Inside Forensic Psychology

Inside Forensic
Psychology
Inside Forensic
Psychology
Tiffany R. Masson, PsyD, Editor
Copyright © 2016 by Tiffany R. Masson
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or
otherwise, except for the inclusion of brief quotations in a review, without prior permission in writing
from the publisher.
Library of Congress Cataloging-in-Publication Data
Names: Masson, Tiffany R., editor.

Title: Inside forensic psychology / Tiffany R. Masson, editor.
Description: Santa Barbara, California : Praeger, [2016] | Includes
bibliographical references and index.
Identifiers: LCCN 2015041770 | ISBN 9781440803031 (hardback) | ISBN
9781440803048 (e-book)
Subjects: LCSH: Forensic psychology. | BISAC: PSYCHOLOGY / Forensic
Psychology.
Classification: LCC RA1148 .I57 2016 | DDC 614/.15—dc23 LC record available at
http://lccn.loc.gov/2015041770
ISBN: 978-1-4408-0303-1
EISBN: 978-1-4408-0304-8
20 19 18 17 16 1 2 3 4 5
This book is also available on the World Wide Web as an eBook.

Visit www.abc-clio.com for details.
Praeger
An Imprint of ABC-CLIO, LLC
ABC-CLIO, LLC
130 Cremona Drive, P.O. Box 1911
Santa Barbara, California 93116-1911
This book is printed on acid-free paper

Manufactured in the United States of America
Contents
Preface vii
Acknowledgments ix
Part I Cases, Approaches, and Practices

1 Ethical Considerations in Cross-Cultural Assessment 3
Rebecca Weiss and Amanda Rosinski
2 Competency to Stand Trial 18

Michelle Hoy-Watkins and Megan E. Shaal
3 Conducting Criminal Responsibility Evaluations 36

Allison M. Schenk, Emily D. Gottfried, and Michael J. Vitacco
4 Capital Case Sentencing Evaluations 55

Samuel Witta Dworkin and Steve K. D. Eichel
5 Conducting Mental Health Diversion Evaluations 80

Virginia Barber-Rioja, Merrill Rotter, and Faith Schombs
6 Sex Offender Risk Assessment 105

Angel Daniels, Georgia M. Winters, and Elizabeth L. Jeglic
7 Civil Commitment: Examining Mental Illness, Differential

Diagnosis, Attributes of Risk, and Application to Case Law 144
Casey Sharpe and Anna Florek
8 The Psychological Assessment of Personal Injury Claims 173

Eric G. Mart
vi Contents
Part II Cases, Approaches, and Practices with

Specialized Populations
9 Psychological Evaluations to Determine Competency to Parent 195
Anthony J. Urquiza, Anna M. L. Westin, and Dawn M. Blacker
10 Termination of Parental Rights 225

Dawn M. Blacker, Anthony J. Urquiza, Lisa Kalich, and
Blake D. Carmichael
11 Child Custody and Parenting Plan Evaluations 248

Robert L. Kaufman and Daniel B. Pickar
12 Overview of the Juvenile Justice System and Best Practices 283

Jeannie S. Brooks and Kendell L. Coker
13 Sentencing Evaluations in Juvenile Court 304

Michael P. Brown
14 Juvenile Competence to Stand Trial 322

Nancy Ryba Panza
15 Juvenile Miranda Waiver: A Naïve Teenager,

Neurodevelopmental Disorder, and the “Interested Adult” 344
Joseph J. Begany
16 Transfer Evaluations in Juvenile Justice 365

Alison R. Flaum and Antoinette Kavanaugh
17 Introduction to School-Based Risk Assessments 385

Jeff D. Stein and Jill G. Durand
Appendix 401
About the Editor and Contributors 403
Index 415
Preface
Inside Forensic Psychology was written to provide readers with a broad and
in-depth understanding of forensic psychology cases as presented by dis-
tinguished experts working throughout this multifaceted field. This book is
intended as a learning tool that professors can use to encourage critical think-
ing and facilitate understanding in students. At present, many professors sup-
plement their own experience by asking one another for redacted clinical cases
or court reports that can bring to life the complex set of issues often found in
forensic psychology cases and in conducting competent forensic evaluations.
Few books are currently available that balance an understanding of the litera-
ture with relevant case law, best practices, and clinical case vignettes. By bring-
ing together this assortment of theory, required background knowledge, and
real-life experience across numerous areas of forensic psychology, we hope to
help students share in the thinking and mindset of the clinician or evaluator
grappling with the multidimensional aspects of a case, and to highlight best
practices and case law that can be used when conducting evaluations or work-
ing with a particular population.
This book is also intended to underscore the complexity of the forensic psy-
chology field. Many case summaries available to students err on the side of
simplicity, carrying with them the danger of infusing a false sense of black
and white, precise formulas and easy answers. This could not be further from
reality. Every case a student or clinician will encounter is unique; while there
are basic tasks to perform and information to gather that are vital to every case
(e.g., knowledge of relevant case law, review of case records, relevant back-
ground information, outcomes of psychological testing/assessment), the way
this information is evaluated and used can depend on a great many factors. For
this reason, several chapters herein include a section on common pitfalls and
considerations, including factors and possibilities we wish we had considered
when starting out in this challenging but rewarding field.
I was motivated to compile this book after teaching for several years and
reflecting on learning methodologies that had the greatest impact on my
viii Preface
students. As a professor, I found myself wanting to bring to life important con-

cepts in ways that challenged students to think critically about complex human
and ethical issues that they will face every day as forensic clinicians and evalu-
ators. The case vignettes, which highlight varying types of forensic evaluations,
were created or adapted into case summaries based on the authors’ professional
experience, and any likeness to an actual case is purely coincidental. The case
vignettes are not meant to serve as a comprehensive forensic report. Rather, the
emphasis is intended as a means of encouraging students to synthesize, evaluate,
and apply information and concepts learned.
Forensic psychology is not an exact science. This book is intended as a col-
lection of case vignettes that provide students with multiple viewpoints into
the work of a forensic evaluator and into a variety of professional approaches.
As a result, the reader may or may not agree with the opinions reached or the
methodologies used in the cases described. The goal is to encourage readers
to think critically about the challenges posed in each specific case, articulate
opposing positions, argue differing points of view, and evaluate all courses of
potential action. It is through this type of thoughtful discourse that students
can be expected to grow into practices and confident professionals.
Acknowledgments
The compilation of this book would not be possible without the support of
family and friends, colleagues—Judy Beaupre, MS, and Alisha DeWalt, MA—
and research assistant—Jenna Hedglen, MA. Moreover, it is with great appre-
ciation that I thank the authors who wrote tirelessly and remained committed
to the vision of this book.
Part I
Cases, Approaches,
and Practices
1
Ethical Considerations in
Cross-Cultural Assessment
Rebecca Weiss and Amanda Rosinski
The goal of forensic assessment is to utilize psychologically based measures

to aid in legal contexts (Heilbrun, 1992). Forensic assessment represents an
important juxtaposition regarding its emphasis on normative and individ-
ual factors. As the evaluations are a form of scientific evidence potentially
used in a courtroom, it is important to utilize empirically supported mea-
sures that rely on normative data (i.e., comparing individual scores with a
representative sample). However, this reliance is problematic, considering the
increasing diversity rates in the United States, which threaten the validity of
those normative data. This trend is likely to become increasingly problematic.
Demographic statistics in the United States reveal a distinct increase in rates
of diversity, with Hispanic and Asian populations increasing 43% from 2000
to 2010 while the non-Hispanic white population decreased over the same
period (U.S. Census Bureau, 2011). While these rates do reveal a nation grow-
ing in diversity, this trend is more pronounced in forensic populations. In
2012, more than 60% of the United States prison population was classified as
minority (Carson & Golinelli, 2013), an imbalance that is unlikely to change
as immigration offenses are among the fastest growing segments of the federal
prison system (Carson & Sabol, 2012).
Relevant Case Law

Cross-cultural forensic assessment is continually shaped by legal precedent.
While there are cases addressing culture that date back to the 1970s, cultural
issues are recurrent in the courtroom. In 1970, United States ex rel. Negron v.
State of New York recognized the need for interpreters and translators in the
trial process. This case held that basic and fundamental fairness of the trial
process includes a non-English speaking defendant’s right to a translator or
4 Inside Forensic Psychology
interpreter at criminal trials, which will be provided at the state’s expense in

the case of an indigent defendant. Iao v. Gonzalez (2005) recognized that inter-
preters of intricate languages might misunderstand statements and that there
is an insensitivity to the challenges associated with determining the credibility
of a person from another culture. This lack of consideration was apparent in
this case, in which the refusal to make eye contact was interpreted as unreli-
able, whereas it is a symbol of respect in Asian culture. Diaz v. State of Dela-
ware (1999) held that the Administrative Office of the Courts (AOC) would
regularly provide all court interpreters with a mandatory orientation to cover
the training of court interpreters, the role of the interpreter in the courtroom,
the ethics and structure of the court system, the social and cultural diversity
issues, and other various topics. Post-Diaz, the Consortium for State Court
Interpreter Certification also increased its standards to advance the profi-
ciency assessment of court-appointed interpreters and to promote due process
(Griffin, 2002). Higher standards were necessary to train interpreters to mir-
ror the language and style of presentation without changing meaning or tone.
If court-appointed interpreters misinterpret to the level of plain error, then
defendants may be entitled to a new trial (Griffin, 2002).
Dia v. Ashcroft (2003) established that cross-cultural differences could
increase the complexity of immigration hearings. However, cultural differ-
ences do not necessarily reflect variability in credibility. It was determined
that immigration judges might have a cultural bias in which they rely on
their own experiences to assess cross-cultural testimony. The court held
that cultural biases might affect even a well-intentioned and meticulous fact
finder. Chouchkov v. Immigration and Naturalization Service (2000) strength-
ened this finding by stating that an idiosyncrasy in one country might be a
cultural norm in another country. Chen v. Holder (2009) held that an immi-
gration judge must be thoughtful and careful before determining that a spe-
cific gesture, tone, or facial expression weakens credibility. Zhang v. District
of Columbia Department of Consumer and Regulatory Affairs (2003) held that
while cross-cultural differences might make the review of evidence more dif-
ficult, review boards must consider this information to ensure due process.
Overall, an awareness for potential cross-cultural differences might help
reduce biases.
Models set forth regarding cross-cultural barriers are applied to a forensic
assessment setting. Dusky v. United States (1960) set forth the notion that every
defendant has a right to a competency evaluation before proceeding to trial.
The Dusky standard for determining competency is that the defendant is capa-
ble of working with an attorney and must have a “reasonable degree of rational
and factual understanding of the proceedings against him” (Dusky v. United
States, 1960, p. 1). The Matter of M-A-M- (2011) held that immigration pro-
ceedings must follow similar standards. Therefore, immigration judges must
Ethics in Cross-Cultural Assessment 5
make mental competency determinations and justify their reasoning so that

proceedings are fundamentally fair. State of Washington v. Sisouvanh (2012)
reasoned that although cultural competency is important and a requirement
for court-appointed mental health evaluators, there is no minimum require-
ment for the qualification to assess competency to stand trial. Cultural com-
petency includes research and investigation into the defendant’s background
and culture, but there is no standard protocol for the minimum cultural com-
petency requirement.
Review of the Literature

When reviewing cross-cultural differences in assessment, acculturation is a
relevant but understudied factor. Acculturation is a process in which members
adopt characteristics of another culture (Berry, 1980). Acculturation exists on
a spectrum for both the culture of origin and the adopted culture. An assess-
ment of acculturation is crucial as it provides a gauge for how adherent one is
to his or her culture and, therefore, provides an estimate of the importance of
cultural effects on measures of assessment.
Psychologists should try to use culturally specific and culturally valid mea-
sures whenever possible (Dana, 1998). This is not an easy task. The foren-
sic population is quite diverse, and therefore, an individual being evaluated
is unlikely to resemble the groups that were used to develop psychological
assessment instruments. Additionally, cultural variability may increase as psy-
chopathology increases (Fields, 2010). Even when objective measures with
standardized scoring are used to aid in the assessment process, cultural vari-
ables may affect the results. Common problems identified by Okawa (2008)
include a lack of orientation to time and cognitive functioning. While many
Americans value the ability to complete tasks quickly, this is not the case in all
cultures. Therefore, assessments that include timed tests could be problematic.
Furthermore, basic cognitive processes, such as attention and memory, can
vary significantly across cultures (Nisbett, Peng, Choi, & Norenzayan, 2001).
Specifically, attention and memory may reflect what an individual considers to
be important. Nisbett et al. (2001) found that East Asians attend more to the
context of a visual object than Westerners do, who tend to separate an object
from its context. Additionally, Nisbett et al. (2001) suggested that thinking
patterns and abstract concepts are often affected by culture. Some researchers
have theorized that at least part of the cultural differences in thought patterns
may result from differences in language (e.g., Hebrew has relatively few abstract
terms; Friedman & Schustack, 2010). The American Psychological Association
(APA) Presidential Task Force on Immigration (2011) acknowledged many of
these concerns and put forth a general call for researchers to address the gap
in available literature regarding cultural-specific expressions of well-being and
distress. However, until this research is conducted, evaluators need to navigate

how to conduct an assessment with culturally diverse individuals.
It is important for the evaluator to be aware of these cultural influences and
not misattribute differences from the norm as necessarily abnormal. However,
interpreting abnormal neuropsychological results is a delicate balance. Not all
deviations from the norm are culturally based, as researchers estimate that
between 25% and 87% of inmates have experienced traumatic brain injury
and are therefore at greater risk to display related cognitive deficits (Diamond,
Harzke, Magaletta, Cummins, & Frankowski, 2007). Although the paucity
of published literature limits the applicability of some forms of testing with
diverse populations, there is a growing literature on the utility of neuropsycho-
logical testing in non-English speaking samples. For instance, Tuokko et al.
(2009) utilized a factor-analytic technique that provided equal support for the
validity of the latent variables (and therefore construct validity) in a neuro-
psychological battery administered in English and French. Similarly, Siedlecki
and her colleagues (2010) found factor structure and loading that supported
the use of a neuropsychological battery across English and Spanish-speaking
groups in a community-based sample. However, numerous studies have found
a disproportionate rate of false-positive classifications for neuropsychologi-
cal disorders in African American and Latino samples (Rivera-Mindt, Byrd,
Saez, & Manly, 2010). The limitations of neuropsychological data with diverse
populations are similar to those for other types of psychological testing,
including a dearth of research support, reliance on Western norms and a basis
in Western culture and linguistics. Therefore, considerable clinical judgment is
necessary in the choice and interpretation of the measures used.
When the construct validity of a measure is considered sound, the measure
often needs to be translated into another language. Translation can be a very
tedious process, as it requires more than the literal translation and is subject
to several different types of biases. Construct bias is when a construct is con-
ceptualized differently in different cultures. Method bias occurs when factors
that threaten validity are present during assessment. Item bias is when items
are translated with poor wording or inaccurately for a specific cultural group
(Van de Vijver & Hambleton, 1996). Trait bias occurs when the assessment
contains factors that invalidate scores for a particular group (Hambleton &
Kanjee, 1995). Joint effects of language and culture differences are likely to
produce the highest amount of bias (Candell & Hulin, 1986).
The International Test Commission (ITC) Guidelines for Translating and
Adapting Tests (2010) provided a commonly adopted method for the advance
translation of measures. Linguistic and cultural equivalence must be consid-
ered in each stage of the translation. After the measure has been translated, a
second individual, who is unfamiliar with the original version of the measure,
will then back-translate the measure. The initial and back-translated versions
should be compared, and final adjustments should be made. Without these
procedures, the evaluator risks jeopardizing the accuracy of the translated

measure and generates assessment data of unknown reliability and valid-
ity. However, regardless of the applied method, psychologists should clearly
state limitations with any translation process, as this limits test interpretations
(Leong, Park, & Leach, 2013).
After the psychological assessments are completed, cultural differences
must also be considered during the interpretation of results. Interpretations
of assessments should consider the individual’s cultural background (Leong
et al., 2013). Cultural studies should examine the clinical setting and develop
an understanding of the individual’s cultural beliefs (Fields, 2010). Psycholo-
gists should research the cultural reliability and validity of the assessments
used. If the statistics are insufficient, psychologists should consider the use of
another measure (Weiss & Rosenfeld, 2012).
Cultural differences also present challenges when conducting psychologi-
cal assessments. Cultural competence is not only the understanding of cultural
knowledge but also the ability to implement that into practice (Fields, 2010).
Cultural psychology focuses on the individual’s symbolic culture. Culture
implies shared knowledge, values, and communication. According to some
researchers, these values aren’t universal or cross-culturally equal (Greenfield,
1997). The cultural factors that may affect an individual’s assessment include
motivation, values, experiences, and degree of test anxiety (Hambleton &
Bollwark, 1991). An example of cross-cultural differences includes the notion
of indigenous conceptions of intelligence, which requires the assessment of
individual differences when measuring IQ. In addition, knowledge might not
be individualized in some cultures, so cooperative construction of knowledge
should be allowed (Greenfield, 1997). To reduce the effects of cultural dif-
ferences, all assessment items must measure the same behaviors across pop-
ulations (Hambleton & Bollwark, 1991). Also, some cultures may focus on
learning instead of speaking, so questions that focus on doing rather than say-
ing may be more beneficial (Greenfield, 1997). Finally, free-response assess-
ments may be more beneficial than fixed-response assessments (Ibrahim &
Arrendondo, 1986).
In addition to cultural differences, professionals who are conducting the
psychological assessments may experience cultural biases. Psychologists
should be aware of their cultural biases and not allow them to lead to unjust
work (Leong et al., 2013; Weiss & Rosenfeld, 2012). To reduce these biases,
cross-cultural knowledge should be a comprehensive curriculum. In assess-
ment, psychologists should first consider the individual as a psychological
entity. Assessment begins with an understanding of the individual’s culture
(Ibrahim & Arrendondo, 1986). Information on an individual’s cultural
background should be gathered prior to the assessment (Leong et al., 2013).
Assessments should use multimethod approaches to measure potentials and
limitations of the individual (Ibrahim & Arrendondo, 1986). Psychologists
should learn culturally competent service delivery styles. Acculturation

measures are suggested to help correct for cultural differences between the
psychologist and the individual (Dana, 1998; Weiss & Rosenfeld, 2012). Psy-
chologists should try to use culturally specific and culturally valid measures
when possible (Dana, 1998).
Research on the impact of language and culture in forensic assessment is
essential for professionals working in the field. It is essential because it pro-
vides professionals with the most current empirical support for the optimal
method of cross-cultural assessment. It is also essential because, currently,
there is no universally accepted standard of care in forensic mental health
assessment. Instead, professional conduct is currently supported by best prac-
tice guidelines (Heilbrun, DeMatteo, Marczyk, & Goldstein, 2008).
Best Practices
The field of psychology is guided by both enforced standards and aspirational
guidelines, which are distinct practices. The APA provides professionals in the
field with the “Ethical Principles of Psychologists and Code of Conduct” (APA
Ethics Code; American Psychological Association, 2002a), which is a set of
mandatory standards. Violations of the APA Ethics Code may result in sanc-
tions, felony convictions, expulsion from the state psychological association,
and suspension or loss of licensure (APA, 2002a). The APA Ethics Code pro-
vides several instructions regarding psychological assessment. Psychological
assessments must be based on scientific and professional judgments (Standard
9.01). Assessments must be purposeful, reliable, valid, and appropriate for
the individual (Standard 9.02). Psychological assessments require obtaining
informed consent from the individual (in forensic settings, this may not always
be the case; Standard 9.03). Psychologists must interpret the individual’s test
results based on the individual’s holistic background characteristics, including
both cultural and linguistic differences (Standard 9.06; APA, 2002a).
On the other hand, APA also provides the specific field of forensic psy-
chology with aspirational guidelines, which are the “Specialty Guidelines for
Forensic Psychologists” (American Psychological Association, 2013). These
are considered guidelines because they are a set of recommendations that
professionals in the field strive to achieve. However, unlike the standards,
guidelines do not have enforceable violations and do not supersede profes-
sional judgment. Included in these guidelines are several goals for working in
cross-cultural populations. For example, forensic psychologists must recog-
nize their own cultural bias and work to limit such bias in practice (Guideline
2.08). Psychologists must also appreciate cross-cultural differences and their
potential effects on psychological services (Guideline 2.08). Appropriate train-
ing or a referral may be necessary (Guideline 2.08; American Psychological
Association, 2013). In addition, several aspirations regarding forensic assess-

ment are noted. Cultural differences are particularly important to consider
when interpreting the results of a psychological assessment, as well as the
strengths and limitations of these interpretations (Guideline 10.03). Psycholo-
gists must focus on the psycholegal issue during the individual’s assessment
(Guideline 10.01). The forensic context of the evaluation must be considered
during interpretation (Guideline 10.04). All data intended to be presented
in the courtroom must be documented, and the psychologist must keep the
records (Guidelines 10.07, 10.08; American Psychological Association, 2013).
When considering forensic assessment in a multicultural context, one must
also consider cultural guidelines. APA has developed a set of cultural guidelines,
which are known as the “Guidelines on Multicultural Education, Training,
Research, Practice, and Organizational Change for Psychologists” (APA, 2002b).
APA has set out six guidelines regarding multicultural issues. First, psycholo-
gists should reflect on their own cultural biases. Second, psychologists should
research the significance of diverse populations. Third, psychologists who
instruct others should teach about multiculturalism in a psychological context.
Fourth, culture-centered psychological research should be established as essen-
tial in the field. Fifth, culturally based training skills should be implemented in
psychological practice. And sixth, policy development should be updated in a
cultural context by psychologists (APA, 2002b).
Case Vignette
Mr. Smith was a middle-aged man from Western Africa, referred for a psy-
chological evaluation by his attorney. At the time of the evaluation, the client
was facing numerous charges, including conspiracy, auto theft, and assault.
A former associate had recently agreed to a plea deal and provided extensive
evidence against other individuals, including Mr. Smith. If Mr. Smith was con-
victed, he would likely face deportation.
Reason for Referral

The referral question was regarding potential mitigating factors. His attor-
ney reported that Mr. Smith suffered from a traumatic brain injury as a child,
which had resulted in memory impairments. Mr. Smith’s attorney asked for a
general report regarding personality functioning and any neurological deficits.
In many ways, this type of referral resembles a typical neuropsychological
evaluation. However, as in many forensic cases, there is a considerable motiva-
tion for external gain (reduce jail time, avoid deportation). These desires can
The case vignette has been redacted and all identifying information removed. It is not meant to
serve as a forensic report. Any likeness to a case is purely coincidental.
motivate individuals to present themselves in a specific (inaccurate) manner

so it is crucial to include measures of feigned symptoms and suspect effort. As
evaluators are asked to be objective, these measures are crucial. However, even
from the perspective of a defense attorney, they can be helpful in that they sup-
port the validity of a client’s presentation. Additionally, it is crucial to establish
the potential impact of culture and language, as this client entered the country
relatively recently and as English was not his first language.
Summary of Relevant Records

In forensic evaluations, collateral information can provide key clues regarding
the validity of a client’s self-report. However, access to this information can
be limited for individuals from other countries. This limitation was true for
Mr. Smith, as he came from a country with an unstable government, which
resulted in an inability to review any medical or educational records prior to
the last few years. Only Mr. Smith’s recent employment records were available,
which supported his self-report.
Relevant Background Information

Mr. Smith grew up in Western Africa in the midst of a civil war. He had become
separated from his family during his teenage years, and he believed that his
parents, brothers, and sisters remained in Africa. His first language was an
African dialect, and he was also fluent in English and French. He reported
that he was an average student and attended school until the eighth grade.
His schooling was in French and occasionally in English. When questioned
further, he reported that his schooling was inconsistent since the school closed
down when rebel groups came through the town, which occurred every few
months. He was unused to paper-and-pencil tests, and he reported that his
testing had been primarily verbal. However, he enjoyed reading, and he was
capable of reading in all three languages.
He denied major health concerns as he was growing up, but he reported
one incident in which rebels had caught him on his way home from school. He
was a target due to his ethnicity. He was severely beaten, specifically around
the head. He believed that he fell unconscious during the beating. He received
stitches at a nearby hospital, but he did not report any lasting physical impair-
ments although he felt his memory was affected by this incident. He had scars
on his forehead that supported this story. He denied any legal history prior to
the instant offense. He reported occasionally drinking with friends, but denied
any alcohol or drug abuse. Although he acknowledged high levels of current
fears and depression, he denied any history of notable psychological symp-
toms or treatment.
Mr. Smith reported that he had come to the United States approximately
four years prior to the evaluation. A man in Mr. Smith’s village had helped Mr.
Smith escape his country, and Mr. Smith gained refugee status prior to enter-
ing the United States, but he was not naturalized (i.e., was not a citizen). This
difference is crucial, as citizenship generally cannot be revoked, but a lawful
refugee can face mandatory deportation if convicted of certain offenses, such
as the ones Mr. Smith faced [Immigration and Nationality Act of 1952]. At the
time of the evaluation, he lived alone and worked full time in construction.
His support network consisted of the men from his country, several of whom
were accused of the same crimes. He denied any lasting romantic relationships
since arriving in the United States and stated that he did not have any children.
Mental Status Examination

Prior to the assessment, Mr. Smith was informed of the purpose of testing
and the limits to confidentiality. Despite being verbally proficient in English,
he was offered the option of an interpreter, which he refused. The evaluator
described the purpose of the testing and informed Mr. Smith that some of the
tests would evaluate the validity of his responses (those specific tests were not
identified). Testing was conducted on two occasions with frequent breaks. He
dressed appropriately and displayed good hygiene. Mr. Smith was consistently
on time and engaged during testing. His thought processes were clear and
logical, he was alert and oriented, and no delusions were evident. He denied
a history of hallucinations, and no hallucinations were apparent during the
interview. His affect was appropriate to the content of his speech. He reported
distress regarding his current situation and specifically the potential for depor-
tation but denied suicidal and homicidal ideation.
Psychological Measures
In adherence to the APA Ethical Code (APA, 2002a), and due to the poten-
tial risk regarding the effect of cultural variables on testing, the evaluator
consulted with two experts in the field, both with experience regarding neu-
rological or forensic testing with minority samples (Standard 2.01b). This
consultation resulted in several decisions regarding the selection of assess-
ments. Mr. Smith’s English proficiency should be established, as this could
directly pertain to testing results. Additionally, as language and culture could
be confounding variables, the evaluator chose to avoid standard measures of
intelligence and memory that often rely on English language, timed ability
testing, and Western concepts. However, if his English abilities were appro-
priate, standard personality measures were recommended. Although accul-
turation was considered, at the time there were no validated measures of
acculturation for African samples. Lastly, as there was substantial external

gain in this case, it was advised that both suspect effort and psychiatric feign-
ing be assessed.
Mr. Smith’s reading level was assessed with STAR Reading (Renaissance
Learning, 2009), a brief reading ability test for children and adults that can
produce scores indicating grade-equivalent reading levels. His general men-
tal ability was assessed using a nonverbal test that utilizes abstract geometric
designs to assess reasoning and problem solving, the General Ability Measure
for Adults (GAMA; Naglieri & Bardos, 1997). The GAMA was designed to
be used for diverse cultural and educational samples, and the test is recom-
mended in neuropsychological and forensic evaluations. His memory was
assessed using the Hopkins Verbal Learning Test–Revised (HVLT-R; Brandt &
Benedict, 2001), a widely used test of verbal learning and memory; the Brief
Visuospatial Memory Test–Revised (BVMT-R; Benedict, 1997), a short test of
visual memory; and the Stroop Color and Word Test (Stroop; Golden & Fresh-
water, 2002), a brief test of working memory. His level of effort in testing was
assessed using two primarily nonverbal brief measures: the Test of Memory
Malingering (TOMM; Tombaugh, 1996) and the Dot Counting Test (DCT;
Boone, Lu, & Herzberg, 2002). Lastly, personality functioning and psychiat-
ric feigning were assessed with the Personality Assessment Inventory, Second
Edition (PAI-2; Morey, 2007).
On the STAR Reading Test, Mr. Smith obtained a score consistent with a
sixth-grade reading level, which indicated that he was capable of completing
the PAI-2, the test with the highest required reading level. Although language
might not have interfered with the accuracy of the tests, Mr. Smith produced
scores that were highly indicative of suspect effort on the tests designed to
assess the validity of his responses. His scores on the TOMM and DCT were
well below the standard cutoffs, as well as the cutoffs for individuals with cog-
nitive impairment and dementia. Thus, the results of cognitive testing admin-
istered during the same evaluation are unlikely to adequately reflect his current
intellectual functioning. On the GAMA, the nonverbal test of general intellec-
tual abilities, Mr. Smith earned a score of 61, with a 95% chance that his true
score falls between 57 and 74. This score is well below average and is equal to or
lower than 99.5% of the population. Although Mr. Smith might have suffered
from intellectual deficits, a general ability score this low is highly inconsistent
with his presentation and level of achievement and unlikely to represent his
genuine abilities. He scored similarly on the HVLT-R, BVMT-R, and Stroop,
producing scores equivalent to bottom 1%–5% of the normative sample. These
types of scores would be inconsistent with an individual capable of navigating
a major city and regularly attending his appointments without assistance.
Lastly, the results of the PAI-2 were invalid. Mr. Smith was consistent in
his responses, and he did not endorse infrequent symptoms. However, he
scored higher than did 99% of similarly aged peers on a scale measuring nega-
tive impression management, which combines exaggerated/distorted self-
impression items and bizarre or unlikely symptoms. Therefore, his responses
on the clinical scales should be interpreted as the symptoms he desired to
report rather than actually experienced. His responses to all clinical scales
were at clinically relevant levels; his scores were more than two standard
deviations above the mean for a sample of clinical patients on scales assess-
ing somatic, depressive, manic, paranoid, psychotic, suicidal, and antisocial
symptoms. As Mr. Smith indicated suicidal ideation on the PAI-2 (although
he denied it during the clinical interview), the evaluator called to follow up.
He denied imminent suicidal intent, and the evaluator connected Mr. Smith
with outpatient services. He began attending these services within a week fol-
lowing the evaluation.
Clinical Summary and Opinion

Throughout an evaluation, a clinician should keep the referring attorney or
agency apprised of the progress and developments. For instance, information
resulting from an evaluation might suggest a change in legal strategy. Addi-
tionally, not all cases referred from attorneys will result in a written report.
After the clinician verbally presented the results of the evaluation described
above, the referring attorney decided that a written report would not be in
the client’s best interest. While it remains important for evaluators to discuss
the case prior to writing a report, this act became less crucial after the 2010
amendments to Federal Rule of Civil Procedure 26(b)(4)(B) (2010), which
allows for trial-preparation protection for draft reports and disclosures.
The evaluation results bring to light the potential negative repercussions
of forensic testing, as well as considerations regarding appropriate testing
choices. Upon providing the referral, Mr. Smith’s attorney indicated that Mr.
Smith appeared to be capable of reading in English, although he occasionally
asked for definitions of legal terms. Language ability is often a crucial element
of psychological assessment, and lack of that ability is confounding factor in
the interpretation of results. However, Mr. Smith’s ability to respond to the
STAR Reading Test, as well as his consistency on the PAI-2 questions, make it
unlikely that language was a factor in his response profile.
There is little doubt that Mr. Smith exaggerated his deficits throughout
the exam. However, the potential effect of cultural variables remains. When
a client does not resemble the normative population, the use of any measure
must be carefully considered and the limitations of the measures must be care-
fully explained (APA, 2002a; Standard 9.02b). While this requirement could
increase the temptation of relying on clinical interviews rather than assess-
ments, personal interviews are just as (if not more) susceptible to cultural
biases. Refusing a referral is also an option, but when a more qualified expert
is hard to find, the repercussions regarding the lack of psychological evalua-
tions for specific clients must also be considered (APA, 2002a; Principle A).
There is no easy answer for this situation, as it involves conflicting duties and
a substantial amount of clinical judgment.
Common Pitfalls and Considerations

When evaluators choose to move forward with clinical evaluations for minority
groups, it is crucial to carefully examine the literature. At the time of Mr. Smith’s
evaluation, there were no published studies regarding the efficacy of measures
of feigning and suspect effort with a non-Western sample. More recently, one
published article questioned the efficacy of the DCT in a non-Western sample
and examined a sample in which participants who were thought to be honest
produced exceedingly high scores (Weiss & Rosenfeld, 2010).
Additionally, a potentially confounding variable based on culture is one of
intent. The definition of malingering is the intentional creation or exaggera-
tion of symptoms motivated by external gain (American Psychiatric Associa-
tion, 2013). However, Mr. Smith’s presentation was inconsistent with those
of many other individuals in similar situations who were attempting to feign
symptoms. When questioned about his responses after the evaluation to assess
his imminent risk, he did not seem to understand the discrepancy between
endorsing items referring to specific symptoms (such as hearing voices) and
describing general distress. He was generally unfamiliar with psychiatric diag-
noses and had a categorical view of all psychological symptoms. Despite con-
versations with his clinician and attorney prior to the evaluation, he felt that he
could most adequately represent his current distress during testing by endors-
ing all symptoms. His explanations after the assessment highlight the need for
an adequate informed consent prior to the evaluation. Even when a client can
understand and repeat instructions and explanations in his own words, it is
important to assess his personal understanding of the purposes and goals of
an evaluation. While Mr. Smith’s interpretations might be idiosyncratic, they
do bring up the importance of research that evaluates the expression of psy-
chiatric symptoms in a variety of cultures. At every stage of the assessment
process, it is crucial to carefully consider the potential for cultural biases and
miscommunication.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental dis-
orders (5th ed.). Washington, DC: Author.
American Psychological Association. (2002a). Ethical principles of psychologists and code
of conduct. American Psychologist, 57, 1060–1073.
American Psychological Association. (2002b). Guidelines on multicultural education,

training, research, practice, and organizational change for psychologists. American Psy-
chologist, 58, 377–402.
American Psychological Association. (2013). Specialty guidelines for forensic psychology.
American Psychology, 68, 7–19.
American Psychological Association Presidential Task Force on Immigration. (2011).
Crossroads: The psychology of immigration in the new century. Retrieved from http://
www.apa.org/topics/immigration/executive-summary.pdf
Benedict, R. (1997). Brief Visuospatial Memory Test–Revised. Odessa, FL: Psychological
Assessment Resources.
Berry, J. W. (1980). Acculturation as varieties of adaptation. In A. M. Padilla (Ed.), Accul-
turation: Theory, models and some new findings (pp. 9–25). Boulder, CO: Westview.
Boone, K. B., Lu, P., & Herzberg, D. (2002). The Dot Counting Test manual. Los Angeles, CA:
Western Psychological Services.
Brandt, J., & Benedict, R. (2001). Hopkins Verbal Learning Test–Revised. Lutz, FL: Psycho-
logical Assessment Resources.
Candell, G. L., & Hulin, C. L. (1986). Cross-language and cross-cultural comparisons in
scale translations independent sources of information about item nonequivalence. Jour-
nal of Cross-Cultural Psychology, 17, 417–440. doi:10.1177/0022002186017004003
Carson, E. A., & Golinelli, D. (2013). Prisoners in 2012. Washington, DC: Bureau of Justice
Statistics.
Carson, E. A., & Sabol, W. J. (2012). Prisoners in 2011. Washington, DC: Bureau of Justice
Statistics.
Chen v. Holder, 579 F.3d 73, 79 (1st Cir. 2009).
Chouchkov v. Immigration and Naturalization Service, 220 F.3d 1077 (2000).
Dana, R. H. (1998). Multicultural assessment of personality and psychopathology in the
United States: Still art, not yet science, and controversial. European Journal of Psychologi-
cal Assessment, 14, 62–70. doi:10.1027/1015-5759.14.1.62
Dia v. Ashcroft, 353 F.3d 228 (2003).
Diamond, P. M., Harzke, A. J., Magaletta, P. R., Cummins, A. G., & Frankowski, R. (2007).
Screening for traumatic brain injury in an offender sample: A first look at the reliability
and validity of the Traumatic Brain Injury Questionnaire. Journal of Head Trauma Reha-
bilitation, 22(6), 330–338. doi:10.1097/01.HTR.0000300228.05867.5c
Diaz v. State, 743 A.2d 1166 (Del. 1999).
Dusky v. United States, 362 U.S. 402, 80 S. Ct. 788, 4 L. Ed. 2d 824 (1960).
Fed. R. Civ. P. 26(b)(4) (2010).
Fields, A. J. (2010). Multicultural research and practice: Theoretical issues and maximiz-
ing cultural exchange. Professional Psychology: Research and Practice, 41, 196–201.
doi:10.1037/a0017938
Friedman, H. S., & Schustack, M. W. (2010). Personality: Classic theories and modern
research (5th ed.). Boston, MA: Pearson Higher Education.
Golden, C. J., & Freshwater, S. M. (2002). Stroop Color and Word Test: A manual for clinical
and experimental uses. Lutz, FL: Psychological Assessment Resources.
Greenfield, P. M. (1997). You can’t take it with you: Why ability assessments don’t cross cul-
tures. American Psychologist, 52, 1115–1124. doi:10.1037/0003-066X.52.10.1115
Griffin, P. W. (2002). Beyond State v. Diaz: How to interpret “access to justice” for non-
English speaking defendants? Delaware Law Review, 5, 131–154.
Hambleton, R. K., & Bollwark, J. (1991). Adapting tests for use in different cultures: Tech-
nical issues and methods. Bulletin of the International Test Commission, 18, 3–32.
doi:10.1027/1015-5759.11.3.147
Hambleton, R. K., & Kanjee, A. (1995). Increasing the validity of cross-cultural assessments:
Use of improved methods for test adaptations. European Journal of Psychological Assess-
ment, 11, 147–157.
Heilbrun, K. (1992). The role of psychological testing in forensic assessment. Law and
Human Behavior, 16, 257–272. doi:10.1007/BF01044769
Heilbrun, K., DeMatteo, D., Marczyk, G., & Goldstein, A. M. (2008). Standards of practice
and care in forensic mental health assessment: Legal, professional, and principles-based
consideration. Psychology, Public Policy, and Law, 14, 1–26. doi:10.1037/1076-8971.14.1.1
Iao v. Gonzalez, 400 F.3d 530 (2005).
Ibrahim, F. A., & Arrendondo, P. M. (1986). Ethical standards for cross-cultural counsel-
ing: Counselor preparation, practice, assessment, and research. Journal of Counseling &
Development, 64, 349–351. doi:10.1002/j.1556-6676.1986.tb01131.x
Immigration and Nationality Act of 1952, § 235(b)(2)(A).
International Test Commission (2010). International Test Commission guidelines for
translating and adapting tests. Retrieved from http://www.intestcom.org
Leong, F. L., Park, Y., & Leach, M. M. (2013). Ethics in psychological testing and assess-
ment. In K. F. Geisinger, B. A. Bracken, J. F. Carlson, J. C. Hansen, N. R. Kuncel, S. P.
Reise, & M. C. Rodriguez (Eds.), APA handbook of testing and assessment in psychology:
Vol. 1. Test theory and testing and assessment in industrial and organizational psychology
(pp. 65–282). Washington, DC: American Psychological Association.
Matter of M-A-M-, 25 I&N Dec. 474 (2011).
Morey, L. C. (2007). The Personality Assessment Inventory (2nd ed.). Lutz, FL: Psychological
Assessment Resources.
Naglieri, J. A., & Bardos, A. N. (1997). Manual for the General Ability Measure for Adults.
Minneapolis, MN: National Computer Systems.
Nisbett, R. E., Peng, K., Choi, I., & Norenzayan, A. (2001). Culture and systems of
thought: Holistic versus analytic cognition. Psychological Review, 108, 291–310.
doi:10.1037//0033-295X.108.2.291
Okawa, J. B. (2008). Considerations for the cross-cultural evaluation of refugees and asylum
seekers. In L. A. Suzuki & J. G. Ponterottto (Eds.), Handbook of multicultural assessment:
Clinical, psychological, and education application (3rd ed., pp. 165–194). San Francisco,
CA: Wiley.
Renaissance Learning. (2009). STAR Reading: Technical manual. Wisconsin Rapids, WI:
Author.
Rivera-Mindt, M., Byrd, D., Saez, P., & Manly, J. (2010). Increasing culturally competent
neuropsychological services for ethnic minority populations: A call to action. Clinical
Neuropsychology, 24, 429–453. doi:10.1080/13854040903058960
Siedlecki, K. L., Manly, J. J., Brickman, A. D., Schupf, N., Tang, M. X., & Stern, Y. (2010).
Do neuropsychological tests have the same meaning in Spanish speakers as they do in
English speakers? Neuropsychology, 24, 402–411. doi:10.1037/a0017515
State v. Sisouvanh, 175 Wn.2d 607, 290 P.3d 942 (Wash. 2012).
Tombaugh, T. N. (1996). TOMM: Test of Memory Malingering. North Tonawanda, NY:
Multi-Health Systems.
Tuokko, H. A., Chou, P. H. B., Bowden, S. C., Simartd, M., Ska, B., & Crossley, M. (2009).
Partial measurement equivalence of French and English versions of the Canadian Study
of Health and Aging neuropsychological battery. Journal of the International Neuropsy-
chological Society, 15, 416–425. doi:10.1017/S1355617709090602
United States Census Bureau. (2011). 2010 Census shows America’s diversity. Retrieved from
https://www.census.gov/newsroom/releases/archives/2010_census/cb11-cn125.html
United States Department of Labor, Bureau of Labor Statistics. (2013). Household data
annual averages. Retrieved from http://www.bls.gov/cps/cpsaat11.pdf
United States ex rel. Negron v. State of New York, 434 F.2d 386 (1970).
Van de Vijver, F., & Hambleton, R. K. (1996). Translating tests: Some practical guidelines.
European Psychologist, 1, 89–128. doi:10.1027/1016-9040.1.2.89
Weiss, R., & Rosenfeld, B. (2010). Cross-cultural validity in malingering assessment: The
DCT in a rural Indian sample. The International Journal of Forensic Mental Health, 9,
300–307. doi:10.1080/14999013.2010.526680
Weiss, R. A., & Rosenfeld, B. (2012). Navigating cross-cultural issues in forensic assess-
ment: Recommendations for practice. Professional Psychology: Research and Practice, 43,
234–240. doi:10.1037/a0025850
Zhang v. Dept. of Consumer and Regulatory AFF, 834 A.2d 97 (D.C. 2003).
2
Competency to Stand Trial

Michelle Hoy-Watkins and Megan E. Shaal
Often, individuals with serious mental illness (SMI) become involved in the
criminal justice system. Since the widespread deinstitutionalization of state
psychiatric institutions beginning in the 1950s, an unfortunate result in
the United States has been that our jails and prisons house individuals with
SMI and provide psychiatric care. According to the Department of Justice,
1.2 million inmates reported mental health problems in state, local, and fed-
eral custody: 64% in jails, 56% in state prisons, and 45% in federal prisons
(U.S. Department of Justice, 2006).
For some criminal defendants, mental or cognitive deficits interfere with their
ability to understand the legal system and the charges against them. Frequently,
forensic mental health practitioners are asked to intervene and assess an individ-
ual’s knowledge about the legal system and the individual’s ability to assist in his
or her defense. This occurs in evaluations for competency to stand trial (CST).
Evaluations for CST involve the assessment of an individual’s mental state
during a specific period in the legal process (i.e., prior to and during trial).
Accordingly, this focuses on the individual’s psychological functioning in the
present. This is in contrast to criminal responsibility—or sanity—evaluations,
which center on the individual’s mental state at the time a crime was commit-
ted and therefore focuses on the individual’s functioning in the past. Addition-
ally, in some states (e.g., Illinois), CST is referred to as “fitness” to stand trial
(Illinois Code of Criminal Procedure, Fitness for Trial, to Plead or to be Sen-
tenced, 1963). In the last several years, some empirical research has referred
to CST as adjudicative competence or competence to proceed (Bonnie, 1992;
Poythress, Bonnie, Monahan, Otto, & Hoge, 2002). For the purposes of this
chapter, these terms are used interchangeably.
The American legal system recognizes many different types of competen-
cies for a defendant: competency to stand trial, to testify, to be executed, and
to make a will. While the issues for these competencies are similar, the focus
in this chapter is on CST.
Competency to Stand Trial 19
Relevant Case Law and Review of Literature

The modern view of CST is that an individual has a fundamental consti-
tutional right to a fair trial, which includes the right to participate in one’s
own defense (Meyer & Weaver, 2006; Slobogin, Rei, & Reisner, 2008; Zapf &
Roesch, 2009). These rights are grounded in the 14th Amendment, specifi-
cally the Due Process Clause. If an individual suffers from mental illness, to
what extent does he or she understand that his or her life and liberty are at
stake? Is that due process? The 1899 case of Youtsey v. United States opines on
this very issue (Zapf & Roesch, 2009). The court stated it is not due process
of law.
Evaluations for CST are one of the most common assessments performed
by forensic mental health practitioners. The most recent estimates are that
approximately 60,000 evaluations are conducted annually (Bonnie & Grisso,
2000). Additionally, between 2% and 8% of all felony defendants are referred
for competency evaluations (Bonnie, 1992; Golding, 1993; Hoge, Bonnie,
Poythress, & Monahan, 1992).
The modern legal standard of CST was established by the 1960 United
States Supreme Court case of Dusky v. United States. On August 19, 1958, Mil-
ton Dusky was charged with assisting in the rape, kidnapping, and transport
of a 15-year-old female across state lines (from Kansas to Missouri). Dusky
was described as “the product of a disorganized home situation” (p. 4). He was
discharged from the Navy due to mental illness. He made suicidal gestures
and attempts. He also engaged in heavy alcohol use. Shortly before his arrest,
Dusky’s psychotic symptoms apparently worsened.
At arraignment, Dusky’s defense counsel raised the issue of his CST.
Dusky was committed to the United States Medical Center for Federal
Prisoners (USMCFP) in Springfield, Missouri, to undergo an evaluation to
determine his CST. While at USMCFP, he was diagnosed with Schizophre-
nia. A competency hearing was held, and a psychiatrist testified that because
of Dusky’s severity of mental illness, he was unable to properly understand
the legal proceedings or assist in his defense. However, the psychiatrist also
testified that Dusky was oriented to person, place, and time, and as a result,
the district court found him competent to stand trial. He was convicted and
sentenced to 45 years. Dusky appealed the district court’s finding of CST
and his conviction; the Court of Appeals for the Eighth Circuit affirmed
both issues.
The Supreme Court of the United States granted certiorari. The question for
the Supreme Court was, what is the test for determining a defendant’s CST?
In a rare unanimous opinion, the Court reversed the lower courts’ decisions
to convict Dusky, and the case was remanded back to the district court to
determine Dusky’s present CST. If Dusky were to be found competent, then
the court would determine the appropriateness of a new trial.
In its reasoning, the Supreme Court found there was not sufficient evidence
that Dusky was competent to stand trial. Specifically, the court questioned the
psychiatric testimony. They opined that the finding that Dusky was oriented to
person/place/time (i.e., a mental status examination) was not enough to make
a determination of CST. To be found competent, an individual must have (a) a
sufficient present ability to consult with his attorney with a reasonable degree
of rational understanding and (b) a rational and factual understanding of the
proceedings against him.
Dusky was a landmark case outlining the basic standards for CST, although
those standards include minor variations or modifications from state to state
(e.g., some states do not incorporate the necessity of rational understanding).
Unfortunately, the case defines neither the meaning of the legal language nor
the specific abilities necessary for CST (Frederick, DeMier, & Smith, 2014).
The challenge for practitioners is to communicate data that is relevant to CST
within the purview of mental health rather than commenting on the ultimate
legal question (i.e., whether the defendant is or is not competent to stand trial;
Frederick, DeMier, & Smith, 2014).
Every state has adopted the Dusky standard verbatim or with minor revi-
sions or expansions (Zapf & Roesch, 2009). For example, Illinois is one state
that has modified its competency (i.e., fitness) standard and expanded it to
include specific functional abilities. The Illinois Statute (725 ILCS 5/104-10,
1963) states:
A defendant is unfit if, because of his mental or physical condition, he is

unable to understand the nature and purpose of the proceedings against him
or to assist in his defense. (n.p.)
Because states differ on this issue, this highlights the importance of practitio-
ners consulting their state statutes for competency standards prior to conduct-
ing CST evaluations (Grisso, 2003; Zapf & Roesch, 2009).
Although the Dusky ruling does not clearly identify mental illness as a fac-
tor in CST decisions, most state laws require the presence of a mental illness
or defect or a physical disorder (Zapf, 2002; see Zapf & Roesch, 2009) as a
condition for denying a defendant’s competence. Some examples of mental
health symptoms that may interfere with an individual’s CST include psychotic
symptoms, such as disorganized thinking and behavior, hallucinations, and
delusions; difficulties concentrating; rapid thoughts or speech associated with
mania, or the opposite, slowed thoughts or speech associated with depression;
memory problems; and intellectual and developmental deficits.
The presence of a mental illness or defect has been described as a neces-
sary but not sufficient condition for CST. That is, possessing a mental illness
does not automatically lead to a finding of incompetence. The U.S. Court of
Appeals case for the Ninth Circuit, Higgins v. McGrath (1951), outlined that
CST is not to be equated with the presence or absence of psychosis or psy-
chotic symptoms.
There are important behaviors and abilities one must demonstrate in order
to be found competent to stand trial. Zapf and Roesch (2009) refer to these as
psycholegal abilities. In 1961, the U.S. District Court case for the Western Dis-
trict of Missouri, Wieter v. Settle, delineated eight minimal functional abilities
related to Dusky that must be demonstrated by a competent defendant. They
included: (a) the mental capacity to appreciate his presence in relation to time,
place, and things; (b) the elementary mental processes to grasp that he is in a
court of law charged with a criminal offense; (c) an understanding that there
is a judge on the bench; (d) an understanding that the prosecutor will try to
convict him of a criminal charge; (e) an understanding that he has a lawyer
who will defend him against his charge; (f) an understanding that he will be
expected to tell his lawyer of the legal circumstances to the best of his men-
tal ability, including the facts of his personal and legal circumstances; (g) an
understanding that a jury will be present to review evidence; and (h) memory
sufficient to relate those things to his personal circumstances (p. 320).
To be found competent to stand trial, a defendant basically must have factual
knowledge of the charges and roles of the legal players, demonstrate rational
knowledge and understanding, and have a reasonable ability to assist counsel.
Factual Knowledge of the Charges and Roles of the Legal Players

This refers to possessing general knowledge about the court and the roles of the
key players (i.e., judge, jury, witness, defendant, defense attorney, and prosecu-
tor). This understanding may comprise an awareness of the current charges,
the components of an offense, the duties of the various courtroom personnel,
and the consequences of a conviction (Zapf & Roesch, 2009). Referring back
to the Dusky standard, this is under the prong of factual understanding.
Rational Knowledge and Understanding

An individual found competent to stand trial must have an appreciation for
the legal case in the context of his or her knowledge of the legal system. That
is, the defendant must possess an ability to recognize information about the
legal system and apply it to his own case. This involves such information as
the possible penalties, the various legal defenses, decision making regarding
testimony, and the likelihood of being found guilty (Zapf & Roesch, 2009). In
summary, this is the ability to make rational, reality-based decisions regard-
ing one’s own case. Referring back to the Dusky standard, this is under the
prong of rational understanding.
An individual competent to stand trial must also be able to demonstrate

reasoning and decision-making abilities. This involves the ability to discrimi-
nate relevant information. This also refers to the ability to weigh and evaluate
the available legal options and their consequences (Zapf & Roesch, 2009). The
importance of this factor lies in the defendant’s ability to reason appropriately
and not necessarily in the “rightness” or “wrongness” of the decisions he or
she makes. Referring back to the Dusky standard, this is under the prong of
rational understanding.
Ability to Assist Counsel

This delineates the ability to consult, relate, and plan a legal strategy with his or
her attorney. A competent defendant should participate in planning his or her
defense. This also involves the abilities to challenge witnesses, testify relevantly,
engage in a discussion, and manage courtroom behavior properly (Zapf &
Roesch, 2009). Referring back to the Dusky standard, this is under the prong of
a sufficient present ability to rationally consult with their attorney.
CST Process and Procedures

In most legal jurisdictions, the defense, the prosecution, or the judge can raise
the question of a defendant’s CST at any stage prior to or during the trial (as
outlined in Pate v. Robinson and Drope v. Missouri). Once the issue of com-
petency is raised, a CST evaluation is conducted. The majority of states allow
such evaluations to include testimony by psychologists (Farkas, DeLeon, &
Newman, 1997). CST evaluations can take place in a variety of settings, includ-
ing inpatient psychiatric hospitals, forensic hospitals, outpatient mental health
clinics, jails, or prisons. However, many states have moved from relying on
inpatient competency evaluations to conducting evaluations at the outpatient
service level (e.g., at mental health clinics or private practices; Grisso, 2003;
Zapf & Roesch, 2009). CST evaluations are typically due to the courts in 30
days with possible extensions of up to 60 days (Grisso, 2003).
Once the competency evaluation has been submitted to the court, there
is a judicial determination of competence. The judge may schedule a hearing
to adjudicate the issue; however, a hearing is not always required if all court
players agree on the defendant’s competence (Grisso, 2003). Often, when one
expert conducts a CST evaluation, the court agrees with the expert’s opinion
regarding CST and recommendations approximately 90% of the time (Zapf,
Hubbard, Cooper, Wheeles, & Ronan, 2004). Hearings are more frequent when
two experts are asked to conduct CST evaluations (Zapf & Roesch, 2009).
When a defendant is found competent, trial proceedings resume. If a
defendant is found incompetent, the court determines whether the provision
of treatment is likely to render the defendant competent to stand trial

(Grisso, 2003). In Jackson v. Indiana (1972) the U.S. Supreme Court held
that incompetent defendants cannot be held for treatment longer than the
nature of their disorder warranted. Thus, courts must address the likelihood
that the defendant can be restored to competence. When the disorder cannot
be treated, the state must either drop the charges and release the defendant
or initiate commitment proceedings under the state’s civil commitment cri-
teria. Medication is the most common form of treatment for incompetent
defendants (Zapf & Roesch, 2009). If they respond to the treatment, they
can return to court for a rehearing on their competence. In Riggins v. Nevada
(1992), the court held that incompetent defendants have the right to refuse
involuntary medications if they can demonstrate that the side effects inter-
fere with their abilities in court.
When a defendant is undergoing treatment, reevaluations and rehearings
on his or her competence are held approximately every three to six months
(Grisso, 2003).
Best Practices
When conducting a CST evaluation and incorporating best practices, infor-
mation is typically collected from three sources: the clinical interview,
forensic assessment instruments, and third-party/collateral sources (Zapf &
Roesch, 2009).
The Clinical Interview

The clinical interview is the primary method for conducting a CST evalua-
tion. When evaluating an individual in any context, it is best practice to con-
duct a thorough clinical interview; however, this is particularly important in
CST evaluations due to the contextual nature of the evaluation and the strong
emphasis on psycholegal abilities (Zapf & Roesch, 2009).
The clinical interview should involve relevant notification information and
informed consent, which includes the nature and purpose of the evaluation,
who the report is submitted to, the procedures used, the possibility of testi-
mony by the evaluator, the limits to confidentiality, and the right of refusal and
consequences of the refusal (Zapf & Roesch, 2009). Additionally, a thorough
background history should be obtained, including developmental and family
history, educational history, marital history, military history, occupational his-
tory, mental health history, medical history, substance abuse history, and legal
history. A mental status examination should be conducted, along with questions
pertaining to psychiatric diagnosis. Furthermore, the evaluator should inquire
about the individual’s knowledge of the charges, his or her understanding of
the legal system, his or her reasoning and decision making about a variety of
legal scenarios, his involvement with the attorney and legal defense, and his
or her proper courtroom behavior. Finally, the individual should be evaluated
within the context of his or her legal charge against him or her and the typical
requirements of defendants with similar legal circumstances.
Forensic Assessment Instruments

Research has found that the reliability of competency determinations increases
when utilizing competency assessment instruments (Nicholson & Kugler,
1991; Skeem, Golding, Cohn, & Berge, 1998). Grisso (2003) expanded on this,
stating that utilizing forensic assessment instruments (FAI) in evaluations of
CST (a) provides structure to the evaluation process, (b) improves communi-
cation to the court, and (c) provides the evaluation with empirical support by
associating psychological findings with legally relevant behaviors.
One such FAI is the Evaluation of Competency to Stand Trial-Revised
(ECST-R; Rogers, Tillbrook, & Sewell, 2004), which was utilized in the case
vignette that appears below. The ECST-R was designed to be consistent with
the prongs of the Dusky standard. The first 18 items are divided into four scales,
each producing total scores: (a) Factual Understanding of the Courtroom Pro-
ceedings (FAC), (b) Rational Understanding of the Courtroom Proceedings
(RAC), (c) Consult with Counsel (CWC), and (d) Overall Rational Ability. The
last 28 items are divided into five scales producing total scores that outline a
defendant’s style of responding to questions: realistic, psychotic, nonpsychotic,
impairment, or both psychotic and nonpsychotic. The total scores on all of the
scales are compared with similar peers who also were administered the instru-
ment. The ECST-R takes approximately 30 minutes to administer. There are
no cutoffs used to determine whether a defendant is competent to stand trial.
The information derived from the ECST-R should be used along with other
information gathered in the course of the evaluation.
Collateral or Third-Party Sources

It is vital to gather outside information from collateral sources that include
information pertaining to the defendant’s charges and allegations surround-
ing the alleged crime, reasons for the referral, and the expectations of the
defendant moving forward. Other relevant information could be prior crimi-
nal history records and interactions with the legal system and interviews with
collateral sources, including mental health professionals, jail personnel, jail
medical staff, and anyone with which he or she has had recent contact (Zapf &
Roesch, 2009).
It is important to note that all third-party records/sources should be
reviewed for accuracy and reliability (Zapf & Roesch, 2009).
Case Vignette
Reason for Referral
Albert Krupen, a 26-year-old man from Northern Europe, was referred for a
court-ordered evaluation. The defendant was charged with unlawful reentry.
Mr. Krupen was referred for a CST evaluation. According to the court order,
dated August 12, 2013, the defendant initially entered the United States on a
work visa. Upon completion of his 12-month service as an au pair, Mr. Krupen
failed to reapply for entrance into the United States.
Relevant Notifications
Upon the initial interview, on September 10, 2013, Mr. Krupen was notified of
the nature and purpose of the evaluation. He was also informed of the unique
limits of confidentiality, given the court-ordered nature of the evaluation. Mr.
Krupen was informed that the evaluation would be conducted in compliance
with a court order and that the information we discussed was not confiden-
tial. Specifically, he was told that clinical interviews would be conducted, psy-
chological testing would be administered, behavioral observations would be
completed, collateral information would be collected, and findings would be
summarized in a report and submitted to the court. He was also told that the
court might require that the evaluator testify in court about the assessment.
There are legal, ethical, and cultural considerations with regard to the dis-
cussion and assessment of the defendant’s understanding of the limits of con-
fidentiality. These considerations are equally as important in disclosing the
nature and purpose of the evaluation. With regard to legal considerations,
the ruling from Estelle v. Smith (1981) requires forensic evaluators to inform
defendants of the purpose of the evaluation and the specific limits of confiden-
tiality relevant to the evaluation (Grisso, 2003).
In terms of ethical considerations, the APA (2002) ethical code indicates
that when services are court ordered, psychologists are required to notify
the defendant that the court has mandated the evaluation. The code (APA,
2002) also recommends that, prior to the onset of the evaluation, the evaluator
inform the defendant of the specific services that will be provided as well as
the limits of confidentiality.
With regard to cultural considerations, the evaluation must be delivered in
a language that is preferred and understandable to the defendant (APA, 2002;
Dana, 2000; Geisinger, 2003). Mr. Krupen was fluent in English, and he indicated
that he preferred to communicate in this language throughout the evaluation.
Assessment of the defendant’s understanding and appreciation of the
nature and purpose of the evaluation, as well as the limits of confidentiality, are
important aspects of the evaluation process. The defendant’s ability to accu-

rately interpret the nature, purpose, and limits of confidentiality of the evalua-
tion may be one of the first indicators of the presence of a mental impairment
as well as the ability to appreciate her or his legal situation. As the evalua-
tor, consideration must be given to whether the defendant’s mental impair-
ment and failure to articulate an understanding of these disclosures represents
impairment in one of several competency-related functional abilities. In this
case, it may provide information about the defendant’s ability to engage, com-
municate, and assist in one’s defense (Zapf & Roesch, 2009).
In this case, Mr. Krupen’s understanding of the charges and reason for the
psychological evaluation suggested a gross misperception due to delusional
ideation. He insisted that the evaluation was a mistake, that he did not need a
psychological evaluation, and that he did not have a mental illness. Mr. Krupen
continued to explain that the family that he worked for had him sent to the
jail. Mr. Krupen verbalized erotomanic delusions about his perceived relation-
ship with the wife of his host family. He was also read and provided a typed
Statement of Understanding. The Statement of Understanding summarized the
purpose of the court-ordered evaluation and the processes involved in the evalu-
ation, and the statement clearly defined the limits of confidentiality. Mr. Krupen
refused to sign the document and refused participation in the evaluation. Thus,
he was informed that this evaluator would contact his attorney and would return
within a couple of days. Mr. Krupen spoke to his attorney and agreed to be inter-
viewed. However, he refused to complete any paper-and-pencil-formatted psy-
chological tests. Prior to subsequent interviews, he was reminded of the purpose
of the evaluation and limits to confidentiality. Each time, he verbalized delu-
sional ideation about the reason for his detainment.
Evaluation Procedures
A total of four clinical interviews with Mr. Krupen were conducted that totaled
7 hours and 45 minutes. The clinical interviews were conducted on September
10, 2013, September 16, 2013, September 23, 2013, and September 29, 2013.
Summary of Relevant Records (Sources of Information)

Court order dated August 12, 2013
Jail Intake Notes dated September 5, 2013

It is important to address the defendant’s reliability as a historian. The goal
is to assess whether the defendant’s mental impairment impacts his ability to
recall remote information and to communicate effectively. Another goal is to

assess the level of effort and overall approach to the assessment process as
demonstrated by defendant. In this case, Mr. Krupen’s ability to provide his-
torical information was limited given his guarded presentation and system-
atized delusions.
Mr. Krupen reported that he was born and raised in Northern Europe to an
intact family. He reported that, although English was his second language, he
spoke the language fluently. Mr. Krupen described an uneventful upbringing.
He stated that he had a close and meaningful relationship with his parents and
three siblings.
Regarding education, Mr. Krupen indicated that he completed elementary
and high school with honors. He reportedly began an associate’s degree pro-
gram in elementary education in the United States. It was during this time
period that he obtained his first job, which was as an au pair. He reported that
his work with the family ended after two months indicating, “My girlfriend did
discuss how much she loved me.” Mr. Krupen reported that he began a “love
life” with the mother of the host family. However, corroborative documenta-
tion indicated that he had no relationship with her other than to work for the
family. He stated that he never made his feelings of love for Mrs. Host known
to anyone. However, he said he left love notes regarding his feelings for her.
Since the time he stopped working for the family, he had reportedly e-mailed
Mrs. Host more than 100 times. However, he said that Mrs. Host never wrote
back. Mr. Krupen had never been married and has no children.
Mr. Krupen denied a significant history of medical treatment. Likewise, he
denied a history of mental health symptoms and treatment. In terms of legal
history, Mr. Krupen reported that he had never been arrested or in trouble
with the law.

The jail intake progress note dated September 5, 2013, was reviewed to assess
Mr. Krupen’s mental status upon arrival to the institution. According to the
note completed by Dr. Intake, Mr. Krupen presented as oriented to person,
place, and time. His demeanor was described as agitated and argumentative.
His hygiene and grooming were reportedly fair. The note indicated Mr. Krupen
articulated paranoid ideations with regard to the purpose of his stay at the jail.
The content of his thoughts reportedly focused on his release from jail and
return to his former employer’s home. His insight into his need for mental
health treatment as well as the reason for the referral was regarded to be poor.
Mr. Krupen was interviewed five times during his competency evalua-
tion. During each interview, his clinical presentation remained relatively
unchanged. He was dressed in a jail uniform, his hygiene and grooming
appeared adequate, and his attitude was pleasant toward the examiner. How-
ever, he made clear that he was not in agreement with the need for the evalu-
ation. Mr. Krupen displayed the ability to communicate his thoughts. He was
well engaged during each clinical interview.
With regard to cognition, Mr. Krupen was fully oriented to person, place,
and time. However, he had an impaired understanding of his legal situation.
Specifically, he communicated the belief that there was no legal basis for his
detainment at the jail, and he was waiting for Mrs. Host to pick him up. His
insight into his legal situation was limited. His judgment was questionable.
Mr. Krupen’s mood appeared euthymic, and his affect was congruent. He
denied thoughts a suicidal or homicidal nature. He reported having a good
appetite and sleep habits. He displayed adequate energy throughout the
evaluation process.
At times it was very difficult to follow Mr. Krupen’s flow of conversation.

His speech was tangential and irrelevant at times. The content of his speech
was replete with erotomanic themes and persecutory delusions as it related to
the purpose of the evaluation, his misperceived relationship with Mrs. Host,
and the pending charges. His responses to questions regarding the charges
were clearly distorted and based on delusional ideation. Mr. Krupen stated
that Mrs. Host was coming to get him and would “release” him. By the third
session, when asked why he believed Mrs. Host did not come to pick him
up, he said that he thought she had to work and could not be excused to
come get him. He added that Mrs. Host wanted to keep him detained as long
as possible to ensure that “I don’t stop loving her.” He consistently denied
hallucinatory processes and evidenced no overt signs suggestive of respond-
ing to internal stimuli. He displayed no insight into his illness. His judgment
appeared tenuous.
Psychological Measures and Results

The use of psychological tests in CST evaluations to assess for competency-
related functional abilities may vary from evaluator to evaluator. However,
when psychological tests are used, competency-specific forensic assessment
tools may be most relevant in addressing the psycholegal questions and in
adding empirical support to the evaluation (Heilbrun, 1992; Grisso, 2003; Hei-
lbrun, Grisso, & Goldstein, 2009; Zapf & Roesch, 2009).
The ECST-R was selected for the purpose of this CST evaluation for several
reasons. First, as discussed earlier in this chapter, the ECST-R was developed
based on the Dusky standard. The scales on the ECST-R also provide infor-
mation directly relevant to the psycholegal issue, competency to stand trial.
Mr. Krupen was administered the ECST-R to assess the psycholegal domains
relevant to the legal standard for competency to stand trial. This test is admin-
istered in an interview format and assesses three primary areas: the defen-
dant’s ability to consult with counsel, the defendant’s factual understanding of
the courtroom procedures, and the defendant’s rational understanding of the
courtroom proceedings.
Mr. Krupen appeared to put forth sufficient effort in answering competency-
related questions. The results suggested a severe impairment in Mr. Krupen’s
ability to consult with his legal counsel as it relates to assisting and planning
a successful defense strategy. While Mr. Krupen articulated a positive view of
his attorney and his attorney’s ability to represent him, he expressed the belief
that his attorney’s services were unnecessary due the defendant’s false belief
that the charges against him do not exist. When asked to provide information
about how he would go about settling a disagreement with his attorney, Mr.
Krupen continued to verbalize delusional ideation. Specifically, he said that
Mrs. Host hired his attorney. Mr. Krupen was able to articulate that if a defen-
dant disagreed with his attorney, then he could hire a new one. With regard
to his own legal situation, Mr. Krupen stated that he would not look for a new
attorney because “Mrs. Host wants me to be here.”
Mr. Krupen’s test results suggested knowledge of specific factual information
of the courtroom proceedings. His overall score in the area of factual under-
standing of courtroom proceedings fell within the normal range. On the other
hand, he continued to express an inaccurate understanding of the criminal
charges against him. When asked to discuss the criminal charges against him, he
insisted that Mrs. Host was responsible for his stay in jail and that there were no
charges against him. After being informed of the documented charges, he was
asked about the possible penalties, such as prison time. Again, his delusional
ideation limited his ability to appreciate the charges against him. Specifically,
he indicated that the only outcome would be to return to live with Mrs. Host.
Legal Statute
Under U.S. Code 4241, the defendant must “be presently suffering from a
mental disease or defect rendering him mentally incompetent to the extent
that he is unable to understand the nature and consequences of the proceed-
ings against him or to assist properly in his defense.”

The summary and opinion section of a CST report must convey to the court
the defendant’s functional abilities as it relates to the issue of competency to
proceed (Grisso, 2003; Zapf & Roesch, 2000). A long-standing debate among
forensic evaluators exists as to whether or not it is appropriate to address the

legal issue in the report or if the ultimate legal issue is to be determined by the
trier of fact. Some researchers suggest that the forensic evaluator must speak
only to the defendant’s functional capacities and abilities (Ogloff & Douglas,
2003; Melton, Petrila, Poythress, & Slobogin, 2008; Heilbrun, Grisso, & Gold-
stein, 2009; Zapf & Roesch, 2009). The authors of this chapter agree with the
latter. Thus, the summary and opinion section will speak to the defendant’s
functional abilities.
Mr. Krupen was interviewed regarding functional abilities relevant to com-
petency to stand trial on several occasions. His ability to provide a factual and
rational account of the charges against him and the circumstances that led to
his arrest were significantly impaired by his delusional thought process. Con-
sequently, he would have difficulty providing the necessary information in
order to assist in his defense. As previously mentioned, Mr. Krupen appeared
to suffer from Delusional Disorder, Mixed type with erotomanic and perse-
cutory features. His false beliefs about having a romantic relationship with
Mrs. Host and persecutory themes of being conspired against by all court
personnel and prison staff (including the undersigned evaluator) dominated
all discussions as it related to his actual charges.
Mr. Krupen was asked questions to assess his factual knowledge of the legal
proceedings against him. He consistently reported the idea that he believes
the charges against him are false despite having reviewed court documents,
which specify the charges and reason for the referral. He was unable to provide
a factual or rational explanation of the charges against him or the events that
led to his arrest. It was evident during each interview that he did not retain
or believe the explanation given to him about the pending charges. Rather,
he asserted that the court documents were “bogus.” By the third interview, he
stated that he did not believe the charges were real and that his “girlfriend”
[Mrs. Host] would come to pick him up the next day. He went on to describe
the delusional themes. Mr. Krupen had no appreciation as to whether or not
the charges against him were a felony or misdemeanor. He simply said, “The
whole thing is fake.” When asked whether a felony or misdemeanor is a more
serious charge, he indicated that he did not know.
Another aspect of factual understanding is having knowledge of the mem-
bers or roles of courtroom personnel and participants. Overall, Mr. Krupen’s
awareness of the roles of courtroom participants during a trial was good. He
was able to accurately define the role of the judge, defense attorney, prosecutor,
witness, and defendant.
The assessment of Mr. Krupen’s understanding of the possible pleas and
consequences and appreciation of the potential outcomes were also key ele-
ments of factual understanding. Mr. Krupen was questioned regarding his
understanding of the possible pleas. It was unclear as to his true level of
knowledge regarding these terms because he never directly addressed the

question. Instead, he continued to deny the validity of the charges against
him. He was unable to examine the available defenses. His appreciation of the
possible penalties was also impaired. Mr. Krupen was asked to articulate his
understanding of what could occur if he were found guilty. He said, “These
charges aren’t real. There is no way I have to leave this country.” Mr. Krupen
denied awareness of the concept of a plea bargain. Although this concept was
explained to him, he was unable to appreciate how this legal concept per-
tained to him because of the belief that all aspects of his case are “superficial”
or have been made up.
Mr. Krupen’s ability to assist in his defense was also assessed. Mr. Krupen
indicated that he knew his attorney and provided his correct name. He stated
that he had confidence in his attorney. Nevertheless, he also expressed the
belief that Mrs. Host hired his attorney. When asked to discuss the meaning
of confidentiality between him and his attorney, Mr. Krupen’s response was
irrelevant to the question asked. Mr. Krupen’s delusional beliefs also mark-
edly impaired his appreciation of the collaborative relationship between him-
self and his attorney. He stated that he must do what Mrs. Host instructs him
to do, not his attorney. He also indicated that he would contact Mrs. Host to
get her advice on whether he should work with his attorney. He was asked
how his attorney could assist him. Mr. Krupen stated that his attorney could
not help him get released. He explained that the only person that could get
him out of jail was Mrs. Host. With regard to settling disagreements with his
attorney, he said that he would not terminate him because Mrs. Host hired
him. In terms of appropriate courtroom behavior, Mr. Krupen expressed an
understanding of the potential consequences of engaging in inappropriate
behavior in court.
Mr. Krupen articulated a limited appreciation for courtroom procedures.
He articulated some confusion about the process of testimony. He said he
thought that defendants were always required to testify in their own cases.
Based on his comments, he did not appear to have an appreciation for the
adversarial nature of cross-examination.
Based on the totality of the information previously outlined, Mr. Krupen
was unable to provide a factual understanding of the charges against him or to
assist in his defense. His ability to do so was markedly impaired by his delu-
sional thought processes. Mr. Krupen lacked an ability to consider and inte-
grate information based on own legal situation due to his delusional beliefs.
He was unable to provide a logical, factual, or sequential account of the events
that led to his arrest due to his psychosis. His explanation of his legal situa-
tion was based upon false beliefs or delusions related to his idealized romantic
relationship with Mrs. Host. Thus, he lacked an appreciation of the potential
consequences of his legal situation.
Mr. Krupen displayed a limited ability to reason and engage in appropriate

decision making as it related to his case. He refused to sign any documents and
negated the relevance of court documentation. Given Mr. Krupen’s firm delu-
sions surrounding his relationship with the victim as it relates to the alleged
offense, it was likely that he would not be able to assist in planning effective
legal strategies.
Mr. Krupen’s reasoning abilities were also impaired due to his mental condi-
tion. Based on his most recent mental status, Mr. Krupen would not be able to
consider relevant information as it relates to his case. Likewise, he was unable
to consider his legal options or potential consequences due to his impaired
thinking.
Mr. Krupen’s ability to explain the basic roles of courtroom members was
fair; however, he expressed a belief that the alleged victim hired his attorney.
His ability to fully participate in the undersigned evaluation was impacted by
his psychosis.
In summary, it was the evaluator’s opinion that Mr. Krupen was presently
suffering from a mental disease or defect that limited his ability to understand
the nature and consequences of the proceedings against him or to assist prop-
erly in his defense.

CST evaluations are the most commonly requested evaluations performed
by psychologists in criminal court (Stafford, 2003). The assessment of CST
requires familiarity with relevant nomenclature and statutes. The language
used to describe “competency” or “fitness” to stand trial may vary across state
and federal jurisdictions. The use of the wrong terminology in an evaluation
may lead to confusion about the referral question at hand. Having a rote under-
standing of the legal system and procedures in the United States will enable a
deeper understanding of how to assess a defendant in a CST evaluation. In
fact, this basic understanding of the legal system and legal principles is an ethi-
cal obligation of psychologists. Furthermore, evaluators must be knowledge-
able of relevant case law and statutory criteria. Inclusion of the applicable state
or federal statute in the report articulates the functional abilities that are to be
assessed according to the law. Thus, it is important to have an understanding
of what the jurisdiction requires of the defendant with regard to functional
abilities. The type of questions in a CST evaluation may differ by jurisdiction.
This chapter offered a case vignette to illustrate the key components of a
CST evaluation. This case also discussed and applied best practices regard-
ing competency-related abilities as recommended by leaders in the field of
forensic psychology (Frederick, DeMier, & Smith, 2014; Zapf & Roesch,
2009; Goldstein & Weiner, 2003; Grisso, 2003; Melton, Petrila, Poythress, &
Slobogin, 2007). A common pitfall is that some evaluators fail to use multiple
sources of data and multiple methods to evaluate the defendant and to form
their hypotheses and conclusions regarding competency to stand trial. When
multiple sources of data (e.g., collateral contacts, records, etc.) are available, it
is a best practice to obtain and integrate the information.
Additionally, evaluators must determine whether they would like to utilize
a specific forensic test to assist in their determination of competence. Thus,
another pitfall is the use of clinical assessment tools that are not relevant to
the referral question. As stated previously, research has shown that utilizing
a competency assessment instrument increases the reliability of competency
determinations. However, the disadvantage of incorporating assessment
instruments is that it opens up more diverse and potentially challenging lines
of questioning in cross-examination if expert witness testimony takes place.
How and to what degree does the presence of mental illness affect the adju-
dication of incompetence? When conducting CST evaluations, it is important
to know that the presence of a mental illness or related symptoms does not
necessarily mean that the individual lacks the functional abilities for compe-
tency to stand trial. Conducting CST evaluations requires consideration of
the defendant’s relevant functional abilities. The evaluation must address the
impact of the defendant’s mental illness and the severity of the defendant’s
symptoms on competency relevant functional abilities.
Another pitfall is the lack of awareness of the constitutional rights of the
defendant. Given that the CST evaluation is conducted at the pretrial stage, it
is important to exclude incriminating information regarding the defendant’s
role in the criminal act. For example, to understand the defendant’s ability to
communicate his or her version of the alleged events, the evaluator may ask
him or her to speak about this. Another example is to assess the defendant’s
ability to reason and weigh the relevance between multiple defense strate-
gies. The defendant may discuss which strategy he or she feels would be most
beneficial. Because this information may speak to the defendant’s admission
of guilt, the evaluator should take caution to not include the details of these
inquiries in the evaluation report. Instead, the evaluator could summarize
the quality of the defendant’s overall psycholegal abilities in those areas. In
summary, inclusion of information in the report regarding the defendant’s
criminal responsibility is a mistake that is often made. Such information is a
post-adjudicative legal matter that does not belong in a pretrial assessment of
competency to stand trial.
With regard to evaluation and conclusions, there are varying opinions
about whether the evaluator must address the ultimate legal question by docu-
menting whether or not the defendant “is competent” or “is not competent.”
According to the “Specialty Guidelines for Forensic Psychology” (APA, 2013),
evaluators are cautioned against answering the legal question at hand; this is
the job of the trier of fact (i.e., the judge). Offering such conclusions is not
within the professional competence of psychologists. However, jurisdictions
differ on what they require of experts in submitting reports and in expert
testimony. Often evaluators may feel pressure from various members of the
legal profession to offer such conclusions (Melton et al., 2007). As specified in
the APA ethical code (2002) when professional and legal obligations conflict,
psychologists are to make known professional obligations first and proceed
accordingly. Ultimately, the CST evaluation must be driven by the psychole-
gal issue documented in the court order, the requirements of the law, and the
functional abilities necessary to be adjudicated to competence to stand trial by
the court.
References
American Psychological Association. (2002). American Psychological Association ethical
principles of psychologists and code of conduct. Retrieved May 20, 2015, from http://www
.apa.org/ethics/code2002.html
American Psychologist, 68(1), 7–19. doi:10.1037/a0029889
Bonnie, R. J. (1992). The competence of criminal defendants: A theoretical formulation.
Behavioral Sciences and the Law, 10, 291–316.
Bonnie, R. J., & Grisso, T. (2000). Adjudicative competence and youthful offenders. In
T. Grisso & R. Schwartz (Eds.), Youth on trial: A developmental perspective on juvenile
justice (pp. 73–103). Chicago, IL: University of Chicago Press.
Dana, R.H. (2000). Handbook of cross-cultural and multicultural personality assessment.
New York: Psychology Press.
Drope v. Missouri, 420 U.S. 162 (1975).
Dusky v. United States, 362 U.S. 402 (1960).
Estelle v. Smith 451 U.S. 454 (1981).
Farkas, G. M., DeLeon, P. H., & Newman, R. (1997). Sanity examiner certification: An
evolving national agenda. Professional Psychology: Research and Practice, 28(1), 73–76.
Frederick, R. I., DeMier, R. L., & Smith, M. S. (2014). Examinations of competency to
stand trial: Foundations in mental health case law (2nd ed.). Sarasota, FL: Professional
Resource Press.
Geisinger, K. F. (2003). Testing and assessment in cross-cultural psychology. In J. R. Graham
& J. A. Naglieri (Eds.), Handbook of psychology: Assessment psychology (pp. 95–117).
New York: Wiley.
Goldstein, A. M., & Weiner, I. B. (Eds.). (2003). Handbook of psychology: Vol. 11. Forensic
psychology. Hoboken, NJ: Wiley.
Grisso, T. (2003). Evaluating competencies: Forensic assessments and instruments (2nd ed.).
New York, NY: Kluwer Academic/Plenum.
Heilbrun, K. (1992). The role of psychological testing in forensic assessment. Law and
Human Behavior, 16 (3), 257–272.
Heilbrun, K., Grisso, T., & Goldstein, A. (2009). The foundations of forensic mental health
assessment. New York: Oxford University Press.
Higgins v. McGrath, 205 F.2d 650 (9th Cir. 1953).
Hoge, S. K., Bonnie, R., Poythress, N. G., & Monahan, J. (1992). Attorney-client decision-
making in criminal cases: Client competence and participation as perceived by their
attorneys. Behavioral Sciences and the Law, 10, 385–394.
Illinois Code of Criminal Procedure, Fitness for trial, to plead or to be sentenced, 725 ILCS
5/104 (1963).
Jackson v. Indiana, 406 U.S. 715 (1972).
Melton, G. B., Petrila, J., Poythress, N. G., & Slobogin, C., with Lyons, P. M., Jr., & Otto,
R. K. (2007). Psychological evaluations for the courts: A handbook for mental health pro-
fessionals and lawyers (3rd ed.). New York, NY: Guilford Press.
Meyer, R. G., & Weaver, C. M. (2006). Law and mental health: A case-based approach. New
York, NY: Guilford Press.
Nicholson, R., & Kugler, K. (1991). Competent and incompetent criminal defendants: A
quantitative review of comparative research. Psychological Bulletin, 109, 355–370.
Ogloff, J. R., & Douglas, K. S. (2003). Psychological assessment in forensic settings. In
J. R. Graham, J. A. Naglieri, & I. B. Weiner (Eds.), Handbook of psychology: Volume 10:
Assessment psychology (pp. 345–363). New York, NY: Wiley.
Pate v. Robinson, 383 U.S. 375 (1966).
Poythress, N. G., Bonnie, R. J., Monahan, J., Otto, R., & Hoge, S. K. (2002). Adjudicative
competence: The MacArthur studies (Perspective in Law & Psychology, Volume 15). New
York, NY: Kluwer Academic/Plenum.
Riggins v. Nevada, 504 U.S. 127 (1992).
Rogers, R., Tillbrook, C. E., & Sewell, K. W. (2004). Evaluation of Competency to Stand
Trial—Revised (ECST-R). Odessa, FL: Psychological Assessment Resources.
Skeem, J., Golding, S., Cohn, N., & Berge, G. (1998). Logic and reliability of evaluations of
competence to stand trial. Law and Human Behavior, 22, 519–547.
Slobogin, C., Rai, A., & Reisner, R. (2008). American Casebook Series: Law and the mental
health system: Civil and criminal aspects (5th ed.). St. Paul, MN: West Academic.
Stafford, K. P. (2003). Assessment of competency to stand trial. In A. M. Goldstein & I. B.
Weiner (Eds.), Handbook of psychology: Vol. 11. Forensic psychology (pp. 359–380). New
York, NY: Wiley.
United States Department of Justice (2006, September). Bureau of Justice Statistics: Mental
health problems of prison and jail inmates (NCJ 213600). Washington, DC: Office of
Justice Programs.
Wieter v. Settle, 193 F. Supp. 318 18 U.S.C. 4241.
Zapf, P. A., & Roesch, R. (2009). Best practices in forensic mental health assessment: Evalua-
tion of competence to stand trial. New York, NY: Oxford University Press.
Zapf, P. A., Hubbard, K. L., Cooper, V. G., Wheeles, M., & Ronan, K. A. (2004). Have the
courts abdicated their responsibility for determination of competency to stand trial to
clinicians? Journal of Forensic Psychology Practice, 4, 27–44.
3
Conducting Criminal
Responsibility Evaluations
Allison M. Schenk, Emily D. Gottfried, and Michael J. Vitacco
Criminal responsibility evaluations are one of the most controversial and con-
tentious areas of mental health law. On one hand, the insanity defense is vastly
misunderstood by the general public due to its sensationalized portrayal in the
media. On the other hand, the notion of convicting someone who was unable
to form intent or understand the wrongfulness of his or her actions, due to a
mental disease or defect, is considered unjust. Despite their contentiousness,
criminal responsibility evaluations are arguably one of the most complex, chal-
lenging, and fascinating in the field of forensic psychology. A criminal respon-
sibility evaluation assesses the defendant’s mental state at the time of an alleged
crime; the retrospective nature of the evaluation adds to its complexity. The
criminal justice system requires those it prosecutes to have committed a crimi-
nal act (actus reus) and also to have had intent or knowledge the act was crimi-
nal (mens rea).
History and Relevant Case Law of Criminal Responsibility

An examination of ancient texts reveals references to criminal actions being
excused for reasons of “madness,” being an “idiot” or “madman,” or possess-
ing the understanding of a child (Melton, Petrila, Poythress, & Slobogin, 2007;
Packer, 2009). In 1723, the concept of insanity was initially defined as follows:
“a man must be totally deprived of his understanding and memory so as not
to know what he is doing; no more than an infant, brute, or wild beast” (Rex v.
Arnold, 1724). It was not until the mid-nineteenth century that the first formal
test of insanity was put forth. Known as the “Wild Beast” test, this standard
would set an almost unattainable bar for a defendant to meet in order to be
found not responsible.
Criminal Responsibility Evaluations 37
In England, Daniel M’Naghten believed he was being persecuted by Eng-

land’s right-wing political party and sought to kill Prime Minister Robert Peel,
the person he thought was most at fault for his persecution (Meyer & Weaver,
2006). He was unsuccessful in killing the prime minister, but he did kill the
prime minister’s secretary. Many medical experts testified about M’Naghten’s
mental state at the time of the crime, which led to his acquittal. To prevent
an insurgence of politically motivated acts of violence, the House of Lords
defined a test for subsequent insanity defenses that stipulated a defendant had
to be “laboring under such a defect of reason, from disease of the mind” that
he did not know the nature or quality of his actions or that they were wrong
(M’Naghten Case, 1843). A century and a half later, there is still a required link
between the “disease of the mind” and the individual’s inability to understand
the consequences and wrongfulness of his or her actions (Rogers, 2008a).
The M’Naghten standard remains the oldest and most widely used test for
legal insanity, and the standard is still employed directly or in some variation
in 26 states today. It has faced some criticism as people have argued this stan-
dard is too rigid or places too much emphasis on assessing the defendant’s cog-
nitive awareness or ability to know right from wrong (e.g., cognitive prong).
This standard is typically referred to as the “right versus wrong” test.
In response to criticisms of the M’Nagthen standard, many jurisdictions
chose to add a volitional prong to their insanity standard. Coined the “irresist-
ible impulse test,” this component allows a defendant to be found insane if he
knew what he was doing was wrong (cognitive prong) but, because of a mental
disease or defect, could not keep himself from engaging in the crime (volitional
prong). A major criticism of the “irresistible impulse test,” which is founded on
a long-standing debate, is successfully differentiating between an impulse that
was not resisted and one that could not be resisted (see Packer, 2009).
The Durham Rule (Durham v. U.S., 1954), or “product test,” was adopted by
several jurisdictions in the United States. This standard allowed the defendant to
be found insane if the criminal actions were the result, or product, of a mental ill-
ness. As with M’Naghten, there must be a direct link between the mental illness
and the criminal act. This standard allowed significant leeway in the expertise of
mental health practitioners regarding mental illness and its influence on criminal
behavior (Bartol & Bartol, 2015). Unfortunately, the courts found the testimony
of experts confusing and “difficult to interpret” (Meyer & Weaver, 2006, p. 118),
as well as inconsistent (Packer, 2009). Ultimately, the “product test” was over-
turned in favor of a more restrictive insanity defense in all jurisdictions except
for one (U.S. v. Brawner, 1973). This standard is currently employed only by New
Hampshire, and this standard remains the least restrictive insanity standard.
In 1962, the American Law Institute (ALI) wrote the Model Penal Code,
which was a new formulation of the standards for the insanity defense. The
goal of the ALI was to strike a balance between the broadness of the Durham
Rule and the rigidity of the cognitively focused M’Naghten standard. In U.S.
v. Brawner (1972), Judge Bazelon modified the Model Penal Code slightly and
devised what is now referred to as either the ALI rule or Brawner rule. The
ALI/Brawner rule incorporates both cognitive and volitional components for
insanity. It states that an individual should be found not guilty by reason of
insanity (NGRI) “if at the time of his unlawful conduct his mental or emo-
tional processes or behavior controls were impaired to such an extent that he
could not justly be held responsible for his act” (as cited in Melton et al., 2007,
p. 207). The ALI/Brawner standard was the first to specify diagnoses related
to criminal conduct (e.g., Antisocial Personality Disorder) did not constitute
a mental disease or defect in the eyes of the court. The ALI/Brawner standard
is still used in many states but was abandoned as the standard for insanity
by the federal government in 1984, following the attempted assassination of
President Reagan.
The landscape of the insanity defense changed dramatically after John
Hinckley was found NGRI for his attempted assassination of the President
and his shooting of two others in 1981. The Insanity Defense Reform Act
(IDRA) in 1984 removed the volitional prong from the insanity defense. For
a defendant to be found NGRI under the IDRA, he or she must have been
“unable to appreciate the nature and quality or wrongfulness” of the act
(Insanity Defense Reform Act, 1984). The IDRA also shifted the burden to the
defendant to prove he or she met this standard at the time of the crime and
limited the testimony that could be given by expert witnesses. Most notably,
expert witnesses are not allowed to provide an ultimate opinion regarding the
question of insanity when testifying (see FRE, 704[b]).
Another change in many jurisdictions was the creation of the guilty but
mentally ill (GBMI) defense. This standard allows a defendant to be found
guilty of the crime but also acknowledges the presence of a mental illness.
A successful GBMI defense still results in a finding of guilt, and the defense
may (but does not have to) reduce the seriousness of the charge or the pen-
alty. In theory, offenders found GBMI would have some form of treatment for
their mental illness incorporated into their punishment. One of the criticisms
surrounding this defense is that effective treatment for these offenders is not
guaranteed, and many can still face the most serious of penalties, including the
death penalty (Bartol & Bartol, 2015; Roesch, Zapf, & Hart, 2010).
To date, four states have chosen to abolish the insanity defense completely:
Idaho, Montana, Utah, and Kansas. Nevada also attempted to eliminate this
defense, but the Nevada Supreme Court ruled that doing so violated both state
and federal constitutions (Finger v. State, 2001). The U.S. Supreme Court has
consistently declined to rule on the issue regarding the constitutionality of
the insanity defense. As recently as 2012, this issue was brought to the U.S.
Supreme Court (Delling v. Idaho, 2012), but only three of the nine justices
voted to hear the case, which was insufficient to grant certiorari (Bartol &
Bartol, 2015). The U.S. Supreme Court did rule in Clark v. Arizona (2006)
that there was no specific language or minimum standard that needed to be
included in a state’s statute surrounding the insanity defense.
In addition to the controversy about the various insanity standards, there
has been a great deal of debate generated regarding the definition of key words
or phrases in these different standards. For example, does wrongfulness refer
to moral wrongfulness, legal wrongfulness, or both? Unfortunately, a complete
discussion of the existing case law and debated definitions of these terms is
outside the scope of this chapter. Readers are encouraged to refer to Packer
(2009) or Melton et al. (2007) for a more thorough account of these terms and
their debated meanings within the insanity standards.
Given the variety of standards and requirements surrounding the insanity
defense and criminal responsibility evaluations, it is essential for the foren-
sic evaluator to be familiar with the statues governing his or her practicing
jurisdiction(s). In addition to which insanity standard is applied in the juris-
diction, it is important to be familiar with other key factors before beginning
the criminal responsibility evaluation. Such factors include the legal standard
of proof for determining insanity, the guidelines for how and to whom the
criminal responsibility report will be distributed, and the rules for proffering
testimony on the ultimate issue (Meyer & Weaver, 2006; Packer, 2009).
Best Practices
Criminal responsibility evaluations entail, at a minimum, clinical interviews
and an extensive review of collateral data. Criminal responsibility, and all
forensic evaluations for that matter, should be focused on testing alternative
theories related to the criminal behavior. For example, in criminal responsi-
bility evaluations, the two hypotheses to be tested involve whether the defen-
dant is or is not criminally responsible. Thinking about forensic evaluations
in a hypothesis-testing manner can be helpful in keeping an open mind about
the case and preventing confirmatory biases from influencing professional
opinions.
Collateral Information
In preparing for a criminal responsibility evaluation, it is important to gather
all pertinent records and read the entire discovery of the case. A review of
police reports can provide important information about the defendant’s men-
tal state at the time of arrest. For example, valuable data can be gleaned from
police interviews, and this provides an opportunity to obtain a sense of the
defendant’s thought process. Any notable or bizarre statements made by the

defendant at the time of arrest or during interviews with the police should be
noted, and it may be beneficial to ask the defendant about these statements
during the clinical interview. Additionally, if video is available of the defen-
dant’s police interview, this could provide critical information about mental
status in close proximity to the alleged offense. For example, an evaluator
watching the interview may be able to determine how organized the defendant
was, as well as if and to what degree he responded to internal stimuli. It is also
important to read police interviews of family members and witnesses to the
alleged crime. These documents can provide information about whether or
not the defendant was behaving peculiarly in the time period leading up to the
alleged offense and may include information about statements the defendant
made during the offense. For instance, if, during the clinical interview, a defen-
dant claims that he did not sleep for four days prior to the instant offense and
if the police report includes a contradictory statement from the defendant’s
wife claiming that her husband was observed frequently sleeping, this would
be beneficial to include in the written report.
In addition to the case discovery, supplementary records should be
requested. Although criminal responsibility is only concerned with the mental
state at the time of the alleged offense, records can provide invaluable historical
information to support or provide evidence against a hypothesis. Requested
records should vary depending on the defendant’s history. School records can
provide information about a defendant’s intelligence, the presence of learning
disorders, early behavioral problems, and psychiatric history. Requesting all
mental health records is also very important. Although a prior psychiatric his-
tory is not necessary to argue that a defendant is not criminally responsible,
this fact has proven useful in differentiating individuals found not responsible
from those found responsible. In fact, Packer (1987) found individuals meet-
ing the criteria for insanity often had previous findings of being not competent
to proceed to trial. These defendants also were less likely to have a previous
felony conviction and were more likely to have prior psychiatric hospitaliza-
tions and psychotic disorder diagnoses.
As discussed in greater detail below, the mere presence of a mental illness is
not enough to claim that an individual is not responsible for their crime. Records
may reveal that a defendant was involuntarily hospitalized in the week prior to
the instant offense or may show that a psychiatrist noted that he or she was not
exhibiting any symptoms during the routine medication management appoint-
ment the previous week. A comprehensive review of records should also include
substance use treatment records. Additionally, jail records should be reviewed
to determine whether the defendant is currently being prescribed medication,
whether symptoms are reported, and what his or her behavior has been like at
the jail. All of this information can be used to support or contradict a hypothesis.
Interviews
After the evaluator reviews all collateral documents related to the case, the
next step is to conduct clinical interviews with the defendant. A forensic noti-
fication outlining his or her rights concerning the evaluation should always be
provided. In some cases, it may be beneficial and prudent to have the defen-
dant sign a form confirming receipt and understanding of the notification of
rights. This will vary by state, but a defendant should be made aware that an
NGRI plea is an affirmative defense, and a defendant should understand the
potential consequences of pleading NGRI. It should be explicitly noted that
the evaluation is not confidential and that everything the defendant says and
does during the evaluation could be described in a written report and in sub-
sequent testimony. The defendant should also be told who will have access to
the report (i.e., the prosecuting attorney). In the best case scenario, the defen-
dant’s attorney will have already informed the defendant of the circumstances
of an NGRI plea, and the defendant is aware that an evaluation is to take place.
It is more often the case that an attorney requested a competency to stand trial
and criminal responsibility evaluation with no mention of that request to his
or her client. In these situations, the defendant will be unaware that an evalu-
ation was requested or what this type of evaluation entails. These situations
require the evaluator to provide a more thorough explanation of the purpose
of the evaluation and notification of the defendant’s rights.
The interview should begin with a review of the defendant’s history, which
includes information regarding developmental, social, abuse, educational,
employment, medical, psychological, substance use, and legal history. A men-
tal status examination should be completed, and the defendant’s appearance,
behavior, cooperation, reliability, speech, thought process, thought content,
mood, affect, insight, judgment, perception, and cognitive functioning should
be described (Robinson, 2008). Diagnostic impressions should be considered,
whether they are made using a structured diagnostic interview or asking about
symptoms during the clinical interview. A diagnosis (or at the very least, spe-
cific symptoms) should be provided in the written report. The history of these
symptoms and all previous treatment and hospitalizations should be described
in detail in the mental health history section of the report, as this information
could provide information about a defendant’s mental illness (or lack thereof),
which is necessary (but not sufficient by itself), for a criminal responsibility
defense.
The next step in the evaluation process is to ask the defendant to provide his
or her account of what happened at the time of the offense. Some defendants
may provide a detailed description of the events, and others may need to be
prompted. Whenever possible, it is best to start with open-ended questions
and progress to more specific, close-ended questions as needed. It is important
to gather information about the defendant’s behaviors and functioning before,

during, and after the alleged offense, as well as his or her understanding and
explanation of these behaviors. This information can provide the evaluator
with an idea of the defendant’s mental status around the time of the alleged
offense. Table 3.1 includes examples of questions that could help the evaluator
elicit such information.
Melton and his colleagues (2007), as well as Packer (2009), also provide
similar examples of questions that can be helpful to elicit information in these
evaluations.
After the defendant provides his or her statement, it is recommended that
the evaluator then ask questions about statements that were made during the
arrest and question other data obtained from the police records. For instance,
a defendant may make a bizarre statement that sounds delusional during the
police interrogation. If given an opportunity to explain such statements, it may
be discovered that the statement was, in fact, quite rational and that it makes
sense once the context is known. Of course, forensic evaluators must be cogni-
zant that evaluees often appear more rational during their interviews. As such,
a close review of all collateral information is useful in parsing out symptoms of
mental illness from atypical behaviors and odd statements.
Defendants Who Deny the Allegations

As a NGRI plea is an affirmative defense, a defendant must admit to commit-
ting the crime. Therefore, an evaluator may conclude that a criminal responsi-
bility evaluation is not possible if the defendant denies the allegations; however,
if the defendant is willing to answer more vague or hypothetical questions, the
evaluation should still continue under these circumstances. Instead of asking
the defendant for specific information regarding the alleged crime, it is rec-
ommended that the evaluator ask more general questions. Examples of such
questions are provided in Table 3.2.
Additionally, asking the defendant to describe what was happening in his or
her life and how he or she was feeling (psychologically and physically) around
the time period of the arrest can reveal important information. Asking about
symptoms, medications, illicit substance use, sleep patterns, and sleep distur-
bances is recommended, even for defendants who deny the allegations.
Testing
Psychological testing is not directly related to criminal responsibility evalua-
tions, and the use of testing is indicated on a case-by-case basis (Packer, 2009).
Packer reviewed studies that found 57% of forensic psychologists indicated
they always incorporated psychological testing into criminal responsibility
TABLE 3.1 Examples of Questions for a Criminal Responsibility Interview
Possible Questions
Behavior Before the Alleged Offense

What was happening in the weeks leading to the crime?
Were you sleeping, eating, prescribed and taking medication?
Were you using alcohol in the weeks leading up to the alleged crime?
Behavior During the Alleged Offense
On what day and where did the alleged crime occur?
Begin with the morning of the alleged crime; tell me about your whole day.
Were you hearing voices, seeing visions?
Did you drink alcohol on this day?
Were you using drugs on that day of the alleged crime?
What happened during the crime?
What were you thinking?
Were there any problems with the way you were thinking?
What was it about that moment/why did you allegedly commit the crime at
that time versus other times?
Behavior After the Alleged Offense
Tell me about what you did after the alleged offense?
Did you do anything to avoid being caught?
What did you think when you got arrested?
What did you tell the police?
Did you tell anyone else about the crime?
Reasoning and Understanding of Actions
What was your reason for doing that action during the alleged offense?
Did you know the victim?
Why did you choose this particular victim?
Have you ever done or considered doing this in the past? If so, where,
when, to whom?
What did you expect to happen as a result of your actions?
Did you consider not taking these actions?
What could have prevented you from taking these actions?
Would you have done the same thing if there was a police officer nearby at
the time of the crime?
Did you know you could get into trouble?
How did the police know that you did it?
How are you different now than you were at the time of the alleged crime?
TABLE 3.2 Examples of Questions for Defendant’s Denying Criminal

Allegations
How would someone go about engaging in these actions?

Why would someone do this?
What purpose would these actions serve?
How could a person benefit from doing this crime?
Would you ever engage in this type of behavior?
Is this crime wrong?
evaluations. Specifically, individuals being charged with a crime may be moti-

vated to malinger or feign symptoms of a mental illness, cognitive deficits,
or intellectual disability. It is recommended that malingering tests be used if
there is any question regarding the genuineness of symptoms. For example,
the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) is
an empirically supported screening measure of feigned psychiatric symptoms.
The M-FAST is one of several measures that assesses feigned symptoms, but
this test is very commonly used as a brief assessment. For a more in-depth
examination of feigning or after a positive M-FAST result, the Structured
Interview of Reported Symptoms, Second Edition (SIRS-2; Rogers, Sewell,
& Gillard, 2010) is recommended as it has been validated and supported by
empirical research (Rogers, 2008b). To examine the feigning of memory defi-
cits, the Test of Memory Malingering (TOMM; Tombaugh, 1996) could be
used. Although the TOMM is frequently used, there are other measures that
can assess feigned memory deficits (for a complete listing of these measures
please refer to Sweet, Condit, & Nelson, 2008).
Other types of testing that may be warranted include standardized intel-
ligence tests, such as the Wechsler Adult Intelligence Scale, Fourth Edition
(WAIS-IV; Wechsler, 2008), or a personality assessment. The use of the Min-
nesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF;
Ben-Porath & Tellegen, 2008) or the Personality Assessment Inventory (PAI;
Morey, 2007) would afford the evaluator an opportunity to examine the defen-
dant’s performance on validity scales that assess effort, exaggeration, and min-
imization, as well as to identify useful information about current symptoms
from the clinical scales. Packer (2009) summarized studies that found that
94% of forensic psychologists studied reported they used the MMPI, and 78%
reported using the WAIS in their evaluations. The use of psychological assess-
ments can be instrumental in hypothesis testing during criminal responsibility
evaluations, but some thought should be put into deciding which tests will be
useful. Like all forensic reports, as the written product of the evaluation could
be scrutinized in court, the use of any psychological test must be fully justified.
Writing the Report

The written product is arguably the most important aspect of any forensic
evaluation and may be the only opportunity an evaluator has to clearly piece
together the evidence and present his or her opinion. It is of utmost impor-
tance to include all relevant facts, even if a particular piece of information
contradicts the evaluator’s final conclusion. Including information that con-
tradicts the opinion, even if it could confuse the clinical picture, contributes to
the creation of an unbiased report.
The written product should begin with the defendant’s identifying informa-
tion, where and when the evaluation took place, and who ordered it. The fact
that the defendant was informed and signed (or refused to sign) a notification
of rights form should be clearly stated, and a list of all of the collateral sources
reviewed should be included. It may be useful to include the statute for the state
in which the criminal responsibility evaluation is taking place to clearly out-
line the framework that is being considered in the evaluation. Next, the relevant
historical information should be described, the mental status examination out-
lined, the results of any psychological tests that were administered explained,
and the diagnostic impressions provided. For the criminal responsibility sec-
tion, a detailed account of the crime should be included based on the police
report and other documents included in the discovery materials. This section
would also be where the defendant’s statement to the police is detailed and any
available witness statements are summarized. The defendant’s description of the
offense obtained during the evaluation should follow the official description of
the crime. The use of quotes can be a helpful way to illustrate how the defendant
described his or her perception of the events of the crime. After the defendant’s
account of events is described, the questions regarding how he or she was func-
tioning in the time period leading up to the crime should be outlined. Some
evaluators then choose to offer their opinion on the ultimate issue (i.e., if the
evaluator believes that the defendant was or was not criminally responsible at
the time of the crime), whereas other evaluators simply describe their evalua-
tion of the defendant and leave the ultimate issue decision to the trier of fact.
The decision to offer an opinion on the ultimate issue should be informed by
one’s practicing jurisdiction’s stance on this issue. For example, for evaluations
in federal courts, Rule 704(b) of the Federal Rules of Evidence (2013) states, “In
a criminal case, an expert witness must not state an opinion about whether the
defendant did or did not have a mental state or condition that constitutes an
element of the crime charged or of a defense. Those matters are for the trier of
fact alone” (pp. 15–16). Despite this prohibition on ultimate opinion testimony,
there are no bans against providing an ultimate opinion in a report. Likewise,
some state courts may not accept a report in which an ultimate opinion is not
offered. Although we acknowledge the debate on the ultimate issue within the
field of forensic mental health (Rogers & Ewing, 2003; Tillbrook, Mumley, &
Grisso, 2003), we propose that reports should contain this information and
allow the trier of fact to place appropriate weight on these opinions.
Regardless of whether or not an ultimate opinion is offered, the written report
should contain enough information that a judge or jury can make an informed
decision and for the reader to draw conclusions for each component of the
insanity standard used in that area. For example, in order to assess the defen-
dant’s appreciation of the nature and quality of the actions (cognitive prong), it
is important to include the defendant’s perception of the crime as well as all col-
lateral information regarding his or her actions during the alleged offense. To
assess the defendant’s appreciation of the wrongfulness of the offense, the evalu-
ator should ask questions that could uncover a delusional thought process, as
this might affect the perception of wrongfulness. In order to assess volition, the
evaluator should inquire about any attempts to engage in alternative actions, as
well as any previous feelings to compulsively engage in this (or similar) actions.
Case Vignette
The following case study is meant to highlight aspects of a criminal responsi-
bility evaluation, which incorporates standards of best practice, as previously
described. This case was created by the authors based on their professional expe-
riences and any likenesses to an actual case are purely coincidental. This case is
not meant to serve as a forensic report.
Reason for Referral

A criminal responsibility evaluation was requested for Mr. Doe by his defense
attorney. Mr. Doe was a 29-year-old Caucasian male who was arrested for first-
degree murder. He was being held at the county jail.
Sources of Information
Prior to evaluating Mr. Doe, available records were requested and reviewed,
including prior medical and psychiatric records, school records, employment
records, the police report and discovery materials for the crime, and records
from the jail where Mr. Doe was being held. Requests also were made to speak
with relevant family members who had regular contact with Mr. Doe.
Notification of Rights
Mr. Doe was evaluated by a forensic evaluator on two occasions for approxi-
mately 180 minutes, and again for an additional 60 minutes, at the county jail.
Prior to the evaluation, Mr. Doe was informed about the purpose of the evalu-
ation, the limits of confidentiality, who would be given copies of the report,
and the voluntary nature of his participation. Mr. Doe also read and signed a
consent form that reiterated this information. He agreed to proceed with this
evaluation.

The evaluation commenced with a brief clinical interview to glean perti-
nent information regarding Mr. Doe’s history. Mr. Doe was considered to
be a reliable but guarded historian. He described an average, unremarkable
development and upbringing. His mother noted that he had difficulty mak-
ing friends growing up and was “a loner.” He also earned average grades in
school and completed two years of college at a local university where he was
studying geology. He explained that he was walking to class one day when
he felt a gust of wind and knew he had “learned everything I would ever
need to know.” He stopped attending classes and eventually dropped out of
college. According to records from the university, he had difficulty concen-
trating in classes, and he would hand in assignments and tests with bizarre
responses. For example, he wrote illogical, tangential essays regarding “dark-
ness and evil.” Mr. Doe explained that when he dropped out of college, he
obtained an apartment and performed odd jobs before being employed as
a janitor at a movie theater. He described an unremarkable medical history
and denied ever being married or fathering any children. Mr. Doe admitted
drinking four beers every night for one year prior to the alleged offense but
denied experimenting with illicit substances or requiring substance abuse
treatment. With some reluctance, Mr. Doe reported receiving mental health
treatment in the community at the encouragement of his parents after drop-
ping out of school. He was prescribed psychiatric medications and diagnosed
with a mental illness but was unable to recall the names of his medications
or diagnosis. His mental health records support a diagnosis of Schizophrenia
and prior medications include a variety of typical and atypical antipsychotics
(e.g., Risperdal, Zyprexa, and Navane). Regarding a family history of men-
tal illness, Mr. Doe reported that his uncle is “crazy” and his grandmother
“had a nervous breakdown.” Mr. Doe denied ever being arrested prior to this
offense, which was confirmed by his criminal records.

During the evaluation, Mr. Doe appeared his stated age of 29. He was slightly
unkempt, as evidenced by his dirty fingernails and long, greasy hair; however, he
was not malodorous. As previously noted, Mr. Doe was guarded, but he coop-
erated throughout the evaluation, and he was considered to be a fairly reliable
historian. He made appropriate eye contact and seemed able to concentrate for
the majority of the evaluation. His psychomotor movements were unremark-
able, and he spoke at a normal rate and volume. There were times when Mr. Doe
seemed to lose track of the question, and he exhibited some word-finding dif-
ficulties. At the outset of this evaluation, he described his mood as “fine.” His
affect presented as flat. While at the county jail, Mr. Doe was prescribed Hal-
dol and Cogentin, which he took voluntarily; however, he lacked insight into
why he was prescribed these medications and how they help him. As previously
noted, Mr. Doe became noticeably more agitated and difficult to redirect when
discussing the events surrounding the crime. His speech was rapid and pres-
sured. He presented as agitated and intent on sharing his account of events. His
responses also were more tangential and much more difficult to follow.
Mr. Doe had some limitations in his fund of general knowledge. He was
able to identify the current president of the United States, but struggled to
list any factual current events as he maintained the only events on the eve-
ning news were the newscasters telling him about his neighbor’s evilness.
Mr. Doe’s immediate memory was intact, as he was able to immediately repeat
back three unrelated words. He had some impairment in his delayed mem-
ory (i.e., the ability to recall information that was previously presented), as
he was unable to recall any of the three words on his own. After being given
categorical prompts, he was able to recall all three words. Mr. Doe was able
to complete five serial seven subtractions, as well as correctly spell words for-
wards and backwards. These tasks were given to briefly assess his working
memory abilities. His abstract reasoning abilities were concrete and limited.
For example, when asked to interpret a common proverb (“the early bird gets
the worm”), Mr. Doe stated, “The birds have to get up, and they eat worms.” He
demonstrated adequate problem solving abilities, as evidenced by his simple
responses to commonplace problems. For example, he responded “yell and get
help” to what he would do if he saw a building on fire.
Mr. Doe’s Account of Events Related to the Alleged Offense

Approximately three months ago, Mr. Doe was working as a janitor at a movie
theater and saw his neighbor enter the theater. Shortly afterwards, Mr. Doe’s
boss called him into his office, and Mr. Doe was fired. Records from his
employer document a history of Mr. Doe coming to work late and missing
shifts and his employer receiving complaints that Mr. Doe followed customers
from the theater and into the parking lot. Mr. Doe reported that he had suspi-
cions that his neighbor was “evil” for a while, and seeing him when he lost his
job confirmed this belief in his mind.
Mr. Doe provided numerous examples of events and explanations for why
he was certain his neighbor was evil. Mr. Doe admitted that he began watching
his neighbor more carefully and documenting in his journal the negative
events he believed his neighbor was responsible for. One commonly docu-
mented event was that whenever Mr. Doe saw his neighbor, he would have
difficulty sleeping that night. Mr. Doe reported that he attributed his difficulty
sleeping to some of his neighbor’s evilness transferring to him whenever they
would pass one another. Mr. Doe also described seeing his neighbor pull into
the parking lot, get out of his car, and enter their apartment building. When
Mr. Doe went to start his car after witnessing his neighbor coming home, his
car would not start. Although Mr. Doe’s car battery was dead, he again attrib-
uted this event to his neighbor’s evilness. Mr. Doe also believed his neighbor
was evil because he drove a red truck. He started going through his neighbor’s
mail and found letters from addresses that contained the number “6,” which
he interpreted as communications with the devil. Mr. Doe detailed a variety of
other events and “signs” that were similar in nature.
Mr. Doe reported that this pattern of watching his neighbor and logging
events went on for approximately two months until he felt unbearably dis-
tressed by the torture his neighbor was inflicting upon him. As he became
more upset by the torture, his sleep impairments worsened. He also reported
that the newscasters on television would tell him how worthless he was, how
meaningless his life was, and how powerless he was to make his life better. He
explained that hearing these messages agitated him further and prompted him
to “take my life back.”
On the day of the crime, Mr. Doe reported he was unable to find his televi-
sion remote. He believed his evil neighbor was behind his missing television
remote to prevent him from hearing the newscasters’ messages to change his
life. At that time, Mr. Doe walked across the hall to his neighbor’s apartment
and knocked on the door. When his neighbor answered the door, Mr. Doe
repeatedly stabbed him while yelling for the “evil to end” and to “stop tor-
turing me.” He then moved the body inside his neighbor’s apartment, shut
the door, and returned to his own apartment. Mr. Doe proceeded to shower,
change his clothes, and place his bloodied clothes and knife in the dumpster.
According to police reports, neighbors heard Mr. Doe yelling while he stabbed
the neighbor. They called the police and identified Mr. Doe as the assailant.
He was arrested in his apartment. After a search warrant was executed for
Mr. Doe’s apartment, the journal in which he detailed every negative event he
attributed to his neighbor was found.
Although Mr. Doe’s presentation was consistent with genuine mental ill-
ness and malingering was not suspected, a Structured Interview of Reported
Symptoms, Second Edition (SIRS-2; Rogers et al., 2010) was administered
to ensure he was not feigning or over-exaggerating his symptoms. As previ-

ously explained, this measure is a structured interview designed to assess
whether someone is feigning psychological symptoms in a variety of ways,
such as exaggerating the severity of symptoms or endorsing very rare,
uncommon symptoms that are inconsistent with genuine mental illness. On
this measure, Mr. Doe responded selectively to symptomatic experiences.
His results on each subscale fell within the “Genuine” range of respond-
ing, which further supported the hypothesis that Mr. Doe was not feigning
symptoms of mental illness. There were no concerns regarding Mr. Doe’s
intellectual functioning based on his self-report, his presentation during
the evaluation, his mother’s report in a phone interview, and corroboration
from educational records. Mr. Doe was administered the PAI, which is a
self-report objective inventory of adult personality that assesses response
style, personality, and psychopathology (Morey, 2007). He produced a valid
PAI profile, which suggested he attended appropriately and consistently to
the test items. Mr. Doe’s responses on the PAI are consistent with individuals
who have reported unusual perceptual experiences, such as hallucinations,
confusion in their thinking, and delusional beliefs. He endorsed some ques-
tions associated with some alcohol use. These results are consistent with
Mr. Doe’s self-report and collateral sources (e.g., records, interview with
family members).
Clinical Summary
Mr. Doe lives in a jurisdiction governed by the M’Naghten standard. This stan-
dard states that a defendant should be found not guilty by reason of insanity
if, at the time of the alleged offense, he was suffering from a mental disease or
defect that prevented him from knowing the nature and quality of his actions
or, if he did have this knowledge, he was unaware that his actions were wrong.
Based on his account of events, Mr. Doe knew that he was stabbing his neigh-
bor with a knife (knowledge about the nature of his actions) and that stabbing
his neighbor repeatedly would kill him (knowledge about the quality of his
actions). Because he believed that killing his neighbor would stop the “torture”
and suffering, he seemed to know the quality of his actions.
The issue in Mr. Doe’s case centers around whether, as a result of a men-
tal disease or defect, he was unable to appreciate that what he was doing was
wrong. His actions of moving the body inside his neighbor’s apartment and
closing the apartment door, as well as showering and disposing of the blood-
ied clothes and knife, suggest that Mr. Doe knew his actions were wrong and
made an effort to hide what he had done. His journal and some of his neigh-
bor’s stolen mail also were found in a drawer with a false bottom in Mr. Doe’s
nightstand.
There are also reasons to suggest that Mr. Doe did not understand that what
he was doing was wrong because of his mental disease or defect. He has a
well-documented history of schizophrenia, and although he was prescribed
psychiatric medications, he had not taken them in more than four months. An
interview with Mr. Doe’s mother reported that over the last few months her
son had become increasingly withdrawn and paranoid. He frequently spoke
about the “evil all around him.” Mr. Doe’s journal also documented a long-
standing belief that his neighbor was evil and torturing him. The journal con-
tained rambling writings from Mr. Doe that he believed he would be killed
by his neighbor if he did not do something to “get control” over his life soon.
Based on his verbalizations during the murder, Mr. Doe believed that he was
freeing himself from torture by killing his evil neighbor.
Questions to Consider When Formulating an Opinion

Because of the complex and challenging nature of criminal responsibility eval-
uations, the following questions in Table 3.3 can be helpful to consider when
formulating an opinion. This is not meant to be an exhaustive list and ques-
tions will vary depending on the specific facts of the case.
In addition to these questions, Rogers (1987) has five points to be consid-
ered when evaluating volitional components of the insanity defense. These
include a capacity to make choices, a capacity for delay, a regard for apprehen-
sion, foreseeability, and avoidability.1

A good criminal responsibility evaluation is one that avoids several common
pitfalls. NGRI is not based on the presence of a mental illness alone. That is,
simply having a psychotic spectrum diagnosis does not automatically suggest
that the individual is NGRI (Miller, 2013). Indeed, one study reported that
individuals who had been adjudicated sane and not NGRI obtained higher
scores on the clinical scales of the MMPI-2 than did those adjudicated NGRI
(Rogers & McKee, 1995). Rogers’s (2008b) review of relevant literature led him
to conclude that elevations on the MMPI family of instruments are not auto-
matically more indicative of being NGRI. Of course, criminal responsibility
evaluations in which an opinion of nonresponsibility is rendered must pro-
vide an explicit connection between the mental illness and the alleged crimi-
nal behavior. To that end, the MMPI-2 and other multiscale inventories are
incapable of making this explicit connection.
Another pitfall to avoid is accepting the defendant’s account of the alleged
offense as complete and accurate and not requesting or reviewing collateral
data that could be contradictory to the defendant’s self-report. It is possible
TABLE 3.3 Examples of Questions to Consider When Formulating an
Opinion
Possible Questions
Cognitive Prong
Was the defendant mentally ill at the time of the alleged offense?
What is the nature and severity of this individual’s mental illness?
At the time of the alleged offense, was the defendant receiving treatment?
If so, was he compliant with the treatment?
Is there evidence that treatment was effective or ineffective in managing
symptoms of mental illness?
Was the defendant abusing substances at or around the time of the offense?
If so, what substance(s)? How much? How frequently?
If the defendant was mentally ill at the time of the offense, how did the
illness directly impact his ability or inability to differentiate right from
wrong? Be specific and identify clear links (if any exist) between his
mental illness and psycholegal deficits.
Was there planning and preparation involved in the act?
If so, how much?
Were there steps taken to destroy or hide evidence?
If so, what were they?
Were there measures taken to avoid apprehension?
If so, what were they?
What is the defendant’s history with the victim?
Was it a random victim or were they known to one another?
Is there a clearly identified motive for the crime?
What was the defendant’s stated explanation for the alleged offense?
What is the defendant’s current understanding of the wrongfulness of the
alleged offense?
An evaluator should always consider potential issues regarding response
style (e.g., malingering). Was there any evidence the defendant was
malingering regarding clinical presentation related to the alleged offense?
Volitional Prong*
If the defendant was mentally ill at the time of the offense, how did the
illness directly impact his ability or inability to conform his actions as
required by the law? (Be specific and identify clear links [if any exist]
between his mental illness and psycholegal deficits.)
What evidence is there for impulsivity?
What is the evidence for planning?
Why was the crime committed at this particular time? Why now?
Were there times when this impulse was successfully resisted?
Were there steps taken to destroy or hide evidence? If so, what were they?
Were there measures taken to avoid apprehension? If so, what were they?
*In jurisdictions that have a volitional prong, additional questions should be considered. There
will be overlap between the questions considered, such as the need for assessing for the
presence or absence of mental illness.
that defendants may attempt to feign or exaggerate symptoms or problems,

while other defendants may minimize or deny problems in order to appear
healthier than they were at the time of the alleged offense. Collateral records
and interviews with other people can help to identify this discrepancy. Addi-
tionally, making an overreaching conclusion that goes beyond what the data is
suggesting is to be avoided.
Finally, a good forensic report should be extremely thorough. As indicated
above, criminal responsibility evaluations should consist of hypothesis test-
ing and evaluators should have their clinical opinions firmly rooted in the
data obtained. Moreover, the report should not reflect the evaluator’s personal
opinions but should include only professional opinions rooted in the scientific
method. Including data in the written product, even data that contradicts the
evaluator’s opinion, is of the utmost importance.
Conclusion
As previously explained, when conducting a criminal responsibility evalua-
tion, it is necessary to know what standard of insanity governs the jurisdic-
tion in which the evaluation is being completed. The evaluation should clearly
present the available evidence both supporting and refuting components of
that standard used to evaluate an insanity defense. The report should pres-
ent this information and clearly guide readers through the evaluators’ thought
process and reasoning. It is important for an evaluator to be aware of the leg-
islative requirements and his or her own professional stance on providing an
ultimate issue opinion in criminal responsibility evaluations. The final report
should be in compliance with these standards.
Note
1. An ultimate opinion is not being provided in Mr. Doe’s case to allow the reader an
opportunity to independently think through the information provided, establish their own
opinion, and identify how they reached that opinion and rejected the alternative hypothesis.
References
Bartol, C. R., & Bartol, A. M. (2015). Psychology and law: Research and practice. Thousand
Oaks, CA: Sage.
Ben-Porath, Y., & Tellegen, A. (2008). MMPI-2-RF (Minnesota Multiphasic Personality
Inventory-2 Restructured Form): Manual for administration, scoring, and interpretation.
Minneapolis: University of Minnesota Press.
Clark v. Arizona, 548 U.S. 735, 126 S. Ct. 2709, 165 L. Ed. 2d 842 (2006).
Delling v. Idaho, 133 S. Ct. 504 (U.S. 2012).
Durham v. U.S., 214, F.2d 862 (1954).
Federal Rules of Evidence. (2013). Washington: DC: Lexis-Nexis Group.
Finger v. State, 27 P.3d 66, 117 Nev. 548 (2001).

