Our distribution centers are open and orders can be placed online. Do be advised that shipments may be delayed due to extra safety precautions implemented at our centers and delays with local shipping carriers. Oxford Clinical Psychology. This book is available as part of Oxford Clinical Psychology Online - quickly navigate between chapters and add your own annotations. Forensic mental health assessment FMHA continues to develop and expand as a specialization.
Since the publication of the First Edition of Forensic Mental Health Assessment: A Casebook over a decade ago, there have been a number of significant changes in the applicable law, ethics, science, and practice that have shaped the conceptual and empirical underpinnings of FMHA.
The Second Edition of Forensic Mental Health Assessment is thoroughly updated in light of the developments and changes in the field, while still keeping the unique structure of presenting cases, detailed reports, and specific teaching points on a wide range of topics. Unlike anything else in the literature, it provides genuine although disguised case material, so trainees as well as legal and mental health professionals can review how high-quality forensic evaluation reports are written; it features contributions from leading experts in forensic psychology and psychiatry, providing samples of work in their particular areas of specialization; and it discusses case material in the larger context of broad foundational principles and specific teaching points, making it a valuable resource for teaching, training, and continuing education.
Now featuring 50 real-world cases, this new edition covers topics including criminal responsibility, sexual offending risk evaluation, federal sentencing, capital sentencing, capacity to consent to treatment, personal injury, harassment and discrimination, guardianship, juvenile commitment, transfer and decertification, response style, expert testimony, evaluations in a military context, and many more.
It will be invaluable for anyone involved in assessments for the courts, including psychologists, psychiatrists, social workers, and attorneys, as well as for FMHA courses.
Preface About the Editors Contributors 1 Introduction and Overview 2 Miranda Waiver Capacity Case 1 Principle: Use nomothetic evidence in assessing clinical condition, functional abilities, and causal connection case contributed by I.
Bruce Frumkin Teaching Point: What is the value of specialized forensic assessment instruments in forensic mental health assessment c ontributed by I. Bruce Frumkin Case 2 Principle: Use case-specific idiographic evidence in assessing clinical condition, functional abilities, and causal connection case contributed by Alan M.
Zapf Teaching Point: How can you use a model to structure the way you write the report? Review the available background information and actively seek important missing elements case contributed by Kirk Heilbrun and Jacey Erickson Teaching Point: How much is enough? Gregory Olley Teaching Point: Gauging the training and experience in forensic and mental health areas needed for this kind of evaluation contributed by Kirk Heilbrun, David DeMatteo, Stephanie Brooks Holliday, and Casey LaDuke Case 2 Principle: Use relevance and reliability validity as guides for seeking information and selecting data sources case contributed by Karen L.
Zapf Teaching Point: Identify assessment targets when legal standards are broad or non-specific contributed by Patricia A. If answered, it should be in the context of a thorough evaluation clearly describing data and reasoning, and with the clear recognition that this question is in the domain of the legal decision maker case contributed by Bill Foote Teaching Point: Answering the ultimate legal question directly contributed by Kirk Heilbrun, David DeMatteo, Stephanie Brooks Holliday, and Casey LaDuke Case 2 Principle: Decline the referral when evaluator impartiality is unlikely case contributed by Alan M.
Goldstein Teaching Point: Declining the case when impartiality would be too difficult contributed by Alan M. Kirkpatrick Teaching Point: Specific strategies for promoting impartiality in a particular evaluation contributed by Kirk Heilbrun, David DeMatteo, Stephanie Brooks Holliday, and Casey LaDuke Teaching Point: Mental health professionals' role in assisting the court in determining the veracity of allegations of child sexual abuse contributed by Kathryn Kuehnle and H.
Kirkpatrick 19 Juvenile Miranda Waiver Capacity Case 1 Principle: Use nomothetic evidence in assessing causal connection between clinical condition and functional abilities case contributed by I. Bruce Frumkin Teaching Point: Applying group-based evidence supporting a specialized forensic assessment measure in a single case contributed by I. Warren Teaching Point: Identifying and implementing strategies for improving inadequate conditions contributed by Kirk Heilbrun, David DeMatteo, Stephanie Brooks Holliday, and Casey LaDuke 21 Juvenile Commitment Case 1 Principle: Accept referrals only within area of expertise case contributed by David DeMatteo and Heidi Strohmaier Teaching Point: What training and experience in forensic, developmental, and mental health areas are needed for juvenile forensic expertise?
