Forensic Psych Flashcards
Name some differences between forensic and clinical
- Forensic more assessment heavy
- Higher importance of truth and veracity in forensic
- More complex presentations
- More involuntary clients
Name some type of assessments forensic psychs do
risk assessmnet, pre sentence, victim impact, parenting capacity, competency, section 14
Forensic assessments aim to answer what type of question
Psycho-legal questions
i.e., was defendent criminally responsible? what is risk of reoffending?
What are the ten major elements of assessment? / What is involved?
- File review
- rapport building
- consent
- choose actuarial and SPJ tests
- Assessment: clinical interview + testing
- Collatoral interviews
- Test marking/interpretation
- Report writing
- Debrief clients
- Defending in court
What is secondary gain?
Impression management on client’s end to do with non-obvious indirect benefits of behaviour
i.e., robbing a bank for street cred not financial motives
What is malingering?
Attempts to fake good or fake bad in the interview or testing due to secondary gain (i.e., faking mental illness for reduced sentence)
How can forensic psych’s control for unreliable self-report/malingering?
- Gather info from multiple sources
- Use validated, objective assessment tools
What were the five core ethical concerns in forensic psych listed in the lectures?
- Informed consent
- Appropriateness/limitations of standardised tests
- Multiple relationships
- Objectivity, unbiased, fair testimony
- Difficulty of impartial testimony when also working as treating psych (balancing wellbeing with accuracy)
Why is informed consent even more important with forensic clients?
Rights and liberties may be at stake + clients may not be accurately aware of these risks
APS 4.1
What information do clients need to be given during informed consent?
There are 6 to name
- Purpose of assessment
- Anticipated use of findings (what will happen with this info)
- Who will have access to info
- The referral question
- Confidentiality and it’s limits
- Voluntary/involuntary nature of assessment
APS 4.1
How do forensic psych’s conduct an assessment who does not have capacity to consent?
Get consent from legal representative. BUT even with this consent, still need to get assent from client.
APS 8.1
What is the main ethical concern with appropriateness of standardised test?
Many assessments are not valid or have not been validated with certain populations. Example:
* First Nations people
* Women
What information is needed for a pre-sentencing report?
There are 12 to name
- Presentation
- Family Background
- Education
- Employment
- Relationships (partners/friends)
- Culture
- Health (physical/mental/AOD)
- Offence history
- Index offence
- Psychometric testing
- Client plans
- Clinician reccomendations
What should psych’s consider if there is history of concussions, ODs, or physical victimisation?
Brain injury
What are the three main skills for forensic interviews.
Give example of each
- Respectful interactions (polite, calm, collected)
- Attending skills (i.e., culturally appropriate eye contact, vocal qualities)
- Active listening skills (i.e., open questions, paraphasing)
What is the main aim or risk assessment?
Predicting risk of future anti-social or offending behaviour
What does the continuum of risk refer to?
Risk is a continuum, not static.
People are dynamically located at different points of this continuum overtime, depending on circumstances
Name two reasons for assessing risk
- To manage/mitigate risk (to individual and community)
- Plan treatments and recommendations (and to match rehab efforts with crimonegenic need)
When is risk assessment used in criminal settings?
There are 4
- Pre-trial
- Sentencing
- Parole/release
- Preventative detention
Name four laws/legal responsibilities relating to disclosure in risk assessment
- “Duty to warn”
- Disclosure re risk of harm to self/others (16A + 16B privacy act)
- Disclosure of offence (Crimes Act)
- Mandatory reporting re children (multiple laws)
What are the three major elements assessed during risk assessment?
- Factors
- Harms
- Likelihood
Elements of Risk Assessment
What does ‘factors’ refer to?
Variables increasing risk of re-offending
Elements of Risk Assessment
What does ‘harms’ refer to?
The nature/type of harm (i.e., sexual vs assualt vs theft)
Elements of risk assessment
Name the two categories of risk factors
One of these has two sub-categories, name these also
- Static
- Dynamic (stable + actute)
What are static risk factors?
