Randall depo Flashcards
Are there different specialties other than clinical and forensic?
There are human factors (more psychology and engineering). There’s neuropsychology, clinical psychology, aspects of clinical psychology, forensic psychology.
What does “clinical” mean?
Clinical means treatment of a behavioral health issue.
What does “forensic” in forensic psychology mean?
Forensic refers to the forum, the forensicist. Forensic psychology is the intersection of a legal issue and a field of study, in this case behavioral health. Specifically there can be civil, family law and probate, or criminal proceedings where you have an intersection of a psychological issue and behavioral health.
What would you call an 18-207 report?
A forensic mental health assessment per 18-207. MSO
When did you first start doing FMHAs?
In the 1990s in Ohio
What kind of assessments did you do when you first started conducting FMHAs?
They varied. E.g., (1) criminal assessments for competence to stand trial; (2) family law assessments [child custody, psyc evals]; (3) some for assessments for NGRI.
When did you move to Texas?
Gradually moved in 2010 and relocated by 2011.
Why did you move to Texas?
(1) chronic sinusitis due to proximity to the Great Lakes; drier atmosphere in Texas; (2) have a son who lives in Austin; (3) winter weather is warmer in Texas
Who coined the term “forensic mental health assessment?”
Kirk Heilbrun
What is an FMHA?
It’s an assessment of a person’s mental condition and defect.
Why did Mr. Heilbrun coin this term?
Standardize terminology in a field that was highly specialized and very localized in the 70s, 80s and 90s.
When you started doing FMHAs, were there guidelines on how to write them?
Yes there were guidelines. They were codified “to some extent.”
When you started writing FMHAs, what guidelines did you follow initially?
[For criminal work] - there were guidelines from experts like Thomas Grisso, Melton. SGFP and APA ethical standards.
When did the APA provide standards? Different standards for different evals including psych assessment and evaluation, specialty guidelines fp, record keeping etc
EPP 1990 SGFP 1991
Is there an updated edition of the standards and guidelines that you follow today?
There are multiple standards and guidelines that I follow and yes they have been revised. SGFP 2013. Record keeping 2007. EPPCC 2017.
Can you name the standards and guidelines?
There are numerous standards and guidelines from at least 7 different organization. What are you interested in.
What guidelines do you follow specifically for criminal cases?
(1) Both the APA ethical standards for professional practice 2017 and the standards and guidelines for forensic psychology 2013 would be primary.
(2) With testing issues, there is a nod to forensic use in the American Educational Research Association 2014 guidelines.
(3) For psychosexual evals, the Association for the Treatment of Sexual Abusers (ATSA) 2014 guidelines.
(4) For assessing abuse allegations with children, the 2017 American Professional Society on the Abuse of Children has guidelines.
Are those guidelines followed by forensic practitioners that are writing FMHAs as a community?
Yes, for those who are in the know.
Based on your discription, is dissimulation an important part of an FMHA?
Yes
What kinds of tools do you use to figure out the presence of dissimulation?
It depends on the issue. SVT, PVT, and dissim built into a test
What kind of issues could there be?
Performance and symptom issues are the primary distinctions.
What are “performance issues?”
What level of effort is a person putting forth to do a test or participate in an evaluation.
Examples of performance issues
Being lackadaisical, disengaged, not putting in a lot of effort.
How do those types of performance issues impact the test or evaluation?
It could cast them in an unfavorable light - negative impression management - through poorer test performance due to poor effort
Can you define “symptom?”
Symptoms would be to assess the likelihood that the presentation of my symptoms are indeed accurate and not overstated or understated.
What is Saint Elizabeth’s in Washington?
Teaching hospital of forensic psychology for years. They have a well-known forensic unit.
When you look at these guidelines, do they tell you how you should conduct a FMHA?
To some extent, they tell you steps that you must or should take. But, they do not provide the process for how to do a particular specific evaluation or assessment.
Example of this?
The guidelines will inform you that you need to tell the litigant that their conversation, depending on who retained me, is or is not confidential, that they do not have to participate … etc. This is notification.
When you’re doing these criminal FMHAs, what is the goal of writing that assessment.
The goal is to address a psycholegal issue.
Were you retained to answer a question in this case?
Yes. D mental condition and defect.
Were you appointed in this case?
No.
Were you retained in this case?
Yes.
When were you retained?
Approximately 11-12-18.
Where do you start with gathering information about the person that you’re going to evaluate?
