Clinical Forensic Practice Research Articles

Forensic Mental Health Nurses' Perceptions and Experiences of Trauma-Informed Care in a High-Secure Hospital.

Implementation of trauma-informed care (TIC) into forensic clinical practice may contribute to positive outcomes for both patients and staff. The current study aimed to describe forensic mental health nurses' perceptions and experiences of using TIC within a high-secure forensic hospital. Twenty-seven forensic mental health nurses were interviewed regarding their experiences of using TIC within a high-secure hospital. Participants recognized the importance of understanding the past traumatic experiences of patients in their care but described a number of barriers to the implementation of TIC. A lack of organizational support, the negative impact of patient psychopathology on nurse well-being, and environmental factors were all perceived to negatively impact the successful delivery of TIC. Participants also discussed a widespread lack of knowledge and confidence in the application of TIC but expressed great desire for training to improve service delivery. The application of TIC into daily clinical practice appears to be suboptimal. To support nurse and patient well-being and contribute to a highly skilled trauma-informed workforce, further training in this area is vital. Training in TIC may contribute to enhanced patient outcomes and promote nurse well-being and should be supported organizationally with sufficient resources.

Racial justice in psycholegal research and forensic psychology practice: Current advances and a framework for future progress.

Police killings of Black civilians have brought unprecedented attention to racial and ethnic discrimination in the criminal justice and legal systems. However, these topics have been underexamined in the field of law-psychology, both in research and forensic-clinical practice. We discuss how a racial justice framework can provide guidance for advancing psycholegal research and forensic-clinical practice related to race, ethnicity, culture, and their intersections. A racial justice framework centers the goal of increasing fair and responsive treatment and just outcomes for the most vulnerable populations involved with the criminal justice, legal, and carceral systems and ending existing disparities. We argue that the framework should include the use of transparent nonobjectivity, in which racial justice is an explicit and acknowledged goal of research and practice that exists alongside a commitment to open and rigorous science and evidence-based practice. We then use the racial justice framework as a backdrop for discussing the articles and broader themes that appear in the special issue, which include racial biases in policing, public views of the police and use of force, expanding research on racial bias in lay judgments, understanding disparities in sentencing and corrections, and improving forensic practice. Finally, we look to the future, discussing practices and perspectives that can facilitate a racial justice approach in psycholegal research and forensic-clinical practice. Our recommendations include engaging in reflexivity and addressing positionality; expanding research questions and methods, especially qualitative and community-based participatory action research; centering and engaging with communities of color; greater emphasis on intersectionality; shifting toward structural and adaptive interventions; and greater integration of work from other fields. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotional Rapid Response Impulsivity in Incarcerated Men and Non-Incarcerated Controls

ABSTRACT So far, few studies have assessed emotional rapid response impulsivity (RRI) in incarcerated men. Available studies use varying methodological approaches and show mixed results, but incarcerated individuals are more likely to be impaired by emotional RRI. None of these studies, however, reported on any correlational or regression analysis assessing whether emotional RRI was linearly related to antisocial behavior in general or aggression and misconduct in particular. The current study investigated whether incarcerated individuals (n = 283) show impaired performance on an emotional Go/No-Go task compared to non-incarcerated controls (n = 51), and whether performance is associated with increased trait aggression, and within-prison misconduct. The results indicate that incarcerated individuals indeed show impaired emotional RRI compared to non-incarcerated controls, irrespective of emotional condition, but impaired emotional RRI was not related to trait aggression or within-prison misconduct. The impairment, relative to non-offending controls, could therefore be related to other factors than their anti-social behavior, which could hamper the use of emotional RRI in risk assessment or forensic clinical practice.

The use and reporting practice of psychological tests in German risk and criminal responsibility expert reports

ABSTRACT Assessment reports about individuals charged/convicted of offenses have an influence on significant personal consequences for examinees by sentencing decisions regarding placement in a forensic hospital or prison. As there is evidence that unstructured clinical judgments have limited accuracy, research-based practice recommendations call for the use of standardised measures and for experts to base their assessments on empirically supported psychological tests. Previous findings on the actual use of psychometric tests indicate an increasing but still heterogeneous use of psychological tests, highlighting the continued relevance of a professional debate on best diagnostic practice. A potential shortcoming, however, is that these studies almost exclusively relied on clinicians’ self-reports. The present paper presents an analysis based on the actual (retrospectively assessed) usage in German risk (n = 489), criminal responsibility assessment reports (n = 272), and corresponding psychological test reports (n = 313) between 1990 and 2016. In accordance with previous survey data, results showed a frequent usage of a diverse range of psychological tests. Contrarily, performance-based personality tests, typically subsumed under so-called (semi-)projective personality tests, are still implemented regularly in forensic-clinical practice, although the number and frequency seem to be decreasing. Taken together, the findings gain an important insight into the psychological testing practive in forensic settings.

