Forensic occupational therapy to reduce risk of reoffending: a survey of practice in the United Kingdom

Forensic services are required to reduce an individual’s risk of reoffending. Despite being integral to forensic mental health services, the contribution of forensic occupational therapy to achieving this aim is unclear. This study describes current forensic occupational therapy practice to reduce reoffending risk in the United Kingdom. Responses to a cross-sectional survey consisting of multiple choice and free-text questions were analysed using frequency counts and percentages, and thematic analysis respectively. Of the 58 participants, 83% actively addressed reoffending risk. Participants informed practice with occupation-focused theories, models and assessment tools. Five themes described forensic occupational therapy to reduce reoffending risk: an occupational perspective of risk assessment and formulation; volitional realignment; increasing protective factors; community integration; and enhancing understanding of forensic occupational therapy. Forensic occupational therapists perceive their practice to contribute to reducing reoffending risk, but are yet to establish routine outcome measurement in this area. Implications for practice and future research are discussed.     

多巴胺受体基因遗传多态性与精神分裂症的关联及法医学意义

精神分裂症是一种常见的多因子参与的复杂疾病,司法精神病学鉴定中对精神分裂症的涉及甚多,但无有效的生物学鉴定指标。研究表明,多巴胺神经递质功能紊乱可能在精神分裂症的发生及其主要症状中发挥重要作用。本文综述了多巴胺受体的分类、基因结构以及近年来关于多巴胺受体基因遗传多态性与精神分裂症的关联研究及其法医学意义。     

Forensic Applications of the Miller Forensic Assessment of Symptoms Test (MFAST): Screening for Feigned Disorders in Competency to Stand Trial Evaluations

Forensic evaluations must systematically assess malingering and related response styles. In the criminal forensic domain, competency to stand trial evaluations are the most common referrals. Effective screens for feigned incompetency would be valuable assets for forensic evaluations. This study evaluates the effectiveness of the Miller Forensic Assessment of Symptoms Test (MFAST) as a screen for feigned incompetency. Using a simulation design, the MFAST was tested on jail and competency-restoration samples. Most notably, recommended MFAST cut score (6) was useful for the identification of feigning cases in competency evaluations. Recommendations for forensic practice, including the advantages and disadvantages of systematic screens, are discussed.     

An Evaluation of Malingering Screens with Competency to Stand Trial Patients: A Known-Groups Comparison

The assessment of malingering is a fundamental component of forensic evaluations that should be considered with each referral. In systematizing the evaluation of malingering, one option is the standardized administration of screens as an initial step. The current study assessed the effectiveness of three common screening measures: the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001), the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2004), and the Evaluation of Competency to Stand Trial-Revised Atypical Presentation Scale (ECST-R ATP; Rogers, Tillbrook, & Sewell, 2004). Using the Structured Interview of Reported Symptoms (SIRS) as the external criterion, 100 patients involved in competency to stand trial evaluations were categorized as either probable malingerers (n=21) or nonmalingerers (n=79). Each malingering scale produced robust effect sizes in this known-groups comparison. Results are discussed in relation to the comprehensive assessment of malingering within a forensic context.     

A risk-based approach to cognitive bias in forensic science

Over the past decade, the potential impact of cognitive bias in forensic science has instigated much discussion and debate between academics, scientists and those in the justice sector. Evidence of bias influencing subjective decision-making across a range of forensic disciplines has been described in the literature. Forensic service organisations are being urged to address cognitive bias in subjective decision-making by designing processes or procedures to limit access to (irrelevant) contextual information or reduce dependence on cognitive functions. Although some laboratories have implemented bias mitigating strategies, with varying impact on operational efficiency, there has been no systematic assessment of the risk posed by cognitive bias. Forensic Science SA assessed the potential impact of bias on forensic interpretations across multiple disciplines, using a risk management framework. This process proved useful in assessing the effectiveness of existing bias mitigating strategies and identified the latent level of risk posed. While all forensic organisations should seek to implement bias limiting measures that are simple, cost-effective and do not adversely impact efficiency, using a risk-based approach has contextualised the limited benefit of introducing resource hungry measures, as postulated in the literature. That is not to suggest that forensic organisations should dismiss the potential influence of cognitive bias but they need to strike an appropriate balance between risk and return, as they do with any business risk.     

新冠肺炎等传染病与法医学鉴定评述

新冠肺炎致死或引发的其他法律纠纷可能涉及法医学病理解剖或者法医临床学鉴定。在日常法医学解剖中时有遇到因传染性疾病死亡患者的尸体,法医鉴定机构及鉴定人应当有风险识别意识,充分认识到在解剖、检查这类尸体时的被传染风险。法医鉴定人需要采取充分有效的防护措施。由于新冠肺炎属于新型传染性疾病,相关研究成果、信息资料更新快,鉴定中的信息参考要慎重选择。同时本文对因传染性疾病死亡患者的尸体解剖中常见的职业伦理、知情同意、保险理赔和环境保护等问题进行讨论。     

Psychological Assessment of Symptom and Performance Validity,Response Bias,and Malingering: Official Position of the Association for Scientific Advancement in Psychological Injury and Law