Insanity Defense Reform Act of 1984, 18 U.S.C. §17.
Melton, G. B., Petrila, J., Poythress, N. G., & Slobogin, C. (2007). Psychological evaluations
for the courts: A handbook for mental health professionals and lawyers (3rd ed.). New
Meyer, R. G., & Weaver, C. M. (2006). Law and mental health: A case-based approach. New
York, NY: The Guilford Press.
Miller, H. (2001). Miller Forensic Assessment of Symptoms Test manual. Odessa, FL: Psycho-
logical Assessment Resources.
Miller, L. (2013). Psychological evaluations in the criminal justice system: Basic principles
and best practices. Aggression and Violent Behavior, 18, 83–91.
M’Naghten case, 8 English Reporter 718 (1843).
Morey, L. C. (2007). Professional manual for the Personality Assessment Inventory (2nd ed.).
Lutz, FL: Psychological Assessment Resources.
Packer, I. K. (1987). Homicide and the insanity defense. A comparison of sane and insane
murderers. Behavioral Sciences & the Law, 5, 25–35.
Packer, I. K. (2009). Evaluation of criminal responsibility. New York, NY: Oxford University
Press.
Rex v. Arnold, 16 Howell’s State Trials 684 (1723).
Robinson, D. J. (2008). The mental status exam explained (2nd ed.). Port Huron, MI: Rapid
Psychler Press.
Roesch, R., Zapf, P., & Hart, S. D. (2010). Forensic psychology and law. Hoboken, NJ: Wiley.
Rogers, R. (2003). The prohibition on ultimate opinions: A misguided enterprise. The Jour-
nal of Forensic Psychology Practice, 3(3), 65–75.
Rogers, R. (2008a). Insanity evaluations. In R. A. Jackson (Ed.), Learning forensic assessment
(pp. 109–128). New York, NY: Taylor & Francis Group.
Rogers, R. (2008b). Structured interviews and dissimulation. In R. Rogers (Ed.), Clinical
assessment of malingering and deception (pp. 301–322). New York, NY: The Guilford
Press.
Rogers, R., & Ewing, C. P. (1987). The APA position on the insanity defense: Empiricism vs.
emotionalism. American Psychologist, 42, 840–848.
Rogers, R., & McKee, G. R. (1995). Use of the MMPI-2 in the assessment of criminal respon-
sibility. In Y. S. Ben-Porath, J. R. Graham, G. C. Hall, R. D. Hirschman, & M. S. Zaragoza
(Eds.), Forensic applications of the MMPI-2 (pp. 103–126). Newbury Park, CA: Sage.
Rogers, R., Sewell, K. W., & Gillard, N. D. (2010). Structured Interview of Reported Symp-
toms, (2nd ed.): Professional manual. Lutz, FL: Psychological Assessment Resources.
Sweet, J. J., Condit, D. C., & Nelson, N. W. (2008). Feigned amnesia and memory loss. In
R. Rogers (Ed.), Clinical assessment of malingering and deception (pp. 218–236). New
York, NY: The Guilford Press.
Tillbrook, C., Mumley, D., & Grisso, T. (2003). Avoiding expert opinions on the ultimate
legal question: The case for integrity. Journal of Forensic Psychology Practice, 3(3), 77–87.
Tombaugh, T. (1996). Test of Memory Malingering (TOMM). New York, NY: Multi Health
Systems.
United States v. Brawner, 471 F.2d 969 (D.C. Cir. 1972).
Wechsler, D. (2008). Wechsler Adult Intelligence Scale, Fourth Edition. San Antonio, TX:
Pearson.
4
Capital Case Sentencing

Evaluations
Samuel Witta Dworkin and Steve K. D. Eichel
In capital cases, a defendant faces criminal charges that could result in a death
sentence (i.e., capital punishment). These are the most serious types of crimi-
nal cases in that the ultimate loss of one life rests in the outcome of a complex
justice system. The defendant, defense counsel, prosecutors, judges, jurors,
victims, experts, media, and others all have a role in this process. This chapter
will focus on the role of the forensic evaluator in cases of capital sentencing,
highlighting the work as part of an interdisciplinary team with mitigation spe-
cialists and defense counsel.
There are numerous types of evaluations that call for experienced and
skilled forensic psychologists, clinicians, and practitioners in the realm of
capital cases. Atkins evaluations, which are geared toward determining a
defendant’s level of intellectual disability (formerly mental retardation), are
quite common. Evaluators conduct competency evaluations on defendants to
ascertain their ability to understand the proceedings and assist their counsel
or ascertain whether the defendants demonstrate the necessary competency
to be executed. Violence risk assessments are also common in capital cases.
This chapter will focus on capital sentencing evaluations, which are con-
ducted, not to determine why the defendant carried out the crime or the
offense for which he or she has been charged but to provide the defense team
with biopsychosocial life history evidence of the defendant that could dem-
onstrate a lower level of moral culpability and support life imprisonment as
an alternative to a death sentence. The question of “why” the crime occurred
is often a guilt/innocence phase issue, whereas answering “how” the defen-
dant got to be in this particular place in life is most applicable in the sentenc-
ing phase of trial. It is the forensic evaluator’s responsibility to work with the
defense team to craft a narrative that persuades the jury on how the defen-
dant’s history, character, and life circumstances affected the trajectory of his
or her behavior. In capital sentencing, the forensic evaluator must develop a

complete, nuanced, and intimate understanding of the defendant to assist the
defense team in presenting the full picture of the defendant to the sentencer. In
this chapter, we will discuss relevant case law, applicable literature, and guiding
beliefs regarding best practices for conducting capital sentencing evaluations.
We will also outline a case vignette to demonstrate in real-life terms how these
evaluations are conducted.
Relevant Case Law

In order to understand the full scope and nature of the proceedings in a capi-
tal case, one must first understand the background and history of the death
penalty in the United States. Capital punishment has roots in the United States
dating back to its early colonization. As explained by Stuart Banner, early
colonialists enacted capital punishment laws for a host of crimes, including
blasphemy, property crimes, and others (Banner, 2002). Throughout the eigh-
teenth and nineteenth centuries, capital punishment was used largely in rac-
ism and oppression, evolving in its scope of offense and offender, but taking
full aim at the minority populations of the United States. In 1972, the United
States Supreme Court struck down the death penalty in Furman v. Georgia,
creating a moratorium on capital punishment. The court concluded that the
imposition of the death penalty was in fact cruel and unusual punishment
in that it violated the Eighth and Fourteenth Amendments. In a review of
the arbitrariness of the state’s statutes, the capital scheme on the whole was
found unconstitutional. Justice Douglas stated, “These discretionary statutes
are unconstitutional in their operation. They are pregnant with discrimination
and discrimination is an ingredient not compatible with the idea of equal pro-
tection of the laws.” Furman v. Georgia provided what might be the most guid-
ing principle in capital case litigation and guidance: death is different. “Death
is a unique punishment,” “Death . . . is in a class by itself,” the “penalty of death
differs from all other forms of capital punishment, not in degree but in kind”
(Furman v. Georgia, 1972).
In 1976, however, in Gregg v. Georgia, the U.S. Supreme Court reinstituted
the imposition of the death penalty and “provided the states with clarification
on the distinction between constitutional and unconstitutional death penalty
statutory schemes” (DeMatteo, Murrie, Anumba, & Keesler, 2011). Since the
moratorium on capital punishment has been lifted, though, there has been
a continued reexamination of statutes and related issues. Efforts to narrow
the imposition and application of the death penalty are seen in decisions like
Atkins v. Virginia in 2002 (making it unconstitutional to execute the mentally
retarded), Roper v. Simmons in 2005 (disallowing the imposition of death for
juveniles under the age of 18 when the offense was committed), and Kennedy
Capital Sentencing Evaluations 57
v. Louisiana in 2008 (barring the death penalty for the rape of a child in which
the child did not die).
Notable case law exists for the purposes of capital sentencing evaluations,
and this case law is illustrated in the emergence of opinions emphasizing
individualized sentencing and the duty to investigate, uncover, and develop
mitigation. In 1975, the U.S. Supreme Court struck down North Carolina’s
statutes of mandatory death sentences for all convicted first-degree murderers.
It stated in a 5–4 decision:
Death, in its finality, differs more from life imprisonment than a 100-year
prison term differs from one of only a year or two. Because of that qualitative
difference, there is a corresponding difference in the need for reliability in
the determination that death is the appropriate punishment in a specific case.
Here we see two interesting points. The court uses language that recognizes
not only the finality of death but also the “need for reliability in the determina-
tion” of the sentence. This is the beginning of the recognition of heightened
scrutiny in sentencing determinations. While not directly stated, this opin-
ion expounds on the importance of expert assistance and evaluations in sen-
tencing. The second component to the decision is the notation of what is “the
appropriate punishment in a specific case.” This is illustrative of the need for
the individualized assessment model on which capital case forensic evalua-
tions are based.
In 1978, The U.S. Supreme Court also held in Lockett v. Ohio that Ohio’s
capital sentencing scheme was unconstitutional:
The Ohio death penalty statute does not permit the type of individualized
consideration of mitigating factors we now hold to be required by the Eighth
and Fourteenth Amendments in capital cases. . . . The limited range of miti-
gating circumstances which may be considered by the sentencer under the
Ohio statute is incompatible with the Eighth and Fourteenth Amendments.
To meet constitutional requirements, a death penalty statute must not pre-
clude consideration of relevant mitigating factors.
Again, we are seeing the emergence of emphasis not only on mitigation in

sentencing but also on individualized consideration. This sets up the basis for
the need of forensic psychologists, psychiatrists, and practitioners to do capital
sentencing evaluations.
In an ineffective assistance-of-counsel claim in 2003, the U.S. Supreme
Court held that Wiggins’s attorneys “fell short of the professional standards”
and that “the scope of their investigation was also unreasonable” given that
“the mitigating evidence counsel failed to discover and present in this case
is powerful” (Wiggins v. Smith, 2003, p. 22). In Rompilla v. Beard (2005), the

court also emphasized the importance of defense efforts in investigating miti-
gation, holding “that even when a capital defendant’s family members and the
defendant himself have suggested that no mitigating evidence is available, his
lawyer is bound to make reasonable efforts to obtain and review material that
counsel knows the prosecution will probably rely on as evidence of aggrava-
tion at the sentencing phase of trial” (p. 18).
Review of Literature
Given the variety of standards and regulations surrounding capital sentenc-
ing evaluations, and the complexities involved in death penalty litigation in
general, it is essential for the forensic evaluator to be familiar with the statutes
governing his or her practicing jurisdiction(s). Aside from the aforementioned
case law, which outlines the necessity and constitutionality of individualized
mental health and mitigation assessments for capital defendants, additional
legal and nonlegal binding literature exists to support the need for, and impor-
tance of, these forensic evaluations.
State courts, federal jurisdictions, and military commissions all employ dif-
ferent language when outlining the complexity of the capital defense team and
its roles. However, it is accepted that the defendant is entitled and required
to have a mitigation investigation take place, and to have the assistance of a
qualified and competent forensic evaluator to assist in the sentencing evalu-
ation. For example, in Virginia, statute §19.2-264.3:1 outlines the defendant’s
statutory right to a forensic sentencing evaluator:
Expert Assistance when defendant’s mental condition relevant to capital sen-

tencing: the court shall appoint one or more qualified mental health experts
to evaluate the defendant and to assist the defense in the preparation and
presentation of information concerning the defendant’s history, character, or
mental condition, including (i) whether the defendant acted under extreme
mental or emotional disturbance at the time of the offense; (ii) whether
the capacity of the defendant to appreciate the criminality of his conduct
or to conform his conduct to the requirements of the law was significantly
impaired at the time of the offense; and (iii) whether there are any other fac-
tors in mitigation relating to the history or character of the defendant or the
defendant's mental condition at the time of the offense. (emphasis added)
The American Bar Association (ABA) also sets forth standards of care and
competence for defense counsel in capital cases. Guidelines 4.1 and 10.4 of
the 2003 ABA Guidelines lay out the minimum requirements for the defense
team composition. It states that, among the qualified counsel, an investigator,
and a mitigation specialist, there must also be “at least one member qualified
by training and experience to screen individuals for the presence of mental or

psychological disorders or impairments”.
Just as the legal team is bound by guidelines and principles, so too is the
forensic evaluator/examiner. Familiarization with the latest America Psychol-
ogy Association (APA) guidelines is a must, specifically the 2013 “Specialty
Guidelines for Forensic Psychology.” Developed by the American Psychology-
Law Society and the American Academy of Forensic Psychology, these guide-
lines lay out several areas of importance for the evaluator. Areas of particular
importance in capital sentencing evaluations include, but are not limited to,
Knowledge of the Scientific Foundation for Opinions and Testimony (Guide-
line 2.05), Appreciation of Individual and Group Differences (Guideline 2.08),
Communication with Collateral Sources of Information (Guideline 6.04),
Focus on Legally Relevant Factors (Guideline 10.01), and others.
Best Practices
The forensic evaluator’s goal is not to do a results-oriented evaluation. This may
be difficult when the defense team has identified the evaluator as the expert of
choice and has had him or her appointed with an understanding of the specific
hypothesis the defense wants confirmed. Although it is unethical to conduct
a “defense team hypothesis-confirmation evaluation,” it is completely reason-
able to have those hypotheses on a short list. In fact, it would be unreasonable
to discount and discard the defense team’s thoughts completely. It is the role
of the mitigation specialist and defense team to supply the practitioner with
interviews, records, and data points that will be considered. These are the same
data points that have led the defense team to its hypothesis (or hypotheses) as
well. It is important for the evaluator to conduct the capital sentencing evalu-
ation with an open mind but also be bound by the scope of the referral ques-
tion, the applicable case law and statutes, and the confines and requirements
of his or her appointment.
For example, in looking back at Virginia’s statute authorizing appointment
of a forensic sentencing evaluator in capital cases (§19.2-264.3:1), note the lan-
guage “to evaluate the defendant and to assist the defense in the preparation and
presentation of information concerning the defendant's history, character, or
mental condition.” Here it is clear that the evaluator is not just to do testing and
an independent evaluation but is to work with the defense team, assisting in the
preparation and presentation of mitigation and sentencing information. Again,
this does not give the evaluator carte blanche to abandon principles of objectiv-
ity and independence. However, the language seeks to inform the evaluator that
he or she is a member of the defense team, tasked with assisting them, working
on behalf of the defendant and for the betterment of that defendant’s sentencing.
It should also be noted that the forensic sentencing evaluator is to conduct
a culturally competent evaluation. This means not only finding an evaluator
who ideally speaks the same language as the defendant but also screening for
culturally appropriate and applicable mental health disorders, as well as using
appropriately normed tests and evaluation materials.
As noted previously, there are many types of forensic evaluations that can take
place in a capital death penalty case. This chapter looks at what goes into conduct-
ing a capital sentencing evaluation and examines the interdisciplinary approach
and skill sets required for this type of evaluation. The first half of the case vignette
tracks the efforts and methods of the mitigation specialist in a capital case. The
second half of the case vignette tracks the efforts of the forensic evaluator.
First, the mitigation specialist works to develop trust and rapport for the
purposes of conducting a social history investigation. This involves gathering
background information about the defendant that guides the investigation.
The mitigation specialist is then informed where to go to collect records and
collateral witness interviews. This process includes, but is not limited to, inter-
viewing the defendant, friends, family, teachers, employers, medical personnel,
and many others, as well as obtaining records of all aspects of the defendant’s
life (see the 2008 ABA Supplementary Guidelines for the Mitigation Function of
Defense Teams in Death Penalty Cases). While utilizing his or her mental health
training and knowledge, the mitigation specialist screens for potential disor-
ders, symptoms of mental illness, neurological impairments, and other factors
that would aid the defense team in making an appropriate selection of a foren-
sic evaluator (see Guideline 10.11E of the 2008 ABA Supplemental Guidelines).
There can be several factors to consider when choosing a forensic capital
sentencing evaluator. Most notable would be the local state statutory require-
ments and guiding principles outlined above by the ABA. Evaluators can have
specialties such as a background in neuropsychology, a focus on adolescent
development and attachment, some foundational work in pharmacology, or
a focus on traumatic brain injuries (TBI). The capital sentencing evaluator
works in consultation with the defense team, engaging in interviewing strate-
gies, reviewing collateral source information received from the mitigation spe-
cialist and defense team, testing (intelligence, neuropsychology, etc.), report
writing, and possible testimony. The evaluator will conduct mental status
examinations, potential psychological tests and measures, and ultimately may
be asked for his or her clinical summary and opinion.
Case Vignette
The following case narrative is not based on any one specific case on the whole;
rather, it incorporates a combination of real-life scenarios and fact patterns
not uncommon to capital defense.
Reason for Referral

Jason Smith was a 21-year-old white male from rural Pennsylvania. He was the
younger child, born to unwed parents who separated after his birth. Mr. Smith
had an older half brother. He has lived in Pennsylvania all of his life, although
never in one permanent residence for more than a couple of years. Mr. Smith
had, at times, lived with his biological father, but he spent the majority of his
time with his mother and stepfather. He did not complete high school, and at
the time of the instant offense was working for a construction company as a
laborer.
Mr. Smith allegedly murdered his girlfriend Clare, who was eight months
pregnant at the time. Mr. Smith called the police himself, and he was appre-
hended presumably only hours after the victims’ deaths. He was being held at
the local county jail, and he has been appointed capital-qualified counsel and
resources, including a mitigation specialist. He was facing the death penalty, as
he had been charged capitally under Pennsylvania’s Title 18, Part I, Ch. 11, Sec.
1102 and Title 42, Part VIII, Ch. 97, Sec. 9711(d) for the first-degree killing in
which the victim was in her third trimester of pregnancy.
RE: Mitigation Specialist: Meeting Defendant and Developing Trust and Rap-
port. During the first meeting with Mr. Smith, the mitigation specialist’s goal was to
build trust and rapport. The defendant was asked whether he likes the name “Jason”
or goes by any nickname. The instant offense was not discussed; rather Mr. Smith
was engaged in conversation and dialogue about his well-being and status. Had he
been able to call family? Was he eating? Are there any immediate problems (other
than his current incarceration) that needed to be addressed? It was important that
Mr. Smith understood and began to see, through the mitigation specialist’s words
and actions, that he or she cared given the circumstances. While it was not known
for sure, it was a distinct possibility that Mr. Smith had not had consistent caring
relationships throughout his life. It was necessary to model positive behaviors and
thoughtfulness of action to Mr. Smith in order to develop trust and rapport.
In the first couple of meetings, the mitigation specialist spent a good deal of
his time with Mr. Smith engaging in conversation, wherever it was to lead. It was
important not to go into the meeting with a checklist of questions, a recorder, or
laptop. It was thought that taking copious notes during the interview would break
up the flow and authenticity of getting to know Mr. Smith, as well as prevent
him from getting to know a valuable member of his legal defense team. A laptop
or note pad creates a barrier that hinders conversation. It was likely Mr. Smith
had already sat in a similar room at the police station upon arrest, with police
officers questioning him—legal pads out and recorders on—and reviewing the
alleged offense in great detail. The goal was for the mitigation specialist to dis-
tinguish himself from that experience with law enforcement in Mr. Smith’s mind
and allow him to appreciate the nature in which they would be working with him
as part of his defense team. One must still type up notes from the conversation
immediately after interviews and disseminate them to the defense team. Keeping
an accurate record of conversations and interviews is extremely important, as
well as keeping the entire defense team informed of progress throughout the
course of the interviews. Rapport is a must, but equally important is document-
ing the interviews and information gleaned from the defendant.

RE: Mitigation Specialist. Trust and rapport did not happen overnight. Nor does
it happen the next week. It was a constantly worked-on and sought-after goal,
requiring honest and genuine dialogue with Mr. Smith. Along the way, and once
established, the mitigation specialist can begin to obtain biographical and social
history information. This information provides the building blocks for the miti-
gation investigation. It helps the mitigation specialist determine whom to speak
with, where to obtain records, and other avenues for investigation.
Mr. Smith revealed that he did not graduate high school and dropped out
after his junior year. He did not do well overall academically, and he recalled
being in special education classes for a period of years in one middle school
leading into high school. Mr. Smith reported that he played football for his
middle school and high school teams but still felt that he did not fit into any
one particular peer group. He thought this may be due to the fact that he
and his mother moved a significant number of times during his childhood.
Mr. Smith attended two elementary schools, three middle schools, and two
different high schools before he ultimately dropped out. While Mr. Smith did
not disclose specific instances or recollections of bullying by his peers, he elu-
sively stated he did not get along with his peer group in school and mentioned
some “behavioral issues” on his part.
Mr. Smith could not recall all the various addresses at which he has lived
over the years. He liked some areas better than others and stated that this was
mainly due to availability of other kids his age. While he never made any long-
lasting friendships, there were several individuals he recalled by name as hav-
ing played with and enjoyed.
Growing up, Mr. Smith remembered not having a father figure. His bio-
logical father was no longer with his mother and was living across the state.
Mr. Smith stated that he did not know his father until the past five or six years.
His mother had many boyfriends while he was growing up. He named two in
particular, but said the majority of her boyfriends did not talk to or associate
with him. He recalled that one of his mother’s boyfriends was physically and
emotionally abusive to her and him. This boyfriend locked Mr. Smith out of
the house when angry. Mr. Smith would get back in after the boyfriend passed
out. This boyfriend would beat Mr. Smith with a belt and extension cord, espe-
cially when he was intoxicated. On several occasions, Mr. Smith watched as
the boyfriend hit and punched his mother. Mr. Smith cried and shook as he
recalled this information.
During visitations with the mitigation specialist, Mr. Smith was asked
about any scars or tattoos on his body. He did not have any tattoos, but he
had several scars. During these conversations, he did not address one scar,
but the mitigation specialist noticed it on his left wrist and made a mental
note to discuss it later and be aware of a possible suicide attempt in his past.
Mr. Smith detailed other scars on his body, speaking about injuries he sus-
tained in various levels of detail. He recalled some of the hospitals and clinics
at which he was treated, but he did not remember all of them, let alone all of
his scars’ origins.
Mr. Smith stated that he had had several jobs over the years. He worked at a
movie theater as an usher, which lasted six months until he quit “just because.”
He then worked at an ice cream store that was part of a chain with locations in
the towns he moved to, so he was able to transfer employment during his relo-
cations. Mr. Smith recalled really enjoying this work. “I liked the place. It was
quiet and I could just be,” he said. After dropping out of high school, there was
a gap in his employment as he moved out of his mother’s home to live with his
father. He returned to the area though and obtained employment with a local
construction company, helping as a runner and with trash removal.
Mr. Smith left to live with his father after an altercation with his mother
that resulted in the police being called. Both parties were found to be at fault
in the disturbance, and since they were family, the police did not charge either
of them that night. Mr. Smith reported that he did not have a real relationship
with his father prior to moving in with him, although they had written to each
other occasionally over the years. He stated that his father was very guarded
and seemed like a “loner.” He was often inebriated. His father was not work-
ing, and Mr. Smith believed his father received a living income from military
service due to disability, although Mr. Smith could not articulate the specifics
of the disability. While he enjoyed the quiet at his father’s residence, his often-
odd behavior and mannerisms were reasons Mr. Smith decided to move back
with his mother.
Upon arriving back at his mother’s home, Mr. Smith found work at a con-
struction company. There he met Clare, an administrative assistant with the
company. The two interacted infrequently but started to develop an attraction
and friendship. Mr. Smith reported that this turned into a romantic relation-
ship very quickly and he became very close to her. As she was the victim in the
case, Mr. Smith had a hard time talking, in general, about his feelings for Clare.
It became clear that she meant a great deal to him, even if the allegations of the
instant offense were true. He reported periods during which she attempted to
end the relationship, but they always got back together. Clare became pregnant
with Mr. Smith’s child and, for the first few months of the pregnancy, they
stayed together. After the third month of pregnancy, Clare decided she did not
want to be with Mr. Smith and spent the next several months trying to end the
relationship.
Relevant Records
Investigation of Collateral Sources RE: Mitigation Specialist. During the
months that the mitigation specialist and Mr. Smith were visiting and speaking, the
mitigation specialist also attempted follow up with collateral sources. He tried to
obtain all of the defendant’s records (e.g., birth, medical, educational, employment,
psychological, and financial) and to speak with everyone who crossed paths with
Mr. Smith (e.g., teachers, coworkers, friends, family, therapists, doctors, neighbors,
supervisors, counselors, and coaches). This parallel investigation was ongoing and
multigenerational. Information obtained from Mr. Smith’s parents, grandparents,
extended family, and others were as crucial to the case as his records. It is widely
known and accepted that that an individual’s mental health problems and disorders
can have genetic components, so delving into these avenues of exploration were also
a critical aspect of the mitigation and sentencing investigation. A brief example
of witness meetings and record gathering is illustrated below. These examples are
provided as means of illustration but are in no way an exhaustive list of the types
or number of interviews and records requested.
Mr. Smith’s various and multiple school records indicated that he had an
individualized education plan (IEP). Records revealed the reason he was
referred, counselors he met with, courses he took, and teachers’ names. It was
imperative that the mitigation specialist meet and speak with all parties men-
tioned, not only to learn about Mr. Smith, gain insight, and more fully appreci-
ate the complete contextual framework, but to also obtain any records those
individuals might possess that were not included in the schools’ files.
The school records included the name of a private psychologist to whom
Mr. Smith was referred. The psychologist was contacted and provided with
an authorization to release and disclose information. She then agreed to meet
and gave the mitigation specialist access to her file, which contained handwrit-
ten notes from individual counseling and therapy sessions. The file revealed
a potential diagnosis of Posttraumatic Stress Disorder (PTSD); notations
included the psychologist’s observations of intrusive thoughts and flashbacks,
nervousness and concentration problems, efforts to block out thoughts by
banging his head, and other symptomology consistent with PTSD criteria. She
noted that Mr. Smith confided in her many of his thoughts and distresses due
to the abuse he suffered and witnessed in his mother’s home. It became evident
that his behavioral problems at school were possibly due to Mr. Smith’s under-
lying mental health problems.
After seeing a notation mentioning the name of one of Mr. Smith’s high
school football coaches, a meeting was scheduled. The coach recalled Mr. Smith,
saying that “while football is a team sport, [Mr. Smith] just couldn’t mesh with
the rest of the guys.” He explained that Mr. Smith played his position fairly well
but did not interact much with the rest of his teammates on or off the field. The
coach described Mr. Smith as a “loner.” The coach also recalled that Mr. Smith
seemed more prone to concussions, as he had approximately three his first year,
and another two the following year.
A canvass was done at the various addresses where Mr. Smith lived while
growing up. At one such address, a neighbor recalled that she was friends with
Mr. Smith’s mother. This was the address where his mother lived while preg-
nant with Mr. Smith until he was approximately 3 years of age. This neighbor
liked Mr. Smith and his mother; however, the neighbor distinctly recalled see-
ing Mr. Smith’s mother drinking alcohol and smoking marijuana while she
was pregnant with Mr. Smith. The neighbor recalled mentioning the impor-
tance of not drinking or using drugs during pregnancy, but indicated that this
did not deter Ms. Smith from drinking alcohol.
Records were requested from the hospitals and clinics that were in the
vicinity of Mr. Smith’s various home residences. Records from one such hos-
pital revealed the nature and cause of the scar on Mr. Smith’s wrist. Approxi-
mately two months prior to the instant offense, Mr. Smith was brought in to
the hospital for a laceration to his left wrist. While he denied any homicidal or
suicidal ideation at the time, the examining nurse practitioner noted “possible
superficial suicide attempt” in the record. Medical records were also collected
from other institutions, which revealed that Mr. Smith had been referred to
child protective services for bruising.
A visit with Mr. Smith’s older half brother, Mr. Tom Smith, provided addi-
tional insight and corroboration into a potential mitigation theory involving
Fetal Alcohol Syndrome (FAS). Tom reported that he had an official diagnosis
of FAS due to his mother’s drinking during pregnancy and that he suspected
she drank while pregnant with Mr. Smith as well. Tom did not grow up with
his brother, as his biological father removed him from his mother’s care and
terminated her parental rights when he was an infant. Tom could not recall
the specifics of his mother’s care but believed that it was severely lacking, and
he reported being thankful to have “escaped that situation when young.”
Identification of Forensic Evaluator RE: Mitigation Specialist. After

getting to know the defendant and starting to gather a good sense of themes
and information that might be pertinent in the sentencing phase, it was time to
obtain a forensic evaluator to be appointed to the team. As noted previously in
the chapter, this practitioner must be well versed in forensic evaluations and have
the ability to assist the defense team in developing mitigation and sentencing
strategies. The use of testing should also be considered at this point. It is important
that the factors specific to the client and case be discussed when choosing the
appropriate evaluator. It is especially important to have discussions about what
potential subspecialties (and types of, if any) might be required for your case. It is
important to discuss whether testing is applicable as well and, if it appears to be
beneficial, what types of testing might be needed.

RE: Forensic Evaluator: Getting Started. After gathering records, speaking
with witnesses, and engaging in the multigenerational mitigation investiga-
tion of Mr. Smith, it became apparent that he had some specific mental health
problems and some areas of concern that might require the assistance of an
expert. Although the mitigation investigation was not complete at this stage,
the defense team agreed that it would be beneficial to have a forensic evalua-
tion of Mr. Smith completed to assist in the sentencing phase of trial.
The team agreed that there was reason to believe that Mr. Smith may have
symptoms of FAS as well as PTSD. Expert testing and evaluation in these areas
was determined appropriate. Because of the coach’s reports of multiple concus-
sions, an expert screening for traumatic brain injuries and other potential neuro-
logical problems seemed appropriate. The team ultimately decided that forensic
psychologists with pharmacology backgrounds were not necessary or applicable
in Mr. Smith’s case but identifying a practitioner with adolescent experience,
and intelligence testing, and neuropsychological testing expertise was preferred.
The decision to use a mental health expert (MHE) as a forensic evaluator
(FE) is not always straightforward. Psychologists and psychiatrists are trained
to consider the complexities of the human psyche, and in terms of courtroom
strategy, complexity can lead to confusion. Juries benefit from simple, clear,
and concise answers. The worst moment in a forensic evaluator’s career is when
she looks at the jury box to find half the jurors looking utterly puzzled while
the other half is yawning and trying to stay awake. While less is sometimes
more when testifying, during the actual evaluation phase the opposite is often
true. The MHE wants to be able to speak with confidence and psychological
certainty; he needs to be convinced in order to be convincing. To do that, he
wants to make sure his evaluation procedure involves data that can withstand
being challenged by invoking the standard error of measurement (tests are not
100% accurate), or Type I (false positive) or Type II (false negative) errors.1
During the penalty phase of a capital case, it is not unusual for mitiga-
tion specialists and defense teams to use the MHE/FE to explain to a jury the
convicted perpetrator’s story. The goal is to gain the jurors’ trust and explain
details accurately. A respected psychiatrist or psychologist is best, but one of
his or her most important characteristics is the ability to emotionally connect

and touch the audience, the jury.
General Considerations
When a decision is made to involve a MHE/FE,2 there are three possible gen-
eral outcomes:
1. The results of the forensic evaluation add data that round out and amplify the
findings of the mitigation specialist and defense team. Their initial hypoth-
esis is confirmed and strengthened. For example, the defense team suspects
neurological impairment from a childhood traumatic brain injury. The
psychologist reviews childhood and educational testing and clinical data
(which suggest neurological impairment), performs his or her own neuro-
psychological evaluation, and finds neurological impairment (specifically
frontal lobe impairment) that affects impulse control and executive func-
tioning. The psychologist can speak with great certainty and authority that a
documented traumatic injury did indeed cause brain damage, that the brain
damage is still evident, and that the damage occurred prior to the crime and
was therefore at least partially to blame for the crime, lowering culpability.
2. The results of the forensic evaluation add data that may not fully confirm
the initial hypothesis but may instead alter it and lead to a modified but not
fundamentally different hypothesis. This is what essentially happened in a
recent capital case in which a 19-year-old man was accused of murdering a
60-year-old man with whom he had become involved, presumably because
the older man wanted sex. The initial hypothesis was based on a difficult-to-
prove history of exposure to vicarious trauma (the family, originally from
a South American country enveloped in a civil war, had been the victims
of a rebel attack). Upon examination, the psychologist discovered (initially
through testing and then subsequent interviewing) a history of ongoing and
violent sexual abuse. Thus, a traumatic antecedent to the crime was indeed
found—one that did not negate the initial hypothesis of traumatic sequelae
but was a much stronger and more easily understood one.
3. The results of the forensic evaluation contradict the initial hypothesis and in
fact lead to the generation of a completely different hypothesis. In the first
example, let’s imagine the defense team discovered the defendant had a
history of having been routinely bullied throughout high school, and that
became the initial hypothesis. However, on evaluation, the neurological
impairment could be traced back to an injury prior to the bullying, so the
psychologist might recommend forgoing a “bullying” mitigation (especially
with certain juries) in favor of the competing hypothesis of neurological
impairment.
Thus, the forensic evaluator is essentially involved in a dialectical process,

one that usually begins with an evaluation of the defense team-generated
hypothesis (thesis), then includes evaluating for the possibility of other com-
peting and even contradictory hypotheses (antithesis), and finally, when
supported by the data, concludes with an explanation that accounts for all
hypotheses (synthesis). In some cases, the evaluator’s findings will not be sup-
portive of mitigation.
Psychological Measures Administered

RE: Forensic Evaluator: Testing and Evaluation. In the example of Mr. Smith,
the strength of the background material uncovered by the mitigation special-
ist strongly suggested that the psychologist’s findings would fall into the first
or second categories; that is, the data would either (1) add to and confirm,
or possibly (2) modify but still confirm the defense team’s hypothesis. Given
the information provided, the forensic psychologist began with a standard-
ized Mental Status Examination and Quick Neurological Screening Test;
both incorporate cognitive, sensorimotor, and memory tasks that are part
of a standard neurological screen in addition to being age-normed and thus
going beyond clinical judgment. A formal assessment of intellectual function-
ing, using the latest edition of the Wechsler Adult Intelligence Scale, Fourth
Edition (WAIS-IV)3 along with the Wechsler Memory Scale,4 was also indi-
cated. Both instruments are thoroughly researched, both provide an incred-
ibly rich fund of information about specific cognitive skills as well as general
intelligence, and both have repeatedly met Daubert admissibility standards
(Flynn, 2009; Hagan, Drogin, & Guilmette, 2010). In addition to neurological
screening, a standard drawing test such as the Bender Visual-Motor Gestalt
Test or the Beery-Buktenica Developmental Test of Visual-Motor Integration
was also suggested.
Given his educational and family backgrounds, it was surprising that
Mr. Smith tested in the low average range of general intelligence, with a Full
Scale IQ between 82 and 89 (90% confidence level). Based on the evidence
obtained thus far, it was highly likely that Mr. Smith would demonstrate
mild impairment in some areas of executive functioning, as evidenced by his
performance on the following WAIS-IV subtests:
1. Borderline to low average-range score on the Similarities subtest, a test of

verbal concept formation.
2. Borderline to low-average-range score on the Matrix Reasoning subtest, a
test of nonverbal concept formation.
3. Borderline to low-average-range score on the Letter-Sequencing subtest, a
test of visual-motor sequencing, attention, concentration, and memory.
4. Low-average-range score on the Digit Span subtest, a test of verbal attention

and memory; it would be expected that his Digits Backward score would be
significantly lower than his Digits Forward score.
His average-range scores on Block Design, Visual Puzzles, Symbol Search,

and Coding were contraindicative of significant (but not “soft”) neurological
impairment. His low-average scores on Information, Vocabulary, and Com-
prehension were interpreted as primarily the result of poor school attendance
and performance.
His performance on the Bender and/or Beery tests were consistent with
his general intelligence and thus not in and of themselves significant indica-
tors of visual-motor neurological impairment. This finding was also consistent
with his WAIS-IV perceptual reasoning and processing speed index scores.
Still, because his WAIS-IV performance provided some evidence of executive
functioning impairment, a referral for full neuropsychological testing (assum-
ing funding permitted it; the HRNB is costly to administer and interpret) was
indicated.
Mr. Smith’s scores on the Halstead-Reitan Neuropsychological Test Battery
(HRNB; Reitan & Wolfson, 1993; Bigler, 2007) Category and Trail-Making
tests provided strong corroborating evidence of executive functioning impair-
ment, specifically in the frontal lobes. The remaining subtest scores were more
diffuse, and the most parsimonious explanation was that they were consistent
with his somewhat low general intelligence and thus not indicative of spe-
cific neurological damage. Because Mr. Smith’s extended family background
included some blood relatives who evidenced average-range or better intel-
lectual functioning, it was reasonable to conclude that Mr. Smith’s overall
intellectual development was not genetic in etiology. Rather, his intellectual
functioning was more likely impaired by a combination of his mother’s sus-
pected prenatal substance abuse combined with early environmental depriva-
tion.5 Thus, one of the defense team’s initial hypotheses could be confirmed,
albeit with a moderate degree of certainty.
The usefulness of personality assessment is not always evident and can be
controversial. Many defense attorneys and forensic evaluators steer clear of
formal psychological testing in general, and personality testing in particular
(Melton, et. al., 2007). Personality is a complex construct—within different
branches of psychology, there are differing ways of defining and measuring.
Psychologists have frequently questioned the value in capital sentencing eval-
uations, typically noting that specific circumstances are almost always a more
accurate predictor of behavior than personality traits (Epstein, 1983; Synder,
1983; Fleeson, 2004). In addition, there is the possibility of discovering that the
defendant has a “personality disorder,” which in most people’s understanding
refers to a characterologically intractable, incurable “mental disorder.”
When a defendant clearly demonstrates impaired functioning below the

2nd percentile (mentally deficient range) on both intellectual and adaptive
functioning measures or a brain injury that can be clearly demonstrated using
both brain imaging technology and neuropsychological testing, thereby meet-
ing Atkins (2002) criteria, personality testing will obfuscate rather than clar-
ify and generally should not be employed. On the other hand, in some cases
(especially when the issue of psychopathy or antisocial personality is raised),
psychologists can sometimes be vulnerable during cross-examination to ques-
tions about why they did not look at personality factors with the same degree
of scrutiny (e.g., with objective psychological tests) as they did other possible
factors (e.g., intellectual functioning).
When utilizing personality assessment, the goal is not necessarily to arrive
at a formal diagnosis using psychiatric nomenclature (e.g., the Diagnostic and
Statistical Manual of Mental Disorders, or DSM6); ever since its third revision
(DSM-III), the DSM has employed a categorical rather than a functional/
process-oriented approach to diagnosing, and although often and erroneously
cited in courts as the “bible” of psychiatry and psychology, it is nevertheless
known for its lack of reliability and subsequent dubious validity. In testimony,
it is better to rely on describing a psychological process as opposed to a diag-
nostic category, since the former is dynamic and therefore impermanent while
the latter is static and implies that the defendant cannot change. For exam-
ple, discussion of a defendant’s emotional instability, great underlying rage,
and tendency to love and then hate a romantic partner would be preferable
to explaining how, depending on one’s interpretation of a single criterion, he
or she may or may not meet the diagnosis of borderline personality disorder.
Such a diagnosis, once arrived at, would never leave her; a borderline may go
into “remission” for decades but is rarely, if ever, cured. In Mr. Smith’s case,
given the less-than-clear neuropsychological findings, the use of empirical
personality testing might also be advised. The evaluator might hypothesize
that he will find indications of impulsivity and emotional/behavioral dysregu-
lation as well as anxiety, depression, avoidance and traumatic flashbacks, all
potential signs of the formal diagnosis of posttraumatic stress disorder. What
the evaluator is not likely to find is equally important; objective personality
tests like the MMPI-2-RF7 and Personality Assessment Inventory (PAI) have
well-researched scales that assess a range of specific factors that contribute to
antisocial tendencies and/or behaviors. In addition to the overall Antisocial
Behavior scale (derived from the “Pd” scale on the MMPI and MMPI-2) on
the MMPI-2-RF, there are related scales that assess Anger Proneness, Juvenile
Conduct Problems, Aggression, Activation and Disaffiliativeness, all of which
are related to overall tendencies to engage in antisocial and/or criminal behav-
ior. The PAI breaks down its general Antisocial Scale score into three compo-
nents: Antisocial Behaviors, Egocentricity, and Stimulus-Seeking. Moderate
elevations on some of these scales may be indicative of a tendency to bend

or break social convention or may be related to abuse substances rather than
engagement in behaviors that are intended to manipulate, abuse, or harm
other people and thus suggest to a jury that the defendant is a hopeless and
helpless psychopath. Taken together, the MMPI-2-RF and PAI assess antiso-
cial behavior, impulsivity, aggression and dominance scales are moderately
correlated with the Psychopathy Checklist, Revised (PCL-R) and thus provide
valuable insight into the presence—or absence—of psychopathy (Walters &
Duncan, 2005; Mufson, 2012).
Based on what was known about Mr. Smith, it was unsurprising when he
scored relatively high on psychological test indices related to depression,8 anx-
iety, and anger proneness. He also scored relatively high on the MMPI-2-RF’s
Juvenile Conduct Problems and PAI’s Stimulus-Seeking subscales, but he did
not score in the clinical range on either the MMPI-2-RF or the PAI scales that
more generally measure antisocial traits and behaviors. The evaluator found
elevated scores on scales related to addiction potential, although not in the
clinical range on the PAI’s Alcohol and Drug Abuse scales. It is the experience
of this evaluator that test scores rarely fall nicely into a “clean” posttraumatic
stress (PTSD) profile pattern. Rather, those who have experienced chronic and
complex trauma (as appears to be the case with Mr. Smith) sometimes present
with a profile that seems indecipherable on the surface and with scores that do
not generally cluster together. Although not part of the “traditional” PTSD pat-
tern, high scores are often seen on the MMPI-2-RF Aberrant Experiences or the
PAI’s Psychotic Experiences or Thought Disorder scales, for example, as well
as various configurations indicating multiple cognitive and/or somatic com-
plaints. The former often turn up as complaints about dissociative-like experi-
ences or sensations. For over a decade, there has been a debate as to whether
PTSD should be strictly classified under the broader categories of anxiety or
dissociative disorders; the DSM-5 attempted to resolve this debate by creat-
ing a third category, Trauma and Stressor-Related Disorders. Although not a
forensic instrument, the Dissociative Experiences Scale (Carlson & Putnam,
1993), now in its second edition (DES-II), can provide structured information
about an individual’s experiences of dissociation; the Clinician-Administered
PTSD Scale (CAPS; Weathers, et. al., 2004) or the Trauma Symptom Inventory
(TSI; Briere, 1995, 1997) can quantify PTSD symptoms. It is advisable to wait
until significant rapport and (whenever possible) trust has been established,
a solid clinical history obtained, and as much information as possible elicited
through standard clinical interviewing before administering structured psy-
chological tests. Contrary to the popular belief that most defendants want to
look “crazy” to either obtain a not guilty by reason of insanity (NGRI) verdict
or a lesser sentence, many defendants in capital cases are loathe to admit to any
psychological disturbance, which they consider a “weakness.”
In Mr. Smith’s case, there is considerably strong historical data, including

interview data from his older half-brother, a previous psychologist, school
personnel, and some family friends or neighbors. This is one reason, of many,
why the mitigation specialist’s investigation is vital. After establishing at least
some degree of rapport, the evaluator worked this information into his clini-
cal interview with Mr. Smith in the hope of obtaining further details and the
expansion of information that would then potentially facilitate more forth-
right responses to the psychological tests administered.
The judicious employment of projective tests, especially the Rorschach
Inkblot Technique, is sometimes appropriate. While most forensic specialists
advise against using projective tests, others believe such a general admonition
is akin to throwing the baby out with the bathwater. Hess (2006), for example,
opined that “if an instrument is banned . . . [how] can we discover its uses?
Moreover, it is the use of the [Rorschach] in the clinician’s hands rather than
the instrument that is central to validated use” (p. 823). In their analysis of the
admissibility of psychological tests in courtroom testimony, Shook and Jack-
son (2014) reported Rorschach results were admitted slightly better than 50%
of the time. Meloy (2008) noted that courts have largely upheld the validity
of the Rorschach (as a technique rather than a “test”) when it was used for the
purposes of assessing what it is best at assessing: ego strength/maturity and
disordered thinking. It is inappropriate to use the Rorschach as a stand-alone
assessment tool or to base diagnoses like depression or anxiety on its results,
since there is little data to support its efficacy in these situations, and there are
far better tools available. Projective tests can add significant clinical informa-
tion especially when the evaluator suspects disturbed thought processes that
the defendant can mask from objective tests like the MMPI-2-RF; as a means
of delineating neurological damage, the Rorschach can be invaluable (Erard,
2012). Rorschach responses are sometimes useful in combating the ubiqui-
tous opinion rendered by most prosecution experts: that the defendant has
Antisocial Personality Disorder. When combined with a history of relational
capacity, clinical impressions, and objective personality test scores that do not
indicate psychopathy, projective tests can add to the argument that the defen-
dant is capable of some degree of warm interpersonal relationships.
In Mr. Smith’s case, there was good reason to employ projective testing.
Based on his history, the evaluator’s clinical impressions and the client’s objec-
tive tests results, both neurological signs and indicators of diminished execu-
tive functioning (planning and impulse control) were expected and obtained.
A basic principle of psychological investigation is that of hypothesis-
generation and corroboration through multiple data sources (Hall & Sbordone,
1993; Achenbach, 2006; Weiner & Hess, 2006); forensic psychologist Kirk Heil-
brun notes that this principle is especially important in forensic cases (Heilbrun
et. al., 2008), and there is no case that impacts a defendant more than one that
could invoke the death penalty. In Mr. Smith’s case, conclusions were drawn
with reasonable psychological certainty based on (a) a clinical history supported
not only by self-report but through corroborating collaterals, (b) data derived
through clinical interview and clinical assessment by the forensic psychologist,
and (c) significant cross-validation between several empirical tests that assess
both cognitive and personality functioning, both historically and in the present.
Forensic Summary and Opinion

RE: Forensic Evaluator: Historical, clinical and empirical data were consistent
in painting a picture of a young man who was probably born with a vulner-
able neurological system to begin with due to his mother’s reported use of
alcohol and drugs during pregnancy. It was evident from the client records,
witness and evaluator interviews, and other materials reviewed that he
exhibited signs of neurological problems from an early age. Moreover, the
data reflected the expected traumatic sequelae of a history of family chaos,
childhood neglect, and both direct and vicarious exposure to physical vio-
lence. These included (1) chronic and severe depression (as indicated by sui-
cide attempts) that, based on test data, continued throughout his young life;
(2) early onset of trauma-related dissociation, again as indicated by test results
as well as intermittent amnesia for significant traumatic events; and (3) numer-
ous trauma-based symptoms as a teenager (and therefore prior to the offense)
as reported by his previous psychologist.
It is clear from myriad studies, but based most notably on results obtained
from the large-scale and ongoing longitudinal Adverse Childhood Experi-
ences study jointly sponsored by the Centers for Disease Control and Pre-
vention and Kaiser Permanente (CDC, 2014; Chapman et al., 2007), that Mr.
Smith had many strikes against him well before he became involved with the
victim, Clare. His medical history and recent test data indicated neurological
impairment, especially of his executive functions (most notably, impulse con-
trol, emotional/behavioral regulation and planning). Although it was not clear
whether this impairment was caused pre- or postnatally, it was clear that it
was present well before the offense, and it was reasonable to assume that early
abuse and neglect either caused or exacerbated it if it existed prior to birth.
Thus, it was concluded that Mr. Smith, a convicted murderer who, by no
choice of his own and therefore with limited responsibility, likely experi-
enced delayed prenatal brain development, was made even more vulnerable
to delayed brain development by his early childhood environment, grew up
under conditions (e.g., ongoing chaos, poor attachment, neglect and abuse)
known to retard cognitive development and make a school-aged child highly
vulnerable to emotional and behavior dysregulation. Ultimately he did not
receive adequate interventions despite early indications of all the above.

The potential impact of capital mitigation can quite literally mean the dif-
ference between life and death. It is therefore especially incumbent on the
psychologist to be aware of potential pitfalls in evaluations of this type. In
this evaluator’s experience, and based on conversations with other forensic
psychologists, these can be grouped under the broad categories of (1) under-
reaching, (2) overreaching, (3) hubris, (4) brain-lock/overspecialization and
(5) opinion-for-hire.
Psychologists who under-reach tend to focus on those areas with which they
are most familiar (e.g., psychosis or mood disorders) and focus too heavily on
exploring those facets of a case to the detriment of other possible, or even more
likely, considerations. If they use tests, their choice of tests reflects this some-
what narrow focus of investigation. They might, for example, employ the Beck
Inventories and find depression and anxiety without giving enough consider-
ation to the examinee’s background, which may include significant trauma that
in fact subsumes the mood and anxiety disorders. In testimony, this psycholo-
gist may sound simplistic and scattered and, therefore, easy to dismiss; after
all, who hasn’t experienced depression and anxiety, so why should a jury give
much weight to these symptoms in someone convicted of murder? Lack of
experience with formal assessment can also result in under-reaching. Although
formal testing is the one activity that most clearly delineates psychology from
the other mental health professions, many psychologists receive relatively little
ongoing training and supervision in formal assessment that includes psycho-
logical testing. This was not always the case; the advent of managed behavioral
healthcare resulted in a sharp decline in (or in some cases the complete elimi-
nation of) reimbursement for testing by insurance plans. As a result, many
agencies and hospitals that once utilized (and trained psychologists) tests as
part of their formal assessment process no longer do so; lack of broad formal
assessment knowledge and skill can be one cause of under-reaching.
Overreach can be problematic as well. Psychologists who use a shotgun
approach to evaluation and basically “throw” tests and assessment procedures
at an examinee may find themselves with a confusing and overwhelming array
of data, both erroneous as well as potentially meaningful. How does she sepa-
rate the wheat from the chaff? In testimony, the psychologist then risks sound-
ing scattered and overly reliant on psychological testing jargon. Testimony that
is overly complicated and too difficult to follow can sound condescending,
obfuscating, irrelevant, and—perhaps worst of all—boring. When testifying
about a defendant’s psychological state, there are few experiences more profes-
sionally debilitating than noticing jurors yawning or even nodding off to sleep.
Moreover, such testimony may bias a jury against taking a nuanced, psycho-
logically sophisticated view of the defendant altogether.
Hubris—overconfidence in one’s abilities and judgment—can be a major

pitfall. In capital cases, it is extremely important to coordinate with and give
weight to the opinions of other members of the defense team. Psychologists
who are well trained in individual psychopathologies may fail to give appro-
priate weight to social and contextual factors, for example. Early in this evalu-
ator’s career, a particular defendant was once judged as psychotic when in fact
his beliefs, thinking, behaviors, and perceptions were not unusual within the
community in which he was raised (an extremely controversial religious “cult.”)
Imprisonment removed him from his community, and in a few months, he no
longer met the criteria for schizophrenia. He was not “cured” of his psychosis;
his unusual thinking and presentation were artifacts of his cult involvement.
When testifying, there can be a thin line between inspiring confidence and
appearing arrogant.
Both overreaching and hubris can contribute to a psychologist “promising
too much.” When reporting high success rates (as defined by favorable court
decisions), it is misleading to claim that favorable outcomes are a direct result
of (or even correlated with) the psychologist’s testimony. In fact, a favorable
decision may at times be made despite a psychologist’s poorly received testi-
mony. Fulero and Wrightsman (2009) similarly warn against the psychologist
substituting advocacy for objectivity. Testifying about new “syndromes” may
attract attention and even sway opinions, but they have little or no basis in
scientific research and can in fact be boldly created to advocate for a specific
belief or social/political position.
Brain-lock is an especially problematic pitfall. Expert witnesses are too often
called into a case because of their strongly held a priori beliefs rather than
their professional objectivity. For example, there are a myriad of controversial
“syndromes” that psychologists have testified about, such as “false memory
syndrome,” “recovered memory syndrome,” “battered woman syndrome,” and
“post-cult trauma syndrome” and, more recently, “affluenza” (the “rich kid syn-
drome” that some media claimed spared a wealthy Texas teenager from serv-
ing jail time after killing four people while driving drunk). Psychologists—and
perhaps especially those engaged in research and academia—may take foren-
sic cases in the hope that they will advance a specific professional and/or per-
sonal agenda. Other psychologists simply have strong beliefs or professional
experiences for which they, consciously or unconsciously, desire vindication
by a court. Sometimes, overreliance on a particular test’s results can result in
brain-lock; a more common pitfall is being overly trusting of one’s own clinical
judgment and experience, despite the plethora of studies that question clinical
accuracy and a mental health professional’s ability to discern when someone is
being deceitful9 (Ekman & O’Sullivan, 1991; Adelson, 2004). When combined
with hubris, brain-lock can lead a psychologist down a path that bears little
resemblance to objectivity or truth.
Overspecialization can also be a cause of brain-lock. This can be a problem

for the psychologist who has considerable training in forensics but not in other
areas of clinical practice (e.g., psychotherapy, consultation). For that reason,
many forensic psychologists maintain at least a small clinical practice as well,
which allows ongoing exposure to and experience with a broad range of con-
cerns, from everyday “problems of living” to severe psychopathology (other
than antisocial behavior or psychopathy).
Finally, and perhaps worst of all, mental health professionals generally
don’t want to admit to being potentially influenced by the potential for future
work and, in a few cases, by fame and fortune. Psychologists can also become
“pigeonholed” as either exclusively experts for the prosecution or the defense,
which can potentially impinge on their objectivity. There is little evidence
to support the feeling that psychologists are “above” being “bought.” In her
provocatively titled book, Whores of the Court, psychologist Margaret Hagen
(1997) targets forensic mental health specialists for being “clinical charlatans
and greedy frauds” (p. 73). While that may be an extreme judgment, if we
are honest with ourselves, this author believes most forensic evaluators will
admit to feeling seduced by those rare cases that garner significant media
attention and/or might involve significant fees. On a more basic and common
level, forensic evaluators can feel pressured to please the attorney, court, or
agency that hired or retained them. There is no simple solution to this problem
(although self-awareness is a necessary start); there are several ways to safe-
guard against, or at least mitigate the risk of, becoming a “hired gun.” Without
exception, the psychologist working for private attorneys should always utilize
a signed contract that clearly identifies the client (the attorney, the defendant/
accused, the court, etc.) and the rights and obligations of all parties involved
in the forensic evaluation. Personally, this evaluator will not work without a
retainer and full reimbursement of fees before any opinion is communicated,
in writing or otherwise, to anyone. If hired by the state (e.g., a court) or a state
agency (e.g., division of family services) a retainer is not required, however
acknowledgment of the terms of the evaluator involvement (financial and oth-
erwise) in writing is required.
In addition to guarding against overspecialization and brain-lock, main-
taining a practice that balances nonforensic against forensic work is another
way of avoiding being seen as (and, in fact, becoming) a “hired gun.” As every-
one in the field knows, the intersection of law and psychology does not accu-
rately reflect everyday people or situations; the court system and all its various
players constitute a world unto itself, complete with its own highly idiosyn-
cratic customs, rules, roles, and rituals. Teaching, consulting, and/or clinical
practice can help keep the forensic clinician connected to the “real world” of
real people, patients, and problems. Thus, in addition to providing another
source of income, a broad and diverse professional practice can enhance the
effectiveness of the forensic specialist’s testimony; it also serves to minimize

the appearance of being a “hired gun” who relies solely on being paid to evalu-
ate and testify in court cases.
Notes
1. A “false positive” error occurs when, say, an expert finds a neurological impair-
ment when in fact one does not exist; conversely, a “false negative” involves mistakenly
missing an important characteristic or diagnosis.
2. For the remainder of this section, the mental health expert/forensic examiner will
be assumed to be a psychologist.
3. As of this writing, in its fourth edition (WAIS-IV).
4. Also in its fourth edition as of this writing (WMS-IV).
5. Based on the fact that Mr. Smith had an IEP early in his academic career, it seems
unlikely that any intellectual impairment would be the result of his concussions, which
occurred when he was in high school.
6. The Diagnostic and Statistical Manual of Mental Disorders, published by the Ameri-
can Psychiatric Association and routinely referred to as the “DSM,” is currently in its fifth
edition (i.e., the DSM-5).
7. The MMPI-2-RF is psychometrically “cleaner” version with significantly better dis-
criminant validity than its predecessors, the MMPI and MMPI-2. The MMPI and MMPI-2
employ a “Pd” (Psychopathic Deviance) scale that often has limited diagnostic utility, especially
in forensic settings, as it could be just as indicative of a tendency to avoid, bend, or break social
convention (think Steve Jobs or Andy Warhol) as it could of actual psychopathic behavior.
8. For example, Demoralization, Suicidal/Death Ideation, Malaise, Low Positive
Emotions, Helplessness/Hopelessness on the MMPI-2-RF/.
9. Psychologists are not especially good at judging when an examinee is lying, for
example.
References
Achenbach, T. M. (2006). As others see us: Clinical and research implications of cross-
informant correlations for psychopathology. Current Directions in Psychological Science
15, 94–98.
Adelson, R. (2004, July/August). Detecting deception. APA Monitor, 35, 70.
Atkins v. Virginia, 536 U.S. 304, 260 Va. 375, 534 S. E. 2d 312 (2002).
Banner, S. (2002). The death penalty: An American history. Cambridge, MA: Harvard
University Press.
Bigler, E. D. (2007). A motion to exclude and the “fixed” versus “flexible” battery in “foren-
sic” neuropsychology: Challenges to the practice of clinical neuropsychology. Archives
of Clinical Neuropsychology, 22, 45–51.
Briere, J. (1995). Trauma Symptom Inventory professional manual. Odessa, FL: Psychologi-
cal Assessment Resources.
Briere, J. (1997). Psychological assessment of adult posttraumatic states. Washington, DC:
American Psychological Association.
Carlson, E. B., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale.
Dissociation, 6, 16–27.
Centers for Disease Control and Prevention. (2014). Linking childhood trauma to long-term
health and social consequences. Retrieved from http://www.acestudy.org/
Chapman D. P., Dube, S. R., Anda, R. F. (2007). Adverse childhood events as risk factors for
negative mental health outcomes. Psychiatric Annals, 37, 359–364.
Daubert v. Merrell Dow Pharmaceuticals, 509 U.S. 579, 589 (1993).
DeMatteo, D., Murrie, D. C., Anumba, N. M., & Keesler, M. E. (2011). Forensic mental
health assessments in death penalty cases. Oxford, UK: Oxford University Press.
Ekman, P. & O’Sullivan, M. (1991). Who can catch a liar? American Psychologist, 46,
913–920.
Epstein, S. (1983). Aggregation and beyond: Some basic issues on the prediction of behav-
ior. Journal of Personality, 51, 360–392.
Erard, R. E. (2012). Expert testimony using the Rorschach performance assessment system
in psychological injury cases. Psychological Injury and Law, 5(2), 122–134.
Fleeson, W. (2004). Moving personality beyond the person-situation debate: The challenge
and the opportunity of within-person variability. Current Directions in Psychological Sci-
ence, 13, 83–87.
Flynn, J. R. (2009). The WAIS-III and WAIS-IV: Daubert motions favor the certainly false
over the approximately true. Applied Neuropsychology, 16, 98–104.
Friedman, H., & Orgel, S. A. (1964). Rorschach developmental scores and intelligence level.
Journal of Projective Techniques and Personality Assessment, 28, 425–428.
Fulero, S. M., & Wrightsman, L. S. (2009). Forensic psychology. Belmont, CA: Wadsworth.
Hagan, L. D., Drogin, E. Y., & Guilmette, T. J. (2010). Science rather than advocacy when
reporting IQ scores. Professional Psychology: Research and Practice, 41, 420–423.
Hagen, M. (1997). Whores of the court: The fraud of psychiatric testimony and the rape of
American justice. New York, NY: ReganBooks.
Hall, H. V., & Sbordone, R. J. (1993). Disorders of executive functions: Civil and criminal law
applications. Boca Raton, FL: CRC Press.
Heilbrun, K., DeMatteo, D., Marczyk, G., & Goldstein, A. (2008). Standards of practice
and care in forensic mental health assessment: Legal, professional, and principles- based
consideration. Psychology, Public Policy, and Law, 14, 1–26.
Hertz, M. R. (1970). Frequency tables for scoring Rorschach responses. Berkeley, CA: Univer-
sity Press Books.
Hess, A. K. (2006). Practicing principled forensic psychology: Legal, ethical, and moral
considerations. In I. B. Weiner & A. K. Hess (Eds.), The handbook of forensic psychology.
Hoboken, NJ: Wiley.
Klopfer, B. (1962). Rorschach Technique: An introductory manual. New York, NY: Harcourt
College.
Meloy, J. R. (2008). The authority of the Rorschach: An update. In C. B. Gacono, F. B. Evans,
N. Kaser-Boyd, & L. A. Gacono (Eds.), The handbook of forensic Rorschach assessment.
New York, NY: Routledge.
for the courts: A handbook for mental health professionals and lawyers. New York, NY:
Guilford Press.
Mufson, L. (2012). Validity of MMPI-2-RF measures of psychopathy (Doctoral dissertation).
Pepperdine University. Retrieved from http://media.proquest.com/media/pq/classic
/doc/2866947541/fmt/ai/rep/NPDF?_s=dd9o7Q%2B8zjWsNFgkQzIPsMadGu8%3D
Reitan, R. M., & Wolfson, D. (1993). The Halstead-Reitan Neuropsychological Test Battery:
Theory and clinical interpretation (2nd ed.). Tucson, AZ: Neuropsychology Press.
Shook, J., & Jackson, M. (2014). Admissibility of psychological assessments in expert
testimony: Assisting the trier of fact. Presentation at the 2014 annual meeting of the
American Psychological Association: Washington, DC. Retrieved from http://dx.doi
.org/10.1037/e551092014-001
Snyder, M. (1983). The influence of individuals on situations: Implications for understand-
ing the links between personality and social behavior. Journal of Personality, 51, 497–516.
Wagner, E. E. (2001). The logical Rorschach: A brief scoring method to screen for psychopa-
thology. Los Angeles, CA: Western Psychological Services.
Walker, L. E. A., & Shapiro, D. L. (2003). Introduction to forensic psychology: Clinical and
social psychological perspectives. New York, NY: Plenum Press.
Walters, G. D., & Duncan, S. A. (2005). Use of the PCL-R and PAI to predict release out-
come in inmates undergoing forensic evaluation. Journal of Forensic Psychiatry and Psy-
chology, 16, 459–476.
Weathers, F. W., Newman, E., Blake, D. D., Nagy, L. M., Schnurr, P. P., Kaloupek, D. G., . . .
Keane, T. M. (2004). Clinician-Administered PTSD Scale (CAPS). Torrance, CA: Western
Psychological Services.
Weiner, I. B., & Hess, A. K. (2006). The handbook of forensic psychology. Hoboken, NJ: Wiley.
5
Conducting Mental Health

Diversion Evaluations
Virginia Barber-Rioja, Merrill Rotter, and Faith Schombs
Diversion programs were created largely as a response to the overrepresenta-

tion of individuals with psychiatric disorders in the criminal justice system.
The main goal of diversion programs is to identify individuals with mental
illness in the criminal justice system and divert them to treatment programs
in the community in lieu of incarceration (Steadman et al., 1999). Depend-
ing on the point of criminal justice contact at which diversion takes place,
diversion programs can be classified into two categories: prebooking diver-
sion, which occurs before the individual is arrested and formal charges have
been filled, and postbooking diversion, which takes place after the arrest and
formal charges have been filled (Broner, Borum, & Gawley, 2002). Diversion
can take place through a special jurisdiction court, such as a mental health
court (MHC; e.g., centralized diversion), or outside of the MHC through any
trial part (e.g., decentralized diversion; Barber-Rioja & Amrhein, 2010).
Regardless of whether diversion takes place inside or outside of a special
jurisdiction court, four key elements to postbooking diversion have been iden-
tified: (1) screening of individuals in contact with the criminal justice system
for the presence of mental illness; (2) evaluation of defendants for treatment
eligibility in lieu of incarceration by mental health professionals; (3) nego-
tiation with prosecutors, defense attorneys, and community-based treat-
ment providers to develop community-based treatment dispositions; and (4)
linkage of individuals to treatment programs in the community (Steadman
et al., 1999). We propose a fifth element, which is the clinical monitoring and
supervision of the participants once released to the community. This chap-
ter focuses on the second key element: the assessment of defendants for eli-
gibility for diversion specifically in the context of postbooking diversion, a
type of assessment that we will refer to as “diversion evaluations.” A diversion
Mental Health Diversion Evaluations 81
evaluation is used to assess a defendant’s eligibility for treatment in the com-

munity in lieu of incarceration. However, it is important to note that diversion
evaluations also inform elements 3, 4 and 5.
The number of diversion programs is rapidly growing nationwide. Approxi-
mately 54 diversion programs were in existence in 1992 (Steadman, Morris, &
Dennis, 1995), whereas over 300 of these programs were in operation by 2005
(Steadman & Naples, 2005). Similarly, since 1997, when the first MHC was
established, the number of these courts has increased to over 300 today, with
these programs found in almost every state (The Council of State Govern-
ments [CSG], 2014; http://csgjusticecenter.org/mental-health-court-project/).
As diversion programs rapidly increase, so do the number of forensic mental
health professionals needed to conduct diversion evaluations. Although no
specific statistic on the number of diversion evaluations conducted nation-
ally is available, diversion programs are increasing at such a rate that they
have probably become one of the most common evaluations requested by
the courts. For example, according the New York Queens District Attorney’s
Office, in a one-year period (October 2009 to October 2010), 1,610 defen-
dants were referred for diversion in the borough of Queens (a jurisdiction with
about 2.3 million residents).
While recommendations for standards governing diversion and MHCs
have been promulgated (e.g., CGS 10 elements), each local jurisdiction imple-
mented its program within a unique legal, clinical, and services context; con-
sequently, these standards did not include a universally accepted definition of
the eligibility criteria or an identification of the relevant forensic issues that
should be addressed as part of diversion evaluations. The focus of the clini-
cal needs within the diversion mission may make it seem that it is purely a
clinical evaluation; however, to the extent that these evaluations are conducted
“for the purpose of assisting the [legal] decision-maker or one of the litigants
in using relevant clinical and scientific data” (Heilbrun, 2001, p. 3), they can
be considered a type of forensic mental health assessment (FMHA; Heilbrun,
2001), and as such, should follow the general principles of FMHA. This chap-
ter constitutes an initial attempt to provide mental health professionals with
some procedures in forensic assessment that apply to diversion evaluations.

The Legal Context of Diversion
It is widely recognized that the prevalence of mental illness in jail and prison
is significantly higher than that found in the general population. The numbers
found in studies vary depending on instruments used and whether only severe
psychiatric disorders are included versus a broader definition of mental ill-

ness. However, even the most restrictive studies have found that about 15% of
individuals who are incarcerated in the jail system suffer from a mental illness
(Steadman, Osher, Robbins, Case, & Samuels, 2009). The causes for the over-
representation of individuals with mental illness in jails and prisons are likely
multidimensional, including deinstitutionalization, more restrictive civil com-
mitment criteria, limited resources in the community, and tougher sentencing
guidelines for drug charges.
The historical origins of diversion can be traced back to the early 1960s
and the bail reform movement. In Brandy v. United States (1960), the
Supreme Court held that a defendant without property who is thus denied
bail is therefore denied “equal protection under the law.” In 1961, the Man-
hattan Bail Project funded by the Vera Institute of Justice began interviewing
arrestees and making recommendations to be considered at the bail hearing.
They found that a very small percentage of individuals who had been released
on recognizance failed to appear (Lotze et al., 1999). Two years later, the
Supreme Court decided in Robinson vs. California (1962) that the mere fact of
being addicted was not enough to warrant imprisonment. This case reframed
addiction as an illness, which had deep implications for policy responses,
including the perception that treatment was a better solution. Within this
climate came the extension of the bail reform movement, which included
enhanced conditions for release, such as clinical and social services. Pretrial
diversion became the term to refer to cases where arrestees were offered the
opportunity to have their charges dismissed in exchange for successful par-
ticipation in social services (Amrhein & Barber-Rioja, 2011). In the 1970s,
the National Coalition for Jail Reform recommended the establishment of
diversion programs. Early diversion efforts concentrated on individuals with
substance abuse disorders, and although many of these individuals likely
had a co-occurring mental illness, programs that explicitly offered diversion
opportunities for individuals with mental disorders did not develop until the
1990s (Barber-Rioja & Rotter, 2015). The rapid increase in jail diversion in
the past decades results from multiple factors, including downsizing of state
hospitals, increased sentences, increased prison population, the drug war,
and the development of the problem-solving court movement (Amrhein &
Barber-Rioja, 2011).
In addition to the belief that jails and prisons are not the appropriate places
to treat individuals with psychiatric disabilities (Barr, 1999), assumption
under which diversion programs were implemented, the creation of special
jurisdiction courts for individuals with mental illness was affected by the prin-
ciples of therapeutic jurisprudence (Winick, 2002). This concept proposes that
the rules of law, legal procedures and legal actors can produce therapeutic or
antitherapeutic consequences (Wexler & Winick, 1991) and advocates the use
of treatment and rehabilitative services to address the offenders’ underlying
problems (Winick, 2002). Diversion programs were not necessarily created
under the assumption that individuals to be diverted committed their offenses
as a direct result of psychiatric symptoms. Therefore, finding a direct connec-
tion between the instant offense and symptoms of mental illness is not usually
a prerequisite for diversion or the focus of the diversion evaluation.
Diversion programs and MHCs differ in a number of ways, such as whether
a guilty plea is necessary prior to entry to the program and whether pun-
ishment should be used for noncompliance with treatment (Petrila, 2003).
However, as MHCs and diversion programs become more open to diverting
individuals with felony charges and violent offenses, they are also more likely
to use post-plea adjudication models and to use jail as a sanction (Redlich,
Steadman, Monahan, Petrila, & Griffin, 2005). Furthermore, some MHCs
require that the participants meet the criteria for Serious Mental Illness (SMI),
whereas others are less strict and require only “demonstrable mental health
problems” (Redlich et al., 2005, p. 607). Some diversion programs would con-
sider an individual who suffers from a personality disorder only, whereas oth-
ers would use a broader definition of eligibility. The monitoring period also
varies across jurisdictions and diversion programs. For example, in New York,
the Queens Felony MHC requires a minimum of twelve months, whereas the
Bronx Felony MHC requires eighteen to twenty-four months.
Despite the variations among programs, the following core features can be
found in most mental health diversion programs that use a post-adjudication
model: the presence of at least mental health difficulties; the requirement for
defendants to enter a plea of guilty before enrolling in diversion (Redlich et al.,
2005); the deferral of the sentence until successful completion of a treatment
plan, at which time charges are either dropped or reduced or the initial convic-
tion is vacated; and finally, the option of an alternative sentence, which is estab-
lished at the time of the guilty plea and given to defendants who violate the
conditions of their plea. Also common to all diversion programs is that can-
didates have the choice to be diverted or continue with regular criminal court
proceedings. Therefore, participation is voluntary, and it requires the consent of
all parties, including the mentally ill defendant (Redlich, Hoover, Summers, &
Steadman, 2010). Although the compliance requirements of diversion pro-
grams also vary, in general, plea agreement conditions include compliance
with mental health or substance abuse treatment, which may include taking
medications and attending both regular meetings with a case manager and
regular status hearings. The sanctions imposed for noncompliance with these
conditions can include increased treatment, increased supervision, and rein-
carceration (Redlich et al., 2010).
Best Practices
There is no single definition of diversion or even a clear or simple description
of what constitutes an MHC; furthermore, there is no legal standard for diver-
sion as defined by case law. As such, legal standards for diversion can be con-
sidered “insufficiently specific” (Heilbrun, 2009, p. 42). Diversion evaluations
should involve a thorough psychological evaluation including a clinical inter-
view, a mental status exam, and on most occasions psychological testing, as
well as a review of collateral information. However, since there is no legal stan-
dard for diversion to guide these evaluations, it is important for evaluators to
understand the forensic issues involved within any given jurisdiction. Broadly
speaking, the question facing the decision maker in the context of diversion
could be broadly described as whether a defendant meets the eligibility criteria
of a manageable mental disorder within a court-mandated context. If so, the
individual will be diverted from incarceration into community-based mental
health treatment and will be able to avoid jail (Redlich et al., 2010). Given the
variety of eligibility standards and regulations surrounding diversion evalua-
tions, it is essential for the forensic evaluator to be familiar with the eligibility
regulations governing his/her practicing jurisdictions, diversion programs or
special jurisdiction courts, as well as with the treatment resources available in
the specific jurisdiction. In addition to which eligibility standard is applied in
the jurisdiction, it is important to be familiar with the factors outlined below
when conducting diversion evaluation.
Relevant Forensic Issues

Diversion evaluations can be conceptualized as a specific type of forensic
assessment in that they are initiated specifically to provide information that
would aid the court and/or prosecutor in making the ultimate legal diversion
decision. Many of the relevant forensic issues involved in diversion evalua-
tions (i.e., risk assessment and assessment of response style) are shared with
those assessed when the legal question is competency, responsibility, or in the
context of incarcerated defendants, “release decision making” (Heilbrun et al.,
2002), which for example guides evaluations conducted for parole boards.
The relevant forensic issues to be assessed in diversion evaluations include the
presence of mental illness, malingering, competency to be diverted/voluntari-
ness of the decision, risk for violence, criminogenic factors, and treatment/
management. In short, as per the general principles of FMHA, the focus of the
diversion evaluation should be whether the defendant has certain “capacitates,
abilities or behavioral tendencies that must be understood” (Heilbrun, Grisso,
& Goldstein, 2009, p. 13) to help the legal decision maker determine whether
a defendant should be diverted, and, if so, under what conditions.
Presence of Mental Illness Before assessing the presence of mental illness,

the forensic evaluator should be familiar with the clinical eligibility criteria for
diversion for the specific jurisdiction or diversion program. Some diversion
programs only require that candidates have identifiable mental health
difficulties (Redlich et al., 2005). However, other diversion programs require
evidence of a Diagnostic and Statistical Manual of Mental Disorders (DSM)
diagnosis (American Psychiatric Association, 2013). Even if the general
requirement includes the presence of identifiable mental health difficulties, the
district attorney’s office may only consent to diversion if the defendant meets
criteria for a SMI other than a personality disorder. For example, it has been
these writers’ experience that it is not unusual for the prosecutor to require
evidence of the presence of a SMI when the instant offense involved violence
and a victim. Therefore, the forensic clinician should also be aware of the
specific requirements of the case. From a clinical risk management perspective
(see section below), SMI disorders are often the most amenable to treatment,
so the forensic clinician may have more confidence in being able to address
the violence risk.
Frequently, defendants are referred for diversion because they have been
diagnosed with a mental disorder while incarcerated, because of a reported
history of receiving mental health treatment, or because attorneys have
observed what they believe to be symptoms of mental illness in their clients.
We strongly advise against using these sources of information as proof of the
clinical eligibility requirement, although they often serve an important screen-
ing and identification purpose. Instead, FMHA principles should be followed,
and clinical characteristics should be assessed through valid and reliable
methods (Heilbrun, 2009). The appropriate identification of mental health
and substance abuse diagnoses is particularly relevant in the context of diver-
sion, as it would guide the treatment plan that defendants will have to follow
if they choose to participate in diversion. In addition, the complex interplay
of mental illness and substance abuse and the confounding influences on their
presentations governs the eligibility decision and monitoring considerations.
In order for forensic evaluators to reliably assess clinical eligibility, it is nec-
essary to obtain relevant historical information (Heilbrun, 2001). Sometimes
a thorough psychosocial history, clinical interview, and mental status exami-
nation are enough to determine the existence of mental illness. Other times,
clinical assessment instruments (such as structured clinical diagnostic inter-
views or personality inventories) are necessary for diagnostic clarification.
The use of clinical assessment instruments in diversion evaluations can
be particularly useful when assessing for the presence of personality disor-
ders. Available studies suggest that the lifetime prevalence of any personality
disorder in the forensic populations may be over 80% (Hart, 2002). Teplin
(1994) found that, in a sample of 728 male inmates, 48% exhibited antisocial
personality disorder, while Jordan, Schlenger, Fairbank, and Caddell (1996)

found a high prevalence of borderline personality disorders among the female
prison population. The assessment of personality disorders in the diverted
population is of special importance due to the increased risk for future vio-
lence, the poor response to traditional psychological treatments observed in
individuals diagnosed with a personality disorder (Hart. 2002), and the need
for specialized treatment approaches. The presence of antisocial or border-
line personality traits generally worsens the prognosis regarding diversion
compliance, and therefore, treatment plans and court expectations need to be
adjusted accordingly. Psychological testing may also be necessary when a cog-
nitive limitation or intellectual disability is suspected, as this may inform the
defendant’s eligibility, as well as the treatment plan.
In addition, the assessment of clinical characteristics in diversion evalua-
tions should include the use of archival and third-party information (Melton,
Petrila, Poythress, & Slobogin, 2007). Melton et al. (2007) listed the following
reasons using collateral information in both forensic evaluations and diversion
evaluations: “greater need for accuracy, differences in response style between
persons in therapeutic and forensic evaluation contexts, and the greater scru-
tiny that the evaluators’ conclusions receive” (p. 53). In the context of diver-
sion, accuracy of diagnosis sometimes determines the decision. It is also
important not to rely solely on the examinee’s self-report in making diagnos-
tic decisions, given the external incentives afforded by being diverted and the
increased knowledge that arrestees have of the existence of a diversion option.
Such diagnoses are often questioned by defense attorneys, prosecutors, or prior
treatment providers who may be invested in a particular diversion outcome.
Symptom Exaggeration Given the incentives afforded by participation in

mental health diversion programs, specifically the avoidance of incarceration
and/or the dropping of criminal charges, jail detainees may attempt to feign
or exaggerate the severity of psychiatric disorders in order to gain access to
the diversion program. The DSM-5 (American Psychiatric Association, 2013)
states that one of the factors indicating that an individual may be malingering
is a lack of treatment compliance (section V65). Conversely, Rogers (1990)
has stated that there is no empirical evidence to conclude that individuals
who malinger are less likely to comply with treatment. However, no further
published studies have specifically examined this relationship. Because
individuals who successfully feign psychiatric symptoms for an external
incentive are sometimes found eligible for diversion and needlessly placed
into mental health treatment programs, it stands to reason that they will be
less likely to adhere to treatment attempts and or to comply with the rules and
regulations of the diversion program. However, the lack of research in this area
makes this prediction speculative.
No published data are available on the prevalence of malingering in individu-

als being referred to diversion. An unpublished dissertation that assessed 61
individuals being referred for diversion in New York City found that 54% of
individuals scored above the cutoff recommended for suspecting malingering
on the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001),
a brief structured interview created to screen for malingering by an assessment
of an individual’s general response style (Barber-Rioja, 2009). Although feign-
ing does not preclude the presence of genuine mental illness, this finding sug-
gests that further assessment of malingering should have been conducted in
more than half of the sample. It is therefore recommended that standardized
instruments to screen and/or assess for feigning and malingering of psychiat-
ric disorders be administered as part of the diversion evaluation.
Competency and Voluntariness One of the core features of diversion is

that participation is voluntary (Redlich, 2005). In addition, all candidates of
diversion are presumed to be competent when allowed to enter a guilty plea
prior to being diverted (Redlich et al., 2010). However, the issue of whether
defendants are actually competent to accept diversion and treatment and
whether participation in diversion is truly voluntary has frequently been raised
(Poythress, Petrila, McGaha, & Boothroyd, 2002; Redlich, 2005; Redlich et al.,
2010; Seltzer, 2005; Stafford & Wygant, 2005). Most research or commentaries
about this issue refer to competency to participate or be transferred to an MHC.
It has been reported that the adoption of nontraditional roles by attorneys,
prosecutors, and judges in MHCs makes participants more vulnerable to
competency issues (Petrila, 2003; Redlich, 2005). This level of informality and
the potentially paternalistic context in which MHCs process cases make courts
more susceptible to violations of due process by adjudicating defendants who
do not understand the voluntary nature of MHCs or do not “understand and
appreciate the decision before them” (Redlich, 2005, p. 605). As in juvenile
and mental hygiene courts, a focus on the defendant’s best interest can, if
unchecked, undermine the justice and fairness associated with the respect
for his or her autonomy. Although this level of informality does not fully
apply to diversions taking place outside of MHCs, the issues of voluntariness
and competency are believed to be applicable not only to MHCs but also to
decentralized diversion.
Some features inherent to diversion increase participants’ likelihood to
experience competency issues. By definition, participants of diversion pro-
grams are mentally ill. Frequently, these defendants are expected to make deci-
sions about their involvement in diversion dispositions after they have been
arrested and spent time in jail without receiving the appropriate treatment for
their mental health needs (Bazelon Center for Mental Health Law, 2003). Such
decisions are therefore made under significant stress and time pressure and
often result in decisions that are not fully informed or voluntary (Erickson,
Campbell, & Lamberti, 2006; Redlich et al., 2010; Seltzer, 2005).
Since MHC comprehension is related to other legal competencies (Redlich,
2005), it is expected that competency to participate in a MHC would be prob-
lematic in a high proportion of the referred cases. For example, according to
Stafford and Wygant (2005), 77.5% of 80 defendants participating in an Ohio
MHC who were referred for competency to stand trial evaluations were found
incompetent, which led the authors to conclude that many of the participants
did not present with the capacity to waive the constitutional rights and to
make the informed decisions required to participate in these courts. A recent
study used the MacArthur Competency Assessment Tool-Criminal Adjudica-
tion (MacCAT-CA; Poythress et al., 1999) to determine whether participants
of two MHCs (Brooklyn MHC and Washoe MHC) experienced impairments
in legal competency. The study found that 16% to 17% of Brooklyn and 9% to
13% of Washoe MHCs participants demonstrated clinically significant impair-
ments in legal competency (Redlich et al., 2010).
The fact that most diversion programs require defendants to enter a plea
of guilty makes competency a relevant forensic issue in diversion evaluations.
The decision to participate in diversion and therefore to enter a plea of guilty
must be “knowing, intelligent, and voluntary” (Melton et al., 2007). In order
for a defendant to make an informed decision regarding his plea and diver-
sion, he must understand all of the conditions of the plea agreement, including
the particular requirements of the diversion program, the release of confiden-
tial information, the consequences of noncompliance including the alternative
sentence, and the alternative courses of legal action (Redlich et al., 2010). It is
also important for the defendant to understand the requirements of the treat-
ment plan being designed, including whether he or she would be required to
attend outpatient or residential treatment or to comply with psychiatric medi-
cations. In addition, defendants usually do not understand that the judge has
discretion over the monitoring period and therefore can extend it if partici-
pants are not fully compliant with treatment and that the time completed in
treatment does not count toward the alternative sentence.
Under Godinez v. Moran (1993), the United States Supreme Court decided
that the legal standard for competency to plead guilty is not higher than
competency to stand trial (CST) in general, although in practice the specific
decisions and decision-making capacities may be different. Decision making
associated with MHCs take into account elements of both general compe-
tency to stand trial and evaluation of a decision to plead guilty. Redlich (2005)
has argued that the constructs of understanding, reasoning, and apprecia-
tion that define adjudicative competence and competence to make treatment
decisions can also be used to define comprehension in the context of MHCs.
She pointed to a number of diversion characteristics that participants need to
comprehend, such as entering a guilty plea, agreeing to engage in treatment,

and consenting to release confidential records to the court. In reference to
reasoning, participants need to consider the repercussions of enrolling versus
not enrolling. Participants also need to appreciate the consequences of drop-
ping out, violating the conditions, or successfully graduating from the court.
Redlich et al. (2010) found that, although most participants of the Brooklyn
and Washoe MHCs understood the basic components of the MHC, few fully
understood more nuanced details. For example, more than half of the partici-
pants reported not knowing that the choice to enroll and therefore plead guilty
was voluntary. It is important to note that frequently a defendant being con-
sidered for diversion does not meet with a mental health professional until he
is being examined for diversion eligibility. Therefore, the clinician conducting
the diversion evaluation may be the first mental health professional to come
in contact with the defendant. As a result, as part of the diversion evaluation,
forensic clinicians should assess whether the defendant understands the volun-
tary nature of his choice and “screen” for adjudicative competency. Examiners
should fully explain to defendants the specific requirements of the diversion
program including the treatment plan, and the voluntary nature of the deci-
sion, and should assess whether the presence of active psychiatric symptoms
or cognitive disabilities may preclude examinees from making knowingly
intelligent and voluntary decisions regarding diversion.
Although a diversion evaluation is clearly not a CST evaluation, forensic eval-
uators who have reasonable doubt about the defendant’s competency to proceed
should raise the competency question to the referral source and recommend that
an adjudicative competency evaluation be ordered. Conversely, if the examiner
does not believe that competency is an issue, this should clearly be stated in the
report, as well as whether the examiner believes that the defendant understands
the voluntary nature of their choice. Assessing these functional legal capaci-
ties as part of the diversion evaluation would hopefully decrease the chances
of engaging in violations of defendants’ due process by minimizing the number
of incompetent participants who enter guilty pleas as a condition of diversion.
Finally, from a clinical perspective, voluntariness is also critical. The greater
the understanding and perception of fairness, the better defendants do within
diversion programs. It is recommended that, given different alternatives in
terms of types of treatment modality, participants be given a choice. Feeling
like they have a choice in the type of treatment that they are mandated to
attend likely increases perceptions of procedural justice (e.g., the degree to
which defendants feel like they have a voice and are heard; Lind & Tyler, 1988),
which in turn is related to MHC graduation and reduced recidivism (Redlich
& Han, 2014). Similarly, the better the insight into at least what treatment they
are agreeing to and the need to comply with a court mandate (if applicable),
the more likely defendants are to complete the program successfully.
Violence Risk Individuals charged with violent offenses are increasingly

being considered for participation in diversion programs. In fact a “second
generation” of MHCs that accept more felonies has been identified (Redlich
et al., 2005). These individuals typically face longer prison sentences if violated
by the diversion program (Barber-Rioja, Dewey, Kopelovich, & Kucharski,
2012), and jail is more often used as a sanction for noncompliance (Relich,
2005). The goal of diverting individuals with mental illness from the criminal
justice system should not take place at the expense of public safety (Barber-
Rioja et al., 2012); therefore, evidence-based violence risk assessment should
also be incorporated into diversion evaluations. In this context, the question is
not one of violence prevention but violence management. The question faced
by diversion evaluators is not only what is the level of risk of a given defendant
but also whether that level of risk can be managed in the community with
the resources available in that jurisdiction. Since the focus is more on risk
management and therefore on dynamic risk factors, the use of Structured
Professional Judgment (SPJ) tools like the HCR-20 is recommended (as
opposed to actuarial tools). This tool has also been shown to be useful in
predicting diversion compliance (Barber-Rioja et al., 2012).
Criminogenic Factors Research has shown that MHCs are effective in

reducing recidivism (Anestis & Carbonell, 2014; Burns, Hiday, & Ray, 2012;
Hiday, Wales, & Ray, 2013; Linhorst & Linhorst, 2012; Ray, 2014), despite no
consistent evidence that diversion programs lead to a significant reduction
in psychiatric symptoms (Boothroyd, Mercado, Poythress, Christy, & Petrila,
2005; Cosden, Ellens, Schnell, Yamini-Diouf, & Wolfe, 2003; Steadman &
Naples, 2005). This lack of symptom reduction suggests that decreases in
reincarceration reported by diversion programs may be due to something
other than mental health treatment. Research has suggested that offenders
with mental illness share the same risk factors as those without mental illness
(Epperson et al., 2011; Skeem & Louden, 2013). In fact, it has been argued that
some negative recidivism outcomes found in interventions that target offenders
with mental disorders may be a result of overreliance on clinical treatment
(Wolff et al., 2013). It is now widely accepted that to attain rehabilitation for
offenders with mental illness, diversion programs should focus their efforts not
only on mental health needs but also on criminogenic risk factors that provide
a range of psychosocial supports (Edgely, 2014). Probably the conceptual
model most frequently used by programs designed to reduce recidivism that
addresses criminogenic factors is the Risk-Needs-Responsivity model (RNR;
Andrews, Bonta, & Wormith, 2011). Although not specifically developed for
offenders with mental disorders (Morgan et al., 2011), its authors argue that
since predictors of general recidivism are almost the same for offenders with
and without mental disorders, RNR can be applied to both groups (Bonta,
Law, & Hanson, 1998). There is evidence that the RNR model and associated
needs are relevant for offenders with mental disorders (Bonta, Blais, & Wilson,
2014; Fass, Heilbrum, Dematteo, & Fretz, 2008; Skeem & Louden, 2013) and
therefore should also be evaluated.
Treatment/Management Planning If the forensic evaluator conducting

the diversion evaluation decides that the defendant is eligible for diversion,
a treatment/management plan that addresses psychiatric/substance abuse
issues, as well as risk factors for violence and recidivism (e.g., criminogenic
factors), should be clearly delineated. It is also important to note that diversion
evaluations frequently have a different audience; although such reports are
prepared primarily for the courts, they are also used to refer individuals to
treatment in the community, making this part of the evaluation critical as it
informs community providers and case managers about the expectations of the
court mandate. The examiner should be knowledgeable about the treatment
resources available in the community; recommending treatment modalities that
are not feasible or not available in the community is not helpful to the courts.
It is recommended that the management plan be organized as suggested by
the HCR-20 V3 manual, which includes delineating four basic types of activi-
ties: monitoring, supervision, treatment, and victim safety planning (Kroop,
Hart, Lyon, & Lepard, 2002). Monitoring refers to using surveillance to evalu-
ate changes in risk over time so that risk management strategies can be modi-
fied accordingly. Diversion monitoring strategies typically involve face-to-face
meetings with case managers, regular urine toxicology exams, and regular court
hearings. The MHC or diversion judge has been identified as an essential ele-
ment that promotes the rehabilitation of the offender with mental illness through
the establishment of a therapeutic alliance (Edgely, 2014). As a result, frequent
supervisory status hearings should be included as a monitoring strategy.
Treatment refers to any rehabilitative services, such as substance abuse or
mental health treatment, vocational services, psychiatric medications, or trauma-
informed counseling. Supervision refers to any restrictions in movement that
limit the opportunities for the individual to engage in violence or criminal activi-
ties. In the context of diversion, this can include a curfew and order of protection,
admission into detox or drug rehabilitation programs, or psychiatric hospital-
izations. Finally, victim safety planning should be delineated when the instant
offense involved a victim, and it should include steps to be taken to protect the
victim when management strategies have failed (Kroop et al., 2002).
Interview
Regardless of the referral source, prior to conducting a diversion evaluation,
the defense attorney should always be informed that his or her client has
been referred for a diversion evaluation and will be interviewed. Sometimes
the attorney may not believe that diversion is in the client’s best interest and
may refuse to consent to the evaluation. For risk assessment purposes, diver-
sion evaluations may elicit information about the instant offense that may be
incriminating if the case is resolved through trial. A review of records, such
as the defendant’s criminal history, medical records, criminal complaint, and
interview with collateral sources of information is necessary to corroborate the
defendant’s self-report and also to obtain information about his or her history
of treatment compliance, the prior response to supervision or court-mandated
treatment, and the presence or absence of social supports in the community.
Prior to the beginning of the evaluation, the defendant should be informed
of the purpose of the interview (e.g., to decide eligibility for diversion), the
voluntary nature of the decision to participate if found eligible, and the limits
of confidentiality. Diversion evaluations often require more than one meet-
ing. During the first meeting, the evaluator gathers the information that deter-
mines eligibility and, during the second meeting, a treatment/management
plan is presented to the eligible client.
The interview requires collecting psychosocial background and a thor-
ough developmental history, including history of abuse or trauma, school and
employment, past and current relationships, psychiatric diagnoses and treat-
ment, substance abuse involvement, and criminal activities. Risk assessment
tools should be used to gather information that identifies violence and crimi-
nogenic risk factors. The interview should also include a thorough mental sta-
tus examination, psychological testing for diagnostic clarification, assessment
of cognitive limitations or intellectual disabilities, and screening for evidence
of malingering.
During the interview the examiner should also gather information about
the client’s insight into his/her mental illness/substance use, triggers for crimi-
nal behavior, and motivation for treatment.
Report Writing
The written report should start with identifying and referral information, fol-
lowed by the sources of information used, the purpose of the interview, and
the limits of confidentiality. In this section the examiner may also include
whether the client appears competent to proceed with the interview and
whether he or she understands the voluntary nature of the decision to partici-
pate in diversion.
The sections that follow provide all relevant background information, an out-
line of the mental status examination, results of any psychological tests, diag-
nostic impressions needed to meet the requirement for diversion eligibility, a
violence risk assessment, and an assessment of recidivism risk. It is the authors’
experience that the risk information must be documented both honestly and
carefully, taking into account the audience (e.g., courts and treatment providers).
If the risk information is not contextualized and associated immediately with the
risk management strategy to mitigate the risk, readers will often become inap-
propriately concerned. The final sections should include an opinion regarding
whether the client is eligible for diversion, based on all the prior sources of infor-
mation reviewed, and a thorough delineation of the recommended treatment/
management plan that will be put into effect if a plea is entered.
Case Vignette
The following case study is meant to highlight aspects of a diversion evaluation,
which incorporates recommendations for the best practices described previously.
All identifying information has been changed.
Reason for Referral

Ms. Johnson was a 26-year-old Caucasian, single, incarcerated female, diag-
nosed with Schizophrenia and Alcohol Use Disorder by the County Jail’s health
services. She was currently charged with arson in the second degree. Ms. John-
son was referred by the district attorney’s office for a psychological evalua-
tion specifically with the purpose of determining her eligibility for diversion
and providing treatment/monitoring recommendations accordingly. Prior to
the interview, Ms. Johnson was informed that the purpose of the interview
was to determine her eligibility for mandated treatment in the community in
lieu of incarceration. She was also informed of the plea requirement and the
voluntary nature of her decision to participate in a diversion option versus
regular criminal proceedings. Ms. Johnson was also informed of the limits of
confidentiality, specifically that the results of the evaluation would be reported
to her defense attorney, prosecutor, judge, and, if deemed eligible for diver-
sion, treatment providers in the community as well. Ms. Johnson appeared to
understand the limits of confidentiality and the voluntary nature of a diversion
option, and the interview proceeded on that basis.

In addition to a clinical interview and testing session of about four hours con-
ducted by a licensed psychologist, the following records were reviewed: medi-
cal records of three psychiatric hospitalizations at a city hospital, the criminal
complaint, and the defendant’s criminal record. Additional collateral informa-
tion was also obtained from Ms. Johnson’s mother over the telephone.
The case vignette has been redacted and all identifying information removed. It is not
meant to serve as a forensic report. Any likeness to a case is purely coincidental.

Background Information was obtained from Ms. Johnson’s mother, a review of
records and Ms. Johnson’s self-report.
Ms. Johnson was born in San Jose, California, and raised by both parents
until the age of 16. She has no siblings. Her father worked in construction
and her mother was a homemaker. She described an upbringing significant for
witnessing violence and being sexually abused. Ms. Johnson’s father suffered
from an addiction to alcohol and would frequently beat Ms. Johnson’s mother.
In addition, Ms. Johnson was sexually abused by her father’s brother from ages
9 to about 12. Escaping from the abuse, Ms. Johnson moved with her mother
to New York to reside with an aunt when Ms. Johnson was 16 years of age. She
reported that her grandmother is diagnosed with Schizophrenia.
Ms. Johnson reported that she experienced learning problems in school and
was placed in special education classes at an early age. However, she attended
school and passed all her classes until the age of 14 when she began showing
up to class intoxicated. Ms. Johnson began drinking alcohol with her father at
the age of 14 and said that she became addicted shortly after. At the age of 15,
while in the tenth grade, Ms. Johnson was expelled from school for cutting
classes. Once in New York, Ms. Johnson had several odd jobs waiting tables and
cleaning houses. However, she was fired from most jobs due to alcohol intoxi-
cation. At the age of 17, Ms. Johnson attended her first alcohol detoxification
and rehabilitation programs at the request of her mother. However, her mother
said that she relapsed within a week of completing the program. While in the
rehabilitation program, Ms. Johnson met a man with whom she maintained
a sexual relationship and became pregnant. She gave birth to her daughter at
18 years of age. Ms. Johnson’s daughter was removed from her custody by social
services shortly after her birth due to Ms. Johnson’s continuous alcohol use.
Ms. Johnson was first admitted into a psychiatric hospital at 20 years of
age after her mother called 911 because she was talking to herself and voic-
ing paranoid ideation (e.g., believing that there were cameras in their house).
She was admitted for one month and prescribed antipsychotic medications.
Ms. Johnson did not follow up with medications or outpatient treatment and
continued drinking once discharged. She was admitted four more times from
20 to 26 years of age in different local hospitals for periods ranging from one
to six months. She has no significant medical conditions.
Ms. Johnson has a history of one prior arrest, also for arson in the second
degree. This charge was eventually reduced to arson in the third degree, and
she was sentenced to time served after ten months in the local jail. With respect
to the instant offense, Ms. Johnson was accused of having placed papers under
a neighbor’s door after lighting them on fire. No injuries were reported but the
building had to be evacuated. Ms. Johnson reported that she was intoxicated
and began hearing voices telling her to set things on fire. Ms. Johnson related a
similar account of the events that led to her prior arson charge. Since her arrest
and incarceration nine months ago, Ms. Johnson was compliant with medica-
tion and free of acute psychopathology.
Ms. Johnson’s mother reported that Ms. Johnson is a calm and sweet per-
son when she is sober but that she becomes agitated when drunk. She also
said Ms. Johnson hears voices at times and becomes paranoid that there are
people out to hurt her and kill her and that people can hear her thoughts.
Ms. Johnson’s mother was not able to identify a significant period of time
during which Ms. Johnson was sober except for her nine-month pregnancy.
She stated that she never fully complies with the hospitals’ discharge plans
because she relapses on alcohol shortly after leaving the hospital. She denied
that Ms. Johnson has ever engaged in any acts of physical aggression or
antisocial behaviors. She denied that Ms. Johnson has ever engaged in any
fire-setting behaviors or voiced any fascination with fire. She corroborated
a family history of Schizophrenia.
A review of records from her hospitalizations indicated that Ms. Johnson
was consistently intoxicated prior to admission into the hospital. However,
it appears that symptoms of psychosis, such as auditory hallucinations and
paranoid delusions, remained for significant periods of time after she had been
detoxed from alcohol. For example, on one occasion Ms. Johnson endorsed
psychotic symptoms for almost three months after admission to the hospital.

During the interview Ms. Johnson presented as a white female of average
height and weight who appeared her stated age. She was dressed in jail attire,
and her hygiene and grooming were appropriate. She was cooperative and
calm during the interview. She related oddly with her interviewers but main-
tained good eye contact. She was alert and oriented across all spheres. Psycho-
motor activity and speech were within normal limits. Her thought process was
logical and goal-directed with no evidence of thought disorder. She reported
her mood as “OK.” Her observed affect was euthymic (neutral), constricted in
range, and appropriate to the content of conversation. She denied any visual or
auditory hallucinations, and no psychotic delusions were elicited. She reported
that she was currently complying with psychiatric medications prescribed by
the jail (Risperdal, an antipsychotic). She denied any suicidal or homicidal
ideation. Ms. Johnson impressed as functioning at a below average range of
intelligence. Her judgment and impulse control during the interview were
grossly intact. She demonstrated adequate insight into her alcohol use disor-
der but poor insight into her auditory hallucinations, her paranoid delusions,
and the symptom improvement that she experiences when complying with
medications. She expressed adequate insight into the reasons for her arrest
(e.g., connection between getting drunk and setting things on fire) but not into
her difficulties remaining sober or complying with treatment.
Given Ms. Johnson’s apparent cognitive limitations (e.g., concrete thinking),
she was administered the Wechsler Adult Intelligence Scale, Fourth Edition
(WAIS-IV), an individually administered test of a person’s intellectual func-
tioning and cognitive strengths and weaknesses. On this test, she obtained a
Full Scale IQ (FSIQ) within the borderline range. Although no significant dis-
crepancies were found among the four indices that composed the FSIQ, her
performance was significantly low on measures of verbal abilities that required
reasoning, comprehension, and conceptualization. To ensure that Ms. J ohnson
put forth adequate effort, prior to the administration of the WAIS-IV, she was
administered the Test of Memory Malingering (TOMM), a forced-choice
visual discrimination task designed to differentiate between feigned and genu-
ine memory impairment that is also sensitive to motivation and effort. On this
test, Ms. Johnson scored above the cutoff for suspected malingering, suggest-
ing that the results of the WAIS-IV were a valid representation of her actual
level of intellectual functioning.
Exaggeration of psychiatric symptoms was not suspected and, in fact, Ms.
Johnson minimized some of her symptoms. As a result, no test for the assess-
ment of malingering of psychiatric symptoms was considered necessary. In
addition, a review of medical records provided ample evidence of Ms. John-
son’s psychiatric symptoms and diagnoses. No further psychological testing
was required.
Since Ms. Johnson’s index offense was a violent felony, a violence risk assess-
ment was indicated and conducted via use of the HCR-20 V3. In addition, to
assess for criminogenic needs, the Level of Service/Case Management Inven-
tory (LS/CMI; Andrews et al., 2004) was administered. The LS/CMI is a tool
developed to assess criminogenic needs of offenders.
Clinical Summary and Opinions

Ms. Johnson was a 26-year-old Caucasian, incarcerated female with a history
of Schizophrenia and Alcohol Use disorder, who was referred by the district
attorney’s office for a psychological evaluation to determine her eligibility for
diversion. Based on a culmination of clinical interviews, behavioral observa-
tions, testing, and collateral information, the following conclusions were made:
Ms. Johnson was cooperative and forthcoming during the interview. There
was no evidence that she attempted to exaggerate or grossly minimize her
presentation. Despite her cognitive limitations, she appeared to understand

the limits of confidentiality and the voluntary nature of her decision to par-
ticipate in diversion. No acute psychiatric symptoms were observed that could
interfere with her competency to enter a plea of guilty at this time.
Diagnostically, Ms. Johnson’s primary problem was a long and severe his-
tory of alcohol use that probably originated as a result of both a biological
predisposition (father’s history of alcohol use) and environmental factors
(drinking with his father and sexual abuse history). However, in addition to
this, there was evidence that she suffered from symptoms consistent with a
diagnosis of Schizophrenia (e.g., auditory hallucinations and paranoid delu-
sions). A review of records provided some evidence that Ms. Johnson had
experienced psychotic symptoms while the effects of intoxication had sub-
sided, making it likely that she also suffered from a psychotic disorder that
became exacerbated when intoxicated. In addition, her chronic symptoms are
unusual for mere intoxication or alcohol-related psychosis, although they may
be more intensely experienced or expressed behaviorally when intoxicated.
Supporting this hypothesis is the fact that Ms. Johnson has a family history of
Schizophrenia. Results of testing indicated that Ms. Johnson functioned within
the Borderline level of intellectual functioning and demonstrated impairments
in her ability to process ideas that involved complex concepts and to general-
ize information. Given her difficulties thinking beyond what was presented as
concrete concepts, once a treatment/management plan was developed and a
plea agreement is negotiated, it was recommended that verbal stimuli be pre-
sented to her in simpler terms and that complex concepts would be repeated
several times until she demonstrated understanding.
Using the structure of the HCR20 V3, the following were identified as rele-
vant violence risk factors for Ms. Johnson: a history of problems with violence
(e.g., arson), traumatic experiences, substance abuse, mental illness, unem-
ployment, and treatment compliance, as well as recent problems with insight.
Given her fire-setting instant offense, programs may be reluctant to house
her, and as such, she would likely experience problems securing structured
community placement—the first of the Risk Management risk factors, that is,
problems with professional services. In addition, her past history indicated
she likely had experienced difficulty with treatment and supervision response
and with coping with stress. On the other hand, Ms. Johnson had a limited
repertoire of dangerous activity, within a very specific context. Her only acts of
violence were setting things on fire and, on both occasions, she was intoxicated
and likely experiencing an exacerbation of symptoms of Schizophrenia due to
treatment noncompliance. Thus, while her risk for violence and in particu-
lar for fire-setting behavior was high in the context of noncompliance with
treatment and intoxication, if she was sober and psychiatrically stable, the risk
would be significantly diminished.
With respect to criminogenic risk, the LS/CMI was used to identify the fol-
lowing risk factors in need of intervention: lack of leisure and recreation, lack
of achieving in education and employment, family problems (lack of custody
of her daughter), and alcohol use. There was no evidence that Ms. Johnson had
a procriminal attitude or orientation or an antisocial pattern.
Given the presence of a co-occurring psychiatric and substance use disor-
der, as well as a level of risk that was considered manageable in the community
under appropriate treatment and supervision, the psychologist concluded that
she is eligible for diversion, and the following management plan was recom-
mended to address her needs:
Treatment Ms. Johnson was primarily in need of substance abuse treatment.

She was detoxed from alcohol while in jail and at this point had been sober in a
controlled environment for a period of nine months. Ms. Johnson had attended
several rehabilitation programs lasting between 28 to 30 days. At this time of the
evaluation, given her charge, no residential treatment program would accept her
in the jurisdiction where she resided. Therefore, intense outpatient treatment
for substance abuse was recommended. Given her long and severe alcohol use
disorder and unsuccessful attempts to quit, pharmacological treatments for
substance-related disorders such as Naltrexone or Antabuse were considered. In
addition, it was recommended that Ms. Johnson should be seen by a psychiatrist
for medication reevaluation once she was discharged. Furthermore, her history
of trauma suggested that she would benefit from trauma-informed care and
individual counseling. To further address her criminogenic needs, Ms. Johnson
expressed interest in vocational training. In addition, it was recommended that
her counselor explore different options for leisure and recreation. Ms. Johnson
expressed a desire to obtain rights to visit her daughter who was currently in
foster care. Therefore, it was recommended that her case manager assist her in
determining the expectations and if this was a feasible option.
Monitoring Given the increased risk that Ms. Johnson posed if she relapsed
back to abusing alcohol, it was recommended that she be tested initially twice
a week and meet face-to-face with her case manager on a weekly basis to
reassess her mental status and level of risk. Due to her difficulties with verbal
comprehension and abstract thinking, it was recommended that her case
manager provide specific written instructions listing all of her appointments
and plea requirements. In addition, since this is the first time that Ms.
Johnson would be in court-mandated treatment, frequent court hearings were
recommended.
Supervision According to the mother, Ms. Johnson tended to engage in

drinking at night when she left the house at about 5:00 p.m. to go to bars or
friends’ houses and returned home at 2:00 or 3:00 a.m. intoxicated. As a result,
a curfew is initially recommended until Ms. Johnson is able to remain sober
for a significant period of time in the community.

One of the most common mistakes made by evaluators when conducting
diversion evaluations is to not be familiar with the forensic issues or the eligi-
bility for diversion within the specific jurisdiction. In this evaluation, the first
relevant forensic issue that needed to be addressed was whether Ms. Johnson
met clinical eligibility for mental health diversion. In the jurisdiction where
this evaluation took place, a finding of mental illness by itself is not enough to
be considered for mental health diversion; in addition, the individual needs to
suffer from a psychiatric disorder (other than a substance use disorder) that
meets criteria for a designation as Seriously Mentally Ill (SMI), meaning that
the individual experiences significant impairment in functioning as a result of a
psychiatric disorder (other than a personality disorder) and is not able to func-
tion in the community without psychosocial rehabilitation efforts. In this case,
the fact that Ms. Johnson had been using alcohol for a prolonged period of time
with no significant periods of sobriety, made it difficult to determine whether
psychotic symptoms were always induced by alcohol or were a result of an
independent psychotic disorder. This distinction is important in the context of
diversion because it determines eligibility and informs treatment planning. If it
were determined that her psychotic symptoms were all alcohol induced, trans-
fer to a drug treatment court or a substance abuse diversion program could be
recommended. Such programs typically manage cases differently, with more
of an emphasis on sanctions and rewards (National Association of Drug Court
Professionals, 1997) and less emphasis on medication compliance. Since Ms.
Johnson does not have appropriate insight into her psychotic symptoms and
was not a good historian when it came to her reasons for hospitalization (e.g.,
she only identified being drunk), a review of records was crucial when clarify-
ing her diagnosis and the interplay between her mental illness and alcohol use
disorder. Psychological testing was necessary to determine her actual level of
cognitive functioning. Her borderline intellectual level made it difficult for her
to understand and appropriately process the requirements of the plea agree-
ment, and it was the opinion of the evaluator that it could interfere with her
ability to follow all of the requirements of post-plea treatment and monitoring.
As a result, potential noncompliance post-plea may be interpreted as resulting
from a lack of interest and therefore leading to a violation of the plea condi-
tions and potential incarceration, as opposed to understanding her noncom-
pliance as an inability to comprehend instructions. Identifying her cognitive
limitations may change the expectations of compliance for the courts and also
inform the treatment providers so that they can adjust treatment accordingly.
Failing to identify significant cognitive impairment throughout the diversion
evaluation process can have significant negative consequences for individuals
(e.g., violation and resulting incarceration).
It is also very important for evaluators to be familiar with the standards
of competency within the jurisdiction so that they can screen for whether
the detainee may need a competency evaluation prior to making decisions
regarding a plea to diversion. Evaluators should also make sure that the cli-
ents understand the voluntary nature of the decision. In this case, despite her
cognitive limitations, Ms. Johnson appeared to understand the limits of confi-
dentiality, the purpose of the evaluation, the concept of diversion, and the fact
that she had a choice not to participate. The assessment of cognitive limita-
tions informed her defense attorney how to communicate with this client (e.g.,
repeat concepts several times and express them in simpler terms) as the plea
negotiation proceeded and her choices became more complicated (e.g., learn-
ing the prison sentence that she would face in case of noncompliance [fifteen
years in her case], or the period of time that she was expected to comply with
court-mandated treatment).
Evaluators should recognize that public safety is a very important part
of diversion, and as a result, providing a diagnostic evaluation may not be
enough to aid the courts when making diversion decisions. Ms. Johnson did
not provide much information in reference to her motivations for engaging in
fire setting, other than that she was intoxicated and hearing voices. She also
did not provide an explanation of why she chose to set something on fire ver-
sus any other behavior responding to auditory hallucinations. A review of the
criminal complaints suggested that in both situations her behaviors appeared
random in that she did not know the neighbor, did not appear to be targeting
anyone in particular, and presented as intoxicated when interrogated by the
police. A sole review of the criminal records would have revealed one arson
conviction and a current arrest for arson, which would have provided no
information about her actual level of risk or what steps, if any, could be taken
to prevent her from engaging in this behavior again. In addition, without plac-
ing the behavior into context (e.g., a risk assessment), it is likely that no treat-
ment provider in the community, including outpatient programs, would have
agreed to accept her.
As previously noted, risk communication is particularly important in the
context of diversion and, if the participant is found eligible, communication
of levels of risk for violence should be directly linked to the management
interventions. A challenge in this case was the fact that her charge made it
impossible for her to be admitted into residential treatment, which may have
been a good option given her long history of noncompliance with outpatient
treatment. When determining whether her level of risk was manageable in the
community given her long history of noncompliance, the evaluator consid-

ered whether any intervention that had not been tried before was available.
Ms. Johnson had never been under any court-mandated treatment or judicial
supervision. The court monitoring and supervision, as well as the knowledge
of the jail time being faced, can motivate individuals to comply with treatment.
In addition, Ms. Johnson had never tried any pharmaceutical interventions
for the treatment of alcohol use, which was thus recommended as part of her
treatment. Monitoring considerations, such as frequent face-to-face meetings
with her case manager, urine toxicologies, and court hearings, were made
based on her risk factors and the lack of appropriate resources in the commu-
nity (e.g., residential treatment).
Finally, evaluators need to be able to communicate risk for recidivism as
involving a different set of risk factors than those related to risk for violence.
Evaluators must be able to identify areas for which targeted interventions can
reduce rearrest. To this end, familiarity with the offender rehabilitation lit-
erature and identification of dynamic offender needs that are changeable with
intervention are essential. In the case described above, Ms. Johnson’s crimino-
genic needs were assessed through the use of the LS/CMI. She was not consid-
ered to be at high risk for recidivism as long as she remained sober and free of
psychotic symptoms, but her criminogenic needs were incorporated into the
management plan.
References
Amrhein, C., & Barber-Rioja, V. (2010). Jail diversion models. In S. A. Estrine, R. T. Hetten-
bach, H. Arthur, & M. Messina (Eds.), Service delivery for vulnerable populations: New
directions in behavioral health (pp. 329–352). New York, NY: Springer.
Andrews, D. A., Bonta, J., & Wormith, J. S. (2011). The risk-need-responsivity (RNR)
model: Does adding the good lives model contribute to effective crime prevention?
Criminal Justice and Behavior, 38, 735–755. doi:10.1177/0093854811406356
Anestis, J. C., & Carbonell, J. L. (2014). Stopping the revolving door: Effectiveness of mental
health court in reducing recidivism by mentally ill offenders. Psychiatric Services, 65,
1105–1112. doi:10.1176/appi.ps.201300305
Barber-Rioja, V. (2009). An examination of predictive variables of success in mental health
diversion programs (Doctoral dissertation). Retrieved from ProQuest Dissertations &
Theses Database. (3378542).
Barber-Rioja, V., Dewey, L., Kopelovich, S., & Kucharski, L. T. (2012). The utility of
the HCR-20 and PCL:SV in the prediction of diversion noncompliance and rein-
carceration in diversion programs. Criminal Justice and Behavior, 39, 475–492.
doi:10.1177/0093854811432609
Barber-Rioja, V., & Rotter, M. (2015). Diversion programs and alternatives to incarceration.
In R. Trestman, K. Appelbaum, & J. Metzner (Eds.), Oxford Textbooks in Psychiatry:
Oxford Textbook of Correctional Psychiatry. New York, NY: Oxford University Press.
Barr, H. (1999). Prisons and jails, hospitals of last resort: The need for diversion and discharge
planning for incarcerated people with mental illness in New York. New York, NY: Correc-
tional Association of New York and the Urban Justice Center.
Bonta, J., Law, M., & Hanson, K. (1998). The prediction of criminal and violent recidivism
among mentally disordered offenders: A meta-analysis. Psychological Bulletin, 123,
123–142.
Boothroyd, R. A., Mercado, C. C., Poythress, N. G., Christy, A., & Petrila, J. (2005).
Clinical outcomes of defendants in mental health court. Psychiatric Services, 56,
829–834.
Broner, N., Borum, R., & Gawley, K. (2002). Criminal justice diversion of individuals with
co-occurring mental illness and substance use disorders: An overview. In G. Landsberg,
M. Rock, L. Berg & A. Smiley (Eds.), Serving mentally ill offenders: Challenges and oppor-
tunities for mental health professionals (pp. 83–106). New York, NY: Springer.
Burns, P. J., Hiday, V. A., & Ray, B. (2012). Effectiveness 2 years postexit of a recently
established mental health court. American Behavioral Scientist, 57, 189–208.
doi:10.1177/0002764212465416
Cosden, M., Ellens, J. K., Schnell, J. L., Yamini-Diouf, Y., & Wolfe, M. M. (2003). Evaluation
of a mental health treatment court with assertive community treatment. Behavioral Sci-
ences and the Law, 21, 415–427. doi:10.1002/bsl.542
The Council of State Governments (CSG), Justice Center. (2014). Mental health courts.
Retrieved from http://csgjusticecenter.org/mental-health-court-project/
Edgely, M. (2014). Why do mental health courts work? A confluence of treatment, support
& adroit judicial supervision. International Journal of Law and Psychiatry, 37, 572–580.
doi:10.1016/j.ijlp.2014.02.031
Epperson, M., Wolff, N., Morgan, R., Fisher W., Frueh, B. C., & Huening, J. (2011). The next
generation of behavioral health and criminal justice interventions: Improving outcomes by
improving interventions. New Brunswick, NJ: Center for Behavioral Health Services &
Criminal Justice Research: Rutgers University.
Erickson, S. K., Campbell, A., & Lamberti, J. S. (2006). Variations in mental health courts:
Challenges, opportunities, and a call for caution. Community Mental Health Journal, 42,
335–344. doi:10.1007/s10597-006-9046-7
Godinez v. Moran, 509 U.S. 389 (1993).
Hart, S. D. (2002). Commentary: The forensic relevance of personality disorder. Journal of
the American Academy of Psychiatry and the Law, 30, 510–512.
Heilbrun, K. (2001). Principles of forensic mental health assessment. New York, NY: Kluwer
Academic/Plenum.
Heilbrun, K. (2009). Evaluation for risk of violence in adults. New York, NY: Oxford Uni-
versity Press.
Heilbrun, K., Grisso, T., & Goldstein, A. M. (2009). Foundations of forensic mental health
assessment. New York, NY: Oxford University Press.
Hiday, V. A., Wales, H. W., & Ray, B. (2013). Effectiveness of a short-term mental health
court: Criminal recidivism one year postexit. Law and Human Behavior, 37, 401–411.
doi:10.1037/lhb0000030
Jordan, B. K., Schlenger, W. E., Fairbank, J. A., & Caddell, J. M. (1996). Prevalence of psychi-
atric disorders among incarcerated women: Convicted felons entering prison. Archives
of General Psychiatry, 53, 513–519.
Lind, E. A., & Tyler, T. R. (1988). The social psychology of procedural justice. New York, NY:
Plenum Press.
Linhorst, P. A., & Linhorst, D. M. (2012). Recidivism outcomes for suburban mental
health court defendants. American Journal of Criminal Justice, 37, 76–91. doi:10.1007
/s12103-010-9092-0
Lotze, E., Clark, J., Henry, D. A., & Juzkiewicz, J. (1999). The pretrial services reference book.
Washington, DC: Pretrial Services Resource Center.
for the courts: A handbook for mental health professionals and lawyers. New York, NY:
The Guilford Press.
Miller, H. A. (2001). M-FAST: Miller Forensic Assessment of Symptoms Test and professional
manual. Odessa, FL: Psychological Assessment Resources.
Morgan, R. D., Flora, D. B., Kroner, D. G., Mills J. F., Varghese, F., & Steffan, J. S. (2012).
Treating offenders with mental illness: A research synthesis. Law and Human Behavior,
36, 37–50. doi:10.1037/h0093964
Ogloff, J. R. P., & Davis, M. R. (2004). Advances in offender assessment and rehabilitation:
Contributions of the risk-needs responsivity approach. Psychology, Crime & Law, 10,
229–242. doi:10.1080/10683160410001662735
Petrila, J. (2003). An introduction to special jurisdiction courts. International Journal of
Law and Psychiatry, 26, 3–12.
Poythress, N. G., Nicholson, R., Otto, R. K., Edens, J. F., Bonnie, R. J., Monahan, J., & Hoge,
S. K. (1999). The MacArthur Competence Assessment Tool—Criminal Adjudication.
Odessa, FL: Psychological Assessment Resources.
Poythress, N. G., Petrila, J., McGaha, A., & Boothroyd, R. (2002). Perceived coercion and
procedural justice in the Broward mental health court. International Journal of Law and
Psychiatry, 25, 517–533. doi:10.1016/S0160-2527(01)00110-8
Ray, B. (2014). Long-term recidivism of mental health court defendants. International Jour-
nal of Law and Psychiatry, 37, 448–454. doi:10.1016/j.ijlp.2014.02.017
Redlich, A. D. (2005). Voluntary, but knowing and intelligent? Comprehension in mental
health courts. Psychology, Public Policy, and Law, 11, 605–619. doi:10.1037/1076-8971
.11.4.605
Redlich, A. D., & Han, W. (2014). Examining the links between therapeutic jurispru-
dence and mental health court completion. Law and Human Behavior, 38, 109–118.
doi:10.1037/lhb0000041
Redlich, A. D., Hoover, S., Summers, A., & Steadman, H. J. (2010). Enrollment in men-
tal health courts: Voluntariness, knowingness, and adjudicative competence. Law and
Human Behavior, 34, 91–104. doi:10.1007/s10979-008-9170-8
Redlich, A. D., Steadman, H. J., Monahan, J., Petrila, J., & Griffin, P. A. (2005). The sec-
ond generation of mental health courts. Psychology, Public Policy, and Law, 11, 527–538.
doi:10.1037/1076-8971.11.4.527
Rogers, R. (1990). Models of feigned mental illness. Professional Psychology: Research and
Practice, 21, 182–188.
Seltzer, T. (2005). Mental health courts: A misguided attempt to address the criminal justice
system’s unfair treatment of people with mental illnesses. Psychology, Public Polity, and
Law, 11, 570–586. doi:10.1037/1076-8971.11.4.570
Stafford, K. P., & Wygant, D. B. (2005). The role of competency to stand trial in mental
health courts. Behavioral Sciences and the Law, 23, 245–258. doi:10.1002/bsl.649
Steadman, H. J., Deane, M. W., Morrissey, J. P., Westcott, M. L., Salasin, S., & Shapiro,
S. (1999). A SAMHSA research initiative assessing the effectiveness of jail diversion
programs for mentally ill persons. Psychiatric Services, 50, 1620–1623.
Steadman, H. J., Morris, S. M., & Dennis, D. L. (1995). The diversion of mentally ill per-
sons from jails to community-based services: A profile of programs. American Journal
of Public Health, 85, 1630–1635.
Steadman, H. J., & Naples, M. (2005). Assessing the effectiveness of jail diversion pro-
grams for persons with serious mental illness and co-occurring substance use disorders.
Behavioral Sciences and the Law, 23, 163–170. doi:10.1002/bsl.640.
Steadman, H. J., Osher, F., Robbins, P., Case, B., & Samuels, S. (2009). Prevalence of serious
mental illness among jail inmates. Psychiatric Services, 60, 761–765.
Teplin, L. A. (1994). Psychiatric and substance abuse disorders among male urban jail
detainees. American Journal of Public Health, 84, 290–293.
Wexler, D. B., & Winick, B. J. (1991). Therapeutic jurisprudence as a new approach to mental
health law policy analysis and research. University of Miami Law Review, 45, 979–1004.
Winick, B. J. (2002). Therapeutic jurisprudence and problem solving courts. Fordham
Urban Law Journal, 30, 1055–1090.
Wolff, N., Frueh, B. C., Huening, J., Shi, J., Epperson, M. W., Morgan, R., & Fisher, W.
(2013). Practice informs the next generation of behavioral health and criminal justice
interventions. International Journal of Law and Psychiatry, 36, 1–10. doi:10.1016/j.ijlp
.2012.11.001
6
Sex Offender Risk Assessment

Angel Daniels, Georgia M. Winters, and Elizabeth L. Jeglic
In the last two decades, there has been heightened public concern about the
potential dangers of sex offenders within the community. Consequently, a
series of laws have been enacted to monitor and contain sex offenders with the
goal of improving community safety (Hanson, 2005). In order for these poli-
cies to be effective, evaluators must be able to assess risk and identify those sex
offenders who would be at higher risk for future offending. Thus, a sex offender
risk evaluation is used to assess the level of risk that an individual poses for
committing additional sexual offenses. The risk assessment is derived from a
variety of sources of data and actuarial information and ultimately provides
information to members of the legal and criminal justice system to assist in
their decisions about the best placement and environment for the offender.
Therefore, a great deal of research and attention has focused on identifying
empirically supported risk factors for sex offender recidivism and developing
evidence-based risk assessment.
Relevant Case Law

As public concern about sex offenders has increased over the last two
decades, the United States has responded with increasingly punitive legisla-
tion and sanctions against them (Edwards & Hensley, 2001; Lussier & Gress,
2013). Compared with those who commit nonsexual crimes, sex offenders
are sentenced to longer periods of incarceration, and their sentences are
increasing over time (Edwards, & Hensley, 2001; Langan & Levin, 2002).
In fact, some states currently allow those convicted of first-degree sexual
assault to be sentenced to life in prison without the possibility of parole,
and others allow for sentencing guidelines to be doubled if the victim of the
sexual offense was a child (Edwards & Hensley, 2001; Levenson, Brannon,
Fortney, & Baker, 2007).
Once convicted of a sex offense, an individual may be subject to any number

of special laws and policies that are directed at sex offenders specifically, and
this individual may experience the impact of these laws and policies long after
his or her incarceration terms have been served. The policies include, but are
not limited to, community registration and notification programs, restrictions
on where the individual may live and work, constant monitoring of an offend-
er’s whereabouts via global positioning systems, and sexually violent predator
statutes (Calkins, Jeglic, Beattey, Ziedman, & Perillo, 2014; Lussier & Gress,
2013). The goal of these policies is to protect the public from sexual offenders
by increasing community surveillance of those who have been released from
prison and incapacitating those who are deemed too dangerous to live in the
community (Lussier & Gress, 2013). It should be noted that these laws are not
without their challenges and criticisms, as these laws have been considered by
some to violate the rights of the offenders and have been blamed for the dif-
ficulties that many offenders experience with reintegration to the community
(Tewksbury & Lees, 2006).
Community Registration and Notification

In response to several highly publicized cases of convicted sexual offenders
recidivating violently against children, Congress passed the Jacob Wetterling
Act and Megan’s Law in the mid-1990s (Calkins et al., 2014; Tewksbury &
Lees, 2006). Together, these laws were aimed at promoting the community’s
awareness of the sex offenders who live among them and preventing recidi-
vism of sex offenders in the community. These laws initiated and formalized
sex offender registration programs and made the information on the registries
publicly available in the hopes that citizens might be empowered to proactively
protect themselves and their children.
In 2006, Congress passed more expansive legislation to bring uniformity
and stricter requirements to the sex offender registration system. The Adam
Walsh Child Protection and Safety Act of 2006 included the Sex Offender Reg-
istration and Notification Act (SORNA), which established national standards
for sex offender registries and included the development of a tiered registra-
tion requirement framework based upon risk and the type of crime comitted
(Visgaitis, 2011). SORNA assigns offenders to one of three tiers, based on the
type of crime that they committed. Tier III requires lifelong registration and
is reserved for the offenders whose crimes were deemed to be most severe,
including sexual contact with a child under the age of 13, kidnapping a minor
(a person under the age of 18) in the course of a sexual offense, sexual assaults
involving sexual acts, or almost any sex offense committed after previously
committing a Tier II offense (Calkins et al., 2014; SORNA, 2006; Visgaitis,
2011). Tier II mandates registration for 25 years, and this tier is used for
Sex Offender Risk Assessment 107
offenders who have committed certain felony crimes against minors, includ-
ing abusive sexual conduct, coercion and enticement, sex trafficking, using a
minor in a sexual performance (i.e., child pornography), soliciting a minor
to engage in prostitution, or producing or distributing child pornography.
Finally, Tier I requires registration for 15 years, and this tier is used for any
offender who has committed a sexual crime that does not fit the criteria for
Tiers II and III, namely, misdemeanor crimes that typically do not involve any
sexual contact (e.g., registration violations, possession of child pornography,
etc.; Calkins et al., 2014; SORNA, 2006; Visgaitis, 2011).
Residence and Employment Restrictions

In 1995, Florida became the first state to pass laws to place limitations on where
convicted sex offenders may live (Galeste, Fradella, & Vogel, 2012). Since then,
over thirty states have approved similar restrictions, which often identify areas
in which convicted sex offenders are prohibited from living, working, or loiter-
ing (Meloy, Miller, & Curtis, 2008). Typically, the laws contain language that
restrict sex offenders from spending significant time near or living or working
within a specified distance from places where children congregate, including
schools, child care centers, parks, churches, bus stops, and certain commercial
businesses (Calkins et al., 2014; Dallas, 2009; Meloy et al., 2008). Some of these
restrictions are so limiting that offenders have found it difficult, if not impos-
sible, to find a place to live and a legitimate job to support themselves that
complies with the contraints. Furthermore, research has strongly indicated
that these restrictions serve to increase stress levels and negatively impact the
social support of offenders in a way that could potentially elevate their risk of
recidivism (Calkins et al., 2014; Levenson & Hern, 2007; Mercado, Alvarez, &
Levenson, 2008).
GPS Monitoring
The use of GPS or other electronic devices to track and monitor sex offenders
began in 1984 in New Mexico and has since been adopted by every other state
(CalGaleste et al., 2012). This particular approach is based on the premise that
offenders may be deterred from engaging in criminal activities or impulsive
behavior if they are being monitored (Galeste et al., 2012). When this approach
is used, certain offenders may be required to wear a GPS transmitter for the
entire term of their supervised release or for a period deemed appropriate by
their probation or parole officer. The transmitter relays information to the pro-
bation or parole officer about offenders’ location, how long they remain in any
given location, and whether they are venturing into locations that are restricted
or off-limits to them (Calkins et al., 2014; Galeste et al., 2012).
Sexually Violent Predator Laws

When an offender is deemed too dangerous or high-risk to live in the commu-
nity, he or she may be subject to Sexually Violent Predator (SVP) legislation.
SVP legislation, generally, may be applied to convicted sex offenders who have
committed offenses that are deemed to be “sexually violent” and who possess
some sort of mental abnormality or personality disorder, present a high risk
for sexually violent recidivism, and exhibit a likelihood of sexual recidivism
that is directly related to their mental abnormality (Calkins et al., 2014). If
an offender meets this criteria (or the specific criteria of the state in which
he or she resides), the offender may be civilly committed (against his will)
to a psychiatric facility after having served the prison sentence. The length
of civil commitment is indefinite, and the individual can be held until he or
she is determined to no longer be at risk of recidivism. There is no shortage
of controversy surrounding SVP statutes, and some of the most pressing con-
cerns include that the criteria for determining “mental abnormality” and risk
of recidivism are vague (Jackson & Richards, 2007; Mercado, Schopp, & Born-
stein, 2005; Schopp, Scalora, & Pearce, 1999) and that civil commitment after
one has served his prison sentence may violate that individual’s constitutional
rights (Janus & Prentky, 2003).
Given that sex offenders are subject to such potentially restrictive policies
and laws, and many of these policies depend on an evaluation of the level of
risk that an individual sex offender poses, the importance of accurately esti-
mating risk of sexual recidivism cannot be overstated. The roles of psycholo-
gists and forensic evaluators are also of key importance, as is their ability to
understand and synthesize available literature and empirical data.