Protective factors as uni- or bipolar factors and their incremental validity and accuracy in predicting general recidivism

This study examined whether protective factors are unique or the opposite of risk factors and whether they have incremental validity in the prediction of general recidivism. Using a sample of 3306 Dutch forensic outpatients, this study was the first large-sample study ever performed on this topic. Results from exploratory factor analyses demonstrated a relatively stable factor structure of 14 factors, consisting of 32 of the initially included 68 risk factors and 11 of the initially included 17 protective items. The protective factors were found to be either bipolar (i.e., mirror images of risk factors) or responsivity characteristics (i.e., motivation for treatment, cognitive disability). Incremental validity for the recidivism prediction was found in one factor with internal protective items (e.g., empathy, financial management, life goals). This factor decreased the recidivism risk by 6%. However, weak predictive accuracy was found for this factor. Implications for clinical forensic practice are discussed with special focus on the risk-need-responsivity model.

How Trauma May Magnify Risk of Involuntary and False Confessions Among Adolescents

Empirical research on police interrogation has identified both personal and situational factors that increase criminal suspects’ vulnerability to involuntary, unreliable, or false confessions. Although trauma exposure is a widely documented phenomenon known to affect adolescents’ perceptions, judgments, and behaviors in a wide array of contexts (especially stressful contexts), trauma history remains largely unexamined by interrogation researchers and virtually ignored by the courts when analyzing a confession. This article argues that trauma may operate as an additional personal risk factor for involuntary and false confessions among adolescents by generating both additive and interactive effects beyond youths’ general, developmentally-driven vulnerabilities in police interrogations. First, we briefly review adolescent trauma symptomatology, emphasizing the heterogeneity of adolescents’ responses to trauma. Next, using Leo and Drizin’s (2010) “Three Errors” framework of police-induced false confessions, we systematically apply clinical findings to each of the three police errors—misclassification, coercion, and contamination—to outline the psychological mechanisms through which adolescents with trauma histories may be at increased risk for making involuntary or unreliable statements to police. Finally, we offer considerations for interrogation research, clinical forensic practice, police practices, and courtroom procedures that could deepen our understanding of trauma’s role in the interrogation room, improve the integrity of investigative and adjudicatory processes, and ultimately promote justice for adolescent suspects with trauma exposure.

Staff Perceptions on the Implementation of Structured Risk Assessment with the START:AV: Identifying Barriers and Facilitators in a Residential Youth Care Setting

An effective implementation approach is crucial for successful integration of structured risk assessment instruments into practice. This qualitative study explored barriers and facilitators to the implementation of the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) in a Dutch residential youth care service. Perceptions of staff members from various disciplines were gathered through focus group interviews at three consecutive occasions. After inductive coding of the interview extracts using thematic analysis, the identified codes were linked to the consolidated framework for implementation research. Through this framework, factors that influence an implementation project can be organized into multiple domains and constructs. In the present study, staff members described implementation barriers related to characteristics of the risk assessment instrument, staff, and the implementation process. In addition, features of the setting were frequently mentioned as hindering the implementation, such as hierarchy, culture, communication, as well as implementation climate and readiness for change. Staff members also identified multiple facilitators, such as experienced advantages of the START:AV compared to the previous risk assessment practice and positive beliefs about the instrument. The article concludes with recommendations for successful implementation of structured risk assessment instruments in forensic-clinical practice.

Misdiagnosed Injuries of Unusual Gunshot Wounds in the Clinical Forensic Practice

Misdiagnosed Injuries of Unusual Gunshot Wounds in the Clinical Forensic Practice

Neuroscience in Forensic Psychiatry and Psychology: An Introduction to the Special Issue

This special issue is dedicated to the potential role of neuroscience in forensic psychiatry and psychology. Although neuroscientific insights are increasingly incorporated in clinical practice, they received less attention in forensic mental healthcare and in the forensic mental health literature. In the last decade there has been an increased interest in using neuroscientific knowledge in the assessment and treatment of psychopathology related to antisocial and violent behavior. Consequently, neuroscientific methods may, for example, be used in detecting psychiatric problems in defendants, one of the topics covered by the scientific field of neurolaw. This current article introduces this special issue by providing an introduction to the neurobiology of antisocial and criminal behavior and will set off discussing how neuroscientific insights may be used in forensic clinical practice.

