu
ltip
le S
ou
rces
U
nder
stan
ds
the
Nat
ure
or
Obje
ct o
f P
roce
edin
gs
P
arti
cip
ate
and
Ass
ist
in D
efen
se
Lac
k o
f C
rim
inal
Res
pon
sib
ilit
y S
tan
dar
ds
M
enta
l D
isea
se o
r D
efec
t
Know
ledge
of
Wro
ngfu
lnes
s of
Act
ions
In
volu
nta
ry T
reat
men
t (S
ecti
on 3
02)
P
ose
s C
lear
and P
rese
nt
Dan
ger
by:
T
hre
aten
s S
erio
us
Bo
dil
y H
arm
to
Oth
ers
T
hre
aten
s S
erio
us
Bodil
y H
arm
to
Sel
f
Att
emp
ted
Su
icid
e
S
elf
Muti
lati
on
Sec
tion
740
2(e)
Req
uir
emen
ts
D
iagnosi
s of
Men
tal
Condit
ion
Cap
acit
y t
o U
nd
erst
and
Ch
arg
es
A
bil
ity
to
Ass
ist
in D
efen
se
Sec
tion
740
2(e)
Pot
enti
al R
equ
este
d O
pti
ons
M
enta
l C
ondit
ion R
elat
ing t
o C
rim
inal
Res
po
nsi
bil
ity
Cap
acit
y t
o H
ave
a P
arti
cula
r S
tate
of
Min
d
95
Com
pet
ency
Sta
nd
ard
s
Ex
amp
les
fro
m
M
ult
iple
So
urc
es 8/1
0
C
om
p
Inco
mp
Ind
et
Bla
nk
Tes
ts/I
nte
rvie
ws
Use
d
A
pp
reci
atio
n o
f C
har
ges
or
All
egat
ion
s
A
bil
ity
to
Un
der
stan
d e
lem
ents
of
the
off
ense
ch
arg
ed
A
bil
ity
to
un
der
stan
d t
he
elem
ents
of
a le
sser
in
clu
ded
off
ense
A
ppre
ciat
ion o
f ra
nge/
nat
ure
of
pen
alti
es
A
bil
ity
to
un
der
stan
d t
he
con
seq
uen
ces
of
a co
nv
icti
on
A
bil
ity t
o u
nder
stan
d t
he
rights
bei
ng w
aived
in m
akin
g a
guil
ty p
lea
A
bil
ity t
o w
eig
h c
on
seq
uen
ces
of
a le
gal
op
tio
n
A
bil
ity
to
mak
e co
mp
aris
on
s b
etw
een
leg
al o
pti
on
s
A
bil
ity t
o a
ppre
ciat
e th
e li
kel
ihod o
f bei
ng f
ound g
uil
ty
A
bil
ity t
o a
ppre
ciat
e th
e punis
hm
ents
involv
ed i
f fo
und
g
uil
ty
A
bil
ity
to
ap
pre
ciat
e a
nd
dis
cern
th
eir
lik
elih
oo
d o
f
ple
adin
g g
uil
ty
R
atio
nal
an
d f
actu
al u
nd
erst
and
ing
of
pro
ceed
ing
s an
d
ad
ver
sari
al n
ature
of
pro
cess
A
bil
ity t
o u
nder
stan
d t
he
role
s of
the
atto
rney
s
A
bil
ity t
o u
nder
stan
d t
he
role
of
the
jury
A
bil
ity
to
un
der
stan
d t
he
role
of
the
jud
ge
at t
rial
A
bil
ity
to
un
der
stan
d t
he
pro
cess
of
ple
adin
g g
uil
ty
A
bil
ity t
o s
eek o
ut
info
rmat
ion t
hat
would
info
rm t
hei
r
ch
oic
es t
hro
ug
ho
ut
the
pro
ceed
ing
A
bil
ity t
o a
ppre
ciat
e th
eir
lik
elih
oo
d o
f b
ein
g t
reat
ed f
airl
y
A
bil
ity t
o a
ppre
ciat
e th
eir
likel
ihood o
f bei
ng a
ssis
ted b
y
def
ense
counse
l
96
Com
pet
ency
Sta
nd
ard
s (C
on
tin
ued
)
Ex
amp
les
fro
m
M
ult
iple
So
urc
es
8a/
10
C
om
p
Inco
mp
Ind
et
Bla
nk
Tes
ts/I
nte
rvie
ws
U
sed
C
apac
ity
to d
iscl
ose
to a
ttor
ney
fact
s re
gard
ing
offe
nse
and
suff
icie
nt
P
rese
nt
abil
ity
to
co
nsu
lt w
ith
co
un
sel
wit
h r
easo
nab
le d
egre
e o
f R
atio
nal
under
stan
din
g
A
bil
ity t
o c
