Effectiveness of modified therapeutic community treatment within a medium-secure service for personality-disordered offenders

There is debate as to whether secure hospital treatment for offenders with personality disorder can be effective relative to criminal justice interventions. This study examines the evidence for long-term treatment of such offenders in hospital within in a modified therapeutic community model including accredited offending behaviour programmes. A panel sample of 47 patients were followed up on measures of violence risk (HCR-20, VRS) and symptom severity (SCL90-R). Intention-to-treat analysis with reliability thresholds showed significant positive change between assessment and discharge in both violence risk (VRS) and symptoms (SCL90-R) indicating a positive treatment effect. Threshold effects for treatment effectiveness seemed to occur at 1?year of treatment for risk and 3?years for symptom reduction.     

Predicting the effect of substance abuse treatment on probationer recidivism

Support for the effectiveness of substance abuse treatment to reduce substance use and recidivism among populations supervised by the criminal justice system continues to grow in substance abuse and criminal justice literature. Recent studies show that a variety of programs including the Breaking the Cycle program and drug courts appear to result in improved outcomes for offenders. In this paper, we examine the effect of non-residential substance abuse treatment on arrest. Our data are for almost 134,000 ‘drug-involved’ individuals sentenced to probation in Florida between July 1995 and June 2000. Nearly 52,000 of these individuals received non-residential substance abuse treatment, while 81,797 did not. Our approach is a methodologically simple one that entails stratifying our data by treatment status, estimating logit and negative binomial models of arrest for each of the two datasets, and then applying each model to both datasets. This approach, which requires that both groups include subjects for whom treatment is appropriate, is analogous to using regression models to predict outcomes for new values of independent variables. For each observation in the dataset, we use the models to predict the expected outcomes for each individual under two scenarios – receiving non-residential treatment and receiving no treatment. Summing over these individual estimates provides an estimate of the total numbers of arrests that would be expected under different levels of population exposure to treatment. Results suggest that non-residential treatment reduced both the expected numbers of individuals who recidivated (i.e., were arrested) and the expected total numbers of arrests in the 12 and 24 months following placement on supervision.**RTI is an independent organization dedicated to conducting innovative, multidisciplinary research that improves the human condition.     

Evaluation of the assessment and treatment of a child sex offender: A case study

Abstract

There is indisputable necessity for engaging child sex offenders in effective therapy to reduce recidivist rates. However, it is becoming increasingly recognised that, to do this, more contemporary psychological methods of treatment are being utilised instead of, or as well as, imprisonment.

To establish what constitutes effective therapy requires the constant search for new and successful treatments. To achieve this, it is advantageous to follow preexisting successful methods of treatment but to acknowledge that therapy must be adapted according to an individual's unique presenting difficulties and therapeutic needs.

This paper details assessment techniques, evaluation of psychological dysfunctions, the therapy plan and treatment outcome of a convicted child sex offender. Specifically, Mr X's background history, psychological dysfunctions and progress, using a functional analysis approach, are examined in detail with critical review of the therapeutic intervention.     

An unusual case of accidental poisoning: fatal methadone inhalation

In this report, the authors present a case of unusual, accidental methadone intoxication in a 40-year-old man, who had inhaled methadone powder. The drug dealer was a pharmacy technician; methadone had been stolen from a pharmacy and sold as cocaine. After having inhaled methadone powder, he suffered cardiopulmonary arrest. He was admitted to hospital where he died after 24 h of intensive care. The autopsy revealed congestion of internal organs and cerebral and pulmonary edema. Microscopically, the heart showed no changes. The toxicological analyses performed on blood and urine taken at the hospital revealed methadone, cannabinoids, and ethanol. The blood methadone concentration was 290 μg/L. The urine methadone concentration was 160 μg/L. Midazolam and lidocaine, which were administered to the patient at the hospital, were also detected in the blood. The cause of death was determined to be methadone intoxication. The literature has been reviewed and discussed. To date, and to our knowledge, only very few cases of accidental death resulting from methadone inhalation have been described up to the case presented herein.     

