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Summary of Book

The Forensic Assessment
Summary of Book: “Guideline: The Forensic Assessment”
Summayyah Aziz
Department of Psychology, University of Karachi
651-D Assessment
Dr. Zi Asma Haneef Khan
Chapter 1-3 April 16, 2020
Chapter 4-5 April 23, 2020
Chapter 6-7 April 30, 2020
Chapter 8-9 May 7, 2020
Chapter 10-12 May 14, 2020
The Forensic Assessment
Chapter 1: Statement of Intent
This guideline is not intended to provide extensive knowledge on the assessment, rather
it has been written to inform the practitioners about the current up gradations in the
assessment tools and proceedings, yet it is advised to choose the assessment technique based
on the characteristics and context of the case. It should always be kept in mind that in order to
practice Forensic Assessments one needs to have a certain qualification requisite in the
Chapter 2: Introduction
The key for a good judicial decision is based on how well the case has been investigated,
and assessment plays a key role in investigation. In many situations a psychological assessment
is requisite for a good decision that’s when the expert opinion is taken. An evidence- based
approach has been taken in this guideline, by working on recent reliable researches and
specialists in Forensic Assessment. This guideline does not set a standard of assessment and
care as each case may vary immensely and require different treatment. It only provides
overview of different types of assessment in civil cases, criminal case and assessment of risk.
Chapter 3: Quality Improvement in Forensic Practice
Research in Forensic settings increased during 90s but most of the work has been done
on forensic report writing and presentation and assessment and interviewing seems to be left
out. The literature provides evidence that we need to work on building consistent practice
techniques to maintain objectivity and understandability. One thing that is important for each
mental health professional is to consider the accuracy and veracity of their work. Research by
Mossman and Colleagues reported that not only qualitative but quantitative assessment
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provides accurate results. The guidelines developed for forensic settings have been established
on ethical and legal guidelines.
Chapter 4: Ethical Foundation
A Forensic Psychiatrist/ Psychologist has obligations towards court and attorney and
also towards the evaluee. Law obliges Practitioner to provide accurate assessment report to the
court, while a practioner patient relationship requires the professional to maintain
confidentiality. This and many other role conflicts are experienced by professionals in various
conditions. Some experts believe that the obligations towards court must be the priority of the
Forensic Practitioner while others find medical ethics to be important and believe that one
should seek to resolve ethical issues with ultimate goal towards medical ethics.
Difference in the assessment of a clinical and forensic expert lies in the objective of that
assessment, as clinicians are doing assessment to have a strong and accurate base of their
treatment plan while forensics experts need to apply those results to legal proceedings. This
difference not only influences the relationship from practitioner’s side but many cases of
malingering and dissimulation have been observed for legal gains. To reduce these issues many
practitioners prefer to use information taken from collateral sources into account as well.
Chapter 5: Assessment Process
5.1: Setting the Stage
Before beginning the assessment it is important for the evaluator to determine if there
is any conflict of interest which can be legal, monetary, administrative or personal, some sort of
resource issues like time required for complete assessment before deadline or required license
for conducting assessment in that particular jurisdiction. It is also suggested to decide prior to
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the initiation of assessment the fees and payment method. Usually a written agreement is
signed between the evaluator and retaining party containing specific legal question that needs
to be answered, what is the role of expert, time frame for assessment completion, estimation
of time and fee structure.
5.2: Confidentiality
Since the confidentiality cannot be maintained as in a clinical setting, the evaluee needs
to be informed regarding the limits of confidentiality, with whom the information will be shared
and why is this assessment being conducted, and if there is any confusion with the role of a
clinical practitioner it should be cleared beforehand. The evaluee also needs to be informed of
the right to not answer, but that too will be recorded and might become a part of report.
If the assessment is ordered by the court evaluator does not need to ask evaluee before
sharing the report to the court or concerned party, but in case the assessment is asked by some
other party the evaluee needs to be asked before sharing any information. In case of abuse,
neglect or harm reported, the evaluator must break the confidentiality agreement and report it
to the concerned agency. A written document is usually signed by both evaluee and evaluator
containing all the confidentiality issues.
Collateral sources should also be informed about the limits of confidentiality, purpose
ans use of assessment and that any information they share can be used in the court.
With all that the evaluee needs to be informed about malingering assessment as well.
