Comparison of HoNOS and HoNOS-Secure in a forensic mental health hospital

The Health of the Nation Outcome Scale (HoNOS) is a widely used tool for monitoring consumer outcomes within mental health services. However, concern about its suitability in forensic mental health settings led to the development of a forensic version of this tool (HoNOS-Secure). To date, no direct comparison of these versions has appeared in the empirical literature. In the present study, a cohort of forensic mental health consumers was rated using the HoNOS and HoNOS-Secure. Pearson correlations were generated to compare the tools at a total score and item level. Logistic regression was employed to evaluate how well these tools categorise patients on a range of measurable outcomes. HoNOS scores were also compared against civil mental health consumers to evaluate differences between these populations. The HoNOS/HoNOS-Secure correlated strongly at the total score level, but demonstrated variable correlations at the item level. Logistic regression suggested that the HoNOS-Secure ‘clinical and social functioning scale’ adds little to the HoNOS in a forensic setting; however, the HoNOS-Secure ‘security scale’ added significant benefit to both versions. Results remained stable when re-evaluated over time. Forensic and civil mental health patients were found to demonstrate the same degree of psychopathology at the point of admission; however, they differed at review and discharge collection occasions. Implications for clinical practice and policy are explored.     

The use of the Personality Assessment Inventory (PAI) in assessing offenders

The intersection between the legal and mental health professions is sometimes marked by controversy, and the application of psychological assessments to forensic issues is no exception. However, the field of psychological assessment holds particular promise for clarifying decision making within the forensic arena, as it can bring a particularly well-established body of theory and data to bear upon clinical forensic practice. This article describes one psychometric instrument, the Personality Assessment Inventory, as an example of how particular assessment instruments can help inform this process.     

HCR-20 violence risk assessments as a guide for treating and managing violence risk in a forensic psychiatric setting

Abstract

Over the past decades there has been a vast development in the research into risk factors for violence and the development of risk assessment instruments. One instrument that has been given special attention is the HCR-20 violence risk assessment scheme. However, little attention has been paid to the clinical applicability of this tool, i.e. how does this assessment scheme perform when utilized in clinical practice as a tool to guide intervention and management in order to alleviate risk of violent behaviour? The present study was a true prospective study into the utilization of the HCR-20 as a clinical routine. Data on forensic psychiatric patients (n = 81) from a forensic unit in Denmark are presented. As part of a clinical routine all patients were assessed for risk of future violence utilizing the structured professional judgement model, the HCR-20. Outcome measures were aggressive episodes during hospitalization and new convictions post discharge. The predictive validity of the HCR-20 was lower compared with previous findings. It is argued that this does not necessarily indicate poor predictive accuracy of the HCR-20. Rather, it may indicate that the HCR-20 is suitable for guiding risk management in order to prevent violent behaviour.     

Sexual fantasies and sensation seeking among psychopathic sexual offenders

Abstract

This study investigated the relationship between psychopathy, sensation seeking behavior and sexual fantasies in a sample of 199 participants from a maximum security forensic hospital. Psychopathy, measured by the Psychopathy Checklist – Revised (PCL-R), and several sensation seeking and sexual fantasy measures were utilized. Results indicated that, in agreement with previous research, sexually deviant psychopaths are more likely to offend against adults than children. Likewise, psychopaths showed some tendency to score significantly higher on sexual sensation seeking measures than nonpsychopathic sexual offenders. Furthermore, a relationship between psychopathy and overall sexual fantasies existed but there were not specific patterns among psychopaths and nonpsychopaths with regard to specific categories of sexual fantasies.     

A brief measure of the triarchic model of psychopathy among community youths: psychometrics and measurement invariance

ABSTRACT

The development and validation of empirically sound measures that operationalize the Triarchic model of psychopathy among youth is currently in the nascent stage. The present study aimed to examine the psychometric properties of a brief refined measure of the Triarchic model of psychopathy based on the Youth Psychopathic Traits Inventory (YPI-Tri-S) among a mixed-gender school sample of 782 youth (M?=?15.87 years, SD?=?1.72) from Portugal. Confirmatory factor analysis offered support for the theoretically expected three-factor structure. Cross-gender measurement invariance using the present sample and cross-sample measurement invariance of the YPI-Tri-S using a previously collected forensic sample of institutionalized males was established. The YPI-Tri-S showed adequate psychometric properties in terms of discriminant validity, convergent validity, concurrent criterion-related validity, known-groups validity, and internal consistency. Findings indicate that YPI-Tri-S is a valuable brief and psychometrically reliable and valid self-report measure of the Triarchic model of psychopathy for use in diverse samples of youth.     

