Running Head: COMPREHENSIVE EXAM
Comprehensive Exam
Trisha R. Podsiadlo
Argosy University
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Running Head: COMPREHENSIVE EXAM
Psychological Theory and Practice
A.
Legal Theory and Application
Assessment, Research, and Evaluation
Leadership, Consultation, and Ethics
Interpersonal Effectiveness
2
Running head: Comprehensive Examination
Comprehensive Examination
Trisha R. Podsiadlo
Argosy University
1
Running head: Comprehensive Examination
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Inmate Austin is presenting for a prison discharge evaluation. He is a 78-year old,
widowed, Caucasian male. He grew up in rural Illinois and describes his family as being poor.
He is the second oldest of six children; three sisters and two brothers. He was abused by his father
and sexually abused by his grandfather. He attended school regularly and reached developmental
milestones at the average age. He did not have many friends and dropped out his junior year of
high school. He was able to hold down several jobs to include a stint in the Navy where he was
honorably discharged. He did develop an alcohol problem during his time in the Navy and did
drugs such as marijuana and mushrooms on occasion with his son. He has a history of mental
health treatment and has attended sex-offender treatment groups.
He is incarcerated due to his history of sexually abusing young girls. His current conviction
involved a sexual offense on a minor girl of only 10-years old. During his incarceration he has
completed psycho-education groups, mandatory sex-offender treatment groups, and alcohol and
drug treatment. He also received individual therapy.
He has been diagnosed with emphysema, and has a history of bronchitis, hypertension, and
cardiac problems. He is on several medications and is very compliant in taking them as prescribed.
Inmate Austin has trouble remembering events from the past to include not remembering the name
of his own children. The staff has noticed a significant decline in his current level of cognitive
functioning and often times he has been observed as being confused and disoriented.
When Inmate Austin presented for his interview he was well groomed and dressed
appropriately. His mood was good and appeared euthymic with congruent affect in normal range
during the evaluation. He was alert and had no trouble following the conversation. He was
oriented to person and place, however, he was disoriented to time and situation. He had coherent
and goal-directed thought processes with no evidence of perceptual disturbance present. He denied
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being suicidal or homicidal. His eye contact was good and his speech was coherent. He had an
even pitch and tone until a subject was brought up that he did not want to discuss. At those points,
his volume of speech would increase and he would avoid answering. He has moderate memory
function difficulty and has poor insight into his present predicament. His social judgement and
impulse control at the time of evaluation was fair. Inmate Austin is also of average intellectual
ability.
Psychological Theory and Practice
A.
During the assessment of Inmate Austin, he showed a lack of insight into his current
problems and when confronted with more difficult issues, he would refuse to talk about them.
He has a history of sexually abusing young girls to include his two grand-daughters, but when
asked about these events, he closes down and makes statements about something else. For
example, when asked about his current conviction for sexual penetration of a victim under the
age of 12, Inmate Austin stated, “I do not want to talk about that now. Just know that I am
rehabilitated”. Due to the history of his crimes, Inmate Austin needs further psychological
assessments. Inmate Austin has a history of sexual abuse as a child and has gone on to become a
sexual offender himself. Due to his proclivities to abuse young girls and history of both
substance abuse and suicide, I would conduct the Columbia-Suicide Severity Rating Scale (CSSRS), Brief Symptom Inventory (BSI), the Minnesota Sex Offender Screening Tool-Revised
(MnSOST-R), and the Substance Abuse Subtle Screening Inventory (SASSI).
Inmate Austin has revealed that he attempted suicide on one occasion, but was unable to
go through with it at the last minute. Due to the fact that he has attempted suicide in the past, he
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must be assessed for suicidal thoughts or ideation at this time. I would conduct the C-SSRS to
determine his risk of attempting suicide.
The C-SSRS has four areas on the assessment which include suicidal ideation, intensity
of ideation, suicidal behavior, and those who answer questions for actual attempts. The suicidal
ideation and intensity or ideation areas of the assessment are answered using simple yes/no
answers and the suicidal behavior and actual attempts portions are scored by points. The suicidal
ideation portion of the assessment asks questions such as Wish to be dead, Non-Specific Active
Suicidal Thoughts, Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act,
Active Suicidal Ideation with Some Intent to Act, without Specific Plan, and Active Suicidal
Ideation with Specific Plan and Intent. The intensity of ideation portion consists of the
following: Frequency, Duration, Controllability, Deterrents, and Reasons for Ideation. The
suicidal behavior portion asks the following: Actual Attempt, Has subject engaged in NonSuicidal Self-Injurious Behavior, Aborted Attempt, Preparatory Acts or Behavior, Suicidal
Behavior, and Completed Suicide. The final portion of the assessment contains only two
questions: Actual Lethality/Medical Damage and Potential Lethality: Only Answer if Actual
Lethality=0.