Psycholegal issue, discovery, meet litigant
Did you request all the discovery in this case?
Yes.
Were you provided with everything that you requested?
How would I know?
Do you feel you had enough information in this case? To come to your opinion?
Yes.
In your report there was a list of information, correct?
No. There was a list of records.
Is Exhibit 1 a true and accurate depiction of your report that you prepared in this case?
It is.
Starting on page 77, that is the beginning of the records that you reviewed for this case?
Yes
So that’s all the information that you reviewed in writing this report?
Records plus discovery provided that may not have been listed and other incidental research
(no question - a continuation from card 44)
We have an assistant who prepares the appendix, and given the voluminous nature and the way the documents are frequently embedded in discovery, I would warrant that she does a good job, but I’m not going to say it’s perfect because what you and I might consider to be a document that should be listed may simply be embedded in a discovery dump.
When you first met with the defendant in this case, you said it was on what date?
11-16-2018
What other dates did you meet the D
11-16-18, 4-17-19, 8-26-19, 8-27-19, 8-28-19, 11-21-19, 1-28-20, 2-13-20, 6-17-20, 7-13-22 TOTAL 10 for 29.90 hours $52,666.93
So when you first met with him on the 11-16-18, how did that meeting go? Where was it?
Recall CCU conference. Chalenging due to his mental condition.
Who was in that meeting?
Me, Mr. Diaz, Mr. Scou, Ms. Enterkine
How long did the meeting last?
2 hours
When writing this report, is the diagnosis important?
Depends on the status or the nature of the psycholegal question, and it depends on the jursidiction.
What about for this case?
Is a dx important? I would say not necessarily at all. There’s divergent views on the use of a diagnosis for a mental state exam.
Why do you put a dx in your FMHA?
Primary reason: in this state, for many psycholegal issues a dx is required. So a 19-2522 or an 18-211, they require a dx. For an 18-207, there is no such requirement.
What is functional behavior?
This is how a person acts (functional abilities) and behaves in real life.
Is that definition you have for functional behavior a clinical definition?
What does “clinical definition” mean?
Is there a clinical definition for functional behavior?
Clinical - DSM-5. But why clinical? Forensic is target.
Do you follow Grisso & Heilbruns approach?
Yes. I’m not diagnostically driven.
Grisso and Heilbrun are people you are familiar with in doing these criminal FMHAs?
Yes.
You say you’re not diagnosis driven.
Correct.
It appears you still diagnose people while doing these FMHAs?
Depending on the jurisdiction and nature of the assessment.
What states do you practice in?
I’m licensed in Oregon, Idaho, Florida, Texas, and interjurisdictional practice in about 34 other states
So you’re practicing in Texas starting in 2011 and then you move up to Idaho when?
Established a parttime dwelling in Idaho around 2015
Are you still practicing in Texas?
Yes
Just forensic work in Texas?
Yes.
Where are you testifying in the past 6 months?
(checks database) CR26
For that testimony, is that all related to criminal FMHAs?
No
Just since June. What’s the percentage of criminal testimony versus we’ll say other testimony, civil, family?
CR26
What kind of cases?
All kinds. A handful of civil. Initially more family law and now it’s more criminal. 23 CR 4 CV 21 FL
Can you give me a percentage?
47% criminal.
**How many are the 18-207?
Table 4-22 **
Thru 7-18 18-211s; 8 18-207s; 51 19-2522s; and 2 coerced confession reports.
Let me strike that question. I can ask a better one. What would the situation be where you wouldn’t generate a report after conducting a FMHA?
Situation?
When you use “odd behavior” in your report, do you have a definition for what odd behavior is?
Odd is probably a very general description. Unusual behavior. Have to see the report for context.
So when you use “odd behavior” in a report, is that a clinical term?
Define “clinical terms.” (If expert term, then yes in MSE or DSM-5 and other treatises)
Is there a definition in the forensic psychology community for “odd behavior,” or is that your term?
There is not one definition that is definitive. The term is used in the forensic community.
You did provide a diagnosis in this report, right?
Yes
Where is your diagnosis in your report?
Schizophrenia paranoid type pg 65
Do you use either of these in helping diagnose a patient with a particular mental disease or defect?
I do.
What’s the difference?
ICD-11, and the International Classification of Disease in general, has been the diagnostic language and coding used by the international community. The Diagnostic and Statistical Manual by the American Psychiatric Association, the DSM, had been used to define mental disorders. So there’s a DSM-2, 3, 4, and now 5.
