Quality of criminal responsibility reports submitted to the Hawaii judiciary

This paper is the third in a series of research reports on quality of forensic mental health evaluations submitted to the Hawaii judiciary. Previous studies examined quality of reports assessing competency to stand trial (CST) and post-acquittal conditional release, in felony defendants undergoing court-ordered examinations. Utilizing a 44-item quality coding instrument, this study examined quality of criminal responsibility reports in a sample of 150 forensic mental health evaluations conducted between 2006 and 2010 by court-appointed panels. Raters attained high levels of agreement in training and quality coding. Similar to the previous studies, overall quality of reports was mediocre, falling below the .80 quality criterion score for report elements, regardless of evaluator professional identification or employment status. Level of agreement between evaluators and judicial sanity determinations was “fair” using Cicchetti's (1994) standards for interpretation of intra-class correlations. Level of agreement was lower than previously published findings for CST reports and better than conditional release reports. Reasons for mediocre report quality and “fair” inter-rater agreement are discussed, including the fact that criminal responsibility evaluations are complex, retrospective in nature, and involve significant degrees of inference. In contrast to CST evaluations, assessment of criminal responsibility involves a mental state at the time of the offense evaluation. Threats to reliability in forensic reports are discussed. Suggestions for improvement of report quality are proffered, including standardization of procedures and report format and use of forensic assessment instruments.     

Abstracting data from medical examiner/coroner reports: concordance among abstractors and implications for data reporting

The purpose of this study was two-pronged: 1) to determine the level of concordance (agreement) between multiple records abstractors who extracted defined data elements from printed medical examiner/coroner (ME/C) death investigation records; and 2) to identify data items for which improved reporting could facilitate the effective use of ME/C reports and data. Four hundred ninety four printed death investigation records were obtained from 224 medical examiner/coroner offices throughout the United States. Trained abstractors were asked to extract information for 110 data elements from investigative reports. Additional data elements for each toxicology workup were abstracted from toxicology laboratory reports and six-digit AIS codes were also abstracted for each injury as described in autopsy reports. The ability of multiple abstractors to identify each data element and identically abstract the data was assessed using Kappa statistical methods. Level of agreement for many data elements was very good (>0.9), but for some data elements agreement was marginal to poor, especially for items related to toxicology, the nature of specific injuries, and dates, times of the occurrence of death and injury. Many data items can be easily abstracted from ME/C records. However, some data items seem difficult to abstract reliably in all cases. Standardizing the report formats used by ME/Cs and/or standardizing the electronic storage of ME/C data would make the abstraction of such data easier and improve the usefulness of ME/C data.     

Presentence Reports

This study investigated the use made by judges of background information provided in presentence reports in reaching their sentencing decisions. The presentence reports were furnished in a number of modified forms during an experimental manipulation in a real-life setting. By obtaining judges' provisional decisions during their reading of the report, along with their indications of what they found useful, the influence of different sections of information in the report was determined. All sections. were used by judges to some extent. The recommendation section was analyzed in some detail; while there was high agreement between the probation officer's recommendation and the judge's final disposal, judges tended to rate the recommedation low in terms of usefulness. However, analysis of changes to intended disposals, which occurred during reading of the reports, indicated that these recommendations were in fact quite influential, and even when there was not perfect agreement the recommendation produced a high frequency of shifts in the final disposal, bringing it closer to the recommendation than a preliminary decision had been. Reasons for these inconsistencies are considered in terms of the different methods used.     

The Views of Psychologists,Lawyers, and Judges on Key Components and the Quality of Child Custody Evaluations in Australia

This study aimed to understand the expectations of and the agreement between professional groups regarding the quality of single‐expert reports written by psychologists (known as child custody evaluations in the United States). 13 psychologists, 18 family lawyers, 26 children's lawyers, and 8 judges (N = 65) in New South Wales, Australia, rated the overall quality of reports and the quality of various components of them. Interprofessional congruence on importance ratings allowed key components to be derived. The results revealed that the overall quality of reports was rated positively, however, significant discrepancies were found between importance and quality ratings on the various components, indicating that reports fall short of expectations in many areas.     

