Forensic Settings Research Articles

Investigation of self-stigmatization and perceptions towards delinguency in inpatient individuals diagnosed with schizophrenia in high-security forensic psychiatry settings in Turkiye

Investigation of self-stigmatization and perceptions towards delinguency in inpatient individuals diagnosed with schizophrenia in high-security forensic psychiatry settings in Turkiye

Candidate Genetic Markers for Post Traumatic Stress Disorder Within the Scope of Forensic Psychiatry

This study was conducted to investigate the role of two candidate polymorphisms to improve the diagnosis of Post-Traumatic StressDisorder (PTSD) in forensic psychiatry settings. Individuals who applied to our unit with PTSD symptoms following a traffic accident were included. The control group consisted of people who had experienced a similar accident without any symptoms. Sociodemographic data-form, Hamilton Depression Rating Scale and Anxiety Sensitivity Index-3 (ASI 3) were applied to the patients and controls, and the frequencies of the rs8042149 polymorphic allele of the RORA gene and the rs717947 polymorphic allele (4p15) were investigated. A total of 103 people were included (54 case, 49 control). The rates of polymorphisms were not different between the groups. Higher education levels were associated with lower PTSD incidence while higher scores in the Social Subscale of ASI strongly predicted the occurrence of PTSD. The polymorphisms assessed did not help to differentiate the groups in the current sample. The potential of the Social Subscale of ASI-3 in predicting the occurrence of PTSD following a trauma should be evaluated in a longitudinal design.

Institutional influence on length of stay in German forensic hospitals: a multilevel analysis of patients with schizophrenia spectrum disorders.

Scientific studies have focused on patient-related characteristics as predictors of length of stay in forensic psychiatry. However, little attention has been paid to the specificities of forensic psychiatric settings. This study aims to test whether differences in forensic admissions transcend individual factors by comparing length of stay between different psychiatric units, controlling for hospital characteristics and patient characteristics. The dataset was derived from a forensic documentation system containing a wide range of information on forensic psychiatric patients. N = 594 patients with schizophrenia spectrum disorders discharged from 6 forensic hospitals in southern Germany were included in a linear mixed regression model. Linear mixed models were calculated, allowing for the simultaneous estimation of variance between patients and hospitals. The final regression model explained 49% of the total variance. The only statistically significant patient-related predictors were age at admission, education and severity of the index offence. Hospital differences explained 41% (ICC) of the variance in length of stay without finding a significant hospital effect in the data. Previous research has primarily analyzed predictors of length of stay in terms of individual patient characteristics. This work suggests that variables other than patient-related factors need to be considered when assessing the length of stay in forensic units. Further multi-center studies are needed to gain a better understanding of how forensic psychiatric hospitals and other institutional influences affect length of stay.

Eigenfemora—Age-at-Death Estimation in the Proximal Femur through an Image Processing Approach

Estimating age at death is essential to establish biological profiles from human skeletal remains in both forensic and archeological settings. Imaging studies of skeletal age changes in adults have described the metamorphosis of trabecular bone structure and bone loss in the proximal femur as well as changes in morphology during different stages of life. This study aims to assess the utility of a digital representation of conventional X-ray films of the proximal femur for the estimation of age at death in a sample of 91 adult individuals (47 females and 44 males) of the Coimbra Identified Skeletal Collection. The proposed approach showed a root mean squared error (RMSE) of 17.32 years (and mean absolute error of 13.47 years) for females and an RMSE of 14.06 years (mean absolute error of 11.08 years) for males. The main advantage of this approach is consistency in feature detection and extraction, as X-ray images projected on the femora space will always produce the same set features to be analyzed for age estimation, while more traditional methods rely heavily on operator experience that can lead to inconsistent age estimates among experts.

Dissimulation in forensic psychiatric evaluations, a case-control study of the Millon Clinical Multiaxial Inventory-III.

The forensic setting can affect a subject's behaviour.Dissimulation is a mechanism of minimization or concealment of a psycho-pathological condition.The MCMI-III can be a useful tool for a forensic psychiatrist or forensic psychologist in assessing dissimulation.