5.3: Collateral Information
Collateral sources are vital in accuracy of the evaluee, it helps counter malingering,
memory deficits and treatment influences. Collateral information can be sought from not only
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family, friends and witnesses but also work place documents and national and police records.
Any individual agreeing to provide this information need to know about the confidentiality and
the use of information they provide. They should know that any information they provide is on
record. All the information sought needs to be related to the legal question. Information sought
from other sources need to be reviewed by the examiner before passing it on to attorney.
There is difference in opinion of whether the information should be reviewed prior to
the interview or not? Going through the data prior to interview helps the interviewer to ask
related questions and not brag around the unwanted information, yet this data reviewing can
also bias the interviewer. Whether before or after the interview, collateral data can help the
evaluator view various aspects of the case. All the data taken from collateral sources need to be
mentioned in the report with complete data of source, which might be helpful in future.
Interview by Other Mental Health Professionals - when working with other professionals
general reliability of the source needs to be checked whether it can be used in this case or more
information is required to make any conclusions.
Additional Sources – Other additional sources that can be reviewed are social
networking and social media accounts of the evaluee. Retaining party can be asked for the
data; in some cases they provide social data with other documents as well.
Criminal Assessments – Criminal assessments of a pre convicted individual can be used
for the assessment to better understand the conduct. This data is used only when required like
criminal assessments are not required when assessing the competence to stand trial. The data
can also be used to know whether the evaluee understands the allegations posed on him.
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With documents the officers can also be contacted to provide details of the event and
conduct of the alleged individual. When interviewing police officers it should be made sure that
they understand the confidentiality and that the information can be shared in open court. The
officers might not be able to recall details of regular events and any information shared will be
in lay terms so the professional needs to convert to professional numbers.
Civil Assessments – In civil assessments the data can be gathered through personnel file
and job description. Computer records and personal notes can also be reviewed for further
information. After wards the interviewee is interrogated with a specific set of prepared
5.4: The Interview
Physical Setting – the place of conducting interview can vary with each case from
attorney’s office to correctional facility. Availability of certain things need to be made sure of
before the interview like, lightening, comfortable room temperature, seating arrangement, a
desk or table for the evaluator, safety measures for the evaluator, means to maintain privacy of
the evaluee and evaluator and arrangement and permission for any instrument for recording
audio or video. In case of presence of third party for any reason i.e. safety of evaluator from
any litigation of misbehavior, relative of the evaluee or for study purpose, the confidentiality
needs to be ascertained.
Interview Style – There are two major interviewing styles one involves asking the general
questions first and more specific and case related later, the other style involves the specific
ones earlier than general ones. The earlier mentioned style is good for rapport building and
later one is useful when there is shortage of time or the evaluee is probable not to cooperate
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long enough, or get emotional. The questions usually asked are open ended and not leading,
giving evaluator good opportunity to explore and understand the evaluee. A skeptical approach
is taken in the interview while being nonjudgmental and unbiased. Appelbaum proposes
‘forensic empathy’ to be included in the interview, which is the awareness of perspectives and
experiences of the interviewees. This has also been called ‘receptive empathy’ by Shuman,
while proposing ‘reflective empathy’ commonly used in clinical setups involving communication
by understanding and interpreting the interviewee. Sometimes the interviewer develops
emotional arousal like secondary PTSD, or over immersion in the interviewee’s world, such
arousal is example of countertransference that the evaluator needs to take care of while
conducting interview. While interviewing about the symptoms the questions might get a bit
leading at this stage the evaluator must consider carefully addition of symptoms reported by
the evaluee.
Recording – With detailed notes some evaluators prefer having audio and/ or video
recordings. It is important that the evaluee acknowledges being video or audio taped and
arrangements can be done. In case the attorney asks for those tapes it is mandated for the
evaluator to provide them. Video recordings of child abuse cases are preferred so that the child
is not required to go through the interviewing process again and again. These recordings can
also be used as evidence in case of litigation of inappropriate behavior. If the evaluee wishes to
record the interview the evaluator must do it as well. Any recording should not be discarded in
while the case is still open, and needs to stay in archives as per the laws of jurisdiction.
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5.5: Assessment without Interview
In case the interview is not permitted or possible and the assessment is based
completely on video recordings or prior taken information, it needs to be mentioned in the
report as a limitation.