Learning from the love letters of erotomania

Objective: To examine whether the love letters of erotomania, have potential to assist in the clinical process of assessment.

Method: A series of illustrative love letters from case examples were selected. The characteristics of the conditional variants were embedded into an adaptation of the technique of forensic psycholinguistic analysis, with a focus on discernible psychopathology, and the likely meaning for the individual.

Conclusion: In all cases, analysis of the erotomanic love letter showed clear potential to be a significant augmenter in the process of clinical assessment. They should, therefore, be retained, reproduced and valued, rather than overlooked or discarded. This paper outlines a suggested approach to make the most of this valuable data source, including a clinical template which may be of assistance to other clinicians. This paper also serves as a general reminder of the ongoing need to recognise verbatim as of high clinical currency in forensic psychiatry.     

Outcome measurement in forensic mental health research: an evaluation

Abstract

Measuring change resulting from healthcare interventions is critical to evaluating their usefulness. The choice of outcome measure is an important part of such evaluations and is driven by assumptions about what is likely to change and how best to capture this. Despite its importance, forensic mental health has paid little attention to determining which are the best measures of outcome. This study used a panel of relevant professionals to (i) assess the relative importance of different areas of potential outcome measurement and (ii) evaluate specific instruments used currently as outcome measures in forensic mental health research. Although a wide range of potential outcomes were endorsed as appropriate, few corresponding instruments have been used consistently. Only three psychiatric instruments deemed by our panel as feasible, relevant and psychometrically adequate have been used in five or more studies (the Beck Depression Inventory; the Brief Psychiatric Rating Scale, and the Symptom Checklist-90–Revised). Significant measurement gaps were noted in areas such as social and emotional functioning. Although instruments exist that could capture most areas, none were sufficiently developed for routine use as outcomes. Further research to develop robust, sensitive and diverse outcome measures is needed. This is an essential precursor to extending the evidence base for forensic mental health interventions.     

The Treatment Engagement Rating scale (TER) for forensic outpatient treatment: Description,psychometric properties,and norms

Abstract

The Treatment Engagement Rating scale (TER) is a Dutch therapist rating instrument for treatment engagement (TE) of forensic outpatients. It yields scores for nine components of TE, which are aggregated in a total score. Following an analysis of the concept of TE, the TER is described, and various psychometric analyses of data from a forensic outpatient sample are reported. The nine component scores were found to constitute a homogeneous scale with good internal consistency (α=0.93, n=328) and adequate inter-rater reliability (intraclass correlation coefficient (ICC)=0.76, n=99). The validity of the TER is supported by correlations of 0.47, 0.66, and 0.91 (n=328) with measures for the motivation to engage in treatment. Applications for the TER in clinical practice and research are suggested.     

Criminal law and mentally ill offenders in comparative perspective

Abstract

In this stick we compare legal arrangements dealing with mentally disordered offenders in the criminal law systems ct Belgium, Canada, Germany, the Netherlands, Norway, Sweden, and the United Kingdom. To describe relevant diffesenoes and similarities in the arrangemeats, we used a checklist containing antral aspects of adjudication, assessment and treatment of mentally ill offenders. These aspects concern: (1) the legal classifications of mental illnesses that can lead to exclusion of criminal responsibility: (2) the acceptance of diminished capacity as a partial excuse; (3) the possibilities for imposing security measures of compulsory treatment instead of or next to criminal punishment; (4) the conditions for their imposition in terms of seriousness of crimes committed and dangerousness of offenders; (5) the available hospitals or special clinics for executing security measures; (6) the role and task of forensic mental health professionals in assessing the offender's state of mind and in advising compulsory treatment; (7) the rules for duration, prolongation and termination of the measures. The findings of this comparative analysis are evaluated in light of legal protection for mentally disordered offenders.     