on
trib
ute
to
th
e co
nce
pt
of
self
-def
ense
A
bil
ity t
o m
itig
ate
the
pro
secu
tion’s
evid
ence
of
inte
nt
A
bil
ity t
o c
on
trib
ute
to t
he
conce
pt
of
poss
ible
pro
vovca
tion
A
bili
ty t
o ex
amin
e fe
ar a
s a
poss
ible
mot
ivat
or f
or o
ne’s
be
havi
or
A
bil
ity t
o e
xam
ine
the
poss
ible
mit
igat
ing e
ffec
ts o
f in
toxic
atio
n
A
bili
ty t
o ap
prec
iate
ful
l di
sclo
sure
of
case
inf
orm
atio
n to
D
efen
se c
ouns
el
A
bil
ity t
o m
anif
est
app
rop
riat
e co
urt
roo
m b
ehav
ior
C
apac
ity
to
tes
tify
rel
evan
tly
97
Com
pet
ency
Con
clu
sion
s 9 /
10
C
on
clu
sion
con
nec
ted
to:
C
on
clu
sio
n r
e co
mp
eten
cy
(ch
eck
all
th
at
ap
ply
)
C
om
pet
ent
Inco
mpet
ent
Bla
nk
Men
tal
Illn
ess
D
irec
t In
dir
ect
Bla
nk
Sp
ecif
ic s
ym
pto
m(s
)
Ex
amp
les
fro
m t
ests
/in
terv
iew
s
Men
tal
Ret
ardat
ion
O
pin
ion o
ffer
ed
Ex
amp
les
fro
m t
ests
/in
terv
iew
s
C
on
clu
sion
re
rest
ora
bil
ity
E
stim
ate
re
len
gth
of
tim
e to
res
tore
R
ecom
men
dat
ion
re
resi
den
tial
/no
nre
sid
enti
al t
reat
men
t
C
on
clu
sio
n r
e co
mm
itm
ent
crit
eria
D
oes
NO
T m
eet
crit
eria
Yes
, m
eets
cri
teri
a
M
enta
l Il
lnes
s
Har
m t
o s
elf
evid
ence
d b
y r
ecen
t b
ehav
ior
caus
ing,
att
empt
ing,
or
thre
aten
ing
such
har
m
M
enta
l R
etar
dat
ion
Har
m t
o o
ther
s
evid
ence
d by
rec
ent
beha
vior
cau
sing
, att
empt
ing,
or
thre
aten
ing
such
har
m
S
elf
Neg
lect
/Sel
f M
uti
lati
on
ev
iden
ced
by r
ecen
t be
havi
or c
ausi
ng, a
ttem
ptin
g, o
r t
hre
aten
ing s
uch
har
m
A
ttem
pte
d S
uic
ide
evid
ence
d by
rec
ent
beha
vior
cau
sing
, att
empt
ing,
or
thre
aten
ing
such
har
m
98
San
ity
Con
clu
sion
s 1
0 /
10
O
ffer
s an
op
inio
n s
uch
as
"sa
ne"
or
"in
san
e"
S
ane
Insa
ne
Bla
nk
Ex
amp
les
fro
m t
ests
/in
terv
iew
s
C
omm
ent
on w
het
her
def
end
ant
cou
ld d
isti
ngu
ish
wro
ng
U
ses
Dir
ect
Lan
guag
e
Do
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99
Appendix B: Rater Questionnaire
88 89
96
100
Rater Questionnaire For each of the following questions, circle one number on the rating scale which reflects your assessment on the issue in question. 1. How does this report reflect the clinician’s familiarity and use of the appropriate legal criteria? Clinician unfamiliar or 1 2 3 4 5 6 7 8 9 Clinician familiar and used wrong criteria used proper criteria 2. To what extent does this report provide the necessary information to assist a judge in making a decision? Not enough information 1 2 3 4 5 6 7 8 9 Provides sufficient presented to make a information to make
decision a decision 3. Please rate your impression of the overall quality of this report.