Poisoning deaths in Central China (Hubei): A 10-year retrospective study of forensic autopsy cases

A retrospective study of autopsy cases was conducted at the Department of Forensic Medicine, Tongji Medical College (DFM-TMC), in Hubei, China to describe the characteristics of poisoning deaths from 1999 to 2008. A total of 212 poisoning deaths were investigated by DFM-TMC during the 10-year period. The poisoning deaths ranged from 17 cases in 1999 to 27 cases in 2008. Of the 212 cases, 82 deaths (38.7%) were from pesticides, 36 deaths (17.0%) from carbon monoxide, 34 deaths (16.0%) from drugs, 22 deaths (10.4%) from alcohol, 17 deaths (8.0%) from other chemicals, 15 deaths (7.1%) from poisonous plants and animals, and six deaths (2.8%) from heavy metals. Of the 82 pesticide poisoning deaths, 43 (52.4%) cases were caused by rodenticides, mainly tetramine (N = 39). The majority of poisoning deaths were accidents (63.7%), followed by suicides (25.9%) and homicides (3.8%). The manner of death could not be determined in 14 cases (6.6%).     

Malnutrition, a rare form of child abuse: diagnostic criteria

Infantile malnutrition is often difficult to diagnose as it is rarely observed in industrialized countries. It may be associated with physical violence or occur in isolation. The essential clinical sign is height and weight retardation, but malnutrition also causes a variety of internal and bone lesions, which lead to neuropsychological sequelae and death. We report a rare case of death by malnutrition in a female child aged 6 1/2 months. The infant presented height and weight growth retardation and internal lesions related to prolonged protein-energy malnutrition (fat and muscle wasting, thymic atrophy, liver steatosis) resulting in a picture of marasmus or kwashiorkor. We detail the positive and negative criteria that established the diagnosis of abuse, whereas the parents had claimed a simple dietary error.     

Domestic violence: A national study of the nature, size and effects of domestic violence in the Netherlands

This article reports on a large-scale nation-wide study conducted by Intomart among 1,000 randomly selected Dutch adults (male and female) about their experiences with domestic violence. An important goal of the survey was to generate general information on domestic violence. It turns out that nearly half of the Dutch population (45%) has at one time been a victim of some form of non-incidental domestic violence. It was also demonstrated that both men and women become victims of domestic violence, and the high percentages of victimization during childhood are particularly striking. Furthermore, it turned out that domestic violence often involves a combination of physical, mental and sexual forms of violence.     

Dental shape match rates in selected and orthodontically treated populations in New York State: a two-dimensional study

Forensically identifying a suspect's dentition from a bitemark in an open population requires the supposition that every person's dental alignment is different. There have been few studies that have tested this claim. Four hundred and ten lower anterior dentitions from a selected population and 110 lower anterior dentitions from one that was orthodontically treated were measured using geometric morphometric analysis, allowing comparison of arch shape. Dental match rates of 1.46% and 42.7% of individuals were found in the respective populations, given an established measurement error. Orthodontic treatment had a strong effect on match rate suggesting that treated or naturally well-aligned dentitions may be indistinguishable. Sexual dimorphism was found to be only slightly significant. Principal shape variation in both populations was degree of arch curvature. Results of studying these populations show that dental matches can occur, and that statements of certainty concerning individualization in such populations should be approached with caution.     

Partial bowel obstruction in a 2-month-old child. A delayed diagnosis of anal abuse

We present the case of an anal sexual abuse involving a 2-month-old boy, who was admitted to the Pediatric Surgery Unit of the University of Padua for low bowel obstruction. The infant had been already hospitalized for 3 days in a peripheral hospital and treated with daily rectal wash-outs for a fecaloma. Only after a careful interpretation of the plain abdominal radiograph, along with the performance of a rectoscopy and a laparotomy, a vegetable foreign body (about 3 cm in diameter and 7 cm in length) was discovered in the sigma. The morphology and dimensions of the foreign body, as well as its location, left no doubt about the etiology of the partial bowel obstruction, proving that it was clearly related to an anal sexual abuse.     

Mentalisation-based therapy (MBT) in a high-secure hospital setting: expert by experience feedback on participation

Evidence for mentalisation-based therapy (MBT) is increasing in relation to the treatment of personality disorder. Individuals with personality disorder are over-represented in inpatient, forensic and forensic inpatient mental health services. This study explores MBT within a forensic setting as an intervention designed to moderate deficits linked to violence and to improve adaptive coping. Interpretative phenomenological analysis was conducted on interviews with four patients who completed MBT at a high-secure hospital. Findings suggest that MBT-enhanced participants’ mentalising which had a positive impact upon their capacity to manage their behaviour and emotions. MBT further enabled participants to process past experiences of violence and develop some degree of empathy for others, which led to a trend in abstinence from risk behaviours. Findings contribute a secure inpatient perspective on the experience of MBT and to MBT clinical outcomes.     