Unchangable/fixed factors
i.e., age at first offence
What are dynamic risk facors? What are the two types of dynamic risk factors?
Give example of two types
Risk factors that fluctuate over time
Types:
1. Stable: slow change (i.e., substance use disorder)
2. Acute: fast change (i.e., intoxication)
Elements of Risk Assessment
What are the two factors being examined when assessing ‘harms’ in risk assessment?
- Ability to produce risk (i.e., actually capable of re-offending? If in custody, less likely)
- Lethality of risk (i.e., in DV strangling more risky than pushing)
Elements of Risk Assessment
What two factors are examined when assessing ‘likelihood’ in risk assessment?
- Base rates (population rates of that particular offence. Low base rate = less data, lower prediction accuracy).
- Quality of estimation (i.e., psychometrics of assessment tool used)
What are the four possible risk classification accuracies?
True negative
True positive
False negative
False positive
What are the four generations of risk assessment
- Unstructured Professional Judgement
- Actuarial (Static)
- SPJ + Static + Dynamic
- SPJ + Static + Dynamic + Protective + Case mgmt/responsivity
What are the major problems with Gen 1 Unstructured Clinical Judgement Risk Assessment?
- Very inaccurate (false pos error rate - 86%
- No set rules or method
- Inconsistency within and between clinicians
- Underpinned by clin experience, which varies
- Effected by cognitive biases and heuristics
What are the five cognitive biases/heuristics that impact Gen 1 Risk Assessments?
- Availability heuristic (relying on info that easily comes to mind)
- Bias blind spot (false belief that we are less biased than others)
- Base rate fallacy (over-estimating risk if you think murder is more common than it is)
- Illusory correlation
- Confirmation bias
What is Gen 2 Risk Assessment?
Actuarial (static)
Static risk score calculated based on population data on the relationship between static risk factors and recidivism (i.e., age at first offence)
What is an example of a Gen 2 Static Risk assessment tool
Static-99R
What is an advantage of Gen 2 Risk assessment?
Outperforms Gen 1 in accuracy
What are disadvantages of Gen 2 Risk assessment?
There are 5
- Item selection is a-theoretical (does not explain why sexually offending against men increases risk)
- Static factors (mostly) stay same or increase over time (same score at 16 and 45)
- Doesn’t focus on intervention
- Does not capture dynamic risk, or changes to person, circumstance, or environment
- Risk communicated at group-level
What is Gen 3 Risk Assessment?
Considers dynamic risk factors that are:
1. conceptually justified (change must be possible)
2. Empirically justified (related to recidivism risk)
Name three Gen 3 Risk Assessment tools
- Central 8 Risk Factors (Andrews & Bonta)
- Level of Service Inventory (LSI-R) (Andrews & Bonta)
- HCR-20
Gen 3 Risk Assesssment
Name some of the 8 risk factors examined in the Central 8 Risk Factors tool
- Anti-social associations (i.e. friends)
- Anti-social cognitions
- Anti-social personality
- Hx of anti-social behaviour
- Family/marital issues
- Education/work problems
- Lack of leisure/recreation
- Substance misuse
Gen 3 Risk Assessment
Name some of the risk factors in the Level of Service Inventory (LSI-R) tool
There are 10
- Accommodation
- Family/marital
- Financial
- Leisure/recreation
- Education/work
- Emotional/personal
- Criminal hx
- Anti-social traits
- Anti-social companions
- AOD problems
Gen 3
What are the three major areas of the HCR-20?
- Historical
- Clinical (present)
- Risk-management (future)
Gen 3 Risk Assessment
Name some of the areas covered in the ‘History’ section of the HCR-20
- Past violence
- Age of violence
- Relationships
- Employment
- Substance use
- Mental illness
- Psychopathy
- Maladjustment
- Personality disorder
- Supervision failure
Gen 3 Risk Assessment
Name some of the areas covered in the ‘Clinical’ (present) section of the HCR-20
- Insight
- Attitudes
- Active mental illness
- Impulsivity
- Responsive to treatment
Gen 3 Risk Assessment
Name some of the areas covered in the ‘Risk Management’ (future) section of the HCR-20
- Feasibility
- Destabilisers
- Personal Support
- Compliance
- Stress
Gen 3 Risk Assessment
What are examples of six treatment goals outlined by Andrews and Bonta?