Poor 1 2 3 4 5 6 7 8 9 Excellent report Comments:_________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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Appendix C: Principles of Forensic Mental Health Assessment
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Principles of Forensic Mental Health Assessment (Heilbrun, 2001)
Bold – Indicates those principles coded for within the current study 1. Identify relevant forensic issues – located within the Legal Issues tab The variable PRINC1 was coded as a 1 (yes) when either the legal issue
inferred was competency (Legal Issue Coder = 1) and Understands the Nature or Object of Proceedings and Participate and Assist in Defense was specifically cited (Nature Proc Cit = 1 & Assist Def Cit = 1) or Aid in Sentencing is specifically cited by the examiner (Legal Issue Examiner = 3)
2. Accept referrals only within area of expertise – located within the Evaluator Information tab All reports were written by psychiatrists – principle not examined 3. Decline the referral when evaluator impartiality is unlikely – Unable to be determined
from report
4. Clarify the evaluator’s role with the attorney – Unable to be determined from report 5. Clarify financial arrangements – Unable to be determined from report 6. Obtain appropriate authorization – located within the Evaluator Information tab Most Authorization was obtained from the court. If this was indicated in
the report (Referral Source = 1), then PRINC6 = 1. If there was none cited in the report (Referral Source = 4), then PRINC6 = 0
7. Avoid playing the dual roles of therapist and forensic evaluator – Unable to be
determined from report 8. Determine the particular role to be played within forensic assessment if the referral is accepted – located within the Evaluator Information tab PRINC8 was coded as present (= 1) if there was no dual-role conflict
(Dual Role = 1) or the dual role is acknowledged (Dual Role = 2); PRINC8 = 0 if the dual role was apparent but not acknowledged (Dual Role = 3)
9. Select the most appropriate model to guide data gathering, interpretation, and communication – located within the Evaluator Information tab PRINC9 = 1 if either the Morse or Grisso model was used within the
report; PRINC9 = 0 if no model was used or use was unclear
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10. Use multiple sources of information for each area being assessed – located within the Sources Information tab PRINC10 = 1 (Yes) if Interview w/detention/jail officer (S2 = 1) or Int. w/
prior mental health provider (S3 = 1) or Jail/detention center medical review (S12 = 1) or Mental health record/evaluation review (S13 = 1) or Criminal Record review (S14 = 1) or School Academic record (S18 = 1) or Other1 (S16 = 1) or Other2 (S17 = 1); otherwise PRINC10 = 0
11. Use relevance and reliability (validity) as guides for seeking information and selecting data sources – located within the Forensic Assessment tab and the Psychological Assessment tab Most reports contained no testing – those that did, did not specify the test used.
Principle was not examined 12. Obtain relevant historical information –located within the General Information tab and Sources Information tab PRINC12 = 1 if the report contained offense history (Offense Hx = 1),
medical/psychiatric history (Hx Medical = 1) or hx of head injuries (Head injuries = 1) or used the section heading “History” (History = 1)
13. Assess clinical characteristics in relevant, reliable, and valid ways – located within the General Information tab and Sources Information tab PRINC13 = 1 if the heading “Clinical Functioning” was used & some form of
collateral information used 14. Assess legally relevant behavior – located within the Legal Issues tab PRINC14 = 1 if the following were specifically cited: Understands the Nature or Object of Proceedings (Nature Proc Cit = 1) or Participate & Assist in Defense (Assist Def Cit = 1) or Mental Disease or Defect (Mental Disease Cit = 1) or Knowledge of Wrongfulness of Actions (Wrongfulness Cit = 1) 15. Ensure that conditions for evaluation are quiet, private, and distraction-free – located within the General Information tab None of the reports indicated the condition of the evaluation; In addition,
only 4 indicated that they were conducted in an in-patient unit, while 1 indicated that the eval. took place at Jefferson University. The rest were unidentified – principle not examined
16. Provide appropriate notification of purpose and/or obtain appropriate authorization before beginning – located within the General Information tab PRINC16a = 1 if the following notifications were noted as procedure Legal Issue (ProcLegal Issue = 1), and Limits of Confidentiality (Proc Limits = 1), and Control of information (Proc Control = 1), and Written report (Proc Report = 1)
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17. Determine whether the individual understands the purpose of the evaluation and the associated limits on confidentiality – located within the General Information tab PRINC17a = 1 if the following def. responses were indicated Legal Issue (PtResponseLegalIssue = 1), and Limits of Confidentiality (PtResponseLimits = 1), and Control of information (PtResponse Control = 1), and Written report (PtResponse Report = 1) 18. Use third party information in assessing response style – located within the Sources Information tab PRINC18 = 1 if third party info was used to assess response style