Development and comparison of forensic interval age prediction models by statistical and machine learning methods based on the methylation rates of ELOVL2 in blood DNA

Age estimation can be useful information for narrowing down candidates of unidentified donors in criminal investigations. Various age estimation models based on DNA methylation biomarkers have been developed for forensic usage in the past decade. However, many of these models using ordinary least squares regression cannot generate an appropriate estimation due to the deterioration in prediction accuracy caused by an increased prediction error in older age groups. In the present study, to address this problem, we developed age estimation models that set an appropriate prediction interval for all age groups by two approaches: a statistical method using quantile regression (QR) and a machine learning method using an artificial neural network (ANN). Methylation datasets (n = 1280, age 0–91 years) of the promoter for the gene encoding ELOVL fatty acid elongase 2 were used to develop the QR and ANN models. By validation using several test datasets, both models were shown to enlarge prediction intervals in accordance with aging and have a high level of correct prediction (>90 %) for older age groups. The QR and ANN models also generated a point age prediction with high accuracy. The ANN model enabled a prediction with a mean absolute error (MAE) of 5.3 years and root mean square error (RMSE) of 7.3 years for the test dataset (n = 549), which were comparable to those of the QR model (MAE = 5.6 years, RMSE = 7.8 years). Their applicability to casework was also confirmed using bloodstain samples stored for various periods of time (1–14 years), indicating the stability of the models for aged bloodstain samples. From these results, it was considered that the proposed models can provide more useful and effective age estimation in forensic settings.

Mental Healthcare through Cognitive Emotional Regulation Strategies among Prisoners.

Prisoners are exposed to a deprived environment, which triggers mental illness and psychological problems. Abundant research has reported that mental illness problems, suicide, aggression, and violent behaviors occur in incarcerated people. Although the mental healthcare system for incarcerated people is emphasized, little research has been conducted due to their limited environment. In particular, the regulation of negative emotion is significantly associated with mental illness and anti-social and violent behaviors. However, mental healthcare through cognitive emotional regulation based on cognitive behavioral therapy has not been fully investigated. This study identified four different patterns in cognitive strategies for regulating negative emotions. Cognitive emotional regulation strategies (i.e., self-blame, other-blame, rumination, catastrophizing, putting into perspective, positive refocusing, positive reappraisal, acceptance, and refocus on planning) were examined and addressed their vulnerable psychological factors. We analyzed a total of 500 prisoners' responses to the cognitive emotional regulation questionnaire (CERQ) by latent class profiling analysis. A four-class model was identified based on the responses of CERQ. In addition, the significant effect of depression on classifying the four classes was found. Furthermore, differences in the average number of incarcerations were also shown across four classes. In conclusion, Class 2 (Negative Self-Blamer) uses dysfunctional/negative strategies that may place the group at a high risk of psychological disorder symptoms, including depression and post-traumatic stress. Class 3 (Distorted Positivity) uses positive/functional strategies but seems to utilize the positive strategies in distorted manners to rationalize their convictions. Class 1 (Strong Blamer) and Class 4 (Moderator Blamer) showed similar patterns focused on the "other-blame" strategy for regulating negative emotion, but they are at different levels, indicating that they attribute incarceration to external factors. These findings provide useful information for designing mental healthcare interventions for incarcerated people and psychological therapy programs for clinical and correctional psychologists in forensic settings.

A Nominal Group Technique to finalise Safewards Secure model and interventions for forensic mental health services.

INTRODUCTION: Safewards is a model developed for acute mental health settings designed to reduce conflict and containment; however, it requires adaptation to forensic mental health settings. To develop the Safewards Secure model, a model to assist forensic mental health services to reduce conflict and containment. A literature review was conducted to elicit possible modifiers and adjustments to the interventions. A Nominal Group Technique was then used to engage forensic mental health experts who had experience implementing Safewards (n = 12) to seek feedback about the suggestions and reach consensus on the Safewards Secure model and interventions. Data were thematically analysed. Experts reached consensus on all suggestions, however, did recommend minor additions and modifications. Two themes were also interpreted: Safewards Secure is just as much for staff as it is for consumers, and the proposed additions encourage more meaningful staff to consumer collaboration. This study identified key challenges experienced by nurses working in forensic mental health settings, however, these challenges were not seen as insurmountable. The Safewards Secure model offers prompts and suggestions to encourage reflection, collaboration and a humanistic approach to care in forensic mental health settings. Addressing reactions to offending behaviour and encouraging more collaboration might assist in ensuring a more person-centred approach to forensic mental health nursing care.