Chapter 6: Assessment Content
6.1: Introduction
Psychiatric assessment can be required in both civil and criminal case, from assessing
risk of crime to giving appropriate punishment. In both criminal and civil cases it is important to
determine how the crime is being defined in that situation, and familiarize oneself with relevant
laws. In civil cases the civil procedure code is applied, and a declaration outline needs to be
prepared for the forensic assessment of the individual who filed the case.
6.2: Information Gathering
Psychiatric History – First it is determined if the evaluee had any previous record of
psychiatric illness. Then its relation to the psycho legal matters needs to be understood. A
psychiatric history includes onset, duration and severity of symptoms, any treatment received,
response to the treatment and chances for future improvement (prognosis). Any symptoms
that might have been overlooked need to be catered too like anxiety and depression. First
episode of psychiatric illnesses are also reported in forensic settings.
Personal History – Personal history obtained in forensic setting includes intellectual,
developmental, physical or neurological disability, prenatal, perinatal or neonatal illnesses,
achievement of developmental milestones during childhood and adolescents, Origin of family
including parents and siblings, educational history including academic performance and highest
The Forensic Assessment
level of education achieved, work history including job changes, performance rating and
relationship with supervisors and colleagues, financial status, current living arrangement,
Previous Trauma – Previous experience of trauma, neglect and victimization can cause a
person to be vulnerable towards exploitation and criminal behavior. This information can be
used for treatment, risk assessment and intervention planning. Information related to previous
traumatic experience can be collected and verified through collateral sources.
Medical History – Medical history involves any serious illnesses, operations, use of
psychotropic medications and current drug use. In case of assessment for fitness to duty,
medical history can play an important role. In some cases physical issues such as diabetes and
brain injury can produce psychological symptoms. Such factors need to be studied in depth in
case of impulsivity, violence or sexually anomalous behavior.
Family History – Family history involves all those aspects that influence the evaluee,
here general information of the family like name, age, occupation, alive or dead, any physical or
psychological illnesses that have occurred, relationship of evaluee with family members and
drug use in family are taken into consideration. This history can help in identifying the
susceptibility inducing factor. It is important to rule out the possibility of mimicking substances.
For this collateral sources can be very helpful.
In medical malpractice cases, it needs to be made sure that the history was taken
completely and no aspects are left out by the physician.
Substance Use – Substance use history of the evaluee involves type of drugs used, first
use, daily dosage, symptoms, signs and severity and any treatment (if received), treatment
response etc. Aside from asking drugs use of medications for health maintenance can be asked.
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For substance use information depending only on evaluee’s information is not recommended,
use of collateral sources like friends, pharmaceutical records and treatment records is
Information Gathering in Criminal Cases – When working on criminal case, the personal,
health, developmental and social problems that the evaluee experienced should be noted.
Experiences involving parental neglect, childhood bullying, traumatic head injury, family
violence, financial issues etc. all experiences relevant to the case are noted. The interview
should be conducted as soon as possible, as to assess mental health closer to the alleged crime
scene. There are two approaches when conducting criminal interviews, first involves having a
full account of incident followed by probing for details, consistencies and contradictions, the
other approach takes cursory information first followed by some questions and then full
detailed account of the event. It is suggested to not ask leading questions especially in case of
children and people with intellectual disabilities as it can induce suggestibility.
Aid in Sentencing Evaluations – Forensic Psychological Assessment is done to assess
whether the environment in jails would be helpful for the evaluee or might aggravate
symptoms, also the risk for future offending is checked for the proceedings. An evaluator is not
qualified to give any suggestion regarding the sentence duration and type.
Death Penalty – Assessment of death row inmates is something not many professionals
would be willing to do. Such an assessment involves checking the understanding of evaluee
regarding the conducted crime, why it is wrong and what punishment they are to be given, it is
considered inappropriate to give capital punishment to the ones who do not have any idea of
their crime. It is important to know if there was any psychiatric illness history before punishing
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the individual. Sometimes jury also asks for any history of parental neglect, abuse or any other
social developmental issue.
Information Gathering in Civil Assessments – Personal, professional and history of
trauma are considered important in such cases. In case where someone else can testify the
information provided by the evaluee, collateral sources are sought, and their testimony is taken
after mental health examination.
Personal Injury – Details of injury by plaintiff are necessary to begin the work on; these
details include precipitating factors, time course, duration and amount of exposure and the
evaluee’s thoughts and processes before, during and immediately after the traumatic incident.