(Response Style TPI = 1) 19. Use testing when indicated in assessing response style – located within the Sources Information tab PRINC19 = 1 if testing was used to assess response style (n = 4) 20. Use case-specific (idiographic) evidence in assessing clinical condition, functional abilities, and causal connection – located within the Sources Information tab PRINC20 = 1 if case specific info is used (CaseSpecific = 1) 21. Use nomothetic evidence in assessing clinical condition, functional abilities, and causal connection – located within the Competency Standards tab and Mental State Information tab PRINC21 = 1 if the following standards were noted with examples from tests/int Appreciation of charges (Charge Appre Ex) = 1, or Ability to Understand Elements (Understand Off Ex) = 1, or Ability to Understand Lesser included off. (UnderstandLessOff Ex
= 1), or Appreciation of Range/Nature of Penalties (PenaltyAppreEx = 1),
or Ability to Understand Conseq of conviction (Convconsex = 1), or Ability to Understand Rts Waived (GuiltyRtsWaived Ex = 1), or Ability to Weigh Conseq (WeighConsEx = 1), or Ability to Make Comparisons of Legal Options (MakeComparEx =
1), or Ability to App. The Likelihd of being found guilty
(AppreLikeGuiltyEx = 1), or Ability to App. Punishments (ApprePunishGuiltyEx = 1), or Ability to App/Discern Likelihd of Pleading Guilty
(LikelyPleadGuiltyEx = 1), or Rational and Factual Understanding of Proceedings
(UnderstandProceedEx = 1), or Ability to Understand Atty Roles (AttnyRolesEx = 1), or Ability to Understand Jury Role (JuryRoleEx = 1), or
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Ability to Understand Judges’ Role (JudgesRoleEx = 1), or Ability to Understand Process of Pleading Guilty (PleadingProcEx
= 1), or Ability to Seek out Info. (SeekInfoEx = 1), or Ability to App. Likelihood of being treated fairly (TreatFairEx =
1), or Ability to Assist Counsel (CounselAssistEx = 1), or Capacity to disclose to Atty (DiscloseConsultEx = 1), or Ability to contribute to self-defense (ContributeSelfDefEx = 1), or Ability to mitigate intent evidence (MitigateIntentEx = 1), or Ability to contribute to possible provocation
(ContributeProvocationEx = 1), or Ability to examine fear as motivator (ExamineFearEx = 1), or Ability to examine intoxication as mitigator
(ExamineIntoxicationEX = 1), or Ability to Appreciate Full Disclosure (AppreFullDisclosureEx =
1), or Ability to manifest appropriate courtroom behavior (AppropBehEx
= 1), or Capacity to testify relevantly (TestifyRelevantEx = 1) 22. Use scientific reasoning in assessing causal connection between clinical condition and functional abilities – located within the Evaluator Information tab PRINC22 = 1 if the report reflected the use of most supporting evidence
for either possible explanations (PossibleSupport = 1) or the “most likely” scenarios (MostLikelySupport = 1)
23. Do not answer the ultimate legal question – located within the Competency Conclusions and the Sanity Conclusions sections PRINC23 = 0,if opinions regarding competency were answered directly
(CL1b = 1) or sanity conclusions were offered as “sane” or “insane” (MS2 = 1)
24. Describe findings and limits so that they need change little under cross examination – located within the Evaluator Information and Sources Information tabs PRINC24 = 1 if report reflects impartiality (Yes - Impartiality = 3) or use
competing explanations (Competing = 1) 25. Attribute information to sources – located within the Sources Information tab PRINC25 = 1 if the report contained attributions to sources other than
simply listing them (Yes - Attribution = 1 or Sometimes - Attribution = 2) 26. Use plain language; avoid technical jargon – located within the General Information tab
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PRINC26 = 1 if No technical terms were used (Language = 1) or terms were used but defined (Language = 2)
27. Write report in sections, according to model and procedures – located within the General Information tab PRINC27 = 1 if Section headings were used (Sections = 1) 28. Base testimony on the results of the properly performed FMHA – Unable to be determined from report 29. Testify effectively – Unable to be determined from report
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CURRICULUM VITA FOR TAMMY D. LANDER
Address: 26 Laurel Lane, Quincy, FL 32352 E-mail: [email protected]
EDUCATION AND ACTIVITIES Villanova University School of Law/Drexel University, Villanova/Philadelphia, PA,
Ph.D. in Clinical Psychology: September 2006 – M.S. in Clinical Psychology, June 2003 J.D.: May 2004
Activities: J.D./Ph.D. Student representative, June 2002-June 2004; Managing Editor of Outside Articles, Villanova Law Review, Volume 48, March 2002-May 2003; Staff writer, Villanova Law Review, Volume 47, July 2001-March 2002.