Risk assessment is broadly defined as the process of identifying the likelihood
of future dangerousness (Association for the Treatment of Sexual Abusers,
2014). This commonly involves the use of empirically derived tools or instru-
ments that are designed to estimate an offender’s potential risk for future
recidivism (i.e., sexual, violent, and/or general reoffending).
There are five main legal contexts for sex offender risk assessments: 1)
pre-adjudication, 2) post-adjudication, 3) registration and community noti-
fication, 4) eligibility for civil commitment, and 5) and release from civil
commitment (Witt & Conroy, 2009). Pre-adjudication evaluations can be con-
ducted to inform decisions such as whether the offender should be released on
bail or could be managed in outpatient treatment on probation. If a person is
found guilty, the post-adjudication evaluations can be useful in determining
whether the offender should receive special sentencing, which may require the
completion of sex offender treatment or a more stringent process before being

released to the community. Risk assessments are also used to inform deci-
sions about the appropriate tier of community notification and registration
on which the sex offender should be placed when released into the commu-
nity. Lastly, sex offender risk assessments are used when deciding whether an
offender should be civilly committed as a sexually violent predator. Evaluators
will then use risk assessment when deciding whether the offender’s risk has
decreased after this commitment and whether it is safe for him or her to return
to the community.
Although the accuracy of sex offender risk assessments has improved over
the past decade, some general limitations should be noted. First, the majority
of sexual offenses go undetected or unreported (Association for the Treatment
of Sexual Abusers, 2014). Therefore, since risk assessments rely on information
about rearrests and reconvictions, these assessments may underestimate risk
for this population (Harris, 2006). Second, the probabilities gathered from risk
assessments are dependent on the length of time the offenders were followed
in the study. Meta-analyses suggest the average follow-up period is five years,
though reoffenses may occur beyond this time frame (Hanson, Stey, & Gauth-
ier, 1993). Third, sex offenders are a heterogeneous group, which raises ques-
tions about the universal applicability of these measures to all sex offenders
(Harris, 2006). Not addressing differences between subgroups of sex offenders
(e.g., child molesters, rapists, exhibitionists) leaves some to question the valid-
ity of these tools in predicting violence across the population. Furthermore,
the current risk assessment measures fail to account for factors that would
contribute to an escalation in an individual’s offenses. In other words, there
are no measures to track an increasing trajectory of offending that would allow
us to predict more severe offenses in the future, such as noncontact sexual
offenders who escalate to contact offenses. Finally, the majority of these risk
assessment instruments were not normed on diverse populations, and thus,
when conducting risk assessment of a nonwhite sex offender, the limitations
of the tool must be noted.
Risk Factors
For risk assessments in general, there are four broad categories of factors that
have been considered (Andrews & Bonta, 1998; McGuire, 2000). The first is
dispositional factors, such as antisocial or psychopathic personality traits.
Second, historical factors such as developmental events, history of criminal
and violent behavior, and prior treatment compliance have been explored.
Third, contextual components of violence are considered, including crimi-
nogenic needs, deviant peers, and lack of positive support systems. Fourth,
clinical factors such as psychiatric and substance use disorders have been of
interest. Evaluators should take into account a wide range of potential risk
and protective factors when conducting risk assessments.
Across all offending populations, studies have identified several predic-
tors of general criminal recidivism, including younger age at first encounter
with the criminal justice system, prior criminal history, substance use, and
antisocial personality traits (Seto, 2013). However, for sex offenders specifi-
cally, several studies have identified two major predictors of long-term sexual
recidivism: 1) sexual deviancy, for example, paraphilia, sexual arousal to chil-
dren, sexual arousal to violence, and victim characteristics, and 2) antisocial
orientation, for example, poor interpersonal competence and failure in adult
relationships (Hanson & Bussière, 1998). Sexual deviancy refers to an arousal
to or interest in people, objects, or activities that are illegal, inappropriate, or
highly unusual (Harris & Hanson, 2010). Sexual deviancy is typically mea-
sured using phallometric testing, self-report measures, and behavioral/crimi-
nal history. The second main factor, antisocial orientation, describes aspects
of an unstable and criminal lifestyle, which may include substance use, a
history of violating rules, employment difficulties, and impulsive behaviors.
It has been found that antisocial lifestyle is highly associated not only with
sexual recidivism but also with violent and general recidivism among sexual
offenders (Hanson & Morton-Bourgon, 2004) and general recidivism among
nonsexual offenders (Bonta, Law, & Hanson, 1998). Given that numerous risk
factors for recidivism have been empirically identified, competent evaluators
must take into account an array of risk factors in order to accurately evalu-
ate risk level. In addition to the aforementioned risk variables, studies have
also shown moderate predictive value for sexual recidivism for factors such
as age, the number of prior offenses, being unmarried, prior treatment failure,
sexual preoccupations, and intimacy deficits (Hanson & Bussière, 1998; Han-
son & Morton-Bourgon, 2004). It is also important to be aware of factors that
have not been empirically shown to increase risk, to avoid assumptions that
these might contribute to increased levels of risk. Some examples include tak-
ing responsibility for the crime, showing empathy for the victim, verbalizing
motivation to offend, and successfully completing treatment goals (Hanson &
Bussière, 1998).
Sex offender risk assessments have typically focused broadly on static and
dynamic factors related to recidivism. Static risk factors are primarily historical
factors (e.g., criminal history) or those highly unlikely to change (e.g., pedo-
philia, psychopathy) and therefore are thought to be strong predictors of long-
term recidivism (Lanterman, Boyle, & Raguse-Salerno, 2014). One advantage
to static factors is that the information is typically available in records and
requires little subjective judgment in identifying the presence or absence of
the factors. In contrast, a dynamic risk factor is one that can change over time
and may include cognitive distortions, substance abuse, and feelings of anger
or depression. Dynamic risk factors are often associated with the predictions
of short-term risk that can change over the course of days, weeks, months, or
even years (Seto, 2013). Dynamic factors can further be divided into stable and
acute factors. Stable dynamic factors can be amendable over time but typically
do not fluctuate in the short term (e.g., cognitive distortions, insight, treat-
ment compliance, criminogenic attitudes). On the other hand, acute dynamic
factors may change over a short period of time and can include factors such
as employment status, residence, relationship status, access to drugs or alco-
hol, or access to potential victims. Hanson and Harris (2000b) found that the
dynamic factors most strongly related to recidivism were social adjustment,
attitudes toward the victim, self-awareness of risk, access to victims, and com-
pliance with supervision and treatment. A study by Knight and Thornton
(2007) found that by adding dynamic risk factors to static information, the
predictive power of risk assessment tools is increased. The major benefit of
identifying dynamic risk factors is the potential to influence treatment and
supervision, given that they may be amenable to change with intervention.
Approaches to Assessment
There are a multitude of methods to evaluate risk among sex offenders. Doren
(2004) identified more than twenty instruments that can be utilized to assess
risk among this population. Some of the measures target general risk for vio-
lence, while others focus on the risk for committing future sexual offenses.
Risk assessments also vary in the level of clinical judgment utilized versus a
purely actuarial tool that leaves no room for subjective decision making. Fur-
thermore, instruments can also be designed to examine static variables, while
others may utilize dynamic factors or both. In general, there are three broad
strategies for assessing risk: unstructured judgment, structured judgment, and
actuarial measures.
Unstructured judgment involves a clinician subjectively selecting and
weighing risk factors, combining the information, and then forming an opin-
ion about the risk for reoffense based upon his or her clinical judgment. This
process involves interviewing the offender, reviewing file information, and
forming a subjective opinion about the risk level. Research has consistently
shown that unstructured judgments were no more accurate than chance pre-
dictions were, and therefore, the field has turned to the use of structured judg-
ment and actuarial tools as alternative methods (Monahan, 1981). It has also
been proposed that unstructured clinical judgment may be subject to various
cognitive biases, such as primacy and recency effects, representative heuristics,
and availability heuristics (Seto, 2013).
Structured judgment or clinically adjusted actuarial measures refer to the
process by which the evaluator uses preselected items related to risk, but the
overall determination of risk lies in the hands of the evaluator. Structured

clinical judgments for sex offenders, such as the Sexual Violence Risk-20
(SVR-20; Boer, Hart, Kropp, & Webster, 1977), typically include dynamic risk
factors that are amendable over time. Proponents of the structured judgment
approach to risk assessment suggest that these types of assessments allow for
clinical case formulation and have stronger predictive accuracy than unstruc-
tured approaches do (Hanson & Bussiere, 1998; Hanson & Morton-Bourgon,
2004). The advantages to clinical actuarial tools include that they are based
on empirical research, that they are more comprehensive than actuarial tools
because they include dynamic factors, and that the predictive validity appears
to be comparable with actuarial measures. Some disadvantages include that
these tools allow more room for errors because of their subjective nature
(Hanson, 1998), that the factors assessed may be highly correlated, which
would provide redundant information (Seto, 2013), and that these tools may
not be applicable to populations not included in the development of the tools.
In the last several decades, actuarial risk assessments have become the gold
standard in the field. Actuarial measures utilize an empirically derived set of risk
factors that are weighted and summed to create a risk score and classification.
Doren (2002) identified two characteristics of actuarial assessments: 1) the risk
items are selected based on their ability to predict future offending, typically
through meta-analytic studies using large samples of offenders; and 2) there
are stringent rules for how to obtain the composite score, allowing little room
for deviation. Proponents of actuarial measures argue that standardizing the
scoring allows for more objective decision making compared with other meth-
ods. Additionally, these actuarial measures allow the evaluator to make proba-
bilistic statements regarding the proportion of people with the same score who
would be expected to reoffend (Seto, 2013). The actuarial tools have also been
praised for containing items that are empirically supported and that these tools
are easily scored using archival data. In the meta-analysis of 188 research stud-
ies examining actuarial tools, Hanson and Morton-Bourgon (2009) found the
predictive accuracy of these tools ranged from low to moderate.
However, actuarial tools are not without their detractors. Actuarial tools
have been criticized for not including dynamic factors, excluding items not
yet validated in meta-analyses, ignoring contextual and situational aspects of
offending behavior, neglecting unique risk factors for particular subgroups,
and not capturing information in unusual cases (e.g., an offense commit-
ted when psychotic). Further, actuarial tools have been criticized for a lack
of a standardization in the definition of recidivism (Stadtland et al., 2005),
the atheoretical nature of the measures (Beech, Fischer, & Thornton, 2003),
the limited length of the follow-up period for which recidivism was assessed
(Harris, 2006), and the lack of validation with certain discrete populations
such as juvenile sex offenders, female sex offenders, and racially and ethnically
diverse sex offenders (Walters, Knight, & Thornton, 2009). Clinicians have
argued that rigid scoring criteria limit the use of the clinical judgment and
that clinically relevant information may be neglected because it does not
fall within the instruments parameters. Additionally, actuarial tools classify
offenders’ risk based on a single composite score. However, this method fails
to account for the fact that offenders who fall within the same risk category
may display very different constellations of risk factors that would be impor-
tant for treatment planning and supervision. It should also be noted that the
base rates used to interpret risk scores may differ based on offense type and
that the recidivism rates used to derive the measures may fluctuate over time
and jurisdictions (Hanson & Morton-Bourgon, 2004).
The Association for the Treatment of Sexual Abusers (ATSA) recom-
mends the use of structured or actuarial risk assessments in their best prac-
tice guidelines. This is largely due to the fact that studies have consistently
demonstrated that actuarial and structured measures are superior in predica-
tive ability compared with the unstructured judgments (Hanson & Bussiere,
1998; Hanson & Morton-Bourgon, 2004). When predicting general recidivism
for sexual offenders, actuarial measures were found most accurate, followed
by guided clinical judgment and unstructured clinical judgment. A meta-
analysis conducted by Hanson and Morton-Bourgon (2004) found that the
unstructured judgment was significantly less accurate than actuarial tools in
predictive general, violent, and sexual recidivism. This is likely due to the fact
that the unstructured judgments rely on subjectively chosen risk factors and
clinical opinion, whereas actuarial and structured tools identify set variables,
operationally define these variables, and have explicit rules for coding. This
decreases the subjectivity, thereby increasing the reliability of the measures.
Risk Assessment Tools

Several tools have been developed to assess risk for recidivism in sex
offenders. The most commonly used and best validated of these tools are
presented below.
RRASOR The Rapid Risk Assessment for Sexual Offense Recidivism

(RRASOR; Hanson, 1997) contains four variables (prior sexual offenses,
extra-familial victim, offender under the age of 25, male child victims), all
of which can be coded by record review. While the RRASOR is commended
for the simplicity, short length, and moderate predictive ability, some argue
it overlooks other important risk factors such as deviant sexual interest,
antisocial orientation, and treatment compliance. Conveying the predictive
accuracy of actuarial tools is typically done utilizing the area under the curve
(AUC), which is “the extent to which a randomly selected sexual recidivist
would be likely to have a higher score on the risk measure than a randomly
selected non-recidivist” (Amenta, Guy, & Edens, 2014, p. 43). Hanson and
Thornton (2000) reported the average AUC for the RRASOR was .68 for
predicting sexual recidivism.
Static-99 The Static-99 (Hanson & Thornton, 1999) is currently the most
commonly used measure of sex offender risk. It has been actuarially derived
and includes ten static factors: current age, live-in intimate relationship for
two or more years, index offense of nonsexual violence, prior offenses of
nonsexual violence, prior charges or conviction for a sexual offense, prior
sentence dates, convictions for noncontact sexual offenses, unrelated victims,
stranger victims, and male victims. The scores from each item are summed
to create a composite score that is associated with observed recidivism rates
across the norm-referenced group. Hanson and Thornton (2000) found that
the Static-99 added to the predictive accuracy of the RRASOR for long-
term risk estimates and found the Static-99 has an average AUC of .71 for
prediction sexual recidivism. The developers also released the Static-99R,
which is a revised version of the Static-99 that includes a continuous scale for
the item inquiring about offender’s age rather than the previous dichotomous
code. Hanson and Thornton (2003) developed the Static-2002 to include more
theoretically meaningful factors that will contribute to risk. The measure
includes fourteen items, with overlap from the Static-99, but organizes
the items in five categories: age, persistence of sex offending, deviant sexual
interests, relationship to victim, and general criminality.
SORAG Another widely used, actuarially derived measure is the Sex

Offender Risk Appraisal Guide (SORAG; Quinsey, Harris, Rice, & Cormier,
1998), which was adapted from a general violence risk assessment measure
called the Violence Risk Appraisal Guide (VRAG; Harris, Rice, & Quinsey,
1993). The SORAG acknowledges psychological variables such as psychopathy
and major mental illness, along with other factors similar to those in the
Static-99. Hanson and Thornton (2000) found the SORAG and Static-99
similarly predict sexual recidivism, although the SORAG was stronger at
predicting violent, nonsexual recidivism.
MnSOST-R Another tool, the Minnesota Sex Offender Screening Tool-

Revised (MnSOST-R), was developed by the Minnesota Department of
Corrections (Epperson, Kaul, & Hesselton, 1998). The measure consists of
sixteen items to assess prisoners, and it has been commended for utilizing
a broader range of categories than do some of the other actuarial tools. The
categories include information about the offender’s criminal and antisocial
history (e.g., number of sexual convictions, length of sexual offender history,
whether the sexual offense was committed while under supervision, antisocial
behavior as an adolescent, substance abuse, employment history), the offense
itself (e.g., offense committed in a public location, use or threat of force, multiple
acts on a single victim, different victim age groups, offenses against a victim 13
to 15 years of age, or that the offender is older than victim by five years, stranger
victim), and the offender’s current incarceration (e.g., discipline history while
incarcerated, chemical dependency while incarcerated, sex offense treatment
while incarcerated, and age at release). The MsSOST-R has been noted as being
more difficult to score compared with the RRASOR and Static-99 and having
variables that might not apply to other states, such as sex offender treatment
and chemical dependency (Beech, Fisher, & Thornton, 2003). The AUC for the
MnSOST-R has been found to range from .70 to .76 in its predictive accuracy
(Epperson, 2000; Langton, Barbaree, Harkins, Seto, & Peacock, 2002).
Other Actuarial Measures

Risk Matrix 2000 (RM2000; Thornton et al., 2003) consists of three static items
(i.e., current age, sexual crime history, and general crime history) and four aggra-
vating factors (i.e., male victim, stranger victim, noncontact sexual offenses, and
lack of long-term intimate relationships). The Sex Offender Needs Assessment
Rating (SONAR; Hanson & Harris, 2000a) targets dynamic factors, but this
measure is still in the nascent stage of research. It should also be noted that the
Psychopathy Checklist-Revised (PCL-R; Hare, 1991) has been implemented in
sex offender risk assessments, though it is not specific to sexual offending. The
reasoning behind the use of a psychopathy measure is that research has consis-
tently shown that psychopathy is correlated with various forms of recidivism.
Structured Clinical Decision Tools

The Sexual Violence Risk-20 (SVR-20; Boer et al., 1977) was developed by
the authors after a thorough review of empirical literature and utilizing input
from experts in clinical and forensic domains. The measure includes twenty
items that target factors in three domains: psychosocial adjustment, nature
of the offense, and future plans. Examples of items include past supervision
failure, offending history, criminogenic thinking, psychopathy, mental illness,
employment and relationship difficulties, lack of planning, and sexual devi-
ancy. The measure also includes three dynamic factors: acute mental disorder,
recent loss of social network, and frequent contact with potential victims. The
SVR-20 does not include a procedure for computing an overall level of risk;
rather the evaluator is instructed to use professional judgments to rate the risk
level as low, moderate, or high. This measurement is praised for its ability to
both assess risk and contribute to case management plans.
Actuarial Assessments for Noncontact Offenders

There is much concern over the likelihood that a noncontact or Internet-
related sexual offender will escalate to contact offenses in the future. There-
fore, risk assessments have been important to those evaluating the potential
for reoffenses for this particular sex offender subtype.
There is evidence that the strong predictors of recidivism, antisocial ori-
entation and sexual deviancy in particular, are applicable to both online and
offline offenders (Seto, 2013). For example, the presence of antisocial charac-
teristics in online sex offenders increases the risk for a future sex offense (Seto,
2003). However, some have proposed that other Internet-specific risk factors
should be considered when determining level of risk for this subtype of sex
offender, such as amount of child pornography or time spent online. However,
it should be noted that to date these have yet to be empirically supported (Eke
& Seto, 2012). Early research findings suggest that modifications to current
risk tools would make the measures applicable to online sex offenders, but
there is a question as to whether the probability estimates would generalize to
that population (Wakeling, Howard, & Barnett, 2011). Seto (2013) concluded
the preliminary research comparing online offenders with contact offend-
ers shows support for common risk factors for both subtypes and that some
modifications to current risk measure would likely result in adequate predic-
tive accuracy for online sexual offenders. However, more research is needed in
assessing risk for noncontact sexual offenders.
Other Sources of Information

Records It has been suggested that the use of collateral information is a crucial
element in risk assessment, and it has even been argued to be more important
than the interview with the offender (Conroy & Murrie, 2007). Records can
include rap sheets, criminal complaints, prison records, and medical and
psychiatric records. Records gathered from various agencies often differ in
quality and comprehensiveness, therefore making it crucial for the evaluator to
identify potential limitations in the files and be open about the shortcomings
in the report. When examining records regarding past convictions, evaluators
should be aware that the reports might not fully encapsulate the offense history,
given that prosecutors often drop or modify charges and that some offenses go
undetected. This further stresses the importance of using a variety of sources in
gathering information for the evaluation.
Collateral Contacts Often, the evaluator can gather important information

from those who have had contact with the offender such as friends, family,
therapists, probation officers, and correctional officers, among others. These
individuals may see the offender on a frequent basis and may have some
insight into the offender’s patterns of behaviors and psychological functioning
that cannot be obtained from records or the offender’s self-report.
Clinical Interview Another element of the risk assessment involves the

clinical interview of the sex offender, which should include a self-report on
his or her criminal and psychological history. While such interviews lack
the standardization and validity of the actuarial and psychological testing,
they can provide useful biographical information, and information derived
through behavioral observation can be used to identify cognitive distortions
and maladaptive thinking patterns. It is also a useful opportunity to probe
for inconsistencies between records and the offender report. The clinical
interview should always be used as but one source of data in conjunction with
a comprehensive risk assessment battery.
Self-Report Measures Psychology testing can be used to assess a wide

range of personality and cognitive functioning. Objective personality tests
such as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2;
Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), the Millon
Clinical Multiaxial Inventory-III (MCMI-III; Millon & Davis, 1997), and
the Personality Assessment Inventory (PAI; Morey, 2007) can help inform
decisions about mental health diagnoses. These scales all have validity indices
that can be useful in determining whether an offender is misrepresenting his
presentation. While such psychological measures of personality can provide
additional corroborative information regarding psychological functioning,
the evaluator cannot make a diagnosis or conclusions based solely on these
tools and must integrate additional sources of information.
Measures of Sexual Preferences Self-report measures of sexual interests

have been developed as an inexpensive and efficient method of gathering
information on the offender’s deviant sexual interests; these include the
Multiphasic Sex Inventory (MSI; Nichols & Molinder, 1996) and the
Multidimensional Inventory of Development, Sex, and Aggression (MIDSA;
Knight, 2008). However, the obvious limitation to these self-report measures
is that offenders may minimize or deny deviant sexual interests or may lack
insight into their sexual preferences.
Psychophysiological Assessment There is much debate in the field about

the use of psychophysiological assessment, though many of these measures are
commonly used in assessing risk for future sexual offending.
Phallometric testing utilizes the penile plethysmograph on a male offender,
which measures the volume or circumference of the individual’s penis while
viewing sexual stimuli. These tests are designed to identify deviant sexual
arousal patterns depending on which stimuli the offender is sexually aroused to.
A meta-analysis by Hanson and Bussiere (1998) found the phallometric testing
correlated well with sexual recidivism for child molesters, though this pattern
was not found for rapists. According to ATSA, phallometric testing can be useful
as a corroborating measure to the offender’s self-report. Penile plethysmographs
have been criticized for their invasive nature and for ethical and practical con-
cerns as well as the validity and reliability of the measure (Witt & Conroy, 2009).
Polygraphs are a second form of psychophysiological assessments that have
the goal of detecting malingering based on observed physiological changes
in response to questioning. ATSA suggests that polygraphs may be beneficial
for two reasons: 1) they generate information beyond that obtained from
self-reports, and 2) they increase compliance with treatment and supervision
conditions (Association for Treatment of Sexual Abusers, 2014). Information
from empirical studies has suggested that evaluators must be wary of
polygraphs since there is a risk for false positives (Branaman & Gallagher,
2005). Given the questionable reliability and validity of these measures, it is
not recommended they be utilized in decisions regarding civil commitment
of sex offenders. However, polygraphs may be helpful in instances of post-
conviction release when the offender is being monitored in the community to
increase accountability.
More recently, several additional cognitively based measures of deviant
arousal have been studied. The Abel Assessment of Sexual Interest (AASI; Abel,
Huffman, Warberg, & Holland, 1998) is one of the most widely used of these
types of tools. The AASI assesses the sex offenders’ viewing time of sexual stim-
uli to make assumptions about sexual deviancy. The hypothesis is that people
will view stimuli they find sexually arousing longer. However, there is great
concern over the high error rate and lack of validity in these types of measures.
In addition, some research has been done assessing response latencies to devi-
ant word and picture stimuli using a modified version of the Emotional Stroop
Task (EST). To date the research on ESTs remains inconclusive and such cogni-
tive measures should not be utilized as part of standardized risk assessments.
Best Practices
Sex offender risk assessment is a high-stakes endeavor. Overestimating risk
can deprive the sex offender of civil liberties while underestimating risk can
put the community at significant risk. Therefore, it is imperative that those
conducting risk assessments adhere to best practices guidelines. Such guide-
lines have been proposed by ATSA and stipulate that clinicians conducting
sex offender risk assessments need to gather and verify information, interview
the offender and collateral contacts, and utilize standardized and validated
actuarial tools. Further, according to the American Psychological Association

“Ethical Principles of Psychologists and Code of Conduct” (American Psycho-
logical Association, 2010) only those competent to administer and interpret
such assessments should perform sex offender risk assessment. A competent
clinician would be one who has appropriate education, training, supervised
experience, consultation, or study with regard to the topic. Given the variety of
standards and regulations surrounding sex offender risk evaluations, it is also
essential, and ethically sound, for the forensic evaluator to be familiar with the
statutes governing his or her jurisdictions of practice.
In terms of selecting a measure, ATSA notes that, due to the heterogeneous
nature of the offending population, there is not one tool that is superior to the
others. The appropriate measures should be selected based on the question
proposed and the particular individual being assessed. Craig and Beech (2009)
suggest that the evaluator must be aware of the methodology and limitations
of the risk assessment tool in order to ensure appropriate application and
interpretation of tools and that these limitations should be noted in reports.
Competent evaluators should understand the concepts and factors that will
influence the actuarial scores, such as base rates, age, gender, race and ethnic-
ity, and downgrading of charges.
Furthermore, it has been proposed that the tools and their applications be
continually monitored through supervision, mentorship, and peer reviewing
processes. Evaluators should utilize multiple sources of data to corroborate
findings including collateral information—such as records, collateral contacts,
psychological assessments, and psychophysiological assessments—through-
out the evaluation process. When possible, collateral information should
ideally be reviewed prior to interviewing the offender in order to focus the
interview and explore any inconsistencies.
Case Vignette
The case study presented in this chapter is based on a composite of clients who
were seen in an outpatient forensic mental health clinic that specializes in the
evaluation and treatment of sex offenders. Generally, a client may be referred
to this particular clinic for a sex offender evaluation by the court or Depart-
ment of Corrections at one of three different stages in the legal process, which
were mentioned earlier in the chapter: 1) pre-adjudication, 2) post-adjudication,
and 3) registration and community notification. These types of evaluations take
slightly different forms, as the presentencing evaluations are generally time-lim-
ited, and rely primarily on brief clinical interviews and the synthesis of empirical
evaluation measures. Conversely, a client who is ordered by the court or Depart-

ment of Corrections to undergo evaluation at the onset of the probationary
period typically enters into a treatment contract with this mental health clinic,
in which he or she agrees to participate in an extended assessment period to
determine whether this program is appropriate and whether the client is, indeed,
amenable to outpatient treatment and community supervision. This assessment
period may last for anywhere from several weeks to several months, as the cli-
ent completes multiple assessment measures, completes psychoeducational and
treatment-oriented homework assignments, and participates in a weekly group
therapy process to gain a greater understanding of his or her ability and willing-
ness to engage in the treatment process. Furthermore, this clinic utilizes a “team-
based” approach, in which the evaluators, clinicians, and probation officers
obtain consents from the client to freely exchange information among them-
selves in order to inform treatment and supervision and ultimately to maintain
community safety.
As discussed earlier, regardless of when or why the sex offender evaluation
is being conducted, best practices always involve the utilization of multiple
sources of information, both empirical and clinical. Clinically, this means
that, in addition to interviewing the client directly about his or her experi-
ences and background, an evaluator should also make every effort to gather
data from collateral contacts that can provide alternate perspectives on the
client’s history, functioning, and lifestyle. Typically, this will take the form of
interviewing the client’s spouse, family members, and any other mental health
professionals who have worked with the client. Empirically, multiple forms of
psychological assessments should be incorporated, including actuarial risk
assessment tools, self-report measures, structured interview templates, legal
records, and any other appropriate measures for assessing functioning. Given
this approach, it is clear that even the briefer forms of sex offender evalua-
tions require a significant amount of time and effort on the part of the evalu-
ator and should never be conducted based on a single session with the client
alone.
Reason for Referral

The client discussed herein was referred to the clinic by his probation officer,
who requested a Psychosexual Risk Assessment to determine his amenabil-
ity and appropriateness for outpatient sex offender treatment. The client had
pled guilty to charges of possession and distribution of child pornography, a
class six felony in the state in which he was convicted, which normally carries
a five- to twenty-year sentence in a state correctional facility. However, due to
the fact that this was his first offense, and in exchange for his guilty plea, this
client was sentenced to five years of supervised release (i.e., probation under
the supervision of the Department of Corrections), with the condition that he

participate in, and complete, a sex offender treatment program.
This case is an example of a hybrid of a post-adjudication evaluation and
a registration and community notification evaluation. The assessment pro-
cess took place over a period of six months, while the offender simultane-
ously participated in individual and group therapy, which were useful not
only in gathering additional clinical information and but also in providing
him with basic behavioral management skills. This client also presented with
a number of psychological assessment reports that had been conducted prior
to his participation in this program, so his final evaluation report incorpo-
rated several forms of psychosexual evaluations—the conclusions drawn
from the time-limited empirical evaluations conducted previously, and the
data obtained from the more in-depth clinical and assessment process by the
forensic evaluator.
As stated previously, the client discussed here, whom we will call Mr. Coe,
presented for sex offender evaluation and treatment, following his guilty plea
to charges of possession and distribution of child pornography. According
to the police report, Mr. Coe had been exchanging videos of prepubescent
females engaged in sexual acts with adult males with another man via e-mail.
His Internet service provider intercepted these e-mail exchanges and reported
them to the National Center for Missing & Exploited Children, which was
able to trace the digital records back to Mr. Coe, and the center reported him
to law enforcement. Initially, Mr. Coe reported to his treatment team (his cli-
nicians and probation officer) that his referral offense represented the first
time that he had viewed or tried to exchange any form of child pornography.
Throughout the assessment period, however, he disclosed that he had actually
been viewing child pornography in various forms for several years. He also
reported several other offending behaviors, and sexually deviant behaviors
and interests, for which he had not been caught and which will be discussed
in greater detail later.
The purpose of the evaluation, the associated limits of confidentiality, and
his rights throughout the process were explained to Mr. Coe when he was
initially interviewed. He reported that he understood, signed all relevant
releases of information and consent forms, and agreed to continue with the
process. The evaluator spent a total of 27.5 hours conducting clinical inter-
views, observation, and testing of Mr. Coe.
Assessment Materials:
• Millon Clinical and Multi-Axial Inventory (MCMI-III)


After obtaining Mr. Coe’s informed consent for the evaluation process, the
next step was to review his previous assessment and treatment records, which
were extensive. Mr. Coe provided his treatment team with several documents
including childhood medical records, psychological evaluations completed
when he was 5 years of age and 9 years of age, a psychosexual evaluation
conducted two months after his arrest, a psychological evaluation dated nine
months after his arrest, and a treatment summary from another sex offender
treatment provider ten months after his arrest.
Records Reviewed:
• Police Department Arrest Report

• District Attorney’s Statement of Facts
• Medical Records: childhood through adolescence
• Psychological Evaluation (age 5)
• Speech, Language, & Hearing Evaluation (age 7)
• Psychological Evaluation (age 9)
• Pre-adjudication Psychosexual Evaluation (two months post-arrest)
• Psychological Report (nine months post-arrest)
• Sex Offender Treatment Summary (previous treatment provider; dated 10
months after his arrest)
• Collateral Contacts:
� Consultation with Mr. Coe’s court-ordered individual and group thera-
pists (treating Mr. Coe during the time period of this evaluation) and
review of their treatment records and clinical notes
� Consultation with Mr. Coe’s probation officer
� Telephone interview with Mr. Coe’s previous sex offender treatment
provider
� Telephone interview with the writer of Mr. Coe’s previous psychological
assessment
� Telephone interview with Mr. Coe’s adoptive mother
� Telephone interview with another treatment provider that Mr. Coe
sought consultation with during the assessment period
Mr. Coe’s childhood medical records revealed that he had significant prena-
tal, perinatal, medical, and developmental issues in early childhood. According
to his records, he was born several months premature, weighing less than four
pounds at birth. His mother was a patient in an inpatient psychiatric hospital
who reportedly received no prenatal care and who was suspected of drinking
alcohol during her pregnancy. His birth was described as “traumatic,” with no
medical staff in attendance. Mr. Coe was hospitalized for the first five weeks
of his life, after which he was adopted by a couple who had several biological
children, and who later adopted another child.
Mr. Coe’s early childhood was marked by significant health issues that required
multiple treatments including respiratory, digestive, and mobility assistance.
By the time he was attending elementary school, Mr. Coe was already exhibit-
ing several problematic behaviors that warranted psychological evaluation and
that raised concerns about his social and emotional development. For example,
between the ages of 2 and 4 years of age, Mr. Coe was reported to have slept
only a few hours per night, to have frequently roamed the house and destroyed
items while his family slept, and to have even occasionally left the house entirely.
His adopted mother also reported that until he was 5 years old, he never cried
“real tears” or responded to any painful stimuli (including getting stitches on
numerous occasions). In addition to exhibiting learning delays, Mr. Coe was
reported to be hyperactive, inattentive, and emotionally dysregulated. Due to
these and other concerns, Mr. Coe underwent two separate psychological eval-
uations at 5 years and 9 years of age, respectively. These evaluations included
the use of the Wide Range Achievement Test-Revised (WRAT-R; Wilkinson
& Robertson, 2006), Robert’s Apperception Test (McArthur & Roberts, 1982),
Projective Drawings, the Bender Gestalt Test (Pascal & Suttell, 1951), Conners’s
Ratings for Hyperactivity (Goyette, Conners, & Ulrich, 1978), the Personality
Inventory for Children (PIC; Lachar, Klinedinst, & Seat, 1981), and the Child
Behavior Checklist, Parent and Teacher Report (Achenbach & Edelbrock, 1983).
The psychological reports indicated that Mr. Coe was in the average to above-
average range of intelligence and was able to follow directions and concentrate
on a task when interested. Academically, he performed at or above his expected
grade level. The writers of his childhood psychological reports concluded that
any learning delays that were exhibited were likely reflections of behavioral
and emotional factors rather than deficits in information processing. Socially,
Mr. Coe exhibited problematic relationships with his peers that included being
subjected to intense teasing and bullying, as well as a tendency to act out his frus-
trations and anxieties behaviorally rather than processing them verbally. It was
recommended that Mr. Coe participate in individual psychotherapy in order to
help him understand and connect his emotions with his behavior. According to
Mr. Coe, he stopped attending psychotherapy after two sessions for reasons that
are unclear.
According to Mr. Coe’s self-report, he was seen by several physicians and
psychologists over the next several years, and he received diagnoses of Atten-
tion Deficit Hyperactivity Disorder (ADHD), Major Depressive Disorder, and
Bipolar I Disorder. He was prescribed a variety of psychotropic medications
to address these issues, but he did not feel as though any of them adequately
addressed his symptoms.
He completed college, a master’s degree, and a teaching credential before
being hired as a middle school physical education teacher. Of course, given
the nature of his charges, his decision to pursue this particular career and his
behavior while performing his job duties warrant further investigation and
will be explored shortly.
Upon his arrest and on the advice of his defense attorney, Mr. Coe opted to
undergo a psychosexual evaluation in order to inform his legal defense (iden-
tified as Pre-adjudication Psychosexual Evaluation [two months post-arrest]
in the list of Records Reviewed). He reported to the clinician providing this
evaluation that he believed his Bipolar Disorder was responsible for his poor
decision making and cited incidents of “getting in trouble” at work for the way
that he spoke to his superiors during what he considered to be manic episodes.
He also began to disclose his sexual interests in this report and indicated that
he first noticed a sexual attraction to preschool children when he was approxi-
mately 7 years of age. He noted several other incidents during adolescence
and young adulthood, during which he found himself attracted to female chil-
dren between the ages of 2 and 12 years and reported that while babysitting
he manipulated situations in order to have physical contact with the children,
which resulted in erections. He maintained, however, that he had never sexu-
ally abused, nor inappropriately touched, a child. The results of this evalu-
ation indicated that Mr. Coe was an individual who was emotionally labile
and exhibited poor insight related to his own behaviors and limitations. It also
concluded that Mr. Coe was most sexually aroused by prepubescent females,
particularly preschool- and elementary-school-aged girls, and by fantasies and
scenarios involving persuasion, coercion, and force. Based on the results of the
assessments administered (MMPI-2 [Butcher et al., 1989] and penile plethys-
mograph examination) and a clinical interview, this report concluded that Mr.
Coe warranted diagnoses of Bipolar I, Pedophilia, and ADHD (by history).
Following the completion of this psychological report, Mr. Coe and his
attorney agreed that it would be in his best legal interest to proactively engage
in sex offender treatment (prior to his trial and sentencing). He participated
in weekly group therapy sessions with a sex offender treatment program for
six months before deciding to seek another opinion about his psychological
status. Eight months after his most recent psychosexual evaluation, Mr. Coe
solicited an independent psychological evaluation by another psychologist.
According to that report (identified as Psychological Report [nine months post-
arrest] in the list of Records Reviewed), Mr. Coe indicated that he was seeking
another assessment because he did not believe that the interventions he had
received to that point had been helpful in improving his symptoms and the
quality of his life. This evaluation included a clinical interview and admin-
istration of the MMPI-2 and Rorschach test (Rorschach, Lemkau, Kronen-
berg, & Morgenthaler, 1942). The Rorschach test is a projective inventory that
provides clinicians with information about how a client is likely to perceive,
process, and respond to information and the implications that may have on his
functioning. Though many forensic evaluators choose to avoid the use of pro-
jective inventories because of ongoing debates about their validity and empiri-
cal value for predicting behavior, the clinician conducting the assessment in
question was simply asked by Mr. Coe’s attorney to provide a psychological
assessment, not a forensic evaluation. Thus, it may explain her willingness to
include this particular measure.
In the clinical interview portion of this evaluation, Mr. Coe indicated that he
had experienced a number of disciplinary problems at work because his bosses
didn’t like him and were harder on him than other staff. One should note that
this is a different view of his behavior than he provided in the previous assess-
ment in which he asserted that his behavior was inappropriate due to symptoms
of mania. The results of the assessment measures revealed that Mr. Coe was
endorsing unusually high levels of emotional difficulties and severe psychiatric
symptoms. The tests also indicated that Mr. Coe was obsessed with sex and had
a heightened focus on the objectification of people. Additionally, he exhibited
a disorganized thought process and often focused on less-relevant details while
missing important information pertinent to everyday life. The clinical impres-
sions of this evaluation concluded that Mr. Coe struggled to develop and main-
tain empathy toward others and needs to understand that any poor treatment in
his past does not justify acting out when he is angry. This evaluator diagnosed
him with what would now be called an Autism Spectrum Disorder (at the
time it was termed “Asperger’s Disorder” by the DSM–IV–TR, but the DSM-5
has since eliminated this particular terminology). The clinician providing this
evaluation also concluded that these results suggested that Mr. Coe should be
receiving consistent, intensive individual therapy, at the very least, or possibly
a more intensive inpatient or partial hospitalization if outpatient therapy was
deemed to be inadequate. Interestingly, collateral contact with this evaluator
revealed that she was not made aware of Mr. Coe’s sexual offense in any signifi-
cant way, which explained why his sexual functioning was not incorporated
into the analysis.
Shortly after this evaluation was completed, Mr. Coe’s sex offender therapist
provided his client’s attorney with a summary of his progress in treatment thus
far, which served to validate and highlight some of the issues that the previ-
ous evaluations had raised. Namely, the treatment summary detailed that Mr.
Coe’s participation in treatment was marked by his hyperfocus on finding a
mental illness that “made” him do what he did, by focusing on small details
that he had found in books that supported his particular perspectives, and on
repeated attempts at “attention-getting.” According to this report, when chal-
lenged to focus instead on learning to adjust his thinking and behaviors, Mr.
Coe reportedly resorted to becoming argumentative, verbally combative, and
enraged. This unwillingness to take responsibility for his choices, in their view,
was reflected in what they saw as his “therapist shopping” and seeking multiple
evaluations that could prove him right. In fact, throughout his participation
in group therapy, he simultaneously began individual treatment with another
provider, against his group therapist’s wishes. In summary, his treatment report
indicated that Mr. Coe’s engagement in therapy was generally counterproduc-
tive and concluded that his prognosis was extremely guarded.

Within six months of the treatment summary, Mr. Coe pled guilty to his charges
and was ordered to begin the assessment and a court-ordered treatment pro-
cess discussed herein. The wealth of information that was provided at the onset
of this assessment phase allowed a preliminary clinical picture to be drawn, on
which an initial treatment plan was developed by his treatment team. Gener-
ally, he was viewed as a client with significant dynamic and static risk factors
including, but not limited to, labile emotions, poor boundaries, limited self-
regulation skills, distorted cognitions, and an intense attraction to children.
Though the treatment program is therapeutic in nature, the first responsibility
is always to protect community safety, so it was deemed necessary to closely
evaluate and monitor him throughout his entire treatment process.
For the purposes of the present evaluation, clinical interviews with Mr. Coe
and collateral contacts produced much of the same background information
as was provided in previous psychological assessments and evaluations. Mr.
Coe had a limited recollection of his childhood, aside from several incidents
of teasing and bullying by his peers, and memories of the few visits he had with
his biological mother, which he described as “scary” and “upsetting.” His por-
trayal of his interpersonal, professional, and behavioral problems in adulthood
reflected his previous therapists’ impression that he was unwilling to accept
responsibility for many of his choices and behaviors. Instead, he unfailingly
blamed his various mental health diagnoses or other people for his mistakes.
In general, information gained from consultation and interviews with collat-
eral contacts further supported previous assessment reports and conclusions.
During the time period that Mr. Coe was undergoing the current evaluation,
he was also participating in court-ordered sex offender therapy. Consultation
with Mr. Coe’s court-ordered individual and group therapy treatment providers
revealed even more information about Mr. Coe’s current functioning. Accord-
ing to his therapists, Mr. Coe’s participation in the therapy process further
illuminated the role that his cognitions and emotion regulation played in his
sexual fantasies and behaviors. These providers reported that Mr. Coe tended to
approach therapeutic interventions as combative and stated on several occasions
that he felt as though his treatment team members were “playing games” with
him, “out to get him,” and unwilling to address the true source of his problems,
which he attributed to his various mental health conditions. He consistently
spent individual sessions attempting to engage his therapist in arguments about

how members of his treatment team have phrased different statements in ways
that offended him and in attempting to educate his therapist about the nature
of his disorders. For instance, he presented the therapist with books and articles
that he requested she read between therapy sessions in order to better under-
stand how his ADHD, Bipolar Disorder, and Asperger’s Disorder have contrib-
uted to his sexual attractions and offense.
Another important aspect of sex offender treatment and evaluation is iden-
tifying any patterns of sexual fantasy and masturbation that may be connected
to emotional, cognitive, or social stressors or processes. Mr. Coe reported that
he found himself having many more sexually violent fantasies following therapy
sessions and following any interactions that he found to be frustrating or distress-
ing. For example, after a boundary was set by a therapist or his probation officer,
Mr. Coe reported going home and masturbating to fantasies involving pain and
humiliation of those individuals, as well as women and children in general. He
would also perseverate on the specific words or tones that he perceived being used
in conversations with others and would dwell on “getting back at” that individual
for offending or hurting him. His sexual fantasies and masturbatory behaviors
were so closely tied to his emotional distress that he began masturbating in his car
immediately following interactions with his treatment team, which was concern-
ing from an offending and public-safety standpoint. Due to the link between emo-
tional distress, which was fed by his distorted cognitions about the intentions and
role of his treatment team, and his increasing sexual acting-out behaviors, it was
decided that Mr. Coe was in immediate need of coping skills to help him tolerate
distress and regulate emotions without reverting to inappropriate fantasies and
masturbation, or worse. Thus, individual therapy utilized techniques from dialec-
tical behavior therapy (DBT; Linehan, 1993), which is designed for people who
experience overwhelming emotions and cope with them in maladaptive ways.
Traditionally, DBT has been used with individuals who have symptoms of Border-
line Personality Disorder and has been especially helpful in reducing self-harming
behaviors associated with the intense emotions experienced by those individuals.
In their book, The Dialectical Behavior Therapy Skills Workbook: Practical DBT
Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation
& Distress Tolerance, McKay, Wood, and Brantley (2007) explain:
For some people, emotional and physical pain feels more intense and occurs
more frequently than it does for other people. Their distress comes on more
quickly and feels like an overwhelming tidal wave. Often, these situations
never end and the people experiencing them don’t know how to cope with
the severity of their pain . . . people struggling with overwhelming emotions
often deal with their pain in very unhealthy, very unsuccessful ways because
they don’t know what else to do. (p. 5–6)
Conceptually, Mr. Coe’s sexual fantasies and behaviors, which were triggered
by extreme anger and distress, could be viewed in the same way that self-harm-
ing behaviors are. Thus, the same techniques used to address those behaviors
were applied to reducing and eliminating Mr. Coe’s use of sexual fantasy and
masturbation as a way to cope with intense emotional distress. Eventually, as
Mr. Coe was taught more coping skills, he was prohibited from engaging in
any sexual fantasies that were deemed inappropriate (i.e., those involving force,
coercion, violence, humiliation, degradation, dehumanization, and children).
He was also not allowed to masturbate when feeling emotionally distressed,
as he was required to utilize more appropriate coping skills instead. Mr. Coe
was not willing or able to adhere to these limits. It was at this point in treat-
ment that Mr. Coe’s acting-out behaviors intensified dramatically. He began
texting his individual therapist on her personal mobile phone (which was to be
used strictly for scheduling purposes) at all hours of the day and night to com-
municate clinically relevant information and express his emotions. Despite
a boundary being set (and recommunicated three weeks in a row) about the
appropriate use of this phone number and of text messaging, Mr. Coe sent a
total of eighteen text messages to his therapist over a four-day period, which
ranged in tone from solicitous, to antagonistic, to accusatory. During this
period, he also made appointments with two different mental health profes-
sionals in which he complained about the techniques and approaches used by
his treatment team and requested that they provide documentation supporting
his belief that he was being treated unfairly. He reportedly also made contact
with a human rights group to report that his basic human rights were being
violated in treatment. Finally, late one evening, Mr. Coe texted his individual
therapist to report that he had seen two attractive female children at a retail
store earlier that day and had purposely lingered in the store to watch them.

When initially meeting with a client to begin a psychological evaluation, the first
objective is to gather basic data to determine whether the client possesses any
cognitive or intellectual deficits or psychological impairments that may impact
his or her ability to participate meaningfully in the evaluation and to assess
overall functioning. Mr. Coe was a 36-year-old Caucasian male who had never
been married and had no children. He owned his own home, he had obtained
a master’s-level education, and until his arrest, he was gainfully employed as a
middle school physical education teacher. Based on the fact that he was able
to complete a graduate degree, obtain employment, and manage his finances,
it was assumed that his cognitive capacities were intact and that he was able to
function professionally and financially. Mr. Coe had no prior criminal charges
or arrests and reported that he was actively involved with his church and had
an adequate social support network. In each of his meetings with the evalua-
tor, Mr. Coe’s affect was agitated and defensive, and he usually described his
mood as “fine” or “frustrated” (the frustration was usually attributed to various
aspects of treatment or probation). In line with his overall functioning prior
to his arrest, he presented as having average to above-average intelligence. He
exhibited no signs of thought disturbance, hallucinations, or delusions. He did
have somewhat paranoid and distrustful views of his treatment team, but those
views were comparable with those of many forensic clients and did not reach
the threshold for delusional beliefs. Throughout the entire evaluation pro-
cess, he denied current suicidal, homicidal, or self-harming ideation, but he
did endorse ongoing sexually deviant fantasies and urges. In summary, it was
determined that he was competent to proceed with the evaluation and treat-
ment process.
Actuarial Tools Most clients convicted of sexual offenses are assessed for
their estimated risk of recidivism using one or more of the actuarial risk
assessments discussed earlier (such as the Static-99 or Static-2002, RRASOR,
and SVR-20), which are the most commonly implemented tools. Unfortunately,
at this time, several of these tools explicitly state that they are not to be used for
the risk assessment of online sex offenders who have not committed a contact-
offense against a victim (Phenix, Doren, Helmus, Hanson, & Thornton, 2008),
and others have not been normed on Internet-only offenders. So, despite the
best-practices inclusion of actuarial data, there were no such tools available that
were appropriate for this particular case (Hanson, Helmus, & Thornton, 2009).
However, it is possible to note, and include, any empirically supported indicators
of risk of recidivism in one’s clinical assessment. In Mr. Coe’s case, he exhibited
characteristics that were associated with both indicators of long-term recidivism
(sexual deviancy and antisocial orientation), which will be discussed later.
Self-Report Measures An empirical assessment of Mr. Coe’s personality

characteristics were warranted at the time of this evaluation, but due to
the fact that he had already completed the MMPI-2 twice in the past year,
it was determined that an alternate measure should be used. Thus, Mr. Coe
was administered the Millon Clinical and Multi-Axial Inventory (MCMI-III;
Millon & Davis, 1997), which, similar to the MMPI-2, is a standardized
personality inventory used to assess for a number of psychological problems
and to identify maladaptive personality characteristics that may impact a
person’s functioning. It contains 175 true-false questions that ask the test-taker
to indicate his or her behavioral and emotional patterns within the past six to
twelve months. It also contains validity scales to detect any attempts on the
part of the test-taker to manipulate the results or misrepresent his functioning,
as well as clinical scales.
According to the validity scales, Mr. Coe did not appear to try to misrepre-
sent himself on the test, and his results were deemed valid for interpretation.
On the clinical scales, Mr. Coe exhibited extremely high levels of depressive
symptoms, anxiety, mood fluctuation, thought problems, suicidal ideation,
and posttraumatic stress. All of these scales were elevated to at least two stan-
dard deviations above the mean, and these deviations are representative of
a significant amount of emotional distress. However, it should also be noted
that scores of this severity are unusual for someone who is not in intensive or
inpatient mental health treatment, so the possibility of him exaggerating his
symptomology must be considered.
His response pattern also indicated some personality characteristics that
may be intrusive in his ability to form and sustain relationships, as he seemed
to approach relationships from a very black-and-white perspective. His
responses suggested that he tended to idealize some people at times, while
demonizing them at other points. He also appeared to approach conflict quite
readily and become emotionally intense very quickly. When someone offended
or betrayed him, in his opinion, he quickly dismissed their perspective, disen-
gaged, and might even have become inclined to retaliate. It appeared as though
he lacked the coping skills to stay more balanced in his perspective and to be
able to problem solve. To some extent, this pattern may have been exacerbated
by a lack of insight into others and the misinterpretation of social cues.
Sexual History It was determined that, in addition to immediately

participating in group therapy sessions with other offenders with pedophilia,
Mr. Coe should also complete a thorough sexual history interview to gather as
much information as possible about his sexual attractions, sexual relationships,
sexual fantasies, pornography use, and any undisclosed sexual offenses. The
gathering of all of Mr. Coe’s sexual history information took longer than
usual, as he fell into a pattern of initially reporting limited information and
then returning the next week to clarify or add new information that he had
intentionally withheld previously. Thus, at any given point, his clinicians and
evaluator were unsure if he was fully reporting all of his sexual interests and
behaviors, which, from a safety management standpoint, was concerning.
Over time, in addition to his attraction to prepubescent children and several
incidents of arousal in the presence of children in his early adulthood, Mr. Coe
disclosed a great deal of new information regarding his behaviors, attractions,
and fantasies.
Mr. Coe claimed that his sexual attraction to minors was not the reason that
he chose to enter teaching profession and maintained that he never inappro-
priately touched any children or students. However, he did report many inci-
dents of engaging with his physical education students in ways that provided
him with sexual pleasure or gratification. These incidents included touching
them unnecessarily to provide “instruction” on various activities, purposely

brushing his hands against their breasts, volunteering to teach sex education
because he found it arousing to talk to them about sex, asking them personal
questions about their relationships, wearing shorts that revealed his genitals,
and purposely holding students after class to talk to them. There is no indica-
tion that any students ever reported his behaviors or were aware of his inten-
tions. He also reported masturbating to fantasies about scenarios involving
coercing or forcing his female students into sexual activity with him.
Sexual Fantasy and Masturbation Log Throughout the sexual-history

gathering process, Mr. Coe was also asked to maintain a log of the sexual
fantasies that he engaged in and masturbated to. Mr. Coe’s log revealed that, in
addition to having pedophilic attractions, he was strongly aroused by fantasies
with sexually sadistic elements. Namely, he claimed that his “most arousing”
fantasies incorporated verbal and physical humiliation of women and girls,
abduction, violent rape, forcing young females to perform sexual acts on one
another, physical abuse, buying a young female child as a sex slave, and sexual
torture involving weapons. To satisfy these attractions, Mr. Coe frequently
viewed and masturbated to violent pornography and fantasies and used phone
sex and web-camera services to pay women to be verbally degraded by him or to
harm themselves while he watched. He recalled two specific incidents in which
he paid young women on a web camera to role-play as young children, cut
themselves with knives, defecate, and eat their own feces. He reported paying
for sex with women in prostitution approximately fifty times in his life, though
he denied incorporating any of his sadistic fantasies into those encounters.
Mr. Coe also reported a history of using nonexplicit stimuli for sexual pur-
poses. For example, he recalled visiting nudist resorts on several occasions to
watch the nude children, viewing mainstream media for sexual gratification
(e.g., he enjoyed watching television shows and movies depicting rape while
imagined himself in the role of the perpetrators), and even calling a suicide
hotline and masturbating to the operator’s voice on multiple occasions.

It was determined that, due to the combination of his mental health issues,
deviant sexual interests, and compulsivity, Mr. Coe was both a high-need
and a high-risk client. This impression was supported by several dynamic
and static risk factors that are associated with long-term risk for recidivism:
deficits in sexual self-regulation (being overwhelmed by sexual thoughts and
urges), deviant sexual interests, socioaffective deficits (e.g., difficulties devel-
oping healthy, respectful, and intimate relationships), self-regulation deficits
(including problems controlling negative emotions), and noncooperation with
community supervision (Lussier & Gress, 2013). Mr. Coe clearly exhibited
deficits in sexual self-regulation, as well as emotional self-regulation problems,
when he repeatedly masturbated to inappropriate fantasies and in inappropri-
ate situations when feeling emotionally triggered. He also repeatedly became
verbally combative and aggressive with members of his treatment team in
reaction to stress or frustration. In terms of sexual deviancy, Mr. Coe reported
sexual interests that are reflective of both a sexual arousal to violence and a
sexual attraction to children (and a combination thereof). His socioaffective
deficits were represented by his having few friends, a history of conflict with
authority, and an absence of romantic relationships in his history. His nonco-
operation with community supervision was reflected in his problems adhering
to treatment expectations and the rules of probation, refusal to take responsi-
bility for his own behaviors, assertion that he was being treated unfairly, and
belief that his treatment team was out to get him.
His mental health issues were recognized and accommodated for by his
treatment team. He had been diagnosed by previous clinicians as having Bipo-
lar Disorder, ADHD, and Pedophilia. In addition, in the course of his disclo-
sures to his treatment team, he also exhibited attractions and fantasies involving
inflicting pain, humiliation, and degradation on others, which warranted an
additional diagnosis of Paraphilic Disorder, Sexually Sadistic Type. Due to his
intense emotional dysregulation, maladaptive and potentially harmful coping
mechanisms, and pattern of unstable interpersonal relationships and interac-
tion styles, it is also likely that Mr. Coe qualified for a diagnosis of Borderline
Personality Disorder. Mr. Coe often reverted to claiming that he was incapable
of behaving as required because of these diagnoses (e.g., he claimed that he was
not able to follow directions and respond appropriately to feedback because of
his ADHD). However, his treatment providers were experienced with treating
individuals with those issues and made reasonable accommodations for those
types of needs by providing feedback and instructions multiple times and in
several different formats and approaches, and Mr. Coe’s lack of compliance
appeared to be due to factors beyond those explained by those conditions.
Throughout his assessment and treatment, Mr. Coe displayed a pattern of
behaviors that is representative of resistance to and fighting against the treat-
ment process. Although he expressed a desire to understand and manage his
sexual interests and attractions, his behaviors did not reflect that claim. In the
group therapy process, he repeatedly received feedback from group facilita-
tors and his peers that he seemed to be more interested in arguing and blam-
ing his behaviors on others, or on forces beyond his control than in learning
how to change and manage them. In individual therapy, he failed to complete
homework assignments, primarily by being unwilling to practice and apply
the coping skills that he had been taught to regulate his emotions, tolerate
distress, accept reality, and refrain from engaging in sexually deviant fantasies.
He also displayed a tendency to react to boundaries by becoming emotionally

escalated and verbally reactive and combative.
Because of his deviant sexual interests involving the use of force, inflicting
pain, and offending against children, it was concluded that Mr. Coe should
optimally be placed in a contained environment that offers a high level of
supervision and restriction. However, due to a significant gap in available
resources, this was not an option for him. For individuals who require inpatient
treatment or a contained environment, there are four general options: 1) pub-
licly funded inpatient/residential mental health facilities, 2) privately funded
inpatient/residential mental health facilities, 3) civil commitment to a state
forensic psychiatric facility for sexually violent predators, or 4) incarceration.
Option 1, publicly funded inpatient/residential mental health facilities,
relies on government and social services funds to cover the costs of treatment
and care for facility patients. Because of the severe limitations of these funds
across the country, these facilities are usually only able to offer treatment to
individuals who are at imminent risk of harming themselves or others and are
believed to be incapable of controlling their own behavior. Because Mr. Coe
was not reporting active suicidal or homicidal intentions, he did not meet the
criteria for admission to one of these facilities. Option 2, privately funded
inpatient/residential mental health facilities, requires that patients be able
to pay for their own care. Mr. Coe’s financial situation prohibited him from
being able to do so. A thorough discussion of the nuances of option 3, civil
commitment of sexually violent predators to a state forensic psychiatric
facility, is beyond the scope of this chapter, but essentially Mr. Coe did not
qualify for the label of a sexually violent predator because he had not been
convicted of an offense involving actual physical sexual contact or violence
against a victim. Many forensic psychology professionals find this particular
limitation frustrating as it represents our legal system’s tendency to be reactive
rather than proactive. In other words, regardless of what clients disclose to us
about their desires and urges to hurt someone, we have to wait for Mr. Coe (or
individuals like him) to actually physically sexually assault a victim before we
have the option of placing them in the contained environment they may war-
rant. Finally, option 4, incarceration, is clearly a matter decided by the courts,
and in this case this option would require that Mr. Coe commit an additional
offense or be found to be in violation of his terms of probation in order to be
confined to a correctional facility.
Given that Mr. Coe did not qualify for any of the four options discussed
above for placement in a restricted environment, in order to ensure community
safety and amenability to treatment he needed to exhibit an ability to contain
himself within the confines of an outpatient treatment program. His treatment
team provided him with the highest available level of treatment (a combination
of weekly group therapy and weekly individual treatment), but Mr. Coe was
apparently unwilling to internalize and utilize the treatment tools that he had
been given. Though his treatment team expressed concerns about his ongoing
resistance to the treatment process and his approach to engaging in therapy,
he continued to exhibit a preference for utilizing therapy time for debating
and seeking justifications for various elements of the treatment program and
for placing blame on various people for his behavioral violations. When chal-
lenged on this type of behavior, Mr. Coe almost unfailingly reverted to claim-
ing that he is incapable of learning or applying coping skills or other elements
of therapy due to his various mental health diagnoses. It is important to note,
however, that there was clear indication that Mr. Coe’s cognitive and learning
abilities were intact, as he exhibited no difficulty in recalling information and
even recalled the precise wording that served to confirm his preexisting ideas
or the point he was trying to argue. This same ability, however, was not applied
when receiving information that challenged or contradicted what he wanted to
believe.
An example of this tendency was the incident he reported in which he
watched two young girls in a retail store. His treatment program’s consistent
stance on incidents such as these is that the client should immediately leave a
location in which he notices an attraction to a minor. His choice to not only
remain in the proximity of the children but also to continue to look at them
(for his own sexual gratification) was highly concerning in itself, particularly
given that his history indicated a willingness to manipulate situations in which
he has access to children for his own sexual gratification. In the context of his
ongoing failure to control and contain himself and his urges in various situa-
tions, this particular incident became an example of a high-risk behavior.
Ultimately, it was clear to this treatment team that Mr. Coe’s pattern of inap-
propriate behavior was not reflective of disability but was instead an indicator
that he chose to engage in ongoing behaviors that were both in violation of
his treatment contract and representative of a failure to internalize treatment
concepts. This pattern included, but was not limited to, ongoing masturba-
tion to inappropriate fantasies (involving force and coercion, inflicting pain
and humiliation, and children), choices that represent poor judgment (renting
movies and watching television programs involving sexual violence and mas-
turbating to them, remaining in the presence of children in public), misuse
of mental health resources (calling the suicide hotline for sexual gratification,
going to the psychiatric emergency room to complain about his current treat-
ment team), and boundary violations (being verbally combative and insulting
to members of the treatment team, misuse of text messaging, and demanding
extra time outside of treatment sessions).
In order for Mr. Coe to participate in and benefit from the outpatient treat-
ment that was available, and to remain safely in the community, he had to be will-
ing to use basic risk management strategies. His participation in the treatment
program and the reports provided by previous treatment providers indicated

that he was unwilling to do so at that time.

As indicated thus far, Mr. Coe was a resistant participant who was unwilling to
conform his behavior to the confines of an outpatient treatment program and
basic risk management procedures. Mr. Coe was diagnosed with Pedophilia
and Sexual Sadism, and admitted to being sexually attracted to pre-pubescent
girls. By nature, these disorders tend to run a fairly chronic, intense, and per-
sistent course. Individuals who suffer from Pedophilia often struggle with the
compulsive nature of the disorder and have difficulty gaining mastery over the
accompanying urges, which is why accountability and risk management prac-
tices are such important components of treatment. In addition, these disorders
represent a lifelong management problem that does not go away, as the interest
will likely always be present (American Psychiatric Association, 2013; Briken,
Fedoroff, & Bradford, 2014; Frances & Sreenivasan, 2008). Currently, there
are no known therapeutic approaches that have been able to successfully alter
one’s sexual orientations or interests, though the intensity of one’s attractions
may fluctuate over time (American Psychiatric Association, 2013; American
Psychological Association, 2009; Chenier, 2012). Mr. Coe had been in treat-
ment for some time and had been given quite a bit of latitude in an attempt
to engage him in the therapeutic process and to accommodate some of his
mental health issues. However, his continued resistance to the process, failure
to take responsibility for his choices, unwillingness to make needed changes,
and unwillingness to put in place adequate protective factors such as avoid-
ing inappropriate situations and materials, indicated that he was not a good
candidate for community containment at that time. Additionally, based on the
behavior described above, it appeared that Mr. Coe was engaging in high-risk
behaviors with few, if any, safety nets in place. As such, he was terminated
from the treatment program for being too high risk for outpatient treatment,
exhibiting a continuing pattern of resistance, refusing to take responsibility for
his behaviors, and failing to make adequate progress in treatment.
Additional Information
Because participation in, cooperation with, and completion of a sex offender
treatment program was a required condition of his probation and because he
was engaging in high-risk behaviors, Mr. Coe was arrested for violating his
probation terms following his termination from treatment. He appeared before
a judge who, given the sex offender risk evaluation discussed above, revoked
his probation and ordered him to serve an additional five years in prison with
three of those years suspended. This means that after two years of incarcera-
tion, Mr. Coe will once again be placed on probation and ordered to repeat the
evaluation and treatment process.

Working with forensic clients can present many challenges for clinicians and
evaluators, even beyond those that are inherent in general clinical practice.
This is especially true for professionals who may have started their careers or
training with nonforensic populations and who then try to adjust to working
with forensic clients.
Emotional Reactions
In order to work with sex offenders in a clinical setting, an evaluator or clini-
cian must be willing to listen to the potentially disturbing details of the crimes
committed, as well as any trauma the client may have been subjected to them-
selves. As is true for working with any trauma survivor, it can be emotionally
trying to hear about, and sit with, the pain and horror that some individuals
have had to experience in their lives. It can make one feel sad, angry, and pow-
erless. But it can be equally as distressing, and even more confusing, to hear
the stories from the offender’s perspective. In fact, it may produce conflicting
feelings of sadness and anger on the victim’s behalf and compassion, grief, and
regret for the offender. The experience of aligning with an offender’s perspec-
tive itself, even minimally, can feel like a betrayal of the victim and can pro-
duce guilt and ambivalence within the clinician. An additional challenge for
the clinician is appearing neutral, or at least not horrified or distressed, in the
midst of this emotional confusion.
Another struggle for a forensic practitioner can be striking the right bal-
ance between genuine emotional self-disclosure (which facilitates an alliance
with the client and can help them to understand the impact of their offenses)
and professional neutrality (that enables a clinician to remain objective). To
further complicate matters, the point on that spectrum that is most likely to
elicit a favorable response will vary with each individual client. So, learning
to continually assess where to find that delicate balance may be a career-long
learning curve.
Though the role of a forensic evaluator is not to determine guilt or punish-
ment for an offender, the outcomes of a sex offender evaluation may result in
severe consequences for the client. This reality can produce feelings of respon-
sibility, and even guilt, for an evaluator who has developed an alliance with
or compassion for a client. Accepting that as a forensic practitioner you may
simultaneously care about a client’s well-being and play a role in them being
sent to prison or experiencing negative consequences can be difficult. It is

important to remind oneself that the only truly responsible parties for any
consequences are the offenders themselves and that your role is simply to use
the tools of psychology to elicit as much information as possible about the
offender’s functioning, needs, and risk level.
Over-Empathizing and Under-Empathizing

When developing a therapeutic or clinical relationship with a client, the cli-
nician’s ability to empathize appropriately can be crucial to ensuring that a
secure alliance is formed. This alliance allows the clinician to accurately per-
ceive and understand the client’s emotional experience and enables the cli-
ent to feel understood, accepted, and safe to lower their defenses. However, as
with trying to strike an emotional balance in forensic work, it can be difficult
to maintain empathy without going to either extreme of over-empathizing or
under-empathizing. Over-empathizing with a client may lead a practitioner to
be less critical of a client’s version of their offenses, and less adept at challeng-
ing them when needed. In essence, a practitioner must be sure that empathy
does not lead to them becoming unquestioning or gullible. On the other hand,
under-empathizing with a client can create an adversarial relationship that
inhibits a client’s trust, openness, and cooperation. Unfortunately, it can also
lead to cynicism and a generalized distrust and dislike of the clients that we
are working with. It can be a complicated process for a forensic practitioner to
find a way to abhor sex offenses without dehumanizing and demonizing the
offender. At the end of the day, if mental health professionals are unable or
unwilling to view their clients (regardless of the population they work with) as
human beings, they have very little hope of facilitating positive change in their
clients’ lives (and ultimately, preventing future offenses and victimization).
Boundaries
Identifying, setting, and maintaining appropriate professional boundaries are
common foci of clinical training and supervision. However, forensic clients
in general, and sex offenders particularly, present with a heightened need for
strong boundaries on the part of their clinician. The very nature of sex offend-
ing indicates a disregard for, or ignorance of, the boundaries and needs of
others, so it is not surprising that sex offenders may model similar boundary
issues with their clinician or evaluator. Furthermore, they have often become
adept at using charm and manipulation to gain the trust of others or to influ-
ence others into relaxing their boundaries. Therefore, it is common for a pro-
vider, especially one who is new to working with forensic populations, to rely
on the types of boundaries that they typically set with clients from the general
population and to find that they have quickly become involved in a dynamic
with their forensic client that has crossed their emotional or interpersonal
boundaries. It is prudent, then, for practitioners to approach interactions with
forensic clients with a heightened awareness of their boundaries and stricter
guarding of them than they might typically apply. It is always much more dif-
ficult to assert or attempt to reassert a boundary that has already been crossed
than to identify and maintain a clear boundary from the onset of treatment.
However, even if a clinician experiences a boundary violation in treatment, it
can be a useful learning experience for both the clinician and client, if com-
municated and discussed appropriately in the clinical setting.
Ethical Considerations
One ethical concern that runs through many elements of the practice of forensic
psychology is that of the clinician serving a dual role. Though it is mandated that
clinicians inform any forensic clients about the limits of confidentiality and who
may receive copies of treatment reports or evaluations, the nature of a clinician’s
work with individuals from forensic populations may still pose opportunities
for ethical opacity. In the case of sex offender treatment and evaluation, a foren-
sic evaluator employs clinical approaches throughout the evaluation process
(while working with the client and attempting to gather as much information
as possible) and simultaneously answers to the legal system (serving the courts,
probation, or parole) regarding any factors that may constitute risk to the com-
munity. Additionally, an evaluator who works in tandem with, or obtains treat-
ment records from, a court-ordered treatment provider may (and should) utilize
information that is disclosed in therapy as part of the risk evaluation. Therefore,
while it is necessary for the client to be completely honest and open about his or
her sexual interests, attractions, fantasies, and behaviors from a therapeutic and
risk-management standpoint, it also places the client in a position in which he
or she may face legal consequences for therapeutic disclosures.
Given the team approach used in Mr. Coe’s case, many of his disclosures
in therapy that could have represented an increased risk to the community
were shared with his evaluator and probation officer. In the interest of protect-
ing potential victims and reducing the likelihood of recidivism, the probation
officer decided to impose additional restrictions or limitations on the client’s
freedoms. While the community’s safety is of primary concern in cases such
as these, it also served to essentially punish Mr. Coe (and clients like him) for
being honest in the assessment process and/or therapy. Great effort was made
to connect the importance of Mr. Coe’s honesty with the purpose of requiring it;
namely, that in order for him to gain control and mastery over his own behav-
iors and choices, he had to be fully open about them. Ultimately, his ability to
manage his behaviors has a direct relationship with the level of risk he poses to
the community. Therapeutically, this honesty and subsequent self-management
is the goal of treatment. However, the goals of other treatment team members
(i.e., probation) are centered on protecting the public from offenders first and
foremost, and the same clinical information could be interpreted and used in
ways that can feel antitherapeutic to the client. Thus, maintaining open com-
munication and trust between clinician and client is often even more challeng-
ing than it would be normally. Ideally, a client would be as committed to the
therapeutic process and the ultimate goal of protecting the public as his treat-
ment team would be, but often clients perceive this dynamic as punishing and
inhibiting.
In Mr. Coe’s case, and in cases like his, another concern arises regarding the
potential of limiting an individual’s freedom not purely based on what they
have done, but in light of what we believe they might do. Though concerns
about potential behavior alone are not grounds for incarceration, they may be
used to revoke the client’s supervised release and ultimately force him to serve
the remainder of his original sentence in a correctional facility. Though a cli-
ent’s supervised release is considered a privilege, rather than a right (since the
original sentence was for a full term in a correctional facility), the revocation
of it based on an estimated level of risk can walk the ethical fine line. There is
always the chance that a clinician’s guided risk assessment, based on clinical
judgment and formalized assessments, indicates that an individual is at a high
risk of reoffending, yet that client may never commit another sexual offense.
Most often, though, forensic professionals operate on the principle that it is
preferable to have a false positive (i.e., predict a high chance of recidivism
when none actually occurs) than a false negative (i.e., predict a low chance of
recidivism and then a reoffense occurs), because the stakes are so high; “recidi-
vism” and “reoffense,” when talking about sexual offending, is equal to one or
more human beings being sexually violated.
References
Abel, G. G., Huffman, J., Warberg, B., & Holland, C. L. (1998). Visual reaction time and
plethysmography as measures of sexual interest in child molesters. Sexual Abuse: A Jour-
nal of Research and Treatment, 10, 81–95. doi:10.1177/107906329801000202
Adam Walsh Child Protection and Safety Act, Pub. L. No. 109–248, 120 Stat. 587 (2006).
Amenta, A. E., Guy, L. S., & Edens, J. F. (2003). Sex offender risk assessment: A cautionary
note regarding measures attempting to quantify violence risk. Journal of Forensic Psy-
chology Practice, 3(1), 39–50. doi:10.1300/J158v03n01_04
American Psychological Association. (2009). Report of the American Psychological Associa-
tion Task Force on appropriate therapeutic responses to sexual orientation. Washington,
DC: Author.
American Psychological Association. (2010). Ethical principles of psychologists and code of
conduct. Washington, DC: Author. Retrieved November 10, 2014, from http://www.apa
.org/ethics/code/index.aspx
Andrews, D. A., & Bonta, J. L. (1998). The psychological of criminal conduct (2nd ed.). Cin-
cinnati, OH: Anderson.
Association for the Treatment of Sexual Abusers. (2014). Risk Assessment | ATSA. Retrieved
November 10, 2014, from http://www.atsa.com/risk-assessment
Bartosh, D. L., Garby, T., Lewis, D., & Gray, S. (2003). Differences in predictive validity
of actuarial risk assessments in relation to sex offender type. International Journal of
Offender Therapy and Comparative Criminology, 47(4), 422–438.
Beech, A. R., Fisher, D. D., & Thornton, D. (2003). Risk assessment of sex offenders. Profes-
sional Psychology: Research and Practice, 34(4), 339–352. doi:10.1037/0735-7028.34.4.339
Boer, D. P., Hart, S. D., Kropp, P. R., & Webster, C. D. (1997). Manual for the Sexual Violence
Risk-20. Professional guidelines for assessing risk of sexual violence. Vancouver, British
Columbia, Canada: Institute Against Family Violence.
Bonta, J., Law, M., & Hanson, R. K. (1998). The prediction of criminal and violent recidi-
vism among mentally disordered offenders: A meta-analysis. Psychological Bulletin 123,
123–142.
Branaman, T. F., & Gallagher S. N. (2005). Polygraph testing in sex offender treatment: A
review of the limitations. American Journal of Forensic Psychology, 23, 45–64.
Briken, P., Fedoroff, J. P., & Bradford, J. W. (2014). Why can’t pedophilic disorder remit?
Archives of Sexual Behavior, 43(7), 1237–1239. doi:10.1007/s10508-014-0323-1
Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). The
Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration
and scoring. Minneapolis, MN: University of Minnesota Press.
Calkins, C., Jeglic, E., Beattey, R. A., Ziedman, S., & Perillo, A. D. (2014). Sexual violence
legislation: A review of case law and empirical research. Psychology, Public Policy, and
Law, 20(4), 443–462.
Chenier, E. (2012). The natural order of disorder: Pedophilia, stranger danger and the nor-
malising family. Sexuality & Culture, 16(2), 172–186.
Conroy, M. A., & Murrie, D. DC. (2007). Forensic assessment in violence risk: A guide for risk
assessment and management. Hoboken, NJ: Wiley.
Craig, L. A., & Beech, A. R. (2010). Towards a guide to best practice in conducting actuarial
risk assessments with sex offenders. Aggression and Violent Behavior, 15(4), 278–293.
doi:10.1016/j.avb.2010.01.007
Dallas, C. (2009). Not in my backyard: The implications of sex offender residency ordi-
nances in Texas and beyond. Texas Tech Law Review, 41, 1235–1244.
Doren, D. M. (2004). Bibliography of published works relative to risk assessment for sexual
offenders. Retrieved November 10, 2014, from http://www.atsa.com/pdfs/riskAssessment
Biblio.pdf
Edwards, W., & Hensley, C. (2001). Contextualizing sex offender management legislation and
policy: Evaluating the problem of latent consequences in community notification laws.
International Journal of Offender Therapy and Comparative Criminology, 45(1), 83–101.
Eke, A. W., & Seto, M. C. (2012). Risk assessment of online offenders for law enforcement.
In K. Ribisl & E. Quayle (Eds.), Internet child pornography: Understanding and prevent-
ing on-line child abuse. Devon, U.K.: Willan.
Epperson, D. L. (2000, March). Minnesota Sex Offender Screening Tool–Revised. Paper pre-
sented at the Sinclair Seminars Conference of Sex Offender Re-Offense Risk prediction,
Madison, WI. (Videotape available from www.sinclairseminar.com.)
Epperson, D. L., Kaul, J. D., & Hesselton, D. (1998). Final report on the development of
the Minnesota Sex Offender Screening Tool-Revised (MnSOST-R). Paper presented at the
17th Annual Conference of the Association for the Treatment of Sexual Abusers, Van-
couver, British Columbia, Canada.
Frances, A., & Sreenivasan, S. (2008). Sexually violent predator statutes: The Clinical/Legal
interface. Psychiatric Times, 25(14), 49.
Galeste, M. A., Fradella, H. F., & Vogel, B. (2012). Sex offender myths in print media: Sepa-
rating fact from fiction in U.S. newspapers. Western Criminology Review, 13(2), 4–24.
Goyette, C. H., Conners, C. K., & Ulrich, R. F. (1978). Normative data on revised Conners
parent and teacher rating scales. Journal of Abnormal Child Psychology, 6(2), 221–236.
Hanson, R. K. (1997). The development of a brief actuarial scale for sex offender recidivism
(User Report No. 1997–04). Ottawa, Ontario, Canada: Department of the Solicitor Gen-
eral of Canada.
Hanson, R. K. (1998). What do we know about sex offender risk assessment? Psychology,
Public Policy, and Law, 4(1–2), 50–72. doi:10.1037/1076-8971.4.1-2.50
Hanson, R. K., & Bussiere, M. T. (1998). Predicting relapse: a meta-analysis of sex-
ual offender recidivism studies. Journal of Consulting and Clinical Psychology, 66,
348–362.
Hanson, R. K., & Harris, A. J. R. (2000a). The Sex offender needs assessment rating (SONAR):
A method for measuring change in risk levels. Canada: Department of the Solicitor Gen-
eral of Canada. Retrieved November 10, 2014, from http://ww2.psepc-sppcc.gc.ca/
publications/corrections/pdf/200001b_e.pdf
Hanson, R. K., & Harris, A. J. R. (2000b). Where should we intervene? Dynamic predictors
of sex offense recidivism. Criminal Justice and Behavior, 27, 6–35.
Hanson, R. K., Helmus, L., & Thornton, D. (2010). Predicting recidivism amongst sexual
offenders: A multi-site study of Static-2002. Journal of Law and Human Behavior, 34,
198–211.
Hanson, R. K., & Morton-Bourgon, K. (2004). Predictors of Sexual Recidivism: An Updated
Meta-Analysis. Ottawa, Ontario Canada: Public Safety and Emergency Preparedness
Canada.
Hanson, R. K., Stey, R. A., & Gauthier, R. (1993). Long-term recidivism of child molesters.
Journal of Consulting and Clinical Psychology, 61, 646–652.
Hanson, R. K. (2005). Twenty years of progress in violence risk assessment. Journal of Inter-
personal Violence, 20(2), 212–217.
Hanson, R. K., & Thornton, D. (1999). Static-99: Improving actuarial risk assessments for sex
offenders (User Report No. 99–02). Ottawa, Ontario, Canada: Department of the Solici-
tor General of Canada.
Hanson, R. K., & Thornton, D. (2000). Improving risk assessments for sex offenders: A
comparison of three actuarial scales. Law and Human Behavior, 24(1), 119–136.
Hare, R. D. (1991). The Hare Psychopathy Checklist-revised. Toronto, ON: Multi-Health
Systems.
Harris, A. J. (2006). Risk assessment and sex offender community supervision: A context-
specific framework. Federal Probation, 70(2), 36–43.
Harris, A. J., & Hanson, R. K. (2010). Clinical, actuarial and dynamic risk assessment of sex-
ual offenders: Why do things keep changing? Journal of Sexual Aggression, 16, 296–310.
doi:10.1080/13552600.2010.494772
Harris, G. T., Rice, M. E., & Quinsey, V. L. (1993). Violent recidivism of mentally disordered
offenders: The development of a statistical prediction instrument. Criminal Justice and
Behavior, 20, 315–335. doi:10.1177/0093854893020004001
Jackson, R. L., & Richards, H. J. (2007). Diagnostic and risk profiles among civilly commit-
ted sex offenders in Washington State. International Journal of Offender Therapy and
Comparative Criminology, 51, 313–323.
Jacob Wetterling Crimes Against Children and Sexually Violent Offenders Registration Act,
Pub. L. No. 103–322, 108 Stat. 1796 (1994).
Janus, E. S., & Prentky, R. A. (2003). Forensic use of actuarial risk assessment with sex
offenders: Accuracy, admissibility and accountability. The American Criminal Law
Review, 40, 1443–1499.
Knight, R. A. (2008). MIDSA clinical manual. Bend, OR: Augur Enterprises. Retrieved
November 10, 2014, from www.midsa.us
Knight, R. A., & Thornton, D. (2007). Evaluating and improving risk assessment schemes
for sexual recidivism: A long-term follow-up of convicted sexual offenders. Retrieved
November 10, 2014, from https://www.ncjrs.gov/pdffiles1/nij/grants/217618.pdf
Lachar, D., Klinedinst, J. K., & Seat, P. D. (1981). Multidimensional description of child per-
sonality: A manual for the Personality Inventory for Children. Los Angeles, CA: Western
Langan, P., & Levin, D. (2002). Recidivism of prisoners released in 1994. Washington, DC:
U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.
Langton, C. M., Barbaree, H. E., Harkins, L., Seto, M. S., & Peacock, E. J. (2002). Evaluat-
ing the prediction validity of seven risk assessment instruments for sex offenders. Paper
presented at the Annual Research and Treatment Conference for the Association for the
Treatment of Sexual Abusers. Montreal, Ontario, Canada.
Lanterman, J. L., Boyle, D. J., & Ragusa-Salerno, L. M. (2014). Sex offender risk assessment,
sources of variation, and the implications of misuse. Criminal Justice and Behavior,
41(7), 822–843. doi:10.1177/0093854813515237
Levenson, J. S., Brannon, Y. N., Fortney, T., & Baker, J. (2007). Public perceptions about sex
offenders and community protection policies. Analysis of Social Issues and Public Policy,
7, 137–161.
Levenson, J. S., & Hern, A. (2007). Sex offender residence restrictions: Unintended con-
sequences and community re-entry. Justice Research and Policy, 9, 59–74. doi:10.3818/
JRP.9.1.2007.59
Linehan, M. M. (1993). Cognitive-behavioral treatment for Borderline Personality Disorder.
New York, NY: Guilford Press.
Lussier, P., & Gress, C. L. Z. (2014). Community re-entry and the path toward desistance: A
quasi-experimental longitudinal study of dynamic factors and community risk manage-
ment of adult sex offenders. Journal of Criminal Justice, 42(2), 111–122.
McArthur, D. S., & Roberts, G. E. (1982). Roberts Apperception Test for Children. Western
McGuire, J. (2000). Explanation of criminal behavior. In J. McGuire, T. Mason, & A. O’Kane
(Eds.), Behavior, crime and legal processes: A guide for legal practitioners (pp. 135–159).
Chichester, England: Wiley.
McKay, M., Wood, J. C., & Brantley, J. (2007). The dialectical behavior therapy skills work-
book: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emo-
tion regulation & distress tolerance. Oakland, CA: New Harbinger.
Meloy, M. L., Miller, S. L., & Curtis, K. M. (2008). Making sense out of nonsense: The
deconstruction of state-level sex offender residence restrictions. American Journal of
Criminal Justice, 33, 209–222.
Mercado, C. C., Alvarez, S., & Levenson, J. (2008). The impact of specialized sex offender
legislation on community reentry. Sexual Abuse: Journal of Research and Treatment, 20,
188–205.
Mercado, C. C., Schopp, R. F., & Bornstein, B. H. (2005). Evaluating sex offenders under
sexually violent predator laws: How might mental health professionals conceptualize the
notion of volitional impairment? Aggression and Violent Behavior, 10, 289–309.
Millon, T., & Davis, R. D. (1997). The MCMI-III: Present and future directions. Journal of
Personality Assessment, 68(1), 69–85.
Monahan, J. (1981). The clinical prediction of violent behavior. Washington, DC: Govern-
ment Printing House.
Morey, L. C. (2007). Personality Assessment Inventory professional manual (2nd ed.). Lutz,
FL: Psychological Assessment Resources.
Nichols, H. R., & Molinder, L. (1996). Multiphasic Sexual Inventory II handbook. Tacoma,
WA: Nichols & Molinder.
Pascal, G. R., & Suttell, B. J. (1951). Bender-Gestalt Test.
Phenix, A., Doren, D., Helmus, L., Hanson, R. K., & Thornton, D. (2008). Coding rules for
Static-2002. Retrieved November 13, 2014, from http://www.static99.org/pdfdocs/static
2002codingrules.pdf
Quinsey, V. L., Harris, G. T., Rice, M. E., & Cormier, C. A. (1998). Violent offenders: Apprais-
ing and managing risk. Washington, DC: American Psychological Association.
Rorschach, H., Lemkau, P. T., Kronenberg, B. T., & Morgenthaler, W. (1942). Psychodiagnos-
tics: A diagnostic test based on perception (rev. and enlarged), including the application of
the form interpretation test. Bern, Switzerland: Verlag.
Schopp, R. F., Scalora, M. J., & Pearce, M. (1999). Expert testimony and professional judg-
ment: Psychological expertise and commitment as a sexual predator after Hendricks.
Psychology, Public Policy, and Law, 5, 120–174.
Seto, M. C. (2013). Risk assessment. In M. C. Seto, Internet sex offenders (pp. 193–223).
Washington, DC: American Psychological Association. doi:10.1037/14191-008
Sex Offender Registration and Notification Act, 72 Fed. Reg. 8896, cod. (SORNA). At 28 C.
F. R. § 72.3 (2006).
Stadtland, C., Hollweg, M., Kleindienst, N., Dietl, J., Reich, U., & Nedopil, N. (2005). Risk
assessment and prediction of violent and sexual recidivism in sex offenders: Long-term
predictive validity of four risk assessment instruments. Journal of Forensic Psychiatry &
Psychology, 16(1), 92–108. doi:10.1080/1478994042000270247
Tewskbury, R., & Lees, M. (2006). Perceptions of sex offender registration: Collateral conse-
quences and community experiences. Sociological Spectrum, 26(3), 309–334.
Thornton, D., Mann, R., Webster, S., Blud, L., Travers, R., Friendship, C., & Erikson, M.
(2003). Distinguishing and combining risks for sexual and violent recidivism. In R.
Prentky, E. Janus, M. Seto, & A. W. Burgess (Eds.), Annals of the New York Academy
of Sciences: Vol. 989. Sexually coercive behavior: Understanding and management (pp.
225–235). New York, NY: New York Academy of Sciences.
Visgaitis, R. L. (2011). Retroactive application of the sex offender registration and notifi-
cation act: A modern encroachment on judicial power. Columbia Journal of Law and
Social Problems, 45(2), 273–302.
Wakeling, H. C., Howard, P., & Barnett, G. (2011). Comparing the validity of the RM2000
scales and OGRS3 for predicting recidivism by Internet sexual offenders. Sexual Abuse:
Journal of Research and Treatment, 23(1), 146–168. doi:10.1177/1079063210375974
Walters, G. D., Knight, R. A., & Thornton, D. (2009). The latent structure of sexual violence
risk: A taxometric analysis of widely used sex offender actuarial risk measures. Criminal
Justice and Behavior, 36(3), 290–306. doi:10.1177/0093854808330341
Wilkinson, G. S., & Robertson, G. J. (2006). WRAT 4: Wide Range Achievement Test. Psy-
chological Assessment Resources.
Witt, P. H., & Conroy, M. A. (2009). Evaluation of sexually violent predators. Guides to best
practices for forensic mental health assessments. New York, NY: Oxford University Press.
7
Civil Commitment: Examining

Mental Illness, Differential
Diagnosis, Attributes of Risk,
and Application to Case Law
Casey Sharpe and Anna Florek
Civil commitment is a state-sanctioned legal process through which individu-

als are deprived of their liberty via involuntary hospitalization. Generally, civil
commitment proceedings occur when an individual presents with a mental
disorder and has acted in a manner that warrants the need for care and treat-
ment due to potential harm to self or others (Pinals & Mossman, 2012; Melton,
Petrila, Poythress, & Slobogin, 2007). In some states, an individual may also
be civilly committed if he or she is gravely disabled or presents with a very
substantial risk to oneself. Such an individual would be considered unable to
take care of his or her own basic, physical needs without the assistance of oth-
ers (Menninger, 2001). Depending on the state, an individual may be eligible
for civil commitment if considered acutely or persistently disabled, in that an
individual is highly likely to suffer severe physical or mental harm because of
impaired judgment due to a mental health condition (Menninger, 2001; Erick-
son, Vitacco, & Rybroek, 2005). The objective of civil commitment has tradi-
tionally been confined rehabilitation. Its purpose is not punishment; however,
institutionalization is, in fact, a “deprivation of liberty” (Melton et al., 2007,
p. 38) and as a result has been controversial (Melton et al., 2007; Erickson
et al., 2005). Despite the intentions to be a rehabilitative process, civil com-
mitment often historically occurred informally and for a wide variety of rea-
sons. Consequently, civil commitment laws were challenged in the courts of
the 1960s and 1970s, suggesting that the process and previously existing laws
were potentially more harmful than helpful (Melton et al., 2007) to the con-
fined individual.
Civil Commitment 145
Today, civil commitment evaluations are among the most common for
forensic evaluators. Civil commitment laws are present in all 50 states, as well
as the District of Columbia (Pinals & Mossman, 2012). While the total number
of yearly civil commitment referrals is unknown, it is safe to reason that thou-
sands are conducted annually nationwide. For instance, New York’s “Kendra’s
Law,” which dictates assisted outpatient civil commitment laws, yielded the
need for over 10,000 evaluations after its implementation in 1999 (New York
State Office of Mental Health, 2005). These numbers only reflect o utpatient
civil commitment referrals in one state. By amplifying these numbers nation-
wide, combining the inpatient and outpatient referrals made federally and in
all 50 states and Washington, DC, we find there are likely upward of tens of
thousands civil commitment referrals made each year.
Navigating the intricacies of civil commitment laws and best practices in
actuarial measurements and psychological testing can be problematic for eval-
uators, as the concept of risk inevitably invites a greater level of complexity to
the evaluation (Pinals & Mossman, 2012). Evaluators are expected to make
rational, well-founded decisions amid a myriad of complicated factors. This
chapter will review relevant mental health case law addressing the evolution of
civil commitment laws in greater depth and briefly explain related best prac-
tices. A case vignette will allow readers to follow the rationale and guidance of
how to formulate opinions in a civil commitment evaluation using best prac-
tices and keeping relevant legal issues in mind.
Relevant Case Law and Common Statutory Considerations

Evaluators need to be familiar with the civil commitment statutes and case
law for the jurisdiction in which they practice. Currently, every state requires
that an individual present with evidence of a mental illness as a predicate
to involuntary commitment (Slobogin, Hafemeister, Mossman, & Reisner,
2014). However, mental illness may be defined differently depending on the
jurisdiction. For the case included in this chapter, mental illness was defined
by administrative code as a mental or emotional disorder that substantially
impairs a person’s thought, perception of reality, emotional process, judgment,
behavior, or ability to cope with the ordinary demands of life but does not
include a developmental disability, dementia or Alzheimer’s disease absent
psychosis, a substance abuse disorder, or an abnormality manifested only by
repeated criminal or otherwise antisocial conduct (405 ILCS 5/1–129). Many
states specifically exclude behaviors that would fall under the description of
Antisocial Personality Disorder or Psychopathy, or drug or alcohol abuse,
and these are important distinctions for the evaluator to consider. However,
it has also been suggested that some personality disorders (e.g., Borderline
Personality Disorder) might meet the statutory definition of a mental disorder
(Pinals & Mossman, 2012). It is not always clear when violent behavior may
be attributable to symptoms of a mental illness, a personality disorder, or the
context of the situation, and the same individual may meet criteria for invol-
untary commitment in one jurisdiction but not another, or at one time but
not another. Many times it is a confluence of various factors that contributes
to an individual’s risk for violence. While it is ultimately the trier of fact who
determines whether an individual meets criteria for civil commitment, the
evaluator must evaluate how these various factors relate to a specific civil com-
mitment statute or law and how an individual may or may not meet criteria
for civil commitment.
Second, most state statutes require evidence that a person’s violent behav-
ior or risk for violent behavior is caused by or the direct result of mental ill-
ness in order to meet the criteria for civil commitment (Slobogin et al., 2014).
Mental illness alone is not sufficient to deprive an individual of his or her civil
liberty. In the landmark case, O’Connor v. Donaldson (1975), the Supreme
Court of the United States held that a state could not confine an individual
who is mentally ill and nondangerous and who is capable of residing safely
in the community either alone or with the assistance of responsible family
or friends. However, the terms dangerousness, dangerous conduct, violent
behavior, or risk of serious harm may have different definitions depending
on the jurisdiction, and even then, these terms may not be clear. In all civil
commitment decisions, courts must determine whether the level of potential
threat a person poses exceeds that individual’s civil liberty interests (Slobogin
et al., 2014). Given this fundamental aspect of the process, clarity of these
terms is important, and the evaluator must also be familiar with statutory
definitions of such, as well as any changes or updates in the law.
For example, the Supreme Court of Illinois recently recognized that Illinois
legislative language related to the term “dangerous conduct” was unconstitu-
tionally vague (In re Torski, 2009). In order to be civilly committed in Illinois,
an individual must first meet a threshold of diminished capacity to make treat-
ment decisions due to mental illness and must pose a threat to others by way of
or because of his or her mental illness. Also according to this ruling, an evalu-
ator must assess both the “magnitude” and “probability” of harm, according
to state statute. The court found that the statutory term “dangerous conduct,”
defined as “threatening behavior or conduct that places another individual in
reasonable expectation of being harmed,” as impermissibly vague, elaborating
that under this language, an individual may be committed for shouting a racial
slur or otherwise causing psychological, emotional, or even financial harm to
someone (In re Torski, 2009). The updated statute now specifies that dangerous
conduct must include a reasonable expectation of being physically harmed (IL
405 5/1–119). This is important for evaluators to take into account, as evi-
dence of an “overt act” is required in many jurisdictions to answer the question
as to whether or not an individual poses a risk to himself or herself or others

(Pinals & Mossman, 2012).
Third, many state statutes also suggest that individuals with mental illness
who require treatment also must be provided this treatment in the least restric-
tive environment or setting (Lake v. Cameron, 1966). This means that, if there
exists a setting that is less restrictive to civil liberty compared with an inpatient
facility, the individual should receive treatment in that environment. The basis
for such was established in Lake v. Cameron (1966), in which the U.S. Court of
Appeals for the District of Columbia decided that an individual cannot con-
stitutionally be confined against his or her will if there is a less restrictive way
to safely manage and treat the individual within the community. Less restric-
tive options can include residential programs, family support, outpatient treat-
ment as described earlier, or other alternative methods of treatment outside
of a hospital setting (Conroy & Murrie, 2007). This aligns with best practices
related to violence risk assessment, which suggest that an evaluator not only
provide an opinion related to risk but also focus on risk management strate-
gies and reduction solutions. In this manner, the evaluator must also consider
what type of setting is best suited to reduce an individual’s risk for violence
in addition to the dynamic or potentially protective factors present. Lessard
v. Schmidt (1972) reaffirmed the least-restrictive-setting requirement for civil
commitment. While this case was specific to the state of Wisconsin, it is con-
sidered a landmark decision that highlighted other rights and processes due
to individuals facing civil commitment. The Lessard decision outlined a set
of specific procedural safeguards for the civil commitment process, and these
closely mirrored those of criminal procedures, which indicated how seriously
the court took the significant restriction of civil liberties. These included an
adequate notice of rights, timely notice of the intent to detain the individual,
a full court hearing, right to counsel, right to a jury trial, notice of privilege
against self-incrimination, and proof beyond a reasonable doubt that a person
is both mentally ill and dangerous.
In Addington v. Texas (1979), the Supreme Court held that, in order to
appropriately balance both personal civil liberty and state public protection
interests, the burden of proof in civil commitment proceedings needed to
be clear and convincing (as opposed to the more strict “beyond a reasonable
doubt” standard as outlined in Lessard). This means that, for an individual
to be involuntarily committed against his or her wishes, the petitioner must
demonstrate with clear and convincing evidence that the individual is men-
tally ill and also poses a danger to himself or others. This raised the burden
of proof from the lower “preponderance of the evidence” standard for many
states. However, this decision established only the minimum burden of proof
and, as noted in the Lessard decision, some states have an even higher standard
of beyond a reasonable doubt. While evaluators should follow best practices
related to data collection and information gathering for civil commitment

evaluations, it is important to recognize that the burden of proof standards
may require more or less data in support of a particular opinion. While this
tends to be more of a concern for attorneys, it is an important aspect of the
evaluative and legal process, which evaluators need to understand.
Another consideration for evaluators involves self-incrimination, as many
times the need for civil commitment may be evaluated in the context of crimi-
nal proceedings, such as competence to stand trial or criminal responsibil-
ity (sometimes referred to as quasi-criminal commitment). While the Lessard
court stopped short of ruling that an attorney should be present for psychiatric
interviews pertaining to civil commitment, it did state that an individual must
be informed that his or her statements could be used in an effort to have the
individual committed to a hospital, and as a result, he or she need not speak
to an evaluator. Many states require that individuals be notified that they may
refuse to speak to an evaluator, and statements made during a commitment
evaluation may not be used against the individual in a criminal proceeding.
This is important for evaluators to recognize, as it may impact what type of
information or data is included in a report.
Lastly, evaluators often rely on many sources of information when con-
ducting an evaluation related to civil commitment. In addition to an inter-
view with the respondent, other sources of information can include police or
arrest records, records related to past hospitalizations, and interviews with
collateral sources such as friends and family members. Typically, if a clinician
or other individual were to testify in court about information not personally
observed, this would constitute hearsay and thus not be admissible. However,
many jurisdictions have hearsay exceptions for civil commitment hearings so
that an evaluator may testify to information that is relevant for commitment
(Pinals & Mossman, 2012). Pinals and Mossman (2012) stress the importance
of evaluators being aware of admissibility standards for the area in which they
practice, as this will have an impact on the methods of data collection as well
as the type of information gathered. For example, while Federal Rule of Evi-
dence 703 allows for the admission of expert opinion based on data not per-
sonally observed but “reasonably relied upon” by experts in a specific field, not
all states have this provision (Fed. R. Evid. 703; Pinals & Mossman, 2012). If
data gathered is likely considered inadmissible in court, this will impact the
utility of the evaluation and subsequent testimony.

In order to understand the process of civil commitment, it is essential that
forensic evaluators be mindful of the jurisprudential basis for civil commit-
ment. Civil commitment is not a criminal proceeding; however, it is useful
to know that some aspects of the criminal justice system play a role in civil
commitment laws. The foundation of civil commitment is best understood as
a hybrid system that encompasses the legal contexts known as police power
and parens patriae, respectively. Police power provides the jurisprudential
basis of criminal law and gives authority to the state to protect the commu-
nity (Jacobson v. Massachusetts, 1905; Melton et al., 2007; Pinals & Mossman,
2012). Jacobson v. Massachusetts (1905) explained that police power is justi-
fied because although freedom is a right, it does not grant citizens permission
to act however they wish. There are reasonable restrictions to liberty, which
are subject for monitoring and enforcement by the governing body. Essen-
tially, police power provides the state with authority to protect the commu-
nity (Melton et al., 2007), address the concept of future dangerousness, and
empower the state to act in the best interest of itself.
Alternatively, civil commitment utilizes parens patriae authority for its pri-
mary justification for action (Melton et al., 2007). Parens patriae means that it
is the role of the state to act in the best interest of the individual, not the com-
munity, as is the case when utilizing police power for public safety. This concept
authorizes the state to care for those who are unable to do so for themselves, be
it due to a mental disorder, grave disability, or persistent or acute disability. In
the circumstances of civil commitment, it allows the state to make appropriate
treatment decisions for those who are unable to do so for themselves (Janus,
1998; Melton et al., 2007; Pinals & Mossman, 2012; Moran, Robins, & Kurzban,
2000). Although the individual is restrained and deprived of liberty for what is
generally thought of as the overall good of the public, the court in Prochaska
v. Brinegar (1960) explained that it is done at the behest of the governing body
for the individual’s “own protection and welfare as well as for the benefit of
society” (as cited in Melton et al., 2007, p. 328). Ultimately, the general basis for
civil commitment legislation relies on both police power and parens patriae to
protect the citizens of the country and rehabilitate those unable to care or act
for themselves who have posed or may pose a potential threat to others.
Applications and Uses

The process of civil commitment, while widely varied among states, gener-
ally follows the same basic principles. According to the Moran, Robins, and
Kurzban (2000), an initial petition is filed under the premise that an individual
presents as an imminent danger to him- or herself or is in need of immediate
treatment. The petition can be filed by any number of individuals; however, it
is most likely to be filed by a hospital administrator or by hospital personnel
(Erickson et al., 2005). Anyone can raise the issue or concern; however, a treat-
ing therapist, police officer, or family member would likely take the individual
to a hospital for safety, rather than doing the actual filing.
Inpatient Commitment The use of civil commitment can vary in that it is

reliant on the circumstances of the situation (e.g., emergency hospitalization or
extended stays of treatment). States are permitted to involuntarily hospitalize
patients, but only for a brief time that has been predetermined (Testa &
West, 2010, Moran, et al., 2000). Due to the progression and advancement of
commitment statutes and standards through case law, patients are protected
from indefinite, involuntary hospitalization (Melton et al., 2007; Testa & West,
2010; Pinals & Mossman, 2012; O’Connor v. Donaldson, 1975). Timeframes
vary by state, but generally, patients can only be hospitalized against their
will for periods ranging from two days to two weeks; however, these stays can
be extended by the court (Testa & West, 2010; Moran et al., 2000). If after
the predetermined length of commitment has elapsed and doctors continue
to express concerns of imminent risk, a recommendation for continued
involuntary commitment can be proposed (Testa & West, 2010; Moran et al.,
2000; Pinals & Mossman, 2012). Patients are entitled to a court hearing with
legal representation regarding the continuation of their commitment at
these hearings (Testa & West, 2010). Regarding the evaluation for extended
commitment, certain states may allow the current treating clinician or
psychiatrist where the emergency hospitalization has occurred to conduct the
evaluation; however, some states may require an independent, court-appointed
evaluator to proceed. It is important to note that psychiatric providers are
responsible for treating the individual using the “least restrictive alternative”
method available (Lake v. Cameron, 1966).
Outpatient Commitment While inpatient commitment is the predominant

form of civil commitment, outpatient civil commitment has become another
option in recent years as a means to satisfy the least restrictive alternative
standards (Conroy & Murrie, 2007). According to Schopp (2003), outpatient
civil commitment is utilized in one of three circumstances. First, an individual
may be released from an inpatient psychiatric setting on a conditional basis,
otherwise known as conditional release. This applies to patients who have
been involuntarily committed to an inpatient facility under the state’s general
civil commitment statute because they have a mental illness and because they
demonstrated an imminent degree of dangerousness or future risk (Schopp,
2003). Such patients are discharged from the hospital on the condition that
they will comply with their treatment plan while in the community. However,
failure to comply with the outpatient treatment plan can result in the return to an
inpatient facility (Schopp, 2003). Second, outpatient civil commitment serves
as an alternative to inpatient placement during civil commitment proceedings,
but it requires strict monitoring as a least restrictive alternative to involuntary
placement while the hearing is in progress (Schopp, 2003). Third, individuals
who do not currently meet the criteria of mental illness and dangerousness but
are soon expected to deteriorate to the point of likely meeting the involuntary
commitment standards in the foreseeable future may be recommended
for outpatient commitment in order to prevent more restrictive inpatient
treatment (Schopp, 2003). Some states do not have provisions for outpatient
commitment, and as a result, inpatient civil commitment may be the only
available option for evaluators to consider.
Best Practices
Civil commitment cannot be divorced from violence risk assessment, as dis-
cussion of one necessitates the other. A thorough overview of best practices
related to violence risk assessment can be found elsewhere in this book, as well
as in other sources (Conroy & Murrie, 2007; Heilbrun, 2009). Additionally,
best practices related specifically to the evaluation for civil commitment also
exist (Pinals & Mossman, 2012). Consequently, this section will focus only
briefly on the steps involved in violence risk assessment and civil commitment.
The actual process of evaluating an individual for civil commitment will
often follow that which is suggested for violence risk assessment. According to
Heilbrun (2009), there are broadly six steps related to violence risk assessment:
1) referral and identification of violence risk as an element; 2) selection of
data sources; 3) interviews, administration of measures, and review of records;
4) interpretation of results; 5) communication of findings; and 6) a judicial
finding. Given the nature of civil commitment, violence risk is naturally an
element of the evaluative process. However, evaluators need to go beyond this
and assess the nexus between an individual’s risk for violence and his symp-
toms of mental illness.
The first step in an evaluation for civil commitment is for the clinician to
determine whether or not a person presents with a mental illness. In doing
so, Pinals and Mossman (2012) recommend that evaluators determine overt,
behavioral manifestations of an illness or mental disorder. Rather than gener-
ally describing an individual as psychotic, it is more useful to be specific about
that person’s symptom presentation (e.g., the respondent believes that the FBI
is bugging his home and inserting thoughts into his brain). This often requires
at least one interview and a careful examination of a person’s mental status, as
well as, collateral interviews and a review of relevant mental health records. It
is important to note that an evaluator can offer an opinion regarding civil com-
mitment using other available data if a respondent declines participation or
cannot participate in the evaluation; however, the opinion should be qualified
(Pinals & Mossman, 2012). At the outset of the evaluation, individuals should
be informed about the limits of confidentiality, the uses of information that the
individual provides (i.e., involuntary hospitalization), and the possibility that
the evaluator may be required to testify to such information in court (Pinals &
Mossman, 2012). At times, individuals may refuse to participate or decline to

provide the appropriate releases of information to obtain protected health infor-
mation. Pinals and Mossman (2012) state that a court order authorizing the
evaluation and access to relevant records is sufficient for a clinician to do so and
that some states have statutes providing permission to share clinical informa-
tion in civil commitment evaluations. These statutes “constitute legitimate bases
for releasing protected health information under HIPAA,” (Pinals & Mossman,
2012, p. 185). Noting the above, it is also important for an evaluator to include
only relevant information as part of the evaluation, keeping in mind a respect
for an individual’s privacy. Muting language or descriptions of events may be
necessary at times, particularly if there is an ongoing criminal investigation or
if there is information that could be potentially embarrassing to the evaluated
individual. Clinicians need to balance respect for privacy with ensuring the clar-
ity of relevant data (Pinals & Mossman, 2012).
Lastly, collateral sources should also be informed of the nature and purpose
of the evaluation, as well as the limits of confidentiality as described above.
Pinals and Mossman (2012) recommend being thoughtful about contacting
individuals not already identified in legal documents or who are otherwise
unaware of the individual’s current situation. They offer two main reasons to
contact collaterals in civil commitment evaluations, one being to determine
the presence and significance of symptoms of mental illness and the other
being to identify or verify the presence of violent or dangerous behaviors. In
an effort to balance privacy with a comprehensive assessment, they recom-
mend revealing as little as possible to any collateral source, particularly if the
individual in question has not provided consent to release information. They
also suggest that an evaluator consider the sources of information and reli-
ability of those sources. For example, a family member may have motivation
to distort the facts of the situation, and it is up to the evaluator to discern how
reliable these informants may be in contributing relevant data.
Although psychological testing is a common tool for clinicians to use in
diagnosing mental illness, Pinals and Mossman (2012) suggest that the use
of such testing is irrelevant to most civil commitment decisions due to the
fact that individuals presenting for civil commitment will likely demonstrate
fairly significant and obvious symptoms of a mental illness. Additionally, only
a few jurisdictions require a formal diagnosis from the Diagnostic and Statisti-
cal Manual of Mental Disorders as part of the evaluation for civil commitment
(Pinals & Mossman, 2012). Most often, evaluators are only required to dem-
onstrate how a respondent meets the statutory criteria for mental disorder,
and most major DSM-5 diagnoses (e.g., Schizophrenia) will align with these.
However, Pinals and Mossman (2012) also acknowledge there are times when
testing may be important with regard to clarification and differential diagno-
sis. That said, the use of psychological testing in civil commitment evaluations
is not always considered necessary.
Currently, there are no forensic assessment instruments designed specifi-

cally for use in civil commitment, and Pinals and Mossman (2012) suggest that
such instruments are unlikely to be created in the future for a variety of reasons.
For example, the main tasks in civil commitment decisions involve diagnosis
and choosing an appropriate setting for treatment. These are issues that involve
the use of standard clinical skills most psychologists and psychiatrists should
possess; additionally, commitment standards vary by jurisdiction, and it would
be impossible to design an instrument that incorporates the myriad nuances
of these standards. However, given that civil commitment decisions typically
involve an assessment of risk, structured professional judgment instruments
used in the area of violence risk assessment may prove useful. To this end, it is
important for the evaluator to be familiar with these tools as well as their utility
and limitations (see Heilbrun, 2009; Pinals & Mossman, 2012). Different groups
of individuals will demonstrate different base rates of violence, and different
risk assessment tools have been normed on specific populations. The Classifi-
cation of Violence Risk (COVR) was designed specifically for the assessment
of violence in individuals who had been psychiatrically hospitalized and dis-
charged to the community, and the COVR has demonstrated very good predic-
tive validity (Monahan, Steadman, Appelbaum, Grisso, Mulvey, Roth, Robbins,
Banks, & Silver, 2006). The HCR-20 (Historic, Clinical, Risk Management) is
another tool that was initially developed and validated with a civilly committed
population and has similarly demonstrated strong predictive validity (Douglas
& Skeem, 2005). It is important to consider the group to which the individual
being assessed belongs (e.g., mentally ill, sex offender, civil). There may be times
in which a risk assessment tool does not exist for the individual being evaluated,
as there tends to be a considerable lack of risk assessment tools that are appro-
priate for individuals from diverse backgrounds. Additionally, no tools measure
other aspects of civil commitment, such as suicide risk specifically or a very
substantial or grave likelihood of harm to self due to mental illness (Pinals &
Mossman, 2012). Lastly, courts tend to be more accepting of idiographic, as
opposed to nomothetic, data (Conroy & Murrie, 2007). In this sense, an anam-
nestic approach may prove to be a useful adjunct or complement to structured
professional judgment or actuarial violence risk tools (Heilbrun, 2009). This
approach involves gathering very specific and detailed information regarding
past episodes of violence in an effort to identify patterns or themes in an indi-
vidual’s violence history.
Once the predicate mental illness or disorder has been established (or ruled
out), the evaluator must consider whether those existing symptoms cause gross
impairment. If such is the case, it must be decided in what areas related to
the statute (e.g., thought, behavior, judgment) are relevant and which specific
behavioral manifestations of that impairment should be sought and described.
As previously noted, it is not enough that a person presents with a mental ill-
ness and demonstrates aggressive or potentially violent behavior; the evaluator
is tasked with demonstrating the nexus between the individual’s symptoms of

mental illness and precisely how those symptoms impact a person’s behavior
(i.e., may be contributory to violent behavior). Pinals and Mossman (2012)
outline best practices regarding the above and suggest that an evaluator ask the
following questions: a) How do I know that the respondent has a substantial
mental disorder? b) Does that disorder cause gross impairment? c) How do I
know that the respondent poses a risk to self or others due to that mental dis-
order? These questions are best illustrated by way of case example and will be
elucidated later in the chapter.
One factor in violence risk assessment and civil commitment that tends to
receive minimal attention in practice is that of base rates related to violence.
Broadly speaking, base rates for violence tend to vary considerably, depend-
ing on the community, population, and type of violence (Conroy & Murrie,
2007), and it has been suggested that clinicians tend to overestimate risk and
thus overcommit individuals (Monahan, 1981, 1992; Eccleston & Ward, 2004).
Anecdotally, it seems that base rates tend to be referred to more often in sex
offender evaluations, given that the actuarial assessment tools designed to
assess risk for recidivism provide results in terms of such. However, it seems
that the use of base rates and, in particular, local base rate data may useful for
a violence risk assessment as courts may be more accepting of local statistics
(Conroy & Murrie, 2007). Conroy and Murrie describe local base rate data
as “data from a specific, narrowly defined population, such as the population
from one large facility, statewide system, or other circumscribed population”
(p. 60). Clinicians should consider seeking out this information if possible,
although it may not always be easy to find, and evaluators may question which
statistics may be most relevant and reliable.
Lastly, clinicians are required to offer an opinion regarding the most appro-
priate setting for an individual’s treatment. There is a growing body of research
that focuses on dynamic risk factors in the assessment process (Douglas &
Skeem, 2005). Both protective and dynamic risk factors as they relate to an
individual’s risk for violence are far less researched than are historical or static
factors. It is important to note that the focus of a risk assessment should include
not violence alone but situations and behaviors that did not result in violence
(Heilbrun, 2009). Pinals and Mossman suggest that an evaluator ask whether
the option for voluntary inpatient treatment had been explored, whether out-
patient treatment would work and, if outpatient treatment had previously been
attempted, delineate why or why not it did not work. It is important here to
emphasize the question of timeframe as an aspect of violence risk assessment.
While not all jurisdictions require imminence as part of their civil commit-
ment criteria, the question of when a particular danger may occur is important
to consider in recommending treatment placement. A particular treatment or
placement may have “worked” briefly; however, a person’s condition may have
decompensated via a series of events or exposure to destabilizers posttreat-

ment. An evaluator must consider a person’s historical response to treatment
in addition to his or her current mental state and amenability or willingness to
engage in less restrictive alternatives.
Not only is it important for the evaluator to describe the nexus between symp-
toms of a mental disorder and violence risk in civil commitment evaluations but
it is also similarly important to describe a lack of this connection where there is
none. Much forensic literature cautions against an evaluator giving an opinion
on the ultimate legal question (Tillbrook, Mumley, & Grisso, 2003) as this deci-
sion is up to the court. This is somewhat different from other forensic questions
in that the basis for civil commitment is the presence of mental illness and need
for hospitalization for care and treatment, which are decidedly clinical issues
(Pinals & Mossman, 2012). Due to the fact that the state is involved in restrict-
ing an individual’s liberty, the ultimate legal decision falls with the trier of fact,
and there is a lack of consensus among clinicians about providing the ultimate
opinion (Pinals & Mossman, 2012). Pinals and Mossman (2012) suggest it may
be appropriate for evaluators to provide something of a penultimate opinion,
whereby symptoms are described and statutory language is used. For example,
an evaluator could describe how delusions and hallucinations represent a sig-
nificant “mental disorder” and how individuals’ suicide attempts place them at a
“substantial risk for harm to themselves” as outlined by the jurisdictions statute.
Case Vignette
Mr. Anderson was a 32-year-old Caucasian man, who was court ordered to
undergo an evaluation of his fitness to stand trial and his need for treatment in an
inpatient hospital setting. At the time of the evaluation, Mr. Anderson was facing
a charge of assault and battery. This evaluator had opined that Mr. Anderson was
fit to stand trial, and thus the question of whether or not he met criteria for invol-
untary hospitalization was separate from that particular legal question.
Reason for Referral

This case was part of a court-ordered evaluation following an arrest on a charge
of assault and battery. It was alleged that Mr. Anderson punched his roommate
in the head during the course of an argument, rendering him unconscious.
This was his first admission to a state hospital. At the beginning of his evalu-
ation, Mr. Anderson was informed of the limits to confidentiality that would
relate to statements he made. He acknowledged that he understood that any
information he provided could be included in a written report and/or oral

testimony provided to the court and that he had the right to choose not to
participate in the evaluation, to answer questions selectively, and/or to stop the
interviews at any time. He was able to repeat this information in his own words
and agreed to participate.
According to the statute under which this evaluation was conducted, a per-
son may not be committed to a mental health facility unless it is shown by
clear and convincing evidence that the individual has a mental illness, that
failure to hospitalize the individual would create a reasonable expectation of
physical harm to that person or others because of the mental illness (emphasis
added), and that there is not a less restrictive treatment alternative to hospi-
talization by which the individual may receive care. Additionally, in this par-
ticular jurisdiction, an individual with a dual diagnosis (including alcohol or
drug abuse) may only be committed if the likelihood of serious harm results
from the respondent’s mental illness (which is not to include a substance abuse
disorder, as outlined via statute). All of these aspects were considered during
the course of this evaluation.

For this evaluation, the police report related to the index offense, and records
from four past hospitalizations and rehabilitation centers were reviewed. Addi-
tionally, relevant progress notes related to his behavior and progress while hos-
pitalized were reviewed.
Although records from three other hospitals were requested, they were not
received prior to the statutorily designated end of the evaluation period. The
evaluator also requested an interview with the alleged victim in this case; how-
ever, Mr. Anderson stated he did not want this interview to take place. Given
this evaluation was court ordered, contacting the victim despite Mr. Ander-
son’s request to not speak with him was considered; however, legal counsel
advised the alleged victim that it would be best to refrain from participating in
the interview since the case was an ongoing potential criminal investigation.
Contact with the police officers who were noted in the official police report
as present at the scene was also attempted; however, they were not available
prior to the end of the evaluation period. Although Mr. Anderson was asked
to participate in psychological testing, he declined to so.
Records from a rehabilitation facility indicated that Mr. Anderson experi-
enced problems in school while growing up. Specifically, he was described as
“a class clown” who was often sent to the principal’s office during grammar
and middle school. These records also stated that Mr. Anderson “always did
poorly in school,” which was later attributed to a diagnosis of Attention Deficit
Hyperactivity Disorder (ADHD).1
Mr. Anderson attended his first drug treatment program at the behest of his
parents. Records from this program indicated that Mr. Anderson was admit-
ted when 22 years of age. His treatment areas included lack of understand-
ing of the disease model of chemical dependency, low self-esteem, difficulty
trusting others, anger, and relapse prevention. These records indicated that
Mr. Anderson struggled with compliance of unit expectations and impulsive
behaviors. A little more than a week after his admission, he was discharged for
various rule violations
While at this drug treatment program, Mr. Anderson participated in psy-
chological testing, which included intellectual, achievement, and personality
testing. He was found to be in the above-average range on intelligence test-
ing, and he obtained scores that were within normal limits on achievement
testing for reading and spelling. Testing indicated depressive symptoms,
including suicidal ideation without intent. Results also suggested he might
have exaggerated symptoms, perhaps as a “cry for help.” It was reported that
Mr. Anderson responded to the test in a manner similar to that of individu-
als who experience psychotic symptoms, including visual hallucinations and
delusions, as well as, a degree of social alienation and isolation. He appeared
to be an individual who was interpersonally suspicious, hostile toward others,
and paranoid. Mr. Anderson was also described as having a high degree of
anxiety and did not appreciate situations involving rules and authority figures.
Mr. Anderson was subsequently admitted to various rehabilitation facilities
between the ages of 24 and 26 years. Records indicated that he was typically vol-
untarily admitted at the urging of his parents due to suspected drug and alcohol
abuse. The psychologist reported that he appeared to demonstrate symptoms
consistent with ADHD, including impulsivity. Additionally, Mr. Anderson dis-
played suicidal and paranoid ideation. He expressed beliefs that there was a
conspiracy against him and that there were cameras in his room and he was
being watched. He was transferred to a dual-diagnosis (for mental illness and
substance abuse) program for thirty days, where he was diagnosed with Bipolar
I Disorder, Most Recent Episode Mixed.2
He reportedly responded well to a medication regimen and no longer pre-
sented with paranoid delusions. He reported feelings of anxiety and mood
swings, and his affect was observed to be expansive and irritable. It was reported
that Mr. Anderson participated minimally in the treatment. He avoided being
around other patients in social situations. He was discharged after thirty days
of treatment, though it was noted that his motivation to participate in treat-
ment was unclear and that his insight into his addiction was minimal.
Mr. Anderson was first admitted to a psychiatric hospital voluntarily when
he was 25 years of age. He was residing at home with his parents and sister
at the time. Mr. Anderson believed that people were inserting thoughts into
his brain and controlling his brain. The discharge summary from the hospital
indicated that he had recently experienced thoughts that someone would kill
him just prior to admission. It was noted that Mr. Anderson improved rapidly
with medication and that his delusional thoughts ceased as a result. There was
no toxicology report available from this hospitalization, although Mr. Ander-
son reported upon admission that he had last used cocaine and alcohol three
to five months prior to admission. He was diagnosed with Psychotic Disorder,
Not Otherwise Specified,3 Cocaine Dependence,4 and Alcohol Dependence.5
He was subsequently admitted to a twelve-step residential program.
Records described him as withdrawn and suspicious of others. Psychological
testing indicated that Mr. Anderson presented with evidence of a psychotic
disorder and depressive symptoms, and he was considered at risk for suicide.
He reported past experiences of auditory hallucinations and periodic paranoid
delusions including the belief that people were following him, including mem-
bers of the federal government. Mr. Anderson’s father reported he received a
phone call from staff stating that his son had stolen items from other residents
in the program. He was discharged after he displayed aggression, striking a
peer after an argument over theft.
Mr. Anderson’s second psychiatric hospitalization followed his discharge
from rehabilitation, where he reportedly struck a peer in the face during group,
in the midst of an argument over seating. It was reported that Mr. Anderson
minimized the significance of the event and reportedly justified his behavior
stating that the individual had taken his usual seat during group. Mr. Anderson
was subsequently transferred to a dual-diagnosis program after one week. He
displayed an increase in irritability, reported auditory hallucinations, and anxi-
ety symptoms. He was transferred to a more acute unit where he was reported
to be threatening and agitated, and he required restraint and seclusion to pre-
vent harm to himself and others. He was discharged to a transitional living
program three weeks later, with a follow-up appointment at an intensive out-
patient program. He received a diagnosis of Schizoaffective Disorder.6
During his initial two weeks at the transitional living program, Mr. Anderson
was described as compliant with the program. His compliance deteriorated after
being informed that he was no longer able to return home upon completion of
the program, due to the fact that his parents were conducting home renovations
at the time. At that point, Mr. Anderson began refusing groups, chose to stay in
bed, and refused medications at times, stating that he wanted to return home to
his parents’ house. Mr. Anderson reported that he felt hopeless, reported that he
was hearing derogatory voices, and reported a belief that others could read his
thoughts. He improved with medication adjustments and upon learning that
his father might be preparing a space for him at home, Mr. Anderson displayed
increased participation at meetings and showed improvement with anger man-
agement, problem solving, interpersonal skills, and coping skills, among other
things. Mr. Anderson was discharged to a residential community program.
According to the police report, Mr. Anderson reportedly yelled, “He [his
roommate] accused me of stealing from him and threatened to hit me, so I was
forced to protect myself!” Mr. Anderson relayed that his roommate “barged”
into their room and demanded that Mr. Anderson give the roommate his
ATM card back. Mr. Anderson stated that he thought his roommate was going
to hit him, and Mr. Anderson allegedly hit his roommate over the side of the
head. Mr. Anderson allegedly told police that his roommate was at fault. The
two employees on the scene offered their account to the officers. The employ-
ees both reported that they were in living room when they heard “yelling over
money,” and that when the employees walked into the dorm room, they saw
Mr. Anderson’s roommate on the floor. The employees stated the roommate
was unconscious at the time. The employees stated that the two roommates
argued often over money, missing items from their respective rooms, and
expectations for living together.
The officer interviewed Mr. Anderson’s roommate who was transported
to the hospital. He stated that he went into the community room where Mr.
Anderson was playing loud music and he asked him to turn it down. Evidently
this had been an ongoing violation from which Mr. Anderson was continually
requested to refrain. The roommate stated that Mr. Anderson said he did not
care, and Mr. Anderson continued to turn the music up louder. A few minutes
later the alleged victim noticed that his ATM card was missing, and went to
confront Mr. Anderson. Mr. Anderson reportedly said, “You owe me money
anyway,” and punched him in the face. Mr. Anderson reportedly noted that he
felt there was hostility brewing between him and the alleged victim for some
time prior to the incident. He reported that he had asked staff to intervene on
his behalf so that his roommate would “stop complaining” and “back off ” of
him.