Benesh Teaching Point: Forensic issues in this kind of evaluation that is conducted in a military context, and comparability with and distinctions from civilian law contributed by Kirk Heilbrun, David DeMatteo, Stephanie Brooks Holliday, and Casey LaDuke Case 2 Principle: Obtain appropriate authorization case contributed by Paul Montalbano Teaching Point: How does the evaluator address the question of "severe mental disease or defect?
Lareau Teaching Point: Using multiple sources for relevant hospitalization and pre-hospitalization information contributed by Kirk Heilbrun, David DeMatteo, Stephanie Brooks Holliday, and Casey LaDuke Case 3 Principle: Describe findings and limits so that they need change little under cross-examination case contributed by Terrance J.
Hart and Kelly A. Cornell Teaching Point: How can threat assessment be distinguished as a form of risk assessment? Cornell Case 3 Principle: Use nomothetic evidence in assessing clinical condition, functional abilities, and causal connection case contributed by Randy K.
His current research focuses on juvenile and adult offenders, legal decision-making, forensic evaluation associated with such decision-making, and diversion. He is the author of a number of articles and books in the area of forensic assessment. His research interests include psychopathy, forensic mental health assessments, drug policy, and diversion. He has authored several books and numerous articles on forensic mental health assessment and related topics.
Her current research interests include adult offenders, risk assessment, interventions for risk reduction, justice-involved veterans, and neuropsychological functioning in veteran populations. Casey LaDuke, MS, is a doctoral candidate in the Department of Psychology at Drexel University, with concentrations in forensic psychology and clinical neuropsychology.
His current interests include forensic mental health assessment, psychopathy, diversion, and the application of clinical neuropsychology in the forensic context. Chad Brinkley, Ph. He provides inpatient treatment for inmates with severe mental illness and civil commitment cases. He is board certified in forensic psychology and does a variety of forensic work including risk assessments, competency evaluations, mental state at the time of the offense evaluations, and competency restoration treatment.
Stanley L. He coordinate the Psychology-Law Ph. His areas of specialization are expert witness testimony, forensic assessment, and psychotherapy with involuntary clients. Her interests include the evaluation and treatment of the mentally ill in a psycholegal context. She is a Diplomate in Forensic psychology, past president of the American Academy of Forensic Psychology, and maintains an active practice conducting both adult and juvenile evaluations for the criminal courts.
Dewey Cornell, Ph. His work is concerned with school climate and safety, youth violence prevention, and threat assessment. Mark D. Cunningham, Ph. His professional contributions and scholarship have been recognized with the National Register of Health Service Psychologists A.
Wellner, Ph. Eric Y. First, the conclusions and opinions need to be formed from a scientific basis. Quality forensic reports substantiate opinions with data and outline the reasons for the conclusions drawn. Forensic examiners must be prepared to defend the method of data collection and its scien-tific basis.
Therefore, data should be collected carefully, and the limits of any data collected should be recognized and reported. Interpretations made during a forensic assessment should be based on multiple methods of data collection. The response style of the examinee should always be assessed for attempts to minimize or feign psychological impairment.
The best method for conducting a forensic assessment and writing a subsequent forensic report is to imagine that all methods and conclusions are being critiqued by an opposing attorney.
Finally, testing instruments, if used, should be related to the legal issue at hand and should be theoretically and psychometrically sound. Typically, when people speak about forensic assessment they are referring to psychological assessments as part of civil or criminal court cases. The broad definition of forensic assessment used in this entry also encompasses forensic assessment in law enforcement and correctional settings.
Overlap may exist between settings; also, a forensic assessment might be conducted for use in more than one setting or might be completed for one setting only to be used later in another setting. Law enforcement is, of course, a broad term for the work of police officers in a variety of settings.