When the ward is the patient: Using the PRISM protocol to understand and reduce violence in an inpatient intellectual disability setting.

Violence in inpatient settings is recognised as a worldwide issue, with inpatient intellectual disability services having higher rates than other mental health settings. Violence results in injury and illness, lack of confidence in the organisation and staff burnout. These combined effects have a negative impact on the ability of services to provide therapeutic environments. Attempts to manage violence tend to focus on the individual. This is only one part of the solution. Situational risk factors for violence within secure settings can be identified and modified to reduce violence rates. The role of situational risk factors in rates of institutional violence requires consideration in addition to individual patient risk assessment and management. To discuss an illustrative case study of a ward experiencing high levels of violence, resulting in staff burnout and low morale. To describe how assessing and addressing the relevant situational risk factors led to demonstrable reductions in violence and improvements in the service provided. This case study demonstrates the practical application of assessing and managing situational risk factors for violence in a locked intellectual disability ward in order to effectively reduce levels of violent incidents. A description of the violence and critical issues faced by the ward is provided, noting key elements of the timeline of events and the application of the Promoting Risk Intervention by Situational Management (PRISM) process to address these. The PRISM protocol enabled a comprehensive assessment and understanding of situational factors relevant to the violence rates in the ward. The recommendations following the analysis enabled the management team to identify areas for immediate and long-term action. Practical steps to address issues such as improving soundproofing were implemented quickly whilst other issues required changes over the longer term. Significantly, reduced levels of violence were observed within a 2-month period of immediate steps being taken, with further gains achieved over the longer term. This paper provides the only example of the use of the PRISM protocol in an intellectual disability inpatient setting. The reduction in violence seen in this unit provides 'real world' evidence that addressing situational factors for institutional violence can be effective in intellectual disability inpatient settings, with beneficial outcomes for patients and staff. Whilst individual patient risk assessment and risk management are key components of forensic mental health care, situational risk factors for violence are highly relevant to rates of violence within secure care settings. Structured assessment of situational risk factors should be considered when inpatient settings experience persistent high levels of violence. Further research on the impact of assessing situational risk factors in forensic mental health settings (including intellectual disability services) would help to develop the existing evidence base.

Dilute and shoot approach for toxicology testing.

Toxicology testing is performed in clinical settings, forensic settings, and for controlling doping. Drug screening is a toxicology test to determine if drugs are present in biological samples. The most common specimen type for drug testing is urine, as drugs and/or their metabolites are often more concentrated in the urine, extending the detection window of drugs. The dilute-and-shoot method is a simple procedure used in toxicology testing, where a sample is diluted before being directly injected into the liquid chromatography-mass spectrometry (LC-MS) system. This method is easy, quick, and cost-saving, and can be used for protein-poor liquid specimens such as urine. Thus, it is reasonable and attractive for busy toxicology laboratories to combine the dilute-and-shoot method with high-resolution hyphenated-MS for urine drug screening. This method has several disadvantages, including a suboptimal detection capability for certain analytes, as well as interference from co-eluting matrix components called matrix effects, in which co-eluting matrix molecules alter the ionization efficiency of the analyte molecules at the ionization source in LC-MS, altering (mostly reducing) the analyte detection capability. The matrix effect testing is essential for the validation of LC-MS-based assays. A reasonable approach to addressing these undesirable effects would be to minimize these components. The most straightforward approach is to reduce the amounts of matrix components by using a higher dilution of the specimen and a lower volume for specimen injection. Optimization of the chromatographic separation is another reasonable approach for reducing co-eluting matrix components with the analyte.

Nitrate ester derivatization for the generation of structurally informative ions via gas chromatography-mass spectrometry