Collateral information from significant others, family and witnesses of the event can be taken to
validate the information provided. Immediate, middle term and long term influences of the
event can be checked. For claimed psychological disturbance, psychiatric, medical and
newspaper records can be gone through. Evaluations of evaluee’s social functioning before and
after the trauma are important for accurate assessment of emotional damage, while it is also
important to rule out other possible stressors that might have caused the disturbance. Detailed
occupational history has its own place in determining the effects of alleged trauma on work life.
Disability and Fitness for Duty Assessment – When assessing for fitness-for- duty
physical, educational and occupational history are important. Evaluator also needs to assess if
the evaluee has been sent reasonably by going through the profiles of previous workers and
any disability claims if made, length of time out of work and accommodation provided. Military
or juvenile record of the evaluee needs to be checked for violence risk assessment.
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Medical Malpractice or Negligence – A medical claim is supposed to have all these
features to build a case on: duty to the patient, dereliction of the duty, directly done and
damage to the plaintiff.
Assessment of Specific Civil Competence – Assessment of the awareness of issue,
understanding of facts related to issues, likely consequences, ability to manipulate, ability to
function in one’s environment and to perform required tasks are done in civil competence
assessment protocol. Other assessments may involve consent to treatment, guardianship
evaluations, testamentary capacity, financial competence and competence to enter a contract.
For assessing the competence of financial management one’s financial situation is assessed.
While assessing competence it is important to make sure that there is no undue influence on
the evaluee.
6.3: Mental Status Examination
Mental status examination involves direct assessment of thoughts and other
psychological processes to determine if there are any influences of psychiatric illness. To check
if there is malingering, the inconsistencies between reporting and behavior patterns are
evaluated. Collateral information can be sought from hospital records and interviews of
Chapter 7: Diagnosis
It is recommended to make a DSM-5 diagnosis, but depending on it alone for legal
decision can be hazardous. Other functional assessments need to be done as well as reported.
For competence assessment, functioning level is more important than DSM diagnosis. In case of
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insufficient information a differential diagnosis should be provided with reasons mentioned in
the report.
Chapter 8: Adjunctive Tests and Forensic Assessment Instruments
8.1: Introduction
When conducting an assessment it is highly recommended to use multiple tests as no
test is completely accurate. And the evaluator should not stick to a specific tool but decide for
each case and evaluee, which test would be best, since we have multiple tools for measuring a
single characteristic differing in their target population.
8.2: Psychological Testing
Psychological testing needs to be done by a trained evaluator while adhering to the
rules of use. The test must be used with similar population as test sample. The evaluation needs
to revolve around the forensic question. Major issues for which testing is done are malingering,
simulation, dissimulation and potential deception. Psychological tests help quantify the
measurements of change. Reliability and Validity of the tests provides some measure of
objectivity to the test.
8.3: Actuarial Tests and Structured Professional Judgment
Actuarial tests are mostly used in insurance companies; it gives probabilistic value of
large groups. Since these tests do not give indication of the guilt, risk or innocence of an
individual, when using an actuarial test it is suggested to make sure that the evaluee is very
much similar to the sample population of the test. Peer reviewed literature can be used to
understand applicability, reliability and validity of these tests.
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Based on the limitations of actuarial tests, structured professional judgment tools have
been made, these tools assess the risk of an individual towards criminal behaviors ranging from
low – moderate – high. For any kind of testing it is not suggestible to depend solely on web
based tools, one should get trained to use those tests.
8.4: Physical Examination
Although a psychiatric has knowledge of physical examination, it is done by general
physicians but the psychiatrist can ask for further testing in case of suspicion of some medical
issue of the evaluee.
8.5: Clinical Testing and Imaging
A psychiatric also needs to have basic knowledge of neuroimaging tests, their
applicability and limitations. Neuroimaging is gaining popularity now a day for its objectivity
and accuracy.
8.6: Penile Plethysmography and Visual Reaction Time Screening
Penile Plethysmography (PPG) and Visual Reaction Time (VRT) screening is done to
explore the sexual interests of an individual. PPG is used with males, and its accuracy has been
evident in many cases. VRT is easier to administer but has some drawbacks that it can be
manipulated by the evaluee, responses can be affected by medications or eye movement
Chapter 9: Opinions
When all the available information is gathered the evaluator develops an opinion and
reports it. In case of insufficient information to have a reliable opinion it is suggested to inform
the referral party before any further proceedings. Many professionals prefer to mention that
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the report is based on the available information and any changes or addition of information
might need reassessment. While it is not suggested to give preliminary report sometimes the
referral party may ask for it.