University of Texas at San Antonio (UTSA), San Antonio, TX, M.S. in Experimental Psychology, May 1999,
Texas Tech University (TTU), Lubbock, TX, B.S. in Chemical Engineering, May 1996.
WORK EXPERIENCE
Psychological Specialist/Intern, Ellen Resch, Ph.D., A.B.F.P., Florida State Hospital, Chattahoochee, FL, Aug. 2005-present. Conducted forensic evaluations within both high security admissions unit and stabilization unit for forensic in-patients, as well as developed operating procedures and study of administration duties in a state hospital.
Consultant, Kirk Heilbrun, Ph.D., Forensic Evaluator Training Project, Philadelphia, PA, July 2004-July 2005. Aiding in development of a training curriculum geared toward forensic mental health professionals centered on improving the evaluation process.
Consultant, Lori Schatzel, M.S.W. & Allison Redlich, Ph.D., Policy Research Associates, Inc., Delmar, NY, May 2004-July 2005. Aiding with evaluation and refinement of NIMH Adult Cross- Training Curriculum Project which offers training centered on mental health and substance abuse issues to both the legal and mental health providers within a community.
Therapist, Pamela Geller, Ph.D. & Kirk Heilbrun, Ph.D., Drexel University Student Counseling Center – MCP Hahnemann Campus, Philadelphia, PA, March 2002-October 2004. Conducted individual therapy and testing for adult outpatients.
PAPERS AND PRESENTATIONS
Lander, T, Pich, M., Loiselle, K, & Heilbrun, K. (2006, March). The Content and Quality of Forensic Mental Health Assessment in Pennsylvania: Validation of a Principles-Based Approach. Presented at the Annual Conference of the American Psychology-Law Society, St. Petersburg, FL.
Marczyk, G. R., Heilbrun, K., Lander, T., & DeMatteo, D. S. (in press). Juvenile decertification: Developing a model for classification and prediction. Criminal Justice and Behavior.
Heilbrun, K. & Lander, T. (2004). Forensic Mental Health Assessment. In Encyclopedia of Applied Psychology (Vol. 2, pp. 29-42). New York: Elsevier Ltd.
Lander, T. (2004). Do Court Appointed Mental Health Professionals Get a Free Ride in the Third Circuit?: An Examination of the Latest Extensions of Judicial Immunity, 22 QUINNIPIAC L. REV. 895.
Lander, T. (2003, July). Battling “Syndromic Lawyer Syndrome”: A Look at Evidentiary Standards of Novel Syndromal Evidence and the Mental Health Professional’s Role. Presented at the International Interdisciplinary Conference on Psychology and Law, Edinburgh, Scotland.
Marczyk, G. R., Heilbrun, K., Lander, T., & DeMatteo, D. S. (2003). Predicting Juvenile Recidivism with the PCL-YV, MAYSI, and YLS-CMI. Int’l Journal of Forensic Mental Health, 2, 7-18.
Marczyk, G. R., Heilbrun, K., Lander, T., & DeMatteo, D. (2002, March). Predicting Juvenile Recidivism & Validating Juvenile Risk Factors in an Urban Environment. Presented at the Biennial Conference of the American Psychology-Law Society, Austin, TX.
Lander, T. & Baird, R. (2000, March). Jury Research: the “Unwilling” Speak Out – Includable vs. Excludable Jurors. Presented at the Biennial Conference of the American Psychology-Law Society, New Orleans, LA.