Psychological assessment in law enforcement settings may involve criminal profiling and psychological autopsies as well as direct work with police officers. Psychological assessment of police officers can include screening of police candidates, fitness-for-duty evaluations, and promotional evaluations. Psychological assessment in correctional settings may be involved at any phase of incarceration or correctional involvement. Forensic assessment might be conducted to provide insight into and predict criminal behavior with the goal of preventing future criminality.
This area of risk or dangerousness assessment has been quite popular in both clinical and research arenas, with much attention given to isolating the variables associated with recidivism, especially violent recidivism. Psychological assessment may also be used to evaluate the mental health needs of jail and prison inmates, as well as the psychological effects of imprisonment.
Both civil and criminal courts increasingly request and use psychological data. Civil courts handle disputes between citizens; criminal courts handle disputes between a citizen and the state.
Examples of where forensic assessment might be involved in civil courts include divorce and child custody cases, competency to consent to treatment or provide care for oneself, examinations of testamentary competence, or civil suits where psychological or neurological injury might be involved e. The two types of quasi-criminal cases are civil commitment hearings and juvenile delinquency cases. Forensic assessment is invaluable in civil commitment hearings, in which most states require a finding that the person is mentally ill and is a danger to self or others or in need of care or treatment.
There are many stages in juvenile delinquency proceedings where forensic assessment can be of assistance.
Issues that used to occur primarily in the adult criminal justice system, such as competency to stand trial, are increasingly being raised in juvenile cases. In addition, juveniles may be evaluated for their amenability to treatment in the juvenile justice system. If they are not considered amenable, their case may be waived to adult court.
A child who is tried through the juvenile justice system may undergo a presentence evaluation to determine the best disposition of his or her case. Sometimes, competency to stand trial and criminal responsibility are confused, and the terms are used interchangeably. Other types of criminal forensic assessment include evaluations of competence to waive counsel and competence to plead guilty.
Forensic assessment, as mentioned earlier, may involve the use of psychological tests or assessment instruments. The decision about how and when to use a test as part of a forensic assessment involves consideration of the relevance of the test to the legal question or to the psychological construct that underlies the legal issue. In studies of imminent instruments, sensitivity was 0. The summary specificity for imminent tools was 0. A summary DOR for imminent tools could not be accurately calculated due to the number of zero-value categories 2 of the 6 samples included had one or more cells with zero values.
The summary diagnostic odds ratio DOR for longer-term tools was 4. The median PPV for imminent instruments was 0. The median PPV for longer-term instruments was 0. Summary accuracy estimates produced by two categories of violence risk assessment instruments. Two different summary estimates of AUC values are reported based on different sample sizes.
The first were calculated as median AUCs from all eligible studies that reported AUC values; this amounted to 78 samples and a total of 6, patients from 43 publications, based on 10 imminent tool samples 1, patients and 68 longer-term tool samples 5, patients. The median AUC for imminent instruments was 0. The summary AUC value for imminent tools in the meta-analysis sample was 0.
The HSROC curve for imminent tools is approaching the top left-hand corner of the graph, indicating high accuracy, but the prediction contour is large, indicating high levels of between-study heterogeneity Fig. The prediction contour is also large, again indicating high levels of between-study heterogeneity. Summary receiver operating characteristics SROC curve from bivariate analysis of imminent violence risk assessment instruments for forensic inpatient violence.
Summary receiver operating characteristics SROC curve from bivariate analysis of longer-term violence risk assessment instruments for forensic inpatient violence. These tools performed moderately for the prediction of inpatient violence with median AUCs of 0.
See Appendix Table 2 in Supplementary material for all accuracy measures for each instrument. No study- or sample-related variables were associated with between-study difference in AUCs Appendix Table 3 in Supplementary material.
This systematic review and meta-analysis examined the predictive accuracy of 9 violence risk assessment instruments for inpatient violence in forensic psychiatric hospitals from 78 samples involving 7, patients from 14 different countries.