- Self-control
- Circle of caring
- Pro-social values
- Pro-social faces and places
- Substance use
- Healthy relationships
What are advantages of Gen 3 Risk assessment?
There are 3
- Outperforms gen 1 + 2 in most cases
- Captures dynamic risks
- Can be used to guide intervention
What are some disadvantages of Gen 3 Risk assessment?
There are 3
- Coding schemas are inflexible
- Only cover a designated set of dynamic factors
- Focus on group-based risk factors (ignores individual and idiosyncratic risk factors - i.e., covid lockdown may decrease risk for someone who steals but increase risk for DV perpetrator)
What is Gen 4 Risk assessment?
Guided by empirically driven static + dynamic risk
PLUS clinician adjusts level of risk based on individual factors (responsivity) i.e., cultural factors, intellectual capacity, health etc.
Measures: level of risk, needs, AND strengths
Structured mechanism for monitoring change + facilitating rehab included
What is an example of a Gen 4 tool?
Note: one that includes static + dynamic not just protective
LS/CMI
Level of Service/Case Management Inventory (Andrews & Bonta)
Extention of Gen 3 LSI + case management options
Gen 4 Risk Assessment
What is the override feature in the LS/CMI?
Clinician can override risk/need score using structured clinical judgement
Gen 4 Risk Assessment
List some of the types of risk covered in the LS/CMI
- Specific risks (personal problems with criminogenic potential i.e., hx or perpetration, racist behaviour)
- Institutional factors (hx or incarceration/barriers to release)
- Other client issues (mental/physical health, finances, accomodation, victimization)
- Special responsivity (responsive/idiosyncratic risks - informed by research + correctional opinion)
Gen 4 Risk Assessment
What is included in the case management/progress record sections of the LS/CMI?
Case management: list of criminogenic needs, non-criminogenic needs, and special responsivity considerations. PLUS strategies to address these.
Progress record: log of activities designed to measure change resulting from CM strategies
What is a Gen 4 Risk Assessment tool that only examines protective factors?
SARPROF
How should Gen 4 SARPROF assessment be used?
In combination with 3rd Gen HCR
Gen 4 Risk Assessment
What are the three major areas covered in the SARPROF?
List some examples covered by each
- Internal (i.e., intelligence, secure attachment, empathy, coping, self-control)
- Motivation (i.e., work, leisure activities, finances, treatment motivation, authority attitudes, goals)
- External (i.e., social network, relationships, professional care, current living, external control)
Do Gen 3 and 4 risk assessments usually produce a risk score or risk category?
Risk category (i.e., low, med, high)
What are the 7 general limitations of risk assessment
Across all generations - not specific
- Sample representativeness (who is norm based on?)
- Criterion definition of risk (is it risk of re-arrest or re-conviction?)
- Criterion measurement of risk (research follow-up limited, predictive validity may be inflated + level of risk may be impacted by unreported evidence)
- No certainty - impossible to be 100% certain
- Only as valuable as info available and clinician scope of competence
- Limited shelf-life (risk can change)
- Many risk assessment tools are not evidence-based (only 25% generally favourable)
What is the general trend in crime in Australia?
What is one exception to this trend and why?
Decreasing or staying the same.
Sexual assualt increasing. Likely due to increased reporting, decreased stigma, legislative changes, and delayed reporting.
What is the general trend in imprisonment rates?
Increasing
What does reintegration mean?
Reintegration occurs when an offender can become an active, productive law-abiding part of a community. Note: should we even call this re-integration, if not integrated to begin with?
Describe the time-lag/delay for offestting criminogenic effects with rehab treatments?
What does this mean for treatment plannning?