So you say schizophrenia is a spectrum.
Yes.
Diagnoses …. So we have these different diagnoses, and along the spectrum is this schizoaffective disorder.
Yes.
Now, which diagnostic criteria – actually, can you explain what diagnostic criteria means?
In the DSM-5 for any diagnosis they have what are specifically called criteria. You have to meet one, two, three, or two of one in a certain time period and so forth. So that’s diagnostic criteria per the DSM-5.
Which of the DSM-5’s diagnostic criteria did you rule in in this case?
I believed and ruled in that he had major depressive disorder, and ruled in and believed that he had schizoaffective disorder with where I believe he was functioning with likely schizophrenia.
When you consulted DSM-5, what are their criteria for diagnosing schizophrenia?
Do you literally want me to go through the criteria per the DSM-5?
Sure
Okay.
Unless you know it off the top of your head.
I prefer to go back to the source document. That way, if I, for some reason, have a hiccup and miss one minor point, it won’t come back to greet me later.
(continuing schizophrenia criteria)
Schizophrenia, diagnostic criteria they have A through F. So criteria A: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3). And then they have five manifestations: (1) delusions; (2) hallucinations; (3) disorganzed speech, namly, for example, frequent derailment or incoherence; (4) grossly disorganized or catatonic behavior; and (5) negative symptoms, for example, diminished emotional expression or avolition.
(continuing schizophrenia criteria)
B: For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic or occupational functioning).
(continuing schizophrenia criteria)
C: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms ( or less if successfully treated) that meet Criterion A (active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the distrubance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form, for example, odd beliefs, unusual perceptual experiences.
(continuing schizophrenia criteria)
D: The schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred during active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
(continuing schizophrenia criteria)
E: The disturbance is not attributable to the physiological effects of a substance, for example, a drug of abuse, a medication, or another medical condition.
F: If there is a history of autism spectrum disorder or a communication disorder or childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).
(continuing schizophrenia criteria)
Then it goes on to “Specify if.” So to continue: “The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria.”
“First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled.”
“First episode, currently in partial remission: Partial remission is a period of time during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partialy fulfilled.”
“First episode, currently in full remission: Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present.”
(continuing schizophrenia criteria)
“Multiple episodes, currently in acute episode: Multiple episodes may be determined after a minimum of two episodes (… after a first episode, a remission and a minimum of one relapse).
“Multiple episodes, currently in partial remission.”
“Multiple episodes, currently in full remission.”
“Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course.”
(continuing schizophrenia criteria)
And then “Unspecified.”
“Specify if: With catatonia (refer to the criteria for catatonia associated with another mental disorder, pages 119-120 for definition).
“Coding note: Use additional code 293.89 (F06.1) catatonia associated with schizophrenia to indicate the presence of teh comorbid catatonia.”
“Specify current severity: Severity is reated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis Symptom Severity in the chapter ‘Assessment Measures’).”
“Note” Diagnosis of schizophrenia can be made without using this severity specifier.”
Now, in diagnosing schizoaffective disorder, what’s the diagnostic criteria listed?
Schizoaffective disorder diagnostic criteria:
“A: An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with criterion A of schizophrenia. Note: The major depressive episode must include Criterion A1: Depressed mood.”
“B: Delusions or hallucinations for two or more weeks in teh absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.”
“C: Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.”
“D: The disturbance is not attributable to the effects of a substance (for example, a drug of abuse, a medication) or another medical condition.”
(continuing schizoaffective criteria)
“Specify whether: 295.70 (F25.0) bipolar type. This subtype applies if the manic episode is part of the presentation. Major depressive episodes may also occur.”
“295.70 (F25.1) depressive type. This subtype applies if only major depressive episodes are part of the presentation.”
“Specify if: With catatonia (refer to the criteria for catatonia associated with another mental disorder, pages 119-120 for definition).”
“Coding note: Use additional code 293-89 (F06.1) catatonia associated with schizoaffective disorder to indicate the presence of the comorbid catatonia.”
(continuing schizoaffective criteria)
“Specify if: The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria.”
“First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled.”
“First episode, currently in partial remission: Partial remission is a time period during which an improvement after a previous episode is maintained and inw hich the defining criteria of the disorder are only partially fulfilled.”
“First episode, currently in full remission: The full remission is a period of time after a previous episode during which no disorder-specific symptoms are present.”