Psychopathic Personality Disorder

The diagnosis of psychopathic personality disorder has salience for forensic clinical practice. It influences decisions regarding risk, treatability and sentencing, indeed, in certain jurisdictions it serves as an aggravating factor that increases the likelihood of a capital sentence. The concatenation of symptom that is associated with modern conceptions of the disorder can be discerned in early writings, including the book of Psalms. Despite its forensic clinical importance and historical pedigree the concept remains elusive and controverted. In this paper I describe an attempt to map the concept of psychopathic personality disorder—the Comprehensive Assessment of Psychopathic Personality (CAPP). I outline the processes used to create the concept map; I summarise evidence in support of the content validity of the map and describe different operations designed to operationalise the construct. It is only when conceptual clarity is achieved that valid operations and measures can be created. I end with a plea for more carefully considered application of statistical methods; applications that better fit the theoretical questions being posed.

Investigating drug-facilitated sexual assault at a dedicated forensic centre in Cape Town, South Africa

BackgroundDrug-facilitated sexual assault (DFSA) is a well-recognised public health concern. In South Africa however, epidemiological and toxicological data associated with suspected DFSA are not available. Toxicological screening is currently not routinely available in clinical forensic practice in the Western Cape, or elsewhere in South Africa. ObjectivesTo preliminary investigate and characterize DFSA in a specific metropolitan setting in South Africa and to identify the drugs/xenobiotics associated with these reported DFSAs. MethodsIn total, 107 survivors of suspected DFSA who reported to Victoria Hospital Clinical Forensic Unit in Cape Town, between 1 October 2013 and 30 June 2016, were included. Blood, urine, and/or hair specimens from survivors were screened for drugs of abuse using a targeted LC-MS/MS method. Breath alcohol measurements were conducted using the Dräger Alcotest 6820 after July 2015. Patient, incident and examination history were recorded on standardized data sheets. ResultsOf the 107 cases investigated, most of the patients were female (n=104, 97%), between the ages of 18–25years (n=54, 50%), and had reported to the Clinical Forensic Unit within 24h (n=78, 73%). Altogether, 30 patients (28%) reported a history of mental health issues, drugs and/or alcohol use, or prior sexual abuse. Most incidents took place in the late evening/early morning at the home of the assailant(s), a friend or of the patient (n=62, 58%), and most assailants were known to the victim (n=66, 62%). Specimens were positive for drugs and/or ethanol in 72 patients (67%), with drugs other than ethanol being detected in 60 patients (56%). Breath alcohol measurements were conducted in 58 cases during the prospective leg of the study with an average reading of 0.1mg/L (range not detected—0.98mg/L). ConclusionDFSA in this setting is mostly opportunistic, with ethanol suggested to be the most commonly involved drug, despite limitations in detection due to delays in reporting. Other common drugs observed were methamphetamine, methaqualone and diphenhydramine either alone or in combinations. The complexity and current inadequacy surrounding investigation of these cases is highlighted in this study as well as the necessity for greater investment into the development of infrastructure to support systematic toxicological analyses and services to assist in the investigation and understanding of these intricate cases. Training and empowerment of role players dealing with the investigation and management of DFSA is required, and subsequent public health education and policy development is essential.

Medico-legal documentation of rape or sexual assault: are community-service doctors equipped for the task?

Background: Following upon two-year internship, community-service doctors make mistakes when they deal with evidence of medico-legal examinations in various settings. These mistakes result in alleged perpetrators being released by courts. This study investigated undergraduate clinical forensic medicine training, based on experiences and opinions of community-service doctors. This article focuses on incidents of alleged rape cases only. 
 
 Methods: The study was a quantitative retrospective cohort study that made use of a questionnaire with an adapted Likert scale. An electronic survey tool was employed to target 150 community-service doctors throughout South Africa. Percentages are used to display results.
 
 Results: A response rate of 59.3% was achieved. Although 80% of the participants reported that they had undergraduate training on how to manage alleged rape or sexual assault cases, only 11.4% of the participants had hands-on exposure to an alleged rape case during their undergraduate training. In addition, the majority of the participants (77.1%) never had undergraduate training on how to complete the J88 form. These findings indicate that clinical forensic training in the undergraduate medical programme does not adequately prepare community-service doctors to meet the challenges of clinical forensic practice. The current curriculum should be adapted to address these shortcomings.
 