9.1: Nature of Psychic Harm
In some case of alleged psychological harm, the evaluator should just work on
answering the forensic questions presented. Special attention should be paid to the pre-existing
conditions, somatization, diagnosable personality disorder and malingering. Sometimes the
individual might already have started developing the disorder prior to the event, sometimes
individual is already predisposed to an illness that got triggered by the traumatic event. The
evaluator must keep all such possibilities in mind and have an objective approach to conduct in
depth assessment. If pre-existing illness has gotten worse as a result of the event, there needs
to be some solid evidence to prove so.
9.2: Disability
For a disability claim, it is important first to determine if there is any psychological
impairment, if yes, at what degree does it influence the work efficacy of the individual.
American Medical Associations guide to Evaluation of Permanent Impairment can be used for
this purpose. Usually in such cases the evaluator is provided with a list of questions to be
answered, most of which revolve around the mental health of the evaluee and its impact on
work. It is also important to determine how long the impairment will last and if it is permanent
or temporary. In case of same occupation policy, it should be seen whether the individual will
be restricted from work or will face limitations.
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Sometimes the evaluator might be asked for suggestion about applicable treatments.
Issue of malingering in such cases is dealt by going through previous job records and attitude
towards work.
9.3: Fitness for Duty
When reporting the fitness of an individual to work and perform the required tasks, the
result can vary from being completely fit to not currently fit but will soon be to Nothing can be
accurately said prior to further assessment to permanently unable. When the individual is not
currently fit, the evaluator needs to provide a probable time for the recovery.
9.4: Prognosis
Prognosis of any illness or disability is important to make any decision, prognosis
depends on the adherence to the treatment, chances of relapse and social support.
9.5: Treatment Recommendations
Evaluator should assess the treatments evaluee received prior to the assessment to
check the adherence, effects of treatment etc. This will help evaluator to give
recommendations for future treatment, such suggestions should always be based on evidence
and while making sure of the availability of the service to the evaluee.
Chapter 10: Special Issues
10.1: Challenging Assessments
Characteristics and mental health status of the evaluee can sometimes produce
challenges in forensic assessment.
Psychotic Evaluees – In case of psychotic evaluees the assessment of past is more
complicated compared to present, that is why it is recommended to have assessment as soon
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as possible. Interview room should be set carefully in order to prevent any harm to the
evaluator. Delusional evaluees can provide evidences and convince evaluator of their believed
story while a paranoid person will resort from sharing information. When doing assessment of
current status of the evaluee follow ups may be required. Current mental status of the evaluee
is important in building opinion and taking decision by jury. Although the evaluator is a mental
health professional and may have expertise in treatment, it is not suggestible to do any sort of
intervention unless there is no other option.
Aggressive Evaluees – It is not unusual to be confronted with an aggressive evaluee. The
most common cause of this aggressiveness is the psychosis or some unfulfilled demand. When
dealing with such people some arrangements like notification to security personnel. Informing
colleagues and careful confrontation are preferred. Prior anticipation of violence risk can help
prepare accordingly, this assessment is done by reviewing the psychological, clinical and
violence history of the evaluee. There are some techniques to ensure safety, these include,
dealing with the evaluee with respect and empathy, having easy access to the door, evaluators
self-awareness of current emotions to prohibit counter transference. In case of counter
transference the evaluator needs to close the interview and prepare for the preventive
measures for the next interview. In case of assault, before filing any complaint the evaluator
should discuss it with other professionals, retaining authority legal or administrative staff.
Uncooperative Evaluees – An evaluator can be faced with the situation when evaluee
refuses to participate in the assessment, in such instances evaluator needs to determine if this
refusal is competent or purposeful. In case when the refusal is competent with complete
knowledge of assessment, the assessor needs to inform to the referral party or judge. And
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further analysis is carried out by collateral data, with all the prospective limitations mentioned
in the report. Presence of attorney or consultant can facilitate participation but law should be
considered before taking the step. If possible, eye contact of evaluee with the evaluator should
be reduced so that the evaluee is not in any way influenced by the body language of the
evaluator. Possibility of dissimulation should be checked as well.