(continuing schizoaffective criteria)
“Multiple episodes, currently in acute episode: Multiple episodes may be determined after a minimum of two episodes (for example, after a first episode, a remission and a minimum of one relapse).
“Multiple episodes, currently in partial remission.”
“Multiple episodes, currently in full remission.”
“Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course.”
(continuing schizoaffective criteria)
“Specify current severity: Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis Symptom Severity in teh chapter ‘Assessment Measures’).”
“Note: Diagnosis of schizoaffective disorder can be made without using this severity specifier.”
“Note: For additional information on development and course age-related factors, risk and prognostic factors, environmental risk factors, culture-related diagnostic issues, and gender-related diagnostic issues. (See the corresponding sectins in schizophrenia bipolar I and II disorders and major depressive disorders in their respective chapters.)”
When you diagnosed the defendant in this case, Mr. Diaz, what diagnostic criteria of schizophrenia disorder did you rule in?
REPHRASE TO SCHIZ
So if I hear you correctly, you weren’t able to rule any of the criteria out?
Given the nature of the evaluation, and the acknowledgement that this is retrospective, and we’re relying on multiple sources of information, that is my best opinion on the diagnosis that would fit.
So you weren’t able to rule anything out?
Given what I just said, that’s correct.
Under diagnostic criteria A for schizoaffective disorder, it relates back to criterion A of schizophrenia. Is that a correct statement?
That’s correct.
So when you looked at criterion A of schizophrenia, what were you able to rule in?
There are delusions, hallucinations, there is disorganized speech, there is disorganized motor activity, and there is negative symptoms. So I think without any doubt from what I saw, there were delusions and there was avolition in terms of negative symptoms. There is some evidence there was some psychomotor disorganization in terms of just lack of drive. But the first two are what I primariliy relied upon.
Which ones were you able to rule out?
ANSWER
Which ones did you not give weight to?
ANSWER
What negative symptoms did you rule in?
Avolition
Were there any negative symptoms that you ruled out?
Again, you’re making it black and white, ruling it in and ruling it out. So I would not agree that I’m ruling it out. I am just not ruling it in as a substantial foundational piece.
What negative symptoms did you not weigh as a foundational piece?
ANSWER
What are the differences?
In a schizoaffective disorder you have the major mood component and you have some less rigorous criteria in terms of the remaining criteria for schizophrenia. Like the time, for example, would be one of those.
What are the similarities of schizophrenia and schizoaffective disorder?
You’re meeting at least the criterion A of schizophrenia, which would be the presence of delusions, hallucinations, psychomotor disturbance, disorganized speech, and negative symptoms.
So in your profession are those two different diagnoses?
Yes
Speaking specifically to schizoaffective disorder, is that a spectrum as well?
It’s in the spectrum of schizophrenia. The initial heading for this whole diagnostic category is schizophrenia spectrum and related disorders.
Do you have a spectrum of severity when it comes to schizoaffective disorder?
Yes
So the labels attached to describing the rating of the disorder go mild to severe?
Yes
Did you do a differential diagnosis in your diagnosis of schizophrenia
Yes
When you did that differential diagnosis, what other conditions were you able to rule out?
ANSWER
You did do a differential diagnosis in thise case?
Yes
Were you able to rule out other mental conditions?
Yes
What were they?
SEE DSM RULE OUTS
Did you, after your assistant compiled this list for the report, did you check that list?
No
Did you read the list to make sure everything was there?
No IMPORTANT?
Well, do you want to take a look at your report and see if there is anything missing in those records?
If you want me to take the rest of the morning and compare what she has and try to find it in the discovery I have, I’ll be glad to do it. It’s up to you.
Is there anything you would have liked to have seen in addition to the records you reviewed?
Since I don’t have an exhaustive list of available records, I have no basis to say there were records I would have liked to have seen.
Would you consider your report complete at this time?
Yes, it’s complete until and unless I have further information that warrants a supplement.
So your opinions and conclusions, they haven’t changed as of today?
Correct.
Do you feel that you have enough information to adequately assess Mr. Randall’s thought process?
I do.
When you came to Idaho, what codes did you consult?
What codes?
When you came to Idaho, what code sections did you consult?
Relevant sections of the criminal code, IRFLP, civil rules of procedure and other codes as necessary.
So you said criminal responsibility. You have in your CV issues mitigating criminal responsibility. Can you tell me what that means?
Mitigating is a factor that would argue for or against a person’s criminal responsibility. So there’s different factors that are either for or against.