Forensic investigations of explosives in post-blast and trace scenarios often utilize gas chromatography-mass spectrometry (GC–MS). Many high explosives (e.g., trinitrotoluene) provide structurally significant ions so that a compound can be confidently identified by GC–MS; however, GC–MS only provides functional group identification for the presence of nitrate esters (e.g., nitroglycerin (NG)), a class of high explosives that is frequently encountered in forensic casework. Nitrate esters vary drastically and are much more accurately identified by their component alcohol structure rather than merely the detection of the nitrate and nitrite ions. Herein, we demonstrate a two-step derivatization reaction requiring no purification steps or advanced sample preparation and characterize several of the reaction byproducts created along with the desired reaction product. In this process, nitrate esters are initially reduced to their component alcohol, and then subsequently silylated. The resulting product, when submitted to GC–MS with positive ion mode chemical ionization, provides mass spectra that characterizes the component alcohol by the pseudo-molecular ion of the reaction product. GC–MS with negative ion mode chemical ionization confirms the presence of a nitrate functional group by the characterization of the unreacted starting material. These results combine to identify nitrate esters in forensic settings, and as a proof of concept, we demonstrate the applicability of the derivatization reaction to pentaerythritol tetranitrate (PETN), NG, and erythritol tetranitrate (ETN) standards, as well as a formulated composition containing PETN-SEMTEX 1A, homemade ETN, and post-burn samples.

Self-harming behaviors and forensic system-related factors: an analysis of the Ontario review board database

BackgroundIn Canada, ensuring public safety, and the safety and well-being of accused individuals under the jurisdiction of the provincial review board are very important. While previous studies have reported a significant risk of self-harming behaviors (non-suicidal self-injury and suicide attempt) in forensic psychiatric settings, no large population study has assessed any relationship between forensic system-related factors and self-harming behaviors. A better understanding of these factors can help clinicians implement protective measures to mitigate self-harming behaviors or actions.MethodsUsing the Ontario Review Board (ORB) database covering 2014–2015 period (n = 1211, mean age = 42.5 ± 13.37 years, males = 86.1%), we analyzed the prevalence and factors associated with self-harming behaviors, emphasizing the characterization of the forensic system-related factors (ORB status, legal status, type of offense, previous criminal history, and victim relationship). The relationships between the forensic system-related factors and self-harming behaviors were explored using five separate logistic regression models, controlling for clinical and sociodemographic characteristics.ResultsApproximately 4% of the individuals in the forensic system over the study period engaged in self-harming behaviors Among the studied patients, individuals determined to be unfit to stand trial and inpatients were significantly more likely to have self-harming behaviors. There was no significant relationship between the type of offence, victim relationship, and previous criminal history with self-harming behavior.ConclusionForensic psychiatry inpatients should have close observation, screening, monitoring, and individual tailored management strategies for self-harming behaviors. The findings of this study indicate that forensic system-related factors, especially those that pertain to the status of individuals in the forensic system (i.e., unfit to stand trial and being an inpatient) are more responsible for self-harming behaviors among forensic patients in Ontario.

Mother-child reporting discrepancies of child physical abuse: Associations with internalizing and externalizing symptoms

BackgroundMother-child discrepancies frequently occur in reports of child physical abuse. Such report discrepancies raise important challenges for interpreting and integrating data from multiple informants in forensic and clinical settings. ObjectivesThe main goal of this study was to identify patterns of mother-child discrepancies in reporting CPA using latent profile analysis. We then tested differences between profiles on mothers' mental health problems and children's internalizing and externalizing symptoms.Participants and setting.Participants were 159 mother-child dyads with police-documented exposure to intimate partner violence. MethodParticipants were recruited from Child Protective Services and shelter residences from all regions of Portugal. After obtaining informed consent, assessment protocols were administered separately to mothers and children. ResultsWe identified two convergent profiles (mother-child agreement on reports of both high and low exposure to CPA) and one divergent profile (the child reported significantly higher exposure to CPA than the mother). Mothers from the divergent profile reported more depressive and post-traumatic stress symptoms than mothers from the convergent profiles. Children of the divergent profile and one of the convergent profiles (mother-child agreement on high exposure to CPA) showed the highest internalizing and externalizing symptoms. ConclusionsThese results illustrate how examining informant discrepancies in the assessment of abusive parenting practices increases our understanding of children's psychological adjustment in high-risk contexts.