There are different scoring systems depending on the population. The important elements
to note are that the higher the scores on the individual items and the more “yes” items, the higher
the suicide risk. The C-SSRS training noted below lists high risk as being “ideation, a four or
five in the past month; or any of the four behaviors in the last three months.
Inmate Austin has been in mental health treatment on a number of occasions throughout
his lifetime. He first received mental health therapeutic services while serving in the Navy.
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There is no information as to why he received treatment or if he was diagnosed with a mental
illness, but it is important to note this event. After his wife died, Inmate Austin was also
admitted and received psychiatric treatment in 1999. He stated that the hospitalization was due
to his grieving the loss of his wife. He has also had individual therapy sessions during his
current incarceration. The Brief Symptom Inventory (BSI) will help in determining his
psychological state at the present time and help in developing the proper treatment plan.
The Brief Symptom Inventory (BSI) is a 53-item self-report inventory designed to assess
psychological symptoms that can be used in both clinical populations as well as the general
public. It takes about 10 minutes to complete and can be used in individuals with at least a sixth
grade education. There are nine primary symptom dimensions and three global indices of
distress. The primary symptom dimensions consist of somatization, obsessive-compulsive,
interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and
psychoticism. Somatization is psychological distress arising from the perception of bodily
dysfunction. Those suffering from the obsessive-compulsive component find that they have
thoughts and actions experienced as unremitting and irresistible by the patient but are unwanted.
Interpersonal sensitivity refers to feelings of personal inadequacy and inferiority. Depression
includes signs and symptoms of clinical depressive syndromes such as dysphoric affect and
mood. The anxiety portion involves symptoms associated with clinical manifestations of anxiety
such as restlessness, nervousness, and tension. Hostility is the portion that is concerned with
hostile behavior to include thoughts, feelings, and actions. Phobic anxiety or symptoms
consistent with phobic anxiety states or agoraphobia. Paranoid ideation is paranoid behavior that
is syndromal in nature such as thoughts that are hostile, suspicious, and central. The final of the
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nine primary symptoms is psychoticism or symptoms of psychoticism in mild forms to extreme
forms.
The three global indices of distress measure the level or depth of distress currently being
experienced by the individual and they include the general severity index (GSI), positive
symptom distress index (PSDI), and the positive symptom total (PST). The GSI combines
measures on the number of symptoms and the intensity of perceived distress. It is considered the
single best indicator of current distress level. The PSDI is a pure intensity measure that does not
include the number of symptoms. It is a measure of response style that indicates if the patient is
“faking bad” or “faking good”. The PSI is a count of the symptoms that the patient reports.
There are three levels of interpretation on the BSI. The first one uses global scores to
determine the overall level of distress. Second, the primary symptom dimensions are looked at
and can highlight specific areas of psychopathology. The final level has a specific focus on
discrete symptoms by looking at individual items
I recommend the Minnesota Sex Offender Screening Tool-Revised (MnSOST-R) due to
Inmate Austin’s extensive history of abusing young girls. He was caught sexually abusing his
grand-daughters, one of which became pregnant by him, he was charged with Sexual Penetration
of a Victim under the age of 12 when he sexually penetrated a 10-year-old neighbor girl and he
was convicted of two counts of Criminal Sexual Assault in 1993. This assessment needs to be
done before Inmate Austin is released to determine the likelihood that he will commit these types
of offences again. This helps in determining the probability of recidivism of a given individual.
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This is so important because it is now dealing with the safety of the community in which Inmate
Austin will be released into and reside.
The MnSOST-R is a 16-item, “actuarial” risk assessment tool initially developed for the
Minnesota Department of Corrections (MDOC) to provide empirically based estimates of risk for
sexual recidivism of incarcerated male sex offenders. An actuarial approach was used in an
attempt to bring greater accuracy and utility to sex offender risk assessments, enabling the
MDOC to more effectively use limited resources.