Coroners' autopsies: quality concerns in the United Kingdom

Safety in health care has increasingly become a key focus of health care providers. Data on "patient outcomes" and evidence-based clinical decision-making have led to real changes in health care policy and care provision. Specialist groups such as the National Patient Safety Agency which operates the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) in the United Kingdom are reliant on good information in order to identify factors that lead to poor patient care. In a recent study the NCEPOD reviewed the quality of coroners' autopsy reports on which they rely for much of their core data. The study found that just over half of the reports (52%) were considered satisfactory by the reviewers, 19% were good and 4% were excellent. However, over a quarter of autopsies were marked as poor or of an unacceptable standard. While analysing the factors associated with poor-quality autopsies, comments and recommendations were made with regard to the processes of death investigation and the degree to which the coroner's death investigation meets the needs of health care services.     

The quality of written expert testimony in alleged child sexual abuse: An empirical study

Abstract

The purpose of this study was to empirically evaluate written expert testimonies in cases of suspected child sexual abuse in Sweden. A total of 121 expert testimonies were rated with an instrument developed for the study, the SQX-12 (Gumpert et al., 2001) which is a 12-item checklist aimed to reflect consensus-established concepts of quality. Reports from different professional groups were compared, as were reports produced before and after the 1991 publication of national guidelines. The results suggested that the reports produced by professionals using statement analysis generally were of higher quality than reports written by professionals from child- and adolescent psychiatry. There was a slight increase in report quality, as measured by the SQX total score, over the studied years. However, it is concluded that the overall quality of written expert testimony on child credibility still does not reach the recommended level in Sweden.     

Committee Inquiries in the Australian Parliament and their Influence on Government: Government Acceptance of Recommendations as a Measure of Parliamentary Performance

Committees in the Australian parliament often make recommendations to government and attempt to persuade the government to accept them. Using a sample of committee reports tabled between the 2001 and 2004 elections, this paper measures the government acceptance of committee recommendations as a proxy for committees' influence. On average, the government stated it accepted three majority recommendations out of 11 per report, although this figure drops to two and a half when viewed as recommendations implemented and not merely promised. The government accepted virtually no minority recommendations. The most important report characteristic is the extent to which it affects the government's reputation, but the breadth of political support that it can muster is also relevant.     

Associations between Parent and Child Reports Of Interparental Conflict/Violence And Child Difficulties in A Family Mediation Setting*

We examined the association between parents’ (N = 52 mothers and 52 fathers) and children's (N = 27) reports of interparental conflict and child difficulties in a family mediation setting. Parents’ reports of conflict were moderately associated with children's reports of exposure to parental conflict, but only fathers’ reports of conflict were associated with children's reports of negative responses to parent conflict. While mothers and fathers agreed on their child's difficulties, only mothers’, not fathers’, report of child difficulties were moderately related to child reports of child difficulties. Mothers’ and fathers’ reports of conflict generally were not strongly associated with reports of child difficulties. In contrast to parent reports, children's reports of exposure to parents’ conflict were moderately and significantly related to self‐reported child difficulties and moderately related to parents’ reports of child academic difficulties. The magnitude of the association between the child's report of interparental conflict and self‐report of difficulties was stronger than the association between parent report of conflict and parent report of child difficulties, suggesting that parents may not fully understand their child's exposure to parent conflict/violence or the problems their child is experiencing.

Key Points for the Family Court Community:
• Family law stakeholders prioritize the creation of parenting arrangements that are in the best interest of the child; however, it is unclear how to gather information about the child and the child's perspective in order to inform such arrangements.
• The study results suggest that parents may not agree with each other or with the child about important family issues, such as parent conflict and child difficulties. For example, parents may not fully understand their child's exposure to parental conflict/violence when in the midst of custody negotiations.
• More research is needed to determine the best method for gathering information about the child during custody proceedings. In the meantime, it is important to gather information from multiple sources and to consider the agreement and differences across such sources of information.