 Conclusions: Perpetrators cannot be convicted if evidence collected cannot stand up in court. Proper training of undergraduate medical students prior to their community-service posting will ensure that medico-legal documentation is completed correctly, leading to the presentation of credible evidence in a court of law in order to ensure successful conviction of alleged perpetrators.
 
 Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2018; DOI: 10.1080/20786190.2017.1348046

Assessing the Risk of Intimate Partner Violence: Expert Evaluations Versus the Ontario Domestic Assault Risk Assessment

ABSTRACTIn the forensic field, a reliable and valid assessment of domestic perpetrators who pose a high risk of reassaulting an intimate partner is needed to implement effective risk management strategies. The purpose of the present study was to examine the accuracy of two violence risk assessment methods in identifying high-risk perpetrators of IPV, comparing forensic experts with psychology students. For a cohort (n = 30) of domestic violent cases that required an expert evaluation in the Canton of Zurich in Switzerland, violence risk was assessed by certified forensic psychiatrists using unstructured clinical judgment (UCJ) and by undergraduate and graduate research assistants scoring the actuarial Ontario Domestic Assault Risk Assessment (ODARA) instrument. After a mean follow-up period of 8.0 years, the base rate of violent recidivism was 20.0%. Students were significantly more accurate than clinical experts in assessing long-term violent recidivism (AUC = 0.78 vs. 0.44). Raters without extensive clinical training could differentiate those spouses who carried on assaulting their intimate partner from those who desisted from violent behavior. Potential explanations are clinical assessment biases and the mediating effect of interventions. Further research should address the lack of use of mechanical instruments in clinical forensic practice.

Firearms and cultural competence: considerations for mental health professionals

PurposeAlthough cultural competence is gaining increased attention among mental health practitioners, such primarily has centered on race, religion, ethnicity, language, and nationality. Thus far, there has been relatively little recognition of specific socialized subcultures aside from the aforementioned groups, and virtually no discussion regarding those associated with various firearm-related subcultures. This topic is particularly relevant to mental health practitioners, as positions on firearm use and ownership frequently split across political party lines, and mental health professionals and academics are more likely to espouse liberal rather than conservative views. It follows that practitioners may understand little about firearms culture and, therefore, are at increased risk for biased decision making when working with clients for whom firearms have relevance. The paper aims to discuss these issues.Design/methodology/approachThis paper takes a conceptual approach to reviewing potential areas of bias in both clinical and clinical-forensic practice in the US context.FindingsThe authors detail the prevalence of firearm-related issues in the USA, contextualize firearm-related issues in forensic treatment and evaluation scenarios, delineate a number of firearm subgroups, and recommend considerations for mental health professionals to develop cultural competence as it relates to firearms and associated subcultures.Originality/valueThis is an original conceptual study of cultural competence and various firearm-related subcultures.

The Structured Interview of Family Risk Assessment in Clinical Use: A Study with Parents of Juvenile Offenders in Detention

In the juvenile clinical forensic settings risk assessment, instruments that allow a dynamic understanding of the interaction between family risk and protective factors are needed.<0} This study aims to contribute to the validation of the Structured Interview of Family Risk Assessment (SIFAR) in juvenile clinical forensic practice. Using a quasi-experimental design, the effects of a family program on risk and protective family factors were assessed with SIFAR and the YLS/CMI. Non-parametric methods were used.<0}<0}<0} The participants were a convenience sample of 16 parents (8 from a control group and 8 from an experimental group) of detained adolescent male delinquents in Portuguese forensic facilities. The YLS/CMI as an actuarial risk assessment tool and SIFAR as a structured professional judgment toll were used. SIFAR and YLS/CMI showed the effects of the program in reducing the family risk on this sample and the usefulness of the complementary use of both risk assessment tools. The findings show that SIFAR is sensitive to changes in the family assessment risk, allowing the understanding of the family risk and protective factors changes and dynamics, being a suitable instrument for case management.