The following history was obtained from an interview with Mr. Anderson on
three different days for a total of approximately five-and-a-half hours, as well
as multiple phone interviews with his father for a total of approximately three
hours. Mr. Anderson did not appear to be a reliable reporter, as he was often
vague and inconsistent with other sources. While his father was considered a
generally reliable historian, there was some information he provided that was
inconsistent with other sources, and he seemed vague when questioned about
particular details of his son’s history and upbringing. The forensic evaluator
also interviewed Mr. Anderson’s psychiatrist at the time of his arrest, as well
as his social worker. Although the evaluator attempted to interview his step-
mother, she declined to be interviewed. Mr. Anderson’s treatment team at the
state hospital was also engaged in a clinical consultation.
Mr. Anderson was born and raised in a relatively small town as the oldest
child of three. Mr. Anderson was raised by his biological father and step-
mother, as his mother passed away when he was 4 years of age, and his father
remarried when he was 6 years of age. Mr. Anderson’s father described his
son as “a great kid” growing up. The father reported that his son was pleas-
ant and often helped around the house. Mr. Anderson’s father reported no
problems with developmental milestones, childhood illnesses, or childhood
injury. Mr. Anderson reportedly grew up in an upper middle class neighbor-
hood with highly educated parents.
Mr. Anderson’s father reported that his son attended private schools and
obtained mostly Bs and Cs throughout his education. Mr. Anderson’s father
denied that his son was ever held back a grade, although the father reported
that his son had to attend at least one semester of summer school for unknown
reasons. Mr. Anderson’s father reported that his son was diagnosed with
ADHD and prescribed Adderall at 10 years of age, stating that his son’s behav-
ior was impulsive and that his son was “getting in trouble” at school.
Mr. Anderson graduated high school and attended one year of college at
a university out of state. Although he reportedly did well, he became drug
involved while at school and eventually dropped out. Mr. Anderson also had a
lengthy history of multiple inpatient rehabilitation stays, dual-diagnosis pro-
grams, residential/transitional living programs, and psychiatric hospitaliza-
tions. Mr. Anderson’s father indicated that they had tried a variety of different
treatment programs and that his son displayed difficulty understanding that
he needed treatment. While he always complied with his parents’ directives
to participate in treatment programs, Mr. Anderson’s father reported that his
son consistently expressed a desire to remain at home with his parents. Since
college, Mr. Anderson had reportedly lived at home for brief (two-to-three-
month) periods of time without incident. Mr. Anderson’s father stated that
he sent his son to various treatment settings because his parents could not
properly monitor him at home as a result of their jobs and had concerns about
the possibility of his using drugs in the home. Mr. Anderson denied use of or
access to drugs while residing with his parents. Mr. Anderson’s father stated
that he called the police on one occasion, due to his son “complaining of his
old college roommate monitoring his thoughts.” His father thought this was
drug related, which is why he contacted the police at the time.
Mr. Anderson’s father reported that they placed his son in residential treat-
ment when he was 26 years of age. Mr. Anderson’s case manager reported
that Mr. Anderson was viewed as not appropriate for that particular program
due to “bullying” behaviors, such as “intimidating” other residents to give
him money, pilfering items from others, and striking another resident in the
face after an argument. Mr. Anderson was then transferred to another inde-
pendent living program, which is where he resided at the time of his arrest.
Mr. Anderson’s case manager reported that Mr. Anderson displayed highly
impulsive behavior related to peer interactions (such as picking up someone
and holding him over his head). His psychiatrist described Mr. Anderson
as rigid and as having low empathy. Mr. Anderson reportedly had difficulty
adjusting his plans, such that he continued to hold onto the idea that he could
simply return to live with his parents, despite lacking insight into drug addic-
tion and independent living skills.
Mr. Anderson was vague about his overall drug use. He reported that he
did not remember the first time he tried drinking alcohol but stated that he
began using both cocaine and marijuana around the age of 18. He reported
that he used to smoke approximately three to four “blunts” per day, for approx-
imately four years. He stated that he typically used cocaine anywhere from
once a month to once a week. Mr. Anderson initially denied that his drug use
ever negatively interfered with his school performance or other aspects of his
life. He later acknowledged that it had negatively impacted his school perfor-
mance; however, he felt that it was worth it because it was “fun.” He reported
that he would “binge” on cocaine for days at a time. Mr. Anderson reported
withdrawal symptoms from cocaine use including “a severe depression” where
he withdrew from others and felt he could not get out of bed. He also stated
he abused his Adderall while in high school, but he denied other drug use.
He reported that cocaine is his drug of choice and that he typically used
money received from his parents or money stolen from others to buy drugs.
Mr. Anderson reported that his longest period of sobriety was for approxi-
mately one year while he was in a locked unit facility, two years prior to the
evaluation. He also reported that he typically refrained from drug use while
living with his parents. When asked about this, he stated, “They would kick me
out if I used at home and I got it good there.” Available records indicated that
Mr. Anderson had consistently received diagnoses of both Cocaine Depen-
dence and Alcohol Dependence. According to staff at his residential program
at the time of his arrest, Mr. Anderson’s last relapse with the use of cocaine was
approximately two months prior to the alleged incident.
With regard to relationships, Mr. Anderson reported several short-term
relationships that he described as insignificant. Mr. Anderson had no signifi-
cant work history. He reportedly obtained a few low level positions, but he
was fired either due to substance abuse or chronic absenteeism. Mr. Anderson
reported that he would like to own a restaurant, although recognized that he
had no experience in this area.
With regard to symptoms of mental illness, Mr. Anderson described feeling
that people were following him and that he was being watched. He reported
feelings of paranoia, including beliefs that people could read his mind. He
also reported hearing voices in the past, which say disparaging things to
him. Mr. Anderson reported that he initially heard voices the first time he
used cocaine, although stated that he also heard them when he is not under
the influence of drugs. Mr. Anderson stated that he first heard voices in the
absence of drug use when he was approximately 20 years of age. He indicated
the last time he experienced auditory hallucinations was approximately one
month prior to the evaluation. He described the voices as “off and on” and
not constant. He denied the use of any coping skills that helped alleviate the
voices when they occurred and stated that they tend to dissipate on their own.
Mr. Anderson reported no history of suicide attempts, although he reported
transient suicidal thoughts in the past. Mr. Anderson said he first thought about
killing himself his sophomore year of college. He reported feeling as though
his family did not love him, and he was dwelling on negative thoughts related
to feeling as though he had no friends or girlfriends. He denied a concrete pat-
tern of occurrences, stating that these episodes typically occurred upon with-
drawals from cocaine, and he stated he had not felt suicidal in approximately
five years.
Aside from the index offense, Mr. Anderson had no prior legal history, and he
had never been arrested. However, according to records from previous facilities,
Mr. Anderson had reportedly engaged in a number of illegal activities through-
out his life. When asked for clarification, his father stated that Mr. Anderson
used to steal “insignificant” items from family members, like small amounts
of money from his parents. He also reportedly got into trouble at school for
stealing from classmates and for fighting, although these behaviors were never
brought to the attention of greater authorities. He was detained by police on
one occasion for possession of drugs (cocaine) while in college; however, he was
reportedly released and charges were never filed.
Just prior to his arrest, Mr. Anderson was residing at an assisted living pro-
gram in his own apartment. He had lived there for approximately six months
before the alleged incident occurred. It appeared as though Mr. Anderson con-
tinued to display problems with independent living skills, in that his living
quarters were reportedly unkempt; however, he was otherwise described as
doing well. He was prescribed an antipsychotic medication, and he was report-
edly medication compliant. According to his treatment team, Mr. Anderson
had not displayed symptoms of mania or psychosis, and he had been abstinent
from drugs or alcohol for approximately two months. Mr. Anderson similarly
denied any drug or alcohol use.
Mr. Anderson’s father reported that he and his wife hoped to have Mr.
Anderson discharged to their home following the evaluation period. He stated
that they had recently retired from their jobs and, as a result, felt they could
provide the care and monitoring their son required. They set up an appoint-
ment with a psychiatrist in the community, who had previously treated
Mr. Anderson, and scheduled an intake appointment for a day treatment
program, which Mr. Anderson agreed to attend. Mr. Anderson reported a
willingness to follow his parent’s advice (e.g., meet regularly with the psychia-
trist, refrain from substance use), and he stated that he preferred to live at
home rather than with other people who were “strangers” to him and whom
he did not trust. He reported that he liked the idea of a day treatment program
because he could return home to his parents’ house when the day was over.

Mr. Anderson was a biracial (African American and Caucasian) man who
appeared his stated age. He was oriented as to the date, time, place, and situ-
ation. Mr. Anderson demonstrated various restless and purposeless actions
(psychomotor agitation), as he often fidgeted in his chair and leaned his
chair back from the table causing it to become imbalanced. He appeared to
have a nonchalant, light-hearted approach to the interview; laughing often
in response to serious topics. He was generally cooperative with questions
although appeared guarded and somewhat evasive with regard to his history.
His affect was both affable and irritable at times and not appropriate to the
situation. He initially reported that his mood was “happy” but then later stated
that he was “depressed.” He had a smile on his face for most of the interview,
regardless of topic. He casually called this evaluator by her first name on sev-
eral occasions during the interview and did not always answer questions seri-
ously. At times, Mr. Anderson would answer questions in French or provide
an answer meant as a joke. For example, when asked what type of job he would
want if he could have any job in the world, Mr. Anderson answered, “The Pres-
ident of Russia.” While his observable mood was one that did not match his
circumstance or situation, he commented on a few occasions that he did not
want to be in jail and believed the situation was “terrible.” Mr. Anderson dis-
played a lack of awareness around social cues, both direct and nonverbal. For
example, when again commenting on his apparent lack of seriousness related
to his hospitalization and arrest, Mr. Anderson reported that this evaluator
had no sense of humor. He was able to self-redirect his attention back to the
evaluation after a brief period of time.
He displayed behavior that appeared intrusive for the setting. For example,
when discussing his past substance abuse, he asked this evaluator about past
personal drug use. He endorsed feelings of confusion at times and reported
that the past few years have “been a big blur” due to the fact that he has been
“in and out of rehabs.” His speech was pressured at times, and, at other times,
Mr. Anderson provided brief, one-or few-word answers without much elabora-
tion, often stating, “I don’t know.” He denied problems with sleeping or eating,
although hospital observations indicated that he slept a few hours per night.
Mr. Anderson stated that he was not currently suicidal. He also stated that he
was not having homicidal thoughts or thoughts of hurting other people.
He endorsed current feelings of paranoia, discussed feeling as though peo-

ple could read his mind, and said that he felt threatened. When asked what
made him feel threatened, he stated it was a feeling he had. He denied that he
would respond aggressively when feeling threatened due to a desire to be dis-
charged. He denied current auditory hallucinations or other perceptual distur-
bances. He reported feelings of anxiety around people or crowds of people at
times. His insight was poor. He denied being diagnosed with a mental illness.
He displayed poor judgment throughout the interview, as evidenced by his
asking the evaluator intrusive questions and consistently asking a corrections
officer outside of the interview room to “join in the conversation.”
Mr. Anderson was able to sustain attention on topics through lengthy
interviews. He presented with average skills for abstraction (could appropri-
ate provide meanings for common proverbs, and apply it to a real-life situa-
tion) and orientation/memory (could correctly state the past four presidents,
was able to retain aspects of the limits of confidentiality warning between
interviews without prompting), and he was able to provide socially appro-
priate answers to common dilemmas. Mr. Anderson was asked whether he
was experiencing any psychiatric symptoms at the time of his arrest, such as
those he had reported experiencing in the past (auditory hallucinations, feel-
ings of paranoia). He reported hearing voices occasionally (once to twice a
month) and thoughts of people reading his mind. He denied that he thought
his roommate could read his mind and stated, “It’s irrelevant, and a waste of
my time.”
Mr. Anderson was admitted to the state hospital following his arrest. He
agreed to take medication upon admission. Mr. Anderson was described as
alert, calm, and cooperative. His affect was noted to be appropriate, and his
thought processes appeared clear and logical, although he was reported to
lack insight into his mental illness and demonstrated problems following staff
direction while in the hospital.
Mr. Anderson was transferred to a more restrictive unit one time during
his period of evaluation, after reportedly pushing another patient. However,
he also reportedly engaged in other types of negative behavior, such as taking
other patients’ food and leaving groups without authorization. When asked
about these situations by the evaluator, Mr. Anderson reported that he pushed
the other patient because the patient “cut” him in line. While he could state
that pushing the other patient was “wrong,” he could not provide reasons for
why taking food from a patient or leaving a group abruptly would be consid-
ered problematic. He justified his decision to push the patient by stating, “He
had no manners and it was disrespectful to me.” He was transferred back to
the less restrictive evaluation unit the following day. Mr. Anderson was pre-
scribed Haldol (antipsychotic). He was compliant with his medication while
hospitalized.
Psychological Testing/Measures Used

Mr. Anderson was asked to participate in psychological testing, but he
declined. An objective measure of personality assessment would have been
helpful in gaining diagnostic clarification regarding his symptoms; however,
in situations such as this, data are not always available. Given that personal-
ity testing was not completed, a reliance on self-report, collateral interviews
with his father, treatment records, and behavioral and clinical observations
were necessary. Despite the lack of personality testing for diagnostic clarifi-
cation, violence risk measures can often be completed without the evaluee’s
participation, as they are based on historical and dynamic factors such as those
found in the evaluee’s records and interview responses. The results of these
measures can greatly contribute to a decision regarding the participant’s future
dangerousness.
For this case, the Historical, Clinical, Risk-20 (HCR-20), and the Psychopa-
thy Checklist-Screening Version (PCL-SV) were selected (Webster, Doug-
las, Eaves, & Hart, 1997; Hart, Cox, & Hare, 2003). These instruments were
chosen given his history of violent behavior and the referral issue, as well as
for these instruments’ utility with psychiatric inpatient, civil, and commu-
nity populations. Additionally, past studies indicated that the HCR-20 added
incremental validity to the PCL-SV when predicting risk for violence in an
inpatient psychiatric population (Douglas, Ogloff, Nicholls, & Grant, 1999),
although later studies have suggested that the HCR-20 used independently of
the PCL-R is uniquely predictive of violence (Guy, Douglas, Hendry, 2010).
The PCL-SV can be used in forensic settings to screen for psychopathic traits
or for diagnosis of individuals undergoing civil psychiatric evaluations (Hart,
Cox, & Hare, 2003). Given the limited evaluation period based on state stat-
ute, the instruments chosen needed to be fairly brief but still able to provide a
structured method to assess risk factors related to violence. The PCL-SV was
used to assess for traits of psychopathy, given that Mr. Anderson appeared to
present with numerous antisocial characteristics, including low empathy and
impulsivity.
Results from the HCR-20 indicated that Mr. Anderson presented with a
number of historical and clinical risk factors for violence. Definite historical
factors included a history of previous violence (including the index offense),
relationship instability (which included a lack of significant intimate relation-
ships with others), employment problems (no history of stable employment),
substance use problems, previous diagnosis of a major mental illness (Bipolar
Disorder, Psychosis NOS), the presence of traits of Psychopathy (score of 19
on the PCL-SV), and prior supervision failure (eloping from previous treat-
ment facility). Another historical factor included the possible presence of a
personality disorder; however, there did not appear to be substantive evidence
to reach a conclusion. Given Mr. Anderson’s history, it was suspected that there
might have been more indicators of early maladjustment; however, the infor-
mation given by his father indicated only possible or less serious indicators,
such as some behavioral problems in school. His first reported act of violence
based on the available information occurred when he was between the ages of
20 and 39 years, and therefore the item, “Young Age at First Violent Incident,”
was given a score of 1.
Definite clinical factors that were present included a lack of insight into
his mental disorder, the impact and consequences of his symptoms, nega-
tive attitudes, and affective impulsivity/instability. Possible clinical issues
present included potential unresponsiveness to treatment (he was accepting
prescribed medication in the hospital; however, he appeared to demonstrate
low motivation with regard to attending groups, etc.) and active symptoms of
mental illness (he was demonstrating some symptoms, such as a belief that
others could read his mind; however, they appeared mild at the time of the
evaluation). Finally, with regard to risk management, Mr. Anderson presented
with considerable personal support (his parents) and little likelihood of expo-
sure to stress (some), but not a strong likelihood of exposure to destabilizers
(drugs or alcohol). His plan for discharge while residing in the community
appeared feasible, given that his parents were able and willing to accept him
into their home and had the time and resources available to monitor him. The
final risk rating based on this information was moderate.
To screen for traits related to psychopathy, the PCL-SV was used. Mr.
Anderson was given a total score of 19 (a score of 18 is indicative of “definite”
psychopathy according to the PCL-SV manual). Most salient to his case were
lack of remorse, lack of empathy, not accepting responsibility for his behaviors,
impulsivity, poor behavioral controls, lack of realistic goals, and irresponsi-
bility. His adolescent antisocial behavior was questionable in that the details
around this topic were unclear, and he demonstrated some (but not definite)
problems related to superficiality, grandiosity, and deceitfulness.

Based on available data, it was opined that Mr. Anderson had a mental illness
as defined in relevant regulations of the Department of Mental Health in the
jurisdiction where the evaluation took place. While in the acute phase of this
disorder, Mr. Anderson experienced paranoid ideation (believing others can
read his thoughts, that someone might kill him, or that people follow him),
auditory hallucinations, thought insertion (believing that people were insert-
ing thoughts into his brain), difficulty with reality testing, and agitation. Mr.
Anderson had experienced these symptoms for many years, including those
times in which he was not abusing substances. Mr. Anderson had also experi-
enced mood-related symptoms including hopelessness, irritability, decreased
energy, and lack of interest in activities, and he was overly expressive and
energetic at times. Additionally, Mr. Anderson had a lengthy history of sub-
stance abuse and dependence problems, and these continued to be ongoing
problems for him. His substance abuse and symptoms of psychosis, coupled
with frequent rehabilitation admissions and hospitalizations, interfered with
his ability to successfully complete college or to hold sustained, meaningful
employment. He had endorsed feelings of hopelessness and melancholy, in
addition to feelings of anxiety, although these symptoms did not appear to
significantly impact his presentation or behavior at the time of the evalua-
tion. Mr. Anderson’s symptom presentation seemed to be best categorized as
Schizoaffective Disorder, Depressive Type.
In addition, Mr. Anderson presented with attributes that were not clear
diagnostically. He seemed unaffected by his situation, despite the fact that he
was facing serious legal charges and could have served time if convicted and
incarcerated. He displayed difficulty understanding why others may have been
concerned about his behaviors (aggression toward others, potentially hurting
others) and described what would usually be considered troubling symptoms,
thoughts, and situations with an observable appearance that appeared flip and
unconcerned. He displayed a casual attitude toward the overall evaluation,
and he appeared unresponsive to social cues and frank discussions regarding
the serious nature of his situation. He displayed impulsive behavior related
to institutional protocols while at the state hospital and within peer relation-
ships, as well as evidence of misinterpreting social cues in social situations. It
was not clear to the evaluator at the time whether these aspects of Mr. Ander-
son’s presentation were the result of symptoms of a mental illness or simply
poor judgment and impulsivity, which could have been characterological in
nature or of some other unknown etiology. Mr. Anderson had a long-standing
history of impulsivity, problems following staff and program directives, pro-
voking other patients, and being aggressive toward other patients at various
programs. Based on a review of his past aggressive behaviors and presentation
while hospitalized, there was no evidence that his suspiciousness, mood issues,
delusions that others could read his mind, or auditory hallucinations were a
risk for violence for him specifically. Rather, due to the long-standing nature
of these issues, it appeared more likely that these behaviors were attributable to
personality issues, rather than his symptoms of mental illness, although they
could have been exacerbated by such symptoms.
How was the opinion reached? Given that Mr. Anderson had never dis-
played aggression or violent behavior toward his family and, in fact, demon-
strated evidence of more controlled and less impulsive behavior while at least
in the presence of his father, there were indications that this plan for discharge
was adequate should the court decide to allow him to await trial in the com-
munity. His parents were both willing and seemingly capable of providing him
with a supportive environment, and with appropriate supervision, given that
his father and stepmother were retired at the time of the evaluation and able to
provide increased supervision (something that was absent when he previously
resided at home). Mr. Anderson indicated a desire to reside at home with his
parents, and he did not have a history of substance use while residing with
them. He demonstrated a history of cooperating with treatment directives
suggested by his parents should the need arise or should his circumstances
change, and he indicated an increased risk for violence due to mental illness.
His parents had also previously demonstrated a willingness and ability to seek
out more restrictive services if needed or seen as necessary.
Best practices suggest that evaluators must take into account not only static
risk factors but also current presentation and risk management factors, when
forming opinions related to violence risk assessment and civil commitment
(Heilbrun, 2009). Additionally, an evaluator must be familiar with the statu-
tory language under which he or she is working, as civil commitment laws vary
in their wording related to definitions of mental illness, their impact on dan-
gerousness and the imminence of potential violent behavior. This case high-
lights the importance of mitigating factors related to violence risk in relation
to a risk management plan, keeping in mind the guideline of a least restrictive
environment.

This case was complex for a variety of reasons. First, this individual presented
with a long history of drug abuse, and thus issues related to dual diagnosis
needed to be considered. According to the state statute under which this eval-
uation was conducted, a mental illness was defined as a substantial disorder
of mood, thought, and perception that grossly impairs his behavior, judgment,
ability to recognize reality, or ability to meet the ordinary demands of life.
The statutes also explicitly excluded alcoholism or substance abuse, and thus
drug or alcohol abuse problems, while important to consider, would not nec-
essarily be classified as a mental illness according to this definition. Second,
Mr. Anderson presented with a history of significant symptoms of mental ill-
ness, seemingly while not under the influence of drugs. Third, Mr. Anderson
presented with some significant personality or characterological issues that
appeared to impact the clinical picture. As a result, it was difficult to tease
apart which symptoms or problems were impacting his risk for violence—
drug use, symptoms of mental illness, a possible personality disorder, or the
confluence of all of the above.
While the aforementioned provisions were thought to be crucial to Mr.

Anderson’s ongoing treatment, there were continued concerns regarding his
mental health and substance abusing behaviors. The evaluator struggled with
these issues in considering how they could impact his future risk for violent
behavior. Mr. Anderson exhibited minimal insight into his mental illness,
impulsive behavior, poor judgment, or related consequences. He had last used
illicit substances approximately five weeks prior to the alleged offense, and he
admittedly used alcohol (albeit in minimal amounts) while residing in the com-
munity. Mr. Anderson was generally compliant with medication while residing
in the community, although had demonstrated periods of decompensation. He
endorsed auditory hallucinations associated with his medication noncompli-
ance in the past. Aside from the index offense, Mr. Anderson had reportedly
not displayed any violent or aggressive behavior while residing in the commu-
nity. Mr. Anderson’s impulsivity with regard to substance abuse coupled with
his existing symptoms of mental illness created an increased risk for aggressive
and violent behavior. Mr. Anderson had a history of failed placements in reha-
bilitation centers and with other psychiatric residential placements. He left one
program and returned home to his parents’ house without staff permission. He
displayed difficulty following staff directives, and he has demonstrated aggres-
sive behavior toward other patients, both of which resulted in his discharge from
certain placements. Further, Mr. Anderson had displayed a history of psychiat-
ric decompensation within less structured settings requiring transfers to places
that are better equipped to deal with more acute symptoms of mental illness.
In evaluations for civil commitment, a common pitfall occurs when evalu-
ators view a person who presents with mental illness and risk factors for vio-
lence as meeting criteria for involuntary hospitalization, when the two may
be unrelated to one another. In this example, while Mr. Anderson presented
with a mental illness as defined by relevant regulations, he did not appear to
meet criteria for involuntary hospitalization at the time of the evaluation, as
his risk for violence appeared unrelated to his symptoms. The guiding statute
under which this evaluation took place indicated that an individual is reason-
ably expected, because of his mental illness and unless treated on an inpatient
basis, to engage in conduct placing such person or another in physical harm or
in reasonable expectation of being physically harmed (405 ILCS 5/1–119). It
was opined that Mr. Anderson was reasonably expected to engage in conduct
placing other persons or possibly himself at risk of physical harm; however,
this risk appeared attributable to Mr. Anderson’s aforementioned immaturity,
impulsivity, poor judgment, and propensity for substance abuse rather than
his symptoms of mental illness. In essence, while Mr. Anderson presented with
a mental illness and with risk factors related to possible violence, it appeared
that his risk for violence was unrelated to his mental illness, and as a result, he
did not meet criteria for involuntary hospitalization. This is not to say that he
may not have met criteria in other jurisdictions, depending on the wording of
the statutes, or that he might not have met criteria if he were more symptom-
atic at the time of the evaluation.
At times, recommendations against involuntary hospitalization may not
carry the risk for violence. It is up to the evaluator to consider all of the fac-
tors that contribute to a risk for violence and compare this with statutory
guidelines.
Another common pitfall occurs when evaluators do not take into account
dynamic risk factors that counter the risk of violence. Such an error can lead
to prematurely dismissing the least restrictive alternative setting for treatment.
For example, Mr. Anderson was not complaining of mood-related symptoms
at the time of the evaluation and denied current suicidal or homicidal intent.
He had been medication compliant while at the state hospital, and his psy-
chotic symptoms had also been largely controlled via Haldol, an antipsychotic
medication. He did not endorse auditory hallucinations while at the hospi-
tal, nor did he present as responsive to internal stimuli. He presented with
residual symptoms of paranoia and, in particular, reported a belief that others
could read his thoughts, although this did not appear to be interfering with his
ability to control his behavior. Further, Mr. Anderson could have potentially
returned home on bail, as he had no known history of violence against his
family members or against others in the community where his family resided.
He had family support, in that they created what was believed to be reasonable
provisions for him in the community. These provisional requirements allowed
him to receive follow-up medication monitoring and day treatment care with
the local community agency. An integrated support system such as this would
contribute to a greater likelihood of success living in the community. Overall,
the combination of factors that both increase and decrease risk play a signifi-
cant role when making decisions regarding civil commitment.
Notes
1. According to the Diagnostic and Statistical Manual (4th ed., text revision; DSM-
IV-TR), ADHD is characterized by six or more symptoms of inattention or hyperactivity/
impulsivity, with some symptoms present prior to age 7 and causing impairment in at least
two settings (e.g., school/home). *DSM-IV-TR diagnoses are included here, as the diagno-
ses were made using this version.
2. According to the DSM-IV-TR, Bipolar I Disorder, Most Recent Episode Mixed, is
characterized by symptoms of both mania and depression.
3. According to the DSM-IV-TR, Psychotic Disorder, Not Otherwise Specified,
includes psychotic symptoms (i.e., delusions, hallucinations, disorganized speech, disorga-
nized behavior) about which there is inadequate information to make a specific diagnosis.
4. According to the DSM-IV-TR, Cocaine Dependence involves a maladaptive pat-
tern of cocaine use, leading to clinically significant impairment or distress, as manifested
by three (or more) symptoms related to tolerance for the drug, withdrawal symptoms,
increased use, unsuccessful attempts to control use, continued use despite recurrent physi-
cal or psychological problems, a great deal of time spent in efforts to obtain or recover from
the drug, or interference in occupational or recreational activities.
5. According to the DSM-IV-TR, Alcohol Dependence involves a maladaptive pat-
tern of cocaine use, leading to clinically significant impairment or distress, as manifested
by three (or more) symptoms related to tolerance for the drug, withdrawal symptoms,
increased use, unsuccessful attempts to control use, continued use despite recurrent physi-
cal or psychological problems, a great deal of time spent in efforts to obtain or recover from
the drug, or interference in occupational or recreational activities.
6. According to the DSM-IV-TR, Schizoaffective Disorder is described as an uninter-
rupted period of illness during which there is either a Major Depressive Episode, a Manic
Episode, or a Mixed Episode concurrent with symptoms of Schizophrenia (e.g., delusions,
hallucinations, disorganized speech/behavior, and/or negative symptoms (e.g., flat emo-
tional expression).
References
Addington v. Texas, 441 U.S. 418 (1979).
Conroy, M. A., & Murrie, D. C. (2007). Forensic assessment of violence risk: A guide for risk
assessment and risk management. Hoboken, NJ: Wiley.
Douglas, K., Ogloff, J., Nicholls, T., & Grant, I. (1999). Assessing risk for violence among-
psychiatric patients: The HCR-20 violence risk assessment scheme and the Psychopathy
Checklist: Screening Version. Journal of Consulting and Clinical Psychology, 67, 917–930.
Douglas, K. S., & Skeem, J. L. (2005). Violence risk assessment: Getting specific about being
dynamic. Psychology, Public Policy, and Law, 11(3), 347–383.
Eccleston, L., & Ward, T. (2004). Assessment of dangerous and criminal responsibility. In
W. T. O’Donohue & E. R. Levensky (Eds.), Handbook of forensic psychology: Resource
for mental health and legal professionals (pp. 85–101). New York, NY: Elsevier Science.
Erickson, S. K., Vitacco, M. J., & Van RyBroek, G. J. (2005). Beyond overt violence: Wiscon-
sin’s progressive civil commitment statute as a marker of a new era in mental health law.
Marquette Law Review, 89(2), 359–405.
Federal Rules of Evidence § 703 (2011). Bases of an expert witness.
Guy, L. S., Douglas, K. S., & Hendry, M. C. (2010). The role of psychopathic personality
disorder in violence risk assessment using the HCR-20. Journal of Personality Disorders,
24(5), 551–580.
Hart, S. D., Cox, D. N., & Hare, R. D. (2003). Hare PCL: SV. Psychopathy Checklist: Screen-
ing Version. New York, NY: Multihealth Systems.
Heilbrun, K. (2009). Evaluation for risk of violence in adults. New York, NY: Oxford Uni-
versity Press.
Illinois Compiled Statutes Mental Health and Developmental Disabilities Code IL 405
5/1–119.
In re Torski, 395 III. App. 3d 1010, 918 N.E. 2d 1218, 335, III. Dec. 405 (4th Dist. 2009).
Jacobson v. Massachusetts, 197 U.S. 11, 26 (1905).
Janus, E. S. (1998). Hendricks and the moral terrain of police power civil commitment.
Journal of Psychology, Public Policy, and Law, 4(1/2), 297–322.
Lake v. Cameron, 364 F.2d 657 (1966).
Lessard v. Schmidt, 414 U.S. 473 (1974).

Menninger, J. A. (2001). Involuntary treatment: Hospitalisation and medications. In Jacob-
son, James L., and Jacobson, Alan M. (Eds.), Psychiatric Secrets (2nd ed., pp. 477–484).
Philadelphia, PA: Hanley & Belfus.
Monahan, J. (1981). The clinical prediction of violent behavior. Washington, DC: Govern-
ment Printing Office.
Monahan, J. (1992). Major mental disorder and violent behavior: Perceptions and evidence.
American Psychologist, 47(4), 511–512.
Monahan, J., Steadman, H. J., Appelbaum, P. S., Grisso, T., Mulvey, E .P., Roth, L. H., Robbins,
P. C., Banks, S., & Silver, E. (2006). The classification of violence risk. Behavioral Sciences
& the Law, 24(6), 721–730.
Moran, G. E., Robins, C., & Kurzban, S. (2000). Civil commitment under Medicaid managed
care. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental
Health Services Administration.
New York State Office of Mental Health (2005). Kendra’s Law: Final report on the status
of assisted outpatient treatment. Albany, NY: New York State Office of Mental Health.
O’Connor v. Donaldson, 422 U.S. 563 (1975).
Pinals, D. A., & Mossman, D. (2012). Evaluation for civil commitment. New York, NY:
Oxford University Press.
Prochaska v. Brinegar, 251 Iowa 834, 102 N.W. 2d 870, 872 (1960).
Schopp, R. F. (2003). Outpatient civil commitment: A dangerous charade or a component
of a comprehensive institution of civil commitment? Journal of Psychology, Public Policy,
and Law, 9(1/2), 33–69.
Slobogin, C., Hafemeister, T. L., Mossman, D., & Reisner, R. (2014). Law and the men-
tal health system: Civil and criminal aspects (6th ed.). St Paul, MN: West Publishing
Company.
Testa, M., & West, S. G. (2010). Civil commitment in the United States. Journal of Psychia-
try, 7(10), 30–40.
Tillbrook, C., Mumley, D., & Grisso, T. (2003). Avoiding expert opinions on the ultimate
legal question: The case for integrity. Journal of Forensic Psychology Practice, 3, 77–87.
Webster, C. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). HCR-20 Assessing Risk for
Violence Manual. Burnaby, British Columbia, Canada: Simon Fraser University, Mental
Health Law and Policy Institute.
8
The Psychological Assessment

of Personal Injury Claims
Eric G. Mart
The psychological assessment of personal injury claims is a complex area of

forensic practice. Such cases are part of the civil rather than the criminal justice
system of the judiciary. In the criminal system, persons accused of committing
a serious crime such as a felony are charged in a formal accusation referred
to as an indictment, while less serious crimes are charged upon information.
Criminal law deals with acts of intentional harm to individuals such as assault,
breaking and entering, or murder. However, these criminal acts are considered
to be offenses against not only the individuals who have been harmed but also
the broader society as a whole. For example, the victim of a home invasion
may be psychologically traumatized and physically harmed, but the commis-
sion of this type of crime affects all of us by making us feel less secure in our
homes. Contrary to popular belief, it is not the responsibility of the victim to
“press charges”; charges are brought by prosecutors on behalf of the govern-
ment, and the victim is not a party to the legal action. In order to be convicted
of a criminal offense, the prosecution must prove beyond a reasonable doubt
that the criminal defendant committed a particular act and meant to cause the
harm that ensued. The action itself is referred to as the actus reus or “guilty act”
and the intentional element is referred to as “mens rea” or “guilty mind.” There
are exceptions to the necessity for mens rea and criminal law in cases that are
referred to as strict liability cases. These are crimes in which there was no con-
scious intent to cause harm, but harm occurred through the defendant’s reck-
less or inattentive behavior coupled with the knowledge that others could be
hurt by such behavior (Cornell University Law School, n.d.; Gifis, 2010, p. 520).
Relevant Case Law

Persons convicted of criminal offenses are punished for a number of rea-
sons including deterring the convicted individual from committing the
crime again and deterring other individuals from acting in a similar man-
ner. Another purpose of sentencing is incapacitation, which means that an
incarcerated individual cannot commit crimes against members of the gen-
eral population while behind bars. Retribution or “just desserts” is another
goal of sentencing, as is the rehabilitation of the criminal (Barton, 2012, p.
504). The civil justice system has very different goals and somewhat different
rules from the criminal justice system. A civil case is brought to court when
an individual or other entity—such as a corporation (referred to as the plain-
tiff)—alleges that another person or entity (the defendant) has failed to carry
out a duty or obligation owed to the plaintiff (The Law Dictionary, n.d.; Gifis,
2010, p. 174). In some cases this is contractual. For example, a contractor
might sue a homeowner if the contractor is not paid the agreed-on amount he
or she was promised for the home repairs performed. In other cases, an indi-
vidual who was injured through the negligence of the hospital that performed
surgery on him or her could sue the hospital for damages.
Cases in which harm to an individual or entity occurs are sometimes
referred to as torts; the term is derived from Old French and means “twisted”
or “wrong” (The Law Dictionary, n.d.; Gifis, 2010, p. 174). Tortious conduct
involves four elements, which must be established before the court. The first
of these is the existence of duty owed to another. There are many definitions
of what constitutes a duty, but it is generally considered to be a responsibility
to another. Examples of such responsibilities include keeping one’s premises
safe and paying adequate attention when driving. Such cases also arise when a
medical, legal, or other type of professional does not act in accordance with the
generally accepted standards of his or her profession (Moffett & Moore, 2011).
The second element of a tort is a breach of the as-defined-above duty owed
to another. For example, a surgeon who leaves forceps in the abdominal cavity
of a surgical patient, a psychologist who does not assess a depressed patient
for suicide potential, or a lawyer who produces a flawed contract that causes
monetary damages for a client would all be considered to be breaching their
duty toward the patient or client (Moffett & Moore, 2011). Such a breach of
duty can be intentional or unintentional, but in either case the behavior of the
defendant toward the plaintiff must be shown to fall below the standards of his
or her profession or constitute negligence when compared with what a “rea-
sonable person” has a right to expect from another (Moffett & Moore, 2011).
When applying the reasonable person standard to a case, the behavior of the
defendant is compared with that of a person exercising average care, skill, and
judgment in a particular situation. However, an individual acting in a profes-
sional capacity will be held to the higher standard of average performance in
his or her area of practice (Hunt v. Bradshaw, 1955).
The third element of a tort is what is known as “proximate cause.” Barron’s
Law Dictionary (Gifis, 2010, p. 75) defines proximate cause as “that which in
Personal Injury Claims 175
natural and continuous sequence unbroken by any new independent cause

produces an event, and without which the injury would not have occurred.”
This is also sometimes referred to as the “but for” test (Cornell University Law
School, n.d.). For example, it might be the case that “but for” the plaintiff having
left the gate to his yard unlocked, the neighbor child would not have fallen into
his swimming pool and drowned. However, the law recognizes that the actions
of the defendant need not be the sole cause of an injury or harm to the plain-
tiff but may significantly exacerbate a preexisting condition. This is sometimes
referred to as the “thin-skull rule,” which states that the defendant is liable for all
harm resulting from his or her behavior, even if the victim was unusually vulner-
able (e.g., had a congenitally thin skull that shattered as a result of the defendant’s
negligence, even though a healthy individual would have been unharmed).
The last element of a tort is the presence of compensable damages. Courts
recognize that while certain harms may occur due to the conduct of another,
these harms must be significant. Not all harms meet this test. For example,
having one’s arm broken due to the negligence of another is likely to be com-
pensable, while receiving a bad haircut or having one’s feelings hurt would
generally not be. There is recognition by the legal system that people will
sometimes act rudely or irresponsibly, but the impact of their behavior is sim-
ply not severe enough to make monetary compensation necessary.
When evaluators are brought into personal injury cases, it is generally to
establish that the plaintiff has suffered psychological damage, harm, or distress
as a result of the tortious conduct of another. All of the elements of a tort apply
to psychological damages.
Before undertaking a forensic assessment related to a personal injury case,
there are a number of ethical issues that must be addressed. The first and most
obvious is whether the forensic evaluator has the required competence to per-
form such an evaluation. After looking at the fact pattern of the case and deter-
mining the psycholegal issues involved, the evaluator must ask him or herself
whether he or she has the competence to address the specific issues involved.
For example, if the case requires the assessment of possible posttraumatic
stress disorder or cognitive deficits brought about by a traumatic brain injury,
does the forensic practitioner have the requisite education, training, and expe-
rience to perform such an evaluation? Section 2 of the “Ethical Principles of
Psychologists and Code of Conduct” (APA, 2002) addresses this directly.
Boundaries of Competence
“Psychologists provide services, teach, and conduct research with populations
and in areas only within the boundaries of their competence, based on their
education, training, supervised experience, consultation, study, or profes-
sional experience” (APA, 2002, p. 4).
Bases for Scientific and Professional Judgments

“Psychologists’ work is based upon established scientific and professional
knowledge of the discipline” (APA, 2002, p. 5). It should be noted that there is
an enhanced standard of competence when undertaking forensic assessments
above and beyond what may be expected in a clinical setting. This is because
an evaluator can reasonably expect that his or her training, experience, and
work product will be subjected to the intense scrutiny of the adversarial legal
system. Further, since forensic psychology operates at the intersection of clini-
cal psychology and the law, there is an expectation that the evaluator will have
a reasonable understanding of the legal issues that inform their assessments.
The “Specialty Guidelines for Forensic Psychology” (APA, 2013) note that:
Scope of Competence When determining one’s competence to provide

services in a particular matter, forensic practitioners may consider a variety of
factors, including the relative complexity and specialized nature of the service,
the relevant training and experience, the preparation and study they are able to
devote to the matter, and the opportunity for consultation with a professional
of established competence in the subject matter in question. Even with regard
to subjects in which they are expert, forensic practitioners may choose to
consult with colleagues.
Knowledge of the Legal System and the Legal Rights of Individuals

Forensic practitioners recognize the importance of obtaining a fundamental and
reasonable level of knowledge and understanding of the legal and professional
standards, laws, rules, and precedents that govern their participation in legal
proceedings and that guide the impact of their services on service recipients.
Forensic practitioners aspire to manage their professional conduct in a man-
ner that does not threaten or impair the rights of affected individuals. They may
consult with, and refer others to, legal counsel on matters of law. Although they
do not provide formal legal advice or opinions, forensic practitioners may pro-
vide information about the legal process to others based on their knowledge
and experience. They strive to distinguish this from legal opinions, however,
and encourage consultation with attorneys as appropriate (APA, 2013, p. 9).
Knowledge of the Scientific Foundation for Opinions and Testimony

Forensic practitioners seek to provide opinions and testimony that are
sufficiently based on an adequate scientific foundation and on reliable and
valid principles and methods that have been applied appropriately to the facts
of the case. When providing opinions and testimony that are based on novel or
emerging principles and methods, forensic practitioners seek to make known
the status and limitations of these principles and methods (APA, 2013, p. 9).
A special issue related to the guidelines noted above is the fact that foren-
sic psychologists conducting personal injury assessments need to make sure
that the techniques and tests they utilize will be admissible in court. There is
some variation in jurisdictions regarding the admissibility of expert testimony.
Initially, all states and jurisdictions utilized the Frye standard (Frye v. United
States, 1923) in determining admissibility. The Frye standard states that for
expert testimony to be admissible, “The thing from which the deduction is
made must be sufficiently established to gain general acceptance in the par-
ticular field in which it belongs” (Frye v. United States, 1923, p. 1). However, in
1993 this general acceptance standard was superseded in many jurisdictions
and in the federal court system by standards put forth in the case of Daubert v.
Merrill-Dow Pharmaceuticals (1993). The Daubert test was more complex and
puts forth a multifactor test to determine the admissibility of expert testimony.
These factors are as follows:
• The testimony must be relevant to the facts at issue

• The theory or technique can be (and has been) tested
• The theory or technique has been subjected to peer review and publication
• The theory or technique has known or potentially knowable error rates
• The theory or technique has attracted widespread acceptance within the rel-
evant scientific community
The decision goes on to state that the standards mentioned above should be
applied in a flexible manner to the principles and methods used as opposed to
the conclusions arising from those principles and methods. In practical terms
this means that experts in personal injury cases should not rely on novel scien-
tific techniques that have not been closely scrutinized and peer-reviewed. Cer-
tain tests in wide usage such as the Wechsler IQ tests or the MMPI-2 would easily
meet this standard. Other tests such as the Thematic Apperception Test or pro-
jective drawings might not be admitted, since these tests lack established reliabil-
ity and validity, and the error rate of conclusions drawn from their use could not
be easily established (Lillienfeld, James, & Howard, 2000; Wechsler Adult intel-
ligence Scale, Fourth Edition, 2003; Butcher et al., 1989; Murray, 1943). Conse-
quently, forensic evaluators performing personal injury assessments should rely
on well-established tests that are widely used in these types of evaluations.
Case Vignette
Reason for Referral
The following case study details a personal injury evaluation performed sev-
eral years ago. It should be noted that all names of individuals, treatment
providers, and institutions have been changed and to some extent hybridized
to protect the identities of these entities. Approximately twenty-two months
before this request was made, Anna Cohen, who was 18 years of age at the
time she was evaluated, was riding her bicycle with several friends along a busy
road at sunset. An inattentive driver drifted off the road and struck Ms. Cohen;
her friends were not injured.

As part of the assessment, documentation detailing the accident, as well as
educational records from before and after the accident, was reviewed. Per-
tinent documents included records from law enforcement and EMTs at the
time of the accident as well as medical records detailing the initial diagnostic
findings related to the injuries Ms. Cohen received as a result of the accident.
These records are important because the severity of a brain injury and the
likely prognosis can to some extent be determined by a number of factors, as
well as scores on rating scales. For example, the Glasgow Coma Scale (GCS;
Teasdale & Jennett, 1974) can be used to rate patients in terms of whether they
can open their eyes normally in response to speech when questioned loudly
or in response to pain such as a pinch. Patients are also rated with regard
to the intelligibility of speech and their ability to follow simple commands.
Lower GCS scores are associated with more severe damage. Other methods of
assessing the severity of traumatic brain injury include the duration of post-
traumatic amnesia, which generally begins at the moment of the injury and
can extend from a few minutes to more than four weeks. The length of post-
traumatic amnesia is generally more accurate than GCS scores in predicting
the victim’s long-term cognitive status (Bishara, Partridge, Godfrey, & Knight,
1992). Initial medical records provide information regarding the nature of the
injury and subsequent cognitive status.
In this case, the police officer who initially responded to the scene of the
accident reported that he immediately called an ambulance and spoke to the
driver of the car who had stopped further up the road. The driver appeared to
be stunned but was able to tell the officer that he had been distracted when he
had spilled his coffee and that his car had crossed onto the berm of the road.
He looked up and saw the bicyclists, but he was unable to stop or maneuver
back onto the road because of the speed he was traveling and the short time he
had to respond. The officer noted that Ms. Cohen had been thrown approxi-
mately fifty feet from the point of impact and had sustained injuries to her
head and back.
The report of the paramedic who initially attended Ms. Cohen noted that
Ms. Cohen had been struck in the back by the automobile and had been
thrown a considerable distance. One of Ms. Cohen’s friends had gone to her
aid immediately and found Ms. Cohen lying on her back, unresponsive and
not breathing. The friend attempted to revive Ms. Cohen without immedi-
ate success, but after a few moments, Ms. Cohen gasped and began breath-
ing again. The same friend reported that, while she waited for assistance,
Ms. Cohen continued in an unconscious state with her eyes rolled back in her
head. The paramedics described Ms. Cohen as having an altered mental status,
confused speech, and right-sided weakness. Additionally, she was described
as having a deep laceration on the right side of her forehead and significant
abrasions on her elbows and knees. She was described as conscious but not
oriented and unaware of what was happening. She was later described as able
to speak and answer certain questions but to be perseverative and distraught.
She attempted to rise but was placed on a backboard and restrained, and she
continued to ask why she was not allowed to go home. Ms. Cohen was initially
taken to a local hospital but was almost immediately taken by helicopter to a
larger regional hospital.
Notes from her immediate treatment were unavailable, but a report of
a follow-up examination by a neurologist who had treated Ms. Cohen had
been obtained. The report indicated that at the regional hospital, Ms. Cohen
received several CT scans of her brain, which revealed a subdural hematoma
that did not require surgical correction. She subsequently developed serious
headaches as well as problems with sleep. The doctor noted that after the acci-
dent, Ms. Cohen had posttraumatic amnesia, which lasted several days after
her injury, along with a relatively brief period of retrograde amnesia. This sug-
gested that she had experienced a moderately severe traumatic brain injury.
It was also reported that she was experiencing significant memory problems
and mood swings and that she had difficulty focusing her right eye. Also noted
were episodes of chest pain that the doctor thought were related to palpita-
tions. The neurologist performed an examination of Ms. Cohen. Her language
was fluent and coherent and her speech was clear with normal prosody. Mem-
ory deficits were apparent as well as difficulties with directional skills. The
neurologist noted that her cognitive status was improved but that she was still
suffering significant symptoms of postconcussive syndrome.
The forensic evaluator was also able to review Ms. Cohen’s educational
records both from before the accident occurred and subsequently. The records
from before her accident indicated that her scores on standardized reading,
mathematics, and writing tests, which were given routinely in her school dis-
trict, were all average to above average. Additionally, her grades were all above
average, and she received no special education or other academic accommo-
dations. This strongly suggested that her cognitive abilities prior to the acci-
dent were at least in the average range.
Several teachers at Ms. Cohen’s high school who had worked with her both
before and after the accident were also interviewed. These conversations made
it clear that, prior to the accident, Ms. Cohen had good to excellent grades and
no difficulty with comprehension, concentration, attention, or organization.
When she was able to return to school, she had much more difficulty in these
areas. She had difficulty focusing in the classroom due to noise and distrac-
tions and her work left her very fatigued. She required special modifications
that allowed her more time to complete assignments and to take tests without
time limits in a separate, quiet environment. She was also noted to be more
anxious and easily startled, and she also had more difficulties relating to her
fellow students and teachers. While these problems gradually improved as the
months went by, and her acute symptoms abated to some extent, she still had
difficulty during the entirety of the following academic year. In performing
the assessment of Ms. Cohen, the evaluator employed the following tests and
techniques:
• Record Review
• Collateral Interviews
• Mental Status Examination
• Clinical Interview
• Reynolds Intellectual Assessment Scales (RIAS)
• Neuropsychological Assessment Battery (NAB)
• Behavior Rating Inventory of Executive Function-Adult Version
{{ Self and Other Rater Forms
• Validity Indicator Profile (VIP)

• Personality Assessment Inventory (PAI)
• Mayo-Portland Adaptability Inventory-4
• Posttraumatic Stress Diagnostic Scale (PDS)

All forensic psychological evaluations should include a formal mental status
examination (MSE). While this component of an assessment is often neglected,
virtually all authorities on the subject of forensic assessment agree that a good
mental status examination is an essential component of such an examination.
For example, in the fifth edition of Neuropsychological Assessment (Lezak
et al., 2012, p. 761) the authors note that “by beginning the examination
with the brief review of cognitive and social behavior afforded by the mental
status examination, the psychologist may be alerted to problem areas that
will need more detailed inquiry; the MSE will usually indicate whether the
patient’s general level of functioning is too low for standard adult assess-
ment techniques. It is also likely to draw out personal idiosyncrasies or emo-
tional problems that may interfere with the examination or require special
attention of procedural changes.” While there are many definitions of what
constitutes mental status examination, is generally considered to be a series

of systematic observations of a subject’s mental state at the time of assess-
ment and is generally based on the observations of the mental health profes-
sional rather than the statements and symptom reports of the individual.
Some practitioners utilize checklists for these observations while others per-
form the examination while simultaneously conducting the clinical inter-
view. Most authorities agree that the mental status examination should cover
the following areas:
• Level of consciousness (alert, drowsy, lethargic)

• Attitude and interpersonal behavior (interested and engaged, distractible,
preoccupied, hostile)
• Appearance (posture, attire, grooming, hygiene, eye contact, facial
expression)
• Activity level and movement (slowed movements, restlessness, psychomo-
tor agitation, tremor)
• Mood and affect (calm, apathetic, labile, flat, or inappropriate emotional
reaction)
• Speech and language (fluency, signs aphasia, amount, and tone)
• Thought processes (logical and coherent, circumstantial, perseverative)
• Thought content (paranoid, ideas of reference, hallucinations, delusions)
• Cognition (fully oriented, memory deficits problems with attention or
abstract reasoning)
• Insight (understanding of his or her deficits or condition)
• Judgment (presence or absence of realistic plans, ability to make good
choices)
When Ms. Cohen was seen for evaluation, her mental status examination
was for the most part unremarkable. She was cooperative and engaged and
appeared to put forth good effort. She did appear anxious at times. Her affect
was appropriate to the content of the interview, although this evaluator did
note that it was slightly flattened and mildly restricted in range. Her speech
was fluent with a mildly slow cadence and low volume. Some difficulties with
verbal abstraction were noted, and her insight into her condition was fair in
that she did not appear to understand some of her current cognitive limita-
tions and their impact on her daily functioning.
The clinical interview provided the subject the opportunity to tell the eval-
uator his or her story with special regard to the events that have led to the
personal injury case. It is also important to take a thorough history in order
to help determine whether the symptoms began with the individual’s injury,
were preexisting but exacerbated by events, or were present before the alleged
injury. The clinical interview of Ms. Cohen revealed that she had been raised
by both biological parents, and she characterized her relationship with them
in positive terms. This evaluator asked her about her adjustment to elemen-
tary school and middle school, and she told me that she did not remember
much about that period of her life and could not recall whether she had been
involved in any extracurricular activities. She had graduated from high school
but had not attempted any college classes. Ms. Cohen did not recall having
experienced any traumatic experiences as a child or adolescent other than
her motor vehicle accident. Her medical history was unremarkable, and she
denied any present or past use of alcohol or illegal drugs. She was not taking
any prescription medications the time of the evaluation. Ms. Cohen had no
history of arrests as a juvenile or adult.

The forensic evaluator questioned Ms. Cohen about any psychiatric history she
might have, and the evaluator was told that Ms. Cohen might have seen a ther-
apist for one or two sessions after her injury but could not give any details. Ms.
Cohen reported occasional moderate symptoms of depression that included
sleep problems and fatigue but denied any thoughts of self-harm. She noted
that she had problems with anxiety and experienced occasional panic attacks.
She gave no indications of delusional thinking and reported no instances of
hallucinations.
When asked about her accident, Ms. Cohen said that she recalled riding
her bicycle with several friends, but she did not recall much about the next
several days; she was unable to estimate how long her anterograde amnesia
persisted. She reported that she experienced debilitating headaches several
times a week and that she had pain in her ankle related to her injuries. The
evaluator asked her about any cognitive changes and was told that, since the
accident, she had been feeling more anxious and self-doubting and worried a
great deal about the future. Ms. Cohen also thought that she was having more
difficulty relating to people and it took her much longer to perform tasks than
it had in the past.
After completing the clinical interview, the evaluator administered the Reyn-
olds Intellectual Assessment Scales (RIAS), which is an IQ test made up of
two verbal subtests and two nonverbal subtests. IQ testing is used in these
types of examinations for a number of reasons. They provide a snapshot of
the subject’s current overall intellectual ability, and they can also be used in
some cases to screen for poor effort or malingering. The RIAS was chosen
for several reasons. It is relatively shorter than the Wechsler instruments,
although highly correlated with that instrument. It is also co-normed with

the Neuropsychological Assessment Battery (NAB), which was also utilized
in her assessment. Ms. Cohen’s scores on the verbal, nonverbal, and compos-
ite indexes all fell in the Borderline to Below Average range. It was the evalu-
ator’s impression that her scores may have been lowered to some extent by
attentional problems.
Since the basis of Ms. Cohen’s personal injury suit was in large part her
claim that she had developed cognitive deficits as a result of her traumatic
brain injury, neuropsychological assessment was required to document the
presence or absence of these problems. There are a number of approaches to
this type of assessment. Some psychologists assemble a battery of individual
test instruments designed to measure cognitive functions such as attention,
memory, language, spatial ability, and executive function. The examiner’s
choice of instruments tends to be based on the professional’s training and
experience. Clearly, any instruments chosen should be normed on popula-
tions with demographic characteristics similar to those of the plaintiff and
should have adequate reliability and validity. Additionally, the instruments
should be sufficiently well developed to be admissible under the relevant
legal standards (e.g., Daubert or Frye). Other practitioners utilize fixed
batteries such as the Halstead-Reitan or Luria Nebraska batteries. In Ms.
Cohen’s case, the evaluator utilized the Neuropsychological Assessment Bat-
tery (NAB), which is a relatively new instrument made up of subtests similar
to many traditional freestanding tests used to assess different domains of
cognitive functioning. The NAB has many advantages for this type of assess-
ment. One major vantage of this instrument is that it includes a screen-
ing module (NAB-SM). The NAB-SM can be given to an individual prior
to administering the full battery. Very elevated or depressed scores on the
screening modules indicate that the subject is not likely to do any better or
worse on the full modules, and these need not be administered. In some
cases, the decision can be made to simply skip the screening module and
simply administer the full battery. In this case, the screening battery was
used because Ms. Cohen did not complain of any difficulties in certain cog-
nitive domains. Ms. Cohen had very depressed scores (below the 2nd per-
centile) on the attention, memory and executive function screening modules
and a well above average score on the language module; therefore, the full
modules in these domains were not administered. Her spatial domain score
fell in the average range, and the full module was administered. She had
extremely low scores in the area of visual discrimination and also did very
poorly on a task that required her to use a map to follow directions. How-
ever, she did very well on a task that required her to copy a complex geomet-
ric figure. Overall, problems with auditory attention and auditory working
memory were observed, as well as slow processing of information, memory
problems, and deficits in executive function. Her overall score on the NAB
was strongly indicative of compromised cognitive functioning.
All assessments of cognitive functioning that occur in the context of a per-
sonal injury case should include a number of tests of effort. This is because
many studies have shown that there is a high rate of feigning and malingering
in these situations. As noted by Bush et al. (2005), “There are many poten-
tial threats to the validity of the information and test data obtained in the
course of a neuropsychological evaluation. Examples of such threats include
the potential for personal gain (malingering), a factitious disorder, opposi-
tion to the evaluation, and the presence of clinical factors that may interfere
with successful participation in a neuropsychological evaluation. In order to
place maximal confidence in the ability to interpret accurately results from
cognitive measures and/or tests of personality or mood, a determination
must be made that the examinee put forth appropriate effort on tasks and
responded honestly to questions. Symptom validity assessment is the pro-
cess through which such determinations are made.” These authors go on to
note that the potential for symptom fabrication or exaggeration is higher in
forensic contexts than in many clinical contexts (Larrabee, 2003; Mitten-
berg, Patton, Canyock, & Condit, 2002). As a result of the client’s increased
incentive to mislead the examiner, neuropsychologists have a responsibil-
ity to conduct a more extensive assessment of symptom validity. Although
there may be instances in which the use of specific symptom validity tests
would not be indicated in forensic contexts, failure to administer at least
one symptom validity test and/or administer tests with internal symptom
validity indicators would need to be justified. As Iverson (2003) stated in the
context of forensic practice, “Any neuropsychological evaluation that does
not include careful consideration of the patient’s motivation to give their
best effort should be considered incomplete” (p. 138). Methods of assessing
effort include the use of embedded measures in standard instruments and
the use of tests specifically designed to assess effort. In this case, I relied
upon embedded measures in the NAB as well as the Validity Indicator Profile
(VIP). The VIP is a computer-administered test of effort and malingering. It
consists of two subtests (verbal and nonverbal) that can be used together or
separately. The subject is not aware of the nature of the test, which appears
to be a measure of cognitive ability. There are a number of instruments that
can be used in this manner including the Test of Memory Malingering, the
Word Memory Test, and the Portland Digital Recognition Test. The VIP is
well regarded and has advantages over the other instruments mentioned as
it both measures intentional efforts to perform poorly and detects individu-
als who are simply not trying very hard on tests of cognitive ability. Both
VIP subtests were administered to Ms. Cohen, and her scores indicated that
she put forth reasonable effort on the tasks. Additionally, the embedded
measures in the NAB indicated that she put forth reasonable effort. As a
consequence, the forensic evaluator felt confident that her overall results on
cognitive testing were likely to be an accurate reflection of her actual ability.
Both Ms. Cohen and her father completed the Behavior Rating Inventory
of Executive Function-Adult Version (BRIEF-A). The BRIEF-A is a question-
naire designed to assist in the assessment of executive function, which is the
ability to engage in purposeful, goal-directed problem-solving behavior. There
have been concerns raised in the neuropsychological literature that more tra-
ditional psychometric tests of executive function lack ecological validity. Lezak
(2012) notes that “Ecological validity is the degree to which a measure predicts
behavior in everyday situations, such as ability to return to work or school,
benefit from rehabilitation, live independently, or manage finances. Tests and
techniques used for neuropsychological assessment are meant to have real-
world validity, but there are many obstacles that limit the degree to which this
can be accomplished. For example, testing in a quiet environment may not
reveal the problems that patients have with concentration and memory as
compared to natural work or home environment with her numerous distrac-
tions.” There is mounting evidence that many traditional neuropsychological
tests do a poor job of predicting an individual’s real-world performance as
related to executive function. Consequently, it is prudent to use both tradi-
tional instruments such as the executive function domain tests of the NAB and
behavior rating forms such as the BRIEF-A in assessing this domain. Ratings
by individuals who know the subject well are also quite helpful. Ms. Cohen
saw herself as functioning normally in most areas measured by the BRIEF-A
with the exception of problems in the area of working memory. The results of
the BRIEF-A completed by her father demonstrated a much higher level of dif-
ficulty in executive functioning, including problems in shifting from one activ-
ity to another, planning and organizing, and monitoring task performance, as
well as working memory. The difference between the self and other scores on
the BRIEF-A suggested that Ms. Cohen appeared to lack insight into the extent
of her problems in this area, which is not uncommon among individuals who
have experienced a traumatic brain injury.
To gather more information about her actual functional capacity, the foren-
sic evaluator had Ms. Cohen’s parents complete the Mayo-Portland Adaptabil-
ity Inventory-4, which is a rating scale designed to measure the most common
sequelii of traumatic brain injury. The use of this type of instrument, which
is completed by others, can be very helpful in assessing personal injury cases.
As noted in the description of the BRIEF-A, the use of this form can give the
evaluator a better sense of the individual’s functional abilities. This instrument
can be completed by a treating professional or by individuals who know the
patient well. The results indicated that Ms. Cohen’s parents viewed their daugh-
ter as having moderately severe impairments in abilities such as attention and
concentration, fund of information, and problem-solving ability. She was also

viewed as having moderately severe difficulties in personal adjustment, includ-
ing high levels of anxiety, fatigue, and headache. Problems with leisure skills,
money management, and employment were also noted.
It has long been recognized that all personal injury is accompanied by
emotional distress, and in recent years this distress has been recognized
as compensable in a personal injury lawsuit. Consequently, this aspect of
personal injury should be assessed in these types of evaluations. Psycholo-
gists evaluating the presence and degree of emotional distress should rely on
multiple sources of data. These sources can include the client’s self-report,
which should be corroborated by other sources to the extent possible, record
review, and the use of objective tests. Tests commonly used for this type of
assessment include the MMPI-2, the Personality Assessment Inventory and
specific tests designed to assess the impact of traumatic events. Ms. Cohen
completed the Personality Assessment Inventory (PAI), which is an objec-
tive test of personality functioning, as part of her assessment. This test was
chosen because it is well validated and reviewed and also because it con-
tains validity scales. Scores of personality measures on the validity scales are
useful in determining whether an individual is either being defensive about
problems and underreporting them or is likely to be exaggerating difficul-
ties. The use of these instruments can be helpful in determining the extent to
which the individual is suffering from depression, anxiety or posttraumatic
stress as a result of the injury, and both tests can reveal somatizing tenden-
cies that may contribute to the persistence of reported symptoms. Ms. Cohen
showed notable defensiveness on the validity scales, which is unusual in the
context of personal injury assessment. Ms. Cohen was somewhat defensive
in her approach to the instrument, which is unusual in personal injury cases
in which people are seeking compensation for their distress. A closer exami-
nation of her scores on the PAI validity scales appeared to stem a general ten-
dency to deny problems in combination with a lack of insight into the actual
severity of her difficulties. Despite this, Ms. Cohen had elevations on a num-
ber of PAI clinical scales. The scores indicated a tendency to develop physical
symptoms under stress, although this can also be seen in individuals who
have actual problems caused by conditions such as traumatic brain injury.
Ms. Cohen also had elevations on scores that measure traumatic stress and
indications that she was having difficulty with concentration, decision mak-
ing, and memory.
Because the presence of trauma-related symptoms was indicated, the
evaluator administered the Posttraumatic Stress Diagnostic Scale (PDS). Ms.
Cohen’s responses indicated that she was experiencing symptoms of avoid-
ance, hyperarousal, and re-experiencing her motor vehicle accident. There are
indications that she was having intrusive thoughts related to the accident as
well as emotional upset when she was reminded of that experience. She also
felt cut off and distant from others in close relationships. Overall, the results
of the PDS indicated that she was experiencing moderate to severe symptoms
of posttraumatic stress, which were causing significant impairment in her day-
to-day functioning. Interestingly, her results on the PDS differed from her self-
report in the clinical interview in that she did not explicitly endorse symptoms
associated with posttraumatic stress disorder when asked about her general
emotional state.

Based on all the available information, the evaluator concluded that Ms. Cohen
was continuing to experience a broad range of both cognitive and emotional
problems since her motor vehicle accident. While her IQ was somewhat lower
than what would be expected based on her school achievement prior to the
accident, given the confidence interval of the RIAS and the magnitude of the
differences between her current IQ scores and her scores on academic tests,
this difference could not be reliably attributed to her traumatic brain injury.
However, her scores on neuropsychological tests were indicative of signifi-
cant cognitive deficits. While her overall language skills were above average, it
was clear that she was experiencing problems in attention and concentration,
memory, visual/spatial skills, and executive function that did not appear to be
present prior to her injury. Her ability to plan, organize daily tasks, and sus-
tain effort were all significantly compromised. Further, there were elements of
anosognosia, a common problem in individuals with traumatic brain injury
that refers to a lack of insight into their current condition and limitations.
This is often problematic since these individuals often do not feel the need to
participate in ongoing treatment or neurocognitive rehabilitation. They may
also become frustrated when their efforts to accomplish tasks or continue their
education do not meet with success.
In addition to symptoms directly caused by her brain injury, Ms. Cohen was
also experiencing emotional problems that stemmed from her injury. She was
experiencing hyperarousal and hypervigilance, avoidance of stimuli associated
with the accident and intrusive, unpleasant thoughts related to her experience.
She also had a foreshortened sense of her future, and she felt distant and cut
off from people with whom she had previously been close. These classic signs
of posttraumatic stress disorder had gone unnoticed both by those working
with Ms. Cohen and by Ms. Cohen herself. There were also indications that
she tended to be preoccupied with her physical condition and experienced
medical conditions such as headaches and generalized pain exacerbated by
her emotional distress. Based on the available information, Ms. Cohen was
diagnosed (DSM-IV-TR under use at time of evaluation) as follows:
Axis I: Cognitive Disorder Not Otherwise Specified

Posttraumatic Stress Disorder, Chronic
Axis II: No Diagnosis
Axis III: Traumatic Brain Injury
Axis IV: Problems Related to Interaction with the Legal System–Litigation
Axis V: Global Assessment of Functioning-61 (Mild to Moderate Symp-
toms and Functional Impairment)
Because of the clear change in Ms. Cohen’s cognitive and emotional status
subsequent to the accident and the absence of any other intervening physical
or emotional traumatic events, the evaluator had no difficulty concluding that
the accident and the resulting traumatic brain injury was the proximate cause
of her current cognitive and functional limitations as well as her posttraumatic
stress disorder.
One of the issues to be addressed in personal injury assessments is the
subject’s prognosis and the likely impact of any observed deficits on the sub-
ject’s future functional status. Individuals in Ms. Cohen’s age group who were
seen for assessment almost two years after a traumatic brain injury had likely
reached an endpoint for improvement. However, the record review and clini-
cal interview of Ms. Cohen made it clear that she had not received any neu-
rocognitive rehabilitation treatment, nor had she received psychotherapy or
psychiatric consultation. It should be understood that in civil cases, individu-
als who are injured by the tortious behavior of another are required to attempt
to mitigate those damages. For example, if a litigant received a disfiguring
facial injury due to the negligence of another that could be corrected with
plastic surgery, the court may refuse to compensate that individual for certain
effects of the disfigurement that could be avoided. In the case of Ms. Cohen, it
was the opinion of the evaluator that it was possible that her functional status
could improve if she received neurocognitive rehabilitation and psychiatric
intervention, but it was not clear what degree of improvement might result.
However, her lack of insight into her limitations was a direct consequence of
the traumatic brain injury caused by the accident.
Often, when there are clear injuries associated with obvious negligence as
there was in this case, and the expert opinions are clear, an out-of-court mon-
etary settlement is reached. After the forensic evaluator’s report was received
by the parties in this case, such a settlement was reached, and the evaluator
was not deposed, nor was he asked to provide expert testimony in court.
Ms. Cohen did follow recommendations for rehabilitation and psychiatric
consultation, and her condition improved, although she never returned to her
premorbid status.

There are a number of problems that commonly occur when performing psy-
chological assessments in cases of personal injury. Most of them come under the
general heading of bias, whether conscious or unconscious. To understand this,
it is important to understand the context in which these assessments take place.
Legal claims of personal injury take place within an adversarial system. Our
civil legal process is predicated on the idea that the true state of affairs in a per-
sonal injury claim will be revealed through vigorous argument and advocacy
between the attorneys for the plaintiff and the defendant. Forensic evaluators
become involved in these cases when the attorney for one of the parties retains
his or her services. Subtle and not-so-subtle pressures that can create bias in
psychological assessments may be in with the very first phone call with the
attorney who wishes to retain a forensic evaluator. Typically, the attorney will
inquire as to whether there is any reason why the evaluator cannot perform
the evaluation. These may include the evaluator having had previous contact
with one of the parties in a treatment or consultative role or any other kind of
prior relationship. After having ascertained that no conflict exists, the attor-
ney will provide a brief outline of the case. This outline will almost invariably
present the case in a manner that supports the position of the attorney’s cli-
ent, whether their representing the plaintiff or the defendant. This is perfectly
appropriate for the attorney, since he or she is an advocacy role with the client.
However, the forensic evaluator has an ethical obligation to be as objective and
impartial as possible. The problem is that once this potentially slanted account
of the case is heard by the evaluator, it can never be unheard. This can lead to
the type of bias that is sometimes referred to as the anchoring effect. Anchor-
ing effects refer to the unconscious tendency to place more weight on informa-
tion that is first encountered than on data that is subsequently elicited. There is
also an associated tendency to neglect to give new, disconfirming information
appropriate weight.
Another related problem in performing these types of assessments is con-
firmatory bias, which is a normal human tendency. In forensic situations
involving confirmatory bias, the evaluator prematurely arrives at conclusions
about the case then unconsciously gives a good deal of weight to subsequent
facts and findings that confirm the initial conclusion while neglecting data
that do not. For example, a forensic evaluator may conclude that the depressive
symptoms that a plaintiff develops after traumatic event are causally related to
that event while neglecting the fact that the same individual had a past history
of developing depressive symptoms when there was no obvious stressor.
Some of the factors that can cause bias in the evaluation reports of forensic
evaluators seem obvious but are sometimes not recognized at the time. One of
these is the fact that the evaluator has been hired by one side or the other and is
being paid by the party by whom they were retained. It can be surprisingly dif-
ficult to accept payment and then come to conclusions that are not favorable to
the retaining party. One way to guard against this is for the forensic evaluator
to take a look at his or her work over a period of years. If he or she finds that
they nearly always provide an opinion that is supportive of the retaining party,
it is likely that he or she is being influenced by a sense of affiliation and obli-
gation, and the evaluator needs to take steps to guard against this tendency.
In the same way, many forensic evaluators can get caught up with the idea of
winning or losing a case, which can affect objectivity.
In general, the best way to try to minimize bias is to employ strategies to
avoid some of these patterns. One of the best ways of doing this is to use mul-
tiple sources of data in performing personal injury assessments. If the forensic
evaluator performs a comprehensive assessment, they will be able to draw on
their clinical impressions of the subject, information from self-report, data from
document review, and other collateral sources as well as the results of objective
tests. If the data from these different sources line up well, the forensic evaluator
is likely to be on firm ground in his or her conclusions, while divergent results
strongly suggest the need for more assessment. Finally, it is important that
forensic assessments and testimony be transparent in the sense that they allow
the court to follow the evaluator’s reasoning and be able to draw independent
conclusions about the information being presented. Developing an awareness
of potential sources of bias and utilizing debiasing strategies will assist evalua-
tors performing personal injury evaluations in minimizing these problematic
tendencies and will increase the usefulness of reports and testimony.
References
conduct. American Psychologist, 57(12), 1060–1073. doi:10.1037/0003-066X.57.12.1060
American Psychologist, 68(1), 7–19. doi:10.1037/a002988
Barton, A. (2004). Just deserts theory. In Encyclopedia of Prisons & Correctional Facilities
(pp. 504–507). Thousand Oaks, CA: Sage.
Bishara, S. N., Partridge, F. M., Godfrey, H. P., & Knight, R. G. (1992). Post-traumatic amne-
sia and Glasgow Coma Scale related to outcome in survivors in a consecutive series of
patients with severe closed-head injury. Brain Injury, 6(4), 373–380.
Bush, S. S., Ruff, R. M., Tröster, A. I., Barth, J. T., Koffler, S. P., Pliskin, N. H., . . . Silver,
C. H. (2005). Symptom validity assessment: Practice issues and medical necessity
NAN policy & planning committee. Archives of Clinical Neuropsychology: The Official
Journal of the National Academy of Neuropsychologists, 20(4), 419–426. doi:10.1016
/j.acn.2005.02.002
Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A, & Kaemmer, B. (1989). The
Cornell University Law School. (n.d.) But-for test. Legal Information Institute. Retrieved
from http://www.law.cornell.edu/wex/but-for_test
Cornell University Law School. (n.d.) Strict Liability. Legal Information Institute. Retrieved
from http://www.law.cornell.edu/wex/strict_liability
Daubert v. Merrill Dow Pharmaceuticals, 509 U.S., 113 S.Ct 2786, 125 L.Ed.2d 469 (9th
Circuit 1993).
Frye v. United States, 293 F.3d F.1013, 34 ALR 145 (DC Cir. 1923).
Gifis, S. H. (2010). Law Dictionary (6th ed.). Hauppauge, NY: Barron’s Educational Series.
Hunt v. Bradshaw, 746 88 SE 2d 762 (N.Carol. 1955).
Lezak, M. D. (Ed.). (2012). Neuropsychological assessment (5th ed.). Oxford, U.K.: Oxford
University Press.
Lillienfeld, S., James, W., & Howard, G. (2000). The scientific status of projective techniques.
American Psychological Society, 1(2): 27–66.
Moffett, P., & Moore, G. (2011). The standard of care: Legal history and definitions: The bad
and good news. Western Journal of Emergency Medicine, 12(1), 109–112.
Murray, H. (1943). Thematic Apperception Test manual. Cambridge, MA: Harvard Univer-
sity Press.
Spooner, D. M., & Pachana, N. A. (2006). Ecological validity in neuropsychological assess-
ment: A case for greater consideration in research with neurologically intact popula-
tions. Archives of Clinical Neuropsychology: The Official Journal of the National Academy
of Neuropsychologists, 21(4), 327–337. doi:10.1016/j.acn.2006.04.004
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. A
practical scale. Lancet, 2(7872), 81–84.
Wechsler Adult Intelligence Scale, Fourth Edition. (2003). San Antonio, TX: Psychological
Corporation.
Part II
Cases, Approaches, and

Practices with Specialized
Populations
9
Psychological Evaluations
to Determine Competency
to Parent
Anthony J. Urquiza, Anna M. L. Westin,
and Dawn M. Blacker
No man really knows about other human beings.

The best he can do is to suppose that they are like himself.
—John Steinbeck, The Winter of Our Discontent

When one considers that psychologists conduct extensive research on so many
important and relevant events, characteristics, behaviors, attitudes, and traits
in humans—it is puzzling that empirical research related to psychological
evaluations of parents involved in child welfare systems has received so little
attention. The psychological literature on how to conduct such evaluations is
sparse. While the American Psychological Association (APA) provides general
guidelines about conducting psychological evaluations in child protection
matters, they focus on basic principles and speak little to the actual process
of conducting evaluations (American Psychological Association, 2013). This
chapter will describe the process of determining the competency to parent
using available best practices for psychological evaluations.
Most case law is specific to the termination of parental right rather than
parental capacity. Guidelines specifying the determination of parental capacity
as well as the termination of parental rights vary from state to state. Generally,
these guidelines contain definitions of child maltreatment, factors that should
be considered by the court prior to returning a child to the custody of the
parent, and factors related to the parent’s involvement in and response to
intervention (Condie & Condie, 2007). Following the Adoption and Safe
Families Act (ASFA) of 1997, many statutes also specify time frames for
successful reunification, as states are offered financial incentives for achieving
permanency (i.e. moving children from foster care to long-term placement,
guardianship, and/or adoption).
While there are many reasons for children to enter the child welfare system,
most of the reasons have little to do with the children themselves—usually,
petitions for placement of a child in protective custody are related to parent
competencies. On this point, most parents who have their children removed
from their care have problems with drugs and alcohol, serious mental health
problems (e.g., intellectual disability, thought disorder), and/or problems
(especially posttraumatic stress disorder and depression) related to their
own childhood (a history of sexual abuse, neglect, or physical abuse that has
resulted in severe long-term problems in functioning) or adult victimiza-
tion (e.g., domestic violence, sexual assault; Dubowitz, Kim, Black, Weisbart,
Semiatin, & Magder, 2011; Friesen, Katz-Leavy, & Nicholson, 2011; Traube,
2012). As a result of these difficulties, some parents are unable to safely and
adequately care for their children.
In situations where the court is required to make a decision about
whether parents can safely and adequately care for their child or children,
they often seek out expert opinion about capabilities, mental health status,
quality of the parent-child relationship, engagement and benefits related to
mental health treatment, and recovery from substance abuse. Psychologists
have unique competencies to evaluate parental competencies. In some
cases, parents have limited abilities to care for their child safely and ade-
quately, which are unlikely to improve over time with services. However,
in many cases, psychologists can provide recommendations to improve
parenting competency in order to increase the likelihood of successful
reunification (Benjet, Azar, & Kuersten-Hogan, 2003; Melton, Petrila,
Poythress, & Slobogin, 1997).
Best Practices
This chapter will describe the process of psychological evaluations to deter-
mine the competency to parent. In contrast to more traditional evaluations,
this type of evaluation is dyadic in focus and requires specialized knowledge
relevant to child welfare. Furthermore, the evaluator needs to carefully con-
sider parent-child fit, issues of timing, and the veracity of the parent report.
Gold standard components of such evaluations include use of standardized
measures, clinical interviews, parent-child observations, review of records,
and consultation with collateral sources. We will start at the beginning of the
evaluation (i.e., referral for an evaluation) and will end with a case example to
illustrate the main points.
Competency to Parent 197
What Is the Referral Question?

An essential element in undertaking an evaluation is having a clear under-
standing of the referral question. Typically, the referral question is related
to determining whether the parents possess the skills and abilities to safely
and adequately care for their child, and if not, what services would enable
them to be able to care for their child. While there may be additional types
of questions (e.g., has the parent successfully completed substance abuse
counseling, can the parent safely manage the behavioral problems exhibited
by the child?), the issues are usually at least indirectly related to the parent’s
ability to care for the child.
Timing of Referral and Evaluation

An additional issue concerning the referral question involves timing. It is
necessary for evaluators to have a full understanding of the child welfare and
institutional statutes related to reunification. Referral of a parent two months
after his or her child enters dependency may be a substantially different cir-
cumstance than a parent with similar issues referred at nineteen months after
a child enters dependency. That is, two months after dependency, the parent
has the right to eighteen months of services to enable him/her to care for the
child, and the referral may be made to assist in the development of a case plan,
especially if the parent has some type of unique mental health concern (e.g.,
limited intellectual ability, severe depression). In contrast, the county has no
mandated requirement to provide reunification services to a parent referred
for an evaluation at nineteen months after the child has entered dependency.
As a result, an evaluation of a parent referred later in the process may be more
related to termination of reunification services or termination of parental
rights (i.e., if the child was returned to the care of the parent at this time,
would the parent be able to safely and adequately care for them?). Timing is
important to consider when clarifying the referral question, as well as when
completing the evaluation. An evaluator must determine not only whether or
not a parent is competent at the time of the evaluation but also whether he
or she has the potential to become competent, and if so, how long it would
take the parent to be able to care for the children safely and adequately. In
some cases, it may be likely that the parent can become competent, but not
within the time frame provided by state statutes.
Focus of the Evaluation as a Parent-Child Dyad

While many traditional psychological evaluations focus on the individual,
psychological evaluations to determine competency to parent should be
framed from a dyadic (i.e., parent-child) perspective. Both the parent and
child have to be acknowledged and assessed for a competent evaluation of
parenting capacity. The relative strengths or weaknesses of both the parent
and child should be considered. For example, it is important to understand
that greater child psychopathology is likely to lead to a need for greater
parenting capacities (e.g., a child with severe aggression and noncompliance
requires greater parental skills and abilities to manage these behaviors). A
child with special medical needs, who requires consistent medication, moni-
toring, or parent-administered medical procedures demands a parent who is
knowledgeable and aware of the severity of the medical problem and who can
reliably meet the child’s medical needs. Conversely, a child with relatively few
behavioral or emotional problems may be fairly easy to parent. Additionally,
a child’s age or developmental level is relevant, as children at different stages
of development have different needs (e.g., a typically developing infant has
different needs, and requires different parenting, than a typically developing
teenager). Thus, the intersection of a child’s age, special needs, and mental
health/behavioral needs requires different parenting abilities. Therefore, it is
best practice that a parent evaluation includes the child (ideally a face-to-face
assessment of the child and, at a minimum, an understanding of the child
through collateral sources and record review). While there may be some
instances where a parent can be evaluated apart from the child, this should
be uncommon and related to situations in which the dominant factor is par-
ent capacity (e.g., parent and a healthy newborn infant), a solitary dimension
of a parent’s capacity (e.g., failure of a parent to sustain in a drug treatment
program), and/or problems inherent in the parent-child relationship that
may destabilize the child’s placement (e.g., a significant increase in trauma
symptoms due to contact with the parent).
Conducting an Evaluation
From Basics to Understanding the Story of the Parent Parental com
petency includes a basic understanding of child development and the ability
to learn and apply basic to complex caretaking skills depending on the child’s
needs. For example, at the most basic level, a parent must be able to consistently
recognize the signs that an infant is hungry and must be able to provide
the right type and amount of food. However, the assessment of parenting
competencies is not simply the verbal recounting of steps necessary to parent,
but a description of the pattern of events that have led to the child being placed
in dependency and the actions toward reunification. This includes the parents
providing information not just about their skills, knowledge, and abilities—
but the entire story that they tell about their life, the roles of significant
people in their life (e.g., children, grandparents, partners), and their past
and current capacities to sustain healthy relationships. While a description

of relationship history is not always a predictor of how parents will engage in
future relationships (i.e., parents will always have the capacity to change the
way in which they live their lives), the pattern of past relationship problems
and their awareness of these problems provide guidance about their ability to
have a safe and healthy relationship with their child. From this viewpoint, it is
incumbent on the evaluator to allow the parents to tell their story about their
history of relationships and, especially, the history of their relationship with
their child that led to their child’s entry into dependency.
As part of the telling of this story, it is essential to hear the content of
what happened and why it happened, to understand the consequences, and
to acquire information about lessons learned. However, because of a parent’s
propensity to present an overly positive façade during the evaluation, it is
also essential to understand the process by which the story is told (Benjamin,
1993). Attachment is one of the most meaningful elements of human develop-
ment, mental health, and safe and healthy families. An individual’s relationship
history is a reflection of his or her self-image and a predictor for the future.
For example, a young woman neglected in early childhood and removed and
placed in foster care at age three, with more than twenty-five subsequent fos-
ter and group home placements throughout the course of her life, is likely to
struggle with understanding and consistently engaging in the give and take
of meaningful relationships as a parent. That is, limited exposure to the many
behaviors and actions of good parenting leaves that child with limited parent-
ing capacities as she grows older. To modify a position asserted by Fogel and
colleagues (Fogel, Garvey, Hsu, & West-Stroming, 2006), relationships are the
architecture through which we learn to live our lives and to live in the lives
of others. Is it possible that a person with a pattern of adverse relationship
experiences that include events such as multiple foster placements, domes-
tic violence, and absence of a trusted confidant could derive and develop the
qualities of good parenting? Certainly. Is it likely? It would be difficult and
uncommon. This is because the story of healthy parenting capacities lies in
the hundreds of thousands of positive affiliative interactions experienced by
a parent throughout the course of his or her own infancy, childhood, adoles-
cence, and adulthood. Is this an assertion that being born of a “good” family
leads to good parenting or that being born of a troubled family leads to poor
parenting? We know that there are many factors that contribute to an over-
all sense of resiliency—an improvement in one’s capacities, even in light of
multiple and sometimes significant adversities.
But everyone has a story—and careful listening to the content and process
of the story can lead to a better understanding of the overall context in which
the parents had their child removed from their care, the potential for them
to be able to successfully reunify with the child, and the steps necessary to
support a healthy parent-child relationship. An essential element of an

evaluator is to listen carefully enough to the parent’s story and to see clearly
enough to provide an opinion that is fair to both the parent’s right to reasonable
services and the best interests of the child.
The Broad Range of Common Child Welfare Knowledge It is necessary for

an evaluator to have a solid understanding of common problems encountered
in the child welfare system (e.g., substance abuse, domestic violence, personality
disorders, limited intellectual abilities, trauma, parent-child relationship
qualities, early childhood attachment). Important and difficult questions arise
that demand an informed clinician:
• What is the effect of methamphetamines on a fetus?

• How does trauma and depression interact to impair awareness of oneself
and the child?
• What is the effect of antidepressants on parental functioning?
• How does one differentiate between Posttraumatic Stress Disorder and
Attention Deficit Hyperactivity Disorder in a young child?
• What are effective treatments for substance abuse?
Additionally, it is important for an evaluator to appreciate the distinctions

of mental health and human development that may be immutable or can be
ameliorated by social services and/or mental health interventions. For exam-
ple, certain conditions (e.g., Down’s syndrome) are likely to limit a parent’s
potential for acquiring increased parenting capacities through interventions,
while other conditions (e.g., depression) may have multiple interventions that
can significantly improve parental functioning. While it is not reasonable for
an evaluator to understand all elements of parenting and child welfare sys-
tems, the level of knowledge to competently conduct such evaluations is typi-
cally well beyond that taught in graduate school. In order to provide quality
services, evaluators may need specialized training in child welfare evaluations
following the completion of their degree.
A Comment about Attachment Without question, research conducted

over the last several decades has identified attachment as the hallmark of
psychological health throughout the lifespan and problems with attachment
as a clear indicator of a range of psychopathologies. While the wide range of
attachment research with children and adults (Cassidy & Shaver, 2008) has
focused on a unifying theme of health throughout life; others have recognized
that child maltreatment (Crittenden & Ainsworth, 1989) and exposure to
violence (Gewirtz & Edleson, 2004) are strongly associated with disrupted
attachment relationships. An extensive discussion of the roles of attachment
and child maltreatment are beyond the scope of this chapter. (For a review,
see Toth & Cicchetti, 2013). However, it is important to highlight that
children may be connected to their parents in a manner that is not healthy
and/or that contributes to their psychopathology.
The important element in the 2 × 2 table (Table 9.1) is to demonstrate that
examining the quality of a parent-child relationship is more complex than
the presence or absence of an attachment relationship. While it should be
understood that parent-child attachment is a complex phenomenon (hence,
the oft-used phrase of attachment being an “internal framework”), description
of a parent-child relationship within the dimensions of positive/negative and
strong/weak at least presents the notion that a child may have a strong rela-
tionship with the parent (and—possibly vice-versa), yet the relationship may
be harmful and damaging to the child. For example, a child may be raised by
a parent who has a chronic problem with alcohol and is physically and emo-
tionally abusive. Due to caregiver difficulties, multiple substitute caregivers
may also be present in the life of the child (e.g., grandparents, foster parents,
aunts/uncles). This may lead to the child having an inconsistent relationship
with their parent that includes frequent anger and hostility.
Veracity—Sometimes Parents Fail to Tell the Truth While it is essential to

listen carefully to the life story of the client, it is also important to understand
that not everything the client shares is truthful or accurate. Sometimes parents
lie about past events in an effort to hide events and characteristics that they
might perceive as damaging to their effort to reunify with their child. Other
times, parents may fail to provide an accurate account of past events, not
because they are overtly lying, but because they have distorted perceptions
of themselves and the world (e.g., poor insight, delusions). For example, a
parent being evaluated asserted a career choice as being an emergency medical
technician (EMT) because she thought her prior history of speeding and
reckless driving would be perceived as a testament to her “exceptional driving
skills.” While this would be an unlikely scenario (and clearly an important
statement concerning her judgment), it appeared to reflect a genuine position
TABLE 9.1 Attachment Strength and Quality
Strong Weak
POSITIVE Positive affiliative parent-child A positive relationship,

relationship, with continuity although with infrequent
and consistency or inconsistent contact
NEGATIVE A stable relationship, with An inconsistent relationship
frequent anger, frustration, with anger, frustration,
and hostility and hostility
by this parent. Finally, although not directly related to veracity, sometimes

parents possess serious limitations in their intellectual and developmental
abilities that result in failure to appreciate the importance of significant events
in their life. A common example would be a mother who repeatedly becomes
involved in intimate relationships with aggressive men, which often results in
domestic violence. Although responsibility for aggression always lies with
the aggressor, a mother’s failure to recognize a pattern of placing herself and
her children at risk through a series of dangerous partners is a level of self-
distortion that weighs on parental capacity.
While it can be frustrating to not obtain a complete or accurate account or
understanding of events, parents’ partial, incorrect, or delusional stories are
still helpful to inform decisions about their parenting competencies. The way
a parent processes information, makes meaning of the world, and chooses to
share it are all significant aspects related to their ability to care for their child
safely and adequately. Nonetheless, issues of poor reporting or overt lying also
highlight the importance of record review and consultation with multiple
collateral sources to support facts (e.g., did the parent successfully complete
his drug program?) and gain alternative perspectives.
Observation of the Parent-Child Relationship As stated earlier, parenting

assessment usually requires assessment of the parent, the child, and the dyad.
Typically, dyadic assessment involves some type of observational session, where
the evaluator can observe specific parent-child behaviors and interactions that
cannot readily be conveyed by collateral sources (e.g., in conversation with a
social worker, a therapist, a teacher). Although some benefit can be gained
through an informal observational session of an interaction between a parent
and a child (e.g., observing a mother care for a newborn infant, change a
diaper, feeding), the use of some type of formal behavioral observation system
is recommended.
There are several formal observational coding schemes that can provide
valuable information about parenting capacity and parent-child relationship
quality (Cerezo, Keesler, Dunn, & Wahler, 1986; Eyberg, Nelson, Duke, &
Boggs, 2005; Biringen, 2008). While no specific behavioral observation coding
scheme is recommended, it is strongly suggested that an evaluator have a good
working knowledge of at least one observational protocol and an awareness of
specific types of parenting or child behaviors that reflect positive relationships.
Being familiar with a behavioral coding scheme can aid the evaluator in seeing
patterns of behavior and understanding parent-child interactional dynamics
rather than solely relying on parental verbal reports or reports from others
(e.g., teacher, social worker, visit supervisor).
As a final note, it is important to understand the limits of behavioral observa-
tions, including that they may provide an artificial snapshot of the parent-child
relationship, depending on a number of factors that may detract or enhance the

extant situation (e.g., child is sick, parent is nervous, observation takes place in
a novel setting, parent brings food/treats to the session). For example, a parent
who has very limited opportunity to visit with his or her child (e.g., one hour
of supervised visitation per week) may not have sufficient contact to maintain a
consistent relationship. Thus, conducting an observation of a parent-child dyad
with limited contact may distort the natural processes of the parent-child dyad
and may lead to faulty conceptualizations about the relationship.
Understanding the Use and Application of Standardized Assessment

Measures There is no single standardized assessment or measure (nor set
of measures) that can definitively determine whether an individual can safely
parent. However, conducting psychological evaluations within a child welfare
setting can result in the need to assess a variety of both parent and child domains.
Because of this, the evaluator will need to be familiar with many different types
of standardized assessments and their appropriate uses. A portion of this issue
is the strong assertion that only measures with demonstrated validity and
reliability be used in child welfare settings. While it may be argued that certain
psychological qualities or concepts can only be captured with a projective
test, others have clearly articulated that there are many inherent flaws in the
development and use of projective tests (Lillienfield, Wood, & Garb, 2000).
It is also important to note that many standardized assessments have not
been developed with discrete versions for different cultural groups. Issues of
language use and language comprehension may distort a parent’s response to
standardized questionnaires. Parents with intellectual disabilities or poor aca-
demic achievement may not be able to complete standardized questionnaires.
Additionally, misuse of standardized questionnaires based on limited research
into cultural differences may increase the likelihood that a parent responds
to a test “differently” and is therefore perceived as possessing greater psycho-
pathology (Urquiza, & Wyatt, 1993). Thus, a careful review of norms and test
development is needed to reduce bias. For example, the Comprehensive Test
of Nonverbal Intelligence (CTONI) may be a better measure of cognitive abili-
ties than the WISC-IV when there are concerns about bias due to language,
hearing, or culture. When standardized measures are not appropriate, and less-
biased alternatives are not available, the evaluator will have to rely more heavily
on other sources of data (e.g., interview, collaterals).
Use of Collateral Contacts While it is important to acquire evaluation

data through clinical interviews, direct informal observation, structured
observations, and use of standardized assessments, contacting collateral
information sources is often vital to a clear understanding of the parent-child
relationship. Often, parents under evaluation may alter their presentation
while participating in an evaluation; they may attempt to present themselves

in the best possible light. By contacting relevant people in the life of the parent
and/or child, an evaluator can gain a better understanding of the functioning
of the parent in his or her role as a caregiver, his or her response to mental
health or social service interventions, and his or her use of informal social
support systems. For example, teachers can provide information about
whether a child arrived at school wearing appropriate clothes and well fed.
A therapist can provide information about a parent’s consistent attendance in
treatment sessions and willingness to address mental health problems. Finally,
grandparents can speak to their ability and willingness to be a support to the
parent and their grandchild.
Culture and Child Welfare Evaluations Culture can be considered a

pattern of beliefs, thoughts, ideas, and traditions commonly held by a group of
people. While many people consider culture synonymous with race or ethnicity,
there is great cultural heterogeneity within racial groups, and many other
group variables are associated with culture (e.g., language, disability status,
socioeconomic status). A review of culture and child maltreatment is beyond
the scope of this chapter (for a comprehensive review, see Fontes, 2005), but it is
important to note that culture influences attitudes about parenting, definitions
of child maltreatment, and system responses to families. For example, African
American families are overrepresented in child welfare investigations, enter the
foster care system at disproportionate rates, and are less likely to be reunified or
adopted than their Caucasian peers (Fluke, Yuan, Hedderson, & Curtis, 2003;
Fox, 2005). Multiple factors impact the rate of child maltreatment, as well as
response of child welfare systems to families, in different cultural groups.
It is important that the evaluator have knowledge of the literature on
culture and child welfare, along with an awareness of his or her own biases.
Different cultures may have different definitions of child maltreatment;
however, child maltreatment is likely clearly defined by law in the loca-
tion where the evaluator operates. Nonetheless, having knowledge of other
definitions will provide a context for the evaluator to better understand
the family. For example, instances of leaving a child unattended that would
qualify as neglect in the United States would not be unusual in Sweden,
and while female genital mutilation is accepted in some parts of the world,
it is considered abuse in the United States. More commonly, American
families will present with varying attitudes about family life, parenting, and
punishment. For example, African American families, and families whom
live in more dangerous neighborhoods (regardless of race), tend to endorse
harsher punishment (e.g., Barajas-Gonzalez & Brooks-Gunn, 2014).
Having a thorough understanding of the presenting family’s culture is
essential in conceptualizing how the family came to the attention of child
welfare and will also influence prognosis and treatment recommendations. A

parent with a belief in harsh physical punishment, who consistently punishes
his or her child (too harshly, by child welfare standards) for not following rules
will be viewed differently than will a parent who does not believe in physical
punishment but who has poor emotion regulation and beats a child in anger
when having a bad day, noncontingent on the child’s behavior. The first parent
may live in a community where the majority of members share their beliefs,
while the second is shamed by peers for unacceptable behavior. While the
second parent would likely benefit from learning coping skills, this may be
irrelevant for the first parent. Thus, an understanding of the parent’s story
includes meaning making, which is embedded in a larger cultural context.
Family culture and experiences with the child welfare system may also
influence an individual’s level of trust, cooperation, and level of honesty when
completing an evaluation about parenting competency. It is the role of the
evaluator to assess these attitudes, expectancies, and experiences to create a
culturally informed conceptualization of the family. In order to be sensitive to
the influence of culture, an evaluator must carefully explain his or her role and
the purpose of the evaluation, select appropriate measures, critically evaluate
information from service providers who may have a biased view of the family,
and include collateral sources the parent would like the evaluator to contact
(e.g., family friends, pastor, employer).
While some cultural attitudes may conflict with safe parenting and healthy
relationships (Terao, Borrego, & Urquiza, 2000; 2001), culture can also repre-
sent a family strength. Such strengths can be used to inform treatment planning,
to motivate change and reunification efforts, and to prevent future child mal-
treatment. For many families, culture may be a strong and important dynamic
in strengthening family ties, involving extended family members in child care,
and keeping children safe. Positive valuing of children, parenting, child care-
giving, and family ties are all positive aspects of a parent’s belief system that
should be assessed. When beliefs contradict safe parenting, psychoeducation
and parenting skills may help teach parents alternative behavior management
strategies that are still consistent with their cultural beliefs (e.g., how can I get
my child to respect his elders without using physical punishment?).
Making Meaning The role of the evaluator is not to simply tally the
pros and cons of a parent’s functioning but to offer an opinion based on
the results of information gathered in the evaluation. There is no clearly
identified guideline, protocol, or log-linear process that can pinpoint—with
any scientific accuracy—the direction the evaluator’s opinion might take.
Instead, it is necessary for the evaluator to utilize and integrate all of the tools
at his or her disposal and then present the most well-reasoned and supported
position to each referral question. In many instances, generating an opinion
for the referral question requires development of a case conceptualization

where none previously existed (Kegan, 1983). It is the responsibility of the
evaluator to provide the court with a coherent understanding of the parent,
within the immediate context of the specific referral questions (and the more
distal context of the child welfare and institution statutes), which results in
a better view of the parent and parent-child relationship. Such a view can
serve to describe both the qualities of the relationship and the strengths and
weaknesses of the parent, with the weaknesses being the focus of interventions
that may reasonably lead to safe and adequate parenting capacities.
Specific and Focused Treatment Recommendations After completing all

aspects of an evaluation, an evaluator addresses each of the referral questions,
often offering recommendations for treatment. Given that the evaluator may have
developed the most thoughtful view of the parent and child, it is therefore incumbent
on him or her to provide a concise, clear, and well-reasoned treatment plan. The
treatment plan should be tailored to the child and parent, and the evaluator should
recommend empirically supported treatments when available. It is helpful for the
evaluator to be familiar with local resources and available treatments. In general,
recommendations should be sufficiently detailed that the parent’s social worker
would be able to review the report and then make the appropriate referrals that
would result in reasonable services to address the parent’s problems.
Case Vignette
The following case vignette illustrates what is often required in completing
evaluations to determine the ability to parent safely and adequately and what
is considered a best-practice approach. Consider the following case example
in light of the APA evaluation guidelines and general standards most courts
must consider when making decisions about parenting competency matters.
This case highlights many of the challenges that evaluators face during the
evaluation process (i.e., caregiver axis I and axis II mental health problems,
understanding the client’s story and meaning making, concerns about veracity,
and assessing strength, valence, and continuity of attachment).
Reason for Referral

Ms. Jones was referred for a court ordered evaluation by the County Deputy
Public Defender, who was acting as her counsel in the child welfare action. The
reasons for the evaluation are 1) to provide an opinion of Ms. Jones’s current
mental health status, 2) to provide an assessment of the bond/attachment

between Ms. Jones and her son, David, and 3) to provide recommendations
for reunification services.
Summary of Relevant Records and Relevant

Background Information
Ms. Jones’s biological parents separated when she was 5 years of age, and she
lived with her mother and stepfather for the majority of her life. She grew up
in a small town in California where she remains. Ms. Jones reported ongoing
sexual abuse by several family members (i.e., her biological mother, biological
father, and stepfather) between the ages of 6 to 17. She does not currently have
contact with her family members and does not have any friends. She gradu-
ated from high school but described ongoing academic and behavioral dif-
ficulties starting in middle school (e.g., special education status, suspensions,
truancy, fighting), which were supported by school records. As a result of her
difficulties, she transferred schools multiple times. Ms. Jones was unemployed,
although she has previously been employed in the fast food service industry.
With regard to romantic relationships, Ms. Jones started dating Mr.
Martinez at age 16, and the couple separated when she was 19 years of age,
approximately a year after the birth of their son, David. The pregnancy and
delivery were unremarkable, and David met developmental milestones on
time. Ms. Jones reports ongoing domestic violence in the relationship with Mr.
Martinez and reports that she ultimately left him, fearing for her own life. She
required medical attention on a number of occasions as a result of violence by
Mr. Martinez. She started dating Mr. Brown immediately following the separa-
tion from Mr. Martinez, and the couple is currently engaged to be married and
cohabitating. There have also been a few instances of violence perpetrated by
Mr. Martinez following the termination of the relationship between Ms. Jones
and Mr. Martinez, including Mr. Martinez threatening Ms. Jones with a gun,
which was witnessed by Mr. Brown. Ms. Jones noted that she did not believe
that she could have successfully sustained her separation from Mr. Martinez
if she had not been supported throughout the process of separation by Mr.
Brown. She described Mr. Brown as “always being there” for her and explained
that the couple “do[es] everything” together. For example, she cited only a very
few instances of their being apart over the last two years. Ms. Jones has never
been single since she started dating at 16 years of age and expressed fears about
being alone.
When asked about mental health symptoms, Ms. Jones endorsed significant
trauma symptoms (e.g., re-experiencing, avoidance, and increased arousal)
with an onset in childhood. She described dissociation associated with trauma
triggers (“I become silent . . . I’m in Lala land”) which was also confirmed by
Mr. Brown (“She becomes spaced out, has no emotion”). She also endorsed
ongoing struggles with depression since adolescence (i.e., depressed mood,
increased sleep need, anhedonia, difficulty concentrating, suicidal ideation).
She described poor self-esteem, low self-efficacy, a passive personality style,
and difficulty making decisions on her own. She was unsure about her own
life goals. She described ongoing fears about Mr. Brown leaving her, despite
reassurance from Mr. Brown that he was happy. Ms. Jones also acknowledged
nine months of illegal drug use (methamphetamines) shortly after her son was
born. She recalled that she felt her drug use was a problem that was impacting
her parenting, so she decided to stop using any type of drug. She denied any
drug use since that time. Ms. Jones denied other mental health symptoms.
Further, she denied receiving mental health services but was open to therapy
and medication management, if appropriate. Ms. Jones currently takes pain
medications, following injuries from a car accident last year.
Ms. Jones made allegations to child welfare that her son, David, had been
sexually abused by herself and several other family members (i.e., David’s
father, Mr. Martinez, David’s maternal grandmother, and David’s maternal
step grandfather). Ms. Jones later denied abusing her son and denied knowing
any information about anyone else abusing her son. The allegations of sexual
abuse were unsubstantiated by child welfare services, but David was neverthe-
less removed from his mother’s care due to concerns about Ms. Jones’s mental
health and her ability to parent David safely and adequately given false claims
of sexual abuse. There was no additional child welfare history or any reports
that David had suffered child maltreatment. At the time of this evaluation,
David was placed with his paternal grandmother (where Mr. Martinez was
also living). He had been removed from his mother’s care for approximately
five months, and had supervised visits with Ms. Jones for one hour in a child
welfare clinic twice weekly.
When asked during the evaluation about her allegations of sexual abuse,
Ms. Jones explained that she had started lying about a number of things (e.g.,
past and current problems) in an attempt to be close to her fiancé. Mr. Brown
had a history of abuse in his childhood, prior drug use, and behavioral
problems in his youth. He reported that he learned that acknowledging past
abuse and any current problems is a necessary part of treatment and recovery,
and he had encouraged Ms. Jones to do the same. Ms. Jones stated that she
believed Mr. Brown might leave her if she did not share similar experiences
so she reported that she had been sexually abused during her own childhood.
She further reported that she had sexually abused her son (and that he also
had been abused by her parents and Mr. Martinez) in an effort to develop a
closer relationship with Mr. Brown. Additionally, Ms. Jones explained that
part of her reasoning to make false allegations were fears related to her fam-
ily members having requested more contact with her son. It should be noted
that throughout the interviews, Ms. Jones cried extensively and said she felt
“disgusted” with herself. Ms. Jones had difficulty articulating her reason-
ing clearly but continued to provide responses related to a strong desire to
sustain her relationship with Mr. Brown. Conversely, Mr. Brown expressed
regret related to unintentionally pressuring Ms. Jones to share past abuse
information.
Evaluation Process
At the beginning of the initial interview, Ms. Jones was provided with a full
explanation of her rights and the reason for the evaluation (i.e., informed
consent), and she agreed to sign a document asserting her understanding of
these rights. In order to complete an evaluation of Ms. Jones, David, and their
relationship, a number of procedures were conducted, including
Document Review
• Social services/court reports
• Ms. Jones’s school records
Clinical Interviews/Observations
• Interview with Ms. Jones
• Conjoint interview with Ms. Jones and Mr. Brown
• Observation of Ms. Jones and David
Psychological Testing for Ms. Jones

• Kaufman Brief Intelligence Test, Second Edition (K-BIT-2; Kaufman &
Kaufman, 2004)
• Personality Assessment Inventory (PAI; Morey, 2007)
• Brief Symptom Inventory (BSI; Derogatis, 1993)
Psychological Testing for David

• Behavior Assessment System for Children—Parent Report (BASC-2;
Reynolds & Kamphus, 2006)
Collateral Contacts
• Mr. Brown, fiancé
• Mr. Scott, county deputy public defender
Typically, evaluations take approximately 8–12 hours to complete (i.e.,

clinical interviewing, administering/scoring psychological tests, collateral
contacts, report writing). This evaluation was slightly longer because the client
lived in a different city—making the overall time to complete this evaluation
slightly longer due to travel time for the clinical observation of the client and
her son.

Ms. Jones was a 21-year-old Caucasian woman of average build who was
monolingual in English. She presented at both visits dressed and groomed
appropriately for her age and the weather. She was interviewed alone and
with her fiancé, Mr. Brown.
During the course of the evaluation, Ms. Jones was interviewed on three
occasions. The first two interviews were conducted at the clinic (lasting about
2–3 hours each), with Mr. Brown in attendance (she indicated that she and
Mr. Brown were always together, did all errands together, and went to all
appointments together). Ms. Jones was interviewed by herself on one occasion
and together with Mr. Brown on another occasion. A third clinical interview
and behavioral observation (lasting about 2 hours) was conducted with her
son at the county visitation center. Because Ms. Jones was required to have
supervised visitation, the evaluator was allowed to be the supervisor for the
visit. Mr. Brown was not allowed in the visitation center, so he was not present.
During the clinical interviews, Ms. Jones often started the conversation with
a calm demeanor, and she was attentive and focused on responding to the ques-
tions presented to her. However, when asked more difficult questions, she cried
extensively and sometimes appeared to be disconnected from the interview pro-
cess (i.e., detached, staring, unfocused). When she was not distraught and cry-
ing, Ms. Jones had insight into her behavior when asked about it. Despite crying,
she continued responding to questions and remained cooperative throughout
the evaluation. Ms. Jones was oriented to time, place, and situation. No delu-
sions, thought problems, or hallucinations were reported or observed. She
denied current suicidal and homicidal ideation.
When Ms. Jones was interviewed and she became upset, she made repeated
self-deprecating statements. For example, when describing the reasons for her
decision to stop taking drugs, she said:
I was losing myself. I felt I was a horrible mother. I was like 90 pounds. I was
disgusting—a person I did not like.
When later asked questions about why she had previously gotten in trouble
for lying, she stated:
I was disgusting. I was lying so much, I was not good. I was lying about a lot
of things. I was a big lie. I was afraid I was gonna lose him (Mr. Brown) so
I just started lying and it kept on happening. I am such a disgusting person.
When interviewed with Mr. Brown, Ms. Jones tended to be more passive.
Mr. Brown often answered questions for Ms. Jones. On a couple of occasions,
he needed to be reminded that a question was presented to Ms. Jones, not
to him. He appeared to easily understand that speaking for Ms. Jones was a
concern and commented that he had a strong personality and that he often
spoke for her. After some prompting, he was able to be less responsive to
questions, allowing Ms. Jones to answer the questions. Ms. Jones frequently
became stuck on questions when Mr. Brown was asked to let her respond. She
had difficulty articulating responses and appeared uncomfortable speaking
for herself.
David was a three-year-old Caucasian and Hispanic boy who appeared
his stated age. He was appropriately dressed and groomed for his age and
the weather during the parent-child observation. His speech tone, pitch, and
production were within normal limits. His gait and motor skills were unre-
markable. He provided developmentally appropriate responses to questions.
His activity level was above average.
Summaries from psychological testing are provided below. Results from any
one test were not used to form diagnostic or treatment conclusions. Rather,
each test was used in conjunction with evaluative data from additional sources
such as interviews, case history, direct observations, and other test data.
Results below were considered valid unless otherwise noted.
Standardized Assessment Information on Ms. Jones

Kaufman Brief Intelligence Test, Second Edition (KBIT-2) The Kaufman
Brief Intelligence Test, Second Edition (KBIT-2) is a brief measure of intellectual
ability. The KBIT-2 comprises two main subtest scores, Verbal and Nonverbal.
In addition, there is an overall score, a KBIT-2 IQ Composite score.
Ms. Jones obtained an overall IQ Composite score (SS = 90) that falls in the
“Average” range. Ms. Jones obtained a “Below Average” standard score of 82 on
the Verbal subscale and an “Average” standard score of 100 on the Nonverbal
subscale. There is a significant difference between her Verbal and Nonverbal
subscale scores, suggesting that additional intellectual assessment is indicated
to more accurately understand her cognitive strengths and weaknesses. How-
ever, her performance, along with data from other sources, does not suggest
concern with regard to cognitive limitations impacting parenting ability. It is
likely that Ms. Jones’s below-average abilities on the Verbal subscale reflect
her inconsistent involvement in school (i.e., school-based learning tends to be
reflected in the Verbal subtests).
Brief Symptom Inventory (BSI) The Brief Symptom Inventory (BSI)

is a 53-item standardized self-report measure used to assess an individual’s
current psychological functioning. Two global indices provided information
regarding overall symptom severity currently experienced by the respondent.
Nine primary symptom dimensions provided more specific information about
possible areas of concern.
On the BSI, Ms. Jones was clinically elevated on all (i.e., Anxiety, Depres-
sion, Interpersonal Sensitivity, Obsessive-Compulsive, Somatization, Paranoid
Ideation, Phobic Anxiety, and Psychoticism) but one scale (i.e., Hostility). Her
overall symptoms and severity index were also clinically significant. This sug-
gests that Ms. Jones was currently experiencing severe and intense mental
health symptoms across a range of areas.
Personality Assessment Inventory (PAI) The Personality Assessment

Inventory (PAI) is a self-administered, objective inventory of adult personality.
The PAI contains 344 items that comprise 22 nonoverlapping scales. As a
clinical instrument, the PAI provides information relevant to clinical diagnosis,
treatment planning, and screening for psychopathology. On the validity
scales of the PAI, Ms. Jones was significantly elevated on Negative Impression
Management, indicating that she may have overrepresented the frequency and
severity of mental health symptoms. The test developers suggest that some
individuals who possess severe and unremitting mental health symptoms
may be elevated on this specific validity scale and that it may represent an
accurate reflection of the severity of problems they are experiencing. It is
suggested in Ms. Jones’s case that the experience of having her child removed
from her care because of her false allegations and her consistent fears that her
partner would leave her, combined with chronic depressed and anxious affect,
together reflect her severe problems. This is further supported by observations
during the clinical interview, where she cried consistently and made many
self-deprecating statements (“I am so disgusting”). Nevertheless, the PAI can
be interpreted only to the degree that it reflects the client’s self-perception.
Based on Ms. Jones’s self-perception, she indicated that she experienced
problems with thinking clearly; currently had (or may have had) a problem
with illegal drugs; experienced cognitive, affective, and physiological symptoms
of depression; experienced significant stress; did not perceive much support in
her environment; was passive in interactions with others; and was emotion-
ally detached from others. Finally, Ms. Jones reported severe and unremitting
trauma symptoms. The PAI profile indicated high likelihood for Dependent
Personality Disorder, Posttraumatic Stress Disorder, Major Depressive Disor-
der, and (past) Substance Use. The treatment response scale suggested a positive
prognosis should Ms. Jones enter mental health services.
Summary of Psychological Measures for Ms. Jones According to

standardized testing, Ms. Jones’s intelligence was within the average range
of functioning, and thus it did not appear that cognitive limitations were
affecting her ability to parent. Additional testing for Ms. Jones confirmed
information shared during clinical interviews and document review.
She endorsed a significant trauma history and significant symptoms of
re-experiencing, increased arousal, and avoidance. She acknowledged a
history of substance abuse, but she denied current use. She also endorsed
interpersonal sensitivity, a passive interpersonal style, and some difficulty
related to staying on task, communicating clearly, and making decisions.
Finally, she endorsed clinically significant symptoms of depression and
anxiety.
Standardized Assessment Information on David

Behavior Assessment System for Children, Second Edition (BASC-2) The
Behavior Assessment System for Children (BASC-2) is an integrated system
designed to facilitate the differential diagnosis and classification of a variety
of emotional and behavioral disorders of children and to aid in the design
of a treatment plan. There are multiple Clinical Scales and Adaptive Scales
that form composite scores, including Internalizing, Externalizing, Adaptive,
and Behavioral Composites. Scale scores in the “clinically significant” range
suggest a high level of maladjustment. Scores in the “at-risk” range identify
either a significant problem that may not be severe enough to require
formal treatment or a potential of developing a problem that needs careful
monitoring.
Parent Report. Ms. Jones completed the parent form of the BASC-2 She
endorsed few concerns about David, only noting “at risk” concerns for hyperactivity
(e.g., David is Often or Almost Always overly active, fidgeting, interrupting, and
throws tantrums).
Summary of Psychological Measures for David Results from David’s

testing were consistent with records, observation, and clinical interview. David
generally functioned well and there were no reported concerns related to
development or behavior. However, his activity level was above average, which
combined with some concerns about frequent whining and tantrums, placed
him at risk for behavioral problems in the future.
Observation of Ms. Jones with David During the clinical observation of

Ms. Jones and David, they were observed in several play scenarios. In the first
scenario, Ms. Jones was asked to allow David to choose what to play and follow
his lead. In the second scenario, Ms. Jones was asked to inform David that
she would pick an activity and get him to play according to her rules. Finally,
Ms. Jones was asked to get David to clean up the toys. The purpose of these
scenarios was to observe the quality of their interactions and to observe how
David responded to Ms. Jones’s instructions/commands.
When David first saw Ms. Jones, he was excited, happy, and immediately
moved to give her a hug. Throughout the observation, he referred to her as
“Mommy” and often sought her out for affection, to share something with
her, or to sit on her lap. Consistently throughout the interaction, Ms. Jones
responded to David by praising his appropriate behavior. They played cooper-
atively throughout the observation, with frequent changes in activity. Because
David had difficulty sustaining his attention on the same activity for longer
periods of time, Ms. Jones and David often moved around the play area. David
tended to be mildly demanding and whiny. Although the whiny behavior
persisted throughout the observation, when Ms. Jones set a specific limit on
David’s behavior (e.g., cleaning up some toys), he was responsive to her. Toward
the end of the observation, David became very whiny and Ms. Jones asked him
whether he was tired. David stated that he was tired and then crawled onto his
mother’s lap and put his head on her shoulder. Ms. Jones explained that this
was about the time that David would take a nap and that he often gets tired
around this time of day.
During a portion of the clinical interview with Ms. Jones and David,
they were coded using the Dyadic Parent-Child Interaction Coding System
(DPICS). The selected portion below reflects a parent who might struggle
with acquiring and sustaining child compliance (DPICS codes are bracketed
below):
Parent and child playing with Legos, when parent is asked by the examiner to
get the child to clean up the toys:
P: It’s time to clean up now. [Information; Indirect Command/No Comply]

C: I want to play with the Space Legos!
P: Let’s put the Legos in this box. [Indirect Command/No Comply]
C: Not yet. Not yet. I have to make a Space Lego man.
P: No, it’s time to clean up. [Negative Talk; Indirect Command/No Comply]
(Child ignores the command and continues to play with Legos)
P: C’mon, let’s clean up the toys. [Indirect Command; No Opportunity to
Comply]
(Child ignores the command and continues to play with Legos)
P: (With mild frustration) I said, it’s time for you to clean up the Legos!
[Indirect Command/No Comply]
C: I’m putting all of these together, then I’m gonna make a car.
P: (Increasingly frustrated) No. It’s time to clean up. Put them away or
[Negative Talk; Information; Direct Command]
(Child responds by grabbing some of the Legos and moving away from the
parent)
P: (Raises voice with a forced angry tone) If you don’t starting putting them
away . . . Now . . . You’re gonna be sorry. [Negative Talk]
C: (Whining, while continuing to play with the Legos) But, I still gotta put
together the Space man.
From this observation, it was apparent that the parent provided inconsis-
tent or weak commands, to which the child did not comply. This may reflect
a parent with limited parenting skills, who may struggle in providing a firm,
clear, and consistent parenting relationship. Additionally, a pattern of child
noncompliance is one signal of greater problems at school and more severe
problems with relationship security. At a minimum, this interaction suggested
that this parent-child dyad is in need of intervention to avoid more serious
problems with child functioning. A pattern of such parental ineffectiveness
and child noncompliance had been identified as one underlying foundation to
child maltreatment (Urquiza & McNeil, 1996), and this pattern may signal an
ongoing problem in both parenting capacities and child management.
Ms. Jones had never received mental health services, and there were there-
fore no service providers available for collateral interviews. Ms. Jones further
did not have any friends and felt uncomfortable with the evaluator contact-
ing her biological family for collateral information (i.e., family members she
reported had abused her in childhood whom she no longer kept in touch with).
However, the evaluator was able to consult with Ms. Jones’s public defender,
her fiancé Mr. Brown, and previous records. These collaterals generally sup-
ported facts shared by Ms. Jones.
As a result of repeated conversations with Ms. Jones’s attorney, Mr. Scott,
it became clear that Ms. Jones had sought out her attorney as a confidant and
source of support. Ms. Jones’s attorney expressed concern that he did not pos-
sess the skills to be a counselor and provide the emotional support requested
of him, and he did not think he should function in this quasi-mental health
capacity. During the evaluation, the attorney was strongly encouraged to
coordinate mental health services for Ms. Jones.

Ms. Jones was referred for a psychological evaluation 1) to provide an opinion
of Ms. Jones’s current mental health status, 2) to provide an assessment of the
bond/attachment between Ms. Jones and her son, David; and 3) to provide
recommendations for reunification services.
Ms. Jones’s Current Mental Health Status After clinical interviews, formal
standardized assessments, a clinical observation (Ms. Jones and her son, Ms.
Jones and her fiancé), and a review of records, this evaluator determined that
Ms. Jones met criteria for three DSM-5 mental health diagnoses. These include
Persistent Depressive Disorder, Posttraumatic Stress Disorder, and Dependent
Personality Disorder. These are described below:
The diagnosis of Persistent Depressive Disorder is characterized by an
individual with depressed mood during most of all of the day, problems
with sleep, an appetite disturbance, low energy or fatigue, low self-esteem,
poor concentration, and feelings of hopelessness. During clinical interviews,
Ms. Jones reported problems with depressed mood, problems with sleeping
(sleeping too much), fatigue, and problems with concentration and demon-
strated a negative self-image/low self-esteem. Her mood problems emerged
during adolescence and have been ongoing since that time. Depressive symp-
toms were also supported by the BSI and PAI results.
The diagnosis of Posttraumatic Stress Disorder (PTSD) is characterized by
experiencing some type of traumatic event, followed by exhibiting symptoms
of recurring intrusive symptoms (e.g., recurring intrusive memories of a past
traumatic event, recurring distressing dreams, dissociative reactions), avoid-
ance of stimuli associated with the trauma (e.g., avoiding stressful memories,
avoiding events/places/people that trigger traumatic memories), and marked
alterations in arousal (e.g., easily agitated, irritable, hypervigilance, problems
in concentration). Although she reported sufficient symptoms to be diagnosed
with PTSD, the nature of this case (Ms. Jones making false allegations about
at least some specific instances of abuse) made the specific trauma she experi-
enced difficult to discern. She reported an extensive history of sexual victim-
ization by her mother, father, and stepfather—although it was not clear if these
abusive events really occurred. In addition, she described repeated instances of
violence by Mr. Martinez, for which there was corroborating evidence (i.e., at
least one incident resulted in her hospitalization, and one incident was expe-
rienced/observed by Mr. Brown). A PTSD diagnosis was further supported by
Ms. Jones’s PAI profile.
It should be noted that it was not the position of this evaluator to make a
determination regarding the veracity of allegations regarding her prior sex-
ual victimization, the allegations that she sexually abused her son, and/or the
allegations of domestic violence by Mr. Martinez. However, Ms. Jones pos-

sessed mental health symptoms (especially trauma symptoms) consistent with
many victims of domestic violence and sexual victimization.
The diagnosis of Dependent Personality Disorder (DPD) is characterized
by someone who has pervasive and excessive concerns about being taken care
of that leads to submissive and clinging behavior and fears of separation. This
was demonstrated by observing the interactions between Ms. Jones and Mr.
Brown and reviewing Ms. Jones’s history. Additionally, Ms. Jones explained
that she was often more passive in decision making with Mr. Brown, and she
expressed a strong fear of being abandoned. Ms. Jones displayed a similarly
passive style in her relationship with Mr. Martinez, noted that she would not
have been able to leave the relationship if Mr. Brown had not supported this
process and that she never had been, and would not feel comfortable being,
single. A passive interpersonal style and a DPD diagnosis are further sup-
ported by her PAI profile.
Ms. Jones’s Allegations of Sexual Victimization Involving David It

should be understood that the pattern of making a false allegation of sexual
abuse of others and including oneself is fairly atypical. Ms. Jones’s explanation
for this disclosure was that she strongly wanted to sustain a relationship with
her current fiancé and felt that continuing to disclose past problems in her life
was one way to sustain his support and attention. While this may seem like an
unusual action to take, it reflects the degree to which Ms. Jones fears the possible
abandonment by Mr. Brown. For many individuals who meet diagnostic
criteria for Dependent Personality Disorder, the fear of abandonment from a
loved one is terrifying and may lead to irrational thoughts and behaviors.
Combined with Ms. Jones’s symptoms of depression (Persistent Depres-
sive Disorder) and trauma (Posttraumatic Stress Disorder), she may have felt
unable to successfully manage her life without the support of Mr. Brown. She
reported feeling little to no support from family or friends and recognized that
seeking symptom relief through illegal drugs (i.e., methamphetamines) was
not safe for her or her son. Given the situation involving her fears of aban-
donment, her depressive and trauma symptoms, and the perception that both
her mother and Mr. Martinez were also seeking access to her son, Ms. Jones’s
decision-making abilities were clearly compromised. By her report, these fac-
tors led to her allegation of sexual abuse that was false. When asked why she
would make a false allegation of sexual abuse that included herself—she had
no clear answer, other than to make self-deprecating comments (“I am so dis-
gusting”). As a result, it is clear that Ms. Jones possessed three areas in need of
mental health services—addressing depressive symptoms, addressing trauma
symptoms, and working to improve her self-esteem, independence, and asser-
tiveness. If these symptoms can be lessened, then it is reasonable to assume
that Ms. Jones can safely care for her son. This opinion is supported by the fact
that there appears to be a close, positive, and strong relationship between Ms.
Jones and her son and that David exhibits relatively few behavioral problems.
Bond/Attachment between Ms. Jones and David After an observation of

Ms. Jones and David, as well as a review of this case, it appears that there is a close
emotional relationship/attachment between them. Ms. Jones had been the
primary caregiver throughout David’s life. As a result of the quantity/stability
and quality of their interactions, their relationship was considered strong and
positive. Ms. Jones was attentive and responsive to David’s needs, as evidenced
by the pattern of her behavior toward her son—and his complementary
response toward her. Additionally, when distressed/fatigued during the
interview, David readily sought out Ms. Jones for comfort.
It was not known how David was managing his day-to-day life in the home
of his biological father and paternal grandmother. Given the situation that
had occurred over the last few months, David had experienced a partial loss of
Ms. Jones by having only limited contact with her. Given that Ms. Jones is
likely David’s primary attachment figure, every effort was made to ensure
that he understood she will continue to be a reliable part of his life and that
eventually he will have his primary attachment relationship with his mother
restored.
Recommendations for Reunification Services At the current time,

Ms. Jones was experiencing several mental health problems. During the
evaluation, she was asked whether she would be willing to participate in
mental health services if directed by the court. In response, she stated that she
would be willing to comply with any court directive. Therefore, the following
recommendations were made for Ms. Jones and her son.
Mental Health Treatment Recommendations Individual therapy was

recommended for Ms. Jones to address problems related to trauma and
depression. She would most likely benefit from a cognitive-behavioral
intervention to address these problems, as well as a component of prolonged
exposure for the trauma she experienced. Ms. Jones appeared receptive to
therapy and motivated to make progress. As therapy progresses, therapeutic
efforts should focus on teaching and supporting Ms. Jones in improving
her self-esteem, changing negative self-attributions, acquiring assertiveness
skills, and developing her independent thinking in light of her significant
dependent characteristics (e.g., fear of abandonment, needing to be involved
in a relationship with another person, seeking advice and reassurance from
others). This may also—eventually—require the involvement of Mr. Brown to
support Ms. Jones in developing these personality characteristics. Continuing
in a treatment relationship that confronts her about these issues can improve
Ms. Jones’s ability to tolerate conflict and disapproval, so that she can form
healthy, honest, and trusting relationships. Treatment should aim to decrease
her overreliance on others, identify the negative consequences of her doing so,
and set appropriate interpersonal boundaries. Ms. Jones could use her coping
skills and emotion regulation strategies to manage disruptive emotions when
she feels threatened by interpersonal rejection, loss, or abandonment.
Psychiatric Assessment and Treatment Ms. Jones has reported a serious

problem with depressed mood. It was likely that she would experience significant
improvement in functioning if she were assessed and prescribed antidepressant
medication. During the course of the evaluation, she was asked if she would
be willing to take antidepressant medication if this was prescribed to her by
a psychiatrist. She acknowledged that she would be willing to do anything
if it would help return her son to her care. Therefore, it was recommended
that Ms. Jones be referred for a psychiatric assessment and comply with any
recommendations resulting from this evaluation.
Parent-Child Interaction Therapy Through informal and structured

observation of David with his mother, and Ms. Jones’s reports on a standardized
assessment, it appears that Ms. Jones had difficulty setting firm limits with
David and acquiring his compliance. Although there appeared to be a positive
relationship between the two of them, when presented with a direct command,
David consistently failed to comply. Therefore, it is recommended that Ms.
Jones and David be referred to Parent-Child Interaction Therapy (PCIT) to
provide her with skills to effectively manage David’s problem behaviors. PCIT
should include the following:
A. Coaching to increase the use of PRIDE skills (i.e., Praises, Reflections,

Imitation, Descriptions, Enthusiasm).
B. Coaching to strategically use labeled praises to increase his prosocial
behaviors (i.e., following directions, keeping his hands to himself, behaving
calmly, sitting still, concentrating, using appropriate language, expressing
positive affect, and other prosocial behaviors).
C. Training to use active ignoring techniques (i.e., silence, redirections, turn
away, and walk away) to reduce negative/inappropriate behaviors.
D. Training to use BE DIRECT strategies and strategic consequences (i.e., time
out procedure and removal of privileges) to further increase compliance.
Further, although no formal assessment or observation was made of

Mr. Brown and David, it was recommended that Mr. Brown be allowed to
participate in PCIT along with Ms. Jones. From information provided by
Ms. Jones and Mr. Brown, they expect to continue their relationship and hope
to be married in the future. This suggested that Mr. Brown would assume a
parenting role in David’s life, which would lead to Mr. Brown benefiting from
PCIT. This would also encourage Ms. Jones and Mr. Brown to have continuity
in their parenting strategies.
Evaluation for Substance Abuse Problem During this evaluation, Ms.

Jones denied currently taking any type of illegal drugs. However, Ms. Jones
reported that she had previously been involved in taking amphetamines
and that this was a problem for her. She further acknowledged that she
understood her drug problem was getting out of control, so she voluntarily
stopped taking illegal drugs. Additionally, she reported currently taking
pain medication—resulting from a car accident in which she hurt her back.
Because of her history of illegal drug use and her current use of legally
prescribed pain medication, it was recommended that she be evaluated for
any substance abuse problem.
Visitation between David and Ms. Jones/Mr. Brown It is important to

note that Ms. Jones had been the primary caregiver for her son for nearly all
of his life, which has resulted in her becoming his primary attachment figure.
Further, David was placed in dependency due to allegations and questions
regarding Ms. Jones’s mental health, not because she was actually sexually or
physically abusive to him. There weren’t any concerns about neglect or failure
to protect her son, and Ms. Jones is currently in a healthy relationship that
does not pose a risk to David. Addressing Ms. Jones’s mental health problems
should render her fully able to care for her son. Given the fact that David
and Ms. Jones have a strong, consistent, and positive relationship, a relatively
rapid plan for increasing the amount of time David is in Ms. Jones’s care is
strongly recommended. Therefore, it was suggested that Ms. Jones be provided
the ability to visit with her son outside of the confines of a visitation center
so that they may begin to reestablish their mother-son relationship in a more
natural setting. Further, it was recommended that, as soon as Ms. Jones has
established a relationship with a psychotherapist and becomes stable on
psychiatric medication (typically within 6–8 weeks after starting medication),
she should be provided the opportunity to have extended visitation and to
further rehabilitate the relationship with her son.