When starting treatment, there is a delay before rehab effects start to offset criminogenic effects (dynamic risk factors)
For this reason, it is not reccommended for someone to start treatment on a short sentence (because treatment drop-out is a risk factor for re-offending)
What is the RNR treatment model?
What are the three areas to consider?
- Risk - who to treat?
- Needs - what to treat?
- Responsivity - how to treat?
Standard treatments like CBT and DBT are still conducted but within an RNR frame
RNR Treatment Model
What is considered in the ‘Risk’ (who to treat) section of the RNR model?
Intensity should match risk of re-offending
High risk = high intensity
Low risk = low intensity (or even no treatment)
RNR Treatment Model
What is considered in the ‘Needs’ (what to treat) section of the RNR model
List examples (there are 8)
Treatment is focused on crimonogenic needs (dynamic factors)
1. Anti-social associates
2. Anti-social personality
3. Anti-social cognitions
4. Family/marital issues
5. Education/work problems
6. Lack of leisure/recreations
7. Hx of antisocial behaviour
8. Substance misuse
RNR Treatment Model
What is considered in the ‘Responsivity’ (how to treat) section of the RNR model?
There are two categories of considerations
How to maximise participation and treatment efficacy
- General factors (common to everyone i.e., therapeutic alliance)
- Specific factors (individually tailored considerations i.e., culture, literacy/language, AOD, individual goals)
Are RNR treatment approaches generally supported in the literature?
Meta-analyses suggest generally well supported
Are RNR treatment approaches more effective when conducted in community settings or residential settings (i.e., gaol/hospital)
Community
Are RNR treatment approaches more effective for high or low risk offenders?
High
Is RNR most effective when all three components are incorporates?
(Risk, need, responsivity)
Yes
Is RNR a strength or deficit based model?
Deficit - focuses on what a person is missing and how this can be addressed
What is an example of a strengths based treatment model?
Good Lives Model
Treatment
Describe the Good Lives Model
4 answers listed
Strengths based model
Builds on individuals capacities and strenghts (and acknowledges that we do not all have the same opportunities)
Views offending as a product of desire for something inherently normal/human
Does not think restricting activity is the only way to avoid offending (i.e., re drug use, goal can be sobriety or safe use/harm-reduction)
Do risk and protective factors lie on opposite ends of one continuum or two different continuums?
Two different continuums.
Someone can be high risk, high protection, or low risk, low protection
Give an example of a static and dynamic protective factor
Static - IQ, secure attachment in childhood
Dynamic - empathy, coping skills, self-control
GEN 4 Risk Assessment
True or False.
The SARPROF can be used to identify:
1. Keys - something you have
2. Goals - something you need
True
What are the five stages in the Stages of Change Model?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
Describe typical behaviour in the pre-contemplation stage of the stages of change model?
Defend current behaviour, don’t see need to change, not interested in engaging, avoid information/discussion about change
What stage of the Stages of Change model are forensic clients usually in?
What can be done in this phase? And is treatment recommended in this phase?
Pre-contemplation phase
Motivational interviewing can be helpful.
Intensive treatment not reccomended in this stage due to risk of drop-out
What are typical behaviours that occur in the Contemplation stage of the Stages of Change Model?
Awareness of problem, starting to think about possibility of change
Procrastinating change, weighing up pros/cons, see ceasing behaviour as a loss
What are typical behaviours that occur in the Preparation stage of the Stages of Change Model?
Information gathering, skill-building, planning
Determination, introspection, reaffirmation
Clin clients more often in this category
What are typical behaviours that occur in the Action stage of the Stages of Change Model?
Making real changes for ‘new life’, openness to support, plans for managing challenges
Willpower + short term rewards key. Stage lasts approx. 6m
What are typical behaviours that occur in the Maintenance stage of the Stages of Change Model?
Working to consolidate and maintain changes, prevent relapse
Coping strategies in place and working
Former behaviours now undesirable (risk relapse reduced)
What is the overall aim in forensic report writing
Providing a documented rational for clinical opinions and reccomendations regarding sentencing, treatment, conditions and obligations
Must be:
1. Evidence-based
2. Practical for the client