The predictive and convergent validity of a psychometric battery used to assess sexual offenders in a treatment programme: an 18-year follow-up

Abstract

This study examined sex offender risk and treatment change based on a battery of psychometric assessment measures administered to 267 treated adult Canadian federal sex offenders followed up an average 18 years post release. Several significant pre–post changes that were frequently moderate in magnitude (d>.50) were observed across these measures. A factor analysis of the psychometric battery generated three broad need domains consistent with the extant literature that were labelled Socioemotional Functioning, Anger/Hostility, and Misogynist Attitudes. The three need domains and a Need Total, created by their summation, converged with the Violence Risk Scale—Sexual Offender version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon, 2003) in conceptually meaningful ways and predicted sexual and violent recidivism to varying degrees. Raw measurements of change obtained from pre-to posttreatment frequently bore weak and non-significant relationships to outcome. However, after creating standardised residual change scores to control for pre-treatment score, treatment changes in the individual measures, need domains and Need Total improved significantly in their prediction of reductions in general and sexual violence.     

Language Barriers in the Wisconsin Court System

Abstract

Over the years, reformers have tried to address the many challenges facing the American court system. However, there are still areas that not only need improving but also need immediate attention. In particular, equal access to the law is being denied to non-English speaking Latinos/as in our nation's courts due to poor (or lack of) interpretation. Given the fact that Latinos/as are now the nation's largest minority group, this matter is of utmost importance. The goal of this paper is to explore the matter in depth in Wisconsin, and to propose remedies to the existing shortcomings of court interpretation.     

Juvenile detention: The hidden closets revisited

This is the first national study of juvenile detention in more than a decade. The findings indicate that these facilities are undergoing a fundamental and substantial change. The consensus of professional opinion as well as recommendations from national standard-setting bodies indicate that juvenile detention centers should be reserved for those youth who present a clear and substantial threat to the community and who need to be confined until they appear in court. Now these facilities are assuming an added function by serving as short-term commitment options for juvenile court judges. In addition, the study found that the excessive use of detention continues to be a major problem.     

The 4 Ds of Forensic Mental Health Assessments of Personal Injury

The field of psychiatric/psychological injury and law concerns tort and other legal claims for injuries sustained in events at issue, such as in motor vehicle accidents (MVAs), worker compensation, or the veteran affairs (VA). The 4 Ds refer to the requirement that legal action in these types of cases can proceed when there is a duty, the duty has been discharged with dereliction, the resultant act has caused directly tortious harm, and damages are applicable. In contrast, the related 4 Cs refer to the conditions of effective forensic testimony. The principles of forensic mental health assessment (FMHA; Heilbrun et al., 2009) underscore the scientific requirements in forensic assessments, as do the American Psychological Association’s (APA, 2013) forensic specialty guidelines. For example, Brodsky’s maxims for effective work in court (Brodsky & Gutheil, 2016) cover a broad spectrum of ethical and practice guidelines for the profession. Similarly, Young (2016 a, b, c) has specified the parameters of admissible evidence in court, functioning ethically for the court, and the need to be comprehensive, scientifically informed, and impartial in forensic mental health assessments. All these sources lead to an integrated set of the principles for effective and ethical practice in the forensic arena of mental health work, referred here as the 4 Ds for the field of psychiatric/psychological injury and law. These revised 4 D principles involve Dignity, Distance, Data, and Determinations.     

Balancing power through law: The state v. the juvenile in delinquency proceedings

A content analysis of Maryland's juvenile court law spanning 1947–1978 posed two questions: (1) Had the state legislature redefined the juvenile court process in the matter of delinquency such that the juvenile received more power resources relative to those of the state? (2) Did the ratio of the state's and the juvenile's power resources diminish to the point of negligibility? Findings suggest that the court process may have been structurally revised without a significant change in the overall relationship of the parties in the process.     

How do psychiatric patients on prison healthcare centres differ from inpatients in secure psychiatric inpatient units?

Abstract

Mentally ill prisoners have consistently been highlighted as a group with complex needs. However, it is not clear what these needs are, how effective prison health services are in meeting the needs of this vulnerable group, and whether there would be any benefit to transferring them to psychiatric facilities. This study compared the characteristics and needs of mentally ill patients in prison healthcare centres (HCC prisoners) with patients in forensic medium secure psychiatric units (MSU inpatients) in the UK. HCC prisoners and MSU inpatients were in fact very similar. Where they did differ, though, was that MSU inpatients were significantly more likely to be of non-white ethnicity, diagnosed with psychotic or substance use disorders, and have recorded histories of drug misuse. HCC prisoners and MSU inpatients reported the same number of needs overall, according to the CANFOR-S (Camberwell Assessment of Need Forensic Short Version), but HCC prisoners reported significantly higher levels of unmet need. The need for transfer to alternative services was common in both groups, with bottlenecks evident at all levels. The high level of unmet need reported in the HCC prison sample is of particular clinical concern and highlights the need for improved assessment and treatment services in this setting.     