Evaluators conducting evaluations of parenting capacity are commonly trained
to conduct more traditional diagnostic evaluations. The shift to conducting
child welfare evaluations can be challenging, and new evaluators commonly
experience some anxiety and confusion. As in most evaluations, the evaluator

needs to have an open mind and integrate information from multiple measures
and interviews to inform an opinion. In addition, the evaluator needs to focus
on dyadic relationships, rather than individual functioning alone. The parents’
mental health diagnosis matters, but is not sufficient to determine whether
they can parent a child adequately or safely. For example, as many as 10% of
mothers in the United States meet diagnostic criteria for a major depressive
disorder (Ertel, Rich-Edwards, & Koenen, 2010). While there may be concern
about these mothers’ ability to care for children (especially young children), it
is suggested that few of them possess incapacities that meet the level of requir-
ing involvement in the child welfare system. The evaluator needs to concep-
tualize not only the parents’ functioning but also their relationship with their
child and their ability to meet the child’s needs. Evaluators need to learn to tol-
erate that there will not always be a clear conclusion. Some parents are clearly
competent or incompetent, but many referrals will be for parents that are in
the middle, “maybe” being competent enough with some type of intervention.
For example, Ms. Jones clearly had some areas of concern, yet she also had
areas predicting a positive prognosis. Evaluators further need to become com-
fortable using some confrontation during interviews, which is uncommon in
traditional evaluation and therapy (e.g., why did you not leave your boyfriend
after you found out he was sexually abusing your daughter?). The process can
become even more difficult when evaluators empathize with parents, whom
themselves may be victims (e.g., feeling bad for Ms. Jones who herself had a
terrible childhood). In contrast, other parents may be more difficult to relate to
or can be quite challenging to work with interpersonally. Related to this point,
evaluators need to establish rapport with clients and conduct evaluations in
a respectful manner, while simultaneously engaging in some fact checking
through record review and collateral contacts. Evaluators need to be aware of
their own biases and values and need to keep in mind the best interest of the
child, regardless of their own feelings about the parent.
Conclusions
Few aspects of clinical psychology require a greater range of competencies
than conducting psychological evaluations within child welfare systems.
Evaluators require a broad and ever-changing body of knowledge to perform
these evaluations, a unique set of skills to conduct interviews, and the ability
to conceptualize cases that bring together diverse information. Psychologists
must balance parents’ right to reasonable services with the best interests of
the child at times when these rights are in direct opposition with one another.
It is challenging to complete these types of evaluations, both intellectually
and emotionally. There is rarely a clear right or wrong position, and both
parents and children may show distress during the evaluation, as well as after
hearing the result of the evaluation recommendations. Evaluators must be
internally motivated to provide a quality evaluation, do their best to under-
stand their limits and biases, and stay up to date on literature and case law.
Sometimes, important interpersonal and statutory priorities conflict, mak-
ing the development of an opinion extremely difficult. In such situations, it
is important to remember that all aspects of the evaluation take place within
the context of the legal system, leading the evaluator to understand and com-
ply with the statutes in their jurisdiction and, to the best of their ability, serve
both the parents’ right to reunify with their child and the best interests of
their child.
After completing a large number of evaluations, it is not uncommon to ques-
tion the place of evaluators to assert such life-changing opinions related to par-
ents and children being able to live together. Is it fair to make judgments that
result in such severe outcomes that a parent may not be able to raise their child?
Is it fair that a child is not able to be raised in the same family as his biologi-
cal siblings? Is it fair that grandmothers and grandfathers be prevented from
seeing their grandchildren? What special insights or knowledge or abilities do
evaluators have that enable them to answer these questions and permanently
alter the lives of families? The first response to this question is that situations
arise in which children are placed in danger, where parents cannot safely and
adequately care for their children and/or where parental incapacities—due to
mental illness, drugs, or other problems—prevent them from maintaining the
integrity and safety of their child. It is because of the risk to children that the
courts have decided that circumstances exist where it is permissible to remove
children from the care of their parents, followed by termination of parents’
rights if parents are unable to demonstrate their ability to safely care for their
child. Because the answers to these questions involve psychological processes
and development, the answers fall to psychologists (and, in some cases, psy-
chiatrists). Therefore, it is essential that those who undertake these types of
evaluations appreciate the gravity their opinions have on the lives of others and,
of course, the limitations and flaws inherent in our opinions.
At best, we can provide reasonable opinions that are influenced by our
academic training but are fundamentally grounded in our knowledge of
families, derived from the families we know best. Few of us have been raised
in households like those of the people we interview, assess, and evaluate. We
may understand theories, testing, and psychological concepts, but few of us
can really appreciate the chronicity of a violence or fear-filled household or
parents who place illegal drugs as the priority in their life. It should be from
this perspective that evaluators should regularly assess and reassess their
judgments so that they can provide the most fair, accurate, and constructive
evaluation possible. This is especially important since much of the territory
of conducting psychological evaluations for child welfare systems treads

new ground.
References
American Psychological Association. (2013). Guidelines for psychological evaluations in
child protection matters. American Psychologist, 68(1), 20–31.
Barajas-Gonzalez, R. G., & Brooks-Gunn, J. (2014). Income, neighborhood stressors, and
harsh parenting: Test of moderation by ethnicity, age, and gender. Journal of Family
Psychology, 28(6), 855–866. doi:http://dx.doi.org/10.1037/a0038242
Barone, N. M., Weitz, E. I., & Witt, P. H. (2005). Psychological bonding evaluations in
termination of parental rights cases. Journal of Psychiatry & Law, 33, 387–411.
Benjamin, L. S. (1993). Every psychopathology is a gift of love. Psychotherapy Research,
3(1), 1–24.
Benjet, C., Azar, S. T., & Kuersten-Hogan, R. (2003). Evaluating the parental fitness of
psychiatrically diagnosed individuals: Advocating a functional-contextual analysis of
parenting. Journal of Family Psychology, 17, 238–251.
Biringen, Z. (2008). Emotional Availability Scales (4th ed.). Colorado State University.
Brodzinsky, D. (1993). On the use and misuse of psychological testing in child custody
evaluations. Professional Psychology Research and Practice, 2, 213–219.
Cassidy, J., & Shaver, P. R. (2008). Handbook of attachment: Theory, research, and clinical
applications. New York, NY: Guilford Press.
Cerezo, M. A., Keesler, T. Y., Dunn, E., & Wahler, R. G. (1986). Standardized observation
codes III. Unpublished manuscript, Child Behavior Institute, University of Tennessee.
Crittenden, P. M., & Ainsworth, M. D. S. (1989). Child maltreatment and attachment the-
ory. In D. Cicchetti & V. Carlson (Eds.), Child maltreatment: Theory and research on the
causes and consequences of child abuse and neglect. Cambridge University Press.
Derogatis, L. R. (1993). BSI brief symptom inventory: Administration, scoring, and proce-
dures manual (4th ed.). Minneapolis, MN: National Computer Systems.
Dubowitz, H., Kim, J., Black, M., Weisbart, C., Semiatin, J., & Magder, L. (2011). Identifying
children at high risk for a child maltreatment report. Child Abuse & Neglect, 35(2), 96–104.
Ertel, K. A., Rich-Edwards, J. W., & Koenen, K. C. (2010). Maternal depression in the
United States: Nationally representative rates and risks. Journal of Women’s Health,
20(11), 1609–1617.
Eyberg, S. M., Nelson, M. M., Duke, M., & Boggs, S. R. (2005). Manual for the Dyadic
Parent-Child Interaction Coding System (3rd ed.). Gainesville, FL: University of Florida.
Fluke, J. D., Yuan, Y. Y. T., Hedderson, J., & Curtis, P. A. (2003). Disproportionate Repre-
sentation of Race and Ethnicity in Child Maltreatment: Investigation and Victimization.
Children and Youth Services Review, 25, 359–373.
Fogel, A., Garvey, A., Hsu, H., & West-Stroming, D. (2006). Change processes in
relationships: A relational—historical research approach. Cambridge, UK: Cambridge
University Press.
Fontes, L. A. (2005). Child abuse and culture: working with diverse families. New York, NY:
Guilford Press.
Fox, K. (2005). Cultural aspects. In A. E. Brodeur & J. A. Monteleone (Eds.), Child
maltreatment: A clinical guide and reference (3rd ed.). St. Louis, MO: G.W. Medical.
Friesen, B., Katz-Leavy, J., & Nicholson, J. (2011). Supporting parents with mental health
needs in systems of care. Washington, DC: Technical Assistance Partnership for Child
and Family Mental Health.
Gewirtz, A., & Edleson, J. L. (2004). Young children’s exposure to adult domestic violence:
Toward a developmental risk and resilience framework for research and intervention.
Packard Foundation, University of Iowa Press.
Kalich, L., Carmichael, B., Masson, T., & Blacker, D. (2007). Evaluating the evaluator:
Guidelines for legal professionals in assessing the competency of evaluations in
termination of parental cases. The Journal of Psychiatry and the Law.
Kaufman, A. S., & Kaufman, N. L. (2004). Kaufman Brief Intelligence Test (2nd ed.).
Bloomington, MN: Pearson.
Lillienfield, S. O., Wood, J. M., & Garb, H. N. (2000). The scientific status of projective
techniques. Psychological Science in the Public Interest, 1(2), 27–66.
for the Courts: A handbook for mental health professionals and lawyers (2nd ed.). New
Morey, L. C. (2007). Personality Assessment Inventory Professional Manual (2nd ed.).
Odessa, FL: Psychological Assessment Resources.
Reynolds, C. R., & Kamphaus, R. W. (2006). BASC-2: Behavior Assessment System for
Children (2nd ed.). Upper Saddle River, NJ: Pearson Education.
Stokes, J. C., & Strothman, L. J. (1996). The use of bonding studies in child welfare
permanency planning. Child and Adolescent Social Work Journal, 13, 347–367.
Terao, S. Y., Borrego, J., & Urquiza, A. J. (2000). How do I differentiate culturally based
parenting practices from child maltreatment. In H. Dubowitz & D. DePanfilis (Eds.),
Handbook for child protection practice, Thousand Oaks, CA: Sage.
Terao, S. Y., Borrego, J., & Urquiza, A. J. (2001). A reporting and response model for culture
and child maltreatment. Child Maltreatment, 6(2), 158–168.
Toth, S. L., & Cicchetti, D. (Eds.). (2013). A developmental psychopathology perspective
on child maltreatment [Special Issue]. Child Maltreatment, 18, 135–204.
Traube, D. (2012). The missing link to child safety, permanency, and well-being: Addressing
substance misuse in child welfare. Social Work Research, 36(2), 83–87.
Urquiza, A., & Blacker, D. (2005). Psychological evaluations and the child welfare
system. In P. F. Talley (Ed.), Handbook for the treatment of abused and neglected
children (pp. 83–119). New York, NY: Haworth Press.
Urquiza, A. J., & McNeil, C. B. (1996). Parent-child interaction therapy: An intensive dyadic
intervention for physically abusive families. Child Maltreatment, 1(2), 132–141.
Urquiza, A. J., & Wyatt, G. E. (1993). Culturally relevant research with children of color. The
APSAC Advisor, 7(3), 1–20.
10
Termination of Parental Rights

Dawn M. Blacker, Anthony J. Urquiza,
Lisa Kalich, and Blake D. Carmichael
Termination of parental rights (TPR) is one of the most extreme and

devastating actions undertaken by the courts. In re Smith (1991) likened the
dissolution of parental rights to a sentence of death, underscoring the finality
and significance of this legal decision. According to the United States Supreme
Court, the termination of parental rights denies parents “physical custody, as
well as the rights ever to visit, communicate with, or regain custody of the
child” (Santosky v. Kramer, 1982, p. 749). As a result of the far-reaching con-
sequences that accompany severing the parental relationship, the state is held
to a higher standard of proof, and parents are afforded additional due process
protections beyond those required in other child protection matters (Condie &
Condie, 2007). Typically, the state is required to demonstrate a finding of abuse
or neglect as well as a parent’s unfitness, even after the provision of relevant,
rehabilitative services.
Relevant Case Law

Guidelines specifying the grounds for termination of parental rights vary
significantly from state to state. Generally, these guidelines contain definitions
of child maltreatment, factors that should be considered by the court prior to
returning a child to the custody of the parent, and factors related to the parent’s
involvement in and response to intervention (Condie & Condie, 2007). Fol-
lowing the Adoption and Safe Families Act (ASFA) of 1997, many statutes also
specify time frames for successful reunification, as states are offered financial
incentives for achieving permanency (i.e. moving children from foster care to
long-term placement, guardianship, and/or adoption). According to Vesneski
(2011), as a whole, most state statutes include far more criteria for termination
of parental rights than the eight provided for by ASFA, with numbers ranging
from seven criteria (Indiana) to twenty two (Kansas).
Grounds for termination may include parental incapacity to care for the child
due to mental illness or substance abuse, extreme or repeated abuse or neglect,
conviction of a crime carrying a long-term sentence, failure of the parent to
improve in response to intervention, and limitations on the length of time a child
may remain in state placement (Condie & Condie, 2007). According to Kundra
and Alexander (2009), a considerable number of state statues also include “dis-
ability language” as a condition for the termination of parental rights, leaving
those with mental illness, substance use, and developmental disability vulnerable
to custody loss. Many of the grounds identified above, specifically those relat-
ing to neglect, substance abuse, and parental failure, are poorly defined in state
law (Vesneski, 2011). While the overwhelming majority of states use the “clear
and convincing” standard to terminate parental rights, recently, the California
Supreme Court upheld a lower burden of proof (i.e., preponderance of the evi-
dence) for findings of fact in that state (Kundra & Alexander, 2009).
Using the prevailing best interest standard (Condie & Condie, 2007),
the court takes into consideration the child’s relationships with parents,
siblings, foster parents, and potential adoptive parents. Parental rights may
be terminated even when a caregiver has made progress in addressing areas
of concern, based on the quality and strength of the child’s relationship to
substitute caregivers and the length of time the child has spent in alternative
placements. In some cases, the advantages associated with a permanent
placement may outweigh the benefits of a continued relationship with a
biological parent, even if that relationship is positive. For example, In re Casey
D. affirmed that the “parent-child relationship (must) promote the well-being
of the child to such a degree that it outweighs the well-being the child would
gain in a permanent home with new, adoptive parents.” Case law has also
established that the “interaction between natural parent and child will always
confer some incidental benefit to the child” (In re Autumn H., 32 Cal. Rpter.
2d 535; Ct. App. 4 Dist. 1994) but that this “incidental benefit” alone was not
sufficient to prevent TPR.
To adequately address questions of parental fitness, the court has begun to
rely on the expertise of mental health professionals. Though the decision to
terminate parental rights is ultimately left to the trier of fact, evaluators are
often asked to evaluate the relationship between parent and child (or between
a child and a substitute caregiver or siblings) in order to assist in making this
determination. Given the significance of this determination for both parent
and child, the need for competent and comprehensive evaluations is para-
mount; however, to date, forensic evaluators vary widely in their approach and
execution of the termination of parental rights evaluations. In part, the vary-
ing approaches to TPR may result from the limitations in scientific knowledge
Termination of Parental Rights 227
regarding parenting capacity. While the literature may inform psychologists

of the qualities of an optimal parent, determining whether a parent is “good
enough” is slightly more elusive.

Identifying Functional Capacities
Because statutes governing TPR vary widely across states and are often vague
and inconsistent in their applications of AFSA, there is a need for objective
criteria to determine parental capacity. Over the past ten years, researchers
have begun to emphasize the importance of a functional analysis of parenting
abilities. Azar’s (1998) widely cited functional-contextual model closely paral-
lels Grisso’s criteria (2003) for establishing a legal competency, offering five
broad domains of parenting skill: a) child management skills, b) perceptual and
observational skills, c) self-control, d) planning and coping skills, and e) social
relationship skills. Building from the work of Grisso and Azar, Donald and
Jureidini (2004) proposed a model that evaluates parental functioning based
on the relationship between parenting capacity, a specific child’s parentability,
and mitigating circumstances that affect parenting. These models provide an
overall framework for evaluators to approach TPR cases.
Reviewing the New APA Guidelines

Despite the progress in developing functional-contextual models of parenting
capacity, according to Kalich et al. (2007), evaluators operate within a consider-
able area of ambiguity when undertaking TPR evaluations, as the profession is
governed by forensic standards that are “vague and open to considerable inter-
pretation” (p. 367). In this regard, the 1994 and 1999 Guidelines for Psycho-
logical Evaluations in Child Protection Matters provided a general framework
for evaluators; however, these documents did little to inform psychologists as
to specific best standards of practice.
In 2013, the American Psychological Association (APA) released the latest
revision of the Guidelines for Psychological Evaluations in Child Protection
Matters. The spirit of the guidelines remains similar to that of its predeces-
sors, with few changes in the guidelines themselves. As with prior iterations,
the guidelines are considered “aspirational” but, nonetheless, are intended to
help “facilitate a high level of practice by psychologists” (p. 20). The guidelines
are divided into three main areas: Orienting Guidelines, General Guidelines,
and Procedural Guidelines. The Orienting Guidelines advise psychologists of
the overarching principles that should govern their decision making in child
protection matters. In contrast to the 1999 Orienting Guidelines, which empha-
size “the child’s interest and well-being” as “paramount” (APA, 1999, p. 3), the
2013 guidelines assumed a more neutral stance, instructing psychologists to

be aware that the different interests represented in child protection matters
(i.e., the interests of the child, the parent, and the state) may not always coin-
cide. Nonetheless, evaluators are encouraged to consider the “developmental
and functional impact” (p. 22) of child abuse and neglect, as well as potential
future risk to the child’s well-being brought about by parental maltreatment
or lack of adequate care or protection. Evaluators are also tasked to examine a
broad range of other risks to the child that may occur as the result of prolonged
state intervention, including multiple out-of-home placements; maltreatment
while in substitute care; inadequate supports due to the limited resources of the
child welfare system; prolonged separation from parents, relatives, and other
potentially adequate caregivers; and unwarranted institutional placement.
Another significant difference between the 1999 and 2013 Orienting Guide-
lines is the newfound emphasis on the “resulting fit” between the parent’s
capabilities and the child’s developmental and psychological needs (p. 22). In
addressing questions of “fit,” it is suggested that evaluators consider both the
adult’s capabilities for parenting with a specific emphasis on maltreatment
concerns, as well as the child’s needs, including the strength of the child’s attach-
ment to the parent and the possible deleterious effects of separation. Rather than
overemphasizing potentially problematic characteristics of the parent (i.e., men-
tal illness, substance use, mental retardation), it is the match or “fit” between
the child’s needs and the parent’s capacities to meet those needs that serves as
the primary focus of TPR evaluations, an idea that has been long been cham-
pioned by proponents of the contextual and functional analyses of parenting
ability described above (Donald & Jureidini, 2004; Azar & Hogan, 2003; Azar
et al., 1998). The importance of this issue cannot be overstated, as individuals
with disabilities, including mental illness, are at high risk for discrimination in
termination of parental rights proceedings (Kundra & Alexander, 2009). In fact,
studies suggest that as many as 70% to 80% of mentally ill parents lose custody
of their children (Kundra & Alexander, 2009), despite substantial research indi-
cating that with effective supports, most parents with mental illness can parent
adequately (Nicholson et al. as cited in Kundra & Alexander, 2009).
Despite these few notable changes to the Orienting Guidelines, the
Procedural Guidelines—the practical and conceptual methods utilized by the
evaluator to reach an opinion—remain largely unchanged from 1999, leaving
evaluators with a relatively vague map with which to navigate this complex
forensic area of practice.
Best Practices
Kalich et al. (2007) provide a useful accompaniment to the guidelines, detail-
ing best practice standards for TPR evaluations. Initially, before proceeding
with a TPR evaluation, the evaluator must develop a clear understanding of the
specific information requested by the referring party. The referral question(s)

will provide a framework for the evaluation and will assist the evaluator in
identifying appropriate methods of data gathering. The evaluator’s ability to
provide a competent and useful evaluation is directly related to the quality and
appropriateness of the referral questions. In this area, it is critical for evalua-
tors to possess a thorough knowledge of the TPR statutes in their jurisdiction
in order to ensure that the information provided will be useful to the court.
Evaluators should be particularly aware of being urged to answer questions
which are beyond the scope of their practice or expertise, including “Was
the child abused” or “Who abused the child?” The evaluator should work
collaboratively with the referring party to reframe or reword these types of
inappropriate referral questions.
Consistent with the 2013 Guidelines, Kalich et al. (2007) emphasize the
importance of relying on multiple methods of data gathering in forming
opinions in TPR cases. Sources of data include multiple clinical interviews;
collateral contacts with extended family members, clinical and social service
providers, and teachers; psychological testing; parent-child observation; and
record review. Given the adversarial context of child welfare evaluations, it
is expected that parents may present with a distorted response style. By rely-
ing on numerous methods of gathering information, including more than one
clinical interview, the effect of these situational variables is mitigated. It is also
essential for the evaluator to consider the veracity and usefulness of collateral
contacts. For example, therapists may have limited information about a client’s
functioning and are likely subject to the same distortions by the parent as the
evaluator. With regard to parent-child observations, another critical piece of
data in TPR cases, Kalich et al. (2007) recommend the use of a semistructured
tool, such as the Dyadic Parent Child Interaction Coding System (DPICS;
Robinson & Eyberg, 1981). The DPICS assesses three scenarios of parent-
child interaction and enables the evaluator to qualitatively and quantitatively
assess the ways in which parent and child engage. Evaluators must also remain
cognizant of situations in which parent-child observations are contraindicated
(i.e., if the parent and child have not had contact in a lengthy period of time
and such contact is judged to be detrimental to the child).
A number of authors (Melton et al., 2007; Kalich et al., 2007, Brodzinsky,
1993) have expressed caution about the overreliance on psychological testing to
answer forensic questions, including those related to parenting capacity, abuse
potential, and termination of parental rights. Most psychological tests were
developed to assist in diagnosis and treatment and have not been normed with
a forensic population. To date, there are few tests designed to provide infor-
mation regarding parenting capacity, and many evaluators continue to rely on
measures that are only loosely correlated with parental fitness. In selecting
appropriate and useful psychological tests in a forensic context, Melton et al.
(2007) advises evaluators to consider a number of factors including, What is
the nature of the construct being assessed? How directly does the test instru-
ment measure that construct? Are there alternative means of assessing the con-
struct more directly? Does the use of this instrument require an unacceptable
degree of inference between the construct and the psycholegal issue? Does the
instrument contain a measure of response style? As with other methods of
gathering data, evaluators should never rely solely on psychological testing to
answer referral questions related to the termination of parental rights.
The 2013 Guidelines also note the importance of properly interpreting
data and providing opinions only when they are sufficiently supported by the
data. Opinions rendered without sufficient support are likely to be the prod-
uct of bias that would significantly compromise the utility and objectivity of
a TPR evaluation. Kalich et al. (2007) encourage evaluators to conceptualize
the client’s functioning in a “meaningful way, acknowledging limitations, and
providing alternate hypotheses for contradictory information are essential in
order for an evaluator to sufficiently support his or her conclusions” (p. 385).
The evaluator’s conceptualization should articulate (in jargon-free language)
the evaluator’s understanding of the parent’s mental health or emotional
functioning. Condie and Condie (2007) suggest that the most useful reports
include interpretations that are “made within a theoretical and developmental
context” (p. 318). Points for explication include the caregiver’s functioning,
the child’s functioning and developmental level, the parent-child relationship,
risk and protective factors related to maltreatment, and amenability to treat-
ment (p. 319). The child’s age at time of the evaluation is also important to
consider (e.g., a 3-month-old compared to a 13-year-old). Pitfalls common in
this domain include a failure to acknowledge alternate hypotheses or to make
clear any limitations on the reliability or validity of the conclusions. Evaluators
should alert the reader to areas that may not have been fully explored by the
evaluator or aspects of the report that may be misinterpreted by readers.
If offered, recommendations should directly address the referral questions
and should be consistent with the data obtained during the course of the eval-
uation. Recommendations may include, but are not limited to, psychological/
psychosocial treatment for the child, psychological/psychosocial treatment for
the parent, and/or suggestions for parental rehabilitation.
Case Vignette
The following case vignette illustrates what is often required in completing
TPR evaluations and what is considered a best-practice approach. Consider the
following case example in light of the APA evaluation guidelines and general
standards most courts must consider when making decisions about TPR mat-
ters. This case highlights many of the challenges that evaluators face during
the evaluation process (e.g., vague referral questions, discrepancies found in
reports/interviews, and conflicting results from psychological measures).
Reason for the Referral

A 40-year-old woman, Ms. Smith, and her 9-year-old son, John, presented for
a court-ordered evaluation. The referring party asked for a “bonding assess-
ment” but did not provide clarification as to the specific matter before the
court. At the time of the referral, John had been in protective custody for
approximately fourteen months. Upon follow-up, the referring party clari-
fied that there was a court order to determine 1) whether Ms. Smith had a
mental health condition that prevented her from safely and adequately parent-
ing John, 2) whether there was a reasonable expectation that Ms. Smith could
successfully address mental health problems within a prescribed period (i.e.,
four to eight months) so that she could become a safe and adequate parent (in
this particular case, statutes dictated that Ms. Smith had eighteen months to
reunify with John), and 3) whether discontinuing the relationship between
Ms. Smith and John would lead to long-term emotional detriment for John
and prevent him from establishing permanency.
Relevant Records and Background

To gather background for this case, the forensic evaluator conducted interviews
and observations:
• Two meetings with Ms. Smith

• Two meetings with John
• One conjoint interview with Ms. Smith and John
• One structured behavioral observation of Ms. Smith and John (using
DPICS)
• Phone interview with the social worker
• Phone interviews with treatment providers for Ms. Smith
� Parenting instructor
� Individual and group substance abuse counselors
� Psychiatrist
• Phone interviews with treatment providers for John

� Individual therapist
� Behavioral specialist
• Phone interview with Ms. Smith’s family friend

• Phone interview with John’s foster mother
The evaluator also reviewed the following relevant records:
• Social services reports

• John’s academic records
• Ms. Smith’s treatment summaries
• John’s treatment summaries
Ms. Smith and six siblings were raised by her biological mother and a
stepfather, Mr. Jones. General family interactions were enjoyable and sup-
portive, though Ms. Smith was sexually abused by her older stepbrother at
13 years of age. Ms. Smith disclosed the abuse to her parents one year after
the abuse started, but they did not believe the abuse occurred. She elected
to leave the home with friends at 14 years of age. Over the next ten years,
Ms. Smith moved among different states and pursued various occupational
endeavors (e.g., singing in a band, working in restaurants, and attending cos-
metology school).
In her late teens, Ms. Smith entered her first romantic relationship. She and
her boyfriend abused drugs and alcohol. By 20 years of age, her drug of choice
was methamphetamine, and, at 25 years of age, she started using heroin.
Ms. Smith “realized (she) would die” if her drug-related lifestyle continued,
and she left her partner. She voluntarily entered substance abuse treatment,
but stopped the program because “they were too confrontational.” Shortly
thereafter, Ms. Smith entered another relationship where she regularly used
methamphetamines (up to daily use continued for approximately five years).
Ms. Smith became pregnant with John at 30 years of age. She stopped using
methamphetamine when she discovered she was pregnant. John’s father left
Ms. Smith while she was pregnant, and no contact was ever reestablished
with him. John was born without drugs in his system, and the birth had no
complications. He met all early childhood developmental milestones on time.
John did well academically, and there were no significant behavioral prob-
lems as a toddler. However, by 5 years of age John exhibited a number of
oppositional and disruptive behaviors at home (e.g., talking back, refusing to
comply, becoming destructive and aggressive). Ms. Smith resumed her use
of methamphetamines when John became school-aged. She had significant
difficulty getting him to complete basic age-appropriate activities of daily liv-
ing (e.g., getting dressed, leaving for school, and brushing his teeth). This
resulted in school tardiness/absences and hygiene problems (i.e., tooth decay,
inadequately dressed for school).
When John was 6 years of age, Ms. Smith was arrested for being under the
influence of methamphetamines. A referral was made to child welfare services
(CWS), and their investigation found the home to be unsafe and unsanitary.
It was discovered that John had stepped on a blood-filled hypodermic needle,
but Ms. Smith had not sought medical treatment. John was placed in a foster
home while Ms. Smith completed twelve months of drug treatment and
parenting services. Ms. Smith described the programs as “wonderful.” Staff
encouraged her “to go to school and to have a life.” John was returned to Ms.
Smith after twelve months, and the case was dismissed. Ms. Smith maintained
her sobriety for the next three years. During that time, CWS investigated three
reports of general neglect, but they were inconclusive.
When John returned to Ms. Smith, she was living with her stepfather,
Mr. Jones, so that she could provide him with daily living assistance (due to his
advanced age). In addition to these demands, Ms. Smith had difficulty manag-
ing John’s behaviors. It was particularly difficult when Mr. Jones undermined
her directives (i.e., giving John special privileges after she attempted to remove
them). Over time, John became more irritable and his moods changed quickly.
He often asked Ms. Smith for help such as “mommy, use your calming voice”
or “mommy hold me,” but the symptoms persisted.
John eventually disclosed to Ms. Smith that he had been sexually abused by
Mr. Jones for approximately twelve months (e.g., sitting naked on Mr. Jones’s
lap while he was touched on his bare chest, stomach, and penis). This was
John’s first disclosure of the abuse. During an unrelated CWS investigation for
general neglect, John disclosed the abuse to the social worker, and Ms. Smith
admitted that John had previously told her of the abuse. She explained that she
did not make efforts to keep John from Mr. Jones because she did not believe
the abuse had occurred. She later acknowledged it was “too much” to think
about her son being abused, and that it triggered her to experience anxiety
symptoms (i.e., racing heart, shortness of breath) as well as “flashbacks” to
her own sexual abuse victimization. As a result of Ms. Smith’s failure to pro-
tect John, he was taken into protective custody at 7-and-a-half years of age.
Because no immediate or extended family was available to take placement of
John, he was placed with a licensed foster family.
After John’s removal, Ms. Smith experienced a significant increase in anxi-
ety and “flashbacks.” She also used methamphetamines on one occasion, after
which she called her sponsor and John’s social worker. Approximately six
months after John’s removal, Ms. Smith acknowledged that John had been
sexually abused, discontinued contact with Mr. Jones, and found her own
apartment. Ms. Smith’s extended family “did not believe the abuse occurred”
so she became estranged from them.
At the time of evaluation, John had been in the same foster placement
for twelve months. Behavioral functioning was normative, and he was
doing well in school. Ms. Smith had become more active in her twelve-step
groups, and she enrolled in parenting classes and a group substance abuse
treatment program. Visitations were attended regularly with no reported
problems.

Ms. Smith promptly attended her appointments, well-groomed and appropri-
ately dressed. Her mood and affect were generally euthymic and appropriate to
the situation. She was admittedly anxious about the outcome of the evaluation,
but she presented as calm and confident. Her speech tone and production were
adequate. She sometimes minimized problems (e.g., John’s tooth decay) and
became defensive (e.g., blaming others for her family circumstances). How-
ever, when challenged, she appropriately acknowledged past failures (e.g., par-
enting “out of guilt” and giving in quickly). Ms. Smith was oriented to person,
place, time, and circumstance. She denied any homicidal or suicidal ideation.
No hallucinations or delusions were noted.
John was appropriately dressed and groomed for age and weather. At the
first appointment (interviewed alone), John was anxious and overactive.
He had difficulty staying on task and responding to questions. He avoided
questions related to emotions or his history of maltreatment. By contrast, his
demeanor was more cooperative, calm, and friendly during the second visit
(when his mother was present). He alluded to “bad things” that happened
with Mr. Jones and endorsed sexual abuse victimization when responding to
questions on the UCLA PTSD Index, but he declined to discuss specifics of
the incident. John’s speech tone, pitch, and production were within normal
limits. He was oriented to person, place, time, and circumstance. He denied
homicidal or suicidal ideation.
Summaries from psychological testing are provided below. Results from any
one test were not used to form diagnostic or treatment conclusions. Rather,
each test was used in conjunction with evaluative data from additional sources
such as interviews, case history, direct observations, and other test data.
Results below were considered valid unless otherwise noted.
Ms. Smith
Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-2) The
Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-2) is a
standardized measure that provides a quick and reliable estimate of IQ based on
four subtests (Vocabulary, Block Design, Similarities, and Matrix Reasoning). The
four subtests comprise the Full-Scale IQ. The Vocabulary and Similarities subtests
comprise the Verbal Comprehension Index (VCI). The Block Design and Matrix
Reasoning subtests comprise the Perceptual Reasoning Index (PRI).
Ms. Smith obtained a Full-Scale IQ in the “average” range. There was no

significant discrepancy between the VCI and PRI; both were in the “average”
range. Results suggested that her cognitive abilities developed evenly across
domains. It was determined that Ms. Smith could understand/process verbal
information in an age-appropriate manner and that she had the capacity to use
logical and abstract reasoning skills.
Personality Assessment Inventory (PAI) The Personality Assessment

Inventory (PAI) is a self-administered, objective inventory of adult personality.
It is comprised of four validity scales, eleven clinical scales, five treatment
scales, and two interpersonal scales. Scales are nonoverlapping, which helps
reduce scale contamination. As a clinical instrument, the PAI provides
information relevant to clinical diagnosis, treatment planning, and screening
for psychopathology.
On the PAI, Ms. Smith underreported problems to which people typically
admit (Positive Impression Management Scale was elevated). Consistent with
her defensive responding, Ms. Smith had no marked elevations on the clinical
scales, and her general stress levels were within normal limits. She reported
having an available support network that likely buffered her negative response
to such stressors. Interpersonal indicators were that Ms. Smith maintained a
balance of warmth, friendliness, autonomy, and assertiveness in her relation-
ships (Dominance and Warmth Scales).
Ms. Smith did acknowledge a history of drug use and dependence
(Drug Scale). There was also an elevation on the Antisocial scale (e.g.,
having a history of rule-breaking behavior, problems with authority,
stimulus-seeking, and limited empathy). These scores were consistent with
Ms. Smith’s clinical interview, in which she acknowledged her drug use,
and maintaining sobriety was a primary focus. The combination of an opti-
mistic outlook, a sense of purpose, and the presence of a support system
were indicative of a positive prognosis, should she commit to treatment
(Treatment Rejection Scale).
Trauma Symptom Index, Second Edition (TSI-2) The Trauma Symptom

Inventory, Second Edition (TSI-2) is used to identify trauma-related symptoms
and behaviors. It consists of two validity scales, twelve clinical scales, twelve
subscales, and four general factors. It evaluates current symptomatology
associated with trauma from any point in the respondent’s lifespan, but it does
not link symptoms to a single stressor or specific point in time.
Ms. Smith’s overall posttraumatic stress factor was within normal limits, and
all clinical scales were lower than clinical thresholds. Essentially, Ms. Smith’s
TSI-2 profile was not indicative of significant PTSD symptoms.
Child Abuse Potential Index (CAPI) The Child Abuse Potential Inventory
(CAPI) is a standardized measure used to assess an individual’s characteristic
similarity to known, active physical child abusers. The abuse scale is comprised
of three factor scales related to psychological difficulties (i.e., distress, rigidity,
unhappiness) and three factor scales related to interactional problems (i.e.,
problems with child and self, problems with family, and problems from
others). There are also three validity scales.
Ms. Smith’s responses led to an elevation on the “Lie” validity scale, which
resulted in a “Faking Good” profile. Although it is not clear if Ms. Smith
intentionally portrayed herself in an overly positive light, her response
pattern was consistent with her tendency to minimize her role in parenting
problems with John.
Parenting Stress Index/Short Form (PSI/SF) The Parenting Stress Index/

Short Form (PSI/SF) is a standardized measure that uses thirty-six items to
identify parent-child dyads that are experiencing stress or that may be at risk
to develop dysfunctional parenting and child behaviors. The index consists
of scales for Parental Distress, Parent-Child Dysfunctional Interaction, and
Difficult Child.
Ms. Smith reported a total level of parenting stress within the normative
range. Her interactions with John were largely reinforcing, and she did not
portray John’s behaviors as significantly disrupting her relationship with
him. She also did not identify John’s behaviors as difficult to manage. This
finding was particularly discrepant from Ms. Smith’s verbal report. However,
Ms. Smith’s perceptions on the PSI may have been altered because John had
not lived with her for the past fourteen months, and there were no reports of
disruptive behaviors during visitation. Therefore, her view of not currently
experiencing John as a difficult child may have been influenced by her limited
time with him.
Substance Abuse Subtle Screening Inventory, Third Edition (SASSI-3)

The SASSI-3 was designed as a substance-abuse-screening measure
composed primarily of “subtle items” that appear to be unrelated to
substance abuse, thus enabling the instrument to identify some individuals
with substance-related disorders even if they are unable to acknowledge
relevant symptoms. The SASSI-3 also provides clinical information that can
be useful in helping identify problem areas, setting treatment goals, and
developing treatment plans. The inventory can be completed according to a
prescribed time period. However, because Ms. Smith was actively involved
in drug treatment services and had maintained three years of sobriety prior
to her recent lapse, she was asked to complete the SASSI-3 with regard to
her lifetime.
Ms. Smith endorsed a number of thoughts, feelings, and behaviors

commonly experienced by clients with substance abuse histories (Symptoms
Scale). An elevation on the Face Valid Other Drugs Index suggested that Ms.
Smith was aware of her substance abuse problem. Given her constellation of
scores, it was likely that Ms. Smith suffered from a substance dependence dis-
order. Although such a result did not suggest that Ms. Smith was actively using
illegal drugs, given her history of use she remained at moderate-to-high risk
for abusing drugs unless she maintained significant structure and treatment
compliance to support her sobriety.
Summary of Psychological Measures for Ms. Smith According to

standardized testing, Ms. Smith was well within the “average range” of
intelligence, and thus it did not appear that cognitive limitations were affecting
her functioning or ability to parent. Additional testing confirmed much of
what she divulged during her clinical interviews and document review. She
acknowledged a history of substance abuse, including her recent lapse after
three years of sobriety. She was confident in herself and showed a balance
of friendliness, autonomy, and assertiveness, reflecting a generally healthy
interpersonal style. She did not endorse specific symptoms of trauma that
would require clinical intervention, though reports of general stress were
variable. This was not atypical given the current family disruption, and it
appeared that she was engaging an adequate support network that served as a
buffer for many of her stressors.
John
Behavior Assessment System for Children, Second Edition (BASC-2) The
Behavior Assessment System for Children (BASC-2) is an integrated system
designed to facilitate the differential diagnosis and classification of a variety
of emotional and behavioral disorders of children and to aid in the design
of a treatment plan. There are multiple Clinical Scales and Adaptive Scales
that form composite scores, including Internalizing, Externalizing, Adaptive,
and Behavioral Composites). Scale scores in the “clinically significant” range
suggest a high level of maladjustment. Scores in the “at-risk” range identify
either a significant problem that may not be severe enough to require formal
treatment or a potential of developing a problem that needs careful monitoring.
Self-Report John achieved an elevated Atypicality scale, along with other

at-risk concerns. He endorsed behaviors that are often considered odd, many
of which are commonly associated with psychosis (e.g., hearing voices).
However, the scale also captures symptoms of dissociation and inattentiveness,
commonly associated with Posttraumatic Stress Disorder (PTSD) and/or
Attention-Deficit/Hyperactivity Disorder (ADHD). An “at risk” score for

Hyperactivity reflected John’s difficulty sitting still, excessive talking, and
related impulsivity. A similar elevation was found for Attention Problems; John
could be easily distracted and find it hard to concentrate. These symptoms
are also commonly associated with ADHD but can also reflect PTSD. With
accompanying “at-risk” concerns for low self-esteem and poor self-reliance,
John did not feel adequately capable of managing distress. However, he did
not have concerns about his relationship with Ms. Smith, a likely source of
strength for him.
Parent Report Both Ms. Smith and John’s foster mother completed the
parent form of the BASC-2. Both parties endorsed few concerns about John,
though they each indicated “at risk” concerns for depressive symptoms. They
also observed John to be easily distracted (Attention Problems Scale). Ms.
Smith’s responses further indicated concern about John’s ability to complete
daily living skills in an age appropriate manner (i.e., needing help to get out of
bed in the morning and reminders to brush his teeth).
UCLA Post-Traumatic Stress Disorder Index (UCLA PTSD Index) The

UCLA PTSD Index for DSM-IV is a self-report paper-and-pencil screening
instrument for the assessment of trauma exposure and posttraumatic
stress symptoms among children and adolescents. At the time of the
evaluation, there was not a published version for the DSM-5. However,
symptom clusters on the current UCLA PTSD Index closely approximate
diagnostic criteria in the DSM-5, including items that directly correspond
with trauma symptoms such as Re-experiencing, Avoidance, and Increased
Arousal.
John completed the UCLA PTSD Index with regard to sexual abuse. The
PTSD Severity Score was well above cutoff scores indicative of significant
trauma. He endorsed clinically significant symptoms across domains
of increased arousal (e.g., hypervigilance, sleep problems, difficulty
concentrating), avoidance (e.g., restricted affect, avoidance of thoughts), and
re-experiencing (e.g., physiological reactivity to trauma reminders). As such,
John’s symptom severity likely warranted trauma specific interventions.
Summary of Psychological Measures for John Results from John’s testing

revealed that he acknowledged having trouble with various mental health
symptoms that are often associated with attention deficit (i.e., impulsivity
and poor concentration). However, a number of these same symptoms
are found in children with PTSD. John avoided discussions about being
sexually abused, but on various measures he endorsed having significant
symptoms of increased arousal (e.g., hypervigilance, sleep problems, difficulty
concentrating), avoidance (e.g., restricted affect, avoidance of thoughts), and

intrusion (e.g., physiological reactivity to trauma reminders).
DPICS Observation of Ms. Smith with John During the clinical

observation of Ms. Smith and John, they were observed in several play
scenarios. In the first scenario, Ms. Smith was asked to allow John to choose
what to play and follow his lead. In the second scenario, Ms. Smith was asked
to inform John that she would pick an activity and get him to play according
to her rules. Finally, Ms. Smith was asked to get John to pick up the room
without her direct assistance. The purpose of these scenarios was to observe
the quality of their interactions and to observe how John responded to Ms.
Smith’s instructions/commands.
Throughout the play, John was observed to smile and laugh. He easily took
turns during game play and in conversations. Most of Ms. Smith’s commands
were indirect or phrased as questions (e.g., “How about we do it one more
time? Let’s put the Legos away”), which allowed him to respond with stalling
and noncompliance. When John did not quickly comply, Ms. Smith repeated
the command until it was completed; no other consequences were provided.
Ms. Smith regularly provided praise, but it was generally unrelated to compli-
ance (e.g., “You are so smart!”). At the conclusion of the appointment, John
expressed disappointment and asked questions about when he would see his
mother again. He was reassured when Ms. Smith informed him they had a
visit the next day, at their regular location. When leaving the clinic, they shared
terms of affection and separated easily after making plans for their next visit.
Collateral sources showed general agreement that Ms. Smith actively and
appropriately participated in treatment services. Her current individual and
group counselors found that Ms. Smith “followed through on recommenda-
tions.” After being gone from her twelve-step program for the previous year,
she was “quickly getting back into twelve-step meetings and connecting with
a new sponsor.” In meetings, she was routinely “aware of her triggers” and
avoided situations/relationships that prompted prior use. She was respectful
and collaborative during group sessions, as well as “independent and moti-
vated,” which helped her with “setting goals for herself.”
A psychiatrist had been working with both Ms. Smith and John for seven
months and two months, respectively, prior to John’s removal. Ms. Smith
was prescribed antianxiety medications for the past eighteen months.
Although she presented with general feelings of anxiety after being sepa-
rated from John, the psychiatrist had no significant concerns about her cur-
rent functioning. During treatment, there were no indications that she was
using illegal drugs or that she desired to do so. She attended appointments
and showed consistent medication compliance. The psychiatrist diagnosed
Ms. Smith with Anxiety Disorder, PTSD (by history), and Opiate Depen-
dence (by history). At the time of John’s intake, the psychiatrist quickly had
concerns about John’s functioning and Ms. Smith’s ability to tolerate stress
resulting from John’s “daily tantrums.” John and Ms. Smith both initially
denied occurrence of abuse, but the psychiatrist was concerned about a pos-
sible history of “abuse or trauma” given John’s presentation (i.e., refused to
be alone in the bathroom, complained of nightmares). John also complained
of “hearing unspecified, non-command voices” for which he was prescribed
an antipsychotic medication. Medication was discontinued after John had
been in foster care for approximately six months, and there was no recur-
rence of auditory hallucinations.
The family’s former parenting/behavior management service provider
worked with the family after John’s initial removal (at 6 years of age). The pro-
vider had last seen Ms. Smith and John three years prior to the current evalu-
ation. John was described as “entitled” and clearly was “in complete control of
the house” at the time. In treatment, Ms. Smith acknowledged her struggles,
and learned to recognize and praise positive behaviors, as well as to remove
privileges for negative behaviors. However, Ms. Smith continued to have dif-
ficulty remaining firm when removing favorite privileges. A major barrier to
progress was that Mr. Jones undermined Ms. Smith’s parenting because he
gave John rewards when they were not earned. Mr. Jones was integrated into
treatment, but he continued to undermine Ms. Smith’s efforts.
A close family friend of ten years made similar observations about
Ms. Smith’s “largely passive parenting.” However, the friend also noted that,
“despite all of John’s tantrums, meltdowns, and aggression,” Ms. Smith “always
took John to the library, and read with him, or did art at home. He loved it.”
Ms. Smith also routinely “spoke to him softly, and never yelled.” Having known
Ms. Smith for the duration of John’s life, the friend stated, “I knew that she
loved him dearly, and was trying to be the best she could be. She was staying
away from Mr. Jones, and she needed to learn how to say no to John.”
John’s therapist had been working with him four months prior to the dis-
closure of the sexual abuse. At the time of intake, John presented with severe
anger outbursts, mood swings, impulsivity, and difficulty respecting author-
ity. He was diagnosed with Mood Disorder NOS, Anxiety Disorder NOS,
and ADHD, Combined Type. Attempts to discuss sexual abuse (after it was
disclosed) were met with John “throwing a fit and demanding to leave the
session.” During collateral contacts, Ms. Smith was “cooperative” in that she
“listened” to the therapist and she tried to implement suggestions. Shortly
after John was removed, Ms. Smith struggled to acknowledge the abuse had
occurred, but shortly after moving away from Mr. Jones, she expressed feeling
“guilty because the abuse took place under her nose.” Ms. Smith appeared
“open about her parenting struggles after John was removed,” and it was clear
that “she wanted her son back.”
When John first arrived in foster care, he exhibited problems with defi-
ance; he was “getting physically aggressive” with similar-aged children. Over
time, it was determined that John was mostly “trying to defend himself ”
from a more aggressive child. After the more offensive child was removed
from the home, John’s behavior was largely appropriate, and he was compli-
ant with house rules. The foster parent explained that John was a “typical kid,
not wanting to clean up” or complete other chores, but when told he has to
do something, he followed through without resistance. Overall John was the
“best boy in the house. He stays calm, quiet, and he does not talk back.”

Prior to making the ultimate recommendation about the potential impact
that TPR would have on John and Ms. Smith, the evaluator had to first deter-
mine 1) whether there were any mental health concerns for Ms. Smith that
prevented her from safely and adequately parenting John, and 2) if concerns
did exist, whether she could address those concerns within a prescribed
period of time (four to eight months) in order to become a safe and adequate
parent (understanding that by statute Ms. Smith had approximately four
months left to reunify with John).
In evaluating someone’s need for mental health services and an ability to
benefit from them, it is important to consider the person’s socioemotional
functioning. A person’s prospects for addressing concerns (if present) must
also be considered when determining whether she has the ability to care for
a child in a responsive and reliable manner. In the event that a parent is not
able to manage her own personal, occupational, and interpersonal affairs, it
becomes more unlikely that the parent would be able to adequately secure for
the needs of a child.
Mental Health Functioning Ms. Smith chronically abused alcohol,

methamphetamines, heroin, and cocaine. She had a history of persistent
desire to use and had unsuccessfully tried to control her use. Her recurrent
use resulted in her failure to fulfill major role obligations at home,
and she continued to use despite having significant negative impacts.
Indeed, Ms. Smith exhibited symptoms of a Substance Use Disorder for
many substances, though her most recent and prominent use had been
with methamphetamine. Therefore, a primary diagnosis of Substance
Use Disorder, In Early Remission, was offered. Ms. Smith also had a
history of anxiety attacks for which she was prescribed medications. She
acknowledged having moderate levels of anxiety associated with her life

circumstances (e.g., worrying about reunification status). Ms. Smith’s
history of sexual abuse had also resulted in disruptive symptoms, though
she denied that they were pervasive or persistent at the time of evaluation. It
was determined that Ms. Smith did not meet full criteria for Posttraumatic
Stress Disorder (PTSD), though associated anxiety symptoms were likely
reduced given that she regularly took antianxiety medication. In the event
that she discontinued the medication, it was anticipated that she would
experience increased anxiety symptoms. It was also notable that Ms. Smith’s
feelings of being overwhelmed after discovering her son’s sexual abuse
initially prevented her from acting in a protective manner and triggered
her lapse in sobriety. Therefore, her difficulty managing anxiety not only
caused her distress but also placed her at risk for relapse. On this basis, a
secondary diagnosis with Unspecified Anxiety Disorder was given.
Despite Ms. Smith’s mental health diagnoses, it was determined that her
mental health condition did not preclude her from becoming a safe and
adequate parent. Individuals who have these diagnoses can learn to use cop-
ing skills in order to address symptoms and maintain medication compliance.
It was anticipated that treating Ms. Smith’s anxiety was likely to improve her
quality of life, her ability to manage difficult child behaviors, and her success
in maintaining sobriety.
Ability to Benefit from Services The evaluator opined that Ms. Smith did
not suffer from a mental health condition that precluded her from safely and
adequately parenting her son. There were positive prognostic signs that Ms.
Smith could improve her mental health functioning, but the evaluator also
expressed significant concerns about Ms. Smith’s present parenting ability.
It was remarkable that Ms. Smith made gains in prior services that helped
her maintain sobriety for an extended period of time. Her continued efforts and
participation in services also spoke to her willingness to enhance her insight
into how her mental health impacts her daily and interpersonal functioning,
as well as her child.
Another encouraging sign was that during the evaluation (within a struc-
tured and controlled environment) Ms. Smith displayed an ability to interact
with and parent John in an appropriate manner. However, when Ms. Smith
and John had been in a more natural setting, with multiple other demands
placed on them (e.g., co-parenting with stepfather, getting John to com-
plete less desirable daily activities), she struggled to manage John’s behav-
iors. Service providers and family friends both observed Ms. Smith to have
poor follow-through with setting limits, and they observed that Ms. Smith
was generally “passive” or “parented out of guilt,” something that would likely
continue without structured intervention.
It was further acknowledged that Ms. Smith previously completed parenting

services (i.e., classes and in-home support). However, she continued to have dif-
ficulty following through with effective commands, providing appropriate con-
sequences, establishing appropriate daily/hygiene routines, and ensuring John’s
physical/sexual safety. It was believed that Ms. Smith’s parenting limitations
could be addressed in treatment more effectively at the present time, particu-
larly now that some of the primary family stressors were no longer present (i.e.,
the stepfather no longer undermining Ms. Smith’s parenting efforts; John was
no longer being sexually abused).
Taken together, the evaluator concluded that treatment services would need
to be in place to address Ms. Smith’s ongoing mental health symptoms (i.e.,
anxiety) and parenting deficits. Given the extent of her symptoms and the
proven benefit she received from prior substance abuse services, it was antici-
pated that Ms. Smith had the ability to become a safe and adequate parent
within four to eight months if she adequately participated in an appropriate
course of treatment (outlined below).
Quality of Ms. Smith and John’s Relationship After determining that

Ms. Smith would be capable of addressing her mental health concerns,
the evaluator addressed the main question for the evaluation: whether
discontinuing the relationship between John and Ms. Smith would lead to
long-term emotional detriment for John and prevent him from establishing
permanency.
An underlying assumption for answering questions for TPR is that a sig-
nificant developmental need for children is forming appropriate and stable
relationships. Predictable and consistent care from a caregiver helps children
develop security and trust and increases the likelihood that children can effec-
tively negotiate future developmental and interpersonal growth/challenges.
The early formation of a stable relationship between a parent and a child (e.g.,
typically the first three years of a child’s life) is essential for promoting a child’s
healthy psychosocial development.
A useful way of evaluating parent-child relationships is by considering the
strength (i.e., strong vs. weak) and the quality (i.e., positive vs. negative) of the
relationship. When evaluating the strength and quality of relationships, it is also
important to consider the timing, duration, and consistency of the relationship
(e.g., How long has the child and caregiver been together? Were there signifi-
cant disruptions in infancy or early childhood?). The early formation of a stable
relationship between a parent and a child (e.g., typically the first three years of a
child’s life) is essential for promoting a child’s healthy psychosocial development.
Predictable and consistent care from a parent helps children develop security
and trust with parents and increases the likelihood that children will be able to
effectively negotiate future developmental and interpersonal growth/challenges.
As the evaluator considered the strength and quality of Ms. Smith and
John’s relationship, it was noted that John was in Ms. Smith’s exclusive care
for the first five years of his life, which spans beyond the critical time period
when attachments are initially being formed between a child and a parent.
John had been separated from Ms. Smith for a year at 6 years of age. Despite
this, collateral sources and clinical observations indicated that Ms. Smith con-
sistently expressed appropriate affection. She was also attentive and responsive
to many of his needs. Additionally, during the current evaluation, John and his
mother expressed shared affect and enjoyment. Ms. Smith also proved capable
of attending to John’s preferences and used many positive parenting skills (e.g.,
praise, physical affection, and reflections).
Although John acknowledged having positive affiliation with various
parties, including his stepgrandfather and foster parents, he endorsed having
a preferred attachment and desire for Ms. Smith over other people. He was
significantly distressed about his removal from Ms. Smith. Taken together, the
evaluator concluded that Ms. Smith and John had a strong and generally posi-
tive bond with one another in spite of the year-long separation. The stability
of this relationship, in part helped sustain John’s ability to tolerate the distress
related to being separated from Ms. Smith and to function well in multiple set-
tings (i.e., community, school, and foster homes). As such, it was believed that
discontinuing John’s relationship with Ms. Smith would negatively impact his
long-term emotional and behavioral functioning, such that his prospects for
permanency would be compromised.
Treatment Recommendations
Ms. Smith It was recommended Ms. Smith continue working with her
psychiatrist, and remain active in substance abuse specific support
services. Such efforts would be particularly important when there were
increased parenting stressors as John returned home and progressed into
adolescence.
It was also recommended that Ms. Smith start her own individual treat-
ment. During the current evaluation, Ms. Smith denied significant trauma
symptoms associated with her own sexual abuse victimization. However, the
recent revelation of John’s sexual abuse triggered memories of her childhood
sexual victimization. Ms. Smith’s therapist was encouraged to assess further
and determine whether specific trauma work was indicated. Regardless, Ms.
Smith would benefit from cognitive-behavioral therapy that directly targets
her anxiety symptoms and maladaptive coping strategies (i.e., avoidance,
withdrawal, denial). Increasing more appropriate coping skills would also help
support her drug recovery.
John Because John was experiencing multiple intrusive, arousal, and

avoidance symptoms consistent with PTSD, it was strongly recommended that
he participate in weekly individual therapy designed to directly address his
trauma/maltreatment history. Trauma-Focused Cognitive Behavioral Therapy
(TF-CBT) was specifically recommended because it is an empirically supported
treatment for trauma and sexual abuse that can be used for children John’s
age. It was also highly recommended because it includes parent participation
and safety planning that helps facilitate a positive, supportive, and protective
parent-child relationship.
Parenting/In-Home Behavior Management Services Ms. Smith previously

completed parenting classes but was doing so while Mr. Jones was in the home.
It was likely that she would benefit from an updated parenting plan where she
was the sole parent in the home. It was recommended that specific parenting
components to address and master would include 1) sustaining a positive
relationship, 2) providing effective commands, 3) using positive reinforcement
for compliance, 4) implementing appropriate consequences, 5) ignoring
negative behaviors (that did not pose a safety risk), and 6) establishing routines
for hygiene and sleep. Effective treatment would require psychoeducation as
well as coaching, role-plays, or modeling of skills.

Consistent with standards detailed by 2013 Guidelines and best practices
for TPR evaluations, the psychologist who evaluated Ms. Smith and John
relied on multiple methods and sources. Review of records, clinical inter-
views of Ms. Smith and John, administration of standardized psychologi-
cal measures, and collateral contacts were conducted. Although there were
concerns about Ms. Smith’s history of substance abuse, her mental health
symptoms, and her difficulty in managing John’s behaviors, ultimately the
evaluator determined that Ms. Smith did not have a mental health condition
at the time that precluded her from benefiting from reunification services or
becoming able to parent her child safely and adequately. There were barri-
ers that impeded her ability to safely and adequately parent John at the time
of the evaluation; however it was expected that Ms. Smith had the ability to
become a safe and adequate parent within a four-to-eight-month timeframe.
Moreover, given the strength and quality of the parent-child relationship,
even without parenting improvements, discontinuing John’s relationship
with Ms. Smith would likely negatively impact his long-term emotional and
behavioral functioning, such that his prospects for permanency would be
disrupted.
As demonstrated with this case, conducting a psychological evaluation

related to the termination of parental rights is a painstaking and difficult
endeavor. Ethical and responsible psychologists and/or forensic evaluators
should undertake such evaluations with a full understanding of child develop-
ment, parent-child relationships, both adult and child psychopathology, and
the role of an evaluation within the context of the child welfare system. It is
the responsibility of the informed psychologist to meld multiple sources of
information into a coherent conceptualization that serves as the foundation
for their opinions. This opinion should fulfill the standards of the American
Psychological Association, the statutes of the local jurisdiction, and most
importantly, fairness to the best interests of the child.
References
American Psychological Association, Practice Directorate, Board of Professional Affairs
Committee on Professional Practice & Standards. (1999). Guidelines for psychological
evaluations in child protection matters. American Psychologist, 54, 586–593.
American Psychological Association, Practice Directorate, Board of Professional Affairs
Committee on Professional Practice & Standards. (2013). Guidelines for psychological
evaluations in child protection matters. American Psychologist, 68, 20–31.
Azar, S., Lauretti, A., & Loding, B. (1998). The evaluation of parental fitness in termination
of parental rights cases: A functional-contextual perspective. Clinical Child and Family
Psychology Review, 1, 77–100.
Benjet, C., Azar, S. T., & Kuersten-Hogan, R. (2003). Evaluating the parental fitness of
psychiatrically diagnosed individuals: Advocating a functional-contextual analysis of
parenting. Journal of Family Psychology, 17, 238–251.
Brodzinsky, D. (1993). On the use and misuse of psychological testing in child custody
evaluations. Professional Psychology Research and Practice, 2, 213–219.
Child Welfare Information Gateway (2007). State Statutes Search. Available at www
.childwelfare.gov
Condie, L., & Condie, D. (2007). Termination of parental rights. In A. Goldstein (Ed.),
Forensic psychology: Emerging topics and expanding roles (pp. 294–330). Hoboken, NJ:
Wiley.
Donald, T., & Jureidini, J. (2004). Parenting capacity. Child Abuse Review, 13, 5–17.
Eyberg, S., & Pincus, T. (2000). Eyberg Child Behavior Inventory & Sutter-Eyberg Student
Behavior Inventory—revised professional manual. Odessa, FL: Psychological Assessment
Resources.
Grisso, T. (2003). Evaluating competencies: Forensic assessments and instruments (2nd ed.)
New York, NY: Kluwer Academics/Plenum.
In re Autumn H., 32 Cal. Rpter. 2d 535; Ct. App. 4 Dist. 1994.
In re Casey D., Court of Appeal, Fourth District, Division 1, California. 1999.
In re Smith, 77 Ohio App.3d 1, 16, 601 N.E.2d 45, 54. 1991.
Kalich, L., Carmichael, B., Masson, T., and Blacker, D. (2007). Evaluating the evaluator: Guide-
lines for legal professionals in assessing the competency of evaluations in termination of
parental cases. The Journal of Psychiatry and the Law, 35, 365–397.
Kundra, L., & Alexander, L. (2009). Termination of parental rights proceedings: Legal
considerations and practical strategies for parents with psychiatric disabilities and the
practitioners who serve them. Psychiatric Rehabilitation Journal, 33, 142–149.
McVey, L., Henderson, T., and Burroughs Alexander, J. (2008). Parental rights and the
foster care system: A glimpse of decision making in Virginia. Journal of Family Issues,
29, 1031–1050.
for the courts: A handbook for mental health professionals and lawyers (2nd ed.). New
Milner, J. S. (1986). The Child Abuse Potential Inventory manual (2nd ed.). Webster, NC:
Psytec.
O’Donnell, R. (2010). A second chance for children and families: A model statute to
reinstate parental rights after termination. Family Court Review, 48, 362–379.
Santosky v. Kramer, 455 U.S. 745 (1982).
Urquiza, A., & Blacker, D. (2005). Psychological evaluations and the child welfare
system. In P. F. Talley (Ed.), Handbook for the treatment of abused and neglected
children (pp. 83–119). New York, NY: Haworth Press.
Vesneski, W. (2011). State law and the termination of parental rights. Family Court Review,
49, 364–378.
11
Child Custody and

Parenting Plan Evaluations
Robert L. Kaufman and Daniel B. Pickar
Forensic mental health professionals (FMHPs) have been venturing farther

and more broadly into areas of disputed child custody for more than three
decades. Few, if any, areas of practice in psychology require professionals
to have as many well developed skills in as broad a range of diverse content
and process areas. Practitioners must be well versed in child development,
individual psychopathology, family systems, parent-child attachment, and the
particulars of family law, as well as an array of special issues that are specific
to child custody work. It is a demanding field and, in many ways, a high-risk
venture for the forensic mental health professional (Kirkland & Kirkland,
2001). However, child custody evaluations (CCEs) also can be enormously
rewarding, as professionals have the opportunity to offer valuable insight and
guidance for children and families at very troubling junctures in their lives.
The field of child custody has greatly evolved and expanded over the last
few decades. FMHPs find themselves in various roles, offering an array of ser-
vices associated with separating and divorcing couples and their interaction
with the family law system. Such roles include court-appointed child custody
evaluators, mediators, co-parenting counselors, parenting coordinators, and
consultants. Each role is defined by the service offered by the professional,
as well as by whether or not the relationship between FMHP and client(s) is
privileged and confidential. This chapter will focus specifically on conducting
child custody evaluations (CCE). The preparation of a child custody report
is the culmination of a lengthy, often-intense, stressful, and intrusive process
for parents and children. The CCE report is the evaluator’s work product that
presents not only a summary of the information collected but also the scru-
tiny and synthesis of all data into a cogent analysis of the case. Opinions and
recommendations are offered to address the legal questions at hand, namely, a
parenting plan to serve the best interests of the children.
Child Custody Evaluations 249
The field is also complex and diverse. Families present with unique histories
and circumstances, and because families enter into these evaluations after
other means of resolving conflicts have failed, there are often very serious alle-
gations to be addressed. Such special issues will only be briefly highlighted,
as primarily this chapter will outline and describe the foundational issues in
parenting plan evaluations, followed by a case presentation.
Relevant Case Law

It was not until the latter third of the twentieth century that case law in matters
of child custody recognized that parents could provide nurturance and quality
care of their children regardless of gender. By the 1970s and 1980s, courts
started to move towards acknowledging the benefits of shared parenting or
joint custody over awarding custody to one parent based on either rights or
dominion (ex. 18th and 19th century assumptions of English courts) or gender-
specific instincts (the “tender years doctrine”). As of 2013, thirty-six states have
supported joint custody via presumption, by stated preference, or by statutory
language in support of cooperative parenting (DiFonzo, 2014). Furthermore,
there has been a trend towards conceptualizing legal custody and physical
custody as decision making and parenting time respectively. Shared parenting,
previously labeled joint custody, indicates that the parents share the authority
to make decisions regarding the children and that each parent spends at least
30%–35% of his or her time with the children (Pruett & DiFonzo, 2014).
The legal standard that governs decision making in child custody matters
is the best interests of the children (BIC), and many of the principles were first
outlined in the Uniform Marriage and Divorce Act of 1970 (UMDA). This
act mandated that courts take into account a variety of factors when judicial
officers determine BIC in custody cases. These generally include:
• The wishes of the parents;

• The wishes of the child;
• The interaction between the child and his/her parents, siblings, or other
person who might significantly affect the child’s best interests;
• The child’s adjustment to its home, school, and community;
• The mental and physical health of all individuals involved (Uniform Law
Commission, 1975).
Over the years, these factors have been further honed to include individual
parenting strengths and weaknesses; each parent’s willingness to support the
child’s relationship with the other parent; aspects of the co-parenting rela-
tionship; the age, adjustment, and developmental stage of the child; and the
stability of proposed living arrangements. Several additional factors, if present,
must also be considered. These possible factors include domestic violence;

substance abuse; allegations of sexual, physical, or emotional abuse; serious
mental health issues; and whether the child has special needs. In states like
California, there has also been a strong trend toward considering the stated
preferences of a child old enough and mature enough to offer a meaning-
ful preference. What the BIC standard does not state explicitly is the relative
weight that should be given to each factor. This is left to the discretion of the
judge. This is one area in which custody evaluators may offer significant input
and assistance to the court.
There has been criticism of the BIC standard as being ambiguous, difficult
to operationalize, and varying across different jurisdictions (Emery, Otto, &
O’Donohue, 2005). In turn, critics say that these shortcomings have led to
too much judicial subjectivity regarding application of the BIC standard for
custody determinations (Shuman & Berk, 2012). Nonetheless, it is clear that
judges require information on a range of specific areas regarding the fit between
parental competence and the child’s needs to assist the court. In California, for
example, the information that the court needs from custody evaluators, as well
as the procedures for acquiring that information, is spelled out in the state’s
Family Code as well as the California Rules of Court.
Review of the Literature: Research on Special Issues in Child

Custody Evaluations
More than in any other area of forensic psychology, child custody evaluators
must be familiar with the available scientific research in the broad range of
areas typically encountered in these assessments. Kuehnle and Drozd (2012)
have noted that social science research is the foundation of the mental health
experts’ conclusions and opinions about parents and children in litigated child
custody cases. First and foremost, evaluators must be aware of the ever-evolving
research base regarding risk and protective factors associated with child and
adolescent adjustment following separation and divorce (Kelly, 2012). Impor-
tant volumes such as Parenting Plan Evaluations: Applied Research for the Fam-
ily (Kuehnle & Drozd, 2012) offer an analysis of the research associated with
many of the most important topics within the family court, describing the
studies and methods utilized in examining such issues and summarizing the
strengths and limitations of each research study. The authors offer an important
caution, namely that “not all research is created equal.” Thus evaluators must
also critically examine the research literature to identify studies that have been
well designed and executed and that are truly pertinent to their particular case
(Drozd, Olesen, & Saini, 2013).
The court frequently orders child custody evaluations involving a num-
ber of special circumstances or populations. Examples include allegations
of domestic violence or child sexual abuse, claims of parental alienation,

or cases of a parent requesting to move to a different geographic location
with children, over the objection of the other parent. The AFCC standards for
custody evaluations (2006) specifically note (Standard 5.11) that evaluators
must have the professional knowledge and training needed to conduct evalu-
ations involving special and complex issues. Therefore, the evaluator must be
familiar with not only the legal statutes and relevant case law regarding these
complex areas but also the empirical research and current thinking regarding
the assessment and analysis of such issues in a CCE. There are a substantial
number of publications on each of these frequently encountered topics, but
some key considerations will be highlighted.
Infants and Very Young Children

Parenting plans are responsibly informed by the cognitive, social, and psycho-
logical characteristics of children across a wide span of ages and developmental
phases. Familiarity with research regarding attachment and overnight time
sharing for infants and very young children is a necessity for working with
this unique age group (Lamb, 2012; McIntosh, Pruett, & Kelly, 2014; Pruett,
McIntosh, & Kelly, 2014). This has also been an area of emerging research and
controversy within the custody field. The debate centers on such questions
as, at what point can infants, toddlers, and very young children benefit from
overnight visitation with the noncustodial parent without experiencing undue
distress?
Relocation In our increasingly mobile society, there are times when one
parent in a divorced family seeks to relocate with the children to a geographic
location that makes continued shared parenting impossible. These cases
are frequently referred for child custody evaluations. This is an area that
evaluators need to understand clearly: the case law of the jurisdiction in
which they practice. This will inform factors that will be weighed by the
court to make an ultimate determination. Austin’s (2008a, 2012) review of
the relevant literature led to the finding that children are at substantial risk
for poorer outcomes when families relocate. This research applied to intact
as well as separated or divorced families. In custody cases involving parent
relocation, Austin (2008a; 2008b, 2012) recommends a comparative analysis
of the relative advantages and disadvantages to the child associated with living
primarily with each parent in different communities and experiencing life in
a long-distance parenting arrangement. Austin’s empirically grounded model
enumerates risk and protective factors that should be weighed in a relocation
case. They include the age of the child, the geographic distance and travel time
between the two homes, the psychological stability of the relocating parent
and parenting effectiveness of each parent, the availability of specialized

educational or therapeutic services for disabled children, the history of
involvement by the nonresidential parent, and the history, if any, of high
conflict or domestic violence between the parents. The evaluator must also
assess the nature and extent of each parent’s support for the child’s relationship
with the non-residential parent (an issue referred to as “parental gatekeeping”)
to understand whether the parent who wishes to relocate with the child also
seeks to restrict the child’s access to the other parent. The motivation for the
relocation is also an important factor that needs to be assessed. Lastly, while
there are some studies specifically regarding the effects of relocation on a child
following a separation or divorce (Braver, Ellman, & Fabricius, 2003), further
empirical research regarding child outcome data is still needed.
Intimate Partner Violence Based on surveys of custody evaluators, Bow

and Boxer (2003) found that 37% of CCEs included an allegation of intimate
partner violence (IPV). Thus, this is a relatively common issue that must be
assessed. Kelly and Johnson (2008) identify three major types of intimate
partner violence (coercive controlling violence, violent resistance, situational
couple violence) and one subtype of situational couple violence (separation-
instigated violence). Several research studies have established a myriad of
negative effects on children exposed to intimate partner violence, including
emotional, behavioral, cognitive, and relationship effects, as well as increased
risk of direct child abuse (Hardesty, Haselschwerdt, & Johnson, 2012).
To promote the safety and healthy adjustment of children, custody evalu-
ators should be familiar with cutting-edge violence risk assessment models.
Jaffe, Johnston, Crooks, and Bala (2008) suggest a differentiated approach for
developing parenting plans when domestic violence is alleged. This includes
assessing risk by screening for the potency, pattern, and primary perpetra-
tor indicators of the violence as a foundation for generating hypotheses about
parental functioning and the potential for future violence. Depending on the
analysis of these factors, these authors also propose guidelines and criteria
for developing parenting plans that might range from highly restricted access
arrangements (no contact or supervised access) to relatively unrestricted ones,
such a parallel parenting or even co-parenting. Austin and Drozd (2012) offer
a revision of the above model, which is research based and expands on the
types and identification of IPV (i.e., coercive controlling violence, intrusive
violence, authoritarian violence, conflict-instigated violence, situation-specific
violence, separation-associated violence, substance abuse-associated violence,
and major-mental-disorder-associated violence). These authors then suggest
analyzing each case utilizing ten behavioral dimensions of violence. They fur-
ther propose that alternative parenting time schedules be developed in light of
the type, severity, active-potency, and risk-threat assessment of the violence.
Child Alienation Family courts frequently encounter families in which

a child is either refusing or resisting contact with one of their divorcing or
separated parents for reasons that seem out of proportion to any parental
failings or the actual parent-child relationship. There is a rapidly growing
literature in this area (Saini, Johnston, Fidler, & Bala, 2012), as claims of
“parental alienation” arise with considerable frequency in high-conflict
families. While initially referred to as “parental alienation syndrome” (Gardner
1992), alienation dynamics in a divorced family are more recently referred
to as “children who resist post-separation parental contact” (Fidler, Bala, and
Saini, 2012). An “alienated child,” as defined by Kelly and Johnston (2001), is
a child who expresses, freely and persistently, unreasonable negative feelings
(such as anger, hatred, fear) toward a parent that are disproportionate to the
child’s actual experience with that parent.
Recent literature on alienation and divorce suggests that children’s relatively
sudden refusals to spend time with a parent are seldom just the result of one
parent intentionally and systematically attempting to undermine the child’s
relationship with the other parent. Rather, there is often a more complex inter-
play of factors operative within the family. (Friedlander & Walters, 2010).
Drozd and Olesen (2004) outline a classification system for the identification
of pathological and nonpathological parent-child relationships, ranging from
children who are realistically estranged from a parent as a result of a history of
abuse or mistreatment by that parent to those children who have developed an
unjustified alienation in rejecting that parent.
Contrary to some past impressions, parental alienation is not a diagnostic
syndrome but rather is considered to be a cluster of commonly recognized
symptoms and/or behaviors. Because of the complexity of these cases, the
evaluator’s task is to conduct a comprehensive assessment of the various fac-
tors that may impede or facilitate parent-child contact problems. Awareness
of the research on various treatment interventions for cases with alienation
dynamics is crucial (Fidler & Bala, 2010).
Child Sexual Abuse Allegations Allegations of child sexual abuse in

custody disputes are among the most difficult to assess. Several preliminary
studies have found that approximately 1% to 2% of contested custody cases
involve an allegation of child sexual abuse, but Kuehnle and Kirkpatrick
(2005) have opined that this appears to be a gross underestimate of the
actual occurrence of sexual abuse allegations embedded in contested custody
matters. There is no solid empirical evidence regarding the occurrence of
false allegations of sexual abuse. Some authorities estimate the rate of false
allegations involving “calculated lying” by a child to be in the range from
6% to 8%. However, if the criteria for false allegations are broadened to
include inaccurate memories and false statements associated with suggestive
questioning and socially desirable responding, others have estimated rates of

23% to 35% of false reports of sexual abuse (Poole & Lamb, 1998).
Child custody evaluations involving such allegations are typically ordered
after child protective services has conducted their investigation and the find-
ings have been determined to be either “unsubstantiated” or “inconclusive.”
Child custody evaluations of this nature should be completed by a FMHP who
has substantial experience and training in forensic interviewing of children
(Lamb, Sternberg, & Esplin; 1998; Kuehnle & Kirkpatrick, 2005). Competent
evaluators should be familiar with research on normative sexual behaviors
in children (Friedrich, 2002), as well as the extensive literature regarding
children’s memory and children’s testimony (Ceci & Bruck, 1995; Ceci &
Friedman, 2000; Goodman, Batterman-Faunce, Schaaf, & Kenny, 2002).
Evaluators must assess the circumstances under which the concern about
sexual abuse arose and the methods by which the child’s statements were elic-
ited or triggered. Kuehnle and Connell (2009) have noted that evaluators can
assist the court by conducting a careful analysis of the data that argue for and
against a conclusion that a child has been sexually abused. Additionally, evalu-
ators can describe the intersection between the child’s developmental level
and the factors that might have contributed to an atmosphere of suspicion.
Relevant research bearing on an examination of the data should be noted, and
evaluators should always discuss the potential limitations of their conclusions.
Best Practices
Ethical Guidelines and Model Standards of Practice for
Child Custody Evaluations
In addition to gaining familiarity with state or local court rules, statues, and
relevant case law, FMHPs who conduct child custody evaluations should be
thoroughly familiar with the relevant professional guidelines and standards
of practice. In the last ten years, the two most important sets of practice
guidelines for child custody evaluations have undergone significant revision
(American Psychological Association [APA], 2010; Association of Family
and Conciliation Courts, 2007). Additionally, both the “Specialty Guidelines
for Forensic Psychology” (APA, 2013) and the “Ethical Principles of Psychol-
ogists and Code of Conduct” (APA, 2002) provide FMHPs with additional
guidance on ethical practice issues that impact how a CCE should be con-
ducted. The focus in this chapter will be on the APA and AFCC (Associa-
tion of Family and Conciliation Courts) guidelines, as they are most centrally
related to CCE practice.
The Guidelines for Child Custody Evaluations in Family Law Proceed-
ings (APA, 2010), a set of fourteen aspirational principles, specify that the
purpose of the custody evaluation is to assist the trier of fact in determining
the psychological best interests of the child and that “the evaluation focuses
upon parenting attributes, the child’s psychological needs, and the resulting fit”
(p. 864). FMHPs must also strive to gain and maintain specialized competence
in the field. Some states have codified this guideline by requiring potential eval-
uators to provide evidence of this specialty training. For example, California
specifies that child custody evaluators must be licensed mental health profes-
sionals who have completed forty hours of initial general training related to
CCEs, as well as sixteen hours of training related to domestic violence, prior to
conducting any CCE. Additionally, according to California Rules of Court, rule
5.225, evaluations are required to complete eight hours of continuing educa-
tion annually regarding CCE related issues, as well as four hours of education,
annually, related to updates in domestic violence law and research. For each
evaluation, FMHPs provide an affidavit to the court prior to beginning a case,
confirming that these requirements have been completed. APA guidelines stress
that FMHPs function as impartial evaluators and engage in nondiscriminatory
practices. They offer some procedural guidelines regarding establishing the
scope of the evaluation, obtaining informed consent, and using multiple meth-
ods of data collection including observational data and psychological testing.
The Model Standards of Practice for Child Custody Evaluation (AFCC,
2007) are the most detailed and useful guidelines to assist the FMHP in per-
forming custody and access evaluations. Not only do the AFCC standards offer
a series of twelve detailed standards but they also provide the closest thing to a
“best-practice” document for the field. As with the APA guidelines, the AFCC
standards are aspirational in nature. The model standards describe education,
training, and experience requirements and emphasize that evaluators should
utilize reliable and valid empirically based assessment methods when analyzing
a case and offering recommendations. Among other things, evaluators should
have reasonable knowledge of applicable statutes, case law, and rules of the
court. The guidelines specifically emphasize the need for evaluators to reduce
any source of potential bias and maintain forensic neutrality in the interest of
providing an objective and impartial report. The importance of such role delin-
eation is also emphasized, with cautions for evaluators not to take on multiples
role and not to offer advice or therapeutic services, which might compromise
the neutrality and objectivity of the evaluation.
Guidelines Offered in the Child Custody Evaluation Literature

Several books offer both novice and experienced practitioners a comprehen-
sive discussion of guiding principles for conducting child custody evaluations.
Gould (2006) and Gould and Martindale (2007) describe in detail the applica-
tion of a forensic and scientifically informed model of practice that emphasizes
the importance of utilizing multiple methods of data gathering to improve the
validity and reliability of the evaluator’s ultimate opinions and that includes
the following principles:
• Identification of psycholegal questions provided by the court to guide the

investigative process
• Multiple interviews with relevant parties and their children
• Use of valid and reliable tests and measure
• Direct behavioral observations, including parent-child interactions
• Review of relevant historical and current records
• Interviews with collateral sources to corroborate or disconfirm hypotheses
• Inclusion of a reference to the empirical literature in the report to justify and
ground recommendations as having some empirical validity; application of
reliable and relevant research
Of particular importance, Gould and Martindale (2007) highlight the need

for the child custody evaluator to maintain a forensic role rather than a thera-
peutic one. This means recognizing the investigative nature of the task and, in
the evaluation report, acknowledging the limitations inherent in the proce-
dures. Several other textbooks (Ackerman, 2006; Fuhrman & Zibbell, 2012;
Hynan, 2014; Stahl, 2011) offer important and well-researched information
that can guide the conduct of a child custody evaluation.
Both novice and experienced evaluators should also keep abreast of
the latest research, practice procedures, and emerging issues in the field by
regularly reviewing the prominent journals relevant to the practice of CCEs.
Among others, the Family Court Review and Journal of Child Custody present
some of the latest thinking and research on best practices. For example, Pickar
and Kaufman (2013) present a pragmatic best-practice model for writing child
custody evaluation reports, which integrates forensic and clinical perspectives.
Other recent articles have offered empirically based best-practice models for
evaluating parenting skills (Moran & Weinstock, 2011), parent-child observa-
tions (Saini & Polak 2014), and the forensic interviewing of children in child
custody evaluations (Saywitz, Camparo, & Romanoff, 2010).
The perception that child custody is a high-risk area of practice has been
borne out over time. Two surveys have revealed that half of the respondents
reported receiving a licensing board complaint in their work as evaluators
(Bow and Martindale, 2009; Bow, Gottlieb, Siegel, & Noble, 2010). These
authors also found that the most frequent type of complaint filed against cus-
tody evaluators was “bias.” Bow et al. (2010) underscore that court-appointed
evaluators must be aware of the various types of personal and cognitive bias
that can impact their work, such as confirmatory bias (Martindale, 2005) or
countertransference bias (Pickar, 2007a). While “bias” is a common charge
levied against evaluators by parents who feel that the report did not support
their position, utilizing a systematic method for organizing and weighing data
can reduce the possibility of such charges. For example, to contend with the
risk of cognitive errors and personal biases by custody evaluators, a notable
book by Drozd, Olesen, and Saini (2013) offers a pragmatic scientifically based
model that can be applied to data analysis and report writing. The approach
is geared towards reducing bias and improving the accuracy of decision mak-
ing. These authors propose using “decision trees” involving checklists and flow
charts to help guide the evaluator through a systematic analysis and synthesis
of the data gathered during the process of a child custody evaluation. Through
such an analysis, pertinent issues are organized into themes that best fit the
data and will ultimately inform parenting plan recommendations made by the
evaluator. Such an approach also targets reduction of cognitive errors and bias
that can unwittingly plague the evaluator’s objectivity.
Lastly, there has been a recent trend in the child custody arena geared
towards developing and utilizing risk-assessment models for use with special
circumstances frequently encountered in child custody evaluations. System-
atic weighing of multiple risk and protective factors should inform parent-
ing plan recommendations to the court. For example, risk assessment models
based on empirical research have been developed in areas such as parent relo-
cation (Austin, 2008a; Austin, 2008b), domestic violence, (Austin, 2001; Jaffe,
Johnston, Crooks, & Bala, 2008; Austin & Drozd, 2012), and special needs
children (Pickar & Kaufman, 2015).
Conducting the Child Custody Evaluation

Child custody evaluations are unique in that multiple individuals are assessed.
In addition, multiple interpersonal relationships and the family system are also
subjects of examination. Every family referred for a CCE has at least two par-
ents and one child. It is incumbent on the custody evaluator to report on the
parenting competencies of each parent and the functioning of each child. In
addition, each parent-child relationship must be understood and discussed,
as well as the co-parenting relationship with respect to how parental conflict
impacts the child (Pickar & Kaufman, 2013).
In general, custody evaluators must use multiple modes of data collection,
including parent and other caretaker interviews, interviews of the child,
parent-child observations, review of relevant documents and interviews
of collateral sources of information. There has been considerable litera-
ture about the utility of psychological testing in custody evaluations (Flens,
2005). However, psychological testing is not a mandated component of the
evaluation. Typically, either the court or the referring attorneys will specify
whether testing is desired, or evaluators will state their preference for utilizing
psychological testing as an additional source of CCE data.
Referrals for custody evaluations should include specific questions about

which the court requires input, in addition to the more global issue of what
parenting plan would be in the best interests of the child. This might include,
for example, why is a child expressing a strong preference for spending more
time with one parent? Does a parent suffer from a serious psychiatric or sub-
stance abuse disorder that significantly impacts his or her parenting capacity?
Has a parent negatively influenced a child’s relationship with the other parent,
such that the child is refusing to spend time with that parent? Specific questions
raised either by the court or by the parents themselves should be addressed in
the custody evaluation report.
More specifically, comprehensive child custody evaluations will include the
following procedures:
• Interview parents individually regarding:

� Their views of custody related issues, including concerns about the chil-
dren, the other parent(s), and the allegations and assertions;

� Their response to allegations and assertions raised by the other parent;
� The history of the parents’ relationship, both prior to and subsequent to
separation and/or divorce;

� Their views of the functioning of each child and their understanding of
the desires of each child;

� Their individual family and relationship history;
� Their views of the parent-child relationship;
� Their views of the co-parenting relationship;
� Their views of evaluation-specific issues (ex. domestic violence, allega-
tions of sexual abuse, view of proposed relocation of a parent);

� Their views of a parenting plan that will address the child’s needs and
their willingness to support the child’s relationship with the other parent.
• Interviewing children regarding:
� The structure and nature of their lives, including school, activities out-
side of school, and peer relations;

� Their day-to-day routines in each parent’s home;
� Their views of their relationship with each parent (including step-parents
and other significant caretakers) and siblings (including step-siblings);

� How rewards and discipline are handled in each home;
� Their views of the existing custody and access plan, if they have any;
� Their experience of living in two households and managing day-to-day
logistics;
� Their moods, worries and concerns.
• Interviewing step-parents and other significant caretakers regarding:

� Many of the same issues as with parents, though there is less emphasis on
personal history.
• Parent-child observations
� Depending on the age, this will take place in the evaluator’s office and
may include unstructured play between parent and child, as well as a

structured task for a parent and child to do together.
� Though not required, many evaluators conduct in-home parent-child
observations. These preplanned visits have the advantage of observing

children in settings in which they are comfortable and in which they
conduct activities typical of their daily lives.
� Recent literature (Saini & Polak, 2014) suggests that multiple observa-
tions of children across settings increases the ecological validity of the

data obtained.
• Psychological testing
� When psychological testing is part of a comprehensive custody evalu-
ation, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2;

Butcher, Dahlstrom, Graham, Tellegen & Kaemmer, 1989) is the most
commonly used assessment instrument. Other tests often used by custody
evaluators include the Rorschach Inkblot Method, the Millon Clinical
Multiaxial Inventory-III (MCMI-III; Millon, Millon, Davis, & Grossman,
2006), and the Personality Assessment Inventory (PAI: Morey, 2007).
� Both AFCC Guidelines and APA Guidelines for Child Custody Evalua-
tions offer cautions about the use of psychological testing for parents in
custody evaluations. These issues, as well as the appropriate forensically
informed use of these instruments have been discussed extensively in
the child custody literature (Flens, 2005; Otto, Edens & Barcus, 2000).
While some tests have been developed specifically to test parenting
abilities, none of them have the requisite validity and reliability to meet
the admissibility criteria for use in court.
� In the case discussed in this chapter, the evaluator utilized the MMPI-2
and the Rorschach. Both instruments have sound and long-standing

empirical bases, are used regularly in forensic evaluations, and meet both
Frye and Daubert standards for use in court. The MMPI-2 is primarily
a measure of psychopathology and is particularly useful for identifying
personality disorders and clinical syndromes that may interfere with
day-to-day parenting. These could include, for example, significant anxi-
ety or depression, deficits in capacity for empathy, problems with reality
testing, and resistance to following rules and orders. The primary draw-
back of the MMPI-2 in custody cases is the high incidence of defensive
profiles, wherein parents are unwilling to report even minor faults, much
less more significant problems in living. This response set can often ren-
der their MMPI-2 protocols invalid.
� The Rorschach Inkblot Method (RIM) has long been described as a
“projective” test. Especially with the development of the Rorschach

Performance Assessment System (R-PAS; Meyer, et al., 2011), it is most

accurately defined as a performance based personality measure that
adds incremental validity to self-report offered in interviews of custody
litigants (Erard, 2014). Many of the concerns about the normative
sample and statistical validity of some structural variables developed
with the Comprehensive System (CS) have been addressed by R-PAS.
The empirical base of the instrument when scored and analyzed via
R-PAS has been strengthened and has led to increased use of the proce-
dure in custody evaluations (Ackerman & Pritzl, 2011). There is ample
research supporting the notion that the RIM, particularly when scored
with R-PAS, yields enormously helpful information regarding stable and
enduring personality characteristics that underlie parenting capacities. It
is especially useful for revealing how individuals manage stressful situ-
ations, how individuals behave in intimate partner relations, and how
their patterns of thinking and feeling emerge over time (Viglione &
Meyer, 2008; Mihura et al., 2013; Erard & Viglioni, 2014).
• Information from collateral sources:
� Written documents submitted to the evaluator that typically include
declarations, pleadings, reports, and other materials submitted to the

evaluator by the attorneys and the parents;
� Interviews with third parties who have had contact and interaction
with the parents, the children, or the family as a whole. These often
include mental health professionals, medical providers, teachers, visita-
tion supervisors, tutors, child-care providers, friends, and other family
members.
The Child Custody or Parenting Plan Report

The CCE report is a forensic work product, which addresses the legal questions
posed by the court and consequently should adhere to guidelines for forensic
psychological reports (deMirer, 2012). These include discussions of data that
are weighed to analyze rival hypotheses and lead to the evaluator’s conclusions
and recommendations. Pickar & Kaufman (2013) note that, in reality, CCE
reports will be read and utilized by parents and attorneys and, potentially, by
various professionals who are assisting families in addition to bench officers.
Therefore, reports should be written with these multiple “clients” in mind
by avoiding jargon, denoting parenting strengths as well as weaknesses, and
creating a sense of hope for families in turmoil. In addition, the well-crafted
custody report makes good use of insightful clinical impressions and under-
standing. As noted by Pickar and Kaufman (2013), “If anything, report writing
grounded not only in science, but in sophisticated and well-reasoned clinical
judgment, plays an essential role in helping the court understand complex and
seemingly contradictory reports from parents, complicated histories, and the
needs of children who are often too young to articulate feelings and needs at
sufficient level of emotional maturity” (p. 23).
Custody evaluation reports that are helpful to the court and to parents
alike provide a clear presentation of the data collected, whether the data are
from interviews, observations, documentary evidence, or psychological test-
ing. Effective reports lay out the scope of the assessment and the psycholegal
questions. Readers should be able to understand how the evaluator weighed
evidence, including conflicting reports from parents, to arrive at conclusions.
This includes discussing evidence and data that do not necessarily support
the evaluator’s conclusions. Given how emotionally charged custody work can
be, evaluators should be particularly careful to avoid describing parents in a
polarized fashion, as bias is the most common complaint lodged against evalu-
ators by custody litigants. In particular, evaluators are well advised to work
hard to incorporate what is termed “the voice of the child” in their reports.
This includes not only the child’s stated preferences but also a picture of how
the child experiences family life.
Most often, CCEs culminate in a set of recommendations regarding both
legal and physical custody. These terms mean, respectively, how decisions are
made regarding the children and how the children divide their time between
homes. This typically includes specific timeshare schedules during the school
year, as well as a plan for holidays and vacations. It is not unusual for reports
to offer additional recommendations that could aid the family. These might
include, for example, mental health treatment for individuals and/or the fam-
ily, methods for addressing interventions related to substance abuse and/or
domestic violence, and supervision for visitation or any other intervention or
structure needed.
It is important to note that there has been controversy as to whether cus-
tody evaluators should be offering specific recommendations at all to the
court, versus providing analysis of data to the trier of fact, who in turn will
make decisions on these key issues (Tippins & Wittmann, 2005). While there
is no argument that judges are charged with making ultimate determinations,
there is some evidence that judicial officers want evaluators to make recom-
mendations, though the recommendations are considered a starting point for
the court, with the judge then likely to hear additional evidence at hearings or
in trial (Ackerman, Ackerman, Steffen, & Kelley-Poulos, 2004; Stahl, 2014).
The Impact of the Evaluation Process

Custody evaluators should be cognizant of the fact that it is invariably stressful
for parents and children to participate in these comprehensive assessments. Par-
ents arrive at the evaluation process when other means of resolving disputes have
failed and when parents have effectively turned critical decisions about their chil-
dren over to third parties. Additionally, the need to have input from the children
directly means that the children are thrust into the midst of their parents’ disagree-
ments. Depending on their age, children are often aware that their input could
affect the evaluator’s views and recommendations. This is especially so since cus-
tody evaluators are required to provide all participants, including children, with
informed consent and an understanding of the evaluation process. Additionally,
one cannot ignore the fact that custody evaluations, especially comprehensive
family assessments, can take as much as three or more months to complete, and
these evaluations are financially costly. While custody evaluators must keep appro-
priate neutrality and distance during the assessment process, they should be care-
ful to treat participants with respect and strive to ensure that parents and children
alike feel that their views have been understood. Application of “forensic empathy”
(Brodsky & Wilson, 2012) can be particularly salient in child custody evaluations.
Case Vignette
Reasons for Referral
Ms. Frankel was 36 years of age and worked as an administrator at a finan-
cial institution. Mr. Frankel, age 42, was employed as a program developer for
a software company. They had one daughter, Julia, age 4-and-three-quarters,
who at the time of the evaluation was enrolled in a local prekindergarten pro-
gram. The parents live within the same county, approximately eight miles from
each other. The family was referred for a comprehensive child custody evalu-
ation by a Family Court Services mediator shortly after their separation and
after the mother filed for divorce. The parents had separated once earlier for
a period of three months, but reconciled and remained together for another
three years prior to the final separation and filing. The ultimate separation took
place after an incident at their home in which the parents had an angry argu-
ment and confrontation in front of their daughter, during which Mr. Frankel
called the police and alleged that his wife had been violent towards him. Ms.
Frankel was ordered to leave the home and Mr. Frankel filed for a restraining
order against her. He was also awarded sole custody of Julia, although, after an
emergency hearing, a plan was adopted that allowed Ms. Frankel to have visits
with their daughter that were supervised by the mother’s family. These visits,
which did not include overnights, lasted approximately one month, at which
time the parents went for county-mandated mediation. Mr. Frankel withdrew
his restraining order, and the Family Court Services mediator recommended a
temporary plan in which the parents had joint legal custody and shared physi-
cal custody, on a rotating “2–2–3” schedule each week. With this schedule,
Julia was with one parent on Mondays and Tuesdays and with the other parent
on Wednesdays and Thursdays, followed by a return to the first parent’s home
for the weekend (Friday, Saturday, and Sunday). These time periods then
alternated on a continuous rotating basis. The parents agreed to this plan and
agreed to seek a private custody evaluation.
By the time the custody evaluation commenced, the timeshare plan had
been in place for four months. From Mr. Frankel’s perspective, the timeshare
and schedule were working well. Still, he had significant concerns about
Ms. Frankel’s emotional stability. He characterized her as generally being very
controlling, both of him and their daughter, but also prone to abrupt mood
swings and outbursts of anger. He emphasized that there had been no fewer
than five prior incidents in which the police were called due to her behavior,
and he was concerned about the ill effects of such incidents on their daughter.
Mr. Frankel noted that since the court had been involved, Ms. Frankel had
been on better behavior. Although his job required some international travel,
Mr. Frankel insisted that it was not as extensive as has been depicted by the
mother. He requested that a system be put in place that would enable him to
receive “make-up time” for days he misses with their daughter. He also pro-
posed a somewhat different custody schedule that would have Julia in each
home for longer blocks of time. That way, he could better plan his business
trips to take place when he did not have his daughter and therefore would need
to ask for fewer changes in the schedule due to his work.
From Ms. Frankel’s perspective, the temporary schedule was not working
well for Julia. She described Mr. Frankel as disorganized, a poor planner, and
overwhelmed by work demands. Consequently, Mr. Frankel had frequently
asked her to trade custodial time or to provide backup for him when he could
not care for their daughter. This included sometimes dropping Julia off at
Ms. Frankel’s house early in the morning so Mr. Frankel could participate
in work calls to clients in Asia or Europe. Ms. Frankel further asserted that,
because of their daughter’s age, Julia would do better spending more time with
her, though she also acknowledged that Julia loves her father and that “he is
a lot of fun.” Ms. Frankel was critical of Mr. Frankel for not keeping Julia on
consistent agreed-upon routines like bedtime and naps. She also strenuously
disagreed with Mr. Frankel’s characterization of her as volatile and suggested
that Mr. Frankel was both provocative and “passive aggressive.” She believed
that Mr. Frankel should have custody of their daughter every other weekend,
with some midweek dinner visits, if he could consistently maintain them.
Evaluation Process
The parents’ attorneys contacted the evaluator and a stipulation to conduct the
custody evaluation was drafted, signed by the parties and their counsel, and
filed with the court. Each parent met with the evaluator individually on three
separate occasions for a total of six hours each. During the initial meeting, the
evaluator reviewed with the parties the terms and conditions of the evaluation
process in detail and also fielded their questions and concerns. Over the course
of the meetings, the parents reviewed their goals for the assessment, their views
of relevant issues that were specific to the custody assessment, their views of
their child, their personal history, and the history of their relationship. In addi-
tion, each parent completed the Minnesota Multiphasic Personality Inven-
tory-2 (MMPI-2) and was administered the Rorschach Inkblot Method. Each
also completed a comprehensive questionnaire regarding their history and
concerns, and further completed the Behavior Assessment System for Chil-
dren, Second Edition (BASC-2), which assisted the evaluator in understanding
each parent’s view of their child’s behavioral and emotional functioning.
Each parent was seen for a one-hour in-office observation with their
daughter. The evaluator also conducted a two-hour parent-child observation in
each of the parent’s homes. This was in addition to two individual sessions with
Julia. For balance, each parent brought Julia to a session and waited for her in
the evaluator’s waiting room. Both parents submitted letters of reference from
friends and family members. With written consent of the parents, the evaluator
also spoke with the child’s pre-K teacher, a former baby sitter, a former couple’s
therapist, and the mother’s current therapist. Court pleadings and declarations
were also reviewed, as were police reports from all incidents noted.
Relevant Background
Both parents were born in an Eastern European country, though they emi-
grated at different times of their lives. They met via an online dating service
and, within a few months, they began cohabitating. Both parents reported that
the early part of their relationship was passionate and exciting, though they
were also prone to episodic arguing and conflict. Arguments focused on the
demanding nature of Mr. Frankel’s work life and Ms. Frankel’s frustration
that they did not spend enough time together. There were several times that
Mr. Frankel would leave the home for a few days or a week but then offer
a very romantic gesture, after which Ms. Frankel would ask him to return.
There was a lengthier period of separation after a particularly volatile incident,
but the parents eventually reconciled. During one romantic weekend away,
Julia was conceived. While the parents had talked at different times about hav-
ing a child, this pregnancy was not planned. Not long thereafter, Mr. Frankel
moved back into Ms. Frankel’s home. They married when Ms. Frankel was
four months pregnant.
Over the ensuing two years, there remained instability in their relationship.
Calm periods were punctuated by romantic reconciliations. The parents also
started to argue over parenting issues. On three occasions, Mr. Frankel called
the local police and alleged that Ms. Frankel was negligent and hence endan-
gering their daughter or that Ms. Frankel had been violent and rageful, includ-
ing handling Julia in a rough way. During one incident, when Julia was 4 years
of age, Mr. Frankel produced a restraining order that he procured previously
unbeknownst to Ms. Frankel. He presented it to the police who ordered Ms.
Frankel to leave the home without their daughter. Over the next two months,
Ms. Frankel had visitation with Julia almost every day, though there were no
overnights. Eventually, the couple mediated the timeshare agreement that was
in place at the beginning of the custody evaluation.
In terms of the parents’ earlier family history, each had endured serious
difficulties during their childhood and adolescent years. Mr. Frankel and his
family came to the United States when he was an elementary school child,
and the family suffered some economic hardship after their relocation, as
his parents were unable to find employment in the fields in which they were
trained. Mr. Frankel felt that there was a significant cultural divide between his
parents and him, as he had grown up largely in the American culture. He also
described his father as dictatorial, controlling, and threatening to the point of
being abusive. After one particularly bad physical confrontation during his
senior year of high school, Mr. Frankel moved out of the family home and
lived with another family, returning only shortly before his graduation. He
went on to college and never returned to the family home. While Mr. Frankel
was able to reconcile with his father some years later, there always remained
tension and a deep cultural divide in the relationship.
Ms. Frankel immigrated to the United States when she was 19 years of age.
After her parents divorced, Ms. Frankel had no further contact with her father
other than one letter when she was an early teenager. Since that time, she has
had no contact with any of her paternal relatives. Ms. Frankel reported that it
was not uncommon in her culture for men to disappear and create different
families after divorce. Thus, Ms. Frankel was raised by her own mother, whom
she described as caring and respectful.
Collateral Contacts
Several professionals were contacted to obtain independent third-party infor-
mation. Current and former teachers and childcare professionals confirmed
that Julia was developing well in terms of cognitive abilities and social skills.
They further noted that Julia was generally happy, well adjusted, and eager to
see whichever parent picked her up from preschool or child care. Julia’s teacher
at the time Julia was separated from her mother reported that she was unchar-
acteristically sad and dysregulated for those weeks. In addition, Julia seemed
confused about when she would see her mother. The parents’ former couple’s
therapist reported that the treatment only lasted six sessions. Mr. Frankel had
initiated the counseling and reported that Ms. Frankel was prone to angry out-
bursts and was demeaning and controlling of him. He alleged that she “got in
my face” and complained that he didn’t make enough money. Ms. Frankel said
she was disappointed in Mr. Frankel and that he needed to be more respon-
sible and reliable. She acknowledged getting frustrated and impatient, but
denied being confrontational. The therapist said that the parents had difficulty
getting beyond the mutual allegations and were unable to be empathic towards
the other. Treatment ended about three weeks prior to the incident that led to
the couple’s separation.
Mental Status Examinations

In individual interviews, both parents were cooperative and well engaged, and
both expressed a great commitment to the positive care of their child. Neither
parent demonstrated evidence of a thought disorder in their clinical presenta-
tion or exhibited overt signs of depression or significant anxiety. Both parents
were intelligent and articulate individuals and evidenced a range of emotions
in ways that were appropriate to the situation. Mr. Frankel was rather charm-
ing and had a boyish quality about him. He could also be warm and humor-
ous. Ms. Frankel was extremely well organized, articulate, very respectful, and
composed. She did, however, become tearful when discussing the imposed
separation from her daughter.
Across the multiple individual meetings with Julia, as well as the parent-
child observations, it was clear that Julia was bright, engaging, and energetic
and did not suffer any developmental delays. She was also very responsive
to and affectionate with both parents. Both parents’ home lives appeared to
center around their daughter, who seemed to be familiar and comfortable with
the routines in each home.
Psychological Measures: Child and Family Observations

There were noteworthy differences in the parent-child observations in the
evaluator’s office. Ms. Frankel arrived for the observation meeting with a
number of toys and play materials. From the onset, she guided and structured
the daughter’s play thorough different activities, and the daughter was very
compliant with her mother’s directions. Ms. Frankel also rewarded Julia fre-
quently for her good performance, which made the daughter become brighter
and more animated. At the same time, she corrected her daughter for rela-
tively minor “mistakes,” even during an art project. Ms. Frankel also led Julia
through some reading games and, at the end of the session, reported that she
wanted the evaluator to get a good sense of Julia’s capabilities.
The home visit with Julia and her mother was somewhat more relaxed,
though Ms. Frankel also took charge of decision making regarding the activ-
ities that we could all play together. During a board game, the Julia tried to
manipulate the materials so she would get an optimal score and win every
time. Ms. Frankel assured Julia that she would win, but when she tried to
set a limit with her, Julia became petulant and verbally balked, insisting on
getting her way. Eventually, Ms. Frankel had to convince the daughter to
switch games.
For Mr. Frankel’s in-office visit, he did not bring any of Julia’s play materials,
which had been an option suggested by the evaluator. Rather, he relied on toys,
games, and art materials already in the office. Julia gravitated towards some art
materials and, for some time, she was engaged in building and creating, with
Mr. Frankel offering suggestions, encouragement, and enthusiastic reinforce-
ment. As Julia became more engrossed in the activity, Mr. Frankel started to
recede and become less engaged, although he did offer some periodic assis-
tance to his daughter.
During the visit and observation at Mr. Frankel’s home, Julia was animated
and playful. She and her father were also playing with a soccer ball and, at
times, she kicked it quite hard and with agility. The daughter also took out
some dolls and started to create scenes and narratives in which her father par-
ticipated. He also directed her to some educational materials they had been
using so Julia could show that she was learning her numbers. Still, Julia con-
tinued to gravitate to games on her iPad. Mr. Frankel suggested that perhaps
she could show the evaluator some dance moves that she had been practicing
or making up. Much time was spent with Julia demonstrating her skills, which
she seemed happy to do, and garnering enthusiastic rewards from her father.
Julia was also seen in separate individual sessions in the office. She was
brought to each meeting by a different parent and her presentation in each
session was roughly equivalent. She had no difficulty separating from either
parent. Julia was well engaged, as well as focused during the interviews. Typi-
cal for children her age, Julia spoke in relatively concrete or practical terms
regarding her life in each home. She explained that her father had to travel, so
sometimes she had to go to her mother’s home early in the morning, which
was hard as she had to wake up early. Julia expressed affection for each par-
ent, and she particularly liked her pre-K class. Julia expressed relief that she
no longer had to listen to her parents fighting, since when she did hear her
parents fighting, she would get scared. In addition, Julia did not understand
why she had to stay only at her father’s home for the weeks after the parents’
most dramatic argument (i.e., after Mr. Frankel obtained a restraining order
against Ms. Frankel). In general, Julia reported no negative information about
either parent, but rather, she expressed that she liked to spend time in each
parent’s home.
Psychological Measures: Results from Psychological Testing

Both parents completed the MMPI-2 and were administered the Rorschach
Inkblot Method. It should be noted that there are no psychological tests that
directly assess parenting abilities with acceptable validity and reliability. Both
the MMPI-2 and the Rorschach have been used extensively in child custody
evaluations, and both tests have met standards for admissibility in court. There
is sound empirical support for using these instruments to generate hypoth-
eses regarding personality characteristics and qualities that are important in
effective parenting. These include, among many others, capacity for empathy,
accuracy of reality testing, ability to express emotions in ways that are nei-
ther overly constricted nor labile, and presence of significant psychopathol-
ogy. While both parents were born in a foreign country, they were bilingual.
Mr. Frankel’s native language was spoken in his childhood home, but he was
educated in English since elementary school. While Ms. Frankel knew limited
English when she came to the United States, she took classes and ultimately
obtained a college degree from an American institution. She became fluent
in English, and her reading capabilities far surpassed the eighth-grade level
required for the MMPI-2.
Mr. Frankel’s response pattern on the MMPI-2 was straightforward and
did not indicate a conscious attempt to portray himself in an overly positive
light. The profile was valid. His MMPI-2 revealed a moderate level of emo-
tional distress. There was a significant elevation on scale 7 (Psychasthenia)
with secondary significant elevations on scale 8 (Schizophrenia) and scale 6
(Paranoia). Analysis of the MMPI-2 code types and subscales indicated that
Mr. Frankel was experiencing moderate dysphoria and some agitation. He
tended to brood over life situations and worry about his social effectiveness
and lack self-confidence. On the positive side, the MMPI-2 findings were con-
sistent with an individual who is analytical, sensitive, and creative, though,
overall, rather cautious about taking risks. In terms of interpersonal relations,
Mr. Frankel’s MMPI-2 profile revealed him to be passive and have difficulty
forming close meaningful bonds. His responses also suggested that he often
felt isolated and lonely, with a long history of hurt feelings and resentments.
While the MMPI-2 results did not reveal Mr. Frankel to be a fundamentally
angry or aggressive individual, there were indications that periods of passivity
could sometimes give way to instances of unpredictable acting out.
Mr. Frankel was also administered the Rorschach Inkblot Method, scored
using the Rorschach-Performance Assessment System (R-PAS; Meyer, et al.
2011), and the results were statistically valid. A review of his Rorschach pro-
file indicated that Mr. Frankel’s characteristic coping mechanism was to avoid
awareness of any emotional aspects of relationships or situations that caused
him distress or made coping too complex and difficult. His tendency was to
restrict his feelings and inhibit expression of emotions as a form of defense.

This is not especially adaptive, and when Mr. Frankel does experience strong
emotions, he becomes prone to acting out in a passive-aggressive manner. The
Rorschach structural data also suggested that his psychological and emotional
resources were strained, particularly by situational factors, leading him to be
impulsive at times and have difficulty restoring emotional equilibrium. At
the time of the evaluation, Mr. Frankel was feeling helpless and at a loss for
how to cope effectively with his life. A problem for Mr. Frankel was that he
did not spend enough time gathering information and understanding people
and situations in adequate depth. Thus, he tended to come to conclusions and
strategies for solving problems with inadequate information and insufficient
forethought. Essentially a risk avoidant individual, Mr. Frankel would typically
seek relatively quick or easy solutions. He was particularly weak in the area
of understanding the nuances of relationship dynamics so that, especially in
close relationships that were laden with conflict, his judgment and assessment
of others tended to falter.
Ms. Frankel approached the MMPI-2 with a degree of caution. The valid-
ity scale scores indicated that she was an individual who was reluctant to
admit personal faults, and who characteristically adopted a moralistic stance
when viewing others and interpersonal relations. Ms. Frankel’s approach to
the MMPI-2 was essentially self-protective. None of the clinical scale scores
reached a criteria level that would suggest severe psychopathology, but again,
her self-protection and defensiveness no doubt suppressed scale elevations. Her
highest score was on scale 6 (Paranoia). Ms. Frankel’s MMP-2 profile suggested
a high level of investment in correct outward behavior, especially in social situ-
ations. She expressed positive beliefs in her capabilities, but at the same time,
was hypersensitive when hearing criticism from others. The MMPI-2 results
suggested that Ms. Frankel had relatively limited insight into her own behav-
ior and a distinct tendency to project blame outside of herself. Resentments,
particularly of family members, were fixed. Ms. Frankel tended to vacillate
between excessive self-control and attempts to control others, with periods
of impatience leading to impulsive behavior. Her profile suggested sound ego
strength and a good ability to meet responsibilities on a day-to-day basis, but
she was also prone to feeling mistreated by others and quick to resent people
and feel morally righteous. She was socially confident and placed value on her
personal independence. Ms. Frankel also tested as someone who could be very
rational, logical and extremely loyal. She would work hard to remain above any
criticism, but she also likely had difficulties letting go of past resentments.
On the Rorschach Inkblot Method, Ms. Frankel produced a valid profile, but
one suggesting that she was warding off more dysphoric feelings and self-doubts
than she would acknowledge. Ms. Frankel’s profile suggested that she was prone
to exerting control in close relationships as a defensive attempt to avoid being
hurt or criticized. Her tendency was to overwork or be perfectionistic in order

to avoid criticism. She was quite alert and hypervigilant to what was taking place
in her environment in an attempt to shield herself from anticipated criticism.
Additionally, the test showed that Ms. Frankel typically avoided deep emotional
involvement and had trouble trusting others beyond the superficial. Still, she
was shown to be capable of realistic and conventional relationships that are
positive, so long as they are not too demanding. However, unmet dependency
needs made it difficult for Ms. Frankel to engage with people intimately and to
let down her guard. Her fear of losing emotional control caused her to expend a
great deal of energy to keep painful emotions out of her awareness, for fear of not
controlling her emotions in the presence of others. Ms. Frankel’s general coping
resources were adequate for dealing with the demands of her environment.
Clinical Summary and Opinions

Determinations of custody and access for this family are based on the “best
interests of the child” standard. In turn, this evaluation shed light on several
factors central to a BIC analysis. They include the following:
• Parent strengths and weaknesses

• Functioning of the child
• Parent-child relationships
• Allegations of domestic violence
• Co-parenting relationship
• Additional factors that impact timeshare determinations
Parenting Strengths and Weaknesses: Father While these parents certainly

shared a deep love and affection for their daughter and, while both could also
recognize the importance of the other parent in their daughter’s life, they had
differences and disputes on several fronts. Their relationship had also been
episodically volatile, with allegations of domestic violence. With regard to Mr.
Frankel, he had clearly been a devoted and dedicated parent. He had been
consistently motivated to be an active and influential part of his daughter’s life.
The evaluation found him to be a sensitive individual who can be emotional,
very warm and caring, and who loves to be in his daughter’s presence. His
parenting style could be described as relaxed, flexible, and not overbearing.
He was at his best in low-stress situations. Mr. Frankel was consistent about
picking up his daughter from child care. Despite the serious allegations Mr.
Frankel levied against Ms. Frankel, he acknowledged during the evaluation
that she had been a highly capable and caring parent. To his credit, Mr. Frankel
was able to respond to his daughter’s expressed desire to spend more time with
her mother when the daughter missed her.
Mr. Frankel’s relaxed and very likeable external presentation masks a some-
what more complex psychological picture. Though clearly competent and
highly intelligent, assessment findings revealed him to have an emotionally
needy and dependent side to his personality. This was particularly evident from
the psychological testing, which raised a concern as to whether Mr. Frankel
focused too much attention on his daughter to fill an emotional hole or the pain
caused by the separation and divorce. Psychological testing, combined with
some historical data, also indicated that Mr. Frankel could be unpredictable in
his emotional control when anger or anxiety arises and, at such times, he was
prone to excessive agitation or dramatic emotional reactions. In terms of direct
parenting, Mr. Frankel’s general skills were assessed to be sound. However,
Mr. Frankel was more authoritative and less indulgent with Julia. Because he
wanted to be liked by his daughter so much, when Julia misbehaved or required
limit setting, Mr. Frankel had been too passive and reluctant to go against Julia’s
immediate desires. Thus far, Julia has been a child who very much wanted to
please and perform for her parents. However, over the course of her develop-
ment, Julia would, no doubt, pose more challenges for both parents. This would
require Mr. Frankel to expand his parenting skills and be firmer and less con-
flict avoidant. The evaluation raised additional concerns that Mr. Frankel had
not developed an adequate support network independent of Ms. Frankel. While
it was positive that he had been willing to allow Julia additional time with Ms.
Frankel when Julia asked for it, his reliance on Ms. Frankel to help him man-
age his work schedule was problematic. This arrangement worked adequately
during those periods when conflict between the parents was low. However,
these were not co-parents who could maintain reasonable calm for very long.
Furthermore, the evaluation validated Ms. Frankel’s concern that Mr. Frankel’s
poor organizational skills impacted planning around Julia’s needs.
Parenting Strengths and Weaknesses: Mother Ms. Frankel presented

as a high-energy and effective person in her day-to-day life. The evaluation
revealed her to be extremely well organized and socially poised, though Ms.
Frankel also presented as someone who is often on guard, exacting and overly
vigilant. Ms. Frankel’s love for Julia was palpable and observable. She took
great pride in her daughter’s accomplishments and her winning personality
and was spontaneously affectionate in ways that seemed genuine and heartfelt.
Ms. Frankel had especially good organizational and coping skills for managing
the diverse challenges of both work and parenting.
The findings from the evaluation did not support Mr. Frankel’s allegations
that Ms. Frankel was negligent at home with their daughter. If anything, she
was observed to be attentive to detail, if not excessively so at times. This impres-
sion was confirmed by independent reports from people such as child care
providers. Despite the episodic parental conflict, the police reports, and the
domestic violence allegations, this evaluation did not reveal Ms. Frankel to be
an individual who was aggressive or had persistent problems with anger and/
or impulse regulation. The evidence suggested that Ms. Frankel was an exact-
ing individual who demanded much from others and had been disappointed
by Mr. Frankel. She had likely expressed her frustration in forceful ways, but
it was important to note that there had not been a finding that she had per-
petrated domestic violence against Mr. Frankel. Ms. Frankel also understood
that Julia’s relationship with her father was important and must be supported.
Ms. Frankel cooperated with the temporary-custody schedule, though she did
not believe it was optimal, and accommodated the father’s requests for changes
in custodial time around his work travel.
Despite her many strengths, the evaluation raised some concerns about Ms.
Frankel’s parenting skills. Data suggested that over time, she may have difficulty
letting Julia make age-appropriate choices and determine her own interests,
particularly if they differed from own desires. There could also be continued
challenges for Ms. Frankel regarding co-parenting. While she accepted and
acknowledged the importance of Mr. Frankel’s role in Julia’s life, she had ques-
tioned his competency in a number of areas. Ms. Frankel expressed a high
degree of confidence in her view of what is best for Julia and did not appear
to view Mr. Frankel as an equal parent. Accepting that Mr. Frankel may have
different, but equally valuable, ways of approaching some aspects of parenting
was a recommended goal for Ms. Frankel in co-parenting counseling. Still,
clinical interviews and psychological testing revealed that she was an indi-
vidual of sound mental health, with no serious social and/or emotional prob-
lems. She was a highly competent parent, and despite her ambivalence towards
Mr. Frankel, it is likely that she would provide very competent and consistent
parenting and facilitate continuing contact between Julia and Mr. Frankel.
Re: Julia As for Julia, this assessment revealed her to be a delightful girl
who can be outgoing, creative, and effervescent. Reports from both parents
and the collateral interviews indicated that she was generally happy and
cognitively and developmentally advanced, and she had no serious social
or emotional problems. Over the times that she was seen by this evalua-
tor, Julia was very sweet, active, and enthusiastic. She was very comfortable
and secure with each parent, and when she did push boundaries or become
mildly oppositional, it was in ways that were age appropriate. The parents
expressed different views of how Julia responded after the domestic violence
charges and the sudden separation from her mother. Reports from collateral
sources who saw Julia at the time reported that, not unexpectedly, Julia did
have emotional difficulties, not only from the exposure to the episodic angry
arguments but also, most significantly, from the abrupt separation from her
mother. The collateral source information also suggested that Julia recovered
well from this difficult situation, and by all indications, she was ready to start
kindergarten next year.
A main area of concern was that Julia felt compelled to please her parents
so much. She had already been exposed to too much overt conflict between
them, and there was also some concern that she could eventually be com-
pelled to take on the role of peacemaker between her parents. By both par-
ents’ reports, Julia had enjoyed the time when the parents were together with
her. It is very typical for children her age to be invested in their parents’ rec-
onciling or remaining together, so these parents will need to be careful not to
give Julia an inaccurate impression of their relationship. It was determined
that Julia would benefit from more stability in her schedule, with clear limit
setting and rules and less volatility between the parents. Fundamentally, Julia
had been very well cared for by both parents. Reports from the preschool
also indicated that Julia was an empathic child who was also well liked by her
peers. Thus, barring further instability or conflict between the parents, the
trajectory for Julia was determined to be positive.
Evaluation-Specific Issues
Domestic Violence and Volatility Regarding the issues of domestic
violence, this evaluator reviewed the police reports, each parent’s declarations,
and the parents’ direct accounts of the multiple incidents in which the police
were called. There had not been a court finding of domestic violence in this
case, and this evaluator’s review of the evidence revealed that there had not
been a persistent pattern of battering or serious abuse perpetrated by either
party. There had, however, been too much volatility and arguing, some of which
had taken place in front of Julia. It was very difficult, if not impossible, to deter-
mine which of the two parents had been the more volatile or who has instigated
the arguments and conflicts more than has the other. Both parents were very
strong-willed, and neither had especially good interpersonal conflict-resolution
skills, particularly in close interpersonal relations. Mr. Frankel’s allegation that
Ms. Frankel was a violent individual did not appear to have much basis in fact.
If Mr. Frankel was fearful of Ms. Frankel, it would have been highly unusual
that, very soon after obtaining a restraining order against Ms. Frankel, he would
spend time with her and Julia on family outings or at Julia’s activities. It is pos-
sible that Mr. Frankel felt fearful when Ms. Frankel became angry, but the data
did not reveal those instances to be extreme or persistent. Mr. Frankel’s actions
raised a question as to whether his calls to the police were the result of a sincere
need for protection or, rather, were driven by a combination of his inability
to manage the interpersonal conflict and his desire to create a record of the
couple’s domestic problems. Overall, there was no evidence that precluded the
parents from having a joint-custody timeshare arrangement.
Respective Allegations about Parenting Skills Both parents levied allega-

tions and concerns about some aspect of the other party’s direct parenting skills.
Mr. Frankel suggested that Ms. Frankel not only indulged Julia but also treated
her as a much younger child, including allowing her to drink from a bottle. He
also alleged that Ms. Frankel was somewhat neglectful at home, letting Julia
play with hot or dangerous appliances without supervision. This allegation was
inconsistent with other information Mr. Frankel provided, as frequently he
described Ms. Frankel as exacting and demanding, if not compulsive. While
custody evaluations involve a limited sampling of parental behavior under
direct observation, this evaluator viewed the mother as a vigilant parent who
was also very oriented to detail in her environment. In her presence, Julia did
not ask to be treated in ways that were inappropriate, nor did Ms. Frankel treat
her like a much younger child to the extent that Mr. Frankel claims. It was true
that Ms. Frankel had been indulgent with Julia and tried to avoid her experienc-
ing even inevitable disappointments (ex. making sure she wins every game on
the home visit), but there was little difference between the parents in this regard.
Ms. Frankel’s main concern about Mr. Frankel was that he had been unable
to meet the demands of a half-time parent due to the challenging nature of his
work life, which frequently involved travel, as well as his general disorganiza-
tion. She offered some statistical evidence showing that he needed her to cover
significant portions of his custodial time to accommodate his work. Mr. Frankel
did not refute Ms. Frankel’s statistics or deny that he had frequently relied on
her for backup child care. Mr. Frankel described his travel schedule differently
at different times during the evaluation. He also portrayed it as less demanding
than Ms. Frankel did. While Ms. Frankel had been willing to assist Mr. Frankel
with child care, this was not a long-term solution, especially as Mr. Frankel had
needed help very early in the morning. Over time, this could be experienced
as intrusive by Ms. Frankel. It did appear to be accurate that Mr. Frankel’s job
responsibilities made it difficult for him to maintain consistently the current
temporary custodial timeshare plan. The situation was further complicated by
the historically accurate fact that these parents can suddenly have significant
conflict at any time and for any reason. Thus, the current plan for Ms. Frankel
to serve as Mr. Frankel’s backup for childcare was not sustainable.
Timeshare Considerations For over a year, Julia’s schedule had placed her in
the custodial care of each parent equally, on a rotating “2–2–3” basis. Julia greatly
benefitted from substantial time with each parent. At the time of the evaluation,
Julia was almost 5 years of age and was scheduled to enter kindergarten in a few
months. Children her age can certainly benefit from an equally shared parenting
plan, so long as attachment relationships are sound and firmly established and
parents enjoy a co-parenting relationship that is also stable and relatively low
conflict. This also assumes that both parents are competent and reasonably
skilled in terms of direct parenting abilities and neither parent suffers from
significant interfering psychopathology. It also assumes that both parents are
available to maintain the custodial schedule consistently.
It is noteworthy, however, that since the court’s intervention and the antici-
pation of a custody evaluation, the parents enjoyed a period of relatively low
conflict and positive collaboration. This evaluator had noted that Julia was
developing well and was fundamentally a happy girl, despite being exposed
to the parents’ arguing. There were some indications, however, that she had
missed her mother, as she had asked with some regularity to spend more time
with Ms. Frankel. To his credit, Mr. Frankel had accommodated his daugh-
ter’s requests, which did not appear to come about by Ms. Frankel’s undue
influence. The findings of this evaluation indicated that Ms. Frankel had been
the more constant parenting figure. She had regularly assumed more custodial
time with Julia due in large measure to the father’s work demands. She pre-
sented her accounting of how custody time had actually been split, with her
having significantly more custodial time due to father’s work schedule. This
accounting was not disputed by Mr. Frankel.
Mr. Frankel had requested a custodial plan that gave each parent longer
blocks of time, such as a week with each parent. He claimed that this would
enable him to plan the majority of his travel during times when Julia would
be with her mother. Such a plan was not a realistic option for a girl of this
developmental stage, given that Mr. Frankel still wanted to maintain a 50%
time-share arrangement. Thus the schedule he proposed, which included Julia
having regular six-to-eight-day separations from her mother, would have
caused Julia to experience too much distress. There was already evidence that,
even with the current temporary schedule, she was missing her mother and
was asking for additional time with her. Mr. Frankel had struggled to maintain
an equal custody arrangement, given the demands of his job, so it is not real-
istic to believe that he can sustain 50% custody of his daughter. The situation
was compounded by his organizational skills, which sometimes were quite
weak. Aspects of Mr. Frankel’s handling of the demands of this custody evalu-
ation only verified that he struggled with planning and organizing his time, as
well as prioritizing his daughter over his work life. Another factor considered
was that Mr. Frankel’s schedule also required the parents to negotiate frequent
adjustments in the schedule. While this was not a large problem for the cur-
rent year, it had the potential for creating increased conflict in the future.
This evaluator considered the option of leaving the existing 2–2–3 custody
schedule in place; however, for the reasons cited above, this did not seem to be
a reasonable parenting plan at the time. As previously stated, Julia would ben-
efit from somewhat more time with her mother, and there remained a concern
that Mr. Frankel, though well intended, could not really maintain the custodial
schedule with necessary consistency. Therefore, it was recommended that the
custodial schedule shift to allow Julia to spend every other weekend with each
parent and some limited mid-week time with her father. This would enable Mr.
Frankel to more easily plan his travel around the basic custodial schedule, hope-
fully minimizing disruptions. It would also enable Julia to have somewhat more
time with her mother at this particular juncture. It was also hoped that, with the
assistance of skilled professional help, these parents could improve their co-par-
enting relationship, which might allow for more flexibility in the future. It was
certainly reasonable to assume that Julia would benefit from a fully shared par-
enting plan when she entered first grade, as she would be 6-and-a-half by that
time. This assumed that the father’s work schedule will allow for this. At that
time a 2–2–5–5 schedule (Monday and Tuesday with one parent, Wednesday
and Thursday with the other parent, with the parents then alternating weekends
with Julia) would be best suited to this family’s situation.
Recommendations
1. The parents will have joint legal custody.
2. The parents will have joint physical custody as follows:
A. Julia will spend a larger percentage of parenting time with her mother.
B. Julia will be with each parent on alternating weekends from Friday
pick-up at school until drop-off at school the following Monday.
C. Julia will also be with her father on the Tuesday following the mother’s
custodial weekend from pick-up at school or 4:00 p.m. (whichever
applies) until drop-off at school or 9:00 a.m. the following morning. In
addition, the daughter will be with the father on Thursday following
his custodial weekend, from pick-up at school or 4:00 PM (whichever
applies) until drop-off at school the following Friday morning.
D. At all other times, Julia will be in her mother’s custody.
3. When Julia enters first grade, she will split her time equally between the
parents’ homes on a “2–2–5–5” basis. That is, she will be with one parent
each week on Monday and Tuesday, the other parent on Wednesday and
Thursday, and weekends will be alternated, from Friday pick-up at school
until return to school on Monday morning.
A vacation and holiday schedule was recommended that equally splits holidays
and vacations each year. There was also a recommendation for co-parent coun-
seling for a minimum of six months.
Legal Standards Considered in the Child Custody Evaluation

The recommendations to the court just described were based upon the legal
standard of “the best interests of the child” (BIC). Because this case was
conducted in California, several family law statutes that define the BIC standard
in greater detail needed to be considered. These included California Family
Codes §§3011, 3111, 3020, 3040, and 3080. In addition to the general factors
that are part of the BIC standard (listed at the beginning of the chapter), these
family codes describe several other factors the court must consider regarding a
parenting plan. These include, among others, which parent is likely to allow the
child frequent and continuing contact with the other parent; whether either
parent has a mental health or substance abuse disorder or history of abusive
behavior towards the child, which could negatively impact the health, safety,
and welfare of the child. The evaluation report noted that, although they had
conflict, these parents appreciated the role of the other parent and were capable
of supporting the child’s relationship with the other parent. Neither parent was
found to have a significant mental health or substance abuse disorder, which
would necessitate restricting his or her contact with their child.
This case also involved consideration of California Family Code §3044, the
domestic violence statute, which states that there is a rebuttable presumption
that a perpetrator of domestic violence shall not have joint or sole physical
or legal custody of one’s child. Although there were allegations of domestic
violence in the case, the evaluator noted that there was not a court finding
of domestic violence. In addition, analysis of the data did not find evidence
of domestic violence that would preclude a joint legal and physical custody
recommendation.