     

Analysis of Dental Case Reports in the Context of Court Decisions: Causal Nexus and Aspects of Fault

The purpose of expert reports is to support the judge in his decisions, by providing technical information. However, it remains uncertain as to what extent the content of these reports is used, and if they are effectively associated with judicial decisions. The aim of this study was to perform a qualitative analysis of case reports in relation to the judicial decisions rendered in association with these reports, by determining the connection between causal nexus and aspects of fault. The case reports included lawsuits against dentists, issued by the Medical Justice Department of the State Court of Appeals of Rio Grande do Sul, Brazil, between 2010 and 2013. Comparing the percentage of agreement between case report and judicial decision, causal nexus was 79.9% and fault was 86.7%. The high percentages of agreement found in relation to fault and causal nexus highlight the relevance of expert reports in weighing the judge's decision.     

Quality assurance in nuclear medicine facilities; availability of final recommendations--FDA. Notice

The Food and Drug Administration (FDA) is announcing the availability of final recommendations prepared by its Center for Devices and Radiological Health (CDRH) on quality assurance programs in nuclear medicine facilities. The final recommendations include the agency's rationale for the recommendations as well as references that can be used as well as references that can be used as guides in conducting quality control monitoring. These final recommendations are available as a technical report in CDRH's radiation recommendations series. They are intended to encourage and promote the development of voluntary quality assurance programs in nuclear medicine facilities.     

Déjà vu! The effect of previewing test items on the validity of the Concealed Information polygraph Test

Abstract

This research compares resident, peer and staff reports of bullying and victimization in one open facility and one secure facility for young offenders. The prevalence of bullies and victims was higher according to resident reports (self-reports) than according to peer or staff reports. There was significant agreement between residents, peers, and staff in identifying bullies and victims. The majority of bullies and victims identified by peers and/or staff were also identified by self-reports. Making the plausible assumption that bullies and victims tend to be concealed, it is concluded that self-reports (in the context of an individual interview) provide the most reliable and valid information about bullies and victims in young offender institutions. Hence, anti-bullying strategies should be based on self-report data.     

Clinical assessment and the detention, disposition, and treatment of emotionally disturbed delinquent youths

This study examines the relationship bbetween the traditional psychodiagnostic assessment-and-treatment recommendation process and the subsequent disposition, detention, and treatment of “emotionally disturbed” delinquent youths.Results revealed that a specially funded crisis unit was significantly faster than the regular clinic in completing the diagnostic-recommendation process. However, for youngsters in both groups, the mean time between the completed recommendation and final case disposition by the court was over fifty days! Compared with the regular clinic, the crisis unit made significantly more treatment recommendations favoring institutionalization and fewer recommendations for community-based treatment strategies. Contrary to the predicted outcome, however, fewer crisis unit recommendations were approved by the court. The trend was for the court to reject recommendations for institutionalization and to support requests for community-based approaches. Furthermore, and again opposite to the outcome predicted, crisis unit clients spent significantly more days in secure detention.Results of a follow-up study on the actual treatment of crisis unit clients revealed that only nineteen percent could be documented as having received part or all of recommended treatment plans. Furthermore, there was no evidence of improved client adjustment as a result of treatment efforts. It is concluded that a tremendous need exists for effective service accountability models and heuristic management strategies within our juvenile court-corrections systems lest we continue to do $5,000 worth of diagnosis for every $5.00 worth of successful treatment.     

Study of the correlation between psychiatric and psychological diagnoses in sample offenders

This study deals with the frequency with which expert psychiatrists and psychologists make structural or nosographic diagnoses within the context of expert assessment.Thus, the rates of concordance between psychiatrists and psychologists in both types of diagnoses will be assessed.To do so, the level of inter-observer agreement on diagnoses between 1990 and 2003 was studied retrospectively in France through psychiatric and psychological assessments of 505 male offenders. The assessment of the correlation rates was carried out using the Kappa coefficient.The results show a range of 0.55 to 0.71 in inter-observer (psychiatrists vs psychologists) agreement for structural diagnoses, and 0.51 to 0.89 for nosographic diagnoses.In addition, a marked correlation between psychiatrists and psychologists may be noted regarding abstention in both structural (k = 66) and nosographic (k = 73) diagnoses. In fact, recommendations are made for improvement in the consistency of offender assessment in the psycho-legal French context.     