Competing ethical paradigms in forensic psychiatry and forensic psychology: Commentary for a special section of legal and criminological psychology

In her paper Gwen Adshead (2013) identifies the principle of respect for justice as the foundation for ethical practice in forensic psychiatry. This commentary discusses how forensic psychologists have approached a key aspect of the justice principle, the ethical imperative to promote the welfare of the individual client. The approaches of the psychiatric and psychological professions are compared and the role of psychologists as allied health professionals working in the forensic setting considered.     

The formation of early stage adipocere in submerged remains: a preliminary experimental study

In some circumstances, the presence of adipocere may retard decomposition and complicate postmortem interval estimation. This article explores the correlation between Accumulated Degree Days (ADD) and early stage formation of adipocere. Sixty wild rabbit (Oryctolagus cuniculus) carcasses were used in this experiment; a control group (N = 30) deposited directly on the ground surface and an experimental group (N = 30) completely submersed in water in individual buckets. Data (water and inner body temperature, pH, and total body score) were collected every 100 ADD. Results indicated that early stage adipocere is correlated to ADD and that its formation on submersed remains is more likely to occur after 630 ADD. Skin sloughing promoted the formation of adipocere. No adipocere was formed on any of the control group rabbits. This study also highlights the fact that multiple factors influence adipocere formation and it is suggested that further research needs to be conducted into this area.     

Metric assessment of the "mastoid triangle" for sex determination: a validation study

Recently, a metric approach to skeletal sex determination was published by Paiva and Segre which is based on the summation of two triangular areas defined by three distinct craniometric landmarks: Porion, Mastoidale, and Asterion. According to the authors, values for the total triangle > or =1447.40 mm(2) are characteristic for male crania, while values < or =1260.36 mm(2) are indicative of female skulls (95% confidence). In order to evaluate the method's validity, two sex- and age-documented samples of different provenience were analyzed (N=197). The results show that while the indicated measurements display significant sex differences, the technique is of little practical meaning where a single individual must be independently classified. It is hypothesized that differences in the expression of sexual dimorphism as well as a population-specific variability of the asterion location undermine the value of the mastoid triangle as a sex determinant.     

An Empirical Analysis of 30 Years of U.S. Juvenile and Adult Sexual Homicide Offender Data: Race and Age Differences in the Victim–Offender Relationship

Abstract: Little is known about the racial patterns of crimes committed by sexual homicide offenders (SHOs). This study examined race and age influences on victim–offender relationship for juvenile and adult SHOs. A large sample (N = 3868) from the Supplemental Homicide Reports (1976–2005) was used. Analyses of victim–offender patterns included examining victim age effects (child, adolescent, adult, and elderly). The findings revealed several race‐ and age‐based differences. Black offenders were significantly overrepresented in the SHO population. This finding held for juveniles and adults independently. White SHOs were highly likely to kill within their race, “intra‐racially” (range 91–100%) across four victim age categories, whereas Black SHOs killed both intra‐racially (range 24–82%) and inter‐racially (18–76%), with the likelihood of their killing inter‐racially increasing as the age of the victim increased. This study underscores the importance of considering victim–offender racial patterns in sexual murder investigations, and it offers practical implications for offender profiling.     

Static and Dynamic Patient Characteristics as Predictors of Criminal Recidivism: A Prospective Study in a Dutch Forensic Psychiatric Sample

If clinicians in forensic psychiatry want to reduce risk of reoffending in their patients, they require insight into dynamic risk factors, and evidence that these add predictive power to static risk indicators. Predictors need to be evaluated under clinically realistic circumstances. This study aimed to validate dynamic and static variables as predictors of reconviction in a naturalistic outcome study. Data on static and dynamic risk factors were collected for 151 patients discharged from Dutch forensic psychiatric hospitals. Community follow-up was prospective, with a 5.5 year minimum. A prediction model was developed using Cox regression analysis. The magnitude of the predictive power of this model was estimated using receiver operating characteristic (ROC) analysis. The final prediction model contained four static and no dynamic predictors. The model's ROC area under the curve was .79 (95% CI .69–.89). Clinical risk ratings were non-predictive. Post hoc analyses exploring the influence of subgroups of patients did not yield better models. It is concluded that a small set of static predictors yielded a good estimate of future reconvictions; inclusion of dynamic predictors did not add predictive power.     