Potential predictors were drawn from research on an earlier version of the tool and from
an updated review of the literature. Only variables based on information routinely available in
correctional records were considered as predictors to ensure that the resulting tool could be
scored for the majority of sex offenders based on a file review. Sexual recidivism, the criterion
variable, was defined as a formal charge for a new sex offense within 6 years of release from
prison.
The way in which each of the items was selected and the process of scoring identified
that there were 16 items which were optimal in predicting sexual recidivism. There are 12
historical or static items and four institutional or dynamic variables included in this assessment.
The 12 historical items contain the number of convictions for sex offenses, length of sex
offending history, commission of a sex offense while under court supervision, commission of a
sex offense in a public place, use or threat of force in any sex offense, perpetration of multiple
sex acts in a single event contact, offending against victims from multiple age groups, offending
against a 13- to 15-year-old victim with more than a 5-year age difference between the offender
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and the victim, victimization of a stranger, persistent pattern of adolescent antisocial behavior,
recent pattern of substantial substance abuse, and recent employment history. The four
institutional items on the assessment are discipline history, chemical dependency treatment
recommendations and outcomes, sex offender treatment recommendations and outcomes, and
age of the offender at the time of release.
Inmate Austin has a history of abusing alcohol and has been convicted of crimes
involving marijuana. He became a heavy drinker in the Navy due to the horrific events he
witnessed on a day-to-day basis. In his words he drank because “It numbed the experience”. He
later admitted to drinking a six-pack of beer every weekend and would occasionally add Brandy
to his coffee and drink it throughout the day. He was also known to use marijuana and
mushrooms with his son, but the problem may have been more severe due to his conviction
dealing with large amounts of marijuana. He currently denies any indications of tolerance or
withdrawal to any of the substances he used and denies any consequences to his prior drug use.
In order to determine if he still has substance abuse problems, I recommend administering the
Substance Abuse Subtle Screening Inventory (SASSI).
The SASSI was developed as a screening questionnaire used for identifying individuals
with a high probability of having a substance dependence disorder.
The desired outcome of the SASSI is to gather pertinent information, organizing that
information, and then coming to conclusions based on that information to determine if someone
has a substance dependence disorder. The SASSI is useful for those individuals who don’t want
to acknowledge symptoms or refuse to acknowledge that they suffer from the disorder or that
they misuse or abuse substances. Guidelines are available for professionals to flag individuals
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with a potential substance abuse disorder for further evaluation. Interpretation of the SASSI
helps the professional in gaining a better understanding of their client and thus helps in coming
up with a treatment plan.
When used by trained professionals, the SASSI can be an important tool in the
assessment of substance use disorders. It is important to note that this assessment is not to be
used in diagnosing individuals as addicts or alcoholics, but rather to screen for those individuals
who have a high likelihood of having a substance dependence disorder. A thorough assessment
of the individual should be done in conjunction with the SASSI to include things such as selfreporting and family history of substance abuse. This comprehensive assessment is required to
determine if an individual meets the accepted standards in the mental health professional's
handbook, Diagnostic and Statistical Manual of Mental Disorders, for a clinical diagnosis of a
substance-related disorder.
The SASSI is easily administered to individuals or groups of people and it only takes
about 10 to 15 minutes to complete. It is a one-page paper and pencil or computer questionnaire
that does not require a high level of reading ability. The assessment can be objectively scored by
hand and interpreted, based on objective decision rules, in a minute or two. The SASSI may be
used by a variety of programs and professionals, including school counselors, student assistance
programs, employee assistance programs, vocational counselors, psychotherapists, medical
personnel, criminal justice programs, and other human service providers.
Some questions on the SASSI ask how frequently clients have had certain experiences
directly related to alcohol and other drugs. These are answered on a four-point scale, ranging
from never to repeatedly. Some items that may appear to be unrelated to substance use (indirect
or subtle items) are in a true/false format. Overall, the items make up 10 subscales. The results
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are reported on a profile form that is discussed with the client. There are separate profile forms
for males and females. The objective scoring system results in a yes or no answer about whether
the client has a high probability of having a substance dependence disorder. The SASSI-3 has
been empirically tested and can identify substance dependence disorder with an overall accuracy
of 94%. More specifically, the SASSI identifies individuals with a substance dependence
disorder with 94% accuracy, and it identifies those without a substance dependence disorder with
94% accuracy. The accuracy of the SASSI is not significantly affected by gender, age,
socioeconomic status, ethnicity, occupational status, marital status, educational level, drug of
choice, and general level of functioning. Research is ongoing to improve the accuracy and
usefulness of the SASSI.