Violence against children: A review of cases at a forensic anthropology unit, Johannesburg, South Africa

South Africa is experiencing a scourge of violence against women and children, with alarming levels of violence, and as such, juvenile cases are sometimes encountered in a forensic anthropological setting. The aim of this research was to assess the cases of juveniles (under 20 years) presenting at the Human Variation and Identification Research Unit (HVIRU) for a 6-year period (2016–2022), in order to assess patterns and types of cases referred. A total of 19 cases were assessed, of which 10 were 16–20 years old, 3 between the ages of 5 and 15 years and 6 less than 5 years old at the time of death. Of the 14 children with known sex, 12 were female with features suggesting that they fell prey to sexual violence. Many of the individuals were either known (and referred for trauma analysis) or identified following investigation. Of the 19 juveniles, 11 (58 %) had evidence of perimortem trauma (sharp and/or blunt), attesting to the violent nature of their deaths. Two cases had both sharp and blunt force trauma, of which one is a possible case of dismemberment. The remains of two individuals showed signs of perimortem burning, which may or may not be related to the cause of death. Three individuals had signs of antemortem (healed) trauma, which may suggest a longer period of abuse. Five of the individuals showed signs of disease – two had cribra orbitalia, while two others had various porous lesions indicative of chronic disease or malnutrition. One individual had advanced osteomyelitis, suggesting a natural cause of death. Some of these cases had unusual trauma and pathology, highlighting the contribution of forensic anthropologists.

Eye movement desensitisation and reprocessing (EMDR) therapy in prison and forensic services: a qualitative study of lived experience

ABSTRACT Background: Posttraumatic stress disorder (PTSD) is common in people with serious mental illness who come into contact with the criminal justice system. Little evidence exists on EMDR treatment in forensic mental health, with no prior qualitative research exploring lived experience perspectives. Objective: This qualitative study recruited adult forensic mental health patients with PTSD and psychotic disorders, predominantly schizophrenia, who had received EMDR as part of a clinical trial, either in prison or in hospital. We sought to understand their experiences of EMDR therapy while receiving forensic care. Method: Ten in-depth, semi-structured qualitative interviews were undertaken and analysed using thematic analysis. We used an inductive, realist approach, reporting the experiences, meanings, and reality of the participants. Results: Five overarching themes were identified. First, severe trauma was ubiquitous and participants felt Seriously Messed Up by their traumatic experiences, with debilitating and enduring PTSD symptoms contributing to offending and psychosis (‘giving the voices something to feed on’). Second, EMDR was regarded with Early Scepticism. Third, the therapy itself was initially emotionally taxing and Not Easy but participants generally felt safe and persevered. Fourth, they were often surprised and delighted by results (And it Worked!), describing significant symptom reduction and personal transformation. Lastly, EMDR Fits the Forensic Setting, bringing empowerment in a place perceived as disempowering. People reported changes that increased their hope in a violence-free future. Conclusions: The limited research on EMDR in forensic mental health is unfortunate given how common PTSD is in mentally unwell offenders and its potential to impede recovery and contribute to further offending. This first qualitative study found participants experienced positive transformative change, extending beyond symptom reduction. Themes support previously published quantitative outcomes showing EMDR to be safe and effective in this cohort. EMDR was well suited to a forensic setting and was seen as an empowering therapy. Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12618000683235. Study registration: The study was registered on the Australia and New Zealand Clinical Trials Network, registration number ACTRN12618000683235 (registered prospectively, 24 April 2018), https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 374682

The politics of face and the trouble with race: Exploring relations at the interface between the individual and the collective in forensic practice.

This special issue interrogates race through the lens of face. Its central faces are those in forensic settings. Promising immediate legibility and access to the individual suspect, forensic faces nevertheless mobilize a variety of collectives. We offer conceptual and methodological tools to examine the face as both an individual and a collective phenomenon, and demonstrate through detailed cases how the face thus allows us to address the absent presence of race. Given its long and convoluted history in physical anthropology, as a marker of racial typology, the face forces us to reckon with colonial histories of ordering human difference. But the face also allows us to question a regime of visuality that congeals around the face in Western culture. In this introduction to The Politics of Face and the Trouble with Race we elaborate these concerns and introduce the contributions to this volume.

Pinpointing change in virtual reality assisted treatment for violent offenders: a pilot study of Virtual Reality Aggression Prevention Training (VRAPT).