Evidence-based forensic psychological opinions require thorough and accurate information about examinees. Psychometric instruments can facilitate diagnostic decision making, but they rely on examinees to respond honestly to questions and put forth good effort on cognitive tests. Given the strong incentives for examinees in psychological injury cases to minimize prior problems and emphasize postaccident or posttrauma problems, the assessment of validity as part of forensic psychological evaluations is essential. Best practices in forensic psychology have their foundation in ethical principles. The purpose of this position statement is to promote ethical psychological practice in legal contexts by reviewing validity assessment issues and their ethical foundations. Because no previously published document focused specifically on symptom and performance validity assessment in psychological injury evaluations performed in forensic contexts, such a position statement provided by a professional organization devoted to the interface of psychological injury and law was needed to inform and guide practitioners and to educate other interested parties. The position statement emphasizes (a) the need for ethical practice in assessing validity, (b) consideration of factors such as culture and functional limitations, and (c) the importance of adopting a comprehensive, impartial, and scientific approach to validity assessment. The position statement acknowledges areas of differing opinions and the need for further research.     

On the added value of forensic science and grand innovation challenges for the forensic community

In this paper the insights and results are presented of a long term and ongoing improvement effort within the Netherlands Forensic Institute (NFI) to establish a valuable innovation programme. From the overall perspective of the role and use of forensic science in the criminal justice system, the concepts of Forensic Information Value Added (FIVA) and Forensic Information Value Efficiency (FIVE) are introduced. From these concepts the key factors determining the added value of forensic investigations are discussed; Evidential Value, Relevance, Quality, Speed and Cost. By unravelling the added value of forensic science and combining this with the future needs and scientific and technological developments, six forensic grand challenges are introduced: i) Molecular Photo-fitting; ii) chemical imaging, profiling and age estimation of finger marks; iii) Advancing Forensic Medicine; iv) Objective Forensic Evaluation; v) the Digital Forensic Service Centre and vi) Real time In-Situ Chemical Identification. Finally, models for forensic innovation are presented that could lead to major international breakthroughs on all these six themes within a five year time span. This could cause a step change in the added value of forensic science and would make forensic investigative methods even more valuable than they already are today.     

Assaultive behavior in state psychiatric hospitals: differences between forensic and nonforensic patients

Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two groups of forensic patients including 469 patients found not guilty by reason of insanity and 76 pretrial patients. Consistent with other studies, nonforensic patients had higher rates of assaults than either group of forensic patients. However, being a forensic patient did not affect the odds of assault when controlling for the effects of demographic and clinical variables in a multivariate logistic regression analysis. Factors associated with assaults in each of the three patient groups were identified using multivariate analyses. Implications are presented for treatment of assaultive behavior, mixing of forensic and nonforensic patients within state hospitals, forensic release policies, and future research.     

Organization and methodological activities of Russian Center for Forensic Medical Expert Evaluations Ministry of Health of the Russian Federation

Analyzes the organization and methodological activities of Russian Center for Forensic Medical Expert Evaluations in 1996-1998. Informs about the federal law on forensic medical expert evaluations and norm-setting acts aimed at improvement of forensic medical service in the Russian Federation, which have been developed at the Center. Offers recommendations on improving the quality control of expert evaluations at territorial centers and continuous education of experts. Formulates the main tasks of the Center fort the nearest future.     

"Who is first on the scene?"

Forensic specialists are well standardised throughout the world and their opinions are respected by the courts. Doctors involved in the immediate clinical forensic assessment of persons in police custody are not, however, so well standardised. Some countries employ trained police surgeons or police medical officers, other countries rely on hospital interns, others simply accept the first doctor available. Can courts rely on their testimony? Can specialists depend on their skills? A call is made for such generalists to meet on an international basis to establish standards.     

新冠肺炎疫情下司法精神医学鉴定的应对

新冠肺炎疫情已被公认为全球性重大挑战。已经、正在,同时仍将对人类社会的诸多方面产生深远的影响。新冠肺炎疫情下司法精神医学鉴定面临诸多挑战,通过梳理疫情下已实施的有关司法鉴定方面的做法、经验,分析涉疫情主要犯罪类型,开展司法精神医学远程鉴定具有必要性和可行性。但应关注其局限性,实施之前应制定相应的操作规范。     

Context Effects in Forensic Entomology and Use of Sequential Unmasking in Casework

Context effects are pervasive in forensic science, and are being recognized by a growing number of disciplines as a threat to objectivity. Cognitive processes can be affected by extraneous context information, and many proactive scientists are therefore introducing context‐minimizing systems into their laboratories. Forensic entomologists are also subject to context effects, both in the processes they undertake (e.g., evidence collection) and decisions they make (e.g., whether an invertebrate taxon is found in a certain geographic area). We stratify the risk of bias into low, medium, and high for the decisions and processes undertaken by forensic entomologists, and propose that knowledge of the time the deceased was last seen alive is the most potentially biasing piece of information for forensic entomologists. Sequential unmasking is identified as the best system for minimizing context information, illustrated with the results of a casework trial (n = 19) using this approach in Victoria, Australia.     