A profile of the SASSI results will be reviewed with the client. The actual scores are
plotted on a profile graph in comparison to a sample of people who were not being evaluated or
treated for addictions or other clinical problems (also called a normative sample). Feedback is
then given in terms of whether the individual has a high or low probability of having a substance
dependence disorder. Individual scale scores may be used to come up with ideas or hypotheses
for further evaluation and treatment. This information is based on clinical experience with the
SASSI. The results may indicate issues that are important for treatment (such as difficulty
acknowledging personal shortcomings, or primarily focusing on others' needs while unaware of
one's own needs). The results may suggest an approach to take with the client (such as increasing
awareness, or acknowledging and validating their feelings). The results may suggest a treatment
plan that the client may respond to (such as addiction self-help groups or an education-focused
program). Finally, the results may indicate appropriate treatment goals for the client (anger
management and/or social skills, for example). The goal of providing feedback about SASSI
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results is to have a two-way sharing and understanding of information that is descriptive and not
judgmental.
B.
Inmate Austin is currently incarcerated so it is hard to tell if he still has sexual impulses
towards young girls. He is not very open about his past criminal acts and often acts as if he does
not remember or simply refuses to talk about the events. However, given the background and
history of Inmate Austin and using the DSM 5, he is suffering from Pedophilic Disorder with
females and not limited to incest. This diagnosis is being made due to the fact that Inmate
Austin was sexually abusing his grand-daughters for a period of over 11 years and he was also
convicted of other sex crimes against miners during that same period of time. This meets the
criteria that the individual, over a period of at least six months, must have recurrent, intense
sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a
prepubescent child or children (generally age 13 years or younger). He acted on the sexual urges
and he is above the stated age of being at least 16 years old and the individuals he abused were
much younger than the five year age difference listed in the DSM-5.
Inmate Austin has several convictions which meet all the specified criteria in the DSM 5.
He was found guilty of two counts of Criminal Sexual Assault with Force in 1993. He further
had been sexually abusing his twin grand-daughters from the age of 3 up until they were 14 at
which time one of them became pregnant with his child. He served a five-year sentence and
completed six-months of voluntary sex offender treatment. His last offence and the one that
landed him in prison for 15-years is the Sexual Penetration of a Victim under the age of 12. He
was caught having a sexual encounter with his 10-year-old female neighbor.
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As stated above, Inmate Austin clearly meets all the criteria for this diagnosis. He is not
willing to discuss his offenses, but since he has acted on his impulses towards young girls he fits
the pattern of approaching multiple children on separate occasions yet denies any urges or
fantasies about sexual behavior involving children. On one occasion he refuses to discuss the
reason for his current incarceration, but does state that he has been rehabilitated. This is an
indirect admission of guilt. The DSM-5 states that these individuals may deny experiences,
impulses, or fantasies involving children, they may also deny feeling subjectively distressed.
Such individuals may still be diagnosed with pedophilic disorder despite the absence of selfreported distress, provided that there is evidence of recurrent behaviors persisting for six months
and evidence that the individual has acted on sexual urges or experienced interpersonal
difficulties as a consequence of the disorder (American Psychiatric Association, 2013).
I’ve ruled out a diagnosis of Antisocial Personality Disorder (APD) due to the limited
information given in his interview. The main feature of APD is a pervasive pattern of disregard
for, and violation of, the rights of others that begins in early childhood or early adolescence and
continues into adulthood. From what I have gathered from the interview with Inmate Austin, he
had an abusive childhood in which he was sexually assaulted, but there is no mention of his
having any issues with others in school or otherwise. He did indicate that he had few friends and
was caught stealing as a child, but this is not enough to subscribe to the theory that he suffers
from APD.
The differential diagnosis for Inmate Austin is Substance Use Disorder due to the fact
that he began consuming alcohol when he was a child and once he joined the Navy, he states that
his drinking was in excess. He drank a six-pack of beer on the weekends and he was also known
to drink brandy with his coffee throughout the day. He is also known for using Marijuana and
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admits to using mushrooms and had two drug convictions in 2000 which included Unlawful
Manufacturing of Cannabis. He spent 120 days in jail for these offenses and had to pay a fine.