Among the various roles played by FMHPs in the forensic arena, conduct-
ing child custody evaluations must be considered as one of the most com-
plex, demanding, and formidable endeavors that one can undertake. The case
described posed a variety of challenges for the evaluator. As is typical in cus-
tody cases, there were conflicting portrayals about incidents that occurred in
the past that influenced the parents’ relative positions in the litigation, as well
as their feelings about each other. Evaluators’ ability to determine the “truth”
amid such conflicting reports is often limited, especially in the absence of
compelling third party information. In addition, the evaluator had to be cog-
nizant of the most common pitfalls in conducting custody evaluations. These
include forming strong impressions too early in the case and then looking for
evidence or data to corroborate those impressions rather than giving adequate
weight to divergent information (confirmatory bias). The evaluator also had to
notice, but not be swayed by themes, behavior, or interactions described by the
parents that might resonate with the evaluator’s own personal experience in
ways that could compromise the evaluator’s ability to maintain neutrality and
a forensic stance (countertransference bias).
In this particular case, the evaluator had to rely on indirect reports and
cumulative evidence to determine that the father was not physically at risk
with the mother and that the child had not been traumatized by witness-
ing the conflict between the parents. One of the dilemmas in this case was
how to sustain and support father’s relationship with his daughter, given the
constraints of his work schedule, the father’s inability to maintain half-time
custody, and the fact that the daughter was craving additional time with her
mother. The evaluator therefore suggested a plan that the father could main-
tain consistently, without having to rely on the mother to assist him with child
care. There was also an attempt to affirm the father’s role with his daughter by
recommending a developmentally appropriate but equally shared parenting
plan in the not too distant future.
The evaluator also had to deal with conflicting reports about potential
domestic violence in the co-parenting relationship. There had been police
involvement with the family, and the father had had a restraining order against
mother. This fact, coupled with reports from both parents, suggested that they
had had a volatile and acrimonious relationship with each other. On the other
hand, since the custody evaluation was ordered, the parents had been working
more cooperatively with each other, with considerable flexibility and mutual
respect. The evaluator came to believe that there needed to be firmer boundar-
ies between the parents given concerns about father’s dependency on mother
and the likelihood that the current collegial relationship was fragile and prone
to additional conflict once the court was no longer actively involved in their
lives. The evaluator anticipated that mother could become more rigid under
other circumstances and that father could become more needy and demanding
as he sought to maintain contact both with his daughter and his ex-wife. The
evaluator was, however, impressed with both parents’ desire for professional
input on what would be best for their daughter. He deemed those desires to
be sincere.
In addition to the demands of conducting an evaluation of multiple family
members while also assessing the complex relationships among those fam-
ily members, writing a CCE report is also one of the most challenging tasks
of analysis and synthesis encountered in forensic psychology practice. Child
custody remains a highly contentious area of practice. While the vast majority
of CCE reports do lead to a custody settlement without a trial, evaluators still
face the distinct possibility of being deposed or subpoenaed and having their
results and conclusions challenged in court. As Stahl noted (2014), to be an
effective evaluator, one must develop a thick skin, because one or more parents
are likely to be upset with the recommendations.
Even with the risks involved, FMHPs in child custody cases can glean many
rewards and considerable gratification. The evaluator can be tremendously
helpful to the court with respect to providing input about parenting skills and
deficits, the child’s developmental needs and preferences, as well as the poten-
tial psychological risks associated with various custody arrangements. One of
the most compelling reasons for engaging in CCEs is the opportunity to have
a positive impact on the lives of children in the midst of very difficult family
circumstances. In the midst of very high family conflict, the custody evaluator
can refocus parents’ attention on the best interests of their children and assist
families to move forward in a healthier direction. As Pickar (2007b) noted,
“add to this the fact that the role of the child custody evaluator is somewhat
akin to being a sleuth, and you have a task which is rich in complexity” (p. 113).
References
Ackerman, M. J. (2006). Clinician’s guide to child custody evaluations (3rd ed.). Hoboken,
NJ: Wiley.
Ackerman, M. J., & Pritzl, T. B. (2011). Child custody evaluation practices: A 20-year
follow-up. Family Court Review, 49, 618–628. doi:10.1111/j.1744-1617.2011.01397.x
American Psychological Association. (2002). Ethical principles of psychologists and code
of conduct. American Psychologist, 57, 1060–1073.
American Psychological Association. (2010). Guidelines for child custody evaluation in
family law proceedings. American Psychologist, 65(9), 863–867. doi:10.1037/a0021250
American Psychologist, 68(1), 7–19. doi.org/10.1037/a0029889
Association of Family and Conciliation Courts. (2007). Model standards of practice for
child custody evaluation. Family Court Review, 45(1), 70–90. doi:10.1111/ j.1744-1617
.2007.129_3.x
Austin, W. G. (2001). Partner violence and risk assessment in child custody evaluation.
Family Court Review, 39(4), 483–496.
Austin, W. G. (2008a). Relocation, research, and forensic evaluation, Part I: Effects of
residential mobility on children of divorce. Family Court Review, 46(1), 137–150.
Austin, W. G. (2008b). Relocation research, and forensic evaluation, Part II: Research in
support of the relocation risk assessment model. Family Court Review, 46(2), 347–365.
Austin, W. G. (2012). Relocation, research, and child custody disputes. In K. Kuehnle &
L. M. Drozd (Eds.), Parenting plan evaluations: Applied research for the family court
(pp. 540–559). New York, NY: Oxford University Press.
Austin, W. G., & Drozd, L. M. (2012). Intimate partner violence and child custody evalu-
ation, Part I: Theoretical framework, forensic model, and assessment issues. Journal of
Child Custody, 9(4), 250–309.
Bow, J. N., & Boxer, P. (2003). Assessing allegations of domestic violence in child custody
evaluations. Journal of Interpersonal Violence, 18, 1394–1410.
Bow, J. N., Gottlieb, M. C., Siegel, J. C., & Noble, G. S. (2010). Licensing board com-
plaints in child custody practice. Journal of Forensic Psychology Practice, 10, 403–418.
doi:10.1080/1528932.2010.489851
Bow, J. N., & Martindale, D. A. (2009). Developing and Managing a Child Custody Practice.
Journal of Forensic Psychology Practice, 9(2), 127–137.
Braver, S. L., Ellman, I. M., & Fabricus, W. V. (2003). Relocation of children after divorce
and children’s best interests. New evidence and legal considerations. Journal of Family
Psychology, 17, 206–219.
Brodsky, S. L., & Wilson, J. K. (2012). Empathy in forensic evaluation: A systematic

reconsideration. Behavioral Sciences & the Law, 31(2) 192–202.
Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A, & Kaemmer, B. (1989). The
Ceci, S. J., & Bruck, M. (1995). Jeopardy in the courtroom: A scientific analysis of children’s
testimony. Washington, DC: American Psychology Association.
Ceci, S. J., & Friedman, R. D. (2000). The suggestibility of children: Scientific research and
legal implications. Cornell Law Review, 34–108.
DeMier, R. L. (2013). Forensic report writing. In R. K. Otto and I. B. Weiner (Eds.),
Handbook of psychology: Vol. 11. Forensic psychology (2nd ed.; pp. 75–98). New York,
NY: Wiley.
DiFonzo, J. H. (2014). From the rule of one to shared parenting: Custody presumptions in
law and policy. Family Court Review, 52(2), 213–239.
Drozd, L., Olesen, N., & Saini, M. (2013). Parenting plan and child custody evaluations:
Using decision trees to increase evaluator competence and avoid preventable errors. Sara-
sota, FL: Professional Resources Press.
Drozd, L. M., & Olesen, N. W. (2004). Is it abuse, alienation, and/or estrangment? A deci-
sion tree. Journal of Child Custody, 65–106.
Emery, R. E., Otto, R. K., & O’Donohue, W. (2005). Custody disputed. Scientific American
Mind, 65–67.
Erard, R. E., & Viglione, D. J. (2014). The Rorschach Performance Assessment System
(R-PAS) in child custody evaluations. Journal of Child Custody, 11(3), 159–180.
Fidler, B., & Bala, N. (2010). Children resisting post-separation contact with a parent:
Concepts, controversies and conundrums. Family Court Review, 48, 10–47.
Fidler, B. J., Bala, N., & Saini, M. A. (2013). Children who resist post-separation parental
contact: A differential approach for legal and mental health professionals. New York, NY:
Flens, J. R. (2005). The responsible use of psychological testing in child custody valu-
ations. Selection of tests. Journal of Child Custody: Research, Issues, and Practices,
2(1/2), 5–31.
Friedlander, S., & Walters, M. G. (2010). When a child rejects a parent: Tailoring the inter-
vention to fit the problem. Family Court Review, 48, 97–110.
Friedrich, W. N. (2002). Psychological assessment of sexually abused children and their fami-
lies. Thousand Oaks, CA: Sage.
Fuhrmann, G. S., & Zibell, R. A. (2012). Evaluation for child custody. New York, NY: Oxford
University Press.
Gardner, R. A. (1992). The parental alienation syndrome: A guide for mental health and legal
professionals. Cresskill, NJ: Creative Therapeutics.
Goodman, G. S., Batterman-Faunce, J. M., Schaaf, J. M, & Kenny, R. (2002). Nearly 4 years
after an event: Children’s eyewitness memory and adult’s perception of children’s accu-
racy. Child Abuse and Neglect, 26(8), 849–884.
Gould, J. W. (2006). Conducting scientifically crafted child custody evaluations. Sarasota, FL:
Professional Resources Press.
Gould, J. W., & Martindale, D. A. (2007). The art and science of child custody evaluations.
New York, NY: Guilford.
Hardesty, J. L., Haselschwendt, M. L., & Johnson, M. P. (2012). Domestic violence and
child custody. In K. Kuehnle & L. M. Drozd (Eds.), Parenting plan evaluations: Applied
research for the family court (pp. 442–475). New York, NY: Oxford University Press.
Hynan, D. J. (2014). Child custody evaluation: New theoretical applications and research.
Springfield, IL: Charles C. Thomas.
Jaffe, P. G., Johnston, J. R., Crooks, C. V., & Bala, N. (2008). Custody disputes involving
allegations of domestic violence: Towards a differentiated approach to parenting plans.
Kelly, J. B. (2012). Risk and protective factors associated with child and adolescent adjust-
ment following separation and divorce: Social science applications. In K. Kuehnle &
L. M. Drozd (Eds.), Parenting plan evaluations: Applied research for the family court
(pp. 49–84). New York, NY: Oxford University Press.
Kelly, J. B., & Johnson, M. P. (2008). Differentiation among types of intimate partner vio-
lence: Research update and implications for interventions. Family Court Review, 46(3),
476–499.
Kelly, J. B., & Johnston, J. R. (2001). The alienated child: A reformulation of parental alien-
ation syndrome. Family Court Review, 39(3), 249–266.
Kirkland, K, & Kirkland, K. L. (2001). Frequency of complaints and related disciplinary
action: A survey of the Association of State and Provincial Psychology. Professional Psy-
chology: Research and Practice, 32(2), 1711–1174.
Kuehnle, K., & Connell, M. (Eds.). (2009). The evaluation of child sexual abuse allegations.
Hoboken, NJ: Wiley.
Kuehnle, K., & Drozd, L. (Eds.). (2012). Parenting plan evaluations: Applied research for the
family court. New York, NY: Oxford University Press.
Kuehnle, K., & Kirkpatrick, H. D. (2005). Evaluating allegations of child sexual abuse within
complex child custody cases. Journal of Child Custody, 2(3), 3–39.
Lamb, M. E. (2012). Critical analysis of research on parenting plans and children’s well-
being. In K. Kuehnle & L. M. Drozd (Eds.), Parenting plan evaluations: Applied research
for the family court (pp. 214–243). New York, NY: Oxford University Press.
Lamb, M. E., Sternberg, K. J., & Esplin, P. W. (2000). Effects of age and delay on the amount
of information provided by alleged sex abuse victims in investigative interviews. Child
Development, 71(6), 1586–1596.
Martindale, D. (2005). Confirmatory bias and confirmatory distortion. Journal of Child
Custody, 2(1/2), 31–48. doi:10.1300/J190v02n01_03
McIntosh, J. E., Pruett, M. K, & Kelly, J. B. (2014). Parental separation and overnight care
of young children, Part II: Putting theory into practice. Family Court Review, 52(2),
256–262.
Meyer, G. J., Viglione, D. J., Mihura, J. L., Erard, R. E., & Erdberg, P. (2011). Rorschach
Performance Assessment System: Administration, coding, interpretation, and technical
manual. Toledo, OH: Rorschach Performance Assessment System.
Mihura, J. L., Meyer, G. J., Dumitrascu, N., & Bombel, G. (2013). The validity of individ-
ual Rorschach variables: Systematic reviews and meta-analyses of the Comprehensive
System. Psychological Bulletin, 139(3), 548–605.
Millon, T., Millon, C., Davis, R., & Grossman, S. (2006). MCMI-III manual (3rd ed.).
Minneapolis, MN: Pearson Education.
Moran, J. A., & Weinstock, D. K. (2011). Assessing parenting skills for the family court.
Journal of Child Custody, 8(3), 166–188.
Morey, L. C. (2007). The Personality Assessment Inventory professional manual. Lutz, FL:
Psychological Assessment Resources.
Otto, R. K., Edens, J. F., & Barcus, E. H. (2000). The use of psychological testing in child
custody evaluations. Family Court Review, 38, 312–340. doi:10.1111/j.174-1617.2000
.tb00578.x
Pickar, D. B. (2007a). Countertransference bias in the child custody evaluator. Journal of

Child Custody, 4(3/4), 45–67. doi:10.1300/J190v04n03_04
Pickar, D. B. (2007b). On being a child custody evaluator. Family Court Review, 45(1),
103–115.
Pickar, D. B., & Kaufman, R. L. (2013). The child custody evaluation report: Toward an
integrated model of practice. Journal of Child Custody, 10(1), 17–53.
Pickar, D. B., & Kaufman, R. L. (2015). Parenting plans for special needs children: Applying
a risk assessment model. Family Court Review, 53(1), 113–133.
Poole, D. A., & Lamb, M. E. (1998). Investigative interviews of children: A guide for helping
professionals. Washington, DC: American Psychological Association.
Pruett, M. K., & DiFonzo, J. H. (2014). Closing the gap: Research, policy, practice and
shared parenting. Family Court Review, 52(2), 152–174.
Pruett, M. K., McIntosh, J. E., & Kelly, J. B. (2014). Parental separation and overnight care
of young children Part I: Consensus through theoretical and empirical investigation.
Saini, M., Johnston, J. R., Fidler, B. J., & Bala, N. (2012). Empirical studies of alienation. In
K. Kuehnle & L. M. Drozd (Eds.), Parenting plan evaluations: Applied research for the
family court (pp. 399–441). New York, NY: Oxford University Press.
Saini, M. S., & Polak, S. (2014). The ecological validity of parent-child observations: A
review of empirical evidence related to custody evaluations. Journal of Child Custody,
11(3). 181–201.
Saywitz, K., Camparo, L. B., & Romanoff, A. (2010). Interviewing children in custody cases:
Implications of research and policy for practice. Behavioral Sciences and the Law, 28,
542–562. doi:10.1002/bsl.945
Shuman, D. W., & Berk, A. S. (2012). Judicial impact: The best interests of the child and the
Daubert and Frye evidentiary frameworks. In K. Kuehnle & L. M. Drozd (Eds.), Parent-
ing plan evaluations: Applied research for the family court (pp. 563–573). New York, NY:
Stahl, P. M. (2011). Conducting child custody evaluations: From basic to complex issues.
Thousand Oaks, CA: Sage.
Stahl, P. M. (2014). Conducting child custody and parenting evaluations. In I. B. Weiner
& R. K. Otto (Eds.), The handbook of forensic psychology (pp. 137–169). Hoboken, NJ:
Wiley.
Tippins, T. M., & Wittmann, J. P. (2005). Empirical and ethical problems with custody rec-
ommendations. Family Court Review, 43, 193–222.
Viglione, D. J., & Meyer, G. J. (2008). An overview of Rorschach psychometrics for forensic
practice. In C. B. Gacono & F. B. Evans (Eds.), with N. Kaser-Boyd & L. A. Gacono, The
handbook of forensic Rorschach assessment (pp. 21–53). Mahwah, NJ: Erlbaum.
12
Overview of the Juvenile Justice

System and Best Practices
Jeannie S. Brooks and Kendell L. Coker
Juvenile offenders have historically been viewed as a special population within

the criminal justice system, constituting a distinct group of young individuals
who were generally considered to be more amenable to rehabilitative efforts in
comparison with their adult counterparts. Many authors have suggested that
juvenile justice reform has been promulgated by the idea that children, in and
of themselves, are inherently innocent, and an assumption of public respon-
sibility is inherent within the historical framework of how juvenile offenders
are handled. The juvenile justice system has evolved, in large part, due to
case law that emerged as a function of concerns regarding perceived exces-
sive leniency and harsh punitive sanctions for juvenile offenders (Lubit & Bil-
lick, 2003). Relatedly, the parens patriae doctrine is based on the premise that
juveniles require certain legal protections from their own immaturity (which
supposedly drives child/adolescent behavior). This mandate for increased
legal/procedural safeguards is deemed applicable, irrespective of a child/
adolescent’s status as being in the care and custody of his or her biological
parent(s) or legal guardian(s). It may also be considered within the context of
cases involving allegations of child abuse and/or neglect, foster care, medical
decision making, and juvenile delinquency.
Fundamentally, the parens patriae doctrine attempts to focus on regulat-
ing juvenile behavior, as a child/adolescent is presumed to be unable to do
so independently in an effective, adaptive, and prosocial manner (Abrams,
2014). Ongoing vacillation between a punitive and interventional/rehabilita-
tive model to restorative justice for juvenile offenders has apparently waxed
and waned over the years, perhaps as a function of greater latitude afforded
to juvenile judges in handling such cases. According to Trepanier (1999) for
instance, pertinent changes have emerged for handling juvenile criminal cases
at differing stages in the legal process since the 1960s and the application of the
parens patriae doctrine. The doctrine has apparently been intended to operate
under the assumption that the courts are responsible for handling juvenile
cases by balancing a reduction of personal risk with the facilitation of pro-
tective legal functions. It is postulated that, over time, legal policies largely
focused on juvenile justice have gradually transitioned in the direction of the
adult criminal court model. Juvenile courts have apparently sought to distin-
guish juvenile offenders from their adult counterparts, and several concepts
appear to delineate such efforts (e.g., the presumption that juveniles may
receive pre-adjudicatory detention that ensures separation from adults). As
such, the relevancy of the parens patriae doctrine has apparently decreased at
various stages in time, and across the country.
While the adult criminal justice system has vacillated between adopting
a punitive versus a rehabilitative model over the years, the juvenile justice
system has been subject to sweeping case law and reform to maintain the
perspective that juvenile offenders, unlike adult offenders, should be afforded
greater opportunities for interventions as opposed to sanctions. Segregation
of juvenile from adult offenders was delineated in the Selected Rules from the
United Nations Standard Minimum Rules for the Administration of Juvenile
Justice (“the Beijing Rules”) that was adopted in 1985 (U.N. General Assembly,
1985; Benekos & Merlo, 2014). These “rules” delineated fundamental pro-
cedural safeguards (e.g., the presumption of innocence, right to notification
of charges, protection against self-incrimination, right to legal counsel, the
right to have a parent/guardian present, the right to confront/cross-examine
witnesses, and the right to appeal during all stages of juvenile legal proceed-
ings). Furthermore, juveniles who were detained pending trial were to be
maintained separately from adults, and restrictions on a juvenile offender’s
personal liberty was to only be imposed subsequent to careful consideration
and was to be limited as much as possible (U.N. General Assembly, 1985). Irre-
spective of the ultimate intentions set forth in these standards, however, sig-
nificant changes occurred with respect to how juvenile offenders were largely
perceived by society and with respect to related modifications to existing legal
policy. Benekos and Merlo (2014) point out that in the 1990s, increasing num-
bers of juvenile offenders were waived into the adult criminal court system for
against-person offenses (e.g., homicide, aggravated assault); albeit, such trans-
fers have reportedly decreased since the mid-1990s, perhaps due to statutory
exemptions and lower crime rates. Examining these trends on a large scale,
however, may not fully account for the myriad cases in which innocence was
lost, families were disrupted, and opportunities for a prosocial lifestyle were
hindered. Accordingly, the timing and nature of an individual juvenile’s com-
mitment of a criminal offense may impact the outcome of individual cases.
More recent decreases in the overall volume of juvenile arrests appear related
to greater focus on a rehabilitative model of juvenile justice.
Juvenile Justice System 285
Given the nuances and the broad ability of judges in the juvenile courts
to influence diversion, disposition, and other aspects of juvenile legal cases,
a best-practices approach to the structure and function of the juvenile jus-
tice system should be delineated. Inherently, the process by which those with
legal decision-making authority and other professionals involved in juvenile
case outcomes (e.g., psychologists and psychiatrists) that work to assess each
individual juvenile offender should hold themselves accountable for remain-
ing familiar with empirical studies relevant to juvenile justice service delivery
and reform. In this way, steps can be taken to ensure the appropriateness of
services and other interventions to serve the best interests of society and the
juvenile in question.
Juvenile court proceedings differ from their adult counterparts in several
ways. For example, differing terminology is used to refer to various stages in
juvenile proceedings (e.g., the term “disposition” is applied rather than “sen-
tencing”), and outcomes in juvenile cases may often involve service referrals
with the intention of providing intervention and rehabilitation rather than
a more finite, punitive outcome that would put an end to the case (Lubit &
Billick, 2003). Invariably then, examination of the quality of interventional
and/or rehabilitative efforts is of paramount importance, as such variables can
significantly influence the direction of an individual juvenile offender’s legal
case, and the likelihood that he or she will remain free of a pervasive life of
crime into adulthood. Thus, when one thinks of the criminal courts in a gen-
eral sense, an adversarial process likely comes to mind. In the case of juvenile
justice however, there appears to be an inherent need to strike an effective bal-
ance between traditional criminal legal proceedings (largely viewed in puni-
tive terms), with a more dynamic and future-oriented approach to handling
legal cases involving juvenile offenders. The role of psycholegal constructs
in paving the way for an ideal model of restorative justice for juveniles then
may be viewed as highly relevant and dynamic. To elaborate on this idea,
there appears to be a shift in thought from consideration of mostly static vari-
ables (e.g., prior criminal history) to ascertain the most appropriate outcome/
disposition in criminal cases; albeit, a more future-oriented and scientific
approach to juvenile case disposition and intervention/rehabilitation may
bring an element of abstract reasoning to determining appropriate outcomes
for individual juveniles.
Evolution of Best Practices within the Juvenile Justice System

Given the continuously evolving nature of the juvenile justice system, it is
imperative to remain aware of growing research to delineate a best-practices
approach to intervening with juvenile offenders. As previously noted, the juve-
nile justice system as a whole appears to operate under the assumption that the
model is intended to maintain a rehabilitative focus, and the juvenile justice

system presumes that the courts are well informed when it comes to deter-
mining the most beneficial sanctions and services to apply in cases involving
juvenile offenders. Although perhaps well intentioned, research efforts appear
to delineate various intervention strategies and/or model guidelines to con-
ducting forensic psychological evaluations and applying interventions with
juvenile offenders. Such efforts appear to build on pertinent case law, albeit,
with a more rehabilitative focus that appears inherently clinical in nature. As
juvenile offenders have increasingly been afforded greater legal protections
and opportunities for rehabilitation—with most responsibility being placed
on larger systems—research efforts have focused on determining what fac-
tors constitute a best-practice model for service delivery within the juvenile
justice system.
Some examples of landmark cases that influenced reform in the juvenile
justice system include Kent v. United States (1966), the first U.S. Supreme
Court case that highlighted the critical impetus of the waiver of a juvenile
offender into the adult criminal justice system, in which the court held that
a juvenile offender retained the right to representation by legal counsel at all
stages of the legal process. Subsequently, the U.S. Supreme Court stated In re
Gault (1967) that juvenile offenders have the right to be notified of charges,
to receive legal counsel, to confront and cross-examine witnesses, and to
receive protection under the Fifth Amendment. The case In re Winship (1970)
established that juvenile delinquency adjudication must be beyond a reason-
able doubt. However, subsequently landmark cases such as the 1971 case,
McKeiver v. Pennsylvania, held that juvenile cases do not necessarily have a
constitutional right to a trial by jury. In the case of Schall v. Martin (1984),
the Court held that juveniles could be detained as a means of self-protection
and societal safeguards. Examination of these cases appears to highlight the
inherent notion that juveniles (by their chronological age alone) may not con-
sistently be viewed as free and competent members of society and as a result
are not always afforded the same rights and freedoms that adult offenders
receive. This invariably creates an assumption that the courts may be expected
to remain aware of what is in the best interests of a child or juvenile offender
and balance that knowledge carefully with the needs of society as a whole.
A review of relevant research on best-practice approaches to clinical service
delivery for delinquent youth focuses on individual factors and risk. There
are numerous individual barriers and needs that may be identified in any given
case in which scientifically validated delivery and assessment models con-
cerning juvenile offenders may be considered relevant. For example, in cases
involving juvenile offenders that experience comorbid substance abuse and/
or dependence, an exploration of relevant research would appear indicated to
ensure service delivery that aligns with best practices. As Chassin (2008) points
out, substance use in juveniles may increase susceptibility for delinquency, and
in turn, specialized treatment models that are informed by valid science may
be considered applicable. One such widely applied used approach to recid-
ivism reduction consists of Juvenile Drug Court, which first evolved in the
1990s. This systemic approach to curtailing juvenile delinquency is not only
based on empirical evidence of comorbid substance-related problems among
juvenile offenders but also on the notion that appropriate clinical service deliv-
ery to reduce or eliminate substance abuse/dependence can thus reduce recid-
ivism risk. With that being said, however, the research indicates that there is
no single treatment model that has, to date, been identified as most useful in
terms of outcome. Conversely, a best-practice approach to juvenile offenders
that is prescriptive and individualized in nature and that incorporates services
that are empirically validated and widely accepted within the standards of care
for a specific discipline (e.g., psychiatry and/or psychology) is indicated. Chas-
sin (2008) further emphasized that when clinical interventions are applied to
juvenile offenders experiencing substance-related difficulties, a multi-layered
and systemic approach to service provision is generally recommended and
deemed accessible; albeit, limitations in terms of service availability remains
an inherent area of concern.
The MacArthur Foundation is perhaps one of the largest organizations
devoted to promoting best practices in juvenile justice reform. According
to its website (www.macfound.org), the MacArthur Foundation prides itself
on furthering educational efforts to assist decision makers in developing the
most effective policies and practices for juvenile offenders. The idea behind
this centers on increasing awareness of fundamental differences among
children, adolescents, and adults, and highlights the probability that treat-
ing juvenile offenders the same as their adult counterparts will only result in
negative outcomes to juveniles and society as a whole. The MacArthur Foun-
dation supports scientific study to promote an evidence-based approach to
juvenile justice. By furthering such investigative efforts and maximizing
education for those with legal decision-making authority, the foundation
posits that an evidence-based approach to juvenile justice can facilitate
an effective balance among personal accountability, rehabilitation, public
safety, and lowered costs. In 2003, the MacArthur Foundation implemented
a novel initiative dubbed “Models for Change: Systems Reform in Juvenile
Justice,” to promote system-wide reform that could be generalized around
the world. This project sought to identify methods of improving system
performance and outcomes initially in four core states (i.e., Pennsylvania,
Illinois, Washington, and Louisiana) and, as of April 2014, had expanded to
sixteen states. This initiative focuses on specific factors such as racial/ethnic
variables, evidence-based practices, and distinguishing factors between the
juvenile and adult criminal justice systems.
Although well intentioned and apparently active, the MacArthur

Foundation’s efforts are dynamic and ongoing, as data continues to be gath-
ered and used as an informative guide to system reform and service delivery
from a best-practices perspective. As there are numerous variables that war-
rant consideration in terms of their applicability to juvenile justice, significant
time and effort appears needed to account for individual differences in juve-
nile offenders and particularly special-needs populations of juvenile offend-
ers that present with unique concerns that might not have been extensively
studied. Furthermore, it is important to emphasize the role of accountability as
it relates to not only personal accountability for the offender but also account-
ability of the courts in terms of ensuring that those with legal decision-making
authority keep abreast of the most current and emerging research trends to be
considered when rendering dispositions in juvenile cases. Accordingly, several
questions remain, including, who should be held accountable for ensuring that
best practices are used in juvenile justice intervention? Who should be held
accountable for ensuring consistent application of best practice models from
case conception to disposition? Furthermore, is it possible to account for all
variables that might impact juvenile offenders on an individualized level at any
given time? In many cases involving juvenile offenders, information regarding
personal characteristics that may influence delinquency can only be extrapo-
lated from self-report. Certain jurisdictions might not consider implement-
ing a comprehensive evaluative process with each individual juvenile offender
that stands before the court, as such efforts may prove to be too costly and/
or time-intensive. In some jurisdictions, comprehensive assessments of indi-
vidual juveniles may not be considered until a juvenile is facing removal from
their home and society as a whole. These concerns highlight a need for more
sweeping reform in terms of what is most pertinent and salient when it comes
to evaluating individual differences and interventional strategies within the
juvenile justice system.
Review of Juvenile Justice Best Practices Literature

There is growing research that examines pertinent variables as they relate to
juvenile offenders that may be considered when approaching system reform
to espouse a best practices perspective. For example, various forms of abuse
and/or neglect that juveniles might encounter in their homes and communi-
ties could arguably influence criminality and recidivism. Additional relevant
variables to consider include gender, age, familial socioeconomic status, intel-
ligence, the presence of a learning disorder, Attention-Deficit/Hyperactivity
Disorder (ADHD), traumatic brain injury (TBI), and various types of offenses.
In one study conducted by Conrad et al. (2014), juvenile female offenders gen-
erally reported higher rates of sexual abuse victimization in comparison with
nonoffending females. This study found that even after other risk factors were
accounted for (e.g., prior legal history and conduct problems), a history of
sexual victimization was the most salient predictor of recidivism in female
juvenile offenders. This study highlights the need for development of gender-
specific and responsive interventions to lower recidivism. Another study
conducted by Hampton, Drabick, and Steinberg (2014) examined whether
intelligence test scores constituted a moderating variable in the relationship
between psychopathy and juvenile offending. Their analysis of 1,354 juvenile
offenders included assessments of intellectual ability, psychopathy, and self-
reporting of offending behaviors at three time intervals (i.e., at the time of ini-
tial interview, and 36 and 84 months later). Results of this study indicated that
although greater levels of psychopathy were associated with increased rates of
offending, the greatest levels of offending were observed in juveniles that pos-
sessed both higher levels of psychopathy and higher intelligence test scores.
To further address treatment considerations and dynamics relevant to
juvenile offenders, it is imperative to analyze outcomes that are delivered in
various settings. Placement within an out-of-home setting (i.e., foster care)
may be relevant when determining treatment application from a best practices
perspective. Multidimensional Treatment Foster Care (MTFC) is an effective
family-based model of intervention that is designed to curtail delinquency.
MTFC has its roots in social learning theory and is essentially a behavioral
reinforcement model implemented within foster care settings, utilizing care-
givers who have received training in effective parent management. Generally
speaking, one of the fundamental objectives of MTFC is to afford youth a
normalized experience of life in various settings (i.e., school), while creating
lasting positive environmental modifications that would otherwise serve to
reinforce problem behaviors (Chamberlain, 2005).
To examine effectiveness of MTFC in female offenders, Kerr et al. (2014)
cited that female juvenile offenders might be at an increased level of risk for
suicidality and depression. The authors sought to examine long-term out-
comes utilizing MTFC on a sample of 166 females. Trajectories of suicidality
and depressive symptomatology using MTFC in comparison with a control
group that received traditional group intervention revealed that MTFC (in
comparison with other group treatments) resulted in greater reductions in
depression, only slightly greater decreases in suicidal ideation, and no effect
on suicide attempts.
Although a good deal of research appears to focus primarily on the efficacy
of MTFC in females, it is also important to consider such data with regard
to male offenders that might also be in the foster care system at the time of
treatment delivery. In a study conducted by Chamberlain and Reid (1998),
treatment outcomes using MTFC were assessed in a population of male juve-
nile offenders who were identified as exhibiting chronic and severe degrees
of delinquency. The study sample consisted of 79 males who received either

MTFC or standard group care. Results indicated that the participants who
received MTFC exhibited significantly less criminal referrals, and they were
also more likely to resume living with relatives in comparison with partici-
pants who received the alternative form of treatment. The authors also stated
that receipt of either treatment modality predicted criminality upon follow-
up, well beyond that of other identified risk factors related to juvenile delin-
quency (e.g., age at first offense and volume of prior offenses).
Perhaps one of the most thoroughly studied interventional models for juve-
nile offenders is Multi-Systemic Therapy (MST). According to a study con-
ducted by Robinson et al. (2014), MST and other evidence-based treatments
that are intended to target juvenile delinquency have been well-researched;
albeit, empirical studies on the potential influence of contextual variables on
treatment outcomes is relatively scarce. Thus, factors such as socioeconomic
status, community variables, and other factors that influence parental moni-
toring may interplay with treatment efficacy. The researchers in this study
sought to specifically examine the influence of socioeconomic status and
community factors in moderating parental monitoring. Results indicated that
community factors did interact with parental monitoring (e.g., parental moni-
toring predicted decreased externalizing behavior only for juveniles residing
in neighborhoods with fewer risk factors). Conversely, socioeconomic status
was reportedly unrelated to changes in externalizing behaviors that responded
to MST. Collectively, the authors asserted that the results highlight a need for
greater understanding of the potential role of the juvenile offender’s larger
social environment to predict outcomes when MST is applied.
There is a plethora of literature highlighting the applicability and effective-
ness of MST as an interventional approach with juvenile offenders. Although
an extensive review of outcome studies concerning this treatment modal-
ity is beyond the scope of this chapter, it is worthy of exploration when
delineating best practices in juvenile justice service delivery. For instance, a
study conducted by Weiss et al. (2013) examined treatment outcomes when
MST was utilized with a sample of 164 adolescents who were not court-
referred to treatment. Although this particular study was not specific to
those juveniles legally mandated to engage in MST, it is deemed relevant, as
some of the factors explored underlie and may predate a juvenile’s entrance
into the juvenile justice system. In this study, independent examination
of MST efficacy on juvenile conduct problems and larger-scale systemic
variables was conducted. Participants in the study were assessed eighteen
months after receiving treatment using self and collateral ratings as well as
a review of criminal records. Analysis of treatment outcomes also occurred
two-and-a-half years post baseline. Collectively, results showed that MST
was related to a significant decrease in externalizing problem behaviors, and
favorable outcomes concerning MST in relation to familial functioning on a

more global scale were also indicated.
Tighe et al. (2012) also sought to explore the efficacy of MST directly from
a familial perspective. In addition to disseminating findings that suggest MST
is an effective treatment model that may be deemed appropriate for use with
juvenile offenders, the authors posited that certain adaptions of the traditional
application of MST (e.g., increased clinical focus on the influence of negative
peer associations and ensuring individual families are afforded necessary sup-
ports to facilitate active and consistent engagement in services to increase the
likelihood of positive outcomes) were also highlighted. Such a multilayered
and systemic focus to service delivery appears to delineate the importance
of multiple interactional mechanisms for lasting change. As juveniles do not
function mutually exclusive from their respective environments, consider-
ation of treatment outcomes while accounting for more global influencing fac-
tors (particularly as they relate to treatment outcomes) appears highly relevant
to determining what truly constitutes best practices.
Given the significant impact that juvenile criminality likely has on fam-
ily functioning as a whole, it is not surprising that research has also focused
rather heavily on examining systemic approaches to service delivery with juve-
niles who engage in delinquent behaviors. Researchers have sought to examine
the efficacy of group- and family-based models of interventions for quite some
time. For instance, Wunderlich, Lozes, and Lewis (1974) highlighted historical
factors associated with group therapy, specifically in relation to drug-related
juvenile court cases. One such approach to treatment originated within Prince
George’s County Juvenile Court in 1968. Guidance, Understanding, and Infor-
mation in Drug Evaluation (GUIDE) was intended to provide brief group
treatment to a population of adolescents who abused substances, and GUIDE
also serviced parents. Parent and youth group sessions were conducted inde-
pendently, and the primary objective of the model was to improve communica-
tion between parents and youth, so as to foster more adaptive problem-solving
and conflict-resolution strategies within family systems. Interestingly, negative
emotions displayed by parents toward their children occurred, in part, as a
result of the interplay between different variables (e.g., dishonesty exhibited
by the youth themselves in relation to their substance abuse and due to inter-
actions with representatives of the juvenile court system). Thus, the model of
intervention developed focused on decreasing such negative emotions since
quite often, criminality in juveniles may constitute a symptom that is reflective
of greater underlying dysfunction within a family system.
Studies have demonstrated efficacy in terms of family treatment outcomes
on adult criminal conduct. In theory, it is not surprising that similar treatment
models may also prove beneficial in terms of reducing recidivism in juve-
nile offenders. One such intervention that has shown promise with juvenile
offenders is functional family therapy (FFT). FFT is designed primarily for

youth between 11 and 18 years of age who have behavioral or emotional prob-
lems and who have a history of involvement in juvenile justice or the child
welfare system. In a study conducted by Datchi and Sexton (2013), for instance,
the researchers discovered that, among participants who received evidence-
based, family-focused intervention, such as FFT, improvement was noted in
terms of individual and relational functioning, as well as in terms of decreased
reports of familial discord, distress, and higher levels of cohesion and organi-
zation within family systems. This study was reflective of preliminary evidence
for the relevance of a family-focused approach to service delivery with adult
and youthful offenders.
FFT may be conceptualized as a systemic and behaviorally based approach
to family treatment that addresses concerns or symptoms via an ecological per-
spective (Rohde et al., 2014). Importantly, Flicker et al. (2008) also indicated
that FFT has been rigorously studied and empirically supported. It is often-
times relied on as an intervention of choice for youth who exhibit acting-out
behaviors across diverse ethnic and racial groups. Importantly, the authors
posit that FFT allows for a good deal of flexibility to be applied clinically, as
each intervention is to be customized to the unique characteristics that may be
associated with an individual family. FFT also relies heavily on interpersonal
needs, which may facilitate consumers to view the treatment model as being
particularly supportive.
In terms of selecting the most appropriate treatment modality with any
juvenile offender and/or their families, it is important to note that the element
of choice does not appear limited in terms of efficacy. For example, in a study
conducted by Baglivio et al. (2014), the effectiveness of MST and FFT were
evaluated in a sample of juvenile offenders, with the outcome being assessed
based on the number of probation and offense violations, both during the
time treatment was delivered and twelve months posttreatment. Collectively,
results identified few significant differences in the effectiveness of these two
treatment approaches, with the exception that in comparison with females in
MST, females who received FFT exhibited decreased recidivism and low risk
youth referred to FFT had fewer rates of new arrests and violations of proba-
tion than did low risk youth referred to MST.
One growing, although limited, area of research to inform best practices
in juvenile justice concerns juvenile sexual offenders. According to Hunter
(2001), sexual offenses perpetrated by juveniles reached a peak in the early
1990s and declined since then (as of the date of this study). Furthermore,
female juvenile sexual offenders were said to account for only about 2% of such
crimes at the time. Differing factors among individual juvenile sexual offenders
lead some to be viewed as more treatment-resistant than others. This invari-
ably confounds efforts to identify the most appropriate intervention models
for both male and female juvenile sexual offenders; albeit, child maltreatment
(e.g., both sexual and physical abuse victimization) has been identified as a
salient developmental variable to consider when intervening with juveniles
who exhibit sexually offensive behaviors.
Hunter and Figueredo (2000) identified four distinct variables that differ-
entiated male children who were previously sexually abused and who went
on to commit sexual offenses as adolescents from males who were similarly
victimized but who did not offend in adolescence. To elaborate, children who
were sexually victimized and subsequently committed sexual offenses in ado-
lescence tended to have been victimized at younger ages and more often than
their nonoffending counterparts. These subsequent offenders also reported
waiting longer periods of time before disclosing their histories of victimization
and, upon reporting past abuse, perceived their families were less supportive
than were families of those adolescents who did not commit sexual offenses in
adolescence. Collectively, these findings appear to imply that adolescents with
more intense and severe developmental trauma are more likely to experience
residual debilitating effects. Furthermore, these findings highlight the impor-
tance of familial and social support to facilitate adaptive coping mechanisms
and successful resolution of past trauma.
The roles that individual and system factors play in juvenile delinquency
highlight the importance of conducting comprehensive and culturally sensi-
tive evaluations of offending youth. Given the possibility that many juveniles
might not report or overtly evidence certain risk factors or other variables
that could potentially inform intervention strategies, the value of comprehen-
sive assessment on the juvenile’s initial contact with the legal system should
not be minimized. Through the careful selection and appropriate utilization
of various psychological test measures, clinical interviewing, and examina-
tion of collateral sources (e.g., case documentation and interviews with third
party sources), such assessment efforts may prove significantly useful in iden-
tifying those factors most relevant to treatment efforts and in targeting cases
that require more specialized treatment models to curtail juvenile offending
behaviors before they transition into adulthood.
Numerous types of forensic psychological evaluations may be deemed
applicable to juvenile offenders. It is imperative for those with legal decision-
making and policy-enhancing authority to identify and utilize only those
professionals who possess the requisite knowledge, training, and expertise
with evaluating juvenile offenders. This can further reduce the likelihood of
misdiagnosis and cursory assessments that might be ineffective and perhaps
even more problematic in exacerbating distress and other variables that have
influenced delinquent conduct. Furthermore, it is important to note that, irre-
spective of whether a forensic evaluator is well intentioned and adequately
informed regarding assessment procedures to utilize with juvenile offenders,
it may not always be possible to administer all available tests to ascertain the
presence of certain risk factors or other psychological variables that might
inform an appropriate course of intervention/treatment. Again, the issue of
self-report comes into play, as in some cases, juvenile offenders and/or their
family culture might not support disclosure of certain experiences or feel-
ings that could provide useful clinical data. Whenever possible, then, a sound
forensic evaluation should consider consistency among multiple data sources
and utilization of psychological test measures that have been scientifically
studied and deemed psychometrically sound.
One area in which juvenile forensic assessment is often utilized concerns
competency to proceed to trial evaluations. Borum and Grisso (1995) empha-
size that there is a good deal of variability in terms of the methodologies and
testing that may be utilized in competency-to-proceed-to-trial evaluations,
and guidelines pertaining to the practice of forensic psychology offer little
details regarding the content and structure of various types of evaluations.
Examining standards in the practice of forensic psychological assessment
with juvenile offenders is pertinent to delineating a best-practices approach
to service delivery.
Ryba, Cooper, and Zapf (2003) analyzed the standard of practice for evalu-
ating juvenile offenders when a question of competency to proceed to trial
arose. These authors surveyed psychologists to identify pertinent elements
that may be included in such assessment reports. They noted that the majority
of respondents indicated that the use of forensic and psychological assessment
measures was relevant and pertinent. Those respondents who noted relying
on psychological test data in rendering conclusions identified intelligence test-
ing as the most highly used instruments, with personality testing and, finally,
achievement testing, weighing in.
When evaluating juvenile offenders, external variables and situational
factors should also be considered. Hecker and Steinberg (2002) posed the
question as to whether predisposition psychological evaluations of juvenile
offenders have a measurable effect on legal decision making. The authors of
this study examined 172 predispositional psychological evaluation reports
from a Philadelphia-area juvenile court jurisdiction and the relationship
between report quality and the judges’ willingness to accept recommendations
proffered in those reports. Results of this study highlighted the importance of
psychologists and judges becoming more aware of what the relevant domains
of assessment are and what constitutes a quality report. Guidelines have been
proposed in the absence of clearly defined standards for conducting psycho-
logical evaluations of juvenile offenders. Detailed and comprehensive assess-
ment of a juvenile’s functioning across time and settings that are relevant to
juvenile case disposition have been identified as pertinent and relevant, along
with psychometrically sound test measures used to evaluate a juvenile’s specific
skills and abilities (e.g., intellectual, achievement, and vocational skills). In

addition, thorough evaluation of the juvenile’s family system may be beneficial
to identify etiological factors associated with conduct-disordered behaviors.
Furthermore, an assessment of the juvenile’s community environment may
also be considered relevant to guide placement and treatment recommenda-
tions. Professionals conducting psychological evaluations of juvenile offenders
should receive necessary educational and training opportunities to provide
meaningfully relevant information. As there appears to be a lack of informa-
tive consensus regarding what constitutes report quality, a need for further
research and delineation of appropriateness in relation to psychological evalu-
ations and report quality is indicated.
To further guide forensic psychological evaluations in juvenile cases
when considering potential placement recommendations, an assessment
of risk appears indicated and should be informed via delineation of psy-
chologically meaningful risk variables. According to Hanson (2009), it is
imperative not only to identify relevant risk factors at a superficial level but
also to work towards identifying the potential source(s) that led to the for-
mation and maintenance of risk factors. Distinguishing between static risk
factors (i.e., historical variables that are not malleable) and dynamic risk
factors (i.e., those that may be amenable to certain interventions) is also rel-
evant in this discussion. Further, ensuring accurate operational definitions
of terminology often used in psychological reports (i.e., “anger management
problems”) should be clearly explained to prevent misunderstanding and
possible overgeneralization of problematic displays of aggression across
time and settings.
Bailey, Gunn, and Law (2014) recommend that any course of study in
forensic psychiatry should include principles of adolescent psychiatry. Dis-
tinctions between clinical screening and assessment in forensic and nonforen-
sic settings are worthy of mention, as an assessment of danger to others may
be considered highly relevant to decision making in relation to policy reform
and legislative modification. Such risk assessment, however, differs fundamen-
tally from a needs-based assessment. A risk assessment fundamentally com-
bines statistical information with clinical data in ways that integrate historical
or static variables along with current personal or dynamic factors within a
contextual framework. Although some of these identified variables may high-
light potential areas of need, the two approaches to assessment are somewhat
distinct, albeit, intertwined. Via early identification of a juvenile offender’s
mental health needs, diversion from detention may be more likely by way of
community-based models of care and intervention. The authors posit that pre-
adjudicatory dispositions should be informed by the best possible evaluative
processes, as specific measures may prove useful to delineate various forms of
psychopathology and ongoing risk to self and others.
In a study conducted by Fonagy (2003), the authors asserted that aggression

and violence are apparently present at a young age, and substantially higher
rates of physically aggressive behaviors have been observed in children and
adolescents who meet diagnostic criteria for Attention-Deficit/Hyperactivity
Disorder (ADHD) and Conduct Disorder. Thus, the presence of these two
comorbid diagnoses in childhood/adolescence may be said to significantly
increase a juvenile’s risk for engaging in conduct-disordered acts that may in
turn place them at a greater likelihood of coming into contact with the juvenile
justice system. At the same time, the possibility of misdiagnosis may be con-
sidered, as children and adolescents that exhibit symptomatology consistent
with diagnoses of both ADHD and Conduct Disorder might actually be best
accounted for by other etiology (e.g., behavioral reenactments of past trauma).
This highlights the import of conducting sound, comprehensive evaluations
for children/adolescents and, particularly, juvenile offenders. Given the poten-
tial traumatic response that may be associated with an out-of-home placement
and the possibility of increased exposure to peers who exhibit similar or more
severe behavioral problems, accurate diagnostic clarification may be para-
mount to identifying both risk factors and individual needs.
Additional diagnostic considerations worthy of further examination in
juvenile offenders might include Autism Spectrum Disorders (ASD), Post-
traumatic Stress Disorder (PTSD), and substance abuse/dependence. As these
conditions might not occur exclusively (i.e., in the absence of other co-morbid
diagnoses), it will be imperative to maximize efforts at conducting comprehen-
sive and scientifically informed evaluation procedures to facilitate diagnostic
clarification in an accurate and meaningful way. Bailey, Gunn, and Law (2014)
discuss specialized medico-legal assessments and the import of considering an
individual’s age, level of maturity, intellectual abilities, and emotional capacities
when a juvenile has been charged with a criminal offense. Certain difficulties
(i.e., a specific learning disability and/or residual deficits from traumatic brain
injury) might impact a juvenile’s ability to adequately assist with various pro-
cesses that occur at differing stages of juvenile legal proceedings and may also
affect competency to proceed to trial. Thus, various psychological assessment
measures that have been subject to empirical investigation for use with juve-
nile offenders are a relevant topic of discussion.
In terms of assessing for static variables, Villar-Torres, Romero, and Gomez-
Fraguela (2014) sought to examine the validity of the Psychopathic Checklist:
Youth Version (PCL: YV) on a sample of Hispanic youth that were involved
with the juvenile justice system. Specifically, the others sought to generalize
results from previous studies that examined the utility of this measure in the
Anglo-Saxon literature. These prior studies reportedly supported the PCL: YV
as a useful tool for predicting recidivism and subsequent violence; albeit, such
data on Hispanic and other minority youth were less prevalent. Importantly,
the authors of this study concluded that their analysis supports the utility of
the PCL: YV with Hispanic youth. The measure is said to provide a convenient
method that is deemed appropriate for use with such populations, specifically,
to assess psychopathic traits and risk for criminality.
Due to the possibility that youth involved with the juvenile justice system
might present with a history of trauma and other complex mental health
symptomatology, a comprehensive approach to forensic psychological assess-
ment with juvenile offenders may be most appropriate to delineate pat-
terns of test results and to obtain consistency across data sources. The Child
Report of Post-Traumatic Symptoms (CROPS) is a brief measure with dem-
onstrated reliability and validity in evaluating a range of symptoms believed
to be associated with posttraumatic stress in children between 7 and 17
years of age in myriad settings (Greenwald & Rubin, 1999). Furthermore,
the Behavior Assessment System for Children, Second Edition, Self-Report
Profile—Adolescent (BASC-2 SRP-A) is a widely used self-report measure
that assesses various domains of behavioral and emotional functioning. The
BASC-2-SRP-A includes clinical scales that tap into maladjustment, as well as
adaptive scales that assess inter- and intrapersonal functioning (Reynolds &
Kamphous, 2004). Perkins, Calhound, and Glaser (2014) examined the BASC-
2-SRP-A and CROPS profiles that were generated from a sample of adjudi-
cated youth. Results indicated that symptoms of posttraumatic stress are often
identified in juvenile offenders. Youth who reported clinically significant lev-
els of posttraumatic symptomatology on the CROPS were also found to have
been increasingly likely to endorse increased mental health symptoms on the
BASC-2-SRP-A.
A juvenile offender assessment that seeks to identify consistencies and
inconsistencies among multiple data points may be considered most useful
and relevant to identify risk level and needs. Moreover, comprehensive assess-
ment may be needed to ascertain whether a juvenile possesses the requisite
capacity to comprehend and to remain involved with the legal proceedings;
albeit, such evaluation of a juvenile’s individual capacities might not be applied
early in a juvenile legal case for various reasons (e.g., the concerns might not
have been identified and/or raised by the involved parties). This again high-
lights the importance of using multiple data sources to obtain an accurate and
comprehensive picture of the risks and needs for each juvenile offender.
It is also important to consider problematic response styles on testing and
general defensiveness during the clinical interview in any forensic psychological
evaluation. Establishing rapport with juvenile offenders may be a daunting task,
even for the most seasoned clinician. Ensuring informed consent and an ade-
quate understanding of matters pertaining to limited confidentiality and other
key components of forensic psychological evaluations may also pose additional
barriers to establishing rapport and maximizing accurate self-disclosure. These
matters should also be considered when disclosing one’s status as a mandated

reporter of abuse or neglect (and in some cases, the need to report concerns of
self-harm and/or harm to others). In such instances, a juvenile may be reluctant
to discuss past or ongoing abuse, neglect, and/or suicidal or homicidal ideation
out of fear of punishment. Thus, a carefully balanced approached to forensic
psychological evaluations with juvenile offenders that is not rushed or cursory
and that is corroborated by as many credible data sources as possible (e.g., col-
lateral records and interviews with third party sources) may prove invaluable
when it comes to delineating risk factors and accurate diagnostic formulations.
Relatedly, diagnostic prevalence rates should be considered prior to render-
ing conclusions. In many cases, professionals may be quick to apply several
commonly seen diagnostic categories to collective sums of juvenile offenders
(e.g., Conduct Disorder), when the true etiology for various manifestations of
delinquency and other forms of mental health symptomatology may be related
to other variables (e.g., those related to trauma). To elaborate, if the Diagnos-
tic and Statistical Manual for Mental Disorders, Fifth Edition or DSM-5 (2013)
identifies a diagnostic category as having a very low prevalence rate, albeit the
diagnosis appears readily applied to large numbers of individuals, then the pos-
sibility exists that the assessment may not be adequately informed.
As previously mentioned, there are several treatment modalities and inter-
vention settings that may be utilized with juvenile offenders. Although some
treatment approaches have been deemed applicable and useful when inter-
vening with juvenile offenders, a prescriptive approach to psychotherapy
may be most beneficial to determine the best treatment for each individual’s
unique needs. For example, although MST appears to be one of the most thor-
oughly studied treatment modalities with this population, an examination of
the juvenile offender’s family system would appear indicated to determine the
appropriateness of utilizing this model. If a juvenile’s family is not open to
receiving services and/or to allowing professionals into their home, this may
increase resistance to the therapeutic process and limit the possibility of posi-
tive treatment outcomes. Furthermore, CBT (which tends to rely heavily on
verbal interventions) might not be most appropriate for a juvenile with a ver-
bal learning disability who may struggle with comprehension and/or grasping
concepts that others might not encounter. Amenability to services delivered
within residential or institutional settings may be impacted by a juvenile’s per-
ception that treatment is solely punitive and that providers are aligned with
those who possess legal decision-making authority. This may not only limit
the establishment of a strong and trusting therapeutic relationship but also
may result in the juvenile resisting treatment delivered in such a setting at
all costs. For juveniles who have encountered significant trauma/abuse, the
idea of receiving therapeutic interventions in a punitive setting may serve to
increase resistance.
Even when juveniles have been comprehensively assessed prior to their case
disposition, the importance of ongoing periodic evaluation of functioning
and treatment progress and/or barriers is needed to identify and implement
effective modifications to service delivery. Only then can such efforts be deliv-
ered from a best-practices perspective and truly account for programmatic
strengths and areas for further development. Ongoing research is needed to
identify various needs and areas for improvement in this regard, so as to reduce
the likelihood of wasted resources and recidivism. Also worthy of consider-
ation is the possibility that a juvenile who experiences a negative treatment
encounter during his or her involvement with the juvenile justice system (and
who subsequently recidivates) may prove less amenable to treatment efforts
in the future. In some cases, this may result in treatment being delivered at a
higher level of care, during which the juvenile might be at risk of developing
thought patterns that equate any treatment services with punishment.
The phrase “continuity of care” may be used to reference several aspects of
an individual’s involvement in a system of treatment. For juvenile offenders,
continuity of care may be operationally defined as collaborative assessment
and treatment efforts among mental health providers, legal professionals, the
juvenile’s family members, and other professionals and nonprofessionals who
may influence the outcome of a case. Although generally viewed as a con-
nection between care that an individual receives in an acute inpatient setting
(i.e., a hospital) and collaborative efforts for discharge planning, continuity of
care for juveniles also involves ongoing planning to prevent recidivism and to
mitigate emotional distress and other risk factors. Thus, comprehensive ini-
tial and periodic assessment of a juvenile’s needs and level of risk is necessary
to reduce the likelihood of continued involvement with the juvenile justice
system and other deficiencies in functioning. Selecting the most appropriate
assessment and intervention methods can be instrumental in maximizing a
juvenile offender’s functioning and opportunities for success in adopting a
prosocial lifestyle that extends beyond the life of their legal case.
Continuity of care for juvenile offenders requires familiarity with treat-
ment outcome studies and case collaboration. For example, when a psycho-
logical evaluation is performed on a juvenile offender to assist the trier of
fact with decisions regarding placement, it is important to ensure that those
with legal decision-making authority receive a thorough understanding of
individualized variables that warrant ongoing attention via further assess-
ment. In cases involving juvenile offenders who have encountered significant
trauma, for example, treatment recommendations geared specifically towards
this population may not be sufficient to ensure that retraumatization and/or
recidivism does not occur. In such cases, the importance of clearly defining
methods of ongoing needs and risk assessment and treatment progress is para-
mount. A study conducted by Thompson et al. (2012) sought to examine the
relationship between past traumatic experience and predictions and/or expec-

tations concerning various outcomes (e.g., educational, academic, and occu-
pational). Several variables were noted to come into play with regards to these
constructs (instability, maltreatment, and exposure to violence). Accordingly,
continuity of care and ongoing assessment of an individual juvenile’s internal
experience and an environment that might not be conducive to promoting
long-term treatment gains should be considered and clearly documented for
those involved in case disposition.
As previously noted, there exists a differentiation between static and
dynamic variables as they relate to both risk and protective constructs. When
identified, dynamic variables may be addressed and periodically assessed to
evaluate treatment progress and barriers. Thompson and McGrath (2012)
point out that a sufficient number of empirical studies have been conducted
to delineate the clinical utility of measures used for risk assessment purposes.
However, individual jurisdictions and/or treatment program might not find
these useful in assessing treatment outcomes and ongoing needs. This high-
lights a need for ongoing educational efforts to maximize development of a
widely accepted approach and appropriate standard for continuity of care
based on a juvenile offender’s functioning at the time of assessment.
Conclusion
This chapter was intended to highlight the evolution of the juvenile justice
system in response to several perceived shortcomings and the need for greater
accountability and consideration of individual and culturally specific variables
when intervening with juvenile offenders. In order for rehabilitative efforts
to be successful, evidence-based approaches to service delivery and interven-
tional models should be utilized and considered comprehensively with mul-
tiple sources of credible data. Although just a few examples of relevant and
effective treatment models and strategies for reducing recidivism were dis-
cussed in this chapter, the following chapters shall more clearly explain addi-
tional pertinent variables to consider with regard to treatment and evaluative
efforts within the juvenile justice system. The need for ongoing assessment of
juveniles and the justice system as a whole is recommended to ensure that a
best-practices model is consistently implemented to reduce recidivism and to
further improve the overall quality of service delivery.
At times, evaluators may have large caseloads and feel the time pressure of
meeting court deadlines. However, it is critical that evaluators do not sacrifice
comprehensiveness in an attempt to improve efficiency. This can not only neg-
atively impact an evaluator’s professional reputation when there is a pattern of
failure to gather critical information but also harm the juvenile because their
needs are not accurately identified. Furthermore, evaluators should appreciate
the importance of culture and the role it plays in behavior. Evaluators should
expand their cultural framework “lens” and realize that culture is more than
just nationality; it is also race, gender, class, disability, and a myriad of other
factors that help shape our identity and experience (Sue & Sue, 2013). These
factors can also contribute to the possibility of juveniles being given strong
diagnostic labels (Rubio, Krieger, Finney, & Coker, 2014). Evaluators should
be aware of these issues as well as being mindful of their cultural biases and the
cultural differences that exist between them and the juveniles they evaluate.
Having biases is not the problem, but rather ignorance or failure to acknowl-
edge biases can lead to false assumptions and negative judgments that can
“seep” into an evaluation.
Also, understanding a juvenile’s cultural context on an individual, commu-
nity, and societal level can give an evaluator critical insight in the underlying
factors that motivate and sustain certain behaviors. For instance, a study
by Stewart and Simons (2009) found that adoption of certain types of cul-
tural norms (i.e., Code of the Street) that develop as a result of racism and
marginalization (Anderson, 1999) predicts violence in African American
youth. Exposure to trauma and community violence can lead to a juvenile’s
problematic behaviors and even cause them to rationalize and justify their
transgressive behaviors (McMahon, Felix, Halpert, & Petropoulos, 2009;
Coker, Ikpe, Brooks, Page, & Sobell, 2014).
Although it may not be possible to account for each and every nuance of
individual factors pertaining to juvenile offenders, a comprehensive and sci-
entifically informed approach to service delivery within the juvenile justice
system may be more widely accepted as the norm, rather than the exception
when appropriate education becomes increasingly available to those with the
ability to bring about even greater legislative changes and reform. Through
increased accountability at the individual, familial, and larger system levels,
it remains hopeful that significant and positive changes to our juvenile justice
system can be realized.
References
Abrams, D. E. (2014). A primer on juvenile protective legislation. Juvenile & Family Court
Journal, 65(3).
American Psychiatric Association. (2013). Diagnostic and statistical manual for mental
disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Anderson, E. (1999). Code of the street: Decency, violence and the moral life of the inner city.
New York: W.W. Norton.
Baglivio, M. T., Jackowski, K., Greenwald, M. A., & Wolff, K. T. (2014). Comparison of
multisystemic therapy and functional family therapy effectiveness: A multiyear statewide
propensity score matching analysis of juvenile offenders. Criminal Justice and Behavior,
41(9), 1033–1056.
Bailey, S., Gunn, J., & Law, H. (2014). Forensic Psychiatry: Clinical, Legal and Ethical Issues
(2nd ed.). CRC Press.
Benekos, P. J., & Merlo, A. V. (2014). Juvenile Justice: International Perspectives, Models and
Trends. CRC Press.
Borum, R. & Grisso, T. (1995). Test use in criminal forensic evaluations. Professional
Psychology: Research and Practice, 26(5), 465–473.
Chamberlain, P. (2005). Intervention outcomes for girls referred from juvenile justice:
Effects on delinquency. Journal of Consulting and Clinical Psychology, 73(6), 1181–1185.
Coker, K. L., Ikpe, U., Brooks, J., Page, B., & Sobell, M. (2014). Social problem solving skills
mediates the relationship between traumatic stress and moral disengagement among
inner-city African American high school students. Journal of Child and Adolescent
Trauma, 7(2), 87–95.
Conrad, S. M., Tolou-Shams, M., Rizzo, C. J., Placella, N., & Brown, L. K. (2014). Gender
differences in recidivism rates for juvenile justice youth: The impact of sexual abuse.
Law and Human Behavior, 38(4), 305–314.
Datchi, C. C., & Sexton, T. L. (2013). Can family therapy have an effect on adult criminal
conduct? Initial evaluation of functional family therapy. Couple and Family Psychology:
Research and Practice, 2(4), 278–293.
Flicker, S. M., Turner, C. W., Waldron, H. B., Brody, J. L., & Ozechowski, T. J. (2008). Ethnic
background, therapeutic alliance, and treatment retention in functional family therapy
with adolescents who abuse substances. Journal of Family Psychology, 22(1), 167–170.
Fonagy, P. (2003). The development of psychopathology from infancy to adulthood: The
mysterious unfolding of disturbance in time. Infant Mental Health Journal, 24(3),
212–239.
Greenwald, R., & Rubin, A. (1999). Brief assessment of children’s post-traumatic symptoms:
Development and preliminary validation of parent and child scales. Research on Social
Work Practice, 9, 61–75.
Hampton, A. S., Drabick, D. A. G., & Steinberg, L. (2014). Does IQ moderate the relation
between psychopathy and juvenile offending? Law and Human Behavior, 38(1), 23–33.
Hanson, R. K. (2009). The psychological assessment of risk for crime and violence.
Canadian Psychology/Psychologie Canadienne, 50(3), 172–182.
Hecker, T., & Steinberg, L. (2002). Psychological evaluation at juvenile court disposition.
Professional Psychology: Research and Practice, 33(3), 300–306.
Hunter, J. A. (2001). Practical aspects of rape investigation: A multidisciplinary approach.
CRC Press.
Hunter, J. A., & Figueredo, A. J. (2000). The influence of personality and history of sexual
victimization in the prediction of juvenile perpetrated child molestation. Behavior
Modification, 24(2): 241–263.
Kerr, D. C. R., DeGarmo, D. S., Leve, L. D., & Chamberlain, P. (2014). Juvenile justice girls’
depressive symptoms and suicidal ideation 9 years after multidimensional treatment
foster care. Journal of Consulting and Clinical Psychology, 82(4), 684–693.
Lipsey, M. W., Howell, J. C., Kelly, M. R., Chapman, G., & Carver, D. (2010). Improving the
effectiveness of juvenile justice programs: A new perspective on evidence-based practice.
Paper for the Center for Juvenile Justice Reform. Retrieved from http://cjjr.georgetown
.edu/pdfs/ebp/ebppaper.pdf
Lubit, R. H., & Billick, S. B. (2003). Principles and Practice of Forensic Psychiatry (2nd ed.).
CRC Press.
McMahon, S. D., Felix, E. D., Halpert, J. A., & Petropoulos, L. A. N. (2009). Community
violence exposure and aggression among urban adolescents: testing a cognitive mediator
model. Journal of Community Psychology, 37(7), 895–910.
Perkins, A., Calhoun, G. B., & Glaser, B. A. (2014). An examination of the CROPS and
BASC-2-SRP-A among adjudicated youth. Journal of Forensic Psychology Practice, 14(3),
193–212.
Reynolds, C. R., & Kamphous, R. W. (2004). Behavior assessment system for children (2nd
ed.). New York, NY: Pearson.
Robinson, B. A., Winiarski, D. A., Brennan, P. A., Foster, S. L., Cunningham, P. B., & Whitmore,
E. A. (2014). Social context, parental monitoring, and multisystemic therapy outcomes.
Psychotherapy, Advance Online Publication.
Rohde, P., Waldron, H. B., Turner, C. W., Brody, J., & Jorgensen, J. (2014). Sequenced versus
coordinated treatment for adolescents with comorbid depressive and substance use dis-
orders. Journal of Consulting and Clinical Psychology, 82(2), 342–348.
Rubio, J. S., Krieger, M. A., Finney, E. J., & Coker, K. L. (2014). A review of the relationship
between sociocultural factors and juvenile psychopathy. Aggression and Violent Behavior,
19(1), 23–31.
Ryba, N. L., Cooper, V. G., & Zapf, P. A. (2003). Juvenile competence to stand trial evalu-
ations: A survey of current practices and test usage among psychologists. Professional
Psychology: Research and Practice, 34(5), 499–507.
Sexton, T., & Turner, C. W. (2011). The effectiveness of functional family therapy for youth
with behavioral problems in a community practice setting. Couple and Family Psychology:
Research and Practice, 1, 3–15.
Stewart, E. A., & Simons, R. L. (2009). Code of the street and African-American adoles-
cent violence. Washington, DC: U.S. Department of Justice, National Institute of Justice.
Retrieved from: https://www.ncjrs.gov/pdffiles1/nij/223509.pdf
Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory and practice (6th ed.).
Hoboken, NJ: Wiley.
Tighe, A., Pistrang, N., Casdagli, L., Baruch, G., & Butler, S. (2012). Multisystemic ther-
apy for young offenders: Families’ experiences of therapeutic processes and outcomes.
Journal of Family Psychology, 26(2), 187–197.
U.N. General Assembly. (1985). United Nations standard minimum rules for the admin-
istration of juvenile justice (“The Beijing Rules”):resolution/adopted by the General
Assembly, November 29, 1985, A/RES/40/33. Retreived from http://www.refworld.org
/docid/3b00f2203c.html
Villar-Torres, P., Luengo, M. A., Romero, E., Sobral, J., & Gómez-Fraguela, X. A. (2014).
Assessing psychopathy in young people: The validity of the psychopathic checklist: Youth
version for a sample of Spanish offenders. Psychology, Crime & Law, 20(9), 865–883.
Weiss, B., Han, S., Harris, V., Catron, T., Ngo, V. K., & Caron, A. Guth, C. (2013). An indepen-
dent randomized clinical trial of multisystemic therapy with non-court-referred adoles-
cents with serious conduct problems. Journal of Consulting and Clinical Psychology, 81(6),
1027–1039.
Wunderlich, R. A., Lozes, J., & Lewis, J. (1974). Recidivism rates of group therapy participants
and other adolescents processed by a juvenile court. Psychotherapy: Theory, Research &
Practice, 11(3), 243–245.
13
Sentencing Evaluations
in Juvenile Court
Michael P. Brown
Once juveniles are adjudicated delinquent, it is customary for judges to order

the juvenile probation department to conduct a presentence investigation and,
from that investigation, produce a presentence report. It is sometimes called
a social investigation report, a social study, or a social background report.
Regardless of its name, the primary purpose of the presentence report is to
provide judges with the information needed to make informed sentencing
decisions. Presentence reports may include, but are not limited to, infor-
mation about family history, school performance, substance abuse history,
mental health treatment, and delinquent behaviors. Usually, the information
found in presentence reports provides the foundational information needed
to make informed sentencing decisions. However, there are occasions when
cases are unusually complex, offenders appear to be especially dangerous to
themselves or others, or information is needed to more fully understand the
mental health status of adjudicated delinquents. In such cases, forensic evalua-
tions are ordered by juvenile courts—upon a motion from the prosecutor—or
they are requested by defense attorneys. A sentencing evaluation in juvenile
court is used to assess how mental health problems, social circumstances, and
environmental influences are related to delinquent behaviors. While prosecu-
tors are seeking information that will help them respond appropriately to the
needs of juveniles and the risks they pose to the safety of communities, defense
attorneys are seeking information that will allow them to be better advocates
for their clients (Melton, Perila, Poythress, & Slobogin, 2007).
When preparing forensic evaluations for juvenile cases, forensic evaluators
apply their expertise in a truly unique legal culture. The contemporary juve-
nile court is charged with sentencing juveniles in a way that strikes a balance
between what is in the child’s best interest and protecting the community
from that child. Grounded in the parens patriae philosophy, the juvenile
Sentencing Evaluations 305
court—acting as a parent—is supposed to provide children with care, custody,

and treatment. This is done, in part, by keeping in mind two core principles
of juvenile justice. First, juvenile court judges should impose the least detri-
mental alternative available in order to promote healthy child development.
Second, judges should rely on the least restrictive alternative necessary to
meet children’s needs and at the same time protect society. Seasoned profes-
sionals sometimes say that these principles are merely guidelines because the
practice of juvenile justice is neither ideal nor principled. Indeed, it is most
often a compromise between what “should” happen and what “will” happen
because of available resources and what parents are willing or able to do for
their children.
Ascertaining the appropriate disposition is a complex endeavor. However,
forensic evaluators can provide insights into psychosocial aspects of behavior
that judges, prosecutors, and defense attorneys find helpful in performing their
jobs. Forensic evaluators who perform work in this arena are specialists who
understand the legal system and know how and when to use forensic assess-
ment instruments and techniques; they understand the intersection between
legal doctrines and mental health evaluations; they know the mental health
literature, and they understand the ins and outs of being an expert witness
(Melton, Perila, Poythress, & Slobogin, 2007).
In this chapter, the author will examine sentencing evaluations for
juvenile court cases. The first part of the chapter involves an examination of
relevant case law, a review of the literature, and a review of best practices in
sentencing evaluations. The second part of this chapter is a case vignette that
allows readers to apply what they learned from the first part of the chapter.
Relevant Case Law

An examination of how case law affects forensic evaluations conducted
for the purpose of informing juvenile court sentencing decisions requires
a review of the Fifth and Sixth Amendments to the U.S. Constitution. It
is important to mention that, while delinquency proceedings have been
described as quasi-criminal in nature, the U.S. Supreme Court held in In re
Gault (1967) that the Fourteenth Amendment and due process rights apply
to juvenile delinquency proceedings as well. So, although the court cases
described here are appeals that originated in criminal courts, the decisions
rendered also apply to juvenile courts.
The Fifth Amendment guarantees protection against self-incrimination
(U.S. Const. amend. V) stating that an individual may not “be compelled in any
criminal case to be a witness against himself.” This protection is for testimonial
evidence that is presented in court, which is an important consideration when
it comes to forensic evaluations.
Initially, it was in the case of Thornton v. Corcoran (1969) that the D.C.
Circuit Court stated “the words of the accused are critically important in
determining his mental condition.” Several years later the U.S. Supreme Court,
agreeing in principle with the Thornton decision, concluded in Estelle v. Smith
(1981) that clinical evaluations—depending on the type of evaluation and how
the information contained in the evaluation is used—are in fact a form of tes-
timonial evidence.
Estelle v. Smith (1981) was a death penalty case appealed to the U.S. Supreme
Court. A critical part of the Estelle decision was a reference to a quotation in
the American Psychiatric Association’s amicus brief that asserted “absent a
defendant’s willingness to cooperate as to the verbal content of his communi-
cations a psychiatric examination . . . would be meaningless.” (Estelle v. Smith,
1981, n. 8). Hence, in Estelle v. Smith (1981), the U.S. Supreme Court held that
in the context of psychiatric evaluations, defendants are protected by the Fifth
Amendment right against self-incrimination at the penalty phase. Evaluators
have a duty to inform the defendant that information he or she provides dur-
ing the course of the evaluation could be used against him or her in a court of
law and that the defendant has a right to remain silent. Statements given dur-
ing court-ordered evaluations, while the defendant is in custody, can be used
in the penalty phase if the offender has been apprised of his or her rights and
has knowingly decided to waive them (Estelle v. Smith, 1981).
A similar ruling was made by the U.S. Supreme Court for noncapital
cases. In Mitchell v. United States (1999), the U.S. Supreme Court held that
defendants may assert their Fifth Amendment right to remain silent and not
incriminate themselves in matters pertaining to sentencing. The justices said
that the defendant has reason to be concerned when testimony is given prior
to sentencing. The testimony could sway the judge, and lengthier incarceration
sentences could be just one of the consequences (Mitchell v. U.S., 1999). There-
fore, the accused may refuse to speak about the crime, even after adjudication,
during presentence interviews.
The issue surrounding the Sixth Amendment and forensic evaluations
has to do with whether defendants have the right to legal counsel. Although
the U.S. Supreme Court held that, while the defendant’s counsel is entitled
to be notified when a forensic evaluation is ordered by the state, the accused
does not enjoy the right to have an attorney present during forensic evalua-
tions. The primary concern with having an attorney present centers around
the potentially adverse effects it may have on the evaluation (Estelle v. Smith,
1981). However, the fact remains that a forensic evaluation has the potential
of adversely affecting sentence lengths and the loss of liberty. As a concep-
tual middle ground, courts sometimes allow for forensic evaluations to be
video recorded and reviewed at a later date by the defense attorney. On other
occasions, courts have allowed an expert working for the defense attorney
to observe the forensic interview in person (Melton, Perila, Poythress, &

Slobogin, 2007).

Researchers have found a variety of risk factors for delinquency. For
example, delinquency has been found to be associated with behavioral and
emotional disorders including depression, attention deficit hyperactivity
disorder (ADHD), and oppositional defiant disorder; (Akse, Hale, Engles,
Raaijmakers, & Meeus, 2007; Grisso, 2004; Wasserman, Ko, & McReyn-
olds, 2004; Teplin, McClelland, Dulcan, & Mericle, 2002); substance use
disorders (Shek, 2005; Loeber, Burke, Lahey, Winters, & Zera, 2000);
sensation-seeking behaviors (Loeber, & Farrington, 2000); post-traumatic
stress disorder (PTSD) resulting from child abuse (Dixon, Howie, & Starling,
2005); developmental delays in such things as language, moral reasoning,
and social interactions (Brownlie, Beitchman, Escobar, Young, Atkinson,
Johnson, Wilson, & Douglas, 2004; Chandler & Moran, 1990); truancy
and poor school performance (Chang, Chen, & Brownson, 2003; Barkley,
2003); family risk factors such as criminal parents or inadequate monitor-
ing; (Gebo, 2007; Resnick, Ireland & Borowsky, 2005; Loeber & Farrington,
2000); delinquent peers (Hinshaw & Lee, 2003; Brody, Ge, Conger, Gibbons,
Murry, Gerrard, M., & Simons, 2001); and poor communities and high-
crime neighborhoods (Chung & Steinberg, 2006; Henry, Tolan, & Gorman-
Smith, 2001; Guerra, Huesmann, Tolan, Van Acker & Eron, 1995).
For many juveniles, the juvenile justice system is the first place in which their
mental health problems are identified by professionals and where attempts are
made to treat them (O’Donnell & Lurigio, 2008). The juvenile justice system
is likewise often the first response to other delinquency risk factors, such as
substance abuse, child abuse, inadequate supervision, and truancy. While it
is unfortunate that treatment and other interventions are often not used until
behaviors rise to a level that a legal response by the justice system is considered
necessary, the reality is that youths who come into contact with the juvenile
court often suffer from and/or are exposed to a variety of individual, environ-
mental, and social risk factors of delinquency.
While forensic evaluations are ordered to inform the court about concerns
related to care and custody, do they affect the types of sentences imposed on
delinquent youths? That is, do forensic evaluations influence judicial decision
making? A review of the literature suggests that there are two answers to this
question.
On the one hand, there is research that has examined how legal factors predict
the sentences judges impose. Research indicates that factors most predictive of
sentences imposed by judges include legal variables such as offense history, the
seriousness of the current offense, and past incarceration sentences (Cauffman,

Piquero, Kimonis, Steinberg, Chassin, & Fagan, 2007). Risk factors associated
with the family, adolescent peer groups, school performance, substance use, and
other risk factors, for instance, have very little (and sometimes no) predictive
power related to the type of sentence imposed (Campbell & Schmidt, 2000).
On the other hand, there is research that has examined how forensic evalua-
tions influence the type of sentences imposed. While there are no studies that have
used an experimental design to determine whether forensic evaluations influ-
ence juvenile court sentences (Cappon & Vander Laenen, 2013), there have been
studies concluded to ascertain whether recommendations from forensic evalua-
tions influence depositions. For instance, several studies have shown that when
appropriate controls are utilized, associations between forensic evaluations and
juvenile court depositions are revealed. For example, after controlling for legal
variables, the mention of mental disorders in forensic evaluations are correlated
with the type of sentence imposed by juvenile court judges (Cauffman, Piquero,
Kimonis, Steinberg, Chassin, & Fagan, 2007). Hecker and Steinberg (2002) found
that when forensic evaluations contained information about mental health his-
tory or had information related to drug or alcohol abuse histories, judges were
more likely to accept the sentencing recommendations found in forensic evalua-
tions (see also, Campbell & Schmidt, 2000).
Similarly, Kempf-Leonard and Sontheimer (1995), Gebo (2007), and
Wordes, Bynum, and Corley (1994) found that when forensic reports included
references to mental disorders, juvenile court sentences were more likely to
involve institutional placements than those without such diagnoses. Cauff-
man, Piquero, Kimonis, Steinberg, Chassin, and Fagan (2007) found that
juveniles who were charged with substance abuse offenses or whose forensic
evaluations noted that they were struggling with substance addictions were
more likely to be institutionalized.
Best Practices
Before preparing sentencing evaluations, forensic evaluators should be familiar
with a variety of issues. For instance, they should know and understand stat-
utes related to sentencing evaluations. Those statutes delineate standards and
regulations that govern sentencing evaluations within the practicing juris-
diction. Also, before evaluations are performed, forensic evaluators should
know the research associated with the psychological tests they believe are
most appropriate for the case at hand. Depending on the nature of the case,
forensic evaluations may therefore include psychological tests that measure
intellect, academic abilities, and vocational skills (Kavanaugh, Clark, Masson,
& Kahn, 2006; Hecker & Steinberg, 2002). Cognitive and personality tests may
also be given in order to gain insight into responsiveness to treatment. When
interpreting the results of the tests that are used, evaluators should be careful
to not infer beyond that which the scientific literature has validated (Kavana-
ugh, Clark, Masson, & Kahn, 2006; Heinbrun, 1992). Psychological test results
can be helpful in sentencing decisions because they provide judges with infor-
mation directly related to the mental health status of juveniles (Melton, Perila,
Poythress, & Slobogin, 2007).
Furthermore, forensic evaluators should make every effort to avoid conflict-
ing interests, especially when those interests may affect impartiality, compe-
tency, or professional effectiveness (American Psychological Association, 2013).
They must know the scope of their competencies. Those competencies should
be based on professional experiences, training, and relevant education. Forensic
evaluators should know the justice system and the rights afforded those who are
accused of breaking the law (The American Psychological Association, 2013).
The American Psychological Association (2013) asserts that agreements
with clients should specify the services to be delivered, the compensation, and
the scope and timeframe in which the services are to be delivered. Forensic
evaluators should make every effort to honor the agreements they enter into,
and services should be competently and promptly delivered. Clients should be
regularly informed about the status of the agreed-on services until the agree-
ment is satisfied.
While gathering information and preparing sentencing evaluations, attempts
should be made to ascertain mental health needs. Gathering information about
social institutions (e.g., the family, peer group, and school) can shed light on
levels of support and prosocial or antisocial influences. Can delinquency in
the case be traced back to social institutions? And, what community-based
resources are available that might meet the child’s needs (Hecker & Steinberg,
2002)? Answers to those questions should be included in forensic reports so as
to inform judges why sentences and conditions were recommended.
While forensic evaluations for juvenile court dispositions have not been
empirically validated, there is general agreement among psychological pro-
fessionals about the methodology used and what should be included within
them (Hecker & Steinberg, 2002). Forensic evaluators should thoroughly
review the child’s file, concentrating their efforts on compiling detailed infor-
mation about how each child and the circumstances surrounding the child’s
offenses differs from common stereotypical beliefs that legal professionals
may possess. In addition, evaluators should conduct multiple clinical inter-
views, collateral contacts, and administer psychological testing if relevant to
the referral question(s). Combining all data sources will undoubtedly human-
ize the juvenile and shed light on the importance of individualized sentences
(Melton, Perila, Poythress, & Slobogin, 2007). Additionally, according to the
American Psychological Association (2013), forensic evaluators must have
integrity and be impartial and fair as they provide expert opinions to judges
and other legal decision makers. Opinions presented in writing or verbally

expressed by way of testimony should be grounded in scientific principles
(American Psychological Association, 2013).
Case Vignette
Reason for Referral
Marcus Aaron, a 15-year-old male was found guilty of theft at the Pearson
County Juvenile Court. This sentencing evaluation came in response to
Judge Dunn’s request for clinical information. The court considered the fol-
lowing sentencing options: a probation sentence with conditions related to
community-based services, Multisystemic Therapy (MST) while remaining in
the community, or residential placement. The court was interested in knowing
Marcus’s mental health needs, the risk and protective factors for recommend-
ing a particular sentencing option, and why one sentencing option may be
more appropriate for Marcus than the others.
Efforts were made to interview Marcus’s mother, Ms. Aaron, on four sepa-
rate occasions, but each time she neither kept the scheduled appointments nor
attempted to reschedule them. The court asked this evaluator to complete the
evaluation without interviewing Marcus’s mother. Additionally, a social inves-
tigation report was not received prior to conducting this evaluation.
A 30-minute phone interview was conducted with Ms. Mack, school coun-
selor, and a 15-minute interview was performed with Probation Officer Sheen.
Before obtaining information from Ms. Mack and Probation Officer Sheen, the
interviewees were informed about the nonconfidential nature of this evalua-
tion, and they agreed to participate.
Three clinical interviews were conducted with Marcus. In total, the inter-
views lasted one hour and 40 minutes. Marcus was administered the Wide
Range Achievement Test, Fourth Edition (WRAT-4) Reading Subsection,
Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV),1 and the
Personality Assessment Inventory-Adolescent (PAI-A). Marcus was informed
about the purpose of the evaluation, and the information obtained from the
interviews would not be confidential, that it would be included in a foren-
sic evaluation and used when giving oral testimony. He was told that the
evaluation would be prepared even if he did not participate. Marcus was also
instructed of his rights and informed that he could stop answering questions
at any time and answer some questions and not others. Marcus indicated that
he understood that the evaluation might be used by the judge to determine his
sentence. Marcus agreed to fully participate in the evaluation.
Sources of Information
The records reviewed for this evaluation were obtained from the Pearson
County General Hospital, Belleville, the Department of Children and Family
Services, and Marcus’s high school. According to available records, Marcus
was hospitalized on two occasions (all hospitalizations occurred at 14 years
of age) for mental health reasons. His first hospitalization followed being
taken into custody by the police for “violent behaviors toward his mother.”
Marcus noted that he was angry because his mother promised him money if
he cleaned the bathroom and then she refused to pay him after he finished.
Marcus admitted to hospital staff that he was “using alcohol and marijuana”
prior to the incident involving his mother. While at the hospital, Marcus par-
ticipated in individual and group therapy. Ms. Aaron refused to participate in
family therapy. Hospital staff worked with Marcus to develop prosocial ways
to express his emotions. Upon discharge, Marcus was prescribed psychotropic
medication and ordered to participate in substance abuse treatment.
Marcus was hospitalized for the second time after he reportedly hit his
mother, drank alcohol, used marijuana, and was noncompliant with tak-
ing prescription medications. Marcus was belligerent upon being taken into
custody by the police; he was also “uncooperative” during admission into
the hospital. Marcus denied ever hitting his mother. A urine toxicology test
showed positive results for cannabinoids and his blood alcohol level was
elevated. While there, Marcus was diagnosed with several psychological and
psychiatric disorders and prescribed psychotropic medication.
Marcus was later admitted to Belleville, a residential facility, and returned
home after one month due to insurance payment difficulties reported by Ms.
Aaron. He admitted to feeling “so sad” on some days that he “did not want to
get out of bed.” Marcus admitted that his violent behavior was “tied to smok-
ing marijuana and drinking alcohol.” While at Belleville, Marcus reported that
he began using cannabis and alcohol at 12 years of age. Marcus stated, “I like
to stay high most of the day. It’s what I do with my friends.” He reported a his-
tory of selling cocaine, but never used the drug. According to therapy records,
Marcus had difficulty “processing emotions” and was often “frustrated.” Addi-
tionally Marcus continued to be “protective about being touched,” which was
speculated as a result of reported physical abuse from his biological father.
Once again, Marcus was diagnosed with several psychological and psychiat-
ric disorders and prescribed psychotropic medication. The residential facility
recommended that he participate in individual, group, and family therapy.
The Department of Children and Family Services (DCFS) investigated
two reports of child abuse involving Marcus and his biological father. The
first investigation involved Marcus’s father fracturing his jaw (occurred at 11
years of age). During the second investigation, a DCFS investigator noted a
“bump” on Marcus’s forehead and a bruise on his neck. Marcus’s biological

father admitted that, in frustration, he grabbed Marcus around the neck and
slammed his head against the wall (occurred at 12 years of age). Marcus’s father
reportedly abandoned the family, and was never heard from again (occurred at
13 years of age). DCFS records also indicated investigations of maternal child
neglect for not providing adequate supervision (13 years of age).
Based on school records, Marcus had a history of academic problems, dat-
ing back to the third grade. As a result, Marcus was retained in the third grade
for an additional year. Over the past year, Marcus had frequent absences and
was suspended from school on several occasions for fighting. Marcus had
problems at school because he had difficulty listening to authority figures and
following the rules. Marcus was easily frustrated by schoolwork and frequently
distracted by his peers. Specifically, school records indicated that Marcus had
“difficulty with reading comprehension and clarifying his thoughts and ideas.”
Marcus was recommended for special education several years ago; however,
there was no indication of a special-education evaluation or that an Individu-
alized Education Plan was completed.

Marcus indicated that he was raised by his biological mother and godmother.
His godmother passed away approximately two years ago and he was report-
edly a witness to her death. He tearfully stated, “She was in a chair and I saw
her take her last breath.” Marcus has two siblings, an older brother (18 years
of age) and a younger sister (10 months of age). Marcus reported having little
contact with his older brother, who was incarcerated at the county jail, but
expressed great love and affection for his sister.
Marcus reported that during the week, he lived with his mother. He man-
aged a family-owned apartment complex and lived with a “family friend” on
the weekend. Marcus indicated that this “family friend” was not in a gang,
but used crack cocaine daily. About five years ago, when Marcus was 10 years
of age, his mother was diagnosed with leukemia. Marcus reported that his
mother attempted suicide soon after the diagnosis and was later hospitalized as
a result. Marcus remembered that, when he was 11 years of age, his biological
father punched him and broke his jaw. Marcus also recalled another incident
(approximately one year after he was punched by his biological father) when
his biological father slammed his head into the wall. Both cases were referred
to the Department of Child and Family Services. He refused to elaborate
on the incidents. Marcus denied any abuse and/or neglect from his mother
despite records that indicated investigations of maternal child neglect for not
providing adequate supervision. He indicated, however, that when his mother
wanted to punish him she forbade him from holding his sister. He stated that
when he was not allowed to hold his sister, it “messed me up . . . she was my
world.” Marcus said that his relationship with his mother “fell apart” when
his godmother died. He reported that when his mother was feeling stress and
loss, she took her emotions out on him by saying that she “hated” him and he
was “stupid, ugly, and useless.” Marcus admitted that when his mother yelled
or called him names that he yelled back. He believed that negative exchanges
with his mother had “increased in recent months.” While records indicated
that Ms. Aaron reported Marcus hit her, he vehemently denied doing so. Mar-
cus contended that his “mother lied to the police in order to have him arrested
and placed in a hospital.” During the collateral interview, Ms. Mack (school
counselor) asserted that Marcus’s “internal pain” was related to family issues
and contributed to his problem behaviors.
When conflict existed between him and his mother, Marcus admitted that
he often left home and spent time with friends who were gang-involved. Mar-
cus reported that he was gang-involved soon after his godmother passed away,
but left the gang shortly after his sister was born. Marcus asserted that he con-
tinued to be friends with gang members, but they allowed him to leave the
gang due to his “situation [birth of sister].” This was consistent with collateral
interview information obtained from Ms. Mack and Probation Officer Sheen.
Marcus admitted to a history of selling marijuana and cocaine while gang-
involved, but reported that he was no longer selling drugs. He admitted to
using marijuana and alcohol since 12 years of age. Marcus said that, at first,
he used marijuana only occasionally, but over a short period of time he “got
used to it and, in order to feel high, smoked about two blunts a day.” Marcus
reported drinking a pint of vodka about once a week. Marcus’s violent con-
duct was reportedly related to his use of marijuana and alcohol. Since being
detained at the Pearson County Temporary Juvenile Detention Center, Marcus
contended that he had not smoked marijuana or drank alcohol.
Marcus admitted that he had a “hard time” controlling his anger. Marcus
reported that, for the most part, he exhibited anger because his mother, kids
at school, or strangers on the street “picked fights with him or called him
names.” Marcus stated that he developed ways of coping with people who pro-
voked him, such as “walking away, exercising, drawing pictures, or writing
poems.” Marcus stated that all of his fights were because he “had to deal with
people who wanted to cause him problems.” He could not recall a time when
he initiated or provoked a fight. Specifically, Marcus reported that all of the
fights involved him defending himself or responding to provocations. Marcus
admitted to fighting at school and engaging in three physical fights within the
academic year, with each resulting in suspensions. During the collateral inter-
view, Ms. Mack reported that Marcus engaged in verbally aggressive behavior
at school and it was difficult for him to disengage without external prompting.
Marcus stated that he “hated school” and his failures were due to being “bored”
and because “teachers were out to get me.” He admitted to having difficulty
learning in school, but denied being enrolled in special education classes. This
was consistent with collateral interview information from Ms. Mack and Pro-
bation Officer Sheen.
Marcus reported that, at 14 years of age, he was hospitalized on two
occasions for psychiatric treatment. Marcus indicated that admissions to the
psychiatric hospital followed arguments with his mother. He asserted that
“she called the police, lied to them that I had hit her, and the police took me
to the hospital.” Although he denied hitting his mother, Marcus admitted to
having a “hard time” controlling his anger. He reported that they prescribed
psychotropic medications for “depression,” the names of which were not
known to him, but that he did not take them consistently once at home because
“those meds don’t mix well with alcohol and my mom stopped reminding me
to take them.” Marcus reported symptoms of depression (e.g., reduction in
appetite, increased isolation, irritability, sadness, feeling hopeless) since his
godmother’s death, which increased in frequency and severity over the past
couple years. He expressed feeling “alone” and asserted that “there is no one
who can be trusted.” He reported no suicidal or homicidal ideation. When
asked about sentencing options, Marcus expressed a considerable desire to
participate in community-based services or MST. He thought MST program-
ming would be most beneficial to him and his family because services would
be provided in the home. Marcus contended that if his “family problems were
fixed” he would no longer have problems with the law. Probation Officer Sheen
also recommended community-based services or MST, but raised concerns
about Ms. Aaron’s commitment to treatment services.

Marcus was a fifteen-year-old male who appeared his stated age and was well-
groomed. Marcus participated in this evaluation and answered all questions
asked of him, with the exception of questions related to incidents of physi-
cal abuse perpetrated by his biological father. He exhibited no difficulty in
understanding the questions asked of him and his memory appeared intact.
He presented with depressed mood and tearful affect. Marcus reported expe-
riencing depressive symptoms (e.g., reduction in appetite, increased isolation,
irritability, sadness, feeling hopeless) since his godmother’s death, which have
increased in frequency and severity over the past couple years. While discuss-
ing his godmother and the nature of their relationship, Marcus became tearful
while recalling her death and stated, “She was in a chair and I saw her take her
last breath.” Marcus presented with organized and logical thinking. There were
no noted speech disturbances. He presented with no preoccupation or rumi-
nations and no thought disturbances were observed. He reported no suicidal
or homicidal ideation. His judgment was considered poor, particularly with

regard to prosocial behavior. Marcus possessed limited insight into his
problem behaviors and emotions.
WRAT-IV The Wide Range Achievement Test, Fourth Edition (WRAT-4)
is designed to assess academic achievement. Marcus was administered
the WRAT-4 Reading Subsection and his score suggested that he read at
approximately the 6.4 grade level.
WISC-IV Marcus was administered the Wechsler Intelligence Scale for

Children, Fourth Edition (WISC-IV). The WISC-IV measures aspects of an
individual’s verbal and non-verbal abilities. An Intelligence Quotient (IQ)
between 90 and 109 is considered average functioning. Data was collected on
a cross section of subjects from across the United States of various ages and
socioeconomic levels. The group on which data was collected also included
subjects from various racial groups based upon their representation in
the general population according to census data. Marcus achieved a verbal
comprehension score of 75, perceptual reasoning score of 75, working memory
score of 62, and processing speed score of 75. He achieved a Full Scale IQ of 67.
This placed him in the extremely low range of cognitive functioning in the 1st
percentile for his age group.
PAI-A The Personality Assessment Inventory-Adolescent (PAI-A) is a

well-standardized measure of adolescent personality. It possesses validity,
clinical, interpersonal, and treatment scales. Marcus’s validity scores fell within
acceptable limits. The PAI-A clinical profile revealed significant elevations
across several scales, indicating a broad range of clinical difficulties that were
associated with marked distress and significant impairment in functioning.
Specifically, the configuration of scores on the clinical scales suggested that
Marcus was experiencing problems with emotional stability, problem behaviors,
and depressive related symptomatology. With regard to emotional functioning,
Marcus’s scores suggested that he manifested fairly rapid and extreme mood
swings resulting in episodes of poorly controlled anger. As a result, he was
likely impulsive, prone to behaviors that were self-destructive/self-injurious,
experienced involvement in intense and volatile relationships, and tended to
be preoccupied with consistent fears of being abandoned or rejected. Marcus
likely experienced difficulties with significant depression, as his scores suggested
he experienced thoughts of worthlessness, hopelessness, and personal failure;
feelings of sadness; loss of interest in normal activities, sense of pleasure in things
that were previously enjoyed, and appetite; sleep disturbances; and decreased
level of energy and drive. Marcus’s interpersonal style seemed to be best

characterized as withdrawn or introverted. The scores indicated that Marcus was
prone to be self-critical, pessimistic, and dwell on past failures with considerable
uncertainty and indecision about his plans for the future. In addition, Marcus’s
scores suggested that alcohol use had a negative impact on his life and behaviors.
Marcus’s scores also suggested that he perceived others as treating him
inequitably and making a concerted effort to undermine his interests.
Sentence Recommendations
Based on records, Marcus has not been afforded the opportunity to engage
in consistent mental health or community-based services to address his spe-
cific needs. In the interest of recommending the least restrictive alternative
disposition and promoting healthy child development, it was recommended
that Marcus be released into the community with several probation con-
ditions, including individual therapy, social skills training, and substance
abuse treatment. It was also recommended that Marcus’s psychiatric needs
be reassessed. Although community-based services were considered the
least restrictive option, it should be noted that Ms. Aaron’s lack of parental
supervision and weak parental attachment were considered to be barriers to
Marcus’s potential success in treatment, as he would need encouragement
and consistent transportation to services. Thus, it was recommended that,
if Ms. Aaron would not engage consistently in community-based family
therapy services and support her son’s mental health treatment by ensuring
transportation to community-based services, the court should consider MST
as a secondary option. Given her refusal to engage in family therapy in the
past, if Ms. Aaron did not demonstrate consistent commitment to this inten-
sive treatment, residential treatment was considered as the next best option.
Individual Therapy Based on Marcus’s behavioral problems and depressive

symptoms as evidenced by records, clinical interview information, and PAI-A
outcomes/scores, it was recommended that he receive Cognitive Behavioral
Therapy (CBT). CBT has proven to be effective in reducing depressive
symptoms and behavioral problems. As such, it was recommended that
individual therapy address the following treatment goals:
• Provide psychoeducation and improved insight into stressors;

• Provide stress management and improved coping skills;
• Provide improved decision-making strategies;
• Assist Marcus in identifying and connecting emotions, thoughts and
behaviors;
• Provide appropriate coping skills to manage emotions;
• Address loss and grief of godmother and abandonment from father;

• Discuss emotions with regard to mother-child relationship and improve
coping strategies when experiencing anger and frustration;
• Provide psychoeducation specific to substance abuse, monitor for substance
use, and explore how marijuana and alcohol use may be related to negative
states;
• Promote prosocial activities;
• Monitor for exacerbation of mental health symptoms;
• Collaborate with other mental health and substance abuse providers to pro-
vide continuity of care.
Family Therapy Based on information obtained from clinical interviews

and records, Marcus’s relationship with his mother was extremely strained and
there was some concern about her ability to adequately care for and protect
Marcus. Thus, it was strongly recommended that Ms. Aaron and Marcus
participate in family therapy. Without family therapy, it was determined
that Marcus was at increased risk of recidivism. The following goals were
recommended:
• Build a positive parent-child relationship and improve communication

between Marcus and his mother;
• Discuss importance of consistent parental supervision and assist Ms. Aaron
in better meeting Marcus’s emotional needs;
• Provide and practice effective and consistent parenting management skills
to better handle Marcus’s problem behaviors.
Since Marcus was being detained, awaiting a dispositional hearing, it was

recommended that family therapy begin immediately upon his return to
his mother’s home. This recommendation was intended to address concerns
about appropriate levels of parental supervision. Marcus was living on his own
during the weekend, and when at home during the week his mother provided
very little parental supervision. Success in community-based treatment often
requires parental support and encouragement.
As noted above, if Ms. Aaron was court ordered to attend family therapy
but chose not to comply, it was recommended that residential treatment be
considered.
Special Education Services Given the administration of the WISC-IV

and scores obtained in addition to the long-standing problem behaviors and
learning difficulties in school, it was recommended that an Individualized
Education Plan be completed that incorporated a full battery of academic and
cognitive testing. This was essential in determining the most appropriate school
placement for Marcus and the potential impact of his problem behaviors on
academic learning.
Social Skills Training It was recommended that Marcus attend highly

structured after-school activities that would expose him to prosocial role
models and assist him in learning appropriate prosocial behaviors across a
variety of contexts. This structure may also reduce opportunities for Marcus to
engage in delinquent behaviors.
Substance Abuse Treatment If individual therapy could not adequately

incorporate or address substance abuse concerns, it was recommended that
Marcus receive specialized treatment for marijuana and alcohol use. Based on
records and clinical interview information, substance use impacts his negative
emotions (e.g., anger) and increases the risk for future violence or angry
outbursts. While Marcus reported that he stopped using marijuana and alcohol
while in detention, it seemed unlikely that he would not use substances if he
were in less structured environments. It was recommended that his substance
abuse treatment provider remain in contact with all of Marcus’s treatment
providers to ensure continuity of care.
Medication Management Although Cognitive Behavioral Therapy was to

play an integral role in the reduction of Marcus’s mental health symptoms, it
was also recommended that he be referred for a medication evaluation. Based
on the PAI-A and clinical interview information, Marcus was experiencing
symptoms of depression that were impacting his daily functioning. Marcus
had not taken medication consistently and it was recommended that the
prescribing physician or psychiatrist be aware of the historical barriers to
medication compliance. It was recommended that the psychiatrist work
closely with all mental health treatment providers to ensure continuity of care.

Forensic evaluators are asked to prepare sentencing evaluations to help juve-
nile courts respond appropriately to juvenile offenders. This is no easy task. It
requires considerable knowledge, experience, and sophistication to do well.
Below are three interrelated challenges that are commonly associated with
preparing juvenile court sentencing evaluations.
First, sentencing evaluations attempt to answer complex and wide-ranging
questions. For instance, to what extent does the juvenile pose a threat to the
community? What mental health problems exist? How severe are they? Are
there social circumstances and environmental influences at play in the case?
What are they and how serious are they? Accurate answers to those and other
questions are difficult to obtain and understand. However, that is what is being
asked of forensic evaluators when they conduct sentencing evaluations.
Second, forensic evaluators are expected to recommend sentences they
believe reflect what is appropriate given the circumstances of cases. Addi-
tionally, sentencing recommendations are fundamentally influenced by two
overarching principles. These principles are as follows:
a) In order to promote healthy childhood development, juvenile court judges

should impose the least detrimental alternative sentences.
b) Juvenile court sentences are not to be overly restrictive. That is, judges
should strive to impose the least restrictive alternative necessary to meet
children’s needs and at the same time protect society.
Third, sentencing recommendations have both short- and long-term con-

siderations. The juvenile justice system is interested in the welfare of children,
behavioral change, and the safety of the community. To those ends, sentencing
recommendations require that the eyes of forensic evaluators remain simulta-
neously on the present and the future. Hence, what do juveniles need now in
order to keep the community safe? Is residential placement necessary? If not,
can restrictions be placed on the juvenile in the community that will keep the
community reasonably safe? How might immediate psychological and social
concerns be addressed to reduce the risk of recidivism? What can be done
to bring about conformity to the law and participation in conventional law-
abiding activities? Are there measures that can be taken in the family to help
create a more loving and supportive environment? Answers to those questions
depend on how well forensic evaluators understand the juvenile justice sys-
tem and the short- and long-term needs of juvenile offenders. Those needs are
reflected in the circumstances surrounding the offense(s) of conviction, the
information derived through interviews, collateral sources, official records,
and information obtained from psychological tests.
Note
1. At the time of the evaluation, the WISC-V (current version of the Wechsler
Intelligence Scale for Children) was not on the market or available to evaluator. The latest
version at the time was the Wechsler Intelligence Scale for Children, Fourth Edition, and
was the reason for its use at the time of the evaluation.
References
Akse, J., Hale, W. W., Engles, R., Raaijmakers, Q., & Meeus, W. H. L. (2007). Co-occurrence
of depression and delinquency in personality types. European Journal of Personality,
21(2), 235–256.
American Psychological Association. (2013). Specialty Guidelines of Forensic Psychologists.

American Psychologist, 68, 1, 7–19. Retrieved from (http://www.apa.org/practice/
guidelines/forensic-psychology.aspx
Barkley, R. A. (2003). Attention-deficit/hyperactivity disorder. In E. J. Mash & R. A. Barkley
(Eds.), Child psychopathology (2nd ed.; 75–143). New York, NY: Guilford Press.
Brody, G. H., Ge, X., Conger, R., Gibbons, F. X., Murry, V. M., Gerrard, M., & Simons,
R. L. (2001). The influence of neighborhood disadvantage, collective socialization,
and parenting on African American children’s affiliation with deviant peers. Child
Development, 72, 1231–1246.
Brownlie, E. B., Beitchman, J. H., Escobar, M., Young, A., Atkinson, L., Johnson, C., Wilson,
B., & Douglas, L. (2004). Early language impairment and young adult delinquent and
aggressive behavior. Journal of Abnormal Child Psychology, 32(4), 453–467.
Campbell, M. A., & Schmidt, F. (2000). Comparison of mental health and legal factors in
the disposition outcome of young offenders. Criminal Justice and Behavior, 27, 688–715.
Cappon, L., & Vander Laenen, F. (2013). Mental health in juvenile judges’ decision-making:
Review of literature. International Journal of Law and Psychiatry, 36, 65–72.
Cauffman, E., Piquero, A. R., Kimonis, E., Steinberg, L., Chassin, L., & Fagan, J. (2007).
Legal, individual, and environmental predictors of court disposition in a sample of seri-
ous adolescent offenders. Law and Human Behavior, 31, 519–535.
Chandler, M., & Moran, T. (1990). Psychopathy and moral development: A comparative
study of delinquent and nondelinquent youth. Development and Psychopathology, 2,
227–246.
Chang, J. J., Chen, J. J., & Brownson, R. C. (2003). The role of repeat victimization in ado-
lescent delinquent behaviors and recidivism. Journal of Adolescent Health, 32, 272–280.
Chung, H. L., & Steinberg, L. (2006). Relations between neighborhood factors, parenting
behaviors, peer deviance, and delinquency among serious juvenile offenders. Develop-
mental Psychology, 42(2), 319–331.
Dixon, A., Howie, P., & Starling, J. (2005). Trauma exposure, posttraumatic stress and
comorbidity in female juvenile offenders. Journal of the American Academy of Child and
Adolescent Psychiatry, 44, 798–806.
Estelle v. Smith 451 U.S. 454 (1981). Retrieved from https://supreme.justia.com/cases/fed-
eral/us/451/454/case.html
Gebo, E. (2007). A family affair: The juvenile court and family violence cases. Journal of
Family Violence, 22, 501–509.
Grisso, T. (2004). Double jeopardy: Adolescent offenders with mental disorders. Chicago,
IL: University of Chicago Press.
Guerra, N. G., Huesmann, L. R., Tolan, P. H., Van Acker, R., & Eron, L. D. (1995). Stress-
ful events and individual beliefs as correlates of economic disadvantage and aggression
among urban children. Journal of Consulting and Clinical Psychology, 63, 518–528.
Hecker, T., & Steinberg, L. (2002). Psychological evaluation at juvenile court disposition.
Professional Psychology: Research and Practice, 33, 3, 300–306.
Heinbrun, K. (1992). The Role of psychological testing in forensic assessment. Law and
Human Behavior, 16, 257–272.
Henry, D. B., Tolan, P. H., & Gorman-Smith, D. (2001). Longitudinal family and peer group
effects on violence and nonviolent delinquency. Journal of Clinical Child Psychology, 30,
172–186.
Hinshaw, S. P., & Lee, S. S. (2003). Conduct and oppositional defiant disorders. In E. J.
Mash & R. A. Barkley (Eds.), Child psychopathology (2nd ed.; 144–198). New York, NY:
Guilford Press.
Kavanaugh, A., Clark, J., Masson, T., & Kahn, B. (2006). Obtaining and utilizing comprehen-
sive forensic evaluations: The applicability of one clinic’s model. Nevada Law Journal, 6,
890–912.
Kempf-Leonard, K., & Sontheimer, H. (1995). The role of race in juvenile justice processing
in Pennsylvania. In K. Kempf-Leonard, C. Pope, & W.H. Feyerherm (Eds.), Minorities in
juvenile justice (pp. 98–127). Thousand Oaks, CA: Sage.
Loeber, R., Burke, J. D., Lahey, B. B., Winters, A., & Zera, M. (2000). Oppositional defiant
and conduct disorder: A review of the past 10 years, part I. Journal of the American
Academy of Child and Adolescent Psychiatry, 39, 1468–1484.
Loeber, R., & Farrington, D. P. (2000). Young children who commit crime: Epidemiology,
developmental origins, risk factors, early interventions, and policy implications. Devel-
opment and Psychopathology, 12, 737–762.
Melton, G. B., Perila, J., Poythress, N. G., & Slobogin, C. (2007). Psychological evaluations
Mitchell v. United States 526 U.S. 314 (1999). Retrieved from https://supreme.justia.com/
cases/federal/us/526/314/
O’Donnell, P. C., and Lurigio, A. J. (2008). Orders in a juvenile court psychosocial predic-
tors of clinicians’ recommendations and judges’ placement orders in a juvenile court.
Criminal Justice and Behavior, 35, 1429–1448.
People v. Rosenthal, 617 P.2d 551 (Colo. 1980). Retrieved from http://law.justia.com/cases/
colorado/supreme-court/1980/80sa221-0.html
Resnick M. D., Ireland, M., & Borowsky, I. (2004). Youth violence perpetration: What pro-
tects? What predicts? Findings from the National Longitudinal Study of Adolescent
Health. Journal of Adolescent Health, 35, 5, 1–10.
Shek, D. L. (2005). Paternal and maternal influences on the psychological well-being,
substance abuse, and delinquency of Chinese adolescents experiencing economic dis-
advantage. Journal of Clinical Psychology, 61, 3, 219–234.
Teplin, L. A., Abram, K. M., McClelland, G. M., Dulcan, M. K., & Mericle, A. A. (2002).
Psychiatric disorders in youth in juvenile detention. Archives of General Psychiatry, 59,
1133–1143.
Thornton v. Corcoran, 407 F.2d 695, 700 (D.C. Cir. 1969). Retrieved from https://casetext
.com/case/thornton-v-corcoran
U.S. Const. amend. I–XXVII. Retrieved from Find Law/Thomas Reuters website: http://
constitution.findlaw.com/amendments.html
Wasserman, G. A., Ko, S. J., & McReynolds, L. S. (2004). Assessing the Mental Health Status
of Youth in Juvenile Justice Settings. Juvenile Justice Bulletin, U.S. Department of Justice
Office of Justice Programs, Office of Juvenile Justice and Delinquency Prevention.
Wordes, M., Bynum, T. S., & Corley, C. J. (1994). Locking up youth: The impact of race on
detention decisions. Journal of Research on Crime and Delinquency, 31, 149–165.
14
Juvenile Competence
to Stand Trial
Nancy Ryba Panza
Juvenile competence to stand trial (JCST) is a newer area of practice in relation

to many of the other types of forensic assessment that are commonly conducted
for the courts. Essentially, a JCST evaluation is used to assess the functioning
of a child or adolescent who has become involved in the legal system. Ques-
tions about competence may arise when there is concern about the presence
of deficits in functioning or limitations in development that cause a young
offender to not be able to function in the role of defendant. Despite the recency
in development of this area of forensic clinical practice, there is a great deal of
information available to aid those who wish to conduct this type of evaluation.
Important aspects of the law and of clinical practice are reviewed in order to
highlight the most essential considerations to which one must attend when
conducting such evaluations.
Relevant Statutes and Case Law

The issue of competence to stand trial for juvenile offenders was rarely
encountered prior to the mid-1990s, as it was mostly irrelevant. Since the first
juvenile court was created in 1899, the primary focus was to aid in the reha-
bilitation of wayward youth (Steinberg & Schwartz, 2000). The idea behind the
juvenile court movement was to hold youth accountable for legal wrongdoing
by providing supervision and guidance in a way that promoted the child’s well-
being. Punishment of wrongdoing was not the focus, instead the court acted
in what has been termed a parens patriae approach in which judges used their
discretion to provide remediation in a manner that supported the “best inter-
ests of the child” (Kruh & Grisso, 2009; Steinberg & Schwartz, 2000).
Two major changes shifted the focus of the juvenile court away from
rehabilitation and toward punishment. The first major change occurred in
Juvenile Competence to Stand Trial 323
the 1960s when the U.S. Supreme Court decided the cases of Kent v. United
States (1966) and In re Gault (1967). Both decisions stemmed from a realiza-
tion that the juvenile court’s well-intentioned lack of due process require-
ments was being abused, and youth were, at times, unfairly detained and
punished without the benefit of the procedural protections that are in place
for adults in criminal court. As a result, the Kent and Gault decisions put
in place many of the due process requirements provided for adults (Grisso,
2013; Steinberg & Swartz, 2000). While this drastically changed the adju-
dication process for juveniles, it tended to be the case that sentencing in
juvenile court was still used as a time to focus on rehabilitation and helping
youth to become more functional and law-abiding citizens (Kruh & Grisso,
2009). It wasn’t until the mid-1990s that the second major change occurred.
During the late 1980s and early 1990s, arrests for juvenile violent crime
increased, and state legislatures responded both by increasing the range of
penalties available within the juvenile court and by making the procedures
for transferring a youth to face trial in adult court much easier (Steinberg
& Swartz, 2000). Taken together, these changes created a juvenile court that
was very different from its informal, rehabilitation-focused origins, and it
was these changes that prompted the need for consideration of competency
to stand trial in the juvenile court system.
The issue of competence to stand trial has been relevant in the American
criminal court system since its creation. With its basis in English common
law, the idea that defendants must have a basic understanding and awareness
of the proceedings they face was considered essential to fair and just legal
procedures (Melton, Petrila, Poythress, Slobogin, Lyons & Otto, 2007). To
try an individual who is unaware of what is happening, who cannot assist in
the defense, or who cannot comprehend the possible loss of liberty that may
result was believed to be a violation of the fundamental rights provided to
those facing legal charges. Every state requires that a criminal court defendant
be competent prior to the commencement of legal proceedings, and the U.S.
Supreme Court set the standard for competence in the 1960 case of Dusky v.
United States. The Dusky decision held that the test for competence to stand
trial was “whether he [the defendant] has sufficient present ability to con-
sult with his attorney with a reasonable degree of rational understanding and
a rational, as well as factual, understanding of the proceedings against him
(p. 402). Thus, to face trial, one must have some degree of understanding of
the legal proceedings and must be able to work with an attorney to help pre-
pare the legal case. In many circumstances, the defendant must also be able
to work with the attorney to make important legal decisions, such as whether
to testify on one’s own behalf or whether to accept a plea agreement. In these
cases, it is important that the defendant be able to make such decisions ratio-
nally (Grisso, 2013). If it is the case that a defendant is lacking in any of these
capacities, he or she will be found incompetent, and efforts to remediate or

restore competence will be enacted.
While the Dusky standard for competence to stand trial applies nationwide
in adult court, it was not inherently clear whether this standard was relevant
for juvenile court cases. Since competence in juvenile court was infrequently
questioned prior to the mid-1990s, there was rarely a need to consider the
issue. However, as the juvenile court became more structured and punitive in
nature, more attorneys began to voice concerns over whether their youthful
clients were able to understand the legal proceedings and work with them to
prepare a proper defense (Kruh & Grisso, 2009). By the late 1990s, these refer-
rals were becoming commonplace.
The Dusky decision provided a nationwide standard for competence for
adults but was silent on whether the standard applied to juvenile offenders.
Therefore, each state was left to determine whether, and how, to apply this
legal standard of competence in juvenile court. Beyond this, many states note
in statutes that, for adults, deficits in competence must be the direct result
of a mental illness or an intellectual disability. However, as JCST evaluations
became more commonplace, it was clear that the reasons underlying incompe-
tence for young offenders were often quite different than were those in adults
(Grisso, 2013; Kruh & Grisso, 2009).
According to recent data, all but six states in the United States have now
developed court rules, statutes, or case law that speaks directly to the issue of
juvenile competence to stand trial, and of these, only one state has ruled that
competence is not relevant in juvenile court (Szymanski, 2013). Of the vast
majority of jurisdictions in the United States that consider competence as rel-
evant to juvenile court proceedings, most have adopted the Dusky standard as
the basis for determining competence; however, there are differences in how
Dusky is applied. Many believe the standard for competence should be applied
in juvenile court just as it is in adult court; however, there are also arguments
for applying Dusky in an alternate manner more fitting for the juvenile court.
As Kruh and Grisso (2009) discuss, there are generally three alternative
approaches offered: a lower bar, an adjusted bar, or a flexible bar. Essentially,
applying Dusky under a lower bar holds juveniles to the same abilities required
for adults, but at a lower level. Under an adjusted bar, only the basic under-
standing and communication abilities are considered necessary, and the more
complex appreciation and decision-making abilities are not considered neces-
sary; under a flexible bar, the level of competence needed is considered on the
basis of the demands of the legal case and the seriousness of the possible pen-
alties faced. There are benefits and drawbacks to each approach, and a consen-
sus has yet to be reached on whether one of these approaches may be best or
whether juveniles do indeed need to be held to the same level of competence
required for adults (Kruh & Grisso, 2009).
Review of the Literature on Incompetence in Young Offenders

Beyond level of impairment, the types of impairment that are considered
acceptable causes of deficits in competence also vary across jurisdictions. Most
states specify that deficits in competence must be the result of a mental illness
or deficits in cognitive functioning, as it is most often the case that incompe-
tence in adults stems from impairments related to symptoms of a psychotic
disorder or the presence of very low intellectual functioning, such as in those
diagnosed with an Intellectual Disability (Kruh & Grisso, 2009; Melton et al.,
2007). While it is the case that juveniles with serious cognitive deficits or
severe mental illness are more likely to be found incompetent, the sources of
deficits in young offenders often go beyond these two factors. In fact, research
has identified a number of correlates of incompetence for youth, and they tend
to look quite different from those seen in adults. The factors most commonly
identified as being relevant to juvenile competence include age, cognitive
functioning, mental illness, and developmental immaturity; many states have
begun to adopt statutes that address the factors that are specifically relevant to
juvenile competence (Kruh & Grisso, 2009).
Age
In the studies that have explored the correlates of incompetence in juvenile
offenders, the most common and consistent finding is that younger defendants
are more likely to show impairments in competence than are those who are
older (Grisso, 2013; Kruh & Grisso, 2009). While studies include a variety of
age ranges and measure competence in varying ways, it is generally accepted
that youth under the age of 14 pose a high risk of incompetence, those in mid-
adolescence ages 14 to 15 are at a heightened risk for impairments, and those
who are 16 or older are more likely to function at a level similar to adults and
therefore pose a lower risk of deficits (Grisso, 2013; Grisso et al., 2003; Kruh &
Grisso, 2009). While looking at age provides a good starting point for deter-
mining one’s overall risk of incompetence, focusing on age alone is not likely
to be helpful as research has demonstrated that other factors, such as cognitive
functioning, academic achievement, mental illness, and immature develop-
ment, are likely to play a role in the relation between age and incompetence
(LaVelle Ficke, Hart, & Deardorff, 2006; Grisso et al., 2003; Viljoen & Roesch,
2005; Warren, Aaron, Ryan, Chauhan, & DuVal, 2003).
Cognitive Functioning
As is the case for adult offenders, juveniles who have significant deficits in
cognitive functioning are likely to show deficits in competence abilities.
Specifically, juveniles diagnosed with Intellectual Disability are likely to show

deficits in competence, and correlations between low intelligence and low
scores on competence measures are a consistent finding in the literature (Col-
well, Cruise, Guy, McCoy, Fernandez, & Ross, 2005; Grisso et al., 2003; Kivisto,
Moore, Fite, & Seidner, 2011; Kruh, Sullivan, Ellis, Lexcen, & McClellan, 2006;
LaVelle Ficke et al., 2006; Viljoen & Roesch, 2005). However, recent research
has moved beyond looking at overall IQ and toward identifying particular
aspects of cognition that are most important to competence. Thus far, stud-
ies have shown links between competence and lower scores of tests of verbal
abilities and attention (Viljoen & Roesch, 2005). Beyond these findings, there
is also mounting evidence that young age and deficits in cognitive function-
ing interact in a way that those who are younger and who also have lower
intelligence are likely to be at particularly high risk for deficits in competence
(Grisso et al., 2003; LaVelle Ficke et al., 2006; Viljoen & Roesch, 2005).
Mental Illness
Far less consistent results have been found when it comes to investigations of
the relations between various mental disorders and deficits in competence.
While most studies have shown that, like adults, juveniles diagnosed with
psychotic disorders are likely to be found incompetent (Cowden & McKee,
1995; Kruh et al., 2006), the findings for other diagnoses have been far
less consistent. For instance, there is evidence both for (Viljoen, Klaver &
Roesch, 2005) and against (Kruh et al., 2006) the relation between a diagno-
sis of ADHD and incompetence. Inconsistent findings have also surfaced for
mood, anxiety, and substance use disorders, and to further complicate the
matter, variation is often found across different competency measures and
across different aspects of competence (i.e., understanding versus decision-
making abilities; Baerger, Griffin, Lyons & Simmons, 2003; Grisso et al., 2003;
Kruh et al., 2006; Warren et al., 2003). Because of this lack of clarity, forensic
evaluators must attend carefully to the presence of symptoms of mental illness
and the possible influence on competence abilities.
Developmental Immaturity
Perhaps the most complex and least understood factor relevant to juvenile
competence is that of developmental immaturity. While adults are presumed
to have the capacity for competence unless some debilitating impairment is
present (i.e., mental illness or cognitive deficit), the same is not necessarily
true for juveniles. Because young offenders are still maturing, it may be the
case that they have not yet achieved a level of functioning in terms of cogni-
tion or social and emotional skills that allows them to possess the abilities
necessary for competence (Grisso, 2005b). In these cases, a juvenile may be
deficient in competence abilities, not due to the presence of mental illness or

some other specific impairment, but instead due to the incomplete develop-
ment of the abilities needed to understand, appreciate, or reason in the context
of the legal setting. In such cases, the juvenile would indeed appear incom-
petent but would be so in the absence of some specific impairment short of a
simple lack of development.
The courts have struggled with this issue, and many jurisdictions have
begun to make statutory changes to directly address the lack of clarity. Some
have specifically noted that incompetence can be due to “age or developmen-
tal immaturity” (i.e., Georgia, Idaho, Maine, Maryland, Vermont), while oth-
ers have specifically rejected this notion and hold that one cannot be found
incompetent without an identifiable impairment that goes beyond a simple
lack of development (i.e., Arizona, Connecticut, Delaware, Montana, Virginia;
Szymanski, 2013). This leaves the role of developmental immaturity in com-
petency evaluations rather unclear. To further complicate the matter, both the
courts and forensic evaluators alike have struggled to find a consistent definition
or conceptualization of immaturity as it relates to competence (Grisso, 2005b;
Ryba, Cooper & Zapf, 2003a). Many aspects of development may be relevant
to consider in terms of deficits in competence, but to simply state that a young
offender is immature and, therefore, incompetent would be far too general an
opinion to offer the courts (Kruh & Grisso, 2009). Therefore, it is important for
evaluators to be clear on what aspect(s) of development are in question (i.e., cog-
nitive, biological, psychosocial; Borum & Grisso, 2007). Further, evaluators
should indicate that a young offender has incomplete or delayed development
in some area, while being clear about the comparisons implied herein (“incom-
plete” is generally in comparison to adults; “delayed” is generally in comparison
to same-aged peers; Kruh & Grisso, 2009). Finally, it is important to note the
concept of maturity goes beyond one’s chronological age and can vary greatly
across different domains.
Other Factors
A host of other factors have been studied to determine the relevance of each
to deficits in competence, and most have shown little influence. For instance,
it appears prior experience with the legal system, race and minority status,
socioeconomic status, gender, and the nature of the charges all have little to no
relation with competency status (see Grisso & Kruh, 2009, for a more detailed
summary of these findings).
Best Practices in JCST Evaluations

With the variation in legal definitions and the potential sources of deficits
underlying incompetence being much broader for juveniles than adults,
conducting evaluations of competence to stand trial with juvenile offenders is

more complex. First, due to the absence of a nationwide standard for JCST, it
is essential for an evaluator to be familiar with the statutes governing the juris-
diction in which one is practicing. Knowledge of local law is best gained via
contact with psychological and legal practitioners in one’s area of practice. Sec-
ond, JCST evaluations require a unique set of skills, and an evaluator should
be familiar with issues pertinent to conducting good competency evaluations
in general as well as issues related specifically to child and adolescent develop-
ment. Fortunately, there are a number of recent publications available to foren-
sic evaluators to aid in gaining an understanding of best practices in JCST
evaluations. In the highly practical Best Practices in Forensic Mental Health
Assessment series, Kruh and Grisso (2009) have written a book entitled Evalu-
ations of Juveniles’ Competence to Stand Trial. This text provides an in-depth
look at the issues discussed above while also providing detailed guidance on
the methods and procedures involved in conducting these evaluations. Addi-
tionally, Grisso (2013) recently published a revised edition of his groundbreak-
ing text Forensic Evaluation of Juveniles in which he devotes a chapter to JCST
evaluations. Finally, as will be discussed in more detail below, Grisso (2005a,
2005b) has also published guides for legal professionals and forensic evalua-
tors who deal with issues of juvenile competence, the latter of which contains
a detailed interview guide that practitioners can use to structure competence
interviews to ensure consideration of the information most important in com-
petency determinations. All of these sources should be required readings for
anyone conducting JCST evaluations.
Conceptualization of the Evaluation

The primary goal of conducting a JCST evaluation is to provide the courts with
information about the present functioning of the offender in the context of
how his or her functioning may or may not impede the ability to be an active
participant in the defense. Grisso (2005b, 2013) summarizes his five-part con-
ceptualization of the considerations necessary to make such a determination.
The first main task of the evaluation is to describe the youth’s functioning in
terms of the abilities necessary for standing trial. This description of func-
tional abilities is typically focused on the aspects of functioning delineated
in the Dusky standard, but may differ across jurisdictions depending on how
competence is defined. While alternate approaches exist, the most commonly
accepted conceptualization of Dusky entails a consideration of one’s ability
to understand (i.e., have a basic knowledge of the legal process, proceedings,
and key players involved), appreciate (have the ability to grasp the personal
relevance of the legal situation), and reason (have the ability to apply one’s
understanding to the legal situation and to make rational decisions based on
the information available; Grisso, 2013). Within these areas, one’s ability to
work effectively with his or her defense attorney is considered, as is the ability
to participate in the courtroom proceedings (Grisso, 2013). Therefore, it is of
utmost importance that an evaluator consider these aspects of functioning and
present a clear description of the youth’s abilities as they relate to each.
Beyond describing the functional abilities related to competence, the eval-
uator must also make a connection between any deficiencies in these abili-
ties and the possible causes (Grisso, 2005b, 2013). Therefore, the evaluation
must include an investigation into potential problems areas that can explain
any deficits identified. For juveniles, problems may stem from the presence
of any of the types of impairment described previously or from incomplete
development in some important area. Once this link is established, the third
important objective is to explain the interactions between the deficits in com-
petence abilities and the demands of the legal proceedings the individual will
face. This approach involves a highly individualized approach to considering
competence. For each case, the demands of the legal case must be considered
and any deficits in the abilities identified must be considered in light of these
demands. It may be that two youth with similar levels of functioning and simi-
lar levels of deficits may be seen differently in terms of competence, if one faces
a much more complex legal case that will involve important decision making
or a higher level of participation at trial (Grisso, 2013). Once deficiencies have
been described, underlying causes for the deficiencies have been specified, and
a connection between the deficits and demands of the legal situation have been
identified, the last two objectives for the evaluation are making a determi-
nation about competence and, if incompetence is likely, making recommen-
dations for remediation of the deficits noted. Using this five-step approach
to conceptualize the nature of the evaluation is an excellent way to keep the
evaluation process on target and to ensure the information gathered and deci-
sions made are done so with the legal standard and needs of the court as the
primary focus (Kruh & Grisso, 2009).
Evaluation Procedures
While the objectives of the JCST evaluation are rather unique, the procedures
involved in gathering clinical data are similar to those in any clinical forensic
evaluation. Generally, the process begins with the receipt of the referral either
from the court or from an attorney, ex parte. While there are some differ-
ences in the outcomes of the evaluation process that depend on the referral
source (see Kruh & Grisso, 2009, for a description of these issues), the first
step after receiving a referral is to contact the defense attorney to clarify the
nature of the referral question, to understand any procedural issues that are
relevant to the case, and to enlist help in obtaining any important records or
reports (Grisso, 2005b, 2013). In Evaluating Juveniles’ Adjudicative Compe-

tence: A Guide for Clinical Practice, Grisso (2005b) includes the Attorney CST
Questionnaire, a concise two-page form that asks questions that help clarify
the nature of the referral question. This form can be quickly and easily com-
pleted by the attorney and can be a very useful source of information relevant
to the reasons for referral as well as the demands of the legal proceedings the
defendant is expected to face.
It is often the case in adult competency evaluations that the records review
will be quite limited and focused primarily on existing mental health records;
however, because JCST deficits may stem from a wider range of impairments
than is typical for adults, JCST evaluations often require a review of school,
court, social services, medical, and mental health records (Grisso, 2005b;
Kruh & Grisso, 2009). Therefore, it is important to obtain and review any
potentially relevant sources of information prior to conducting any in-person
interviews. Having this information beforehand will aid forensic evaluators in
determining what parties will need to be interviewed and what, if any, testing
may be to be conducted with the offender. While it may be the case in other
types of evaluations that an interviewer may wish to “go in blind” and inter-
view the client without having prior access to information about the client, this
is not advised in JCST evaluations. In fact, it is quite necessary to understand
as much as possible about the child or adolescent and the specific legal case at
hand so that the interview questions can be tailored to potential deficits and
questions directly relevant to the legal case can be asked.
Interviews with the youth and any primary caretakers will be important
in order to clarify and elaborate on information obtained from the records
review as well as to gather information specific to the identification of com-
petence deficits. Many of the tasks in these interviews mirror those in any
clinical evaluation, such as reviewing important historical information (i.e.,
medical, mental health, family, social, educational, legal, etc.) and inquiring
about one’s current mental status and clinical functioning. However, addi-
tional interview tasks are very specific to the forensic question and include
a review of the current legal issue, questioning about competence abilities,
and explorations of how any deficits seen in this line of questioning can be
explained by the present functioning (Grisso, 2005b; 2013; Kruh & Grisso,
2009). It may also be necessary to interview the youth on more than one
occasion. This is typically the case when one’s understanding is questionable
and attempts to educate the youth are made. In these cases, it is best practice
to follow up at some point in time later to determine whether the efforts to
improve one’s understanding are lasting or not (Grisso, 2005b). Oftentimes,
it is helpful to use structured interviews or formal psychological testing to
supplement the data obtained from the records and interviews; however, the
usefulness of psychological testing will vary greatly from one evaluation to
the next and should be considered a potential, but not required, aspect of
JCST evaluations (Kruh & Grisso, 2009).
Psychological Testing
There are generally two reasons to use psychological testing in JCST evalua-
tions: one is to clarify whether there are deficits in competence abilities, and
the other is to determine the nature of the underlying cause of such defi-
cits. In the case of identifying deficits in competence abilities, CST-specific
instruments can be useful, and a number are available to forensic evaluators,
although each has its benefits and drawbacks. Since the 1960s, over a dozen
instruments have been developed for use in competency evaluations (Grisso,
2003; Kruh & Grisso, 2009). These instruments vary in terms of both structure
and data produced. Thus, the selection of a particular instrument should con-
sider the appropriateness of the tool for the particular client (Kruh & Grisso,
2009). Most importantly, none of these instruments were developed for use
with juveniles and, while some studies have provided preliminary support for
the use of some tests with young offenders (Viljoen, Slaney, & Grisso, 2009;
Viljoen, Vincent & Roesch, 2006), no formal measures have juvenile-specific
norms available (Grisso, 2013).
In fact, the only tool that has been developed specifically for use in JCST
evaluations is the Juvenile Adjudicative Competence Interview (JACI; Grisso,
2005b). This semistructured interview guide includes items that mirror the
abilities identified in Dusky as important to competence and provides stan-
dardized questions applicable to most juveniles. It allows for flexibility in what
information is relevant to a particular case, includes opportunities for educa-
tion on relevant issues with a means for following up on educational efforts at
a later interview, and aids the examiner in using a developmental approach to
considerations of competence (Grisso, 2005b, 2013; Kruh & Grisso, 2009). The
JACI is not a scored instrument, nor does it allow for any normative compari-
sons. For an extensive review of the strengths and weaknesses of all of the CST
instruments, see Grisso (2003) or Kruh and Grisso (2009).
General psychological testing can also be useful in JCST evaluations in that
these instruments can help to clarify the nature of any aspects of functioning
that may underlie deficits in competence abilities. Because the deficits that
may affect juveniles’ functioning can vary widely, the types of tests that may be
informative also vary (Grisso, 2005b, 2013). Prior surveys and reviews of test
use indicate practitioners rely on an array of tests in their JCST evaluations;
the most commonly used include intelligence tests, achievement tests, person-
ality tests, clinical inventories, neuropsychological tests, behavior checklists
and response style instruments (Kruh & Grisso, 2009; Ryba, Cooper & Zapf,
2003b). While this list of tests is extensive, it is important to note that the goal
of a JCST evaluation is not to include an extensive battery of psychological

tests in order to rule out any and all possible psychological issues but instead
to limit testing to those instruments needed to clarify the nature and extent of
those deficits indicated via data gleaned from records and interviews.
Forming and Presenting an Opinion to the Courts

After all data for the evaluation are collected, the evaluator must formulate
an opinion and communicate the evaluation results to the court in the form
of a report and, possibly, in-person testimony. It is often most useful to struc-
ture the report according to the following sections: summary of the refer-
ral issue, method and process of the evaluation, summary of developmental
and clinical history, summary of current clinical status and results of psy-
chological testing, summary of competence abilities, and summary of inter-
pretations and opinions for the courts. Alternative formats and methods for
presenting data are described in the various texts available (Grisso, 2005b,
2013; Kruh &Grisso, 2009); however, the nature of the information included
remains generally the same across all approaches. Essentially, the examiner
should elucidate the nature of the referral, provide all information about the
youth that is relevant to the referral, provide a contextual understanding of
the nature of any deficits in competence as well as the underlying causes
of such deficits and the connection between the deficits and the demands
of the case, and provide an opinion regarding competence and/or remedia-
tion, as appropriate. In preparing a report for the court, examiners should
be aware of issues related to offering ultimate opinions, as jurisdictions vary
as to whether judges expect forensic evaluators to offer opinions on the legal
question or limit their input to the clinical issue (Kruh & Grisso, 2009). Fur-
ther, forensic evaluators should be aware of whether or not a flexible opinion
approach is considered acceptable in their jurisdiction. In a flexible opinion,
the examiner can take a contextual approach a step further and offer an “if
this, then that” approach to the opinion (Zapf & Roesch, 2009). For instance,
it may be that a juvenile appears to possess the abilities necessary for com-
petence because the demands of the case are relatively low; however, should
the demands of the case increase and require more of the defendant in a way
that may go beyond his or her capacities, competence would then become
unlikely. A flexible opinion gives the court the option to proceed as long as
the demands of the case remain low. Again, jurisdictions vary in the accept-
ability of this approach to formulating and communicating opinions. Finally,
on the more practical side, all reports should be written in clear, jargon-
free language and should be free from pejorative information and opinions
that are not firmly grounded in data obtained during the evaluation process
(Kruh & Grisso, 2009).
Case Vignette
The following information is drawn from a JCST report. All names and iden-
tifying information have been changed, and some details have been altered to
aid in the clarity of the information presented.
Reason for Referral

Joe was a 13-year-old male who is currently on a secure hold at the Residen-
tial Treatment Unit of County Hospital. He faced juvenile court charges of
breaking and entering and larceny that stemmed from an incident in which
Joe and another youth were arrested for being found on school grounds after
hours and in possession of school property. Mr. White, a public defender, was
assigned to Joe’s case at arraignment. After their initial meeting Mr. White
became concerned about Joe’s competence to stand trial due to Joe’s confu-
sion over some of the legal issues discussed during that meeting. Juvenile
Court Judge Black ordered the present evaluation, which was then conducted
through the County Juvenile Court Services Program.
Method and Process of the Evaluation

The evaluation process included the following interviews: two interviews with Joe
spaced apart by one week (interview 1 lasting 2 hours, interview 2 last 40 min-
utes) and brief in-person interviews with nursing and correctional staff at the
hospital. Phone interviews were conducted with (a) Joe’s attorney, Mr. White;
(b) the ADA assigned to the case, Ms. Grey; (c) Joe’s school guidance counselor,
Ms, Scarlet; and (d) a social worker who is assigned to work with Joe’s family, Ms.
Green. In addition, the defense attorney, Mr. White, provided copies of relevant
records, including the police report, court intake notes, psychological testing from
County Middle School (conducted 6 months prior), and a summary report from
the Department of Social Services (DSS). No contact was made with Joe’s mother,
Ms. Peach, as she was hospitalized and receiving mental health treatment.
Mr. White was given Grisso’s Attorney CST Questionnaire to complete. The
questionnaire revealed concerns over Joe’s level of cognitive functioning. Specif-
ically, Mr. White indicated that during his initial meeting with Joe, he attempted
to explain some of the likely steps in the legal proceedings that Joe would face
and, when he asked Joe to repeat back the information, Joe was unable to do
so. Mr. White was unclear as to whether Joe was having trouble understanding
the information, whether Joe was understanding but having trouble explaining
things in his own words, or whether Joe was simply not actively engaged in the
discussion. One of Mr. White’s specific concerns was whether Joe would be able
to understand the concept of a plea bargain, as he felt this was a likely possibility
since this was the first time he had faced legal charges.
During the interviews with Joe, the Juvenile Adjudicative Competence
Interview (JACI) was used to guide questions about Joe’s understanding,
appreciation, and reasoning regarding the legal process. The results of the
JACI are incorporated into the description of Joe’s competence abilities below.
Due to the recency of past intellectual and academic testing and the consis-
tency of Joe’s presentation with the results of those test results, no further cog-
nitive measures were given during the present evaluation. In addition, current
hospital records included screens for clinical issues, such as depression and
psychosis; no further psychological testing was deemed necessary.
Summary of Relevant Background Information

The following information was drawn from the in-person and phone inter-
views conducted, as well as from the records reviewed.
According to Joe’s report and the information received from the DSS worker,
Ms. Green, Joe was primarily raised by his mother, Ms. Peach. He has had no
contact with his biological father since shortly after his birth. The only father
figure(s) Joe had in his life were the series of men with whom his mother had
relationships, although Joe had not established a bond or parental-type rela-
tionship with any of these men. Joe’s family life can be described as chaotic
and unstable as his family had moved often, necessitating several changes in
schools and often leading to frequent absences. Joe’s mother had a long history
of alcohol and drug use and mental illness, although the nature of her diagno-
ses remained unclear. According to the DSS report, Joe was recently removed
from his mother’s care due to charges of neglect that stemmed from her inabil-
ity to provide consistent care and supervision for him. Ms. Peach was currently
hospitalized and undergoing court-ordered treatment services.
Joe had been physically healthy and had no history of prior medical con-
cerns. He had no history of mental health issues or treatment, although DSS
records indicated that the family was referred for counseling three years
ago. There was no evidence that any services were obtained, and Ms. Green
reported the lack of follow-up care was due to inconsistency in the family’s
living arrangements, which made it difficult for DSS to locate the family. Inter-
views with hospital staff revealed that while Joe was thin and possibly a bit
undernourished, he did not presently suffer from any physical ailments or dis-
abilities and had been a quiet and cooperative patient since his arrival on the
unit. Nursing staff reported that Joe was rather withdrawn and that he inter-
acts minimally with other patients. Hospital records indicated screenings for
depression and other mental health issues were conducted upon admission
and revealed no significant areas of concern.
According to Joe’s guidance counselor, Ms. Scarlet, as well as the school
records provided by Mr. White, Joe was currently in 8th grade at County Mid-
dle School. Mr. Scarlet described Joe as “somewhat below average” academi-
cally and indicated that he did not have problems in school behaviorally, but
instead kept to himself and rarely interacted with teachers or administrative
staff. She noted that he appeared to spend time with a small circle of friends.
He had not failed any grades previously, but his grades were consistently below
average and his teachers indicated that frequent absences caused him to fall
behind the level that is typical for his same-grade peers.
According to Ms. Scarlet and the school records reviewed, approximately
six months ago, Joe received psychological testing within the school system
to determine his current level of functioning academically and to rule out the
possibility of learning disabilities or below average intellectual functioning.
The results of this testing, revealed his overall intellectual functioning to be
slightly below average (Full Scale IQ of 89, 95% confidence interval 83–96)
with his verbal abilities substantially lower than his nonverbal abilities (Ver-
bal IQ of 85, Performance IQ of 93).1 Achievement testing indicated that his
performance in reading and writing were somewhat below what would be
expected for someone of his chronological age and grade level, and additional
testing indicated Joe had particularly low scores in the area of expressive lan-
guage abilities. While his test results revealed a weakness in language skills,
particularly expressive language skills, the underlying source of the impair-
ment appeared to be more likely explained by Joe’s lack of engagement with
the academic material than by a specific learning disorder. Prior to being hos-
pitalized the school counselor was working with Joe to monitor his attendance
and to attempt to increase his motivation to complete his work both in and
out of school. Joe had also been receiving tutoring in language skills and was
expected to receive follow-up testing during the next academic school year to
continue to monitor his progress.
Socially, Joe was consistently described by others as fairly shy and
withdrawn. Joe agreed with this assessment of his personality and noted that
he preferred to only spend time with a few close friends and that he did not
feel very comfortable around adults. The school counselor noted that it was
her impression that Joe appeared to have a desire to make friends and that, at
times, he tended to do whatever he thought his friends wanted him to do in
order to be liked and accepted.
Joe reported having no prior arrests or legal charges and information from
the ADA assigned to his case confirmed this report. Aside from his current
admission, Joe had not received mental health services or been hospitalized
for psychiatric reasons in the past. He admitted to experimenting with drugs
(i.e., marijuana) and alcohol in the past, but he said that he did not use either
on a regular basis, stating he had “no way to buy that stuff even if I wanted to.”