Preventing relapse into violence and its destructive consequences among persistent re-offenders is a primary concern in forensic settings. The Risk-Need-Responsivity framework models the best current practice for offender treatment, focused on building skills and changing pro-criminal cognitions. However, treatment effects are often modest, and the forensic context can obstruct the delivery of interventions. Developing treatments for offenders should focus on the best method of delivery to make "what works work." Virtual reality (VR)-assisted treatments such as Virtual Reality Aggression Prevention Training (VRAPT) are a new and innovative approach to offender treatment. This pilot study followed 14 male violent offenders who participated in VRAPT in a Swedish prison context and measured changes from pre-treatment to post-treatment and 3-month follow-up in targeted aggression, emotion regulation, and anger. It also investigated potential impact factors (pro-criminal cognitions, externalizing behaviors, psychosocial background, and childhood adverse experiences). In Bayesian linear mixed effects models, participants showed a high probability of change from pre-treatment to post-treatment and to follow-up on all outcome measures. All outcome measures demonstrated a low probability of change from post-treatment to follow-up. Analysis of reliable change showed that participants' results ranged from recovery to deterioration. We discuss the implications of the study for VRAPT's impact on the target group, those who might benefit from the approach, and suggested foci for future studies in the field of VR-assisted offender treatment. The study was preregistered at the International Standard Randomized Controlled Trial Number registry (https://doi.org/10.1186/ISRCTN14916410).

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: Nurses' observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion. Coercive practices may cause distress to patient-staff relations. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients. Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness. Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized. Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion. Pixellating the video camera would give a sense of privacy and dignity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs. A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision. Viewing panels (small window on the seclusion door) are important in establishing two-way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients. Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness. More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations. Patient education is paramount. Providing prior information to patients using a co-produced information leaflet might reduce their anxiety and make them feel safe in the room. When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. ABSTRACT: Introduction A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method A retrospective phenomenological approach, using semi-structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion.

Results of Symptom Validity Testing in Portuguese Prison Inmates: The Influence of Educational Level, Age, and Conviction Status

Current guidelines for psychological assessment recommend the use of multiple validity measures in an evaluation protocol, particularly in forensic settings. As such, self-report instruments which detect distorted symptom reporting have become essential. We studied a pooled sample of 240 male inmates with the Self-Report Symptom Inventory (SRSI), the Structured Inventory of Malingered Symptomatology (SIMS), and the Symptom Validity Scale–Version 2 (EVS-2). Concurrent validity was analyzed via correlations between all three symptom validity tests (SVTs), revealing strong associations (rho ranging from .72 to .79), and ROC analyses yielded areas under the curve (AUC) values over .9 for every model. Base rates of SVT failure ranged from 7.9 to 13.3% using the most conservative cutoff scores, although true and false positive rates were not established. Education was shown to have a statistically significant effect on the mean results of the three SVTs (rho ranging from − 162 to − 283), associating lower educational levels with more bogus symptom endorsement. The influence of age and conviction status (pre-trial vs. post-trial) on the SIMS results was statistically significant as well (rho estimates of .171 and − 232). With data showing robust construct validity and excellent predictive accuracy, the instruments were shown to be adequate for use in the Portuguese prison context, but further research is required, in particular using forensic inpatients and clinical populations, and including systematic data on the presence of mental disorders.

Comprehensive Dialectical Behavior Therapy for Adolescents in a Juvenile Correctional Treatment Center: A Pilot Evaluation.

Incarcerated youth commonly present with emotion dysregulation, aggression, and comorbid psychiatric disorders, yet often do not receive necessary mental health treatment while confined. It is therefore crucial to expand the evidence base regarding empirically supported mental health interventions which are feasible to implement in secure settings to address incarcerated youth's mental health needs. Through a community-academic partnership, the current pilot study evaluated a comprehensive Dialectical Behavior Therapy program implemented in a juvenile correctional treatment center. Youth participants (N=113) were on average 15.37 years old (SD=1.10, range=13-17), 68.1% boys, and identified as 69.0% Latinx, 22.1% Black, 8.0% White, and 0.9% Native American. Youth received comprehensive Dialectical Behavior Therapy for Adolescents (DBT-A), including individual therapy, skills training groups, family therapy, multi-family skills training groups, and skills coaching in the milieu by direct care staff who participated in extensive training and ongoing consultation team meetings. As part of a facility-designed program evaluation, youth completed a battery of empirically validated assessments of mental health and emotion regulation prior to and following completion of the program. Results show that comprehensive DBT-A is feasible to implement in a juvenile correctional treatment center and overall, youth improved from pre- to post-treatment in mental health symptoms and emotion regulation, with small to medium effect sizes. These findings build upon a growing literature showing Dialectical Behavior Therapy is a promising intervention for treating emotion dysregulation and mental health conditions and can be successfully implemented in juvenile forensic settings.