For Substance Use Disorder there are numerous criteria which can determine if an individual
meets this classification of disorder. The first criterion which Inmate Austin fits is that the
individual takes the substance in larger volumes or over longer periods of time than was
originally intended. Again, he was drinking a six-pack of beer on the weekends and he drank
alcohol throughout the day to become “numb” as he put it. Criterion 3 is that the individual
spends a great deal of time obtaining the substance, using the substance, or recovering from its
effects. In instances of more severe substance use disorders, virtually all of the individual’s daily
activities revolve around the substance. Criterion 4 deals with craving and is manifested by an
intense desire or urge for the drug that may occur at any time but is more likely when in an
environment where the drug previously was obtained. In addition to the four criteria listed above,
there are social impairments that go along with this diagnosis. This involves the use of drugs or
alcohol and that use resulting in failure to fulfill major role obligations at work, school, or home.
This disorder involves risky use of the substance. This involves the recurrent substance use in
situations in which it is physically hazardous. Lastly are the pharmacological criteria which
consist of building up a tolerance to the substance and suffering from withdrawal symptoms
when the individual does not have access to the substance.
In addition to the above disorders, I would do testing on Inmate Austin to determine if he
has a family history of or the gene for Alzheimer’s disease. According to the DSM-5, to be
diagnosed with mild neurocognitive disorder due to Alzheimer’s disease the individual must first
meet the criteria for a mild neurocognitive disorder. There must be evidence of modest cognitive
decline from a previous level of performance in one or more cognitive domains (complex
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attention, executive function, learning and memory, language, perceptual-motor, or social
cognition. There must be concern of the individual, a knowledgeable informant, or the clinician
that there has been a mild decline in cognitive function and a modest impairment in cognitive
performance, preferably documented by standardized neuropsychological testing or, in its
absence, another quantified clinical assessment. This criteria has been met as Inmate Austin on
multiple occasions is unable to recall events from his past to include his own children’s names.
The nursing and therapeutic staff also noted that there had been a significant decline in Inmate
Austin’s current level of cognitive functioning and had been observed on numerous occasions to
be confused and disoriented. The second portion of the diagnosis is that the cognitive deficits
don’t interfere with capacity for independence in everyday activities. Inmate Austin is still fully
able to function on his own. Further, his cognitive deficits do not occur solely in the context of
delirium and the deficits cannot be better explained by another mental disorder.
Legal Theory and Application
A.
To explain human behavior, social learning theorists place great emphasis on cognitive
process, which are the internal processes we commonly call thinking and remembering.
Classical and operant conditioning ignore what transpires between the time the organism
perceives a stimulus and the time it responds or reacts. Skinnerian behaviorists claim, “if we can
account for the facts by using observable behavior, why worry about the labyrinths of internal
processes?” Social behaviorists, however, counter that this perspective offers an incomplete
picture of human behavior.
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The term social learning reflects the theory’s strong assumption that we learn primarily
by observing and listening to people around us or the social environment. In fact, social learning
theorists believe that the social environment is the most important factor in the acquisition of
most human behavior. Humans are basically social creatures. These theorists do accept the
necessity of reinforcement for the maintenance of behavior, however. Criminal behavior, for
example, may initially be acquired through association and through observation, but whether or
not it is maintained will depend primarily upon reinforcement (operant conditioning).
B.
Individuals who have suffered childhood sexual trauma may suffer greatly from those
events. Some individuals appear to be asymptomatic while others are openly impacted by the
event or events. Sexual trauma can affect many normal developmental processes that occur in
childhood and be exhibited by emotional or behavioral signs showing that they are clearly in
distress. The effects of such trauma can also have lasting effects that continue into adulthood.
Intra and interpersonal problems can arise from sexual trauma to include depression, anxiety,
Post-Traumatic Stress Disorder (PTSD), dissociation, personality and eating disorders, and
dyadic distress. In addition to the more prevalent problems listed previously individuals may
also have somatic concerns, dissociative patterns, denial, sexual problems, relationship problems,
and continue to experience further trauma.
The psychological problems seen from those who have been sexually abused as children
often occur regardless of the level of trauma that the child experienced during the abuse. One of
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the main problems faced by these individuals is that they may suffer from post-traumatic stress
disorder. The DSM-5 classifies the trigger to PTSD as exposure to actual or threatened death,
serious injury or sexual violation. There are four distinct diagnostic clusters associated with the
disorder: re-experiencing, avoidance, negative cognitions, and mood, and arousal. The exposure
must result from one or more of the following scenarios in which the individual: directly
experiences the traumatic event; witnesses the traumatic event in person, learns that the traumatic
event occurred to a close family member or friend (with actual or threatened death being either
violent or accidental); or experiences first-hand repeated or extreme exposure to aversive details
of the traumatic event (not through media, pictures, television, or movies unless work-related).
