General Forensic Assessment Mental Health Assessment You are working for the client What is the psychopathology diagnoses o Thinking o Affect o Interpersonal relations Treatment recommendations prognosis The audience is usually other treatment providers o Write it for other people that work in the business o Important because it dictates what you can and can t do o Treatment isn t really considered Forensic Assessment Who are you working for o Examples Attorney Court Correctional facility Client rare Different assessment questions o Competency o Insanity o Violence recidivism risk o Psychological damages o Child custody Who s the Audience Report goes to o Judges o Lawyers o Probation Watch your language o Don t use lingo i e pervasive dysthymia o He is likely a rather sad man who experiences a pervasive dysthymia with recurring periods of anxiety His thinking may frequently be over controlled although occasionally distracted by an upsurge of disruptive ideas Pervasive dysthymia light depression Anxiety Over controlled Upsurge of disruptive ideas Hearing voices Stressed Tough to clearly interpret Who Gets A Crack At It You may have to defend the report in court o Write it like a good attorney is going to challenge it o Look in detail for weaknesses and flaws Acknowledge them Think legally more than psychologically o Run it by a colleague The focus writing should be to the data not the case Rules of Forensic Assessment Avoid basing it only on a clinical interview Use more than one assessment instrument o Even if there s overlap o Different instruments have different strengths different weaknesses Get outside collateral information o Talking to the person s friends family o Talking to the person s mental health provider Back it up with research Assessment Structure Clarify with client referral source purpose and informed consent o Referral source attorney is the client not the person being evaluated o Purpose this isn t treatment this is an evaluation o Informed consent know who may see what they say Be up front with them about how this ties in with their legal situation There are a number of competency assessment instruments Clinical Interview Psychosocial History What would you cover o Developmental history Childhood o Relevant medical history Brain injury Accident o History with criminal justice system o Mental health history drug alcohol substance abuse history Treatment history If it has has not worked in the past These 2 histories work together o Education Employment history o Family history How they grew up History of diseases o Trauma history o Interpersonal relationships o Sexual history Good proxy for other things Sex with men Women Prostitutes STDs Good developmental marker when did you hit puberty Instruments to Use Instruments must fit the assessment question Instrument expectations Know strengths and limitations of instruments o Which would be the best to use o Limitations o Norms and impact on interpretation Types of Instruments Objective vs Projective o Objective means scoring is the same no matter who does it o Projective means that the scorer determines the score IQ Cognitive functioning WAIS KAIT KBIT Self report MMPI MCMI o Efficient Semi structured interview PCL Psychopathy Check List Structured interview SCID o SCID is good for diagnosing Why the MMPI is a Model The most widely used psychopathology personality psychological test Provides profiles Extensively used in forensic assessment o Most legally defensible test Examines multidimensional as opposed to unidimetional psychological characteristics Strong research base Originally developed in the 1930s Has 2 main sections o Validity scales tells you the test taking approach o Clinical scales look at to see what s going on main scale 50 is the normative mean and 65 is clinically significant Validity Scales o Cannot say number of unanswered items o L Lie measure of how often he she is lying I m a perfect person idea if elevated o F Infrequency pick up exaggeration of symptoms malingering People who tend to fake over endorse symptoms First 370 questions o FB Back F same as F except it s calculated based on the last 267 question back half If F is normal and Back F is elevated it could be due to testing fatigue o FP also an F scale meant to pick up faking bad for psychiatric populations Not very good Elevated means individuals who are faking above and beyond to distinguish them from truly psychotic people o FBS Fake Back Scale Not well researched Not reliable negative behavior symptoms look good o K Defensiveness unwillingness to disclose what people perceive as o S Positive Self presentation sophisticated attempt to make ones self o VRIN Variable Response Inconsistency inconsistent answers Most susceptible to reading deficits Random responses noticed here Elicits yes yes response Most susceptible to reading deficits Elicits yes no response o TRIN True Response Inconsistency inconsistent answers Basic Scales o 1 Hs Hypochondriasis complains of vague physical problems when there is no physical evidence Goes along with depression o 2 D Depression mood is depressed low self esteem etc Often tired loss of appetite etc o 3 Hy Hysteria rely on denial and repression to deal with stress Na ve melodramatic narcissistic not insightful outgoing o 4 Pd Psychopathic Deviate antisocial Engaging in crime drug alcohol use family issues deceptive irresponsible Trouble with work school and or criminal justice system o 5 Mf Masculinity Femininity measures stereotypical gender behavior High Mf means that you do things that are not stereotypical of your gender o 6 Pa Paranoia overly distrustful Distressful guarded obsessive shrewd aloof Externalize blame and harbor grudges against others Hallucinations elevate it o 7 Pt Psychasthenia obsessive compulsive Obsessive is the thinking part Compulsive is the physical part o 8 Sc Schizophrenia Hearing voices Poor judgment erratic moods shy withdrawn flat affect More socially isolated Hallucinations elevate it o 9 Ma Hypomania manic behavior Very energetic impulsive start something don t follow through erratic bizarre Manic episodes last at least a few days if not weeks or months o 0 Si Social Introversion socially reserved Reserved submissive don t do well in social environments Low scorers are extroverted outgoing gregarious expressive talkative but insincerely so Cultural Issues Language and interpreters Available instruments Cultural impacts on tests Cultural impact on diagnosing o Ends