Minimizing mistakes in clinical diagnosis.

It would be quite reasonable for us to expect the progress made in diagnostic technology to be accompanied by a parallel improvement in diagnostic accuracy. In reality, however, the frequency of misdiagnoses remains the same, despite the fast progress which has been made by medical technology in the last 30 years. Autopsy is the best source of information on diagnostic accuracy. According to one hypothesis, an increase in the number of autopsies performed and the follow-up on them could reduce the number of diagnostic mistakes. In recent times, however, the number of autopsies in comparison with the registered number of deaths has been declining steeply. We studied the autopsy reports for 1997, kept at the archive of the Institute for Forensic Medicine. We only took into account the deaths which occurred within 24 h of admittance to the emergency wards of the Ljubljana University Hospital, including those patients who died subsequently as a consequence of accident or injury. We also included cases of sudden deaths which occurred during operating or within 24 h after it. Following selection, we analyzed 444 out of the total of 921 autopsy reports, for each of which we carried out a comparison between the postmortem diagnosis and the clinical diagnosis, contained in the medical report on the death and the causes of death, which is modeled on WHO recommendations, i.e., the International Classification of Diseases (ICD), and in the medical documents, if any were submitted. Data are entered in these by using the ABC system where: A) direct cause of death, B) are circumstances that influenced the occurrence of death, and C) is original cause of death. The findings were then organized into five groups, depending on the degree to which the clinical diagnosis agreed with the postmortem diagnosis. The first group is comprised of the cases where the clinical and postmortem diagnoses agree completely; the second group is comprised of the cases of partial disagreement on the direct cause of death; the third group is comprised of the cases of disagreement on the original disease; the fourth group, of complete disagreement between the clinical and postmortem diagnoses. The fifth group is comprised of those cases where, under the ABC standards on the classification of diseases, injuries and causes of deaths as specified by the WHO, the documentation was incomplete. A complete agreement between the diagnoses was established in 48.87% of cases; partial disagreement in 22.74%; and total disagreement in 13.5%. 9.68% of cases were classified as falling into group 5. For the three diseases that are among the most common causes of death, we established the percentage of agreement, the percentage of overdiagnosis and the percentage of underdiagnosis. The most frequently underdiagnosed disease (in 61% of cases) was pulmonary thromboembolia; in 15% a thromboembolia was confirmed in autopsy. In 24%, a myocardial infarction was not diagnosed clinically and in 60% the clinical diagnosis of a myocardial infarction was confirmed in autopsy. In 33% a heart failure was not diagnosed during the clinical stages but only in autopsy, in 66% the clinical diagnosis of a heart failure was confirmed in autopsy.     

Agreement on intimate partner violence among a sample of blue-collar couples

This study assessed agreement level about the occurrence of past-year male-to-female partner violence (MFPV) and female-to-male partner violence (FMPV) among a sample of 897 blue-collar couples. Intimate partner violence (IPV) was measured with the Physical Assault subscale of the revised Conflict Tactics Scales (CTS2). Agreement level was assessed with Cohen's kappa statistic. Lower-bound estimates (based on couple agreement that an IPV event occurred) and upper-bound estimates (based on uncorroborated reports from either partner that an IPV event occurred) were calculated. Results indicated low agreement for most IPV behaviors (kappa < .40). Estimated lower- and upper-bound rates for MFPV were 6.7% and 21.2%, for FMPV, 7.1% and 24.2%, and for any IPV, 10.1% and 30.2%. Findings suggest that single-point IPV prevalence estimates are biased; lower- and upper-bound estimates using collateral reports should be calculated when possible. In addition, findings underscore the importance of conducting IPV research among understudied populations, such as working-class couples, that may be at elevated IPV risk.     

