Mental Health Matters
Forensic Edition
March 2009
Published by: Lepage Associates 
How to Strengthen Your Case with a Risk Assessment
Risk Assessments in the criminal sector are generally used to determine the likelihood of re-offense. In this article I will first discuss how to ensure you end up with a forensic evaluation, as needed for court cases, versus the more common clinical evaluation provided by mental health professionals. Then I will discuss specific risk assessments to include: amenability to treatment, violence, sexual offender, domestic violence, child abuse, and malingering.
When considering whether a client is likely to commit a crime or harm someone again, it is important to obtain a forensic evaluation. How do you pick the right expert for your evaluation? Knowing when and how to obtain a forensic evaluation - which typically goes beyond the scope of a basic clinical interview - could make or break your case. Following are several things you should look for in a forensic evaluation:
In all evaluations, psychologists complete a clinical interview with the client. Some psychologists stop here, and while a clinical interview is certainly better than no evaluation, it is not the most thorough method of assessment as it is purely self-report. In addition, in a risk assessment, the psychologist conducting the interview should be a forensic psychologist who is specifically trained to interview for the factors that increase risk in the area of concern being presented.
It is more helpful to use psychological testing so that the bulk of information is not based on the client's self-report. Many psychologists administer psychological instruments such as the Minnesota Multiphasic Personality Inventory (MMPI-2), which is an objective measure of personality and major categories of psychopathology. The MMPI-2 is widely used because it is well known to be a reliable, valid test. It also has a Lie Scale to help determine if someone is trying to form a favorable impression or mislead the examiner regarding severity of illness. However, though better than an interview only, this test is, again, based on the client's self-report.
It is therefore recommended that multiple tests be completed. A full battery should look at the client's cognitive, emotional, and personality functioning. A battery gives added weight to your argument that the client was fully evaluated. (Tests that are specific to the situation are described below.) This may be where some psychologists end their evaluation.
However, a full battery could still be a clinical evaluation and not a forensic evaluation. According to the American Academy of Forensic Psychology, a full forensic evaluation includes actively seeking information from more than one source that would differentially test plausible rival hypotheses
. This means psychologists need to actively seek prior records. They also need to talk to people who know the client, to assess both pre- and post-functioning. These collateral contacts are not only family members with a vested interest in the client, but also professionals or disinterested parties who will provide impartial accounts of the client.
Amenability to Treatment
This type of evaluation is appropriate for adult and juvenile offenders to determine if their behavior is likely to reoccur and to what extent treatment can ameliorate future criminal behavior. These evaluations often look at the individual's cognitive functioning, social support, family life, work history, substance use, mental health diagnoses and personality functioning, acceptance of responsibility for behavior, insight into problems, impulsivity, and age of onset of criminal behavior. Different measures can include the Wechsler Intelligence Tests, MMPI-2 (or Adolescent version), Millon Clinical Multiaxial Inventory (MCMI-III or Adolescent version), and Stages of Change for substance use.
Violence Risk Assessment
A psychologist will look at different variables to determine if someone is at risk of violence. Static predictors evaluate historical factors such as child abuse. Dynamic predictors evaluate things that do not change over time such as the tendency to be angry and hostile in interpersonal interactions. Risk management predictors evaluate the nature of the situation or environment in which the person currently lives or in the future such as access to drugs and alcohol and weapons. Assessment instruments such as the Hare Psychopathy Checklist-Revised and the Violence Risk Appraisal Guide are used in these evaluations.
Sex Offender Assessment
A psychologist evaluates the level of violence used in the past, age and gender of victims, use of drugs or alcohol, sexual fantasies, urges, and behavior, history of sexual abuse, age-appropriate sexual relationships, and age of onset of deviant interests. Different measurements of anger, denial, empathy, intimacy, and personality can be used. Instruments such as the Minnesota Sex Offender Screening Tool-Revised look at historical and institutional information such as treatment participation. The Multiphasic Sex Inventory includes scales for sexually deviant acts, cognitive process, behavioral aspects of offenses, and deceptive styles.
Domestic Violence Risk Assessment
The Spousal Assault Risk Assessment Guide is the only empirically validated assessment available. It identifies 20 risk factors, the presence or absence of critical items, and gives a summary risk rating of low, medium or high. However, checklists of behavior regarding actions that are emotionally and physically abusive, as well as life-threatening, can also be completed such as the Conflict Tactics Scale. Domestic violence dramatically increases with substance use so instruments such as the Michigan Alcohol Screening Test can also be used.
Child Abuse Risk Assessment
This is a very difficult area to assess and cannot help determine if someone has actually abused a child. Once child abuse is confirmed, the decisions to be made should focus on the risk of reoccurrence. There are different risk factors to consider: 1) individual and parent characteristics such as young age and lower socioeconomic status, 2) family factors such as marital discord, 3) community factors such as social support and employment stress, and 4) cultural values which support the likelihood of child maltreatment. The Child Abuse Potential Inventory has been found to have acceptable reliability and validity but should be completed along with parent interviews and observations.
An assessment of malingering may be required when you believe that a suspect is not being completely honest. There are different types of malingering. The pathogenic malingerer may have a genuine disorder even if they are not being truthful about what is going on with the case. It may be that someone is pretending to have schizophrenia but they actually have post-traumatic stress disorder. They also may tell you or their attorney that they do not have any mental disorder when they actually do. The criminological malingerer is usually someone with antisocial personality disorder. They tend to lie in most situations when they are not getting desired outcomes. This dishonesty tends to be malicious in intent and they may even be lying to their own attorney. They are more likely to drag out the evaluation process. The adaptational malingerer is trying to get out of trouble but it not a general liar. This type of person usually repents easily when confronted. Psychological instruments can be administered such as the MMPI-2; however, as stated earlier, it is a self-report measure. More sophisticated measures of malingering are instruments such as the Structured Interview of Reports Symptoms (SIRS). The SIRS assesses a variety of areas such as defensiveness, uncommon symptoms, changes in behavior during the assessment, and common symptoms. One can determine if someone is trying to fake memory problems by using an instrument such as the Test of Memory Malingering. 
American Academy of Forensic Psychology website listed below:
Melton, G., Petrila J., Poythress, N., & Slobogin, C. (2008). Psychological Evaluations for the Courts - A Handbook for Mental Health Professionals and Lawyers, (3rd Ed.). New York: Wiley.
Sparta, S., & Koocher, G. (2006). Forensic Mental Health Assessment of Children and Adolescents. New York: Oxford Press.
Wrightsman, L. & Fulero, S. (2005). Forensic Psychology, Second Edition. Thomson Wadsworth.

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