Sexually Violent Predator Evaluations: Empirical Evidence,Strategies for Professionals,and Research Directions

Several states have passed civil commitment laws that allow the precautionary detention of sex offenders who have completed their criminal sentences. Over 2,500 sex offenders have been committed across states with such statutes and several thousand more sex offenders have been evaluated. Most statutes call for an evaluation of risk by a mental health professional and, although each state statute is worded differently, three main elements common to sexually violent predator evaluations are used to guide evaluators: mental abnormality, volitional capacity, and likelihood of future sexual violence. The current article presents empirical evidence for the main tenants of these forensic evaluations, provides recommendations for evaluators in light of current limitations of evidence, and offers suggestions for future research in this area of forensic assessment.     

法医毒理学的结果解释（下）

法医毒理学的主要任务是从生物检材中分析毒（药）物,并且推断毒（药）物浓度对死亡或行为能力的作用程度,结果解释是法医毒理学的最终目的。现代法医毒理学主要包括死后法医毒理学、滥用药物筛查和行为能力影响三个方面,由此探讨在进行结果解释时的诸多影响因素。进行法医毒理学的结果解释时应非常慎重,充分了解案情和调查结果,全面考虑毒（药）物的毒性、生物检材、药代动力学、体内再分布、药物交叉反应等多种因素,才能对案件作出较为准确的结果解释。     

Clinical presentation of malingerers diagnosed by experienced forensic psychologists

Little is known about the incidence of malingering or the diagnostic criteria for malingering employed by forensic clinical psychologists conducting pretrial evaluations for the criminal justice system. The clinical presentations of 39 criminal defendants diagnosed as malingering psychotic symptoms were contrasted with 25 defendants diagnosed as genuinely psychotic. The incidence of diagnosed malingering was 8% in a series of 314 consecutive evaluations. Malingerers differed from psychotics on 14 of 24 clinical presentation variables, including measures of general presentation, affect, hallucinations, delusions, and formal thought disorder. Results indicate consistent clinical features associated with the diagnosis of malingered psychosis.A summary of this study was presented at the 1988 Annual Convention of the American Psychological Association in Atlanta, Georgia. We very much appreciate the contribution made by the six forensic clinical psychologists at the Michigan Center for Forensic Psychiatry who volunteered to participate in this study.     

Analysis of the structure of forensic chemical studies carried out in the Perm regional bureau of forensic medical expert evaluations in 1997-2000

Analysis of statistical data on forensic chemical studies carried out in the Perm Regional Bureau of Forensic Medical Expert Evaluations in 1997-2000 indicates an increased number of expert evaluations with positive results. The specific share of expert evaluations with positive results for Perm was 66.6% of the total number of evaluations. The absolute number of the detected agents in combinations with other agents increased more than 2-fold over the studied period. The number of detected agents increased 1.8 times, the rate of detection of narcotics increased sharply (6.5 times).     

Are Forensic Evaluations “Health Care” and Are They Regulated by HIPAA?

Forensic mental health providers (FMHPs) typically do not release records to the examinee. The Health Insurance Portability and Accountability Act (HIPAA) federal regulations might change this position, given that they have created a basic right of access to health care records. This legislation has led to a disagreement regarding whether HIPAA regulates forensic evaluations. The primary argument (and the majority of scholarly citations) has been that such evaluations do not constitute “health care.” Specifically, in this position, the nature and purpose of forensic evaluations are not considered related to treatment (amelioration of psychopathology) of the patient. In addition, it asserts that HIPAA applies solely to treatment services; thus, forensic evaluations are inapplicable to HIPAA. We describe the evidence for and against this argument, the strengths and limitations of the evidence, and recent court decisions related to it. The weakest part of the “HIPAA does not regulate forensics” argument is that HIPAA has no exclusion criteria based on type of services. It only creates an inclusion criteria for providers; once “covered,” all services provided by that provider are thence forward “covered.” Authoritative evidence for patient access can be found in the HIPAA regulations themselves, the US Department of Health and Human Services’ commentaries, additional statements and disciplinary cases, the research literature, other agency opinion, and legal opinion. It appears that the evidence strongly suggests that, for those forensic mental health practitioners who are covered entities, HIPAA does apply to forensic evaluations. The implication is that FMHPs potentially face various federal, state, and civil sanctions for refusing to permit patient access to records.     

Forensic pathology then and now. Retrospect and reflections

The past half-century has witnessed significant progress and multiple, meaningful changes in the day-to-day practice of forensic pathology as it has in all other branches of laboratory and clinical medicine. Associated with the welcome advancing "scientific" aspects of our work have been gratifying changes in the professional status of our much misunderstood area of medical activity, the latter most vividly and convincingly represented by American Board of Pathology certification in Forensic Pathology and the appearance of such growing, vital, national professional organizations as the American Academy of Forensic Sciences and our National Association of Medical Examiners and the creation of such highly respected periodicals as the Journal of Forensic Sciences and our American Journal of Forensic Medicine and Pathology. Objective assessment of the foregoing accomplishments leads to the inescapable conclusion that forensic pathology has emerged from its previous role as the "invisible profession" and become a respected and productive branch of laboratory medicine.