Inconsistencies in Mothers’ and Group Therapists’ Evaluations of Resilience in Preschool Children who Live in Households with Intimate Partner Violence

The association between mother-reported child adjustment problems and group therapists’ ratings of resilience was evaluated in preschool-aged children who reside in homes where intimate partner violence (IPV) is present. Multiple reporters’ evaluations of resilience were assessed to determine how young children display resilience at home and in treatment. Reporters were mothers and child therapists who evaluated resilience in 52 preschoolers who lived in households where IPV occurs. Group therapists’ ratings of resilience were negatively correlated with children’s externalizing behavior problems. Findings indicated poor rater agreement between mothers and group therapists on some aspects of resilience. Evaluations differed based on demographic factors, with the most variability in resilience by child age. Given the lack of research on this topic and the common practice of only one informant supplying most of the data used in studies of child functioning, the current study provides unique information by comparing multiple reports across settings.     

The enhanced cognitive interview: could individual differences in visuo-spatial working memory explain differences in recalling an event?

The Enhanced Cognitive Interview (ECI) is one of the most useful witness interviews, consisting of 5 techniques (context reinstatement: CR; report everything: RE, mental imagery: MI, change order: CO and change of perspectives: CP) aimed at increasing both the quantity and the quality of elements recalled. All the techniques require mental imagery skills. The present study investigates the relationship between forward and backward visuo-spatial working memory (VSWM) and correct elements recalled through the ECI with respect to its techniques. 99 college students (48 males) watched a color videotape of a fictional crime and performed a visuo-spatial working memory task. The following day they were interviewed about what they had seen. Results showed that high forward VSWM capacity has a role in favoring the total amount of correct information recalled, specifically in the MI technique. This suggests that maintaining and processing mood-related contents in VSWM is easier for individuals with high working memory skills.     

Mutual Recognition of the Food and Drug Administration and European Community Member State Conformity Assessment Procedures; pharmaceutical GMP inspection reports, medical device quality system evaluation reports, and certain medical device premarket evaluation reports--FDA. Proposed rule

The Food and Drug Administration (FDA) is proposing to amend its regulations pursuant to an international agreement that is expected to be concluded between the United States and the European Community (EC) (Ref. 1). Under the terms of that agreement, FDA may normally endorse good manufacturing practice (GMP) inspection reports for pharmaceuticals provided by equivalent EC Member State regulatory authorities and medical device quality system evaluation reports and certain medical device premarket evaluation reports provided by equivalent conformity assessment bodies. FDA is taking this action to enhance its ability to ensure the safety and efficacy of pharmaceuticals and medical devices through more efficient and effective utilization of its regulatory resources. The agency is requesting comments on the proposed rule.     

Incapacitation and imprisonment: prisoners' involvement in community-based crime

Abstract

The impact of incapacitation on prisoners' offending behaviour is a neglected area of research. The aim of this study was to examine the extent and nature of prisoners' involvement in community-based crime in the UK. Participants were selected from nine prisons in the UK and consisted of 360 prisoners, 81 females and 279 males. Offenders were interviewed to assess levels and forms of involvement in community-based crime and perceptions of other prisoners' involvement. Levels of prisonization and institutional and demographic characteristics were used to identify vulnerability to involvement in community-based crime. Twenty-five per cent of the sample admitted personal involvement and 63% reported other prisoners' involvement in a diverse range of crimes. Analyses revealed prisoners involved in community-based crime are likely to be young, male recidivists who hold prisonized attitudes. Prisoners who are white, prisonized and recidivist reported highest levels of other prisoners' involvement in community-based crime. No age or gender differences delineated prisoners' reports of others' involvement. The results show that incarcerating offenders may not prevent their involvement in community-based offending. Discussion centres on the characteristics of involved prisoners and considers the implications of the results for rehabilitation and penal policy.