Joe was interviewed two times, one week apart, on the residential treat-
ment unit of County Hospital. During both meetings, Joe was appropriately
dressed and well groomed. He is of average height and weight and appears
his stated age. He was cooperative during the interviews, but he spoke qui-
etly and had poor eye contact, often looking down when answering questions
and frequently responding, “I don’t know.” When given adequate time and
encouragement, Joe was able to provide answers to many questions to which
he initially replied, “I don’t know,” although he struggled to find words to
express his thoughts and feelings. His vocabulary was limited for his age, and
when faced with trying to explain something he found difficult, he tended to
shut down and become withdrawn.
During the interviews, Joe displayed a fairly low level of energy and sat in
his chair a bit slumped over. He displayed no signs of hyperactivity or overt
distractibility, although he did get restless during the first interview and began
rocking back and forth in his chair when discussing particularly sensitive top-
ics, like his mother’s recent hospitalization and being removed from her care
by DSS. When asked to focus on a particular topic, Joe was able do so. When
asked about his present concerns, he mostly focused on recent family events
and concerns over what would happen with his legal case and his living situ-
ation should he be released from custody. Clinically, Joe displayed no symp-
toms of psychosis or thought disorders, and he was in touch with reality and
appropriately oriented. He reported that he had felt sad often in the past and
feels this way at present due to his legal situation, being held at the hospital,
and being removed from his family home. He denied any suicidal ideation and
had no thoughts of harming others.
Competency Abilities
The information in this section was drawn from the interviews with
Joe, the results of the JACI, and from information received about Joe’s legal
case form his defense attorney, Mr. White, and from the ADA assigned to
the case, Ms. Grey.
In terms of demonstrating an understanding and appreciation of the
charges, possible penalties, and plea agreements, Joe was able to state the cur-
rent charges against him, describe what those charges meant, and indicate that
he could go “to juvie if they find me guilty.” When asked about the seriousness
of the charges, he indicated they were “kinda bad” but that “it’s not like I
killed someone or something.” When asked to describe what happened at a
trial, he struggled to find words to describe the process. At first, he replied “I
don’t know,” but when asked more concrete questions, he was able to provide
answers. For instance, when asked what he will do during the trial, he stated,
“I sit in a chair by my lawyer and listen to him talk and argue with the other
lawyer.” When asked about what happens after the lawyers finish talking, he
stated, “the judge tells you if you go to juvie or not.” When asked about plead-
ing guilty or not guilty, again he struggled to find the words to explain these
concepts and frequently replied ,“I don’t know,” but when questioned more
concretely or when offered yes/no or multiple choice type options, he was
able to provide answers that indicated a simplistic, but accurate, understand-
ing of these concepts. However, when asked about what a plea bargain was,
even with simplistic and concrete questions, he was not able to demonstrate
an understanding. This concept was explained to him during the first inter-
view and then he was questioned about this topic again during the second
meeting. At that time, he still replied, “I don’t know” initially, but when asked
direct questions or given multiple choices, he demonstrated a much better
understanding of what a plea agreement entails. Joe was able to demonstrate
an understanding of the range of possible penalties that may result if he is
found guilty.
In terms of demonstrating an understanding and appreciation of the
trial participants and their roles, Joe’s performance was very similar to that
described above related to the trial process. He consistently struggled to find
the language to express his thoughts, but when questioned in a simplistic and
concrete manner, he was able to show an adequate understanding of the roles
of his defense attorney (“to help me get clear”), the district attorney (“to lock
me up”), and the judge (“to keep the attorneys in line and tell me if I go home
or not”). The judge’s role in overseeing the trial, determining what evidence
may be presented, and deciding the outcome of the case were explained to him
during the first meeting and, when questioned about these facts during the
second meeting, Joe was able to describe the judge’s role, albeit in simplistic
language.
In terms of his ability to assist counsel, Joe understood that his defense
attorney was “on my side” and that it was good to talk with him about the
case. When asked to recount the events surrounding the legal incident in
question, Joe was able to give a superficial account of the case, but when ques-
tioned about details that were in the police report but not in Joe’s account,
he responded, “I don’t know” and was unable to elaborate further. While Joe
verbalized an understanding of his attorney’s role in helping him to present
case, Joe appeared reluctant to fully rely on or trust Mr. White.
In terms of his ability to make decisions about his legal case, Joe was able to
grasp the nature of what it meant to plead guilty or not guilty and, after some
education about what a plea agreement entailed, he was able to concretely
express his understanding of that process as well. When given an example of
someone taking a lesser penalty by agreeing to accept a guilty plea, Joe was
able to explain why this might be a good option (i.e., “you get out of juvie and
get to go home instead of having to maybe stay in there a long time”). In terms
of Joe’s decision making outside of the legal context, he appears very eager to
please his friends but reluctant to engage with adults that he does not know
well. This hesitance may prove challenging for his attorney until Joe develops
some sense of familiarity and trust in him.

Based on the data obtained, it was this evaluator’s opinion that Joe appeared to
possess the very minimum of capacities necessary to be considered competent
to stand trial in juvenile court and that because Joe’s competence was right on
the border, he was someone for whom a functional assessment of competence
abilities was appropriate. A functional assessment means that the specifics of
his case and the demands for his involvement in the legal proceedings must be
considered when determining his competency to proceed. More specifically,
if the demands of Joe’s case remained relatively low and the court was willing
to work with Joe to ensure his understanding and engagement throughout the
trial process, then Joe appeared competent to proceed; however, if the demands
of his case become greater than expected, Joe’s capacities would very likely be
exceeded, and he would not be able to actively participate and/or assist the
defense attorney in the case.
In terms of Joe’s legal situation, he was facing relatively serious charges,
but his defense attorney had indicated that, if the case goes to trial, Joe’s in-
person testimony would not be required and that instead, Joe would primarily
be required to follow along with testimony and to provide information as his
attorney prepares his defense. The attorney further expected that the court
was willing to make concessions to aid Joe in his ability to follow along (i.e.,
allow the defense attorney additional time to explain complex terms, to check
in to ensure Joe’s understanding, etc.), and the ADA concurred with these
expectations. If this was the case, Joe was likely to possess the abilities neces-
sary to understand and assist in his defense. On the other hand, should the
legal parties involved be unwilling or unable to make these concessions or
should the complexity of Joe’s participation at trial increase, it was likely the
demands of the trial would exceed Joe’s current capacities.
Overall, Joe demonstrated a simplistic, but accurate, understanding and
appreciation of the trial process, the potential consequences of his trial, and
the roles of the key legal players involved. While his understanding was limited
at times, he was able to gain a greater understanding after an explanation was
provided, and he was able to maintain that knowledge when questioned again
a week later. Therefore, while Joe’s understanding of legal issues was minimal,
he demonstrated the capacity to learn and retain information about the legal
process. Joe’s difficulties demonstrating his knowledge of the legal issues likely
stemmed from his below average expressive language skills (as documented
in the school testing), as such difficulties often caused trouble in formulating
verbal responses. For Joe, these limitations likely impeded his ability to explain
and convey his understanding of court information, and it would likely take
him longer and require more effort than is typical to find the language neces-
sary to explain his thoughts. However, when given time and assistance, Joe was
able to express his thoughts adequately.
Beyond these issues, Joe’s abilities to assist his attorney and make decisions
about his case were intact, but tentative as well. Joe was able to describe events
surrounding his case and to work with his attorney; however, his limited trust
and tendency to answer “I don’t know” when uncomfortable or struggling for
language put him at risk. Should his attorney be able to work closely with Joe
to develop a good working relationship and provide time and opportunity for
Joe to formulate answers beyond Joe’s default “I don’t know” response, then
Joe’s ability to assist his defense counsel and provide input in important deci-
sion making would likely to be adequate.
The fragility of Joe’s understanding and appreciation of the trial process
and the limitations in his ability to assist counsel appear to be directly related
to the documented impairments in expressive language skills and to his hesi-
tancy to trust unfamiliar adults. Both issues are clearly documented in the
prior academic testing and throughout interviews with those most familiar
with Joe. His language skills and hesitance to trust unfamiliar adults certainly
make Joe’s participation at trial tentative. However, information from inter-
views with others as well as from the present interviews indicated that, with
patience, careful formulation of questions, and a slow pace of interactions, Joe
does have the capacity to understand information presented to him and to
develop his own responses to questions or inquiries presented to him. Fur-
ther, given time and patience in working with Joe, it is likely his attorney can
develop a working relationship with Joe that will be adequate for allowing Joe
to work effectively to assist with his own defense.
While it is the opinion of this examiner that Joe possesses the minimal
capacities necessary to stand trial in juvenile court, the potential effect of Joe’s
limitations regarding understanding the trial process was very important to
consider. It is likely that Joe will be an active and able participant in the trial
process if the judge and the attorneys (particularly Joe’s defense attorney) are
willing to slow the pace of information down to a level Joe can understand.
Further, Joe should be given enough information and time to formulate his
responses and to make decisions. Should the nature of the trial become highly
complex or require Joe to make complicated decisions or explanations, it is
likely Joe will not be able to comply and will thereby be unable to actively par-
ticipate in the trial process. Should the options for various pleas be presented
in a manner that does not consider his limited vocabulary and should complex
answers be expected in response, Joe is likely to have difficulties. Also, if the
court determines that such alterations are not possible or that the necessity
of making such alterations is too burdensome, Joe is most likely going to be
unable to proceed to trial. In this case, remediation efforts might focus on
strengthening his knowledge and understanding of court procedures as well
as working with him to increase his ability to use verbal communication more
effectively. However, the demands related to the provision of complex in-per-
son testimony are likely to be unaffected by remediation efforts as Joe’s expres-
sive language difficulties are likely to be unaffected by educational efforts.

Conducting JCST evaluations is a complex endeavor, and while the above
information is intended to give a thorough overview of the history and cur-
rent state of practice in this area, reviewing a short chapter alone is obviously
not nearly enough training to begin taking on cases of this nature. A review of
the texts mentioned above combined with in-person training offered by one
of the many forensic psychology professional organizations would be strongly
advised, as would working with a professional experienced in the area to
receive supervision on cases both in the beginning and whenever a particu-
larly difficult case is undertaken. Further, whenever evaluations of children or
adolescents are conducted, one must use extreme caution in formulating diag-
noses and making conclusions due to the challenges that are inherent when
communicating with young people about complex issues, as is always the case
in JCST evaluations. The best protection against making poor judgements or
harmful decisions in clinical work is good training and ongoing supervision.
With that said, there are difficulties inherent in all clinical forensic work
and particularly with competency evaluations. For instance, it is always a
struggle to know how much information is sufficient and how much is too
much. The courts tend to prefer concise and direct reports, while forensic
evaluators are often trained to include any and all possibly relevant informa-
tion. Learning to balance these demands is important. In evaluations of JCST,
a more thorough review of background information and records may be nec-
essary than is typical for CST evaluations with adults. However, this does not
mean that any and every detail from one’s past is relevant and important to
include. In addition, the desire to administer every possible test that may be
relevant can be strong, but it is also unnecessary. While one should always
conduct testing when it will reveal important information about the youth’s
present abilities as they relate to standing trial, it is not necessary to adminis-
ter a full battery of tests merely to provide the court with as much information
as possible. This is generally not favorable to judges and attorneys who wish
to know the bottom line of whether the offender is competent or incompetent
to proceed.
Finally, there are a few cautions to all who conduct forensic evaluations.
As with other clinical forensic work, one must be cautious not to align with
either the defense or prosecution and to always indicate accurately the level
of certainty one has in the data that are included in a report. Any time an
expert is hired by either the prosecution of the defense, the tendency to align is
strong. The evaluator wants to please the person who has retained them as an
expert, and our tendencies to be biased in our work is well documented in the
literature (Murie, Boccaccini, Guarnera, Rufino, 2013). Therefore, all forensic
evaluators are cautioned to be aware of this literature and to continually evalu-
ate themselves and their work to minimize potential sources of bias. Along
these lines, classic texts have advised evaluators to cross check information
that is included in reports and, whenever possible, to only include information
that can be corroborated by more than one source (Melton et al, 2007). Cross-
checking one’s work and ensuring accountability of the information included
in all reports is a practice sure to improve the quality and accuracy of one’s
work and is strongly recommended.
Note
1. At the time of this evaluation, the WISC-III was used, which produced these scores
rather than the four index scores one would see on the WISC-IV currently.
References
Baerger, D. R., Griffin, E. F., Lyons, J. S., & Simmons, R. (2003). Competency to stand trial
in preadjudicated and petitioned juvenile defendants. Journal of the American Academy
of Psychiatry and the Law, 31, 314–320.
Borum, R., & Grisso, T. (2007). Developmental considerations for forensic assessment
in delinquency cases. In A. Goldstein (Ed.), Forensic psychology: Emerging topics and
expanding roles. Hoboken, NJ: Wiley.
Colwell, L. H., Cruise, K. L., Guy, L. S., McCoy, W. K., Fernandez, K., & Ross, H. H. (2005).
The influence of psychosocial maturity on male juvenile offenders’ comprehension and
understanding of the Miranda warning. Journal of the American Academy of Psychiatry
and the Law, 33, 444–454.
Cowden, V. L., & McKee, G. R. (1995). Competency to stand trial in juvenile delinquency
proceedings—Cognitive maturity and the attorney-client relationship. Journal of Family
Law, 33, 629–660.
Dusky v. United States, 362 U.S. 402 (1960).
Grisso, T. (2003). Evaluating competencies: Forensic assessments and instruments (2nd ed.).
New York, NY: Kluwer Academic/Plenum Press.
Grisso, T. (2005a). Clinical evaluations for juveniles’ competence to stand trial: A guide for
legal professionals. Sarasota, FL: Professional Resource Press.
Grisso, T. (2005b). Evaluating juveniles’ adjudicative competence: A guide for clinical practice.
Sarasota, FL: Professional Resource Press.
Grisso, T. (2013). Forensic evaluation of juveniles (2nd ed.). Sarasota, FL: Professional
Resource Press.
Grisso, T., Steinberg, L., Woolard, J., Cauffman, E., Scott, E., Graham, S., Lexcen, F.,
Repucci, D., & Schwartz, R. (2003). Juveniles’ competence to stand trial: A comparison
of adolescents’ and adults’ capacities as trial defendants. Law and Human Behavior, 27,
333–363.
In re Gault, 387 U.S. 1 (1967).
Kent v. United States, 283 U.S. 541 (1966).
Kivisto, A. J., Moore, T. M., Fite, P. A., & Seidner, B. G. (2011). Future orientation andcom-
petence to stand trial: The fragility of competence. Journal of the American Academy of
Psychiatry and the Law, 39, 316–326.
Kruh, I., & Grisso, T. (2009). Evaluation of juveniles’ competence to stand trial. New York,
NY: Oxford University Press.
Kruh, I. P., Sullivan, L., Ellis, M., Lexcen, F., & McClellan, J. (2006). Juvenile competence to
stand trial: A historical and empirical analysis of a juvenile forensic evaluation service.
The International Journal of Forensic Mental Health, 5, 109–123.
LaVelle Ficke, S., Hart, K. J., & Deardorff, P. A. (2006). The performance of incarcerated
juveniles on the MacArthur Competence Assessment Tool-Criminal Adjudication.
Journal of the American Academy of Psychiatry and the Law, 34, 360–373.
Melton, G., Petrila, J., Poythress, N., Slobogin, C., Lyons, J., & Otto, R. (2007). Psychological
evaluations for the courts (3rd ed.). New York, NY: Guilford Press.
Murie, D. C., Boccaccini, M. T., Guarnera, L. A., & Rufino, K. A. (2013). Are forensic experts
biased by the side that retained them? Psychological Science, 24, 1889–1897.
Ryba, N. L., Cooper, V. G., & Zapf, P. A. (2003a). Assessment of maturity in juvenile compe-
tency to stand trial evaluations: A survey of practitioners. Journal of Forensic Psychology
Practice, 3, 23–45.
Ryba, N. L., Cooper, V. G., & Zapf, P. A. (2003b). Juvenile competence to stand trial
evaluations: A survey of current practices and test usage among psychologists.
Professional Psychology: Research and Practice, 34, 499–507.
Steinberg, L., & Schwartz, R. (2000). Developmental psychology goes to court. In T. Grisso
& R. Schwartz (Eds.), Youth on trial: A developmental perspective on juvenile justice
(pp. 9–31). Chicago, IL: University of Chicago Press.
Szymanski, L. A. (2013). Juvenile competency procedures. Juvenile justice: Geography, policy,
practice, statistics. Pittsburg, PA: National Center for Juvenile Justice.
Viljoen, J. L., Klaver, J., & Roesch, R. (2005). Legal decisions of preadolescent and adoles-
cent defendants: Predictors of confessions, pleas, communication with attorneys, and
appeals. Law and Human Behavior, 29, 253–277.
Viljoen, J. L., & Roesch, R. (2005). Competence to waive interrogation rights and adjudi-
cative competence in adolescent defendants: Cognitive development, attorney contact,
and psychological symptoms. Law and Human Behavior, 29, 723–742.
Viljoen, J. L., Slaney, K. L., & Grisso, T. (2009). The use of the MacCAT-CA with adolescents:
An item response theory investigation of age-related measurement bias. Law and
Viljoen, J. L., Vincent, G. M., & Roesch, R. (2006). Assessing adolescent defendant’s
adjudicative competence: Interrater reliability and factor structure of the Fitness Inter-
view Test-Revised. Criminal Justice and Behavior, 33, 467–487.
Warren, J. I., Aaron, J., Ryan, E., Chauhan, P., & DuVal, J. (2003). Correlates of adjudicative
competence among psychiatrically impaired juvenile offenders. Journal of the American
Academy of Psychiatry and the Law, 31, 299–309.
Zapf, P. A., & Roesch, R. (2009). Evaluation of competence to stand trial. New York, NY:
15
Juvenile Miranda Waiver:

A Naïve Teenager,
Neurodevelopmental Disorder,
and the “Interested Adult”
Joseph J. Begany
[T]he greatest care must be taken to assure that [a minor’s] admission was
voluntary, in the sense that it was not coerced or suggested, but also that it
was not the product of ignorance of rights or of adolescent fantasy, fright or
despair.
—Justice Abraham Fortas, Associate Justice to the U.S. Supreme Court,
1965–1969, In Re Gault, 387 U.S. 1 (1967)
Relevant Case Law

In 1967, the U.S. Supreme Court decided that 15-year-old Gerald Gault had
not been afforded procedural due process rights when:
• Without prior written notice to him or his parents informing them of the
issue(s) to which they must attend, the Gila County Sheriff went to Gerald’s
home and took Gerald into custody while his parents were at work;
• During the subsequent custodial interrogation, Gerald made incriminat-
ing statements as to his alleged involvement in the incident1 for which he
had been detained. Gerald made the statements in the juvenile court judge’s
chambers in the presence of the judge, his parents, and a probation officer;
• The alleged victim was not present and Gerald was not afforded the protec-
tion of defense counsel;
• There was no recording or transcript of the hearing, and at the time, Arizona
state law prohibited appellate review in juvenile court cases.
Juvenile Miranda Waiver 345
The 14th amendment of the U.S. Constitution states that “No state shall . . .
deprive any person of life, liberty, or property, without due process of law; nor
deny to any person within its jurisdiction the equal protection of the laws.” In
1966, the U.S. Supreme Court ruled in the landmark case of Miranda v. Arizona
that whenever the police take a person into their custody, they must inform
him or her of their right against making self-incriminating statements.
The test for determining whether a suspect has effectively waived his
rights under Miranda has been stated as follows: “First, the relinquishment
of the right must have been voluntary in the sense that it was the product of
a free and deliberate choice rather than intimidation, coercion, or deception.
Second, the waiver must have been made with a full awareness of both the
nature of the right being abandoned and the consequences of the decision to
abandon it” Moran v. Burbine, 475 U.S. 412, 421 (1986).
The question of how the issue of competence to waive Miranda rights
applies to a juvenile delinquency proceeding in Massachusetts is not fully clear
from the statutes, and this issue has never been the subject of appellate review.
The Interested Adult

In 1974, the Pennsylvania Supreme Court decided that juvenile defendants were
unable to comprehend adequately their Miranda rights without the benefit of
consultation from an “interested adult.” This decision would establish one of
the foundational criteria of the per se approach to determining the validity of a
juvenile’s waiver of their Miranda rights. The court held that juveniles undergo-
ing custodial interrogation must have the opportunity to consult with an inter-
ested adult who himself or herself has been informed of the juvenile’s rights, as
well as of the consequences of waiving those rights. According to Grisso (1980),
courts that adhere to the “interested adult” standard must decide whether
the adult who was present during the juvenile’s interrogation was “genuinely
concerned with the juvenile’s welfare. They must also determine whether the
adult was informed of the juvenile’s rights, whether the adult understood those
rights, whether the child and the adult had an adequate opportunity to confer
in private and whether the conference was meaningful” (p. 1142).

The question of whether a child or adolescent who has been taken into police
custody and who subsequently chose to participate in a police interrogation
did so knowingly and voluntarily can be thought of as a psycholegal problem
defined by the nexus between the impact of a child’s mental health function-
ing, broadly speaking, and the legal requirements for producing a valid juve-
nile Miranda waiver. In considering the mental health functioning relevant
to the waiver, the evaluating clinician must be attentive to variables of mental

functioning such as what the child’s developmental stage is, whether the child
suffers from a psychiatric illness, and whether the child suffers from a neuro-
developmental (e.g., Communication Disorder) or acquired condition (e.g.,
Traumatic Brain Injury) that might reduce the child’s ability to produce a valid
Miranda waiver.
The Question of Developmental Immaturity

There is a growing body of literature aimed at explicating the hypothesized
relationship between child and adolescent development and the competence
to waive Miranda protections. For instance, in his two 1980 studies of juve-
niles’ appreciation of Miranda rights, Grisso (1980) identified two groups
of accused juveniles under 17 years of age who were unable to demonstrate
understanding of their Miranda rights with even minimal adequacy: one
group of juveniles younger than 15 (i.e., 11–15) and a second group of 15- and
16-year-olds with Full Scale IQ scores equal to or less than 80 demonstrated
deficits in understanding their Miranda rights to the extent that “their waivers
cannot be considered meaningful” (p. 1161).
There appears to be a significant disparity between the percentages of juve-
nile defendants who waive their Miranda rights, compared with adult defen-
dants (Rogers et al., 2008). In fact, Rogers et al. (2005) found that 75% of the 11
to 15-year-old juvenile participants in their study waived their Miranda rights
while nearly 90% of all juveniles under 17 years of age waive their Miranda
rights during interrogation (Feld, 2006; Grisso et al., 1978). This contrasts with
only about 20% (Rogers et al., 2005) to 60% (Redlich et al., 2004) of accused
individuals aged 17 years and older waiving their rights to silence and legal
representation during interrogation.
Comprehensibility of Miranda Language

Researchers focused on the comprehensibility of juvenile Miranda warnings
have been finding a remarkable lack of uniformity across U.S. jurisdictions.
For instance, Rogers et al. (2008) analyzed 122 juvenile Miranda warnings
from across the United States according to the number of words that com-
prised the warnings, reading level required to comprehend the vocabulary and
syntax, and content. They found that juvenile Miranda warnings seem to be
even more variable than general Miranda warnings. According to Rogers, the
juvenile warnings
ranged from 52 to 526 words; inclusion of Miranda waivers and other mate-
rial substantially increased these numbers (64–1,020 words). Flesch-Kincaid
reading estimates varied dramatically from Grade 2.2 to post-college. Differ-

ences in content included such critical issues as (a) right to parent/guardian
input, (b) specification of free legal services for indigent defendants, and (c)
statements of right to counsel in conditional terms.
Mental Health Issues, Neurodevelopmental Disorders,

and Miranda Comprehension
Researchers estimate that about 30% to 70% of children and teenagers before
juvenile courts on delinquency matters suffer from some kind of mental dis-
order. The most common conditions seen in populations of juvenile court-
involved youth include ADHD, Learning Disorders, Communication Disorders,
Depression, Anxiety and Disruptive Behavior Disorders. Increasingly, children
and teens suffering from Autism Spectrum Disorders are also coming before
juvenile courts for a range of offenses including sexual and physically violent
offenses (Sondenaa et al., 2014; Salseda, 2011).
Neurodevelopmental disorders are disorders that stem from prenatal and/
or postnatal disruption in the development of the brain or central nervous
system. There is a strong heritability factor associated with neurodevelop-
mental disorders, but they can also be acquired via some kind of neurologi-
cal insult such as prenatal alcohol and/or drug exposure or lead exposure/
poisoning in early childhood. The disruption(s) can result in a wide vari-
ety of functional impairments including deficits in intellectual abilities,
attention, learning, memory, executive functions, motor functions, social
cognition and self-regulation, which, in turn, can lead to a wide variety of
problems meeting the demands of everyday life, such as social, academic, and
family-based demands. Common neurodevelopmental disorders include the
different forms of Attention Deficit Hyperactivity Disorder (ADHD), Com-
munication Disorders, Autism Spectrum Disorders (ASD), and Intellectual
Disabilities (ID).
While there is a great deal of overlap in functional impairments across
neurodevelopmental conditions, many of these conditions are characterized
by the prominence of certain specific functional impairments among a range
of often less prominent (but nonetheless problematic) neurodevelopmental
deficits. For instance, impaired attention is common to most neurodevelop-
mental conditions, but particularly so with ADHD. Social skills deficits can
be features of a variety of neurodevelopmental disorders, but social commu-
nication and social interaction deficits along with repetitive behaviors and
restricted interests (Troyb et al., 2010, in Fein, 2011; Hill and Frith, 2003)
are the hallmark characteristic of Autism Spectrum Disorders. Communica-
tion Disorders include expressive and receptive language deficits. Individuals
suffering with expressive language impairments struggle to use written and
spoken language to convey their thoughts and feelings and to engage in fluent
discourse. Individuals struggling with receptive language problems have defi-
cits in their ability to understand spoken language. Expressive and receptive
language deficits often co-occur, and these deficits can result in substantial
social, academic, and vocational deficits.
Intellectual and neuropsychological deficits can bear substantially on juve-
niles’ understanding of their Miranda rights (Grisso, 1980; Nestor et al., 1999;
Viljoen & Roesch, 2005) and on their ability to consider the long-term conse-
quences of waiving those rights during interrogation. The following vignette
illustrates some of the ways in which the impairing action of a communication
disorder, of ADHD, and of the pressures of an adult [i.e., Edgar’s mother) whose
status as a genuinely “interested adult,” from a statutory standpoint, is arguable,
converge to produce a Miranda waiver of highly questionable validity.
Best Practices
The evaluation of a juvenile Miranda waiver is called for when a juvenile taken
into police custody has chosen to waive his or her right to counsel and has
then made inculpatory statements to the police during the custodial interroga-
tion. Defense attorneys who are attentive to the standards of a valid juvenile
Miranda waiver (e.g., an “interested adult” must be present during the waiver
and interrogation, there must be an appreciation for the potential legal con-
sequences of the waiver and subsequent statements) will seek an evaluation
of the validity of their juvenile client’s decision to waive the right to counsel
and to then provide the police with evidence, often in the form of inculpatory
statements, as to their involvement in an unlawful act. As previously noted in
this chapter, the test for determining whether a Miranda waiver was valid was
stated as follows in Moran v. Burbine, 475 U.S. 412, 421 (1986):
First, the relinquishment of the right must have been voluntary in the
sense that it was the product of a free and deliberate choice rather than
intimidation, coercion, or deception. Second, the waiver must have been
made with a full awareness of both the nature of the right being abandoned
and the consequences of the decision to abandon it. (Moran v. Burbine, 475
U.S. 412, 421, 1986)
The evaluation of the validity of a juvenile’s Miranda waiver should focus

building a database on which to rest a forensic opinion as to whether the juve-
nile’s waiver was voluntary and knowing: that is, that the child chose freely to
waiver his or her rights, and that he or she did so with adequate appreciation
of the rights themselves, as well as of the potential legal (e.g., a guilty finding
in the court) and social (e.g., loss of liberty, exclusion from mainstream school
setting) consequences of the inculpatory statements that he or she made dur-

ing a custodial interrogation. Such an evaluation can be used specifically to
assist the trier of fact in determining whether the juvenile’s waiver was valid
and whether the juvenile’s statements made subsequent to the waiver, should
be allowed as evidence.
Best practices dictate that the evaluator in a juvenile Miranda waiver case
develop a well-rounded database with data gathered from multiple sources
in order to adequately address the psycholegal question as to whether psy-
chological factors interfered with a child’s ability to knowingly and volun-
tarily waive their Miranda rights. Accessing multiple sources of information
is standard practice in forensic assessment, and it is particularly important in
the forensic evaluation of children (G. Koocher in Sparta & Koocher, 2006).
When evaluating a child as to the validity of their Miranda waiver, sources
should include at least one interview of the child focused on explicating their
mental status, current substance abuse, school performance, social milieu,
and experience with the legal system. Sources should also include interviews
with educational and mental health providers, as well as caregivers, and a
review of relevant educational and mental health records. Assessing a child’s
understanding and appreciation of their Miranda rights and of waiving those
rights could be included in the first interview or reserved for a second meet-
ing. Grisso’s Miranda Rights Comprehension Instruments (Grisso et al.,
2012) is the most widely used assessment tool in juvenile Miranda waiver
evaluations.
Finally, it is of critical importance that the evaluating clinician be familiar
with the statutory requirements of a valid juvenile Miranda waiver. For instance,
some jurisdictions rely on the totality of the circumstances approach to deter-
mining whether a child’s Miranda waiver was valid, while other jurisdictions
(including the jurisdiction from which the case vignette below originated) rely
on the per se approach to determining the validity of a juvenile Miranda waiver.
There is nothing less useful to a juvenile defendant, a juvenile defense attor-
ney, and by extension, a juvenile court judge, than an evaluation that does not
address the psycholegal question at hand according to the statutory require-
ments of that jurisdiction.
In addition to ensuring a level of familiarity with jurisdictional require-
ments of a valid juvenile Miranda waiver that will hold up under the com-
petent cross examination, evaluating clinicians also need to consider several
other factors before undertaking a given evaluation. Such factors include, but
are certainly not limited to, a child’s suggestibility during interrogation, the
language in which he or she is most fluent, as well as the language of primary
fluency of the interested adult present during the interrogation, the mental
status of the interested adult at the time of interrogation, and the child’s level
of effort during the evaluation.
Case Vignette
Reason for Referral
Edgar was the 14-year-old Hispanic son of Ms. Vic, a single mother.
Edgar’s father had been incarcerated, since Edgar was a very little boy, in an
out-of-state prison for attempted murder and drug-related offenses. At the
time of the evaluation, Edgar lived with his mother, his older sister (16), older
brother (15), and younger sister (8) in a neat, clean double-decker two-family
house in a coastal urban setting. Edgar was a special education middle school
student who recently began attending an alternative public school placement,
after being transferred from a regular education middle school within the dis-
trict, owing to the delinquency charges against him (see below). Before moving
to the new school district, Edgar had been receiving special education sup-
port services for a long-standing and well-documented health disability (i.e.,
ADHD) and a Communication Disorder (i.e., Mixed Expressive-Receptive
Language Disorder). However, the current school district changed his IEP eli-
gibility because of a district psychologist’s evaluation, which stated that Edgar
struggled with an “underlying emotional disorder” per the findings of a poorly
conducted psychological evaluation. At the time of the evaluation, he was pre-
scribed and reportedly compliant with a long-acting stimulant medication
that his primary care physician prescribed.
This was Edgar’s first experience with the juvenile delinquency system.
Edgar was before the juvenile court facing one count of indecent assault and
battery on a child under 14 years of age. The charged stemmed from an inci-
dent that occurred in the winter of 2013 just after Edgar moved from out of
state to his current coastal urban location. It was being alleged that during a
recess period on the playground of the middle school, and at the prodding
of two other male schoolmates, Edgar ran over to a 13-year year-old female
peer who was talking with several friends. As he ran by her, he reached out his
hand, grazed her vaginal area over her pants, and then ran off. Edgar’s mother
became aware of the incident from the school officials who immediately
intervened, informing the police and suspending Edgar. School administra-
tors informed Ms. Vic of the incident that afternoon. The victim’s parents also
filed a police complaint that afternoon. According to Edgar’s defense attorney,
Ms. Vic “marched Edgar down the police station the following morning and
prevailed upon him to make statements about his alleged involvement in the
incident.” Ms. Vic stated to this evaluator that, as a recovering heroin addict
steeped in the 12-step recovery program, she lived by “the rules of God” and
insisted that “It’s my job to make sure that my son does the right thing and
tells the truth and owns up to what he did.”
Because of the alleged sexual assault on his female schoolmate, Edgar was
facing not only the possibility of Department of Youth Services committed time
as well as probation thereafter, he was also facing the specter of court court-
ordered registration with the state’s Sex Offender Registry Board (SORB), as a
sex offender for up to 20 years if found guilty of the sexual assault charge. He
would face restrictions on his proximity to other children his age and younger
and on his living circumstances as well as those of his mother and siblings.
Edgar’s juvenile defense attorney requested that a forensic evaluator assess
Edgar in connection with the charges he was facing before the Juvenile Court.
Specifically, she asked this evaluator to conduct an assessment of Edgar’s abili-
ties directly related to his competence to waive his Miranda rights owing to
concerns that Edgar may not have knowingly and voluntarily waived those
rights prior to the police interrogation. The defense attorney indicated that
Edgar’s mother “dragged him down to the police station to confess.” She noted
Edgar suffered from cognitive impairments for which he had been receiv-
ing special education services since early elementary school. Defense coun-
sel expressed concern that Edgar’s cognitive deficits, his young age, and his
mother’s undue pressure may have converged to interfere with his ability to
competently waive his Miranda rights.
As with adult clients, it is necessary to gain consent for the juvenile client
to participate in an evaluation. Therefore, it was necessary for the evaluator to
explain the parameters of the evaluation to Edgar. However, this also requires
the presence of the interested adult, as the mediator of the information and
facilitator of the child’s understanding of the conditions of the evaluation. To
that end, at the outset of both of our meetings, the evaluator explained to Edgar
and his mother that whatever was discussed or produced during testing could
be shared with Edgar’s defense attorney, and if she requested it, the evaluator
could prepare a report and/or testify in court. It was further explained to them
that Edgar was not required to answer the evaluator’s questions and that he
could refuse the interview and/or testing. The evaluator explained that if there
were some questions he wished not to answer, he could decline to answer them
and could end the meeting at any time.
In response to the evaluator’s request that he explain his understanding of
what had just been explained, Edgar stated, “I don’t actually remember what
you said.” The explanation was repeated and Edgar was again asked whether
the content of meetings would be kept private, and he said, “No.” He was then
asked if he was required to participate in the evaluation and he said, “Not
really, but I will.” When Edgar was asked if he could selectively respond to
questions and stop his participation at any time and he replied, “I think so.” He
looked to his mother and she affirmed his answer with a nod of her head. She
then nodded at me, indicating that he understood the parameters. Based on
Edgar’s responses to my questions, and on his mother’s acknowledgement of
his understanding, it was my opinion that Edgar’s ability to agree to participate
in the evaluation and his understanding of the limits of confidentiality were at

least minimally adequate.

In addition to ongoing consultation with the defense attorney and conduct-
ing approximately three hours of interviews and testing with Edgar over the
course of two meetings separated by about six weeks, the evaluator interviewed
Edgar’s mother and the school social worker. The evaluator also reviewed rel-
evant records from the police department and juvenile court, as well as educa-
tional records from the current and past school districts that included the IEP,
psychological testing, and incident reports, and primary care medical records.
It is common in forensic evaluations that some records will not be available
in a timely manner. The evaluator did not receive child protective services
records from either state. These records would have provided important rel-
evant information about the relationship between Edgar and Ms. Vic, who was
the interested adult present during the interrogation in which Edgar reluc-
tantly participated and who prevailed on him to participate in the interroga-
tion. Data gathered from relevant records was integrated into the presentation
of the background information detailed in the following section.

Ms. Vic indicated that Edgar’s father suffered from ADHD and substance
abuse problems and would become aggressive and violent. She indicated that
he had never been a part of Edgar’s life, and was currently incarcerated in the
federal prison system on drug and attempted murder convictions.
Ms. Vic indicated that depression was common on her side of the family but
stated that, to her knowledge, none of her family members had ever been psy-
chiatrically hospitalized. Ms. Vic had a history of addiction that began when
Edgar was a child. Ms. Vic indicated that her addictions included different
opioids but maintained that she did not use drugs or alcohol during pregnancy
with Edgar. Ms. Vic indicated that she and her children moved out of state
when Edgar was about 4 years of age and that she was able to maintain sobriety
for a few months after their relocation, but she then relapsed into drug abuse.
The out-of-state child protective services (CPS) removed Edgar from her care
for about one month while she sought substance abuse treatment. The family
also had in-state CPS involvement before moving out of state, in part because
when Edgar was about 2 years of age, he set a fire in the family’s apartment.
Edgar and his family moved back to the local area in December 2013.
Edgar was born via C-section after an uncomplicated and healthy preg-
nancy. He sustained a hypoxic injury at birth as well as hyperglycemia. During
his early development, Edgar exhibited substantial developmental motor and

language delays, neither walking nor talking until 3 years of age. There is no
report of Edgar receiving early intervention services, but he did attend Head
Start at 3 years of age. In addition, at 3 years of age, he began showing signifi-
cant aggression (e.g., throwing things at preschool, hitting adults) at home and
at school. The public school district evaluated Edgar at that time and found
him eligible for special education services based on “conduct problems, learn-
ing disabilities and language difficulties.”
Edgar’s learning and behavior problems persisted through the third grade.
The out-of-state school district transferred Edgar from a supported regular
educational setting to an alternative therapeutic educational placement where
“his distress and instability continued, and where staff restrained [him] regu-
larly.” Prior school-based psychological test findings indicated that Edgar had
a history of intellectual weaknesses primarily in the language-based domain of
cognitive functions. A spring 2010 evaluation of Edgar’s intellectual and speech
and language abilities yielded impaired performances on two of three tests of
language-based cognitive functions. His overall Verbal IQ (i.e., Verbal Com-
prehension Index score) was impaired at the 6th percentile. Edgar’s visuoper-
ceptual abilities (so-called “nonverbal” abilities represented in the WISC-IV
Perceptual Reasoning Index) were measured at average compared with his
peers at the 27th percentile. Speech and language testing from October 2010
yielded impaired scores on expressive and receptive language tests.
Edgar gradually began making progress in school. In the sixth grade, Edgar
attended an alternative middle school during the time he and his family lived
out of state, because his social and academic problems persisted. School
records described Edgar in a variety of ways. For instance, his IEP stated the
following:
Edgar is a polite, funny and sensitive 12-year-old 6th grader at the

out-of-state school. He has a playful and impish personality. Edgar is able
to contribute to class discussion, and seems to enjoy science when he is
focused. . . . He has been able to establish friendships with students both
inside and outside of his age group.
His IEP also described him in the following terms:
Edgar struggles with overall academics and maintaining focus in class. He

has difficulty expressing his ideas and emotions. . . . He appears to struggle
with auditory processing of information. . . . Edgar is slow to process infor-
mation; he lags behind; his speech is monotone and slow. . . . Edgar needs
time to process; requires clarification . . . [and] he needs guidance with
certain things.
According to his school records, when Edgar became overwhelmed in the

face of the demand to process more information than he can readily handle, he
“shut down . . . became argumentative, and at times, aggressive.” According to
records, he struggled with misinterpreting situations, has difficulty expressing
dissatisfaction appropriately (often shutting down), and struggled with overall
academics and maintaining focus in class.
After Edgar and his family returned to the local school district in December
2013, Edgar began attending the regular education middle school. January 2014
psychological testing that a school district psychologist conducted suggested
that Edgar did not suffer from ADHD, and that his difficulties may be better
explained by an “underlying emotional disorder and precociousness regard-
ing his sexual development.” However, that report relied only on WISC-IV and
invalid and unreliable testing procedures (i.e., Rorschach, Thematic Appercep-
tion Test, and various so-called projective drawings) to generate unreliable data
from which to draw opinions about the nature of Edgar’s difficulties. The school
district psychologist did not attempt to access collateral data. The WISC-IV test
findings yielded the following index scores: Verbal Comprehension = 71, 3rd
percentile; Perceptual Reasoning = 96, 28th percentile; Working Memory = 74,
4th percentile; Processing Speed = 78, 7th percentile; Full Scale IQ = 73, 4th
percentile. The school psychologist concluded that Edgar did not appear to meet
criteria for ADHD because he did not produce an “ADHD profile” in his test
performance. It is important to point out that ADHD is a heterogeneous neuro-
logical condition, and by definition, no such profile exists.
Edgar had no history of psychiatric hospitalization or major mental illness.
The alternative school clinical director indicated that Edgar seemed to have a
problem with bullying and being bullied.” Ms. Buckley characterized Edgar’s
negative peer interactions as a part of mutual acclimation between him and
his peers. She indicated that he “has had no major [behavioral] events” since
beginning at the alternative school.
Edgar had a history of outpatient individual counseling in which he was
engaged inconsistently owing in large part to his mother’s ambivalence
about him “telling his business to a stranger.” At the time of incident in ques-
tion, he had not been in counseling for about eight months, but his mother
claimed that she had put him on the waiting list a local community mental
health clinic.

The forensic evaluator met Edgar at his home for both meetings. He initially
presented as apprehensive and guarded until it was explained to him that he
was not in trouble and that his lawyer asked this evaluator to meet with him.
Edgar then relaxed and became more engaged and cooperative. Edgar was
generally quiet during the meeting. However, he was particularly interested

in talking about his involvement with a local arts group that specializes in
working with children and teens. Edgar participated in the evaluation without
refusal.
Edgar described his current mood as “fine.” He indicated that he usually
feels “good.” Edgar did not endorse symptoms of anxiety, depression, mood
instability, mania, hallucinations, delusions, obsessions, compulsions, or trau-
matic stress. He did not endorse having the burden of suicidal thoughts and
feelings, and he did not endorse preoccupations with harm to others. The
content of Edgar’s speech appeared normal. His receptive language abilities
appeared weak based on his apparent reticence to initiate discussion, his need
to have instructions repeated, and he had what seemed to be a tendency to
misunderstand test instructions. Regarding his expressive language abili-
ties, Edgar demonstrated word-finding problems during conversation, which
may be reflective of problems with expressive language, semantic memory or
both. Edgar also had difficulty maintaining goal-directed speech in that he
frequently inserted off-topic comments, such as a long digression focused on
a new action movie.
Edgar told the evaluator that he has struggled with attention in school since
he was a little boy. He indicated that he had particular difficulty controlling
his attention during times when the topics of discussion or instruction are
not of interest to him. He indicated that he was usually distracted by his own
thoughts, generally related to extracurricular activities. Edgar’s thinking was
concrete and organized. His social judgment appeared deficient, based on his
explanation of the interactions with his peers that led to his current delin-
quency charges.
The use of psychological test measures in evaluating a juvenile’s understand-
ing of Miranda is critical in addressing the question of whether the juvenile’s
waiver of his or her right to counsel was knowing and voluntary. In this case, it
seemed to hold additional importance given what appeared to have been some
degree of coercion on his mother’s part through behavior that she explained
as having been morally driven. As a first time alleged offender, Edgar had no
experience with the juvenile justice system, so that measurement of his under-
standing of and full appreciation for the waiver of his Miranda rights via the
Miranda Rights Comprehension Inventory (Grisso et al., 2012) was indicated
in order to establish Edgar’s baseline level of Miranda understanding going
forward, as well as establishing his likely level of understanding and apprecia-
tion of a Miranda waiver at the time of the interrogation. Kalbeitzer, Zelle, and
Riggs-Romaine (2011) noted that the new version of the Miranda assessment
instrument includes a juvenile sample in the normative data. They found the
MRCI to have good reliability and validity. In Edgar’s case, it was particularly
important to measure objectively whether Edgar possessed adequate indepen-
dent ability to knowingly and voluntarily waive his Miranda rights and then to
make inculpatory statements or whether he relied completely on his mother
to provide him the protection of an interested adult who was ostensibly able
to fully, or at least adequately, appreciate the implications of her son’s Miranda
waiver and subsequent making of inculpatory statements but who may have
been acting out of her own moralistic motivations, naïve about the potential
serious and long-term implications of her son’s statements.2
The Gudjonsson Suggestibility Scale (Gudjonsson, 1995) is a test of a defen-
dant’s susceptibility to suggestive interrogation techniques. While it was not
specifically designed for use with juvenile defendants, juveniles as young as 15
were used in the initial reliability and validity studies. Given that Edgar was
subjected to interrogation in the presence of three authority figures (i.e., two
police officers and his mother, whose ability to provide the protections of the
interested adult according to legal standards may have been prohibitively com-
promised), it was important to be able to gauge objectively the extent to which
he might acquiesce to the pressures of authority figures during interrogation,
as many teenagers tend to do. In Edgar’s case, it was particularly important to
assess his degree of suggestibility to his mother’s pressure, which included the
threat of physical punishment for refusing to confess to the crime (see Inter-
view with Edgar below).
The Wechsler Individual Achievement Test, Third Edition, Reading Com-
prehension subtest is a measure of a child’s reading comprehension skills. In
providing an arrested person with their Miranda rights, the police are required
to verbally convey the Miranda warning, and they typically provide the
arrested person with a sheet on which the Miranda rights are printed, to sup-
plement the verbal warning. The reading levels of those warnings vary greatly
across jurisdictions, so it is important to know whether the arrested child was
able to read and comprehend the written version of the warning the police
provided. When measuring a child’s reading level, percentile scores should
be used to compare the child’s reading comprehension level with a national
sample of their age peers, as it is the most psychometrically robust comparison
as opposed to comparing with grade level peers. Edgar scored in the 4th per-
centile on that reading comprehension test.
The Test of Memory Malingering (TOMM; Tombaugh, 1996) is test of
malingered memory symptoms. It is used to gauge performance validity in
the context of psychological evaluations. While the published norms apply to
those 17 years and older, Kirkwood et al. (2011) and others have validated the
use of the TOMM in children as young as six years of age. The Dot Counting
Test (DCT; Boone, Lu, et al., 2002) is also an assessment of test-taking effort.
While it is normed for individuals 17 years of age and older, it too has been
validated for use in children as young as 13 years of age.
Test Results Bearing on Juvenile Miranda Waiver

Suggestibility during Questioning The Gudjonsson Suggestibility Scale is a
test of a defendant’s susceptibility to suggestive interrogation techniques. The
first section of the test involves reading the defendant a narrative passage and
then asking him to immediately recall as much information from the passage
as possible. After a 40-minute delay, Edgar was able to recall 3 of 39 target
details from the passage, placing his score below the 1st percentile (i.e., the
lowest score out of 100) compared with the general population, or in the 9th
percentile (i.e., below average) compared with a clinical forensic sample of
patients.
Following the second recall condition, the defendant was asked a series of
20 questions about the passage, only four of which he answered from the pas-
sage correctly. The remaining questions tested interrogative suggestibility and
are presented in a manner in which the participant is forced to choose between
two incorrect choices. The questions are structured to suggest that a particu-
lar response is desired over the other response choice. The number of answers
a person provides for the suggestive questions is then scored. Edgar’s score of
16 on this section of the test (named Yield 1) is placed in the 99.6th percentile
(compared to forensic sample; mean score = 7, standard deviation [SD] = 3.5).
The second edition of the test (named Yield 2) is designed to test a defen-
dant’s suggestibility due to negative feedback from the test administrator and, by
extension, an interrogator. After several moments during which the test admin-
istrator is instructed to appear as if he were scoring the first set of responses, the
administrator is instructed to firmly state to the participant that he performed
poorly on the test, that he gave a number of incorrect responses, and that the
questions would have to be asked again. The participant is encouraged to try
harder, the 20 questions are repeated, and the number of questions to which the
participant changes his initial responses is noted and scored. Edgar changed
a total of 9 of 20 of his responses. Edgar’s score was within the average range
(mean score of 7, SD = 3.5) when compared to forensically involved patients
and the general population (mean score of 4, SD = 3).
The Yield 1 and Yield 2 scores are added together to provide a rating of
overall suggestibility. The average score for the general population is 7 (SD =
5). Edgar’s score (16 + 9) of 25 is approximately 3.25 standard deviations above
the average score of 7, placing his score above the 99th percentile. According
to the manual, the average score for a forensically involved population is “about
10 with a standard deviation of 5.5” (Gudjonsson, G, H., 1997, p. 53). Edgar’s
score of 25 is approximately 2.8 SDs above the forensic population, placing
him in the 99.7th percentile. His overall scores strongly suggest that, out of 100
forensically involved people, he would likely be extremely vulnerable to inter-
rogative suggestibility during interrogation.
The second edition of Grisso’s (2012) Miranda Rights Comprehension Instru-
ments (MRCI) was used to assess Edgar’s knowledge of and appreciation for
his Miranda rights.
Regarding Comprehension of Miranda Rights The forensic evaluator

administered the test titled Miranda Rights Comprehension Instruments
(MRCI; Grisso, 2012) to assess Edgar’s understanding of Miranda warnings.
The test is divided into four sections. The first section, titled Comprehension
of Miranda Rights, assesses a person’s understanding of Miranda rights by
asking him to state in his own words the meaning of the sentences comprising
the Miranda warning. The results are scored from 0 to 10. Edgar achieved a
score of 3. According to the normative data, Edgar’s score was comparable
to the mean score of other 12 and 13 years-of-age juvenile defendants with
Full Scale IQ scores of 71–80 (M = 1.5, SD = 2.12). About 10% of the entire
sample of juvenile defendants earned a score lower than Edgar’s, indicating
that his score was well below the average range compared to that of most
juvenile offenders. Of note was Edgar’s explanation of his understanding of
the following statement, “You do not have to make a statement and have the
right to remain silent.” Edgar indicated that, to him, that statement meant,
“Angry—I don’t know—like you have to be quiet or something.”
The second section is titled Comprehension of Miranda Rights, Recogni-
tion. During this task, a person is given the target sentences from the Miranda
warning and then read alternative sentences that are either synonymous with
the target sentence or different in meaning. The person is then asked to indi-
cate whether the sentence read to him is the same as or different from the
target Miranda sentence. Scores range from 0 to 15. Edgar earned a score of 6,
which was approximately 2.5 SD below the mean score for 12 and 13-year-old
juvenile defendants with Full Scale IQ scores between 71 and 80. In comparing
Edgar’s score to the overall sample of juvenile defendants (n = 181), 0% of the
juvenile sample had scores lower than Edgar’s.
Regarding Comprehension of Miranda Vocabulary The third section of

the test is titled Comprehension of Miranda Vocabulary. The purpose of this
task is to assess a person’s understanding of key words used throughout the
Miranda warning. The person is read a target word, it is used in a sentence,
and then it is repeated. The person is then asked to define the word. Scores
can range from 0 to 32. Edgar earned a score of 12, which was approximately
1.5 SDs below the mean for 12- and 13-year-old juvenile defendants with Full
Scale IQ scores ranging from 71–80 (M = 19.67, SD = 5.15). In comparing
Edgar’s score with the standardization sample, 4.6% of the standardization

sample scored lower than Edgar on this task, indicating that he scored well
below the average range.
Regarding Functions of Rights in Interrogation The fourth section of

the test is titled Functions of Rights in Interrogation. It is divided into three
subsections and is designed to assess a person’s understanding of the nature
of interrogation, the right to be represented by an attorney, and the right to
silence. Edgar’s total score of 11 (out of a possible 30 points) was slightly more
than 3 SDs below the mean score for 12- and 13-year-old juvenile defendants
with Full Scale IQ scores between 71 and 80. Almost all (99.4%) of the entire
juvenile sample (n = 169) earned total scores higher than Edgar’s.
In the first subsection of this task that assessed an understanding of the
nature of interrogation, Edgar scored 4 out of possible 10 points, which was
approximately 5 SDs below the mean score of other 12 and 13-year-old juve-
nile defendants (mean = 9.36, SD = 1.05). Less than 1% of the entire juvenile
sample (n = 169) scored below Edgar’s score. Edgar’s score on the second
section pertaining to his understanding of the right to counsel of 5 out of
a possible 10 points was 1 SD below the mean score for 12- and 13-year-
old juvenile defendants (mean = 7.73, SD = 1.83). About 98% of the entire
juvenile sample scored above Edgar’s score on this subsection of the test.
Edgar’s score of 2 on the section pertaining to his understanding of the right
to silence (also out of a possible 10 points) was 1 SD below the mean score
of other 12- and 13-year-old juvenile defendants (mean = 4.67, SD = 2.09);
6.6% of the entire juvenile sample scored below Edgar’s score on this subsec-
tion of the MRCI.
Test Performance Credibility The question of whether a defendant might

be purposely performing poorly on tests of competence and related abilities
(in this case, competence to waive Miranda and interrogative suggestibility)
should always be considered when poor performance on those tests could
increase the likelihood of avoiding prosecution (i.e., secondary gain in
failing the tests). Edgar’s score of 50 out of a possible 50 on the first trial of
the TOMM is a passing score. His score of 21 on the Dot Counting Test was
well above the cutoff for learning disabled individuals (≤ 14). Taken together,
these performance credibility test scores strongly suggested that his other test
performances were credible.
In summary, test results show that Edgar is extremely susceptible to
interrogative pressure, which in turn causes him to show a strong tendency
toward suggestibility during interrogation; his knowledge and appreciation
of his Miranda rights is deeply deficient; and his performance on these tests
is credible.
Additional Information Specifically Pertaining to Validity of

Miranda Waiver
Interview with Edgar In discussing his case with the forensic evaluator,
Edgar was able to convey the facts of the incident in a coherent manner, but
he required support (i.e., cuing during the discussion) to elaborate beyond
the basic facts of the circumstances. Edgar recalled that the school principal
suspended him and then sent him home. He remembered that when his mother
arrived home from work, she was angry with him and disappointed in his
behavior. Edgar indicated that she gave him the choice of accompanying her
to the police station to “own up to what he did” or face physical punishment.
He said, “I’m more scared for (sic) her than the cops. She (sic) beat my ass! She
(sic) done it before! She be hittin’ my [16-year-old] brother, too.”3 When asked
whether he would have spoken to the police if they had come to his house and
arrested him, Edgar replied, “I don’t know. I didn’t give a F&@% about talking
to them.”
When asked whether he knew at the time that his statements to the police
could lead to the judge ordering him to register as a sex offender with the Sex
Offender Registry Board, which would likely mean that he would not be able
to attend regular school or continue to live in his current neighborhood. Edgar
replied, “I do now.” When asked again, Edgar confirmed that he was unaware
of the possibility that his statements could lead to a guilty finding in court and
subsequent SORB registration and all of its proscriptions.
Interview with Ms. Vic In addition to having provided detailed

information pertaining to Edgar’s history, his mother, Ms. Vic, discussed the
incident in question and her decision to press her son into participating in
the police interrogation. Ms. Vic immediately began discussing her history of
drug addiction, which included having engaged in various addiction driven
crimes such as armed and unarmed robbery, exchanging sex for drugs, leaving
her small children alone during drug binges, and allowing “men in and out
of my place when my children were there.” She explained that when she
finally began to recover from addiction, she felt compelled “to get right with
God” and atone for her crimes (e.g., she completed terms of probation that
included community service of some kind). Ms. Vic adamantly insisted that
she would not fail her children again and that she would fulfill what she saw
as her parental duty to ensure that her son “own up” to his allegedly assaultive
behavior, with the full force of her convictions. When asked about whether
physical punishment would be a part of her efforts to prevail on her son to
talk with the police, she looked over her shoulder from the kitchen stove (the
interview took place in their apartment) and said “You (sic) damn right! And
his ass know (sic) it, too!”
This evaluator asked Ms. Vic if she informed the police of Edgar’s lifelong
special education status, including the specific impairments of language pro-
cessing for which school districts had been providing services. She stated, “Yo,
I’m not trying to make excuses for him and what he did. If he did it, then he
(sic) gonna tell them the truth and own up to it like a man. I understand that
maybe he was just trying to fit being the new kid at school and all, but he gotta
learn he can’t jump off a bridge just because them boys dared him to.”
Ms. Vic discussed the possibility that Edgar’s statements to the police might
result in the court requiring him to register with the state’s Sex Offender Reg-
istry Board for up to 20 years should the court find him guilty of the charges.
Ms. Vic was adamant that “my son ain’t no sex offender! He did something stu-
pid because as a dare and he learned his lesson! Ain’t no judge gonna say he’s
a sex offender from that. I don’t care what Edgar’s lawyer say (sic).” I informed
her that in fact, the judge could very well mandate Edgar’s SORB registration if
he determines that Edgar is at risk for reoffense. She simply replied, “God ain’t
gonna let that happen.”
Review of Digital Audio Recording Edgar’s interrogation lasted 16

minutes and 54 seconds. Two detectives conducted the questioning. Edgar’s
mother was present during the questioning. At the outset of the interrogation,
one of the officers asked Edgar whether he was allowed adequate time before
the interrogation to discuss his participation with his mother. Edgar said, “Yea.
I guess so.” The officer then asked Edgar whether he was willing to talk about
what happened, and Edgar’s mother interjected, “He’s gonna talk to you.” The
police officers accepted her statement of Edgar’s willingness to participate.
One of the officers then said to Edgar, “We just want to find out what happened
on the playground with you and the girl. Nobody’s getting arrested here.”
The other officer then asked Edgar, “So tell us what happened there on the
playground with you and the girl.” Edgar’s mother then asserted, “Tell them
the truth, Edgar. Tell them everything.” Edgar then provided the police officers
with his recollection of the incident, which included inculpatory statements.
Disposition
The suppression hearing lasted approximately 45 minutes, most of which con-
sisted of the evaluator’s testimony; the presiding juvenile court judge in this
case rejected Edgar’s motion to suppress his statements. The judge’s written
opinion stated that his denial of the motion was primarily based on Edgar’s
statement that he “didn’t give a F&@%” about having made inculpatory state-
ments to the police. The judge misconstrued Edgar’s statement as an indication
that Edgar understood adequately the implications of confessing to the police,
that his mother had provided Edgar with adequate support and consultation
during the interrogation, and the police had taken “the greatest care” in ensur-
ing that Edgar’s waiver was knowing and voluntary. The judge rendered his
decision despite the weight of the evidence to the contrary. Edgar’s defense
attorney did not appeal the decision. Edgar eventually pled to a lesser charge
and was given 18 months probation, which he violated by getting into a fight
with the alleged victim’s older male cousin, who physically assaulted Edgar on
his way home from school the following school year, reportedly in retaliation
for Edgar’s behavior toward her the year before. Edgar was held in detention
for 90 days after the court found him dangerous according to statutory crite-
ria. He was released to the custody of the state’s child protective services and
placed in a group home for troubled teens where he remains as of this writing.

Among the many possible barriers that juvenile forensic evaluators might
encounter over the course of an evaluation, there are those that will always
remain beyond our ability to control. For instance, while a skilled evaluator
might be able to communicate with a child and family in such a way that might
maximize the chances for good rapport and participation, ultimately, we have
very little influence over the motivation and willingness of a given child and
their family/caregivers to participate in an evaluation. Also, try as we might,
collateral providers are sometimes reticent to provide information to an evalu-
ating clinician for fear of being called to court to testify to their statements.
There will nearly always be someone who you consider to be of critical impor-
tance to your evaluation, who does not return your calls and e-mails. Fur-
ther, it is not uncommon that a forensic clinician’s written request for mental
health or educational records goes unheeded, leaving the clinician with a gap
in their otherwise pristine database. However, there are two common pitfalls
that could be considered as fatal flaws to a juvenile Miranda waiver database
that are easily avoided.
An error considered of the fatal variety to any juvenile forensic evalua-
tion is the failure to test for effort in the child being evaluated. Many children
and most teenagers are capable of understanding the benefit to them of the
increased likelihood of avoiding prosecution if the court finds they were not
competent to waive their Miranda rights and then suppresses their statements
to the police. Kirkwood et al. (2012) showed that children as young as eight
years of age are capable of intentionally putting forth poor effort during an
evaluation. The Test of Memory Malingering, a commonly used test of per-
formance validity, has been shown to be appropriate to administer to children
as young as six years of age. Other measures of performance validity known
to be appropriate for children include Green’s Word Memory Test, the forced
choice measure of the California Verbal Learning Test, Second Edition, and
the Discriminability measure of the California Verbal Learning Test, Chil-

dren’s Edition. It is of critical importance that one be able to testify to the
validity of the database. Whether the data presented represents a reasonable
facsimile of the truth is a major concern to the trier of fact.
Failure to collect third party data in the form of interviews and records sub-
stantially limits the interferences that one can defensibly draw from interview
and test data. It is necessary to interpret the child’s interview and test data in
the context of what is known about their academic skills, cognitive abilities,
and prior experience with the juvenile court system in order to meaningfully
apply that data to the psycholegal question of whether their Miranda waiver
was knowing and voluntary.
Inexperienced evaluators sometimes provide what is referred to as “the
ultimate opinion” in their reports, stating whether the child was or was not
competent to waive their Miranda rights at the time of interrogation. The
role of the forensic evaluator who is addressing the question of whether a
child’s Miranda waiver was knowing and voluntary is to provide the finder of
fact with data as to how the child’s mental functioning effected their waiver.
Whether the child was competent to waive their Miranda rights and whether
the waiver was valid is a legal decision to be rendered only by the trier of fact.
However, if during testimony the judge were to ask a direct question of the
testifying evaluator for their opinion as to the child’s competence to waive
their Miranda rights, then this evaluator would recommend providing the
ultimate opinion with the following qualifying statement: “Whether the child
was competent to waive his or her Miranda rights at the time of interrogation
is a legal determination reserved for the finder of fact, but since your honor
has instructed me to provide my opinion in that regard, then I will do so. It is
my opinion that child X [was or was not] competent to waive their Miranda
rights at the time of the police interrogation.”
Notes
1. On the morning of June 8, 1964, the Gila County Sheriff took custody of Gerald
Gault after a neighbor accused him of calling her on the phone and making lewd sexual
comments. At the time, he was already on probation for being in the company of another
boy who had stolen a wallet from a woman’s purse.
2. In Edgar’s case, he was facing the prospect that, if found guilty, he could be required
by the court to register with the state as a sex offender for at least 15 years postconviction.
Such a classification would limit his life in a range of ways including limiting his access to
housing, limiting his access to school placement, and forcing an increase in his socialization
with court-involved peers.
3. Edgar’s disclosure raised obvious protective concerns pertaining to physical abuse
in the home. After our meeting, I fulfilled my legally mandated reporting obligations per
Massachusetts state law.
References
Bishop, D. M., & Farber, H. B. (2007). Joining the legal significance of adolescent
developmental capacities with the legal rights provided by In Re Gault. Rutgers Law
Review, 60(1), 125–173.
Boone, K., Lu, P., et al. (2002). The Dot Counting Test. WPS.
Farber, H. B. (2004). The role of the parent/guardian in juvenile custodial interrogations:
Friend or foe? American Criminal Law Review, 41, 1277–1312.
Feld, B. (2006). Juveniles’ competence to exercise Miranda rights: An empirical study of
policy and practice. Minnesota Law Review, 26–100.
Feld, B. (2013). Real interrogation: What actually happens when cops question kids. Law &
Society Review, 47, 1–35.
Grisso, T., & Pomicter, C. (1978). Interrogation of juveniles: An empirical study of proce-
dures, safeguards and waiver rights. Law and Human Behavior, 1(4), 321–342.
Grisso, T. (1980). Juveniles’ capacities to waive Miranda rights: An empirical analysis.
California Law Review, 68(6), 1134–1166.
Grisso, T., Goldstein, N., & Zelle, H. (2012). Miranda rights comprehension instruments:
Manual for juvenile and adult evaluations. Professional Resource Services.
Gudjonsson, Gisli H. (1997). Gudjonsson Suggestibility Scales (pp. 1–56). Psychology Press.
King, K. J. (2006). Waiving childhood goodbye: How juvenile courts fail to protect children
from unknowing, unintelligent, and involuntary waivers of Miranda rights. Wisconsin
Law Review, 431–477.
Redlich, A. D., Silverman, M., Chen, J., & Steiner, H. (2004). The police interrogation of
children and adolescents. In D. G. Lassiter (Ed.), Interrogations, confessions, and entrap-
ment: Perspectives in law & psychology (Vol. 20, pp. 107–125).
Rogers, R., Shuman, D. W., & Blackwood, H. L. (2008). The comprehensibility and content
of juvenile Miranda warnings. Psychology, Public Policy and Law, 14(1), 63–87.
Salseda, L. M., Dixon, D. R., Fass, T., Miora, D., & Leark, R. A. (2011). An evaluation of
Miranda rights and interrogation in autism spectrum disorders. Research in Autism
Spectrum Disorders, 5(1), 79–85.
Sondenaa, E., Helverschou, S. B., Steindal, K., Rasmussen, K., Nilson, B., & Nottestad,
J. A. (2014). Violence and sexual offending behavior in people with autism spec-
trum disorder who have undergone a psychiatric forensic examination. Psychological
Reports: Disability & Trauma, 115(1), 32–43.
Viljoen, J. L., & Roesch, R. (2005). Competence to waive interrogation rights and adjudi-
cative competence in adolescent defendants: Cognitive development, attorney contact,
and psychological symptoms. Law and Human Behavior, 29(6), 723–742.
16
Transfer Evaluations in
Juvenile Justice
Alison R. Flaum and Antoinette Kavanaugh
Relevant Case Law

Every state in the country has a juvenile justice system that is separate from
the criminal justice system in which adults are tried. Every state also has a
jurisdictional cutoff—usually age 18—that determines, by and large, which
cases are directed to which system. But, in recent decades, this dividing line
has been blurred by laws allowing certain young people below the age cutoff
to be prosecuted as adults. These “transfer laws” vary greatly from state to state
in terms of which young people are eligible for transfer and how the transfer
decision is made. Some states designate every young person charged with a
crime as transfer-eligible, providing criteria and standards for assessing each
case. Other states deem certain charges “automatic transfer” offenses, meaning
that any child facing those charges is sent directly to criminal court without
a hearing of any kind. But virtually every state has some category of cases for
which transfer is discretionary and for which courts—sometimes in the juve-
nile system, sometimes in the criminal system—are tasked with determining
whether to try a particular young person as an adult.1
Forensic evaluators are essential to this process. Courts holding such
hearings are ordered to consider various “transfer factors” that are best under-
stood with the assistance of an expert clinician. In fact, clinicians not only
are ideally suited for collecting and evaluating data on certain specific trans-
fer factors—such as a youth’s mental health history or her amenability to
rehabilitation—but may also be called on to educate the court more generally
about relevant topics, such as adolescent development. As discussed below,
specific transfer factors vary by jurisdiction, as do the standards and presump-
tions involved. In some transfer cases, the court will render a decision based
on “the best interests of the community”; in other cases, the ultimate legal
question is whether the child at issue “is amenable to rehabilitation.” Thus, cli-
nicians will want to become familiar with not only the transfer factors at play
in their jurisdiction but also the exact legal question or questions to be decided
by the court. Indeed, the “Specialty Guidelines for Forensic Psychology” (here-
after referred to as “Specialty Guidelines”) clearly state that a forensic psychol-
ogist should be competent in and knowledgeable regarding specific relevant
legal issues and standards (APA, 2013). In addition, other aspects of transfer
law may be helpful for a forensic evaluator to know—such as what types of
evidence are admissible at the hearing or whether the transfer decision is to be
made pre- or posttrial. These mechanics, and more, are discussed below.
Regardless of how the transfer question is framed or litigated in a given juris-
diction, transfer decisions have great impact on all the parties involved.2 With
limited exceptions, young people transferred to criminal court are subjected to
the same penalties as every other criminal defendant.3 Young people who are
transferred also lose access to the confidentiality and supportive services pro-
vided by the juvenile justice system and may well be held in adult jail and prison
facilities.4 In addition, criminal prosecution of young people has implications
for community safety—both the United States Department of Justice and the
Centers for Disease Control have concluded that youth who are prosecuted in
the criminal system are more likely to commit additional crimes upon release.5
Raising the stakes even further, these debates take place against the
backdrop of cases and research that increasingly reexamine the overarching
wisdom of equating juveniles and adults. Indeed, in recent years, the United
States Supreme Court, as well as various lower courts across the country, have
declared youth to be “categorically less culpable”6 and cautioned against effac-
ing the essential distinctions between those who commit crimes as children
and those commit crimes later in life. Interestingly, these legal findings are
grounded in large part on the work of psychology professionals who have estab-
lished both the unique neuropsychological features of adolescence and their
impact on a young person’s judgment, actions, and rehabilitative potential.7
Still, every year, thousands of young people are subject to transfer proceed-
ings.8 Though the specific features of these hearings vary from state to state, as
a general matter, a forensic psychologist should expect that
• The transfer decision will be made by a judge, usually in juvenile court.

• Although transfer statutes vary by state, most statutes will set out
{{ The factors to be considered by the court;
{{ The standard of proof (i.e., how certain the court needs to be before ren-
dering its decision);

{{ The burden of proof (i.e. whether juvenile court or criminal court is the
default in a given case, and which party has the burden of overcoming
that presumption);
Transfer Evaluations 367
{{Any other legal presumptions (e.g., whether certain crimes or certain

transfer factors must be weighted more heavily than others are or must
incline the court for or against transfer);
{{ The ultimate legal question (i.e., whether the court is directed to resolve
the transfer question based on what is best for the community, what is
best for public safety, whether the child can be rehabilitated, etc.).
• A forensic evaluator may be retained by either the defense or the
prosecution—or appointed by the court.9
• There may be limits on the forensic evaluator’s access to the child in ques-
tion and/or on whether the child may be questioned about the alleged crime,
especially if the transfer hearing happens pretrial.
• The forensic evaluator’s observations and findings may not be privileged or
confidential and may be subject to the rules of discovery.
While transfer factors also vary by jurisdiction, common factors on which

a clinician may be asked to opine include:
• The child’s medical history;

• The child’s history of out of home placements and mental health services;
• The child’s educational history, including (but not limited to) special educa-
tion needs and services;
• Evidence of abuse or neglect;
• The child’s role in the alleged offense;
• Whether the child acted in an aggressive or premeditated manner in the
alleged offense;
• The child’s suggestibility and the role of peer pressure, or pressure by adults,
in the alleged offense;
• Whether the child was able to foresee what occurred during the alleged
offense, especially if the child is charged via “accountability” (i.e. where the
child is being held legally responsible for another person’s actions);
• Whether the child is amenable to rehabilitation;
• The advantages of treatment in the juvenile justice system relative to the
criminal justice system.
Although it is the judge who will issue the ultimate transfer ruling, the
forensic evaluator in a transfer case arguably plays an even more important
role, providing both essential case-specific facts and, crucially, context for
understanding how those facts relate to larger psychological phenomena,
such as adolescent development or adolescent resilience. Essentially, a trans-
fer court is tasked with determining whether the child in question can be
rehabilitated—a weighty and challenging prospect under any circumstances
but especially when the triggering allegation is a serious one. As both field
reporter and neutral expert interpreter, no other evidence or witness carries

more weight than a clinician with regard to this crucial question. In fact,
a recent study regarding “reverse waivers” (hearings to determine if a child
who has been transferred to criminal court ought to be returned to juvenile
court) found that the forensic evaluator’s opinion was the most influential
factor in the judge’s decision about whether a case would remain in the adult
jurisdiction or be transferred back to the juvenile court (Means, Heller, &
Janofsky, 2012).
At the same time, a clinician must take care not to undercut his or her
influence by neglecting to translate findings into lay terms—a recent national
survey of juvenile court judges found that forensic evaluators’ reports were
less helpful when they contained jargon and were not written at a level
that could be understood by nonmental health practitioners (Brannen
et al. 2006).

Materials Regarding Transfer Policy, Transfer Data, and Related
Juvenile Justice Issues
A great deal of literature exists regarding the wisdom and implications of try-
ing young people as adults; transfer reform is a subject of fierce and ongoing
policy debate. Studies and discussions along these lines can be found via the
websites of juvenile justice and sentencing policy organizations.10 Additional
materials—and rich data—may be found via various government entities,
including the Centers for Disease Control and the Department of Justice’s
Office of Juvenile Justice and Delinquency Programs.
Resources are also available regarding related issues and fields, includ-
ing recidivism studies,11 studies regarding the impact of incarceration on
youth (and on families and communities),12 examinations of the relationship
between transfer and deterrence (Redding, 2008; Jordan & Myers, 2011; Ward,
2003; McGowan, Hahn, Liberman & Crosby, 2007), evaluations of juvenile
risk for violence (e.g., Hoge & Andrews, 2010), and assessments of malinger-
ing and deception in adolescents (e.g., McCann, 1998) and studies regarding
youthful resilience (e.g., Steinberg, 2014).
In cases where the forensic evaluator may be called on to opine about the
relative treatment options—and likely outcomes—in a jurisdiction’s youth
and adult prisons, the Office of Juvenile Justice and Delinquency Prevention,
which is part of the United States Department of Justice, offers a great resource
in its Model Programs Guide (MPG), which is available at http://www.ojjdp
.gov/mpg/. The MPG contains information about, and evaluations of, many
evidence-based intervention, prevention, and reentry programs.
Additional Psychological Issues Germane to Transfer Evaluations

The issue of how to conduct transfer evaluations began to appear in forensic
psychology publications in the 1980s (e.g., Barnum, 1987). Since then, more
attention has been paid to the various issues related to conducting these assess-
ments (Salekin, 2002; Penney & Moretti, 2005; Grisso, 2010 and Grisso, 2013).
Heilbrun and DeMatteo (2012) have articulated the need for establishing
standards of practice in juvenile forensic mental health assessments. As such,
they propose that the assessment of juveniles is a specialty area within the
domain of forensic assessment, which requires knowledge of both relevant
legal concepts as well as concepts relevant to normal and abnormal develop-
mental immaturity. The following is a brief summary of the topics related to
conducting forensic transfer evaluations and aspects associated with present-
ing one’s findings, be they in written form or via testimony.
Psychosocial Maturity A clinician conducting forensic evaluations must

be familiar with the growing body of research regarding issues related to
normative developmental processes of psychosocial maturity as well as the
various courses of youth violence. The clinician needs to be familiar with
developmental differences related to impulsivity, resistance to peer influence,
and risk-taking (Steinberg & Monahan, 2007; Steinberg et al., 2008; Steinberg,
Cauffman, Woolard, Graham & Banich, 2009), as well as the body of empirical
literature related to the manner in which the adolescent and adult brain differ
(Weinberger, Elvevåg & Giedd, 2005; Lenroot & Giedd, 2006). Finally, the
clinician conducting transfer evaluations should be familiar with literature
that explains the developmental and normative course of youth violence.
Moffitt (2003) reviews this literature. A recent OJJDP publication empirically
examined the relationship between these trajectories and psychosocial
immaturity. In short, most adolescents engaging in antisocial activities stop
engaging in these behaviors by the time they are in their 20s (Steinberg
et al., 2015). Those who frequently engage in antisocial behaviors during
adolescence tend to be less psychosocially mature; however, as they mature,
their engagement in antisocial behaviors tends to decrease or stop (Steinberg
et al., 2015).
Risk Assessment Many states have transfer statutes that implicitly or

explicitly indicate the judge is to consider the risk the youth poses to society,
and this is within the domain of a clinical forensic evaluator. However, when
the defendant is a juvenile, the risk assessment requires a different set of
factors, tools, and instruments than what one would use when conducting a
risk assessment of an adult. Consequently, it is imperative that the clinician
conducting transfer evaluations be well versed in this area and be familiar
with writings that discuss the utility of different instruments in juvenile

proceedings, such as those by Hoge and Andrews (2010) and Urquhart and
Viljoen (2014), in addition to studies such as those written by Spice, Viljoen,
Gretton, and Roesch (2010) that empirically examine the utility of different
instruments in juvenile proceedings.
Additionally, the clinician should understand the potential sentencing options
and how each may impact the assessment of risk. For example, if the youth is
not going to be returned to the community in the near future, then the risk
that youth poses may be different than if he or she were in the community, and
the risk assessment should take this into account. Therefore, the evaluator may
want to be familiar with literature regarding institutional infractions of youth in
different justice settings (e.g., Kuanliang, Sorensen, & Cunningham, 2008).
Psychopathology and Issues Related to Diagnoses and Treatment The

clinician should be familiar with the mental health needs of youth in the juve-
nile justice system as well as potential controversies surrounding this issue.
The literature regarding mental health needs among youth in the juvenile
justice system is rich (e.g., MacKinnon-Lewis, Kaufman, & Frabutt, 2002;
Cauffman & Grisso, 2005; Osterlind, Koller & Morris, 2007). In the areas
of controversies, the clinician should be familiar with diagnostic nosology
controversies as they pertain to youths. For example, Moffitt et al. (2008) pres-
ent a review of research and controversies related to the DSM-5 and conduct
disorder.
Many jurisdictions ask the fact-finder to consider whether the youth needs
treatment and, if so, which system is better suited to meet these clinical needs.
Consequently, it is imperative the clinician be familiar with which treatments
are effective for which disorders and in which settings or conditions. The lat-
ter issue requires the clinician to contact treatment providers in the potential
setting. However, the former issue requires the clinician to be familiar with
empirical literature regarding the efficacy of treatment and to review publica-
tions such as Hoge (2009), Lipsey (2009), Lipsey et al. (2010), and Underwood,
Warren, Talbott, Jackson, & Dailey (2014).
Materials Regarding Best Practices

Books have been written about conducting forensic evaluations of juveniles
(e.g., Grisso, 2013; Grigorenko, 2012, Salekin, 2015), as well as books on the
screening and assessment of youth in the juvenile justice system (e.g., Grisso,
Vincent & Seagrave, 2005) and chapters on conducting transfer evaluations
(e.g., Chen & Salekin, 2012; Grisso, 2013; Salekin, Price, Adams, Ang, &
Rosenbaum, 2013). The clinician conducting forensic transfer evaluations
should be familiar with these texts and those germane to conducting forensic
assessments in general (e.g., Heilbrun et al., 2014, and Heilbrun & Grisso,
2008). Additionally, the clinician needs to be familiar with potential ethical
pitfalls (e.g., Allan & Grisso, 2014), as well as potential biases related to foren-
sic evaluations (Neal & Grisso, 2014).
In short, evaluators conducting forensic evaluations will want to make sure
this is an area in which they are competent to practice and understand the
legal issue at hand. With the assistance of the referring party, the clinician
identifies which statutory factors are clinically relevant and whether the clini-
cian will discuss the alleged offense with the juvenile. The latter issue requires
both the youth and the attorney to weigh the possibility of putting the offense
in a developmental context with giving up rights related to self-incrimination.
The clinician should collect data by reviewing records and conducting a
series of interviews with the minor exploring multiple domains of the youth’s
life, including academics, life in the community, home life, peers, substance
use, mental health treatment, prior juvenile justice involvement, willingness
to engage in treatment, and issues related to prosocial development. Addi-
tionally, the evaluator will want to interview the youth’s parents or guardians
and collect data on these domains as well. As part of the evaluation, the cli-
nician may choose to administer general psychological instruments such as
those that assess cognitive functioning, mental health status and personality, as
well as a forensic assessment instrument such as the Structured Assessment of
Violence Risk in Youth (SAVRY; Borum et al. 2006) or the Risk-Sophistication-
Treatment Inventory (RSTI; Salekin, 2004).
Also, with the consent of the referral source, the clinician will want to con-
duct collateral interviews with a variety of sources ranging from those who knew
the youth prior to his or her arrest and can provide information related to the
youth’s psychosocial development to those who can explain what types of ser-
vices would be available to the youth in the juvenile or criminal justice systems.
Consistent with the “Specialty Guidelines,” it is recommended the clinician
present data in a manner that separates the data from the clinical opinion.
The clinician is advised to present the relevant data points from each source,
followed by a clinical summary in which an opinion is offered regarding each
of the relevant statutory factors. In offering a clinical opinion, the clinician
should use the data collected to clearly support the rationale for the opinion.
Some, but not all, written clinical reports will result in the clinician being
asked to provide testimony in court. In such a case, it is imperative the clini-
cian meet with the retaining party or, in the case of a court-ordered evaluation,
the party for whom the clinician will testify, to go over the clinician’s testimony
as well as potential questions the opposing party may ask of the clinician. The
clinician can refer to texts by Greenfield and Gottschalk (2008), Karson and
Nadkarni (2013), and Otto, DeMier, and Boccaccini (2014) to assist them in
presenting the data to the court via a written report or testimony.
Case Vignette
Reason for Referral13
Jason, a 15-year-old African American male, was referred by his attorney
because he was facing a discretionary transfer hearing. At the time of the refer-
ral, Jason was in the detention center charged with first-degree reckless homi-
cide, hit and run resulting in death(s), and operating a vehicle without the
owner’s consent. He had been in the detention center seven months awaiting
hearing. During the initial contact with the attorney, the forensic evaluator
requested records related to the current offense, Jason’s previous mental health
and substance abuse treatment history, academic records, and prior juvenile jus-
tice records, as well as social services records. During the initial conversation,
the evaluator and attorney also identified which of the statutory criteria were to
be considered. Lastly, as part of the initial conversation, the evaluator received
permission from the attorney to discuss the alleged incident with the attorney’s
client. It is important that this issue be clarified initially as the information
obtained from the defendant could be self-incriminating, and obtaining such
information may not be consistent with the plan the attorney had for the case.
Evaluation Techniques
Jason was interviewed in private at the Great County Temporary Detention
Center on April 13 and 16, 2014, for a three-and–a-half hours and two hours
and fifteen minutes, respectively. As part of the evaluation, the Personality
Assessment Inventory-Adolescent (PAI-A) was administered and the Risk-
Sophistication-Treatment Inventory (RSTI) was utilized.
Jason’s mother, Ms. Jones, and his grandmother, Ms. Victor, were inter-
viewed separately at the evaluator’s office on April 25, 2014. The interview with
his maternal grandmother lasted two-and-a-half hours while the interview with
his mother lasted approximately one hour. Three collateral telephone interviews
were conducted. On May 1, 2014, Jason’s detention caseworker, Mr. Mathews,
was interviewed for approximately twenty minutes. Dr. Johnson, program direc-
tor at the State Department of Corrections, Juvenile Division, and Dr. Smith,
program director at the State Department of Corrections, were interviewed
separately on May 3, 2014, and each interview lasted approximately thirty min-
utes. Prior to conducting each interview or assessment, the interviewee was
informed of the purpose and limits of confidentiality of the interview.
Records reviewed and relied on in forming the clinical opinion were Officer
Smith’s arrest report dated January 15, 2014; Officer Price’s supplemental report
dated January 15, 2014; and Jason’s report cards from Achievement Academy.

Per police reports, Jason and his friends stole two cars and were playing “car
tag” when the car Jason was driving fatally hit a victim who was riding a bicy-
cle. The cars fled the scene and, less than a mile later, an officer stopped the
car Jason was driving because he was speeding. Jason acknowledged hitting
the bicyclist and insisted it was an accident. Those in the car were arrested at
the scene.
School records revealed Jason was not a special education student and that
he attended a school ranked in the top 10% in the city. Jason’s report cards for
the three years prior to the offense indicated he attended school regularly, was
rarely late, and typically earned As and Bs.

Jason, his mother and his grandmother were the source of information for this
section of the report. Jason lived exclusively with his maternal grandmother
for the first ten years of his life because of his mother’s drug addiction. His
mother had abstained from any drugs or alcohol for the previous six years and,
as a result, Jason had divided his living arrangements between his mother’s and
his maternal grandmother’s residences during the past five years. In order to
obtain a complete developmental, academic, and psychosocial history, Jason’s
mother and grandmother were interviewed separately. Highlights of their
interviews are as follows:
A freshman in high school, Jason had performed reasonably well in school.
He was not a special education student, and he had never failed or skipped a
grade. While living with his grandmother or mother, he occasionally violated
curfew but always called his guardian to let her know where he was, typically
at a friend’s house playing video games. He attended church regularly with his
grandmother and occasionally had odd jobs mowing grass or shoveling snow.
Jason denied any significant medical or trauma history and had not received
any mental health or substance abuse treatment. Although he denied drinking
alcohol, he acknowledged that for the past year he had started smoking mari-
juana on a weekly basis.
Jason denied any gang involvement but acknowledged that some of his peers
had arrest records or were on probation. Although his only prior arrest was for
a shoplifting charge at 12 years of age—a charge that was later dropped—he
admitted to stealing cars with two of his friends and their girlfriends for the
previous three months. He described doing this on the weekends, late at night,
or early in the morning. He explained that he got permission to spend the
night at one of these friend’s houses, and they snuck out from that location to
steal cars and joy ride.
Jason’s Account of the Offense

Jason was interviewed extensively about the alleged offense so the evalu-
ator could place the offense in a psychosocial developmental context. Jason
explained he and his friends frequently stole cars to go for joy rides. Never
before had they hurt anyone nor had they damaged a car other than stripping
the steering wheel to drive the car. Jason explained he always wanted to learn
to drive but neither his mother nor grandmother could afford the cost of the
driver’s education class. He explained that his friends taught him to drive and,
over time, taught him how to steal a car. He said he only stole cars when he
was with his friends.
Regarding the night at hand, Jason explained that he sped up after his
friends and the car behind him tapped the bumper of the car he was driving.
Once they did that, he turned around to tell them to stop. As he did, he was not
watching the road and hit the cyclist. He said he did not realize he killed the
cyclist and thought the cyclist was just hurt. When asked why he didn’t stop at
that point, Jason explained that he was scared and that his friends were yell-
ing at him to keep driving. Consistent with the police report, Jason explained
once the police stopped him and asked why he was speeding he began crying
and told the police he thought he hit a person on a bike. In describing the
offense, unsolicited, Jason described how badly he felt for the victim and his
family. Jason repeatedly voiced regret for his actions and insisted that when
he and his friends took the car for a joy ride, he never thought anyone would
get hurt.
Collateral Contacts
Relevant Data from Mr. Mathews, Jason’s Detention Center Caseworker
Jason’s caseworker, Mr. Mathews, indicated he had been Jason’s caseworker
during his entire stay in the detention center. Mr. Mathews stated Jason’s
mother and grandmother had not missed a visit and had participated in every
family programming opportunity. He explained Jason had been on the highest
behavioral level since his second month in the facility. Mr. Mathews described
Jason as a “helpful” young man whose “behavior had been remarkable.” He
described an incident when, unprompted, Jason told staff he had learned
about another resident who had threatened to sexually assault a third and
younger resident. Mr. Mathews indicated when he spoke with Jason about this
incident, Jason said he brought it to the staff ’s attention because he feared for
the younger resident’s safety. Finally, Mr. Mathews said Jason volunteered to
join the Resident Advisory Board. Only fourteen of the two hundred residents
participate on the board, which makes decisions regarding programming and
commissary requests for residents.
Relevant Data from Dr. Johnson, Program Director at the State

Department of Corrections, Juvenile Division Dr. Johnson said that, if
sentenced as a juvenile, Jason could be held until his 21st birthday, and he
would be eligible for a variety of services including individual and group
cognitive-behavioral treatment, instruction until he completed a GED or
diploma, and opportunities for family engagement.
Dr. Johnson also explained that the front line and clinical staff were all
trained on various aspects of adolescent development and the units utilize a
behavioral management (or point system) that reflect adolescents’ develop-
mental needs, their behavior, and their progress toward their therapeutic and
academic goals.
Relevant Data from Dr. Smith, Program Director at the State Department
of Corrections Dr. Smith said the Department of Corrections has desig-
nated units for those under 18 years of age, so that adolescents do not have
contact with older inmates. Staff who work on the youth units, however, have
no specialized training in adolescent development. All incarcerated youth are
expected to attend school, but they do not receive any other programming
until sixty days before their release date.
The statute indicated that the judge should consider Jason’s treatment needs
and risk to the community. Consequently, reliable and valid instruments with
embedded validity scales were used to gather data related to these factors.
Since Jason did not have a clinical history and the Millon Adolescent Clini-
cal Inventory was normed on a clinical sample, this test was determined to
be not appropriate for this case. As Jason was not a special education student
and his academic records indicated an above-grade reading level, the evaluator
considered administering the Personality Assessment Inventory-Adolescent
(PAI-A) and/or the Minnesota Multiphasic Personality Inventory Adolescent
(MMPI-A), ultimately choosing the PAI-A.
To determine the his risk for violence, utilization of the Structured Assess-
ment of Violence Risk in Youth (SAVRY) and/or the Risk Sophistication Treat-
ment Inventory (RSTI) was considered. The evaluator chose to administer the
RSTI because it provides additional information such as the maturity of the
youth and the youth’s willingness to engage in treatment, which the court
would consider when rendering its opinion.
Personality Assessment Inventory-Adolescent (PAI-A) The PAI-A is a

264-item, self-report instrument designed to aid in the clinical assessment
of youths 12–18 years of age. Jason produced a valid PAI-A profile indicating
that he responded in a consistent and forthright manner. None of the clinical

scales reached a clinically significant level, and the scales in his profile for
depression, paranoia, antisocial features, drug problems, and alcohol problems,
as well as the aggression scale, were in the normal range for adolescents. His
profile was not clinically significant but was consistent with youth who have
an inflated self-esteem.
Risk-Sophistication-Treatment Inventory (RSTI) The RSTI is a rating

scale designed to aid the clinician in assessment of risk for dangerousness,
sophistication/maturity, and treatment amenability for youths 9–18 years of age.
The RSTI is unique in that it compares a youth with other youths who are in the
juvenile justice system. Compared with other juvenile offenders, Jason scored
within the low range on the Risk for Dangerousness Scale. A good prognostic
indicator was compared with other juvenile offenders; his psychopathic features
were in the low offender range, indicating he has fewer psychopathic features
than the average juvenile offender. Youth who score in the low range on the
Psychopathic Features subscale display a normal range of remorse and guilt and
are not more manipulative or deceptive than one would expect.
Jason appeared more mature than most youth in the juvenile justice system.
He scored in the 98th percentile on the Sophistication-Maturity Scale of the
RSTI. Youth in the juvenile justice system who score high on this scale have a
greater emotional awareness and possess the skills needed to make good judg-
ment most of the time. The behavior he had displayed in the detention center
was consistent with what one would expect given his score on this scale.
Finally, regarding the Treatment and Amenability scale, his score was in the
high range, which suggested he was more willing to engage in treatment than
most juvenile offenders.

Space limitations prevent the author from presenting a detailed version of
what would have been offered to the court. In this case there were several legal
factors that were clinically relevant. What follows is the sample of statutorily
defined factors, which were both clinically and legally relevant to the court in
determining whether Jason was to be transferred to the adult jurisdiction. As
these factors were derived from the statute and are typically presented individ-
ually in the statute, it is good form for the clinician to reference and respond to
each factor individually in their report.
Section 670.032(1)(c): Any Previous Abuse or Neglect History of the

Minor Jason did not have a history of abuse or neglect. In fact, as caseworker
Mathews reported, his mother and grandmother had been a great support to
Jason while he has been detained. His lack of abuse history coupled with the
level of family support weighed in favor of keeping this case in the juvenile
justice system as family support is a key component in successfully addressing
juvenile delinquency.
Section 670.032(1)(d): The Seriousness of the Crime The death of a human

is always a serious event. Jason expressed remorse for his actions. Consistent
with this, although he did not stop at the scene, when he was apprehended for
speeding moments later, he acknowledged the act and expressed regret for it.
Jason contended that, when he was in the car with his friends, he did not
appreciate the likelihood that someone could get hurt. It is important to under-
stand this contention from a developmental perspective. Research has shown
when adolescents are with their peers, they tend to make riskier decisions than
they make on their own or compared with their adult counterparts.
For example, using a standard video game paradigm, Chein (2011) and his
colleagues studied three groups of subjects—adolescents 14–18 years of age,
young adults 19–22 years of age, and adults 24–29 years of age—and demon-
strated that adolescents took more risks when they thought their peers were
watching than did adults, which resulted in more disastrous outcomes.
While they performed the tasks, subjects were connected to a machine that
measured which parts of the brain were being engaged. Chein et al. (2011)
demonstrated that the reward system was more active in adolescents compared
with adults when their peers were watching. Additionally, adults engaged or
used the prefrontal cortex more, regardless of whether they were in the pres-
ence of their peers or not.
Although the crime itself was serious, the manner in which it occurred
was consistent with normative developmental differences between adults and
adolescents. As such, it was yet another factor that indicated the case should
remain in the jurisdiction of the juvenile courts.
Section 670.032(1)(g): Is Transferring Jurisdiction Necessary to Deter

This Minor or Other Juveniles from Committing the Crime for Which
the Minor Is Charged? It is unlikely that transferring jurisdiction would
deter Jason or other juveniles. Little empirical evidence exists supporting the
concept that transferring a youth to adult court is a deterrent to youth who
are transferred. Based on a systematic review of literature, McGowan et al.
(2007) concluded, “On the basis of strong evidence that juveniles transferred
to the adult justice system have greater rates of subsequent violence than
juveniles retained in the juvenile justice system, the Task Force on Community
Preventive Services concludes that strengthened transfer policies are harmful
for those juveniles who experience transfer. Transferring juveniles to the adult
justice system is counterproductive as a strategy for deterring subsequent
violence” (p. S15). Furthermore, research consistently demonstrates that those

youths who are transferred to, and prosecuted in, adult court recidivate more
quickly and at higher rates than do their counterparts who were prosecuted
in the juvenile justice system (Fagan, 1995; Bishop, Frazier, Lanza-Kaduce &
Winner, 1996; Myers, 2003; Bishop & Frazier, 2000). Similarly, the Office of
the Juvenile Justice Delinquency Prevention found “the bulk of the empirical
evidence suggests that transfer laws have little or no general deterrent effect”
(Redding, 2008, p. 2).
Likewise, little evidence exists indicating that transferring a youth is deter-
rence to other youths. For example, Redding and Fuller (2004) used a unique
perspective to examine general deterrence. They asked questions of youth who
were charged with felonies including murder. The vast majority of those who
had already been transferred to adult court reported that, prior to their arrest,
they did not know they could be charged as an adult for the offense (Redding &
Fuller 2004). This demonstrates that the transfer laws were not a deterrent to
those youths who went on to commit a transferable offense. Another way to
demonstrate this is to examine the change in the rate of juvenile crime follow-
ing changes in the law that make it more likely that youth will be transferred. As
cited in Myers (2003), changes in the law in New York and Idaho “had little mea-
surable effect on juvenile crime, and in the case of Idaho, it may have actually
backfired by contributing to an increase in juvenile offending. Thus, these laws
did not produce the general deterrent effect expected by policy makers.” (p. 80).
The opinion that it is unlikely transferring Jason would be a deterrent to
him or other juveniles can be understood when viewed from a developmental
lens. As discussed previously, research has demonstrated, compared with their
adult counterparts, juveniles are less likely to accurately anticipate the con-
sequences of their actions and perceive rewards rather than risks. These two
lines of research shed light on why the concept of deterrence would apply for
adults but, when viewed in the context of the normal developmental process,
are less likely to apply to juveniles.
Consistent with best practice standards, the clinician did not provide an
ultimate opinion. Instead, data were provided for each clinically relevant fac-
tor. In doing so, the clinician indicated whether each factor weighted for or
against transferring the case or whether the data were mixed for the specific
factor.