The main finding was that instruments designed for the prediction of imminent violence performed better at predicting inpatient violence than instruments designed for longer-term follow-up periods, based on a range of performance measures. As a measure of overall accuracy, the median AUC for imminent tool studies was 0. Generally, AUC values greater than 0. The HCR is the most widely-used violence risk assessment instrument internationally, yet our findings from this review show that it has at best moderate accuracy across a range of performance measures, with regard to the prediction of inpatient violence.
These lower levels of accuracy are likely a consequence of how the HCR has been developed, as it is a general violence risk assessment instrument with applications and recommendations for use in a broad range of contexts, populations and follow-up periods. Although their performance may be acceptable for some populations in the community, the current evidence does not support their use for the prediction of inpatient violence in forensic psychiatry.
The two instruments designed specifically for imminent inpatient violence prediction the BVC and the DASA performed with higher accuracy for a number of measures. There were more studies focused on the poorer performing tools, such as the HCR, suggesting a need to move towards research examining short-term tools, and possibly optimizing them by considering novel risk factors [ 43 ].
Our findings indicate that the use of instruments designed for the imminent prediction of violence over the hour period post-assessment yielded higher accuracy for multiple measures of performance. In clinical practice, consideration should be given to the use of the BVC and the DASA, both of which are recommended tools in one clinical guideline for short-term management of violence and aggression in inpatient mental health settings [ 3 ].
Furthermore, the narrow hour window within which violence is predicted allows for prevention and management strategies to be implemented when they may be most needed. Both the BVC and DASA are brief checklists 6 and 7 items, respectively , have the advantage of scalability and can easily be integrated into routine practice. However, other clinical contexts will exist where longer-term instruments may be more relevant or appropriate; the high sensitivity 0. Considering the brevity of the BVC and DASA, they could act as a screen before a longer term tool is used considering the expense involved in administering time-consuming and resource-intensive instruments [ 44 ].
However, for both imminent and longer-term tools, it is important for there to be a link with clinical interventions and outcomes to link the risk prediction element with subsequent management of risk. One randomised controlled trial RCT has been conducted finding a positive effect reduction in inpatient violent incidents when the BVC was used in a forensic psychiatric sample combined with implementation of a violence management strategy and training [ 47 ].
To our knowledge, this is the first comprehensive review and meta-analysis of violence risk assessment instruments in the context of their predictive accuracy for inpatient violence in forensic psychiatric populations. There has been one previous review of risk assessment for inpatient violence in forensic psychiatric patients [ 45 ]. However, it used mean correlation coefficients between violence risk assessment scores and inpatient violence, which is limited to examine predictive accuracy.
Recent criticism of risk assessment literature has stated that there is an insufficient focus on subpopulations in a specific context [ 46 ]. Unlike previous reviews of risk assessment tools, the current one investigates a particular patient group in one setting. In addition, the literature on predictive accuracy of violence risk assessment has been limited by relying on one or two measures of accuracy [ 46 ].
To address this, we investigated a range of accuracy measures although none of the included studies reported calibration measures. One limitation is that only studies reporting true and false positives and negatives could be included in the full meta-analysis.
However, median AUCs were reported for the wider sample of eligible studies. Further, we corresponded with authors requesting unpublished data and increased the number of possible samples from 11 to 35 samples that report a range of performance measures. Another limitation is the large amount of between-study heterogeneity, perhaps due to variations in cut-off scores used for risk classifications. A number of other possible explanations were investigated in meta-regression and no associations were found to explain the variation between tools.
This heterogeneity is expected, especially in prognostic as opposed to diagnostic studies, and the use of a random-effects model accounted for this variation. Further, where possible, the same cut-off scores were applied for each sample of the same instrument. There were differences between the imminent and longer-term groups of studies with regard to the type of primary outcome used interpersonal violence only vs. Although this was investigated in meta-regression analyses and found to have no effect on the AUC accuracy estimate for longer-term tools, this analysis could not be performed for imminent instruments due to lack of available data.
It is possible, therefore, that the better performance of the imminent tools based on AUCs is based on higher rates of softer outcomes i. Whether this merits a change in how these tools are used in practice and for which inpatient settings requires further work. Future research on violence risk assessment in forensic inpatient settings should focus more on imminent instruments as this meta-analysis found a smaller proportion of the research literature based on these instruments.