Perceptions and use of videoconferencing in forensic mental health assessments: A survey of evaluators and legal personnel

ABSTRACT

The use of videoconferencing (VC) to conduct forensic mental health assessments (FMHA) is increasing. Yet, little is known about its acceptability among clinicians or legal professionals. In Study 1 (N?=?156), forensic evaluators were asked about their use of VC, reasons for its use, and opinions about the validity, usefulness, ethics, and legality of its use. An estimated one-third of evaluators have used VC in the past. Although evaluators overall expressed moderate concern over the ethics and legality of use, prior experience appeared to mitigate concerns. Younger practitioners were also more open to using VC. Reduced costs for courts was the most frequently endorsed benefit associated with VC, while restricted ability to administer psychological testing and potential technological problems were seen as the biggest disadvantages. In Study 2 (N?=?27), attorneys and judges were surveyed about frequency with which they encounter VC for FMHA and their perceptions about the validity of those assessments. Findings indicated legal personnel expressed rather negative views without having much first-hand experience of VC, including concerns about establishing rapport and technical difficulties. These studies have implications for whether VC will be adopted more frequently in FMHA.     

Prediction of stature based on radiographic measurements of cadaver long bones: a study of the Croatian population

We tested a new approach to the stature prediction that could be used in the identification process of human skeletal remains of unknown identity. The stature of 19 female and 21 male adult cadavers was measured within 24 h after death and considered to be equal to the living stature. The antero-posterior radiographs of all limbs were taken, and the maximum length of the six long bones was measured from radiographs. There was a significant difference in the stature and maximum length of long bones between female and male cadavers (p<0.001 for all). The correlation between the stature and long bone length was the best for the humerus in females (r=0.792) and the tibia in males (r=0.891). Regression equations specific to the Croatian population were computed separately for each long bone in males and females and proven to be reliable in predicting the living stature of the individual.     

Taphonomy of child-sized remains: a study of scattering and scavenging in Virginia, USA

Child-sized pig carcasses (Sus scrofa) were placed in surface deposit and buried scenarios in a wooded area of Virginia from May 1998 through December 2000, to examine the taphonomic effects of decompositional changes, predator scavenging, and the extent of remains scattering. Changes were observed through on-site examination, charting of remains, and recorded video imaging. Analysis of data revealed that utilization of corpses as food sources by vertebrates was dependent upon invertebrate colonization. Vertebrates avoided feeding on the corpses while invertebrate colonization was active, and would feed before invertebrates successfully colonized a corpse, or would wait until the invertebrate populations migrated away from the corpse. Among vertebrates, there was no apparent succession order for the animals utilizing the remains as a food source. Different vertebrates would feed at different times based upon diurnal or nocturnal predilection. Analysis noted an accidental cooperative relationship between the invertebrates and vertebrates scavenging on the corpses. Certain vertebrates gained access to the internal tissues by utilizing openings in the corpses caused by invertebrate and other vertebrate scavenging. Alternately, carrion-frequenting insects were afforded access to previously inaccessible colonization sites as a result of scavenging vertebrate activities.     

The use of material culture to establish the ethnic identity of victims in genocide investigations: a validation study from the American Southwest*

Successful prosecution of genocide requires that the victims constitute one of four protected groups: national, religious, ethnic, or racial. Establishing victim identity in prior trials has relied on positive identification of decedents, been largely presumptive, or was based on untested methodology. This report details a validation study of one untested method: the use of material culture in establishing ethnic identity. Classes of clothing and personal effects were scored on 3,430 individuals of known Hispanic or White ancestry from autopsy records in New Mexico. Significant differences were seen in evidence of language, nationality, and religious affiliation between the two groups, as well as clothing types and currency. Predictive models used to estimate ethnic identity in random, blind subsets produced an overall accuracy of 81.5% and estimates of 61-98% in specific subsets. Results suggest material culture, when present, can provide reliable evidence of ethnic affinity in genocide investigations.