Mute Evaluees – Prior to assessing mute evaluees it is important to determine their
cause of mutism (congenital, neurological acquired aphasic, catatonic, conversion or selective)
for that consultation from other professionals can be sought. Assessing the congenitally mute
evaluees requires the client to be able to communicate in sign language. Careful observations,
previous records and collateral information is sought for the assessment. Differentiating
between malingering and conversion requires history to be sought. Malingers have a history of
antisocial behaviors while conversion is the result of distress and has various other symptoms
as well.
10.2: Child and Adolescents Forensic Assessment
Some aspects need to be taken care of while dealing with children and adolescents.
Informed Consent – For minors the consent of participation is taken from parents or
legal guardians. In some cases such as emancipation and waive to adult criminal court, the can
give consent himself. Even if the consent is taken from guardians, children need to be informed
about the reason they are being assessed and confidentiality without asking for their reply. In
instances when this information can make child suggestible or provide some particular sort of
information, reason for assessment is not shared. There are some ethical issues to be
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considered, firstly the interests of child and the referral party may vary and secondly, the child
may get attached to the evaluator.
Observation by Others – Any form of third party observation is not recommended, it is
allowed only when the child feels anxious when separated from known adult. If necessary for
someone to observe, the individual should not be visible to the child.
Collateral Interviews and Information – As children are unable to provide details of
event, collateral information form parents need to be sought, if parents do not assent to give
information, other sources should be looked for like school for educational records.
Interviewing Style – Interviewing style with children is different from adults as they are
more suggestible. One should get trained before assessing children.
Published Standards for Child Abuse and Child Custody Assessments – There are
different standards of dealing with children, so one should follow the required protocols in the
jurisdiction. Child protection should be provided when necessary.
Civil Litigation Involving Children and Adolescents – When assessing the emotional
trauma experienced by the child, it is important to know if a physical or mental harm led to the
damage. In cases to negligence the 4D’s of malpractice need to be established. When the mode
of death is not certain, psychological autopsy may be requested. Special educational
assessments may also be requested to resolve disagreements between parents and school.
Child custody assessments are required mostly to determine the best possible guardian.
10.3: Assessments of Persons with Intellectual Disability
Assessment needs to be adapted to meet the level of an intellectually disabled evaluee.
Evaluator needs to consider laws when dealing with ID individuals.
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Nomenclature – Earlier used term of ‘Mentally Retarded’ has been replaced by
‘Intellectually Disabled’ in DSM-5.
Conducting the Assessment – There are certain strategies that can help in doing an
accurate assessment. Firstly, the location of interview should be quiet and has least possible
distractions. Secondly, any information provided by the evaluee should be matched with
collateral data. Thirdly, Family or familiar staff should be included in the first interview to have
accurate history but are not recommended for further assessment. Some ID individuals are not
able to understand the dynamics and give consent for the assessment, in such instances the
consent is taken from the guardian.
Direct Observation of Behavior – Observation of direct behavior in everyday life can
provide handful of valuable information.
Complications in Assessment – Dual Diagnosis (having some other mental disorder with
ID) needs careful assessment. Malingering and dissimulation are commonly observed, so such
possibilities need to be removed before confirming the diagnosis. Level of functioning and
history can be compared with information from family and friends.
Degree of Suspicion about Intellectual Disability – Even the slightest suspicion about
intellectually should be catered before completion of assessment.
Evaluator Bias – Evaluator bias can result from prior expectations or pressure from the
referral party. To prevent this biasness the evaluator needs to have understanding of the
irritability, disruptive behaviors, vulnerability to stress and inadaptability to social changes, and
such issues can increase the requirement of adequate psychological assessment.
10.4: Cultural Factors in Forensic Evaluations
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Contextualizing Culture, Race, and Ethnicity in Forensic Assessments – Understanding of the
evaluees cultural context can help individual better understand their mental health and overall
Disparities in Diagnosis – Preconceived notions about a particular group can hinder the
objectivity of assessment and may result in misdiagnosis and faulty treatment plan.
Culture as Part of Formulation – Culture formulates the thinking and living style of any
individual, understanding of culture can help find the rationalizations of the evaluee behind certain
actions, and thus in determining appropriate punishment or rehabilitation.