Another useful direction for research would be further exploration of whether there should be a screen before longer-term instruments are used [ 44 ]. As the two imminent tools in this study rely predominantly on dynamic variables, research could investigate the role of novel dynamic variables to improve risk prediction, and whether adding static variables can add incremental performance.
Further to this, new technologies that have been developed for the use of risk prediction and monitoring should be examined [ 49 ]. Overall, this meta-analysis supports previous recommendations that future work in violence risk assessment requires the development and validation of tools designed for specific populations [ [46] , [50] , [51] ]. We thank the following study authors for providing tabular data for the analyses: Dr.
Kaoru Arai, Dr. Vivienne de Vogel. We would like to disclose no conflicts of interest of funding sources for this review. National Center for Biotechnology Information , U. Sponsored Document from. Eur Psychiatry. Author information Article notes Copyright and License information Disclaimer. Seena Fazel: ku.
This article has been cited by other articles in PMC. Associated Data Supplementary Materials mmc1. Abstract Background and Aims Violent behaviour by forensic psychiatric inpatients is common. Methods The nine most commonly used violence risk assessment instruments used in psychiatric hospitals were examined. Results Fifty-two eligible publications were identified, of which 43 provided information on tool accuracy in the form of AUC statistics.
Interpretation The performance of current tools in predicting risk of violence beyond the first few days is variable, and the selection of which tool to use in clinical practice should consider accuracy estimates. Risk assessment tools Based on recent reviews and questionnaire surveys [ [15] , [16] , [17] ], the 11 most commonly used instruments for forensic inpatient violence risk prediction were identified. Table 1 Characteristics of the nine included violence risk assessment instruments.
Instrument type and name No. Open in a separate window. Systematic search A systematic search was conducted to identify studies that measured the predictive validity of the nine instruments in forensic psychiatric settings for the outcome of inpatient violence. Quality assessment The QUADAS-2 tool, designed to assess methodological quality for systematic reviews of studies investigating diagnostic or prognostic accuracy, provided a risk of bias for each study, with low or high risk of bias categorisations.
Meta-analytic model We followed guidelines in the Cochrane collaboration for systematic reviews of diagnostic and prognostic test accuracy [ 32 ]. Heterogeneity Heterogeneity is expected in meta-analyses of diagnostic or prognostic test accuracy due to the bivariate nature of the analysis and variation in cut-off scores; therefore, the standard Q and I 2 statistics are not recommended [ [35] , [36] , [37] , [38] , [39] ], but with no consensus on what to use [ 40 ].
Meta-regression and subgroup analyses Meta-regression analyses were conducted to investigate the relationship between an overall accuracy estimate the AUC value and pre-specified study and sample characteristics, to test whether any had a moderating effect on the AUC. Descriptive characteristics For the wider sample of studies that reported on AUC values, information was collected for 6, participants in 78 samples from 43 independent publications.
Comparison between groups In the meta-analysis of all performance measures, there were 1, patients in the 6 imminent tool samples reported in 4 publications , compared to 1, patients in the 29 longer-term tool samples 15 publications.
Predictive accuracy 3. Table 3 Summary accuracy estimates produced by two categories of violence risk assessment instruments. Individual tool performance The HCR is the most widely-used violence risk assessment instrument internationally, yet our findings from this review show that it has at best moderate accuracy across a range of performance measures, with regard to the prediction of inpatient violence.
Clinical implications Our findings indicate that the use of instruments designed for the imminent prediction of violence over the hour period post-assessment yielded higher accuracy for multiple measures of performance. Strengths and limitations To our knowledge, this is the first comprehensive review and meta-analysis of violence risk assessment instruments in the context of their predictive accuracy for inpatient violence in forensic psychiatric populations. Future directions Future research on violence risk assessment in forensic inpatient settings should focus more on imminent instruments as this meta-analysis found a smaller proportion of the research literature based on these instruments.
Acknowledgements We thank the following study authors for providing tabular data for the analyses: Dr.
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