Transfer evaluations, as is the case with most forensic evaluations, present
some potential ethical issues. First and foremost, consistent with sections 2.01
and 2.03 of the “Ethical Principles of Psychologists and Code of Conduct”
(EPPCC) it is important that transfer evaluations be an area of competence
for the clinicians conducting them. Clinicians can obtain and maintain their
competence in a variety of ways, including staying abreast of the most current
literature, attending conferences such as those offered by the Division 41 of
the American Psychological Association, or attending continuing education
workshops offered by the American Academy of Forensic Psychology. When
conducting any forensic evaluation, the clinician’s attention to record-keeping
must go beyond those articulated in the EPPCC to include relevant aspects of
the “Specialty Guidelines,” the law, and the rules of discovery.
Clinicians conducting this or any type of forensic evaluation should under-
stand how different types of bias could impact their work and strive to reduce
this influence (see Kassin, Dror, & Kukucka, 2013, and Gutheil & Simon, 2004,
for discussions on bias in assessment and testimony). Clinicians are encour-
aged to ask themselves a series of questions such as “Is the money affecting my
judgment (especially, for example, in taking on a case outside my expertise)?”
or “Am I unduly fixed on winning, pleasing the retaining attorney and mak-
ing a name for myself on this case?” as a means of reducing the influence of
bias (Gutheil & Simon, 2004, p. 268). Alternatively, actively considering rival
hypotheses could be a means of minimizing the effects of confirmation bias.
Unlike most forensic evaluations, transfer evaluations typically require
the clinician to consider the following question as it applies to the juvenile
and adult justice systems: “Can the system provide the services to meet this
particular youth’s needs?” In most jurisdictions, the juvenile justice and adult
systems offer different programmatic and therapeutic services, and what is
offered may change in response to changes in budget and in personnel. Con-
sequently, collateral interviews with administrators or direct service providers
in each system are very important. The clinician is warned that it may take
longer than expected to identify and get in touch with these types of collat-
eral sources. Additionally, the evaluator should not be surprised if a potential
collateral source wants to consult with his or her supervisor before speaking
with the evaluator. Regardless, as is the case with any forensic evaluation, it
is important all successful and unsuccessful efforts made to obtain data are
noted in the report.
Notes
1. For a brief but thorough history of the nation’s transfer laws and trends, see U.S.
Department of Justice, Office of Justice Programs, Office of Juvenile Justice and Delin-
quency Prevention, Trying Juveniles as Adults: An Analysis of State Transfer Laws and
Reporting (September 2011) at 8–10. For more in-depth data regarding discretionary trans-
fer, see U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and
Delinquency Prevention, Delinquency Cases Waived to Criminal Court, 2011 (December
2014).
2. See, generally, Kent v. United States, 383 U.S. 541 (1966; “the waiver of jurisdiction is
a critically important action determining vitally important statutory rights of the juvenile”).
3. A small minority of states allow criminal court judges to exempt young defen-
dants from certain criminal penalties, under limited circumstances. See An Analysis of State
Transfer Laws and Reporting, supra, at 7.
4. Though state laws vary widely as to whether youth can be housed in adult facili-
ties, recent surveys by the U.S. Department of Justice have established that approximately
10,000 young people are held in adult jails and prisons on any given night. See U.S. Depart-
ment of Justice, Bureau of Justice Statistics, Jail Inmates at Midyear 2009 (June 2010); U.S.
Department of Justice, Bureau of Justice Statistics, Prison Inmates at Midyear 2009 (June
2010).
5. See Centers for Disease Control, Effects on Violence of Laws and Policies Facilitating
the Transfer of Youth from the Juvenile to Adult Justice System (November 2007; finding that
placing youth in the adult criminal court system increases the likelihood that they will com-
mit future crimes by 34%); U.S. Department of Justice, Office of Justice Programs, Office of
Juvenile Justice and Delinquency Prevention, Juvenile Transfer Laws: An Effective Deterrent
to Delinquency? (June 2010; finding that public safety increases when young people are tried
in the juvenile court system). See also Patrick Griffin, Sean Addie, Benjamin Adams, and
Kathy Firestine, Trying Juveniles as Adults: An Analysis of State Transfer Laws and Reporting,
Juv. Offenders and Victims: Nat’l Rep. Series, at 24, 26 (September 2011; sending children to
adult prison has a “counter-deterrent effect” of increased recidivism).
6. Roper v. Simmons, 543 U.S. 551, 569 (2005; children have a “lack of maturity and
an underdeveloped sense of responsibility . . . [that] lead[s] to recklessness, impulsivity, and
heedless risk-taking. . . . [Children also] are more vulnerable . . . to negative influences
and outside pressures [and have limited] contro[l] over their own environment”); Graham
v. Florida, 560 U.S. 48, 50, 68 (2009; children have diminished culpability and greater pros-
pects for reform and are accordingly “less deserving of the most severe punishments”);
Miller v. Alabama, 132 S. Ct. 2455, 2464, (children “lack the ability to extricate themselves
from horrific, crime-producing settings. . . . [A] child’s character is not as well formed as
an adult’s; his traits are less fixed and his actions less likely to be evidence of irretrievabl[e]
deprav[ity]”; internal citations omitted).
7. Roper, supra, at 569–70; Miller, supra, at 2464.
8. Only a handful of states publicly report their transfer data; it is impossible to know
exactly how many youth are transferred each year. See An Analysis of State Transfer Laws
and Reporting (September 2011) at 1. We can be confident, however, that the number is
significant—a 2007 report including data from only 21 states documented nearly 14,000
transfers that year. Id.
9. Of course, regardless of who the retaining party is, the forensic psychologist should
strive to be unbiased and impartial (APA, 2013 Specialty Guideline 1.02).
10. See, e.g., the Campaign for Youth Justice Resource List, available at http://www
.campaignforyouthjustice.org/about-resources.html
11. See, e.g., University of Pittsburgh, Center for Research on Health Care, Pathways
to Desistance: A Longitudinal Student of Serious Adolescent Offenders. (2011)
12. See, e.g., Justice Policy Institute, The Dangers of Detention: The Impact of Incarcer-
ating Youth in Detention and Other Secure Facilities. (2006)
13. Space limitations prevent the author from presenting a detailed version of what
would have been offered to the court. Jason’s mental status was fairly unremarkable except
that he endorsed signs and symptoms of depression, but these appeared to be related his
current legal circumstances.
References
Allan, A., & Grisso, T. (2014). Ethical principles and the communication of forensic mental
health assessments. Ethics & Behavior, 24(6), 467–477.
American Psychological Association. (2010). Ethical principles of psychologists and code
of conduct. Retrieved from http://www.apa.org/ethics/code/index.aspx
American Psychological Association. (2013). Specialty guidelines for forensic psychol-
ogy. American Psychologist, 68(1), 7–19. Retrieved from http://www.apa.org/practice
/guidelines/forensic-psychology.pdf
Barnum, R. (1987). Clinical evaluation of juvenile delinquents facing transfer to adult court.
Journal of the American Academy of Child and Adolescent Psychiatry, 26(6), 922–925.
doi:10.1097/00004583-198726060-00018
Bishop, D. M., & Frazier, D. (2000). Consequences of transfer. In J. Fagan & F. Zimring
(Eds.), The changing borders of juvenile justice: Transfer of adolescents to the criminal
court (pp. 13–43). Chicago, IL: University of Chicago Press.
Bishop, D. M., Frazier, C. E., Lanza-Kaduce, L., & Winner, L. (1996). The transfer of juve-
niles to criminal court: Does it make a difference? Crime & Delinquency, 41, 171–191.
doi:10.1177/0011128796042002001
Borum, R., Bartel, P., Forth, A., & Psychological Assessment Resources, Inc. (2006). SAVRY:
Structured assessment of violence risk in youth: professional manual. Lutz, FL: PAR.
Brannen, D. N., Salekin, R. T., Zapf, P. A., Salekin, K. L., Kubak, F. A., & DeCoster, J. (2006).
Transfer to adult court: A national study of how juvenile court judges weigh pertinent
Kent criteria. Psychology Public Policy and Law. doi:10.1037/1076-8971.12.3.332
Cauffman, E., & Grisso, T. (2005). Mental health issues among minority offenders in the
juvenile justice system. In Our children, their children: Confronting racial and ethnic dif-
ferences in American juvenile justice (pp. 390–412). Chicago, IL: University of Chicago
Press.
Chein, J., Albert, D., O’Brien, L., Uckert, K., & Steinberg, L. (2011). Peers increase ado-
lescent risk taking by enhancing activity in the brain’s reward circuitry. Developmental
Science, pp. F1–F10.
Chen, D. R., & Salekin, R. T. (2012). Transfer to adult court: Enhancing clinical forensic
evaluations and informing policy. Handbook of Juvenile Forensic Psychology and Psy-
chiatry, 105–125.
Fagan, J. (1995). Separating the men from the boys: The comparative advantage of juvenile
versus criminal court sanctions on recidivism among adolescent felony offenders. In
J. C. Howell, B. Krisberg, J. D. Hawkings, & J. J. Wilson (Eds.), A sourcebook: Serious
violent and chronic juvenile offenders (pp. 238–260). Thousand Oaks, CA: SAGE.
Greenfield, D. P., & Gottschalk, J. A. (2008). Writing forensic reports: A guide for mental
health professionals (1st ed.). New York, NY: Springer Publishing Company.
Grigorenko, E. L. (2012). Handbook of juvenile forensic psychology and psychiatry. New
York, NY: Springer.
Grisso, T. (2010). Clinicians’ transfer evaluations: How well can they assist judicial discre-
tion? Louisiana Law Review, 71(1).
Grisso, T. (2013). Forensic evaluation of juveniles (2nd ed.). Professional Resource Press.
Grisso, T., Vincent, G., & Seagrave, D. (2005). Mental health screening and assessment in
juvenile justice (1st ed.). New York, NY: Guilford Press.
Gutheil, T. G., & Simon, R. I. (2004). Avoiding bias in expert testimony. Contemporary
Psychiatry, 260–270.
Heilbrun, K., & DeMatteo, D. (2012). Toward establishing standards of practice in juvenile
forensic mental health assessment. Handbook of Juvenile Forensic Psychology and Psy-
chiatry, 145–155. doi:10.1007/978-1-4614-0905-2_10
Heilbrun, K., DeMatteo, D., & Holliday, S. B. (2014). Forensic mental health assessment: A
casebook (2nd ed.). Oxford University Press.
Heilbrun, K., Grisso, T., & Goldstein, A. (2008). Foundations of forensic mental health
assessment. New York, NY: Oxford University Press.
Hoge, R. (2009). Advances in the assessment and treatment of juvenile offenders. Krimi-
nologija & Socijalna Integracija, 17(2), 49–69.
Hoge, R. D., & Andrews, D. A. (2010). Evaluation for risk of violence in juveniles. Oxford,
UK: Oxford University Press.
Jordan, K. L., & Myers, D. L. (2011). Juvenile transfer and deterrence: Reexamining the effec-
tiveness of a “get-tough” policy. Crime & Delinquency. doi:10.1177/0011128708319111
Karson, M., & Nadkarni, L. (2013). Principles of forensic report writing. Washington, DC:
American Psychological Association.
Kassin, S. M., Dror, I. E., & Kukucka, J. (2013). The forensic confirmation bias: Problems,
perspectives, and proposed solutions. Journal of Applied Research in Memory and Cogni-
tion, 2, 42–52. Retrieved from http://dx.doi.org/10.1016/j.jarmac.2013.01.001
Kuanliang, A., Sorensen, J., & Cunningham, M. (2008). Juvenile inmates in an adult prison
system: Rates of disciplinary misconduct and violence. Criminal Justice and Behavior,
35(9), 1186–1201. doi:10.1177/0093854808322744
Lenroot, R., & Giedd, J. (2006). Brain development in children and adolescents: Insights
from anatomical magnetic resonance imaging. Neuroscience & Biobehavioral Reviews,
30(6), pp. 718–729.
Lipsey, M. W. (2009). The primary factors that characterize effective interventions with
juvenile offenders: A meta-analytic overview. Victims & Offenders. doi:10.1080/15564
880802612573
Lipsey, M. W., Howell, J. C., Kelly, M. R., Chapman, G., & Carver, D. (2010). Improving
the effectiveness of juvenile justice programs: A new perspective on evidence-based prac-
tice. Retrieved from Center for Juvenile Justice Reform, Georgetown University website:
http://cjjr.georgetown.edu/pdfs/ebp/ebppaper.pdf
MacKinnon-Lewis, C., Kaufman, M., & Frabutt, J. (2002). Juvenile justice and mental
health: Youth and families in the middle. Aggression and Violent Behavior, 7(4), 353–363.
doi:10.1016/S1359-1789(01)00062.3
McCann, J. T. (1998). Malingering and deception in adolescents: Assessing credibility in clini-
cal and forensic settings. Washington, DC: American Psychological Association.
McGowan, A., Hahn, R., Liberman, A., & Crosby, A. (2007). Effects on violence of laws
and policies facilitating the transfer of juveniles from the juvenile justice system to the
adult justice system: A systematic review. American Journal of Preventive Medicine, 32,
S7–S28.
Means, R. F., Heller, L. D., & Janofsky, J. S. (2012). Transferring juvenile defendants from
adult to juvenile court: How Maryland forensic evaluators and judges reach their deci-
sions. Journal American Academy of Psychiatry & Law, 40.
Miller v. Alabama, Supreme Court of the United States, Certiorari to the Court of Criminal
Appeals of Alabama, No. 10-9646, Argued March 20, 2012–Decided June 25, 2012.
Moffitt, T. (2003). Life-course-persistent and adolescence-limited antisocial behavior: A

10-year research review and a research agenda. In Causes of Conduct Disorder and Juve-
nile Delinquency (pp. 49–75). New York, NY: Guilford Press.
Moffitt, T., Arseneault, L., Jaffee, S., Kim-Cohen, J., Koenen, K., Odgers, C., & Viding, E. (2008).
Research review: DSM-V conduct disorder: Research needs for an evidence base. Journal
of Child Psychology and Psychiatry, 49(1), 3–33. doi:10.1111/j.1469-7610.2007.01823.x
Myers, D. L. (2003). Adult crime, adult time: Punishing violent youth in the adult crimi-
nal justice system. Youth Violence and Juvenile Justice, 1, 173–197. doi:10.1177/154120
4002250878
Neal, T., & Grisso, T. (2014). The cognitive underpinnings of bias in forensic mental health
evaluations. Psychology, Public Policy and Law, 20(2), 200–211. doi:10.1037/a0035824
Osterlind, S. J., Koller, J. R., & Morris, E. F. (2007). Incidence and practical issues of mental
health for school-aged youth in juvenile justice detention. Journal of Correctional Health
Care, 13(4), 268–277. doi:10.1177/1078345807306802
Otto, R. K., DeMier, R. L., & Boccaccini, M. L. (2014). Forensic reports and testimony: A
guide to effective communication for psychologists and psychiatrists. Wiley.
Penney, S. R., & Moretti, M. M. (2005). The transfer of juveniles to adult court in Canada
and the United States: Confused agendas and compromised assessment procedures.
International Journal of Forensic Mental Health, 4(1), 19–37. doi:10.1080/14999013.2005
.10471210
Redding, R. E. (2008). Juvenile transfer laws: An effective deterrent to delinquency? Retrieved
from US Department of Justice/Office of Juvenile Justice and Delinquency Prevention
website: https://www.ncjrs.gov/pdffiles1/ojjdp/220595.pdf
Redding, R. E., & Fuller, E. J. (2004). What do juvenile offenders know about being tried as
adults? Implications for deterrence. Juvenile and Family Court Journal, 35–44.
Salekin, R. T. (2002). Clinical evaluation of youth considered for transfer to adult criminal
court: Refining practice and directions for science. Journal of Forensic Psychology, 2,
55–72.
Salekin, R. T. (2015). Forensic Evaluation and Treatment of Juveniles: Innovation and Best
Practice, American Psychological Association.
Salekin, R. T., Price, K., Adams, E., Ang, X., & Rosenbuam, J. (2013). Evaluation for dis-
position and transfer of juvenile offenders. In Roesch, R., & Zapf, P. A. (2013). Forensic
assessments in criminal and civil law: A handbook for lawyers (pp. 249–263). New York,
NY: Oxford University Press.
Salekin, R. T., & Psychological Assessment Resources. (2004). RSTI, risk-sophistication-
treatment inventory; risk for dangerousness sophistication-maturity treatment amenabil-
ity: Professional manual. Lutz, FL: PAR, Psychological Assessment Resources.
Spice, A., Viljoen, J. L., Gretton, H. M., & Roesch, R. (2010). Psychological assessment
for adult sentencing of juvenile offenders: An evaluation of the RSTI and the SAVRY.
International Journal of Forensic Mental Health, 9, 124–137. doi:10.1080/14999013.20
10.501846
Steinberg, L. (2014). Age of opportunity: Lessons from the new science of adolescence. New
York, NY: Houghton Mifflin Harcourt.
Steinberg, L., Albert, D., Cauffman, E., Banich, M., Graham, S., & Woolard, J. (2008). Age
differences in sensation seeking and impulsivity as indexed by behavior and self-report:
Evidence for a dual system model. Developmental Psychology, 44(6), 1764–1778.
Steinberg, L., Cauffman, E., & Monahan, K. C. (2015). Psychosocial maturity and desistance
from crime in a sample of serious juvenile offenders. Highlights from Pathways to Desis-
tance. U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice
and Delinquency Prevention.
Steinberg, L., Cauffman, E., Woolard, J., Graham, S., & Banich, M. (October 2009). Are ado-
lescents less mature than adults? Minors’ access to abortion, the juvenile death penalty,
and the alleged APA “flip-flop.” American Psychologist, 583–594.
Steinberg, L., & Monahan, K. (2007). Age differences in resistance to peer pressure. Devel-
opmental Psychology, 43(6), 1531–1543.
Underwood, L. A., Warren, K. M., Talbott, L., Jackson, L., & Dailey, F. (2014). Mental health
treatment in juvenile justice secure care facilities: Practice and policy recommendations.
Journal of Forensic Psychology Practice, 14(1), 55–85. doi:10.1080/15228932.2014.865398
Urquhart, T., & Viljoen, J. (2014). The use of the SAVRY and YLS/CMI in adolescent court
proceedings: A case law review. The International Journal of Forensic Mental Health,
13(1), 47–61. doi:10.1080/14999013.2014885470
Ward, J. M. (2003). Deterrence’s difficulty magnified: The importance of adolescent
development in assessing the deterrence value of transferring juveniles to adult court.
UC Davis Journal of Juvenile Law & Policy, 7, 253–284.
Weinberger, D. R., Elvevåg, B., & Giedd, J. (2005). The adolescent brain: A work in progress
(pp. 1–36). Washington, DC: The National Campaign to Prevent Teen Pregnancy.
Retrieved from http://web.calstatela.edu/faculty/dherz/Teenagebrain.workinprogress.pdf
17
Introduction to School-Based
Risk Assessments
Jeff D. Stein and Jill G. Durand
Relevant Case Law

School-based risk assessments diverge from other topics in this forensic
psychology compendium because there is no legal standard or statutory guide-
line on which to form a clinical opinion. Rather, the issue of school violence has,
until the late 1990s, typically been addressed after a tragic event, often attributed
to some form of bullying. In the last fifteen years, legislatures in forty-five states
have directed their respective school districts to adopt policies to address
bullying (U.S. Department of Education, 2011). The fruits of those efforts are
yet to be seen, however, as indicated by the National Center for Education Sta-
tistics (Robers et al., 2014). For example, as of 2012, students were more likely
to be victimized at school than away from school, and there were 5.2 victimiza-
tions for every 100 students across the United States. The previous year, 2011,
28% of students across the country reported being bullied at school, and 7% of
students were threatened or injured with a weapon, such as a gun, knife, or club,
on school property. Some have indicated that schools are relying on profiling,
as opposed to research-based risk assessments, as a means of identifying those
students at risk of committing acts of violence (Reddy et al., 2001; Sewell &
Mendelsohn, 2000).
A school-based risk assessment may include, but does not require, involve-
ment by outside agencies or individuals such as law enforcement or the legal
system. This type of psychological evaluation requires the consent of the juve-
nile’s legal parent or guardian for the evaluation to occur, and typically the
results are provided to the educational setting or school district. As a result,
there are many risk management factors for the evaluator to consider, such as
ensuring that all parties are aware of the limits of confidentiality, the duty to
warn, who is paying for the evaluation, and who is entitled to receive the results
or a copy of a written report. A school-based risk assessment is considered to

fall within the jurisdiction of “forensic psychology,” primarily because han-
dling the ethical and management issues needed to address concerns about
school violence requires a systematic approach to data collection familiar to
clinicians in forensic mental health. Psychologists conducting school-based
risk assessments must have a firm understanding of the ethical issues that
underlie such evaluations, as outlined by the American Psychological Associa-
tion (2010, 2012).1
This first section of this chapter is dedicated to the scientific “ancestry” of
school-based risk assessments, including General Issues in Risk Assessments,
Developmental Pathways of Aggression, and School Risk Assessments. The
second section will consist of a case vignette.
General Issues in Risk Assessment

A commonly utilized approach to conducting a violence risk assessment in
general is referred to as “structured professional judgment,” which involves
determining whether an individual possesses characteristics of known, aggre-
gate factors associated with risk of violence and establishing an opinion about
the strength of the individual’s risk compared to those base rates. There are
several published instruments, such as the Violence Risk Appraisal Guide
(VRAG; Harris et al., 1993) and the Historical Clinical Risk Management-20
(HCR-20; Webster et al., 1997), which provide a numerical risk score based
on an algorithmic calculation of an individual’s presenting factors. A current
perspective on these risk assessment instruments is that no single instrument
is demonstrably more effective in predicting risk than another and that any
instrument applied to an individual should be selected on the basis of the
purpose of that evaluation (Monahan & Skeem, 2014).
Much of the literature that addresses violence among adolescents is still
in its infancy, and has focused largely on juvenile offenders—adolescents
who have been adjudicated for a criminal act. As a result, the lens through
which these risk assessments have been viewed came from adult assessment,
including the application of measures originally designed for adults and later
modified for younger individuals. Examples of juvenile forensic instruments
used include the SAVRY (Structured Assessment for Violence Risk in Youth;
Borum, Bartel & Forth, 2003), the PCL: YV (Psychopathy Checklist: Youth
Version; Forth et al., 2003), and the MAYSI-2 (Massachusetts Youth Screening
Instrument—Version 2; Grisso & Barnum, 2006). However, assessing for psy-
chopathy in juveniles is controversial. In one survey of forensic evaluators by
Viljoen et al. (2010), for example, a majority (79%) reported using structured
psychopathy measures on adolescents while also cautioning that juveniles
should not be labeled as psychopaths. Overall, there is insufficient evidence of
School-Based Risk Assessments 387
a direct link between psychopathic traits starting in childhood or adolescence

and persisting into adulthood, and measures of psychopathy are unlikely to
yield a reliable estimate of violence on their own, particularly in the long-term
(Edens et al., 2001). An alternative and potentially valuable source of psycho-
logical data can also be obtained from the use of well-researched, structured
instruments that assess personality traits or behavioral patterns, such as the
Millon Adolescent Clinical Inventory (MACI; Millon 1993) and the Behav-
ior Assessment System for Children, Second Edition (BASC-2; Reynolds &
Kamphaus 2004).
Any risk assessment is a “snapshot” in time of an individual’s function-
ing and potential for violence because, although some risk factors are static
and unchangeable (i.e., gender and history of violence), others may change
with time or intervention (i.e., employment and substance abuse). As noted
by Appelbaum (2011), “the unknowable contingencies of life” (p. 819) can
immediately alter any prediction offered in an individual assessment. This
is particularly true for juveniles because, compared with adults, personality
features and cognitive capacities vary and evolve quickly during this stage of
development. Borum (2006) suggests incorporating research-driven data on
known risk factors that are correlated to violence with individual dynamic
(changeable) factors, such as the home environment and peer influence.
When considering the current state of the field regarding evaluations of risk
for harm, much of the focus is on adults who may act in a violent manner. In
fact, the definition of “risk assessment” has often been characterized as esti-
mating the probability that an act of physical violence will be perpetrated on
others (see, e.g., Kraemer et al., 1997; Skeem & Monahan, 2011). Yet the role
that risk assessments play in legal arenas and health care has continued to grow
over the last few decades, underscoring the need to carefully gather impor-
tant data and communicate that information to those who are responsible for
making decisions. Such communications can potentially be misleading and
have far-reaching consequences, including the implementation of limits on an
individual’s well-being, liberty, and livelihood (Heilbrun et al., 2000). In addi-
tion, rather than simply providing a statistical estimate of probability that an
act of violence will occur, a school-based risk assessment should identify the
presence of both risk and protective factors. Through that process, one may
discover concerns that an identifiable individual is being targeted for a harmful
act, prompting a pressing Tarasoff-type circumstance (Borum & Reddy, 2001).
Developmental Pathways of Aggression

Before assessing risk, it is important for evaluators to understand the different
types of violence as well as developmental factors that can lead to aggressive
and violent behaviors among children and adolescents.
First, research has often separated youthful aggressive behavior into two
subtypes: reactive and proactive aggression. Reactive aggression is a retalia-
tory response to a perceived threat and is the most common form of violence
among youth. Youth who engage in this type of aggression are often sensitive
to hostile or aggressive cues or misperceive benign social cues. The aggres-
sive act is often impulsive, and the youth may have a psychiatric condition.
The behavior may be defensive or a reaction to a highly stressful situation.
In comparison, proactive aggression is often controlled and goal-directed. It
is instrumental, or used to achieve a particular outcome. Youth who engage
in proactive aggression often believe that aggression is a legitimate tool to
achieve a goal (Borum, 2006).
In general, regardless of whether such conduct is reactive or proactive, or
even very serious, the commission of a violent act during adolescence does
not indicate that a youth is at risk of being a long-term or serious offender as
an adult. While many engage in delinquent and aggressive acts as teenagers,
the majority do not continue with such behavior as adults. Most delinquent
and aggressive behavior is limited to adolescence. Moffitt (1993, 1997) has
identified two primary types of delinquent patterns: adolescent-limited and
life-course persistent. Most fall into the first category. There are developmental
factors and influences, which tend to increase the likelihood that a child will
continue to demonstrate aggressive behaviors into adulthood. This factor is
important to consider when assessing the risk of future violence.
Assessing risk of future violence requires careful consideration to devel-
opmental and contextual factors that may influence behavior. However,
research to date has focused mainly on male children and adolescents.
Given the low base rate of female children and adolescents who engage in
violent behavior, the risk factors identified below may not directly apply to
this population. Furthermore, while research has consistently demonstrated
that there are historical, clinical, personality, and environmental factors that
increase the risk of violent behavior, there is no definitive combination to
allow for prediction of future violence. Research has shown that various con-
ditions can lead to the same outcome (equifinality), while the presence of
such risk factors may not lead to aggression or violence at all (multifinality;
Cichetti et al., 1996).
For those juveniles who continue to display aggressive and delinquent
behaviors into adulthood, research has shown that the critical historical factors
that increase the likelihood of future violence include a history of antisocial
behaviors prior to age 13 and past engagement in proactive violence. Male gen-
der also raises risk. Clinical and individual factors that increase risk include low
intelligence, mental disorders, hyperactivity, early expression of antisocial per-
sonality traits, poor attitudes toward school, poor academic progress, and early
substance use. There are numerous environmental factors that also raise the
likelihood of violence, including low socioeconomic status, antisocial parents,

parental discipline styles (harsh, lax or inconsistent), exposure to violence on
television, separation from parents, poor parent-child relationships, abuse and
neglect, and antisocial peer groups. For adolescents, additional risk factors
include weak social connections, antisocial peer groups, and gang member-
ship (U.S. Surgeon General’s Report, 2011). For those children who engage in
aggressive behaviors but do not continue to offend into adulthood, research
has identified the following features: childhood histories that are relatively free
from difficulty (e.g., fewer behavior problems, less likely to have a co-occurring
disorder), antisocial behaviors that do not emerge until after age 13, a lower
incidence of predatory violence, and an ability to develop and maintain appro-
priate attachments to others (Moffitt, 1993, 1997).
With regard to individual and personality factors, children who demon-
strate antisocial tendencies, particularly conduct problems and psychopathic
traits, are more likely to show aggressive behaviors in childhood and adoles-
cence and likely to continue to demonstrate antisocial behavior into adulthood
(Frick and Loney, 1999). Research has shown that after controlling for other
risk factors such as prior offenses, drug use, and delinquent peers, the pres-
ence of callous-unempathic personality traits predicts later antisocial behavior
(Salekin, 2008) and is more predictive of severe, stable, and aggressive behav-
iors (Edens et al., 2007; Leistico et al., 2008). Youth who present with callous-
unemotional traits have been shown to demonstrate aggression that is both
reactive and proactive, while antisocial youth without such traits show less
overall aggression and less proactive aggression in particular (Frick & Viding,
2009). However, the same temperamental risk factors may have different out-
comes, depending on the nature of exposure to varying parenting styles and
environmental factors.
Given that most children and adolescents who engage in violent acts do
not continue to do so into adulthood, it is important to also consider the
unique developmental issues of this group. Adolescents are more vulner-
able to external influences, particularly peer pressure, and interactions with
an antisocial peer group can have a significant impact on decision mak-
ing. In general, adolescent social development is marked by an increase
in the importance of peers, and adolescents are far more likely to com-
mit crimes in groups than are adults (Zimring, 1998). While some may be
directly influenced by peer pressure, in general there is a greater desire for
peer approval and a fear of rejection, which may lead adolescents to act
in ways they might not otherwise, including aggressive acts. Furthermore,
risk-taking may be “activated” by the presence of peers or emotional arousal,
and “the net result is that adolescents are more likely than either children or
adults to change their decisions and alter their behavior in response to peer
pressure” (Scott & Steinberg, 2008, p. 20).
Finally, adolescence is a period of great malleability and personality

formation. Both psychosocial and neurological development continue into
early adulthood, and behaviors that are present in adolescence may not
continue into adulthood. Adolescents differ from adults in three salient ways:
their developing capacity for mature judgment and decision making, vulner-
ability to external negative influences, and identity growth. Furthermore, the
research in neuroscience has provided evidence and supported the develop-
mental research findings, demonstrating that adolescent brains are not fully
developed in the regions responsible for executive functions (i.e., impulse
control, planning, assessing risk) and that the limbic system (emotional,
impulsive responses) is more readily activated during this period of devel-
opment compared with adulthood. Adolescents are less likely to consider
future consequences for their actions, and their decisions tend to be short-
sighted. They are more likely to choose smaller, immediate rewards over larger,
longer-term rewards, and they prefer immediate gratification as opposed to
long-term consequences (Cauffman & Steinberg, 2000.)
Best Practices in School-Based Risk Assessments

For the purposes of conducting an evaluation of an individual for poten-
tially harmful behavior in a school, Halikias (2004) described two groups
of students who may be referred for a risk assessment—those juveniles who
have a history of impulsive violence and anger problems (dangerousness),
and those who select targets and carefully plan an act of violence (threat).
The basis for a school seeking a risk assessment regarding a student is often
because a specific incident—such as a physical altercation, an incendiary
Internet communication, or a threatening statement made in the presence
of others—served as a trigger for worry about dangerousness or a threat.
These signals, which Meloy and O’Toole (2011) conceptualize as “leakage,”
may indicate the need for a forensic professional to determine the likelihood,
severity, and imminence of an act of violence.
When conducting a school risk assessment, critical data points should
mirror research-driven factors known to be associated with violence, similar
to those that are captured by the SAVRY (Borum, 2006). Those include the
following:
1. Static factors such as history of family violence, childhood abuse or

maltreatment, disrupted attachment relationships, and family criminality;
2. Individual risk factors such as antisocial attitudes/perceptions, impulsivity
and substance abuse, anger problems, and lack of empathy;
3. Social risk factors such as delinquent peers, poor parental monitoring, and
community dysfunction.
The critical factors outlined above should be obtained from multiple sources.
Interviews with the student and family members, as well as collateral informa-
tion from objective professional sources such as a mental health provider and
physician, provide the data from which the evaluator can form hypotheses and
confirm or disconfirm clinical appraisals about the level of risk posed by the
juvenile. Among several other questions that require clarification, the evalua-
tor will want to know about the juvenile’s behavioral patterns, signs of mental
illness, self-perceptions and need for attention, ability to cope with frustration,
rejection and failure, social inclusiveness and isolation, use of information
technology and social media, range of extracurricular interests and motiva-
tion, and level/nature of parental and family involvement. These points of
information are used to determine the juvenile’s motivation, preparation, and
contributing factors to engaging in an act of violence and, equally important,
to delineate the mediating factors and possible interventions that will reduce
this risk. For example, social supports, positive attachment relationships, good
working relationships with authority, and resiliency are known protective fac-
tors against risk of violence. Participation in support services such as mental
health treatment and organized activities might also mitigate this risk.
Case Vignette
Reason for Referral
Billy was a 16-year-old junior at a suburban high school. He was referred for a
risk assessment by school administrators who were concerned about a statement
Billy made in class that he was going to “bring in an AK and shoot everyone
up.” At the time of the threat, police were called to the scene and took Billy to
a hospital for an inpatient evaluation, two days after which he was psychiatri-
cally cleared. However, upon a police follow-up visit to his home to interview
Billy and his parents, a collection of knives and other weapons were confiscated,
and police charged him with two criminal offenses related to the threatening
statements he made at school. In addition to a question about whether Billy
was a risk to himself or others, school personnel intended to use the results as a
supplement to determine the appropriateness of his academic placement.
As part of the evaluation process, Billy participated in a clinical interview
lasting for one hour, and he completed a self-report, psychological assessment
instrument, the Millon Adolescent Clinical Inventory (MACI). The examiner
also conducted separate interviews of each of his parents, lasting a total of two
hours and thirty minutes, and a collateral phone conversation with his current
therapist. The following records were reviewed: 1) Billy’s psychoeducational
testing report, completed when he was in the 10th grade, and 2) discharge
records from the psychiatric hospitalization following the index threat inci-
dent at school. At the initial meeting with all parties and collateral sources, the
purpose of the risk assessment and the limits of confidentiality were explained.
All participants provided a satisfactory understanding of the explanation and
consented to participate.

The following information was obtained during the course of the evaluation:
Billy is the oldest of three children. Billy’s father, Mr. Smith, was a nationwide
real estate developer, and his mother, Ms. Smith, is a homemaker. There were
no indications of parental psychiatric illness, substance abuse, or domestic
violence. In describing Billy’s early development, both parents reported he
performed at an average level academically, but he was subjected to teasing
and ridicule by his peers when he was in third grade. He also made a vague
threat to “kill” a peer following one conflict that year. Billy was also physi-
cally bullied by a school peer who lived nearby. In an effort to gain popularity
at school, when he was in the fifth grade, Billy brought a toy gun to school
and, on another occasion, empty machine gun shell casings from his father’s
World War II memorabilia collection. By the eighth grade, Billy was exhibiting
poor social skills, characterized by impulsivity and immaturity in his verbal
communications. Billy’s mother initiated a change in schools for Billy in the
fifth grade and ninth grade because of parental dissatisfaction with how school
administrators responded to his adjustment issues. His grades showed a slow
decline through middle school and entering high school. His parents also
reported that Billy had difficulty modulating his statements and that he did
not comprehend rules of social conduct, particularly when larger groups of
his peers were engaging in normal mild, disruptive behavior in class. They said
that Billy had difficulty making and keeping friends, because he was impulsive,
loud, and competitive. At the same time, they reported that he had managed
to maintain a part-time job for two years at an outfitter’s surplus warehouse,
selling gear for fishing, camping, and hunting.
Both parents described “walking on eggshells” around Billy at home, due to
his overreactions when he is disciplined. They reported one incident in the last
year when, after Mr. Smith physically removed an air gun from his possession,
Billy retreated to his room and smashed a large television to pieces. Mr. Smith
acknowledged that he is impatient with his son, and Ms. Smith stated that
Billy appears less stressed and irritable when Mr. Smith is away on business
for longer periods of time. Billy’s parents reported that their son did not use
drugs or alcohol, and he had not exhibited signs of psychoses or severe mental
illness, but they acknowledged long-standing irritability, oppositional conduct
at home, and excessive anger in response to limit setting, such as when video
game playing is restricted. Following the school incident during which Billy
made a general homicidal threat, his parents expressed concern that their son’s
life had been upended in that he had been suspended from school, he was not
working at his part-time job, and his plans to be a police officer or join the
army were now in question.
When asked about reports of Billy having a collection of weapons, his par-
ents explained that he enjoyed whittling with knives and engaging in target
practice using air guns with plastic BBs. Mr. Smith noted that he took away
some of Billy’s knives several months ago because the weapons looked “treach-
erous” and because Billy would leave the knives lying around, unsecured, yet
refused to discuss the issue. He said that Billy had purchased a samurai blade
online, without the parents’ awareness, which was discovered following the
police investigation of weapons in the household. Ms. Smith acknowledged
there was some miscommunication about when Billy could have his weapon
collection back following Mr. Smith’s departure on a one-month sales trip. Mr.
Smith acknowledged that he (Mr. Smith) also had a collection of knives and
firearms, which were kept under lock and key. Both parents acknowledged
that Mr. Smith worried that Billy would attack him with a knife out of impul-
sive frustration over their tense relationship. Ms. Smith said that Billy slams
his door and yells loudly but exhibited physical harm toward anyone at home.
Neither of Billy’s younger siblings were exhibiting developmental deficits or
social/behavioral problems.
Interview with Billy

Billy was cooperative and spontaneous in response to interview questions.
He acknowledged having a hard time socially, which he attributed to being
the “new kid” who is typically shunned by others who are more familiar with
each other. He acknowledged that he formed relationships with peers who
were more likely to get in trouble but that he did not spend time with them
outside of school hours. He acknowledged there were “a lot of bad influences
there,” such as a peer group involved with drug and alcohol use. Billy admit-
ted that he had used marijuana on a periodic basis, usually by himself. He also
expressed daily enjoyment of popular simulated video games, particularly
war gaming.
When asked to explain events leading up to his current suspension from
school, Billy said that he was being “loud and goofy,” which created conflicts,
and when one of the kids in his engineering class was engaging in a routine of
disruptive behavior, Billy thought he would give the peer “a taste of his own
medicine” by hiding his hat. He said that the peer became angry, and other stu-
dents in the class also began yelling, so Billy threatened to “be the next school
shooter.” He said that “everyone freaked out,” and he regretted it. When asked
why he felt regret, Billy said, “I guess it scared people.”
When asked for basic information about himself, Billy said he gets along
well with his mother but not with his father, which he attributed to his father’s
criticisms of him. Billy mentioned a particular neighborhood peer who had
been harassing him for several years. When asked how he would react if this
peer were accidentally killed, Billy reported that he would be sad. He added
that he is often disciplined when he retaliates against others who bully him,
and although he feels the world is “not fair,” he wants to obtain justice by
“proving someone else wrong.”
Billy acknowledged he loves collecting knives in particular because of their
utility and the way they feel in his hand. He said that his mother does not have
a problem with his weapons collection, but from his mother’s perspective, his
father “didn’t feel safe with [Billy] having them.” He acknowledged having a
temper, which is evoked by “mostly being told ‘no’ or being threatened,” such as
his mother or father telling him he is not permitted to do something or having
some of his belongings taken away. Billy denied hearing voices or having
strange sensations; he denied feeling as though someone is out to get him; and
he denied any thoughts or plans of killing himself, either past or present.
Collateral Contacts
In a collateral phone contact, Dr. Jones, a psychologist, reported that for the
past two years he had been providing weekly counseling to Billy, who was
periodically accompanied by his mother but not his father. Dr. Jones said that
Billy presents with attention and impulse-control problems, consistent with
his long-standing diagnosis of ADHD, but also a cluster of other symptoms,
such as oppositional behavior, irritability, and poor interpersonal skills. He was
aware Billy had amassed a collection of knives, but there were no signs that
Billy ever fantasized about violence or that he might be prone to a planned
attack on anyone. He agreed that Billy and others might be at risk if Billy were
to carry a knife as a means of self-protection from bullying and react impul-
sively. Dr. Jones also suggested that Billy’s educational setting was not sufficient
to address his ongoing mental health/emotional difficulties and that he may
need a therapeutically informed educational program in order to graduate high
school. Dr. Jones acknowledged that he had not shared such an opinion with
Billy or his parents, and he was unsure how that would be received, but it was
his clinical belief that sharing such an opinion outweighed any risk that doing
so would pose for the therapeutic relationship.
As noted above, Billy was administered the MACI, which was chosen as a
structured, objective measure of his developing personality traits and any
relevant mental health symptoms. Results of this psychological measure

produced a valid profile that highlighted Billy’s social anxiety and guardedness.
He responded similarly to adolescents who possess a strong desire for accep-
tance, which is countered by anticipation of humiliation and rejection. Such
adolescents are uncomfortable in social situations and retreat from the normal
reciprocity involved in interpersonal relationships. Also salient in the testing
results was Billy’s apparent indifference to the behaviors and feelings of others.
He responded similarly to those who are irresponsible and careless, fail to
anticipate consequences for actions, and are easily bored. Diagnostically, the
test highlighted Schizoid, Avoidant, and Antisocial traits, accompanied by a
Depressive Disorder.
School records indicated psychoeducational testing prior to his sophomore
year of high school. The results revealed intelligence skills in the average
range, along with significant deficits in receptive and expressive language
and difficulties with behavioral and emotional regulation. Hospital discharge
records from his inpatient admission immediately following the school threat
included Mood Disorder Not Otherwise Specified (MD-NOS), Posttraumatic
Stress Disorder (PTSD) with history of bullying, Attention Deficit Hyperactiv-
ity Disorder (ADHD) by history, and episodic substance abuse (alcohol and
cannabis abuse).

Billy Smith was a 16-year-old junior in high school who lived with his par-
ents. His early development was positive for deficits in fine motor control
and organizational skills. He was subjected to bullying by peers for sev-
eral years in school and became the object of scrutiny by school officials
on several occasions (i.e., threatening a peer, bringing symbolic weapons
to school, and disrupting class). Dissatisfied with the school’s response to
their son’s difficulties, Billy’s parents changed his schools a few times. His
academic skills continued to decline, and he started using marijuana since
early puberty. A comprehensive psychoeducational evaluation completed
when he was 15 years of age revealed notable signs of executive function
difficulties, such as poor impulse control, organizational skills, and language
comprehension deficits.
Concurrent with Billy’s cognitive function deficits revealed by his previous
psychoeducational testing, there have also been long-standing signs of prob-
lematic interpersonal skills and social alienation. Without adaptive peer rela-
tionships, Billy’s principal sources of social skill building had apparently come
through playing violent video games and working part-time at a commercial
retailer of outdoor sporting goods. In the evaluator’s opinion, this dynamic
created a bridge between an imaginary world of conflict resolution through
violence and easy access to a wide variety of potential weaponry (toward

which he had developed a fascination).
Regarding his threat made in a school classroom, the evaluator was of the
opinion that Billy did not present with identifiable patterns of physical harm
toward others. His threat of harm was not directed at any one individual but
rather was made impulsively and without a true appreciation until well after-
ward, when he recognized the fear that such a comment might cause in others.
There was no evidence that Billy has had a particular plan to harm someone.
The incident appeared to reflect what was referred to earlier in this chapter as
“reactive aggression,” given that Billy was impulsive, had a long history of using
poor judgment with his verbal commentary, and struggled to maintain healthy
peer relationships. He had only one identified incident of physical aggression,
in which he destroyed property at home following a conflict with his father,
but overall his functioning did not translate to a high risk of actual physical
violence in the absence of a plan, history, or other identified factors associated
with violence (i.e., psychotic thought process, lack of insight or empathy, or a
substance abuse disorder). Finally, there were protective factors in place, such
as having involved parents with no history of problematic adjustment (i.e.,
substance abuse, domestic violence, incarceration) and Billy’s participation in
therapy with a psychologist who was very familiar with the factors involved
in Billy’s current difficulties. That said, there was, without question, a risk that
Billy could lash out in anger at an individual whom he perceived to be tor-
menting him, even if he provoked a negative interchange by virtue of his social
deficits or impulsivity.
The evaluation also revealed that Billy possessed a number of historical,
clinical, and environmental risk factors that are associated with risk for
violence. For this reason, there were understandable concerns that he was at
risk for acting out against his father if he was feeling angry or thwarted. There-
fore, Billy’s access to weapons or involvement in violence-themed activities
should be limited. It was recommended that Billy’s goal for therapy should be
to gain better insight about his impulsive propensities and the need to effect
some protective measures for when he gets angry, particularly at home.
Furthermore, there was substantial data indicating the presence of a mood
disorder, and in this evaluation circumstance the most appropriate DSM-5
diagnosis would be Unspecified Depressive Disorder. He showed a devel-
opmental history and current functioning suggestive of a vulnerability for
continued psychiatric dysfunction requiring ongoing mental health treatment
including psychopharmacological consultation. Regarding Billy’s educational
needs, academic programming should include a substantial therapeutic sup-
port for his mental health condition, to supplement the goals of his special
education plan. Given the pervasive social difficulties Billy has as a result of
his mental health issues and executive (cognitive) deficits, both at home and
school, consideration should also be given to Billy living outside the home in
a residential program. Among the benefits to living in a treatment program,
Billy’s safety and that of others would be better managed, he would be pro-
vided more support and structure than he receives at home, and he would
receive daily and consistent therapeutic support.

School risk assessments serve as a unique and complex service that forensi-
cally trained clinicians can offer educational institutions. These evaluations
are based on a multitude of factors, including the individual and family
functioning, demands of educational systems, community safety, and the
pressure on a clinician to manage all of these issues while producing a thor-
ough, forensic-based opinion of risk of harm. Like any forensic psychologi-
cal evaluation, clinicians must be cognizant of the peripheral factors that
could be at play and influence a clinical opinion. It is incumbent on the
forensic assessor to inquire about and appreciate the history of support,
conflict, distrust, and cooperation existing within the school community,
between the school and the parents, between the parents and the student,
and so on. For example, there may be significant financial motivations for
either a school system to insist that a high-risk student can be managed
internally or for a family to demand a costly, out-of-district therapeutic
education for their child, resulting in an embellishment or exaggeration of
various factors incorporated into the evaluation. There are often pulls, either
internally or from the referral source, to make a certain prediction about
whether violence is going to occur, and it behooves any clinician conduct-
ing school-based risk assessments to be familiar with what is profession-
ally responsible and defensible. In short, the risk assessment must include
the broader psychological and political climate within which the student
and his behavior are embedded. Due to the high-stakes nature of making
recommendations that could have a prominent, even lifelong impact on a
young person’s future, the authors would advise evaluators to ensure suf-
ficient training has been obtained in conducting forensic mental health
assessments and also to have access to colleagues from whom consultations
can be obtained regarding complex cases.
Note
1. The “Specialty Guidelines for Forensic Psychology” of the APA (2012, p. 7) “apply
in all matters in which psychologists provide expertise to judicial, administrative, and
educational systems” such as offering expert opinion to administrators and in educational
activities.
References
conduct. Retrieved from http://www.apa.org/ethics/code/index.aspx
American Psychologist, 68(1), 7–19.
Appelbaum, P. (2011). Reference guide on mental health evidence. In Federal Judicial Cen-
ter, Reference Manual on Scientific Evidence (pp. 813–896). Washington, DC: National
Academies Press.
Borum, R. (2006). Assessing risk for violence among juvenile offenders. In S. N. Sparta
& G. P. Koocher (Eds.), Forensic mental health assessment of children and adolescents
(pp. 190–202). New York, NY: Oxford Universities Press.
Borum, R., Bartel, P., & Forth, A. (2003). Manual for the Structured Assessment of Violence
Risk in Youth, version 1.1. Tampa, FL: University of South Florida.
Borum, R., & Reddy, M. (2001). Assessing violence risk in Tarasoff-type situations: A fact-
based model of inquiry. Behavioral Sciences and the Law, 19, 375–385.
Cauffman, E., & L. Steinberg. (2000). (Im)maturity of judgment in adolescence. Behav-
ioral Science and Law, 18, 741–754.
Cichetti, D., & F. Rogosh. (1996). Equifinality and multifinality in developmental
psychology. Development and Psychopathology, 8, 597–600.
Edens, J. F., & Cahill, M. A. (2007). Psychopathy in adolescence and criminal recidivism in
young adulthood: Longitudinal results from a multiethnic sample of youthful offenders.
Assessment, 14, 57–64.
Edens, J. F., Skeem, J. L., Cruise, K. R., & Cauffman, E. (2001). Assessment of “juvenile
psychopathy” and its association with violence: A critical review. Behavioral Sciences
and the Law, 19, 53–80.
Forth, A. E., Kosson, D., & Hare, R. D. (2003). The Hare PCL: Youth Version. Toronto,
Ontario, Canada: Multi-Health Systems.
Frick, P., & Loney, B. (1999). Outcomes of oppositional defiant disorder and conduct dis-
order. In H. C. Quay & A. E. Hogan (Eds.), Handbook of disruptive behavior disorders
(pp. 507–524). New York, NY: Kluwer Academic/Plenum.
Frick, P. J., & Viding, E. (2009). Antisocial behavior from a developmental psychopathology
perspective. Development and Psychopathology, 21, 1111–1131.
Grisso, T., & Barnum, R. (2006). Massachusetts Youth Screening Instrument—Version 2:
User’s manual and technical report. Sarasota, FL: Professional Resource Exchange.
Halikias, W. (2004). School-based risk assessments: A conceptual framework and model
for professional practice. Professional Psychology: Research and Practice, 35(6), 598–607.
Harris, G. T., Rice, M. E., & Quinsey, V. L. (1993). Violent recidivism of mentally disordered
offenders: The development of a statistical prediction instrument. Criminal Justice and
Behavior, 20, 315–335.
Heilbrun, K., O’Neill, M. L., Strohman, L. K., Bowman, Q., & Philipson, J. (2000). Expert
approaches to communicating violence risk. Law and Human Behavior, 24(1), 137–148.
Kraemer, H., Kazdin, A., Offord, D., Kessier, R., Jensen, P., & Kupfer, D. (1997). Coming to
terms with the terms of risk. Archives of General Psychiatry, 54, 337–343.
Leistico, A. M., Salekin, R. T., DeCosta, J., & Rogers, R. (2008). A large scale meta-
analysis relating the Hare measures of psychopathy to antisocial conduct. Law and
Millon, T. (1993). Millon Adolescent Clinical Inventory (MACI). Minneapolis, MN:
National Computer Systems.
Moffit, T. (1993). Adolescent limited and life course persistent antisocial behavior: A
developmental taxonomy. Psychological Review, 100, 674–701.
Moffitt, T. (1997). Adolescence-limited and life-course persistent offending: A complemen-
tary pair of developmental theories, In T. Thornberry (Ed.), Developmental theories of
crime and delinquency (pp. 11–54). New Brunswick, NJ: Transaction.
Monahan, J., & Skeem, J. L. (2014). The evolution of violence risk assessment. CNS
Spectrums, 19, 419–424.
Reddy, M., Borum, R., Berglund, J., Vossekuil, B., Fein, R., & Modzeleski, W. (2001).
Evaluating risk for targeted violence in schools: Comparing risk assessment, threat
assessment, and other approaches. Psychology in the Schools, 38(2), 157–172.
Reynolds, C. R., & Kamphaus, R. W. (2004). Behavioral Assessment System for Children,
2nd Edition (BASC-2). Minneapolis, MN: Pearson Assessment.
Robers, S., Kemp, J., Rathbun, A., & Morgan, R. E. (2014). Indicators of School Crime and
Safety: 2013 (NCES 2014-042/NCJ 243299). National Center for Education Statistics,
U.S. Department of Education, and Bureau of Justice Statistics, Office of Justice
Programs, U.S. Department of Justice, Washington, DC.
Salekin, R. T. (2008). Psychopathy and recidivism from mid-adolescence to young adult-
hood: Cumulating legal problems and limiting life opportunities. Journal of Abnormal
Psychology, 117(2), 386–395.
Scott, E. S., & Steinberg, L. (2008). Adolescent development and the regulation of youth
crime. The Future of Children, 18(2), 15–33.
Sewel, K. W., & Mendelsohn, M. (2000). Profiling potentially violent youth: Statistical
and conceptual problems. Children’s Services: Social Policy, Research, and Practice, 3,
147–169.
Skeem, J. L., & Monahan, J. (2011). Current directions in violence risk management. Current
Directions in Psychological Science, 20(1), 38–42.
Steinberg, L., & E. Scott. (2003). Less guilty by reason of adolescence: Developmental imma-
turity, diminished responsibility, and the juvenile death penalty. American Psychologist,
58(12), 1009–1018.
U.S. Department of Education. (2011). Analysis of state bullying laws and policies.
Washington, DC: Author.
U.S. Department of Health and Human Services. (2001). Youth violence: A report of the
Surgeon General. Rockville, MD: Author.
Viljoen, J. L., McLachlan, K., & Vincent, G. M. (2010). Assessing violence risk and
psychopathy in juvenile and adult offenders: A survey of clinical practices. Assessment,
17, 377–395.
Webster, C. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). HCR-20: Assessing risk for
violence, version 2. Burnaby, British Columbia, Canada: Simon Fraser University, Mental
Health, Law, & Policy Institute.
Zimring, F. (1998). American Youth Violence. New York, NY: Oxford.
Appendix
Forensic Psychology Organizations

American Board of Forensic Psychology—http://www.abfp.com/
American Board of Professional Psychology—http://www.abpp.org/i4a
/pages/index.cfm?pageid=3356
American Psychological Association—http://www.apa.org/
American Psychological Association Ethical Principles of Psychologists and
Code of Conduct—http://www.apa.org/ethics/code/index.aspx#
American Psychology-Law Society—www.ap-ls.org
Articles, Research, and Resources in Psychology—http://www.kspope.com
/index.php
Association of Family and Conciliation Courts—afccnet.org
National Criminal Justice Reference Service—https://www.ncjrs.gov
/whatsncjrs.html
Online Resources
APA-Law Society Division 41 reference—http://www.apadivisions.org
/division-41/education/programs/internship.aspx
Forensic Psychology Online—http://www.forensicpsychologyonline.com/
Huffington Post—http://www.huffingtonpost.com/news/forensic
-psychology//
Masters in Psychology Guide.com—http://mastersinpsychologyguide.com
/specializations/forensic-psychology
National Criminal Justice Reference Service—https://www.ncjrs.gov
/whatsncjrs.html
Payscale—http://www.payscale.com/research/US/Job=Forensic_Psychologist
/Salary
402 Appendix
Psychology Degree Guide.org—http://psychologydegreeguide.org/job

-resources/
Psychology Information Online—http://www.psychologyinfo.com/
Reddy’s Forensic Page—http://www.forensicpage.com/new31.htm
About the Editor
and Contributors
Editor
TIFFANY R. MASSON, PsyD, is a licensed clinical psychologist with extensive
training and experience in forensic psychology. In addition to maintaining a
private forensic practice, Dr. Masson has held a variety of faculty and admin-
istrative positions with increasing responsibility at The Chicago School of Pro-
fessional Psychology, where she is currently an associate professor and vice
president of E-Learning and Global Innovation.
During the decade she has spent at The Chicago School, Masson served as
director of the Forensic Center, the practice arm of the Forensic Psychology
Department, where she introduced Parent-Child Interaction Therapy (PCIT)
and trained graduate students to implement this evidenced-based treatment
with families involved in court-mandated parent skills training. She also code-
veloped a country-specific 12-day trauma training program (Global HOPE
Training Initiative), which has been successfully implemented in Rwanda
and Zambia. The initiative trains teachers to effectively recognize, assess, and
intervene with traumatized children, using culturally based practices. She has
worked with local government and educational systems to assess the efficacy,
overall impact, and sustainability of the program as a first step in building a
strong paraprofessional counseling infrastructure in those countries.
She has an expertise in forensic assessments (e.g., juvenile, criminal, child
protection, and civil matters), complex trauma, and evidenced-based treatment,
and she speaks internationally about these issues. She has provided expert tes-
timony and coauthored articles on issues of juvenile justice, child protection,
and conducting competent Termination of Parental Rights Evaluations.
Contributors
VIRGINIA BARBER-RIOJA, PhD, earned her doctorate in clinical forensic
psychology from John Jay College of Criminal Justice (City University of New
404 About the Editor and Contributors
York). Although originally from Spain, she is currently based in New York City
and works as the clinical director of EAC Network’s Brooklyn and Staten Island
court mental health diversion programs and jail and prison reentry programs.
From 2009 to 2011 Dr. Barber-Rioja was the clinical director of the Queens
TASC (Treatment Alternatives to Safer Communities) Mental Health Diversion
Program, which works in collaboration with the Queens Mental Health Court.
She subsequently worked as an attending psychologist in the Forensic Inpatient
Unit at Bellevue Hospital Center, providing services to psychiatrically acute
inmates. She currently serves as a clinical instructor in the Department of Psy-
chiatry of New York University School of Medicine, and as an adjunct professor
in the Psychology Master’s Program of New York University. Dr. Barber-Rioja
has published several chapters and articles in peer-reviewed journals on the top-
ics of diversion and risk assessment in the context of alternatives to incarcera-
tion programs. She has presented numerous workshops and papers on criminal
justice diversion and violence risk assessment in the context of diversion. Her
research interests include criminal justice diversion, risk assessment, therapeu-
tic jurisprudence, forensic assessment in general and in the context of immigra-
tion proceedings specifically, and cross-cultural psychological assessment.
JOSEPH J. BEGANY, PhD, is a forensic neuropsychologist in private practice
at Psychological Consulting Services, Salem, Massachusetts, providing a wide
range of forensic evaluations for children, teens, and adults. Begany has par-
ticular expertise providing forensic evaluations to psychiatrically complicated
children and teens who suffer from intellectual disabilities, neurodevelopmen-
tal disorders such as autism and ADHD, seizure disorders, and neurological
impairments acquired from traumatic brain injuries. Evaluations include com-
petence to stand trial, criminal responsibility, competence to waive Miranda
rights, aid to disposition and sentencing, malingering/feigned cognitive
impairment, risk assessments for juvenile sex offenders, and evaluations of
parents and children involved with the Massachusetts Department of Children
and Families. Begany also provides consultation to school districts and private
schools through neuropsychological evaluations of students, risk assessments
of troubled students, and special education program evaluations. As a juvenile
court clinician certified by the Massachusetts Department of Mental Health
and UMass Medical School, Begany worked for five years providing evalua-
tions to children and families involved with the Suffolk and Essex County Juve-
nile Courts. He recently completed the Massachusetts Department of Mental
Health adult forensic certification program, after three years of conducting
court-ordered forensic evaluations of adult defendants in Massachusetts dis-
trict and superior courts.
DAWN M. BLACKER, PhD, graduated from the California School of Pro-
fessional Psychology-Alameda in 1998. She currently serves as associate
director at the UC Davis Children’s Hospital CAARE Center. She is also

the co-training director of an American Psychological Association accred-
ited predoctoral internship. She provides training in Parent Child Interac-
tion Therapy and Trauma Informed System of Care and conducts Trauma
Focused-Cognitive Behavioral Therapy and Dialectical Behavior Therapy.
Areas of focus include treatment of child physical and sexual abuse, devel-
opmental assessment of maltreated children, complex trauma, implementa-
tion of Empirically Based Treatment’s, Commercial Sexual Exploitation of
Children, and early intervention.
JEANNIE S. BROOKS, PsyD, is a Florida and New York State licensed psy-
chologist in private practice, specializing in clinical forensic evaluations.
Brooks has published quite extensively in the areas of domestic violence law,
juvenile corrections, cognitive-behavioral therapy, and patient satisfaction.
After graduating from Nova Southeastern University (where she completed a
specialty track in forensic psychology), Dr. Brooks was one of the first forensic
interns at the University of Medicine and Dentistry of New Jersey (UMDNJ),
and she subsequently completed her postdoctoral fellowship within NYU/
Bellevue Hospital Center’s Inpatient Forensic Psychiatry Service. Her clinical
and research endeavors are quite diverse, encompassing forensic evaluations
within the context of dependency court, family and criminal law, and neu-
ropsychological evaluations. Dr. Brooks maintains a thriving practice and
proffers expert witness testimony within various court systems throughout
Florida. She also consults with attorneys regularly regarding best practices,
ethical considerations in forensic evaluations, and child protection matters,
and she provides trainings to various professionals, including attorneys and
other mental health providers.
MICHAEL P. BROWN, PhD, earned his degree in sociology, with concen-

trations in criminal justice and social psychology, from Western Michigan
University in 1992. Brown holds the rank of professor of criminal justice and
criminology at Ball State University, Muncie, Indiana. He teaches courses in
juvenile delinquency, community corrections, and comparative criminology.
Brown has published numerous journal articles, book chapters, invited manu-
scripts, and research reports. He consults with probation and prisoner reentry
programs.
BLAKE D. CARMICHAEL, PhD graduated from the California School of

Professional Psychology-Alameda in 2001. He is currently the Evaluation
Program Manager at the UC Davis Children’s Hospital CAARE Center. He
conducts psychological and child welfare evaluations, including parent-child
relationship assessments, differential diagnosis, treatment/reunification plan-
ning, juvenile competency, and juvenile/adult recidivism risk assessment.
Within the CAARE Center’s American Psychological Association accredited

internship program, Carmichael provides training in conducting child wel-
fare and psychological evaluations, as well as conducting Trauma Focused
Cognitive Behavioral Therapy (TF-CBT). For the past 10 years, Carmichael
has provided consultation to social service and forensic programs through-
out Northern California regarding child sexual abuse disclosure, emergent
mental health concerns, treatment needs, and adoption/placement planning.
His areas of focus include assessing the impact of violence and maltreatment
on families, conducting quality child welfare evaluation services, providing
evidence based practices for maltreated children, and decreasing placement
disruption for children in foster care.
KENDELL L. COKER, PhD, JD, is a full-time assistant professor at Univer-
sity of New Haven (UNH) for the College of Arts & Sciences with a dual
appointment in the Department of Criminal Justice. Dr. Coker is a faculty
researcher at the Tow Youth Justice Institute at the University of New Haven.
His research in juvenile justice is supported by a grant from the Tow Founda-
tion. Kendell received his PhD in clinical psychology, with a specialization
in forensic psychology from Nova Southeastern University. He completed his
clinical postdoctoral training through Northwestern University at the Cook
County Juvenile Court Clinic where he conducted sentencing evaluations on
youth involved with the Department of Probation. Kendell then received his
JD from Loyola University Chicago School of Law where he graduated with
cum laude honors, was an entering Health Law Scholarship recipient, and also
served as the editor-in-chief for the law school’s health law and policy review,
Annals of Health Law. He served as a council member on the Juvenile Defense
Resource Institute at Northwestern University School of Law, which was a
project designed to strategize ways to reduce recidivism and improve legal
representation of juveniles involved in the criminal justice system. Kendell
also completed a National Institute of Drug Abuse (NIDA) T-32 postdoctoral
fellowship at Yale University in the Department of Psychiatry’s Forensic Drug
Diversion Program (FORDD). This chapter is dedicated to Dr. Coker’s close
friend, Herbie Gonzalez.
ANGEL DANIELS, PhD, received a bachelor of science degree in psychol-
ogy in 2001 from Santa Clara University, a master of arts degree in forensic
psychology from Marymount University in 2006, and a doctorate in clinical
psychology in 2012 from Palo Alto University, in California. Her clinical work
has focused on the various dynamics involved in sexual abuse, violence, and
exploitation. She specializes in both trauma-informed therapy for survivors
of sexual violence and the evaluation and treatment of the perpetrators of
sexual violence. Daniels is currently an assistant professor in the Department
of Forensic and Legal Psychology at Marymount University in Arlington,

Virginia, and she provides sex offender treatment and evaluation in a private
outpatient clinic. In addition, Daniels is the founder and executive director
of the not-for-profit Sexual Abuse, Violence, & Exploitation Research Group,
which conducts research on the various elements of sexual behavior and vic-
timization and provides a range of services to survivors of sexual exploitation
and the organizations that serve them.
JILL G. DURAND, PsyD, is a licensed psychologist in Massachusetts. Durand

earned her doctorate from William James College and went on to work as
a juvenile court clinician for seven years. Durand is currently a psychologist
with Psychological Consulting Services, LLC. Her practice focuses on clinical
and forensic evaluation of children, adolescents, and adults. Durand’s profes-
sional interests include assessing court-related competencies, assessing risk
of violence and fire-setting behavior, and assessing the impact of trauma on
childhood development.
SAMUEL WITTA DWORKIN, MA, is a mitigation specialist and private

investigator with over nine years’ experience in capital defense. He was previ-
ously employed at the Northern Virginia Capital Defender Office for over five
years. In early 2012, Sam started his own practice, Dworkin Investigations,
LLC, and he has been appointed to capital cases in Virginia and throughout
the country. He has an undergraduate degree in psychology from the Penn-
sylvania State University and a graduate degree in forensic psychology from
Marymount University. Dworkin has worked on capital cases at both trial and
postconviction stages and at both state and federal levels. He is devoted to
indigent and criminal defense cases, sentencing, and merits investigations.
Since the fall of 2013, he has also been an adjunct professor, coteaching the
course The Death Penalty and Mitigation to graduate level students at Mary-
mount University’s Department of Forensic and Legal Psychology.
STEVE K. D. EICHEL, PhD, ABPP, is a licensed and board-certified psycholo-

gist in independent practice in Newark, Delaware. He has a highly varied pro-
fessional history that includes extensive experience working with and running
programs for traumatized and high-risk, adjudicated youth. He is considered
a national expert on undue influence and destructive cults, and he currently
serves as president of the International Cultic Studies Association (ICSA). His
forensic experience in both civil and criminal courts has ranged from mal-
practice and custody evaluations to sex offending and capital cases. In 2003, he
served as one of the expert witnesses in the death-penalty defense of “Beltway
Sniper” Lee Boyd Malvo, who was accused of murdering over a dozen people
while under the physical and psychological control of John Muhammad.
ALISON R. FLAUM, JD, is the legal director of the Children & Family Justice
Center, a clinical program housed at Northwestern University Law School,
where she is also an associate clinical professor of law. Flaum has prac-
ticed criminal and juvenile defense for 20 years and specializes in children
being prosecuted as adults. She holds an AB from Brown University, a law
degree from Yale University, and an LLM in advocacy from the Georgetown
University Law Center.
ANNA FLOREK, PsyD, recently completed her post-doctoral fellowship and is
now a staff psychologist at the DuPage County Jail in Wheaton, Illinois. Florek’s
clinical interests have been predominantly focused in the area of criminal foren-
sic evaluations and correctional psychology. As a student-practitioner, she per-
formed court-ordered psychological evaluations for Kane County, Illinois and
conducted diagnostic evaluations in the Indiana and Colorado correctional sys-
tems, respectively. Florek received the Excellence Award during her internship
at the Colorado Department of Corrections for her assistance in a governor-
requested task to improve the assessment, treatment, and placement process of
mentally ill offenders in administrative segregation. Florek completed her bach-
elor of arts degree in psychology at the University of Kansas in 2006. She relo-
cated to Chicago, where she completed her master’s degree in 2009 in forensic
psychology, and later her doctorate in clinical forensic psychology in 2014, both
at The Chicago School of Professional Psychology. She currently teaches assess-
ment and correctional psychology courses as an adjunct faculty member at The
Chicago School of Professional Psychology. Aside from civil commitment, her
other professional interests include jury consultation, criminal responsibility,
competence to stand trial, the application of culture in the context of criminal
defense, and mental health in corrections. She is a member of the American
Psychological Association and the American Psychology-Law Society.
EMILY D. GOTTFRIED, PhD, earned her doctoral degree in clinical psy-
chology from Florida State University. She completed an internship at Patton
State Hospital and a postdoctoral fellowship in forensic psychology at Georgia
Regents University in a partnership with East Central Regional Hospital in
Augusta, Georgia. After completing her fellowship, she accepted a position as
a contractor and clinical instructor in the Community and Public Safety Psy-
chiatry Division of the Department of Psychiatry and Behavioral Sciences at
the Medical University of South Carolina. Gottfried’s research interests include
the accurate assessment of malingering during criminal forensic evaluations,
personality predictors of poor treatment outcomes, suicide risk assessment,
and female offenders.
MICHELLE HOY-WATKINS, PsyD, is an associate faculty member in the
Department of Forensic Psychology at The Chicago School. Prior to joining
The Chicago School, Hoy-Watkins worked in a variety of clinical, correc-

tional, and forensic settings. She graduated from the California School of Pro-
fessional Psychology, Alameda, in 1997. She completed her internship at the
Federal Bureau of Prisons’ Metropolitan Detention Center—Los Angeles. In
1998, Hoy-Watkins completed a forensic postdoctoral fellowship at the United
States Medical Center for Federal Prisoners in Springfield, Missouri. Upon
completion of her fellowship, Hoy-Watkins worked at the Forensic Treatment
Program in Elgin Mental Health Center—Forensic Treatment Program where
she performed risk assessment evaluations for individuals acquitted through
not guilty by reason of insanity and fitness to stand trial evaluations. Hoy-
Watkins later became the director of the Mental Health Juvenile Justice Initia-
tive in Cook County. She also worked as a contractual forensic psychologist for
the Metropolitan Correctional Center—Chicago, where she conducted court-
ordered criminal forensic evaluations. Hoy-Watkins has also provided con-
sultative services, performing preemployment screenings and fitness for duty
evaluations for local law enforcement agencies, fitness evaluations, mental
health disability reviews, and school-based violence prevention programming
with youth. She joined The Chicago School in 2002 as an adjunct faculty mem-
ber and has been a full-time faculty member with the Forensic Department
since January 2003. She became the associate chair of the Clinical Forensic
PsyD Program in 2008 and served as the chair of the Department of Forensic
Psychology from August 2010–2015.
ELIZABETH L. JEGLIC, PhD, is a professor of psychology at the John Jay
College of Criminal Justice in New York City. Jeglic’s research focuses broadly
on the assessment and treatment of sex offenders.
LISA KALICH, PsyD, ABPP, is employed as a forensic psychologist at the Cali-
fornia Department of Corrections and Rehabilitation, Board of Parole Hear-
ings, Forensic Assessment Division, where she is responsible for conducting
violence risk assessments for life term inmates eligible for parole. In her career,
Kalich has been employed in a variety of forensic settings and has conducted
evaluations in areas including sexual offender risk assessment, termination
of parental rights, and disability determination. She obtained her doctorate
of clinical psychology from the California School of Professional Psychology
and completed her internship and postdoctoral fellowship at the University of
California Davis, Medical Center, CAARE Center. Kalich is also board certi-
fied in forensic psychology by the American Board of Professional Psychology.
ROBERT L. KAUFMAN, PhD, ABPP, is a clinical and forensic psychologist in
independent practice in the San Francisco Bay Area. He is board certified in
forensic psychology and has worked on a wide range of both civil and criminal
cases. For over 20 years, a large focus of his practice has been family law, where
he has served as a court-appointed custody evaluator, mediator, co-parenting

counselor, and consultant to attorneys. He has taught and trained other men-
tal health professionals, attorneys, and bench officers, and he has published
a number of articles relevant to child custody matters. Kaufman is currently
on the board of the California Chapter of the Association of Family and Con-
ciliation Courts and is past-board president of the Family and Children’s Law
Center in San Rafael, CA. For more than 15 years, he has been a senior trial
consultant with Bonora-Rountree, LLC, a trial and litigation consulting firm
in San Francisco.
ANTOINETTE KAVANAUGH, PhD, is board certified in forensic psychol-
ogy by the American Board of Professional Psychology. She is the former
clinical director of the Juvenile Justice Division—Cook County Juvenile Court
Clinic and served as a clinical professor at Northwestern University’s School
of Law for 10 years. Currently, Dr. Kavanaugh is a Lecturer at the Feinberg
School of Medicine, Northwestern University, Chicago, IL. In private prac-
tice since 1999, Kavanaugh evaluates youth and adults on a variety of forensic
issues including competence to understand Miranda rights, competence to
stand trial, transfer to adult court, wrongful convictions, ability to form intent,
disputed confessions, pleas of not guilty by reason of insanity, and mitigation,
and she has been retained in multiple Miller v. Alabama cases. Additionally,
she testifies regularly in state and federal courts. As an author, Kavanaugh
writes in the area of forensic training, forensic evaluations, and providing use-
ful clinical information to the court. She also conducts presentations and con-
sults with a variety of national organizations, including the Office of Juvenile
Justice and Delinquency Prevention, on issues related to juvenile justice and
adolescent development.
ERIC G. MART, PhD, ABPP, is a board-certified forensic psychologist in pri-
vate practice in Portsmouth, New Hampshire. He is licensed in Vermont, New
Hampshire, Virginia, and Massachusetts. Mart received his PhD in school
psychology from Ferkauf Graduate School of Yeshiva University in 1983,
and he subsequently retrained in clinical and forensic psychology. His prac-
tice includes child custody and parenting assessments, evaluations of civil
and criminal competencies, personal injury assessment, and school consulta-
tion. Mart is the author of Issue Focused Forensic Child Custody Assessment,
Munchausen’s Syndrome by Proxy Reconsidered, and Getting Started in Foren-
sic Psychology Practice. He has appeared on 20/20, NBC News, BBC4, and
National Public Radio, and he has been featured in articles in the New York
Times, Psychology Today, and the New Yorker.
NANCY RYBA PANZA, PhD, completed her doctorate in clinical psychol-
ogy, with a concentration in psychology and saw, at the University of Alabama
in 2004. She spent four years working as an assistant professor in the Psychol-
ogy Department at John Jay College of Criminal Justice in New York City
before accepting her current position at California State University, Fullerton.
Dr. Panza’s clinical work and research focuses on criminal forensic assessment
and police psychology. Dr. Panza has worked within county, state, and fed-
eral facilities providing clinical and forensic services for juvenile and adult
offenders. She is currently licensed to practice psychology in New York and
California.
DANIEL B. PICKAR, PhD, ABPP, is a board-certified child psychologist. He
completed his undergraduate studies at Brown University and received his
PhD from the California School of Professional Psychology—Berkeley. In his
private practice, he conducts child custody evaluations, mediation, consulta-
tion to family law attorneys, and psychoeducational evaluations of children.
He previously served as chief of Child and Family Psychiatry at Kaiser Perma-
nente Medical Center in Santa Rosa, California, for 12 years. He has published
articles in the areas of child custody evaluation and mediation and serves on
the editorial board of the Journal of Child Custody.
AMANDA ROSINSKI, MS, is from Brooklyn, NY. She is a doctoral student
in the Clinical Psychology PhD program at the CUNY Graduate Center,
hosted at John Jay College of Criminal Justice. As a doctoral student, Amanda
researches cross-cultural issues in clinical forensic assessment, under the men-
torship of Rebecca Weiss. She earned her master’s degree in forensic psychol-
ogy from John Jay College of Criminal Justice, also under the supervision of
Weiss. Amanda received her bachelor’s degree in criminal justice from Utica
College of Syracuse University in Utica, NY.
MERRILL ROTTER, MD, is a forensic psychiatrist working at Albert Einstein
College of Medicine where he is associate clinical professor of psychiatry and
director of the Division of Law and Psychiatry for the Department of Psychia-
try. Dr. Rotter received his BA/MD from the Boston University Six-Year Com-
bined Liberal Arts Medical Education Program. Trained in clinical psychiatry
at Columbia and in forensic psychiatry at Yale, Dr. Rotter leads a program of
teaching, research, and clinical service for Einstein as well as the New York State
Office of Mental Health (NYSOMH). In his OMH role, Dr. Rotter is senior foren-
sic consultant to the commissioner of NYSOMH and the director of the Divi-
sion of Forensic Services at Bronx Psychiatric Services. In addition, Dr. R otter
is the medical director of the EAC Network, whose Criminal Justice Division
provides mental health diversion services in Brooklyn, Queens, the Bronx, and
Staten Island (including serving the mental health courts therein), and reentry
services for inmates leaving Rikers Island and NYS prison. Dr. Rotter is creator
and project director of SPECTRM, a research, training, and treatment program
aimed at helping to meet the needs individuals with mental illness who have a
history of incarceration. Dr. Rotter’s research interests include risk assessment,
violence risk management, mental health diversion, and assessing and address-
ing the medical, behavioral health, social service, and engagement challenges of
individuals with seriously mental illness and criminal justice contact. In 2009
Dr. Rotter received the award for Best Teacher in a Forensic Psychiatry Fellow-
ship from the American Academy of Psychiatry and the Law.
ALLISON M. SCHENK, PhD, earned her doctoral degree in clinical psychol-

ogy from West Virginia, University with an emphasis in forensic psychology.
She completed an internship at the United States Medical Center for Federal
Prisoners and a postdoctoral fellowship in forensic psychology at Georgia
Regents University in a partnership with East Central Regional Hospital in
Augusta, Georgia. After completing her fellowship, she accepted a position as a
clinical psychologist at the United States Medical Center for Federal Prisoners
in Springfield, Missouri. Schenk’s research interests include cyberbullying, risk
predictors for prison violence, female offenders, and best practices for forensic
evaluations.
FAITH SCHOMBS, MA, is currently a forensic case manager at EAC Brook-

lyn TASC Mental Health Diversion. She received her master of arts in gen-
eral psychology with a concentration in forensic psychology from New York
University in May 2015.
MEGAN E. SHAAL, PsyD, HSPP, is a licensed psychologist with an endorse-

ment of health service provider in psychology in Indiana. She is the staff psy-
chologist for the Isaac Ray Treatment Center at Logansport State Hospital
in Logansport, Indiana, where she conducts evaluations for competency to
stand trial. During 2012–2013, her doctoral dissertation, “Cross-Validation of
the RRASOR, the SSPI, and the Static-99 with Indiana Sex Offenders,” was
awarded an American Academy of Forensic Psychology Dissertation Award.
Shaal completed her American Psychological Association-accredited predoc-
toral internship at the Colorado Mental Health Institute at Pueblo (CMHIP),
Colorado’s primary forensic hospital. She also completed a postdoctoral fel-
lowship in forensic psychology at The Chicago School Forensic Center, the
practice arm of the Department of Forensic Psychology at The Chicago School
of Professional Psychology. Her predoctoral clinical training took place at
Indiana State Prison in Michigan City, Indiana; Hartgrove Hospital in Chi-
cago, Illinois; and the Metropolitan Correctional Center—Chicago (Federal
Bureau of Prisons). Prior to graduate school, she worked in professional prac-
tice for several years in a range of settings, including inpatient and outpatient
psychiatric settings, community/residential settings, and corrections.
CASEY SHARPE, PsyD, obtained her master’s degree in forensic psychology

in 2005 and doctoral degree in clinical psychology in 2009. She currently holds
the position of assistant professor in the Forensic Psychology department at
The Chicago School of Professional Psychology. In addition to her role as fac-
ulty, Dr. Sharpe also serves as a supervising psychologist at The Chicago School
Forensic Center, where she conducts fitness to stand trial evaluations and vio-
lence risk assessments for individuals court ordered to treatment after being
found unfit to stand trial. She also provides expert testimony and provides
supervision to students in clinical training at The Chicago School’s Forensic
Center. Prior to joining the faculty at The Chicago School, Dr. Sharpe was a
postdoctoral fellow in forensic psychology at the University of Massachusetts
Medical School, Law & Psychiatry program. She conducted forensic evalu-
ations (competency to stand trial, criminal responsibility, aid in sentencing,
civil commitment/risk assessments) at state hospitals in Massachusetts. She
provided expert testimony in cases involving civil commitment for individu-
als with mental illness and risk for violence, as well as dangerousness related
to drug/alcohol abuse. Sharpe also conducted individual therapy with clients
who were civilly committed after a finding of not guilty by reason of insan-
ity (NGRI). Additionally, she performed competence to stand trial and crimi-
nal responsibility screening evaluations, as well as assessments related to civil
commitment and treatment for drug and alcohol abuse at various court clinics
throughout the state of Massachusetts. In addition to her faculty and clinical
responsibilities at The Chicago School, Dr. Sharpe also conducts psychologi-
cal evaluations on a contractual basis for various entities in Illinois, includ-
ing psychological pre-employment screening evaluations and fitness for duty
evaluations for the Chicago police department, and works as a psychological
consultant for the Social Security Administration.
JEFF D. STEIN, PhD, is a clinical and forensic psychologist in Massachusetts,
where he performs a wide range of psychological assessments for attorneys,
judges, schools, government agencies, and corporations. He has a particular
interest in matters involving child and adolescent psychological development,
family relationships, and identifying risk and protective factors associated with
adaptive functioning. For 10 years, he has been working in a private group
practice, Psychological Consulting Services, in Salem, MA.
ANTHONY J. URQUIZA, PhD, is a clinical psychologist, professor in pediat-
rics at UC Davis Children’s Hospital, and director of both the CAARE Center
and the UC Davis PCIT Training Center. He earned undergraduate and gradu-
ate degrees at the University of Washington and completed an internship at
Primary Children’s Medical Center in Salt Lake City, Utah. The CAARE Cen-
ter provides medical evaluations, psychological assessments, and a range of
mental health treatment services primarily for abused and neglected children.
He is a nationally recognized expert in the areas of trauma, child maltreatment,
mental health treatment for victims of interpersonal violence, and the imple-
mentation of mental health interventions.
MICHAEL J. VITACCO, PhD, earned his doctoral degree from the Univer-
sity of North Texas. He completed an internship at the University of North
Carolina School of Medicine and a postdoctoral fellowship at the University
of Massachusetts School of Medicine. He is currently an associate professor at
Georgia Regents University, where he serves as the director of Forensic Psy-
chology Training. Vitacco’s research interests include psychopathy, violence
risk assessment, malingering, and conditional release with insanity acquittees.
REBECCA WEISS, PhD, is an assistant professor of forensic assessment at
John Jay College and a licensed clinical psychologist in the state of New York.
Before joining the faculty at John Jay, she completed her clinical training at
Yale University School of Medicine. She received her PhD and MA in clinical
psychology from Fordham University. She received her BA in psychology and
international studies from Northwestern University. Her research interests
include the effect of group membership (e.g., culture, intellectual disabilities)
on validity in psychological assessment and the impact of trauma on the treat-
ment and development of aggression and substance use disorders.
ANNA M. L. WESTIN, PhD, currently works as a licensed psychologist at
the Children’s Hospital and Medical Center in Omaha, NE, specializing in
child trauma. Westin completed her PhD in clinical child and community
psychology at the University of Maryland, Baltimore County, in 2014. She
completed her American Psychological Association accredited internship
and postdoctoral fellowship at the UC Davis CAARE Center specializing
in child maltreatment. She has experience in child welfare evaluations and
empirically supported treatments for trauma. Westin is also chair of the Early
Career Psychologist (ECP) committee of APA Division 37’s Section on Child
Maltreatment.
GEORGIA M. WINTERS is a clinical psychology PhD student at John Jay
College of Criminal Justice and the Graduate Center, City University of New
York. Georgia is a member of the Sex Offender Research Lab at John Jay
College.
Index
Note: Page numbers followed by n indicate note numbers.

AASI (Abel Assessment of Sexual Interest), juvenile Miranda waiver; transfer
118 evaluations in juvenile justice
ABA. See American Bar Association Adoption and Safe Families Act (ASFA) of
ABA Supplementary Guidelines for the 1997, 195–196, 225, 227
Mitigation Function of Defense Teams in AFCC standards, 251
Death Penalty Cases, 60 “affluenza,” 75
Abel Assessment of Sexual Interest age: of juvenile offenders, 325; psychosocial
(AASI), 118 maturity of the juvenile offender,
acculturation: description of, 5 369; youth in adult criminal court
actuarial tools: for risk assessment of system, 380n5
sex offenders, 112–113, 129 aggression: developmental pathways of,
actus reus (guilty act), 173 387–390; proactive, 388; reactive, 388
Adam Walsh Child Protection and Safety alcohol abuse, 145, 161
Act of 2006, 106 alcohol dependence, 158; in DSM, 171n5
Adderall, 160 alcohol use disorder, 93–101
Addington v. Texas, 147–148 ALI (American Law Institute), 37–38
ADHD. See attention deficit hyperactivity allegations: about parenting skills, 274; of
disorder child sexual abuse, 253–254; defendant’s
adjudicative competence, 89. See also account of events related to alleged
competency to stand trial offense, 48–49; defendants who deny,
Administrative Office of the Courts 42; of sexual victimization, 217–218
(AOC), 4 American Academy of Forensic
adolescents: in adult criminal court system, Psychology, 59
380n5; developmental immaturity of, American Bar Association (ABA):
346; gangs and, 313; psychiatry and, Guidelines, 58–59
293; psychopathology of the juvenile American Law Institute (ALI), 37–38
offender, 370; psychosocial maturity American Psychological Association
of, 369; sexually abused as children, (APA): “Ethical Principles of
293. See also juvenile competence to Psychologists and Code of Conduct,”
stand trial; juvenile court, sentencing 8, 119, 175, 254; general guidelines for
evaluations; juvenile justice system; conducting psychological
416 Index
American Psychological Association attachment, 200–201; competency to

(continued) parent and, 200–201, 218; strength and
evaluations, 195; Guidelines for Child quality of, 201 (table)
Custody Evaluations in Family Law attention deficit hyperactivity disorder
Proceedings, 254–255; Guidelines for (ADHD), 123, 124, 132, 156, 200, 238,
Psychological Evaluations in Child 240, 288, 296, 307, 326, 347, 350, 394,
Protection Matters, 227–228; Guidelines 395; in DSM, 170n1
on Multicultural Education, Training, Attorney CST Questionnaire, 330, 333–334
Research, Practice, and Organizational AUC (area under the curve), 113–114
Change for Psychologists, 9; Presidential autism spectrum disorder (ASD), 125, 347;
Task Force on Immigration, 5–6; in juvenile offenders, 296
reviewing new Guidelines, 227–228;
“Specialty Guidelines for Forensic background information: for capital case
Psychology,” 8–9, 33–34, 59, 176, 254, sentencing evaluations, 62–64; for child
366, 371, 397n1 custody evaluations, 264–265; for civil
American Psychology-Law Society, 59 commitment, 159–163; for competency
amnesia: anterograde, 182; posttraumatic, to parent, 207–209; for competency
179; retrograde, 179 to stand trial, 26–27; for criminal
anterograde amnesia, 182 responsibility evaluations, 39–40, 47;
antidepressants, 200 for diversion evaluations, 94–95; for
antipsychotic drugs, 164 ethics in cross-cultural assessment,
antisocial conduct, 145 10–11; for juvenile competence to
antisocial personality disorder, 38, 145 stand trial, 334–336; for juvenile court,
anxiety disorder, 240, 326, 347 sentencing evaluations, 312–314; for
AOC (Administrative Office of the Courts), 4 juvenile Miranda waiver, 352–354; for
APA. See American Psychological psychological assessment of personal
Association injury claims, 182; for school-based risk
APA Ethical Code, 25; in forensic assessments, 392–393; for sex offenders,
psychology, 11–13 126–128; for termination of parental
area under the curve (AUC), 113–114 rights, 231–233; for transfer evaluations
ASD. See autism spectrum disorder in juvenile justice, 373
ASFA. See Adoption and Safe Families bail reform movement, 82
Act of 1997 Banner, Stuart: on capital punishment, 56
Asperger’s disorder, 125 BASC-2. See Behavior Assessment System
assessment: cross-cultural, 3–17; for Children, Second Edition
psychophysiological assessment of sex “battered woman syndrome,” 75
offenders, 117–118. See also personal Bazelon, Judge, 38
injury claims, psychological Beery-Buktenica Developmental Test of
assessment of Visual-Motor Integration, 68, 69
Association for the Treatment of Sexual behavior: bullying, 160; of defendants,
Abusers (ATSA), 113, 118 40–41, 43 (table); developmental
Atkins evaluations, 55 pathways of aggression, 387–390;
Atkins v. Virginia, 56 in-home parental behavior
ATSA (Association for the Treatment of management services, 245; observations
Sexual Abusers), 113, 118 for competency to parent, 202–203;
Index 417
observations for competency to stand Brief Visuospatial Memory Test–Revised

trial, 27–28; paranoid ideations, 27; (BVMT-R), 12
sensation-seeking, 307; violent, 146 BRIEF-A (Behavior Rating Inventory of
Behavior Assessment System for Children, Executive Function-Adult Version),
Second Edition (BASC-2), 209, 213, 180, 185
237, 264, 297, 387 BSI (Brief Symptom Inventory), 209, 212
Behavior Rating Inventory of Executive bullying, 160, 392, 395
Function-Adult Version (BRIEF-A), burden of proof, 366
180, 185 “but for” test, 175
“Beijing Rules,” 284 BVMT-R (Brief Visuospatial Memory
Bender Gestalt Test, 123 Test–Revised), 12
Bender Visual-Motor Gestalt Test, 68, 69
best interest standard, 226 California Family Codes, 277
best interests of the children (BIC), 249, California Verbal Learning Test, Second
250, 255, 276–277 Edition, 362–363
best practices: of capital case sentencing CAPI (Child Abuse Potential Index), 236
evaluations, 59–60; of child custody capital case sentencing evaluations, 55–79,
evaluations, 254–262; of civil 306; antithesis in, 68; best practices,
commitment, 151–155, 168; of 59–60; brain-lock and, 75, 76; case
competency to parent, 196–206; vignette, 60–73; common pitfalls of,
of competency to stand trial, 23–24; 74–77; controversial syndromes and,
of criminal responsibility evaluations, 75; culturally competent evaluation
36–54; of diversion evaluations, in, 59–60; death penalty and, 56–58;
84–93; of ethics in cross-cultural general outcomes of, 67–68; hubris
assessment, 8–9; of evaluation of and, 75; identification of forensic
juvenile competence to stand trial, evaluator, 65–66; investigation of
327–332; of juvenile court, sentencing collateral sources, 64–65; mental status
evaluations, 309–310; of juvenile examination, 66–67; for neurological
justice system, 285–288; of juvenile impairment, 69; overreaching judgment
Miranda waiver, 348–349; of risk in, 75; overview, 55–56; psychological
assessment of sex offenders, 118–119; measures administered, 68–73; reason
of termination of parental rights, for referral, 61–62; relevant background
228–230; of transfer evaluations information, 62–64; relevant case law,
in juvenile justice, 370–371; 56–58; relevant records, 64–66; results
of violence risk assessment, 147 of the forensic evaluation, 67–68;
BIC. See best interests of the children review of the literature, 58–59; synthesis
bipolar disorder, psychosis, not otherwise in, 68; thesis in, 68
specified, 165 capital punishment, 55; Banner on, 56
bipolar I disorder, 123, 124, 132; in DSM, CAPS (Clinician-Administered PTSD
170n2 Scale), 71
borderline personality disorders, 86, 127, case law: for capital case sentencing
145–146 evaluations, 56–58; for child custody
boundaries: of forensic evaluator, 137–138 evaluations, 249–250; for civil
Brandy v. United States, 82 commitment, 145–148; for competency
Brief Symptom Inventory (BSI), 209, 212 to stand trial, 19–23; for criminal
418 Index
case law: for capital case (continued) juvenile justice system; termination of
responsibility evaluations, 36–39; for parental rights
ethics in cross-cultural assessment, Child Abuse Potential Index (CAPI), 236
3–5; for juvenile competence to stand Child Behavior Checklist, 123
trial, 322–324; for juvenile court, child custody evaluations (CCEs), 248–282;
sentencing evaluations, 305–307; for allegations about parenting skills in,
juvenile Miranda waiver, 344–345; for 274; best practices, 254–262; case
psychological assessment of personal vignette, 262–276; of child, 272–273;
injury claims, 173–177; for sex child alienation, 253; child sexual abuse
offenders, 105–108; for termination of allegations, 253–254; clinical summary
parental rights, 225–227; for transfer and opinions, 270–273; collateral
evaluations in juvenile justice, 365–368 contacts in, 265–266; collateral sources
case vignettes: of capital case sentencing and, 260; conducting the evaluation,
evaluations, 60–73; of child custody 257–260; “decision trees” and, 257;
evaluations, 262–276; of civil divorce and, 253; domestic violence and
commitment, 155–170; of competency volatility in, 273; ethical guidelines and
to parent, 206–220; of competency model standards for, 254–257; impact
to stand trial, 25–32; of criminal of process of, 261–262; for infants and
responsibility evaluations, 46–51; very young children, 251; interviews
of diversion evaluations, 93–101; of for, 258; intimate partner violence and,
ethics in cross-cultural assessment, 252; legal standards considered in,
9–14; of juvenile competence to stand 276–277; mental status examinations
trial, 333–340; of juvenile court, of parents, 266; observations of parent-
sentencing evaluations, 310–318; of child behavior, 259; overview, 248–249;
juvenile Miranda waiver, 350–362; of parental timeshare considerations,
psychological assessment of personal 274–276; parenting plan report for,
injury claims, 177–189; of school- 260–261; principles of, 255–256;
based risk assessments, 391–397; of process of, 263–264; psychological
sex offenders, 119–136; of termination measures for child and family,
of parental rights, 230–246; of transfer 266–267; psychological testing in, 259;
evaluations in juvenile justice, 372–378 recommendations for, 276; referrals,
CBT. See cognitive behavior therapy 262–263; relevant background,
CCEs. See child custody evaluations 264–265; relevant case law, 249–250;
CDC (Centers for Disease Control), relocation and, 251–252; results from
366, 368 psychological testing in, 268–270;
Centers for Disease Control (CDC), review of the literature, 250–254;
366, 368 standard for best interests of the child,
Chen v. Holder, 4 249, 250, 255, 276–277; strengths and
child: abuse of, 229, 307; alienation of, 253; weaknesses of father, 270–271; strengths
in child custody evaluations, 272–273; and weaknesses of mother, 271–272
foster placement of, 233; interest and child protective services (CPS), 352
well-being of, 227–228; observations Child Report of Post-Traumatic Symptoms
of, 213–215; with special needs, 250; (CROPS), 297
substance use in juveniles, 287. child welfare: common knowledge of, 200;
See also child custody evaluations; culture in evaluations of, 204–205
Index 419
child welfare services (CWS), 232–233 termination of parental rights, 239–241;

Chouchkov v. Immigration and in transfer evaluations in juvenile
Naturalization Service, 4 justice, 374–375
civil commitment, 144–172; best communication disorders, 347, 350
practices, 151–155, 168; case vignette, competence to proceed: juvenile
155–170; common pitfalls and point of forensic assessment for, 294. See also
difference, 168–170; common statutory competency to stand trial
considerations, 145–148; description of, competency: abilities of juvenile offender,
144–145; eligibility for, 144; evidence 336–338; boundaries in psychological
of violent behavior and, 146; inpatient assessment of personal injury claims,
commitment, 150; language and, 146, 175; cross-cultural, 5; evaluation of,
152; length of, 150; mental status 4–5; functional abilities of juvenile
examination, 163–164; objective of, offender, 329; scope of, 176. See also
144; outpatient commitment, 150–151; competency to parent
overview, 144–145; parens patriae competency to parent, 195–224;
authority and, 149, 283–284; process allegations of sexual victimization,
of, 149–151; psychological testing and 217–218; attachment and, 200–201;
measures used, 165–166; referrals, 155– best practices, 196–206; case vignette,
156; relevant background information 206–220; collateral information on,
for, 159–163; relevant case law, 145–148; 215; common child welfare knowledge,
relevant records for, 156–159; review of 200; common pitfalls, 220–221;
the literature, 148–151; symptoms of a conducting an evaluation, 198–206;
mental disorder and, 155 culture and child welfare evaluations,
Clark v. Arizona, 39 204–205; evaluation as parent-child
Classification of Violence Risk dyad, 197–198; evaluation process,
(COVR), 153 209–210; making meaning, 205–206;
clinical interview. See interviews mental illness and, 217; mental status
Clinician-Administered PTSD Scale examination, 210–211; observations of
(CAPS), 71 the parent-child relationship, 202–203,
coaching, 219 213–215; parent report, 213; parent-
cocaine dependence, 158; in DSM, child interaction therapy, 219–220;
170–171n4 psychological testing, 211–213; referral
cognition, 28; deficits in, 183; function question, 197; referrals, 206–207;
of juvenile offenders, 325–326; relevant background information,
functioning and, 184 207–209; relevant records, 207–209;
cognitive behavior therapy (CBT): for reunification services, 218; review of
juvenile offenders, 298 the literature, 195–196; standardized
cognitive disorder, not otherwise assessment, 213–215; story of the parent,
specified, 188 198–200; substance abuse evaluation,
cognitive prong, 52 (table) 220; timing of referral and evaluation,
collateral sources, 24; in child custody 197; treatment recommendations, 206;
evaluations, 260, 265–266; in civil use and application of standardized
commitment, 152; in competency assessment measures, 203; use of
to parent, 203–204, 209, 215; in collateral contacts, 203–204; veracity
school-based risk assessments, 394; in and, 201–202; visitation, 220
420 Index
competency to stand trial (CST), 18–35; CPS (child protective services), 352
behavioral observations, 27–28; best criminal justice system: serious mental
practices, 23–24; case law, 19–23; case illness and, 18
vignette, 25–32, 29–32; certiorari, 19; criminal responsibility evaluations: best
clinical interview, 23–24; collateral practices for, 36–54; case vignette,
sources, 24; common pitfalls and 46–51; collateral information, 39–40;
considerations, 32–34; confidentiality common pitfalls of, 51–53; defendant’s
and, 25–26; diversion evaluation and, account of events related to alleged
88–89; evaluation procedures for, 26; offense, 48–49; defendants who deny
factual knowledge of the charges, 21; allegations, 42; examples of questions
factual understanding, 21; forensic for defendant’s denying criminal
assessment instruments, 24; legal allegations, 44 (table); examples of
standard of, 19; legal statute, 29; mental questions for interview, 43 (table);
status examination, 27–28; overview, examples of questions when formulating
18; process and procedures, 22–23; an opinion, 51, 52 (table); history and
psycholegal abilities, 21; psychological relevant case law of, 36–39; information
measures and results, 28–29; rational sources, 46; interviews, 41–42;
knowledge and understanding, 21–22; “irresistible impulse test,” 37; mental
reasonable ability to assist counsel, status examination, 47–48; notification
22; reasoning and decision-making of rights, 46–47; overview, 36; “product
abilities, 22; referral, 25; relevant test,” 37; psychological measures, 49–50;
background information, 26–27; questions to consider when formulating
relevant notifications, 25–26; relevant an opinion, 51; referral, 46; relevant
records, 26; review of the literature, background information, 47; “right
19–23; roles of the legal players, 21. See versus wrong” test, 37; testing, 42–44;
also juvenile competence to stand trial writing the report, 45–46
comprehension of Miranda rights, CROPS (Child Report of Post-Traumatic
recognition, 358 Symptoms), 297
comprehension of Miranda vocabulary, 358 cross-cultural assessment, 3–17; best
comprehensive system (CS), 260 practices, 8–9; biases of, 7–8; case
Comprehensive Test of Nonverbal vignette, 9–14; competency and, 5;
Intelligence (CTONI), 203 false-positive classifications of, 6;
conduct disorder, 296, 298 interpretation of results, 7; language,
confidentiality, 25–26; in civil 8; models of, 4–5; notifications for, 25;
commitment, 151–152 validity of, 6; variability of, 5. See also
confirmatory bias, 189 forensic mental health assessment
Conners’s Ratings for Hyperactivity, 123 CS (comprehensive system), 260
Consortium for State Court Interpreter CST. See competency to stand trial
Certification, 4 CTONI (Comprehensive Test of Nonverbal
Consult with Counsel (CWC), 24 Intelligence), 203
continuity of care, 299–300 culture: attitudes about, 205; biases of, 3–4;
counsel: defendant’s reasonable ability to child welfare evaluations and, 204–205;
assist, 22 description of, 7; of the family, 204–205
COVR (Classification of Violence Risk), CWC (Consult with Counsel), 24
153 CWS (child welfare services), 232–233
Index 421
damages, 175 298; alcohol dependence, 171n5;

Daubert admissibility standards, 68 attention deficit hyperactivity disorder,
Daubert v. Merrill-Dow Pharmaceuticals, 170n1; autism spectrum disorder,
177 125; bipolar I disorder, 170n2; cocaine
DBT (dialectical behavior therapy), 127 dependence, 170–171n4; dependent
DCFS (Department of Children and personality disorder, 216, 217; diagnosis
Family Services), 311, 312 in civil commitment, 152; persistent
DCT. See Dot Counting Test depressive disorder, 216; posttraumatic
death penalty, 56–58, 306; Justice stress disorder, 216; psychotic order,
Douglas on, 56; mandatory, 57; as not otherwise specified, 170n3;
unconstitutional, 57–58 schizoaffective disorder, 171n6;
defendants: account of events related to symptom exaggeration factor in, 86
alleged offense, 48–49; behavior of, dialectical behavior therapy (DBT), 127
40–41; for capital case sentencing Diaz v. State of Delaware, 4
evaluations, 61–62; competency of, disruptive behavior disorders, 347
87–89; examples of questions for Dissociative Experiences Scale (DES-II), 71
defendant’s denying criminal allegations, diversion evaluations, 80–104; best
44 (table); GPS monitoring of, 107; practices, 84–93; case vignette,
impaired functioning of, 70; mental 93–101; clinical eligibility for, 85–86;
health records of, 40; mental health clinical monitoring and supervision of
symptom exaggeration and, 86–87; participants in, 80–81; competency and,
monitoring of, 98; notification of rights 87–89; criminogenic factors, 90–91;
in criminal responsibility evaluations, determination of level of risk, 100–101;
46–47; personality assessment of, 44, 69; eligibility for, 83; establishment of
plea of guilty, 88, 89; rights of, 33, 176; diversion programs, 82; focus of, 84;
statutory right to a forensic sentencing interview and, 91–92; legal context
evaluator, 58; suicide attempts, 63, of diversion, 81–83; mental status
65; supervision of, 98–99; treatment examination, 95–96; mistakes made by
for substance abuse, 98; treatment in evaluators, 99–101; nonspecific legal
outpatient or residential setting, 88; standards for, 84; overview, 80–81;
violence risk of, 90; voluntariness of, presence of mental illness and, 85–86;
87–89; who deny allegations, 42 psychological measures and, 96; public
Delling v. Idaho, 39 safety and, 100; referral, 91–92, 93;
delusional disorder, 30 relevant background information,
demographics, 3 94–95; relevant forensic issues, 84–93;
Department of Children and Family relevant records and, 93; report
Services (DCFS), 311, 312 writing, 92–93; review of the literature,
Department of Justice, 18 81–83; symptom exaggeration, 86–87;
dependent personality disorder, 216, 217 treatment/management planning and,
depression, 219, 307, 347; in juvenile 91; violence risk and, 90; voluntariness
offenders, 314, 315, 318 in, 87–89
DES-II. See Dissociative Experiences Scale diversity, 3; immigration and, 4
Dia v. Ashcroft, 4 divorce, 253
Diagnostic and Statistical Manual of domestic violence, 207; in child custody
Mental Disorders (DSM), 70, 77n6, evaluations, 273
422 Index
Dot Counting Test (DCT), 12, 14, 356–357 family: background information for
Douglas, Justice: on death penalty, 56 evaluation of competency to parent,
DPICS. See Dyadic Parent-Child 207–209; evaluation in child custody
Interaction Coding System evaluations, 257; functional family
Drope v. Missouri, 22 therapy, 292; history of, 265
DSM. See Diagnostic and Statistical Manual Family Court Review, 256
of Mental Disorders Family Court Services, 262
Due Process Clause, 19 family courts, 253
Durham Rule, 38 family therapy: functional, 292; for juvenile
Durham v. U.S., 37 offender, 317
Dusky v. United States, 4, 19, 20, 21, 24, 28, FAS (fetal alcohol syndrome), 65, 66
323–324, 328–329 FE. See forensic evaluator
Dyadic Parent-Child Interaction Coding Federal Rule of Civil Procedure, 13
System (DPICS), 214–215, 229, 239 Federal Rules of Evidence, 45
fetal alcohol syndrome (FAS), 65, 66
ECST-R (Evaluation of Competency to fetus, 200
Stand Trial–Revised), 24, 28–29 FFT. See functional family therapy
emergency medical technician (EMT), 201 Finger v. State, 38
employment: restrictions of sex fitness to stand trial. See competency to
offenders, 107 stand trial
EMT (emergency medical technician), 201 FMHA. See forensic mental health
EPPCC (“Ethical Principles of assessment
Psychologists and Code of Conduct”), FMHPs. See forensic mental health
378–379 professionals
Estelle v. Smith, 25, 306 forensic assessment instruments (FAI):
“Ethical Principles of Psychologists and diversion evaluations, 80–104;
Code of Conduct” (EPPCC), 378–379 in evaluation of competency to stand
ethics, 3–17; best practices, 8–9; case trial, 24
vignette, 9–14; for child custody forensic evaluator (FE), 73; best practices
evaluations, 254–257; of forensic in juvenile sentencing evaluations,
evaluator, 138–139; race and, 3–5 309–310; boundaries of, 137–138; in
ethnicity: case vignette, 9–14; sex offenders civil commitment, 147–148; common
and, 112–113 pitfalls of, 100; conflicting interests
Evaluation of Competency to Stand of, 309; diversion evaluations and,
Trial–Revised (ECST-R), 24, 28–29 89; emotional reactions of, 136–137;
ethics of, 138–139; identification of,
FAC (Factual Understanding of the 65–66; mental status evaluation and,
Courtroom Proceedings), 24 66–67; mistakes made by, 99–101; over-
factitious disorder, 184 empathizing and under-empathizing of
factual understanding: in competency to sex offenders, 137; in personal injury
stand trial, 21 claims, 175; in transfer evaluations in
Factual Understanding of the Courtroom juvenile justice, 366–367
Proceedings (FAC), 24 forensic mental health assessment
FAI. See forensic assessment instruments (FMHA), 81. See also cross-cultural
“false memory syndrome,” 75 assessment; personality assessment
Index 423
forensic mental health professionals GAMA (General Ability Measure for

(FMHPs): in child custody evaluations, Adults), 12
278–279; role in child custody gangs, 313. See also peers
evaluations, 248 GBMI (guilty but mentally ill), 38
forensic psychology: APA Ethical GCS. See Glasgow Coma Scale
Code and, 11–13; assessment General Ability Measure for Adults
instruments used in competency to (GAMA), 12
stand trial, 24; best practices, 8–9; Glasgow Coma Scale (GCS), 178
capital case sentencing evaluations, Global Assessment of Functioning-61, 188
55–79; case vignette, 9–14; child Global HOPE Training Initiative, 403
custody evaluations, 248–282; civil Godinez v. Moran, 88
commitment, 144–172; competency Graham v. Florida, 380n6
evaluation and, 4–5; competency to Green’s Word Memory Test, 362
parent, 195–224; competency to stand Gregg v. Georgia, 56
trial, 18–35; cross-cultural assessment Gudjonsson Suggestibility Scale, 356
of, 3–17; demographics and, 3; Guidance, Understanding, and
ethical considerations, 3–17; goals Information in Drug Evaluation
of, 3; juvenile competence to stand (GUIDE), 291
trial, 322–343; juvenile court, GUIDE (Guidance, Understanding, and
sentencing evaluations, 304–321; Information in Drug Evaluation), 291
juvenile justice system, 283–303; Guidelines for Psychological
juvenile Miranda waiver, 344–364; Evaluations in Child Protection
language used, 3–4; mental status Matters, 227
examination, 11; models of, 4–5; guilty act (actus reus), 173
organizations, 401; personal injury guilty but mentally ill (GBMI), 38
claims, psychological assessment guilty mind (mens rea), 173
of, 173–191; pitfalls and point of guilty plea, 88, 89
difference, 14; referrals, 9–10; relevant
background information, 10–11; Hagen, Margaret, 76
relevant case law, 3–5; review of the Haldol, 164
literature on, 5–8; school-based risk Halstead-Reitan battery, 183
assessments, 386–399; standards of, Halstead-Reitan Neuropsychological
4; summary of relevant records, 10; Test Battery (HRNB), 69
termination of parental rights, 225–247; HCR-20 V3 (Historic, Clinical, Risk
transfer evaluations in juvenile justice, Management) tool, 91, 96, 97, 153,
365–384 164, 386
foster placement, 233; for juvenile Higgins v. McGrath, 21
offenders, 289 Hinckley, John, 38
Frye v. United States, 177 HIPAA, 152
FSIQ. See Full Scale IQ Historic, Clinical, Risk Management
Full Scale IQ (FSIQ), 96, 234–235, (HCR-20 V3) tool, 91, 96, 97, 153,
315, 346 164, 386
functional family therapy (FFT), 292; home visits, 267
effectiveness of, 292 Hopkins Verbal Learning Test–Revised
Furman v. Georgia, 56 (HVLT-R), 12
424 Index
HRNB (Halstead-Reitan 91–92; examples of questions for, 43

Neuropsychological Test Battery), 69 (table), 44, 52; for juvenile competence
HVLT-R (Hopkins Verbal Learning to stand trial, 330–331; for juvenile
Test–Revised), 12 court, sentencing evaluations, 310; for
juvenile Miranda waiver, 360–361; for
Iao v. Gonzalez, 4 psychological assessment of personal
ID (intellectual disabilities), 347 injury claims, 180; for school-based
IDRA (Insanity Defense Reform Act), 38 risk assessments, 393–394; for sex
IEP. See individualized education plan offenders, 117, 125; for termination
Illinois Statute, 20 of parental rights, 231; for transfer
immigration: competency determinations evaluations in juvenile justice, 372; used
and, 4–5; diversity and, 4 in competency to stand trial, 23–24, 26
Immigration and Nationality intimate partner violence (IPV), 252
Act of 1952, 11 IPV (intimate partner violence), 252
In re Autumn H., 226 IQ, 187, 315; in capital case sentencing
In re Casey D., 226 evaluations, 68; measurement of, 7; of
In re Gault, 286, 305, 323, 344 juvenile offenders, 326, 335; testing,
In re Smith, 225 182–183
In re Torski, 146 ITC. See International Test Commission
In re Winship, 286
incarceration: of juvenile offenders, 380n4; JACI (Juvenile Adjudicative Competence
of sex offenders, 133 Interview), 334
individualized education plan (IEP), 64, Jackson v. Indiana, 23
77n5, 350, 352, 353–354 Jacob Wetterling Act, 106
inpatient commitment, 150 Jacobson v. Massachusetts, 149
insanity defense, 37–38; abolishment of, JCST. See juvenile competence to
38–39; concept of, 36; standards for, stand trial
38–39; test of, 36; “Wild Beast” Journal of Child Custody, 256
test of, 36 judge: criminal court, 380n3; in juvenile
Insanity Defense Reform Act (IDRA), 38 courts, 285; as trier of fact, 34, 261
intellectual disabilities (ID), 347 judgment: bases for scientific and
intelligence, 7 professional judgment, 176; in capital
International Test Commission (ITC): case sentencing evaluations, 75;
Guidelines for Translating and in juvenile justice system, 301; of
Adapting Tests, 6–7 psychologists, 77n9; structured,
Internet: online forensic psychology 111–112; unstructured, 111
resources, 401–402; sex offenders “just desserts,” 174
and, 116 Juvenile Adjudicative Competence
interpersonal skills, 394 Interview (JACI), 334
interviews: for child custody evaluations, juvenile competence to stand trial (JCST),
258; clinical, 23–24, 180, 181–182; for 322–343; ability to assist attorney,
competency to parent, 209, 210–211; for 338–339; age of juvenile offenders
competency to stand trial, 23–24, 26; and, 325; best practices in evaluation
for criminal responsibility evaluations, of, 327–332; case vignette, 333–340;
41–42; for diversion evaluations, clinical summary and opinion of,
Index 425
338–340; cognitive function of 285; psychological evaluations

juvenile offenders, 325–326; common and, 293–294; review of the
pitfalls in, 340–341; competence literature, 288–300; risk assessment
abilities of juvenile offender, 336–338; and, 295; transfer evaluations in,
developmental immaturity of juvenile 365–384
offender, 326–327; evaluation juvenile Miranda waiver, 344–364;
conceptualization, 328–329; evaluation best practices, 348–349; case
procedures, 329–331; forming and vignette, 350–362; common pitfalls
presenting opinion to the courts, 332; of, 362–363; comprehensibility
interviews for, 330–331; mental illness of Miranda language, 346–347;
and, 326; mental status examination for, comprehension of Miranda rights,
336; method and process of evaluation 358; comprehension of Miranda
for, 333; overview, 322; psychological vocabulary, 358; disposition of,
measures for, 333–334; psychological 361–362; evaluator and, 349, 351–352;
testing in evaluation of, 331–332; functions of rights in interrogation,
referrals, 333; relevant background 359; “interested adult” standard and,
information, 334–336; relevant statutes 345, 348; interviews, 360–361; mental
and case law, 322–324; review of the health issues and, 347–348; mental
literature on incompetence in young status at time of evaluation, 354–355;
offenders, 325–327; understanding Miranda comprehension, 347–348;
trial process, 339. See also adolescents; neurodevelopmental disorders
competency to stand trial in juvenile offenders, 347–348;
juvenile court, sentencing evaluations, psychological measures, 355–357;
304–321; best practices, 308–310; case question of developmental immaturity
vignette, 310–318; common pitfalls and, 346; referrals, 350–352; relevant
of, 318–319; family therapy for family background information, 352–354;
of juvenile offender, 317; individual relevant case law, 344–345; relevant
therapy for juvenile offender, 316; records, 352; review of digital audio
interviews, 310; overview, 304–305; recording for, 361; review of the
psychiatric care for juvenile offender, literature, 345–348; suggestibility
318; referrals, 309; relevant background during questioning and, 357–358; test
information, 312–314; relevant performance credibility and, 359; test
case law, 305–307; relevant records, results bearing on, 357–359. See also
312–314; review of the literature, adolescents
307–308; sentence recommendations, juvenile sexual offenders, 292–293
316; social skills training for juvenile
offender, 317; special education services Kaufman Brief Intelligence Test, Second
for juvenile offender, 317; substance Edition (KBIT-2), 209, 211
abuse treatment for juvenile offender, KBIT-2 (Kaufman Brief Intelligence Test,
318; treatment recommendations for Second Edition), 209, 211
juvenile offender, 318 Kendra’s Law, 145
juvenile justice system, 283–303; best Kennedy v. Louisiana, 56–57
practices within, 285–288; continuity Kent v. United States, 286, 323, 380n2
of care for juvenile offenders, 299–300; Knowledge of the Scientific Foundation for
overview, 283–285; proceedings within, Opinions and Testimony, 59
426 Index
Lake v. Cameron, 147, 150 Lockett v. Ohio, 57

language, 8; in capital case sentencing LS/CMI (Level of Service/Case
evaluations, 59; in civil commitment, Management Inventory), 96
146, 152; comprehensibility of Miranda Luria Nebraska battery, 183
language, 346–347; comprehensibility
of Miranda vocabulary, 359; delays in, MacArthur Competency Assessment
353; fluency of, 25 Tool-Criminal Adjudication
learning disorders, 347 (MacCAT-CA), 88
legal standards: best interests of the MacArthur Foundation, 287–288
children, 249, 250, 255, 276–277; in MacCAT-CA (MacArthur Competency
child custody evaluations, 276–277 Assessment Tool-Criminal
legal statutes. See statutory law Adjudication), 88
legal system: knowledge in psychological MACI (Millon Adolescent Clinical
assessment of personal injury claims, 176 Inventory), 387, 394–395
legislation: Adam Walsh Child Protection major depressive disorder, 123
and Safety Act of 2006, 106; Adoption malingering, 184
and Safe Families Act of 1997, Manhattan Bail Project, 82
195–196; HIPAA, 152; Immigration Massachusetts Youth Screening
and Nationality Act of 1952, 11; Instrument—Version 2 (MAYSI-2), 386
Insanity Defense Reform Act, 38; Jacob masturbation: of sex offenders, 131
Wetterling Act, 106; Kendra’s Law, Matter of M-A-M, 4–5
145; Megan’s Law, 106; Sex Offender Mayo-Portland Adaptability
Registration and Notification Act, Inventory-4, 180, 185
106–107; Sexually Violent Predator MAYSI-2 (Massachusetts Youth Screening
legislation, 108; Uniform Marriage and Instrument—Version 2), 386
Divorce Act of 1970, 249 McKeiver v. Pennsylvania, 286
Lessard v. Schmidt, 147, 148 MCMI-III. See Millon Clinical Multiaxial
Level of Service/Case Management Inventory-III
Inventory (LS/CMI), 96 MD-NOS. See mood disorder, not
literature review: on capital case otherwise specified
sentencing evaluations, 58–59; on Megan’s Law, 106
child custody evaluations, 250–254; men: masturbation, 131; sexually abused as
on civil commitment, 148–151; on children, 293; strengths and weaknesses
competency to parent, 195–196; on of, 270–271
competency to stand trial, 19–23; on mens rea (guilty mind), 173
diversion evaluations, 81–83; on ethics mental health: in juvenile offenders,
in cross-cultural assessment, 5–8; on 347–348
incompetence in young offenders, mental health court (MHC), 80–81;
325–327; on juvenile court, sentencing criminogenic factors and, 90–91;
evaluations, 307–309; on juvenile justice versus diversion programs, 83; legal
system, 285–288; on juvenile Miranda competencies of, 88
waiver, 345–348; on sex offenders, mental health expert (MHE), 66
108–118; on termination of parental mental health facilities: civil commitment
rights, 227–228; on transfer evaluations of sexually violent predators to a
in juvenile justice, 368–371 state forensic psychiatric facility, 133;
Index 427
privately funded inpatient/residential, Miller v. Alabama, 380n6

133; publicly funded inpatient/ Millon Adolescent Clinical Inventory
residential, 133 (MACI), 387, 394–395
mental health professionals: in child Millon Clinical Multiaxial Inventory-III
custody evaluations, 254; ethical (MCMI-III), 117, 121, 129, 259
guidelines for, 254–255 Minnesota Multiphasic Personality
mental health records, 40 Inventory Adolescent (MMPI-A), 375
mental illness: in competency to parent, Minnesota Multiphasic Personality
216–217; definition used in civil Inventory-2 (MMPI-2), 259, 264,
commitment, 145, 166–167; diversion 268, 269
evaluations and, 85–86; establishment Minnesota Multiphasic Personality
of, 153–154; exaggeration of symptoms, Inventory-2-Restructured Form
86–87, 96; of juvenile offenders, 326; (MMPI-2-RF), 44, 51, 70, 72, 77n7,
symptoms of, 161–162; therapy for, 77n8, 117, 124, 177, 186
218–219 Minnesota Sex Offender Screening
mental status: of juvenile offender at time Tool-Revised (MnSOST-R),
of evaluation, 354–355 114–115
mental status examination: areas covered, Miranda: comprehension of rights of
181; for capital case sentencing juvenile offender, 347–348, 358;
evaluations, 66–67, 68; for child comprehension of vocabulary of, 359;
custody evaluations, 266; for civil functions of rights in interrogation, 359.
commitment, 163–164; for competency See also juvenile Miranda waiver
to parent, 210–211; for competency Miranda Rights Comprehension
to stand trial, 27–28; for criminal Instruments, 349
responsibility evaluations, 47–48; Miranda Rights Comprehension Inventory
for diversion evaluations, 95–96; for (MRCI), 355
ethics in cross-cultural assessment, Miranda v. Arizona, 345
11; “false negative” errors, 66, 77n1; Mitchell v. United States, 306
“false positive” errors, 66, 77n1; mixed expressive-receptive attention deficit
forensic evaluator and, 66–67; for hyperactivity disorder, 350
juvenile competence to stand trial, MMPI-2. See Minnesota Multiphasic
336; of parents, 266; for psychological Personality Inventory-2
assessment of personal injury claims, MMPI-2-RF. See Minnesota Multiphasic
180–182; for sex offenders, 128–131; for Personality Inventory-2-Restructured
termination of parental rights, 234 Form
methamphetamines, 200, 232 MMPI-A (Minnesota Multiphasic
M-FAST (Miller Forensic Assessment of Personality Inventory Adolescent), 375
Symptoms Test), 44, 87 M’Naghten, Daniel, 37
MHC. See mental health court M’Naghten standard, 37
MHE (mental health expert), 66 MnSOST-R (Minnesota Sex Offender
MIDSA (Multidimensional Inventory Screening Tool-Revised), 114–115
of Development, Sex, and Aggression), Model Penal Code, 38
117 Model Programs Guide (MPG), 368
Miller Forensic Assessment of Symptoms Model Standards of Practice for Child
Test (M-FAST), 44, 87 Custody Evaluation, 255
428 Index
models: for child custody evaluations, notifications: community registration and

254–257; of cross-cultural barriers, notification of sex offenders, 106–107;
4–5; individualized assessment, 57; for competency to stand trial, 25–26;
of juvenile justice, 286; Risk-Needs- of rights in criminal responsibility
Responsivity model, 90–91; for violence evaluations, 46–47
risk assessment, 252
“Models for Change: Systems Reform in O’Connor v. Donaldson, 146, 150
Juvenile Justice,” 287 Office of Juvenile Justice and Delinquency
monitoring: of sex offenders, 107 Prevention (OJJDP), 368
mood disorder, not otherwise specified OJJDP (Office of Juvenile Justice and
(MD-NOS), 240, 326, 395 Delinquency Prevention), 368
Moran v. Burbine, 345, 348 opinions: examples of questions when
MPG (Model Programs Guide), 368 formulating, 51, 52 (table); forming and
MRCI (Miranda Rights Comprehension presenting, in juvenile competence to
Inventory), 355 stand trial, 332; knowledge of scientific
MSI (Multiphasic Sex Inventory), 117 foundation for, 176–177
MST. See Multi-Systemic Therapy oppositional defiant disorder, 307, 394
MTFC (Multidimensional Treatment outpatient commitment, 150–151
Foster Care), 289–290 Overall Rational Ability, 24
Multidimensional Inventory of
Development, Sex, and Aggression PAI. See Personality Assessment Inventory
(MIDSA), 117 PAI-2. See Personality Assessment
Multidimensional Treatment Foster Care Inventory, Second Edition
(MTFC), 289–290 PAI-A. See Personality Assessment
Multiphasic Sex Inventory (MSI), 117 Inventory, Adolescent
Multi-Systemic Therapy (MST), 290–291; paranoia, 164, 268
effectiveness of, 292; for juvenile parens patriae doctrine, 149, 283–284
offenders, 298, 310 Parent and Teacher Report, 123
parent-child interaction therapy (PCIT),
NAB (Neuropsychological Assessment 219–220, 403; evaluation as parent-
Battery), 180, 183, 185 child dyad, 197–198
NAB-SM (Neuropsychological Assessment parent-child relationship: observation of,
Battery-screening module), 183 202–203, 259; quality of, 201 (table). See
National Coalition for Jail Reform, 82 also termination of parental rights
neurodevelopmental disorders, 347; in Parenting Stress Index/Short Form
juvenile offenders, 347–348 (PSI/SF), 236
Neuropsychological Assessment Battery parents: divorce of, 253; in-home parental
(NAB), 180, 183, 185 behavior management services, 245;
Neuropsychological Assessment Battery- observations of, 213–215; quality of
screening module (NAB-SM), 183 relationship of, 243–244; report of, 213,
NGRI. See not guilty by reason of insanity 238, 260–261; shared parenting, 249;
not guilty by reason of insanity strengths and weaknesses of father, 270–
(NGRI), 38, 51; as affirmative 271; strengths and weaknesses of mother,
defense, 41; seen as weakness by 271–272; timeshare considerations in
defendant, 71 child custody evaluations, 274–276. See
Index 429
also competency to parent; termination PIC (Personality Inventory for Children),

of parental rights 123
Pate v. Robinson, 22 plaintiff, 174
PCIT. See parent-child interaction therapy Portland Digital Recognition Test, 184
PCL: YV (Psychopathic Checklist: Youth postconcussive syndrome, 179
Version), 296–297, 386 “post-cult trauma syndrome,” 75
PCL-R (Psychopathy Checklist, Revised), posttraumatic amnesia, 179
71, 115 Posttraumatic Stress Diagnostic Scale
PCL-SV (Psychopathy Checklist-Screening (PDS), 180, 186–187
Version), 165 posttraumatic stress disorder (PTSD), 64,
PDS (Posttraumatic Stress Diagnostic 66, 71, 188, 200, 216, 237–238, 242, 307,
Scale), 180, 186–187 395; in juvenile offenders, 296
pedophilia, 124, 132 Pre-adjudication Psychosexual Evaluation,
Peel, Robert (Prime Minister), 37 124
peers, 307, 312, 394. See also gangs PRI (Perceptual Reasoning Index), 234
Perceptual Reasoning Index (PRI), 234 PRIDE (praises, reflections, imitation,
persistent depressive disorder, 216 descriptions, enthusiasm) skills, 219
personal injury claims, psychological prisons: personality disorders among
assessment of, 173–191; background female population, 86
information, 182; bases for scientific probation, 135–136
and professional judgments, 176; Problems Related to Interaction with the
boundaries of competence and, 175; Legal System–Litigation, 188
case vignette, 177–189; confirmatory Prochaska v. Brinegar, 149
bias and, 189; knowledge of the Projective Drawings, 123
legal system and legal rights of proximate cause, 174–175
individuals, 176; knowledge of the PSI/SF (Parenting Stress Index/Short
scientific foundation for opinions Form), 236
and testimony, 176–177; legal claims psychasthenia, 268
and, 189; mental status examination, psycholegal abilities, 21
180–182; overview, 173; problems in psychological testing: for child custody
assessments, 189–190; psychological evaluations, 259, 266–267; for civil
measures for, 182–187; referrals, commitment, 165–166; for competency
177–178; relevant case law, 173–177; to parent, 209, 211–213; for criminal
relevant records for, 178–180; scope of responsibility evaluations, 42–44; for
competence and, 176 juvenile competence to stand trial,
personality assessment, 44, 69. See also 331–332; of juvenile offenders, 293–294,
forensic mental health assessment 355–357; for psychological assessment
Personality Assessment Inventory (PAI), of personal injury claims, 182–187;
44, 50, 71, 117, 180, 186, 209, 212–213, results from, 268–270; for school-
235, 259, 315; Adolescent, 372, 375– based risk assessments, 394–395; for
376; Second Edition, 12–13 termination of parental rights, 234–239.
Personality Inventory for Children See also phallometric testing
(PIC), 123 psychologists: becoming “pigeonholed” in
phallometric testing, 117–118. See also capital case sentencing evaluations, 76;
psychological testing judgment of, 77n9
430 Index
Psychopathy Checklist, Revised (PCL-R), 231–233, 232; for transfer evaluations

71, 115 in juvenile justice, 372–373
Psychopathy Checklist: Youth Version “recovered memory syndrome,” 75
(PCL: YV), 296–297, 386 referrals, 9–10; for capital case sentencing
Psychopathy Checklist-Screening Version evaluations, 61–62; for child custody
(PCL-SV), 165 evaluations, 262–263; for civil
psychophysiological assessment: of sex commitment, 155–156; for competency
offenders, 117–118 to parent, 206–207; for criminal
psychosocial maturity, 369 responsibility evaluations, 46; for
psychotic order, not otherwise specified, diversion evaluations, 91–92, 93; for
158; in DSM, 170n3 juvenile competence to stand trial, 333;
PTSD. See posttraumatic stress disorder for juvenile court, sentencing evaluations,
public safety, 100 310; for juvenile Miranda waiver,
350–352; for psychological assessment of
Quick Neurological Screening Test, 68 personal injury claims, 177–178; reason
for, 25; refusal of, 14; for school-based risk
RAC (Rational Understanding of the assessments, 391–392; for sex offenders,
Courtroom Proceedings), 24 120–121; for termination of parental
race: biracial, 163; ethics and, 3–5; sex rights, 231; timing of, 197; for transfer
offenders and, 112–113 evaluations in juvenile justice, 372
Rapid Risk Assessment for Sexual Offense residence: of sex offenders, 107
Recidivism (RRASOR), 113–114, 115, resources: forensic psychology
129 organizations, 401; online resources,
rational understanding, 21 401–402
Rational Understanding of the Courtroom retribution, 174
Proceedings (RAC), 24 retrograde amnesia, 179
recidivism: prediction for sex offenders, reunification services, 218
110–111; risk for, 101; sexual offense, Rex v. Arnold, 36
113–114, 115, 129; tools for assessment Reynolds Intellectual Assessment Scales
for risk of, 113–115 (RIAS), 180, 182–183
recordings: review of digital audio RIAS (Reynolds Intellectual Assessment
recordings for juvenile Miranda Scales), 180, 182–183
waiver, 361 Riggins v. Nevada, 23
records: for capital case sentencing RIM. See Rorschach Inkblot Method
evaluations, 64–66; for civil Risk, Sophistication, and Treatment
commitment, 156–159; for competency Inventory (RSTI), 371, 372, 375, 376
to parent, 207–209; for competency to risk assessment: of civil commitment, 151–
stand trial, 26; for diversion evaluations, 155; definition of, 108; determination
93; for juvenile court, sentencing of level of risk, 100–101; of future
evaluations, 311–313; for juvenile violence, 388; general issues in, 386–
Miranda waiver, 352; for psychological 387; of juveniles, 295; recidivism and,
assessment of personal injury claims, 101; risk factors and, 109–111; school-
178–180; for risk assessment of sex based, 386–399; of sex offenders, 105–
offenders, 116; for sex offenders, 122– 143; of transfer evaluations in juvenile
126; for termination of parental rights, justice, 369–370
Index 431
Risk Matrix 2000 (RM2000), 115 Selected Rules from the United Nations
Risk-Needs-Responsivity (RNR) model, Standard Minimum Rules for the
90–91 Administration of Juvenile Justice, 284
Risperdal, 95 self-report measures: for sex offenders, 117,
RM2000 (Risk Matrix 2000), 115 129–130; for termination of parental
RNR (Risk-Needs-Responsivity) model, rights, 237–238
90–91 Self-Report Profile—Adolescent (SRP-A),
Robert’s Apperception Test, 123 297
Robinson v. California, 82 sensation-seeking behaviors, 307
Rompilla v. Beard, 58 sentencing: deferral of, 83; goals of, 174
Roper v. Simmons, 56, 380n6 serious mental illness (SMI), 18, 83, 99
Rorschach Inkblot Method (RIM), 259, Sex Offender Needs Assessment Rating
264, 268, 269–270, 354 (SONAR), 115
Rorschach Performance Assessment Sex Offender Registration and Notification
System (R-PAS), 260 Act (SORNA), 106–107
Rorschach test, 124 Sex Offender Registry Board, 360
R-PAS (Rorschach Performance Sex Offender Risk Appraisal Guide
Assessment System), 260, 268 (SORAG), 114
RRASOR. See Rapid Risk Assessment for sex offenders: actual assessments for
Sexual Offense Recidivism noncontact offenders, 116; actuarial
RSTI. See Risk, Sophistication, and measures for, 115; actuarial tools for,
Treatment Inventory 129; approaches to assessment of,
111–113; best practices, 118–119;
Santosky v. Kramer, 225 boundaries of forensic evaluator,
SASSI-3 (Substance Abuse Subtle 137–138; case vignette, 119–136; clinical
Screening Inventory, Third Edition), interview of, 117; clinical summary and
236–237 opinion of, 131–135; collateral contacts,
SAVRY. See Structured Assessment of 116–117; community registration and
Violence in Risk in Youth notification of, 106–107; court-ordered
Schall v. Martin, 286 therapy for, 126–127; emotional
schizoaffective disorder, 158; depressive reactions of forensic evaluator, 136–137;
type, 167; in DSM, 171n6 ethics of forensic evaluator, 138–139;
schizophrenia, 19, 93–101, 268 female, 112; GPS monitoring of,
school-based risk assessments, 386–399; 107; incarceration of, 133; Internet
case vignette, 391–397; clinical summary and, 116; juvenile, 112; measures
and opinion of, 395–397; collateral of sexual preferences, 117; mental
contacts and, 394; common pitfalls and status examination, 128–131; over-
point of difference, 397; developmental empathizing and under-empathizing
pathways of aggression, 387–390; of forensic evaluator, 137; overview,
general issues in, 386–387; 105; phallometric testing of, 117–118;
interviews, 393–394; psychological prediction of recidivism, 110–111;
measures and, 394–395; referrals, probation of, 135–136; psychological
391–392; relevant background measures, 121; psychophysiological
information, 392–393; relevant assessment of, 117–118; racially and
case law, 386–391 ethnically diverse, 112–113; records
432 Index
sex offenders: actual assessments State of Washington v. Sisouvanh, 5

(continued) Statement of Understanding, 26
for, 116; referrals, 120–121; relevant Static-99, 114, 129
background information, 126–128; statutory laws: for civil commitment, 145–
relevant case law, 105–108; relevant 148; for competency to stand trial, 29;
records of, 122–126; residence and for juvenile competence to stand trial,
employment restrictions of, 107; review 322–324; Section 670.032(1)(c): Any
of the literature, 108–118; rights of, Previous Abuse or Neglect History of
106; risk assessment of, 105–143; the Minor, 376–377; Section 670.032(1)
risk assessment tools for, 113–115; (d): The Seriousness of the Crime, 377;
risk factors of, 109–111; self-report Section 670.032(a)(g): Is Transferring
measures, 117, 129–130; sexual fantasy Jurisdiction Necessary to Deter
and masturbation log, 131; sexual This Minor or Other Juveniles from
history of, 130–131; sexually violent Committing the Crime for Which the
predator laws, 108; structured clinical Minor Is Charged?, 377–378; in transfer
decision tools for, 115 evaluations in juvenile justice, 376–378
sexual abuse, 233, 351; allegations of, Stroop Color and Word Test, 12
253–254 Structured Assessment of Violence in
sexual fantasy, 121; of sex offenders, 131 Risk in Youth (SAVRY), 371, 375, 386,
sexual offenders: juvenile, 292–293; male, 390–391
293 Structured Interview of Reported
sexual preferences: of sex offenders, 117 Symptoms, Second Edition (SIRS-2),
sexual victimization, 217–218 44, 49–50
Sexual Violence Risk-20 (SVR-20), 112, Structured Professional Judgment (SPI), 90
115, 129 substance abuse, 200, 395; evaluation of,
Sexually Violent Predator (SVP) legislation, 220; treatment for juvenile offenders,
108 318; treatment of defendants, 98
SIRS-2 (Structured Interview of Reported Substance Abuse Subtle Screening
Symptoms, Second Edition), 44, 49–50 Inventory, Third Edition (SASSI-3),
SMI (serious mental illness), 18, 83, 99 236–237
social skills training: for juvenile offender, substance use disorders, 241–242, 307, 326;
318 in juveniles, 287, 307
SONAR (Sex Offender Needs Assessment suicide, 162; attempts by defendant, 63, 65
Rating), 115 SVP. See Sexually Violent Predator
SORAG (Sex Offender Risk Appraisal legislation
Guide), 114 SVR-20. See Sexual Violence Risk-20
SORNA (Sex Offender Registration and
Notification Act), 106–107 TBI. See traumatic brain injuries
special education services: for juvenile “tender years doctrine,” 249
offender, 317 termination of parental rights (TPR),
SPI (Structured Professional Judgment), 90 225–247; ability to benefit from services
SRP-A (Self-Report Profile—Adolescent), and, 242–243; best interest standard
297 for, 226; best practices, 228–230; case
standard of proof, 366 vignette, 230–246; clinical summary and
STAR Reading Test, 12, 13 opinion in, 241; collateral information
Index 433
in, 239–241; grounds for termination, relevant case law, 365–368; relevant
226; identifying functional capacities, records and, 373; review of the literature,
227; mental health functioning and, 368–371; risk assessment and, 369–370;
241–242; mental status examination, transfer data and, 368; youth in adult
234; overview, 225; parent report in, criminal court system, 380n5
238; parenting/in-home behavior Trauma Symptom Index, Second Edition
management services, 245; psychological (TSI-2), 235
testing in, 234–239; quality of parental trauma training program, 403
relationship, 243–244; referrals, 231; trauma-focused cognitive behavioral
relevant case law, 225–227; relevant therapy (TF-CBT), 245
records and background, 231–233; traumatic brain injuries (TBI), 60, 66, 188,
review of the literature, 227–228; 288
reviewing new APA Guidelines, 227– TSI-2 (Trauma Symptom Index, Second
228; self-report in, 237–238; treatment Edition), 235
recommendations and, 244–245. See
also parent-child relationship UCLA Post-Traumatic Stress Disorder
Test of Memory Malingering (TOMM), 12, Index (UCLA PTSD Index), 234, 238
44, 96, 184, 356, 359, 362 UCLA PTSD Index (UCLA Post-Traumatic
testimony: expert, 188; knowledge of Stress Disorder Index), 234, 238
scientific foundation for, 176–177 UMDA (Uniform Marriage and Divorce
TF-CBT (trauma-focused cognitive Act of 1970), 249
behavioral therapy), 245 Uniform Marriage and Divorce Act of 1970
Thematic Apperception Test, 354 (UMDA), 249
therapy: for juvenile offenders, 317; for United States ex rel. Negron v. State of New
mental illness, 218–219 York, 3–4
“thin-skull rule,” 175 United States Medical Center for Federal
third-party sources. See collateral sources Prisoners (USMCFP), 19
Thornton v. Corcoran, 306 U.S. Code 4241, 29
TOMM. See Test of Memory Malingering U.S. Constitution: Eighth Amendment,
torts: elements of, 174–175 56, 57; Fifth Amendment, 305, 306;
TPR. See termination of parental rights Fourteenth Amendment, 19, 56, 57,
transfer evaluations in juvenile justice, 305, 345; Sixth Amendment, 305,
365–384; best practices, 370–371; case 306–307
vignette, 372–378; clinical summary and U.S. Department of Justice, 366, 368
opinion, 376–378; collateral contacts for, U.S. Supreme Court, 19–20, 23; civil
374–375; evaluation techniques for, 372; commitment, 146; death penalty and,
incarceration and, 380n4; interviews 56; distinction between constitutional
and, 372; policy of, 368; potential and unconstitutional death penalty,
pitfalls of, 378–379; psychological issues 56; due process, 344–345; juvenile
and, 369–370; psychological measures delinquency proceedings, 305, 306;
in, 375–376; psychopathology of the mandatory death penalty and, 57; on
juvenile offender, 370; psychosocial rehabilitation versus punishment of
maturity of the juvenile offender, 369; juvenile offenders, 322–323; ruling on
records and, 372–373; referrals, 372; denial of bail, 82; ruling on insanity
relevant background information, 373; defense, 38–39; test for Miranda, 345
434 Index
U.S. v. Brawner, 37–38 Wechsler Abbreviated Scale of Intelligence,

USMCFP (United States Medical Center Second Edition (WASI-2),
for Federal Prisoners), 19 234–235, 315; IV (WISC-IV),
315, 341n1
Validity Indicator Profile (VIP), 180, 184 Wechsler Adult Intelligence Scale, Fourth
VCI (Verbal Comprehension Index), 234 Edition (WAIS-IV), 44, 68–69, 96, 177,
Vera Institute of Justice, 82 354
Verbal Comprehension Index Wechsler Individual Achievement Test,
(VCI), 234 Third Edition, 356
victims, 173; sexual victimization, 217–218 Wide Range Achievement Test-Revised
violence: attributable to mental illness, (WRAT-R), 123
146; domestic, 207, 273; of intimate Wieter v. Settle, 21
partners, 252; rates of, 154; risk Wiggins v. Smith, 58
assessment of future, 388; risk in WISC-IV, 203, 315. See Wechsler
diversion evaluations, 90; sexually Abbreviated Scale of Intelligence, IV
violent predator laws, 108. See also sex women: “battered woman syndrome,”
offenders 75; female sex offender, 112;
Violence Risk Appraisal Guide (VRAG), juvenile female offenders, 288–289;
114, 386 personality disorders among female
VIP (Validity Indicator Profile), 180, 184 prison population, 86; strengths and
visitation: of parent-child, 220, 249, 274–276 weaknesses of, 271–272
volitional prong, 52 (table) Word Memory Test, 184
VRAG (Violence Risk Appraisal Guide), WRAT-R (Wide Range Achievement Test-
114, 386 Revised), 123
WAIS-IV. See Wechsler Adult Intelligence Youtsey v. United States, 19

Scale, Fourth Edition
WASI-2. See Wechsler Abbreviated Scale of Zhang v. District of Columbia Department
Intelligence, Second Edition of Consumer and Regulatory Affairs, 4

Inside Forensic Psychology

Uploaded by

Copyright:

Available Formats

Inside Forensic Psychology

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Inside Forensic Psychology

Uploaded by

Copyright:

Available Formats

What is the book about?

What is the book about?

What topics are covered in Part I of the book?

What topics are covered in Part I of the book?

Inside Forensic

Library of Congress Cataloging-in-Publication Data

Names: Masson, Tiffany R., editor.

This book is also available on the World Wide Web as an eBook.

This book is printed on acid-free paper

Part I Cases, Approaches, and Practices

2 Competency to Stand Trial 18

3 Conducting Criminal Responsibility Evaluations 36

4 Capital Case Sentencing Evaluations 55

5 Conducting Mental Health Diversion Evaluations 80

6 Sex Offender Risk Assessment 105

7 Civil Commitment: Examining Mental Illness, Differential

8 The Psychological Assessment of Personal Injury Claims 173

Part II Cases, Approaches, and Practices with

10 Termination of Parental Rights 225

11 Child Custody and Parenting Plan Evaluations 248

12 Overview of the Juvenile Justice System and Best Practices 283

13 Sentencing Evaluations in Juvenile Court 304

14 Juvenile Competence to Stand Trial 322

15 Juvenile Miranda Waiver: A Naïve Teenager,

16 Transfer Evaluations in Juvenile Justice 365

17 Introduction to School-Based Risk Assessments 385

About the Editor and Contributors 403

students. As a professor, I found myself wanting to bring to life important con-

The goal of forensic assessment is to utilize psychologically based measures

Relevant Case Law

interpreter at criminal trials, which will be provided at the state’s expense in

make mental competency determinations and justify their reasoning so that

Review of the Literature

distress. However, until this research is conducted, evaluators need to navigate

procedures, the evaluator risks jeopardizing the accuracy of the translated

should learn culturally competent service delivery styles. Acculturation

Association, 2013). In addition, several aspirations regarding forensic assess-

Reason for Referral

motivate individuals to present themselves in a specific (inaccurate) manner

Summary of Relevant Records

Relevant Background Information

Mental Status Examination

acculturation for African samples. Lastly, as there was substantial external

Clinical Summary and Opinion

Common Pitfalls and Considerations

American Psychological Association. (2002b). Guidelines on multicultural education,

Competency to Stand Trial

Relevant Case Law and Review of Literature

A defendant is unfit if, because of his mental or physical condition, he is

Factual Knowledge of the Charges and Roles of the Legal Players

Rational Knowledge and Understanding

An individual competent to stand trial must also be able to demonstrate

Ability to Assist Counsel

CST Process and Procedures

of treatment is likely to render the defendant competent to stand trial

The Clinical Interview

Forensic Assessment Instruments

Collateral or Third-Party Sources

important aspects of the evaluation process. The defendant’s ability to accu-

Summary of Relevant Records (Sources of Information)