Cultural Identity – There are different cultural ways of living, one thing that is appreciated in one
culture might be a sign of dishonor in other culture, thus when assessing an individual their cultural and
religious background needs to be addressed as well. And it should also be noted that people hold
different views about mental disorders in different cultures.
Culture and Diagnosis – Disorders are experienced and expressed differently in different
cultures. There are certain culture bound disorders that can be diagnosed in a particular culture.
Language Issues – Evaluee should be interviewed in their native language or bilingually, in case
there is and translator working s a moderator, that individual shoud be asked to translate the verbatim
word by word.
Culture, Psychological Testing, and Mental Status Examination – Psychological tests being used
for the assessment should be culturally appropriate. Influence of culture of test scores should be
considered and norms should be evaluated for that particular culture. Even the formal mental
assessment should be adaptable to cultural veracity. Not only sociocultural but religious affiliation also
influences the ways of expression.
Culture in Specific Types of Assessments – Regardless of the type of assessment and evaluator
needs to be considerate of the cultural variations and possible biases, to have an accurate assessment.
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10.5 Malingering and Dissimulation
Malingering remains a major issue in psychiatric assessment, with neurotechnology still unable
to detect malingering, its detection remains a major skill for mental health professionals.
Malingering – Malingering is the conscious faking of symptoms. It is usually motivated by either
avoidance of some undesired event or punishment, or to gain some kind of compensation or
Clinical Indicators of Malingering – The indicators include slow answering, incomplete
knowledge, overacting of symptoms, inconsistency in symptoms, mixed presentation of symptoms, noncooperative, hesitant and hostile when confronted.
Comprehensive Malingering Assessment – When detecting malingering an interview can give a
good deal of information. Different psychological tests can be used for malingering; these include Test of
Memory Malingering (TOMM), best suitable for evaluees with ID. Structured Interview of Reported
Symptoms 2nd Edition (SIRS-2), Minnesota Multiphasic Personality Inventory (MMPI-2) and Miller
Forensic Assessment of Symptoms Test (M-FAST) are also used to detect feigning.
Malingered Posttraumatic Stress Disorder – PTSD is more easily feigned than other disorders,
usual trauma measuring tools are not much useful to detect malingering, for this purpose MMPI-2 and
Personality Assessment Inventory (PAI) are used. While interviewing open ended questions should be
asked before providing the checklist.
Clinical Assessment of Malingering in Criminal Defendants – Before interviewing the evaluator
should go through the crime data and defendant’s profile, for questioning the evaluee. It is rare but
sometimes the perpetrator may get traumatized as a result of violence, resulting in loss of event related
memory. A crime without any motive is more likely to be the result of some mental disturbance. Those
evaluees who malinger symptoms usually have history of violence and anti-social behaviors and also
show double denial, first from committing the crime and then attaching crime to the mental issue.
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Dissimulation – Although dissimulation is relatively rare in criminal cases, yet the professional
needs to be aware of it.
Chapter 11: Risk Assessment
11.1 Introduction
Risk assessment is an important area of forensic assessment. APA has published psychiatric
violence risk assessment document for guidance of practitioners assessing the risk of violence. It is
helpful in determining the probability of the individual to act in a certain way. These assessments
involve inquiring what can happen, in what situation and how long.
11.2 Ethics
A forensic psychiatric has its duty first towards court and society and then towards the client,
even if it means prolonging the tenure of punishment due to potential risk of harm.
11.3 Conducting the Evaluation and Writing the Report
An evaluation should be as complete as possible in the given circumstances. One on one
interview with the evaluee is sometimes not possible which should be mentioned in the report with
probable shortcoming of the evaluation due to lack of interview. A report should also include potential
risk, with factors that can exacerbate or mitigate those risks.
11.4 Risk Assessment for Sexual Offenses
Usually the sex offenders respond with denial, defensiveness and minimization of their actions.
Risk assessment involves sexual history including sexual orientation, gender identity, sexual dysfunction
and any sexually transmitted disease experienced, social history including formation and maintenance of
relationships, substance use and medical assessment of thyroid, sex hormones and diabetes.
Chapter 12: Conclusion
This guideline provides basic information a beginner needs to understand how
assessment work and learn current trends in this area. It promotes having skeptical view
The Forensic Assessment
towards different things. It provides an overview of processes and considerations in doing
assessment with latest research at hand.