Faculty of clinical forensic medicine (FCFM); proposed training and CPD programs

In January 2014, the RCPA established the Faculty of Clinical Forensic Medicine to enhance the recognition and development of clinical forensic medicine as a unique medical discipline, and to promote education, research and training in the field by ensuring a sustainable specialist career pathway to attract new trainees and support the work of existing practitioners. It is anticipated that the promotion of stronger links with forensic pathology, odontology and science will be of great value in this process. This presentation will outline the proposed development of a training program for Fellowship using the RCPA template and incorporating components of the existing Australasian Association of Forensic Physicians (AAFP) clinical forensic medicine curriculum and continuing professional development programs, and integrating international best practice in curriculum development and outcomes-based education. The curriculum and assessment procedures will be developed to align with RCPA policy and fit within the AMC requirements structure, setting clear standards and expectations for trainees and supervisors through a matrix of standards, outcomes and assessment indicators. The progress of candidates towards achievement of standards determined by the Faculty will be evidenced through a suite of assessment activities, designed to reflect the nature of clinical forensic practice and continually inform the learning of practitioners in the field.

The Use of the HCR-20V3 in Dutch Forensic Psychiatric Practice

In this article, the applicability of the recently published HCR-20V3 for violence risk assessment in forensic psychiatric practice is discussed. This revision of the HCR-20 is the result of a multi-year development process based on worldwide empirical research, clinical expertise and consultation. Recently, the HCR-20V3 was implemented in Dutch forensic psychiatric practice by a research team that was also involved in beta-testing and pilot research into the interrater reliability and predictive validity of the first HCR-20V3 Draft version. This paper presents results of this beta-testing and the pilot study, as well as results from a recently conducted survey into the clinical value and applicability of the Dutch HCR-20V3. Overall, the results demonstrate that the HCR-20V3 is a promising revision with sound psychometric properties and improvements compared to the prior version of the HCR-20 for violence risk assessment and management. Furthermore, the first impressions of 192 workshop participants about the HCR-20V3 were positive. To illustrate the applicability of the HCR-20V3 for risk assessment and management in forensic clinical practice, a detailed forensic case study is presented.

Adapting the HCR-20V3 for Pre-trial Settings

The present study investigated the use of the HCR-20V3 (Douglas, Hart, Webster, & Belfrage, 2013) among a sample of 84 male inmates in a pre-trial correctional facility. Overall, results indicated that the newly revised instrument can be adapted for use in a pre-trial context, although some scoring obstacles (e.g., participants’ uncertain legal status) were encountered when attempting to rate certain HCR-20V3 items. Also, some group differences in risk ratings were found when comparing our sample to HCR-20V3 data collected from external psychiatric inpatient and post-adjudication samples. Implications for clinical forensic practice are reviewed, focusing on modifications that may be helpful or necessary for use in pre-trial settings.

A randomised controlled trial to explore insight into psychosis; effects of a psycho-education programme on insight in a forensic population

A psycho-education programme for people with psychosis has been delivered across forensic services for years. A multi-site randomised controlled trial was carried out over a three and a half year period, to review the effectiveness of the programme. A range of psychometric instruments were used to measure the following: insight; knowledge of psychosis; general mental health, including depression, quality of life, and social behaviour. Results from (n = 81) indicate a significant improvement in knowledge and empathy. An improvement was also noted in the measures of insight, mental health, and quality of life, although they did not reach significance. In conclusion, psycho-education has a place in forensic clinical practice. It is recommended that psycho-education programmes are used across the forensic network as part of a package of care, to improve the patient experience and reduce the likelihood of re-offending.

The persistence of ligature marks: towards a new protocol for victims of abuse and torture

One of the most frequently observed lesions in clinical forensic practice concerns the patterned abrasion on skin due to constriction by various types of ligature. Detection of ligature marks and their patterns may be fundamental for reconstructing events and supporting testimony of an aggression, sexual abuse, or maltreatment. But very little actually exists in literature concerning their detectability and how long they last. This study aims at evaluating the time of persistence and detectability of skin signs left by different types of ligatures in living persons: on the arms of three volunteers, eight different ligatures were applied; 123 tests were performed, with time of contact ranging between 1min and 2h and 45min. In addition, the persistence of the shape and pattern of the ligature was evaluated 15, 30, and 60min after a 5- and 15-min compression. Polyvinyl siloxane, applied by a gun dispenser, was used to perform a cast of the skin mark. The results show that the pattern was less distinguishable with the decrease of time of contact, going from 75% after 10 and 15min of contact, to 45.8% after 1min. Above 15min, the specific pattern was always recognizable. In addition, a progressive decrease of the detectability of the pattern with time, respectively, up to 12.5 and 37.5% in 5- and 15-min tests was observed. This study provides useful results for the assessment of patterned injuries in forensic pathology and clinical forensic medicine, both on dead and living persons: in addition, the use of silicone casts seems to be a reliable and cheap method for easily recording and preserving the morphological profile of skin lesions.