‘Our normal is different’: autistic adults’ experiences of the family courts

ABSTRACT

This article reports the findings of a small-scale qualitative study exploring the experiences of autistic adults who have had experience of the family justice system. While participants related some positive elements to their experiences, in particular with regard to the willingness of professionals to try to learn more about their clients’ needs, the overall picture showed significant concerns. The reports given showed significant misunderstandings about autism, and a system which struggled to make appropriate adjustments which would allow autistic court users to have access to justice on an equivalent basis to non-autistic litigants. This situation stands in contrast to the position regarding other disabilities in the Family Justice System, but also to the relatively greater level of provision for autistic people within the Criminal Justice System. Based on participants’ experiences and existing good practice in other areas, we make recommendations that could be adopted by the Family Court and practitioners.     

Decision-Making in court: Observing the sentencing of men and women

Abstract

Using systematic observation together with an analysis of the relevant court and criminal records this research examined the processing and sentencing of a small number of male and female defendants in an English magistrates' court. The findings indicate that sentencing was indirectly affected by a defendant's sex and directly affected by at least one aspect of a defendant's demeanour. These results provide support for the view that combining systematic observation with an analysis of court records offers a more effective means of investigating the differential treatment of male and female defendants than either unsystematic observational studies or the analysis of court records alone.     

Actuarial risk assessment and recidivism in a sample of UK intellectually disabled sexual offenders

Abstract

This study examines the effectiveness of three risk assessment instruments: Static-99, Risk Matrix 2000 (RM2000) and the Rapid Risk of Sex Offender Recidivism (RRASOR), in predicting sexual recidivism among 27 intellectually disabled sex offenders. The overall sexual offence reconviction rate was 30%, while non-recidivists remained offence-free over 76 months of follow-up. Static-99 presented as performing as well as guided clinical judgements in mainstream population studies [area under the curve (AUC)=0.64] exceeding the performance of RM2000 (AUC=0.58) in predicting sexual recidivism. However, the results were not statistically significant. In contrast to previous findings, the RRASOR presented the worst level of prediction (AUC=0.42). These results highlight the need to investigate further with larger sample sizes and in conjunction with more dynamic measures of risk. Proposed relevant factors are discussed in detail.     

Government and education news

Abstract

The issue of feedback to students on assessment has been identified by many law schools as an area of high priority. Feedback to students is a key component of quality assessment, student progression and the academic experience of students. However, provision of high quality feedback is also a workload factor for lecturers.

Kingston University and Nottingham Trent University both have identified assessment feedback as an action area in their respective Learning and Teaching Strategies. The learning and teaching co‐ordinators within the Law Schools of these two universities decided to collaborate on a survey of the feedback techniques and practices used.

This study was undertaken to explore strategies to sustain and strengthen the quality of feedback in the context of larger classes, increased student numbers and pressure on resources. The aim was to establish the range of feedback and practices used and to identify student and staff perceptions of existing assessment feedback practices. Using semi‐structured questionnaires, data was collected and analysed in terms of the extent to which assessment feedback was perceived as effective, the extent to which these findings were consistent with the literature and to make recommendations on how assessment feedback could be enhanced.

Findings showed that students clearly distinguished between different features of assessment feedback and evaluated these differently, that there was little consistency in the perceived experience of assessment feedback, and that feedback given often did not meet students’ expectations. Staff perceived that giving good feedback was important but that students seldom acted on feedback. Staff also reported that giving individual written feedback was their preferred method although this is one of the most time‐consuming methods. The conclusions of the study offered practical ways of improving the quality and effectiveness of assessment feedback by revisiting established assumptions about feedback and raising students’ awareness of the various sources, forms and functions of assessment feedback.

For staff, larger classes, increased student diversity and diminishing resources mean that staff will need to work smarter, with regard to providing effective assessment feedback, if there is to be a consistently better student experience of assessment feedback.