There are however distinctions listed in the DSM-5 for the criteria of PTSD for children under
six and adults.
For adults, adolescents, and children over the age of six the criteria are:
•Exposure to actual or threatened death, serious injury, or sexual violation
•Presence of 1 or more specified intrusion symptoms in association with the traumatic event(s)
•Persistent avoidance of stimuli associated with the traumatic event(s)
•Negative alterations in cognitions and mood associated with the traumatic event(s)
•Marked alterations in arousal and reactivity associated with the traumatic events(s)
•Duration of the disturbance exceeding 1 month
•Clinically significant distress or impairment in important areas of functioning
•Inability to attribute the disturbance to the physiologic effects of a substance or another medical
condition
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For children ages six and younger:
•Exposure to actual or threatened death, serious injury, or sexual violation
•Presence of 1 or more specified intrusion symptoms in association with the traumatic event(s)
•Symptoms indicating either persistent avoidance of stimuli associated with the traumatic
event(s) or negative alterations in cognitions and mood associated with the event(s)
•Marked alterations in arousal and reactivity associated with the traumatic events(s)
•Duration of the disturbance exceeding 1 month
•Clinically significant distress or impairment in relationships with parents, siblings, peers, or
other caregivers or in school behavior
•Inability to attribute the disturbance to the physiologic effects of a substance or another medical
condition
There are numerous factors that can contribute to the effects of childhood trauma on each
individual affected. It is likely that a child who has experienced sexual trauma by someone who
is close to them such as a family member or family friend may have a more profound negative
impact on their life. Children sexually abused at earlier stages in their development may not yet
have the proper resources and capabilities to handle such an event and may have a harder time
with coping skills thus suffering more adverse consequences. Sexual abuse can be a single event
or can continue over an extended period of time. As seen in the case concerning Inmate Austin,
he sexually abused his grand-daughters for more than 11 years. Children may not be fully aware
of what is happening to them, but they may still experience the negative psychological effects of
the event. The most common psychological consequences seen in children and even in older
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adults are depression, anxiety, internal somatic complaints, and thought problems. As
individuals continue into adulthood these problems don’t simply go away, but continue to linger
and may cause sexual problems and they may have problems in relationships.
As mentioned previously, depression is one of the most common long-term side effects of
sexual trauma. Survivors of childhood sexual abuse may have feelings of confusion,
disorientation, nightmares, flashbacks, and difficulty feeling and expressing their feelings.
Another key protective measure that some survivors use to shield themselves from the event is
that of dissociation. They use this mechanism to protect themselves from reliving the sexual
abuse and use this when they feel unsafe or threatened as adults. This shows the long-term
effects that childhood sexual trauma can have on the individual. This is not just an event that
occurs and is then forgotten, but is something that sticks with the person and they struggle to deal
with it for the rest of their lives. Each individual deals with this type of trauma in their own way
and not all effects will be the same. This makes it so important for the clinician dealing with
survivors to key into that person’s story and their individual experience and subsequent issues
associated with that trauma. Not all sexual abuse survivors can be treated in the same manner.
Victims of child sexual abuse are known to attempt a number of ways to escape from the abuse
(e.g. avoidance, attempts at memory repression, distraction, and even addictive behaviors) and
they attempt to use cognitive processes (e.g. cognitive reappraisal, reframing, minimization, and
working through the abuse).
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C.
Defendants are competent to stand trial if they have the sufficient present ability to
consult with their lawyer with a reasonable degree of rational understanding and a rational as
well as factual understanding of the proceedings (Bartol & Bartol, 2011).
Milton Richard Dusky was a 33-year-old man at the time of his arrest with no criminal
history and a prior diagnosis of Schizophrenic Reaction, Chronic Undifferentiated Type. He was
married with children but intermittently suffered from visual hallucinations, morbid
preoccupations, and depression and had a long history of alcoholism. While being treated
psychiatrically in a Veteran Affairs hospital in March of 1958, his wife left him for his brother.
The night before the offense on August 19, 1958, Mr. Dusky drank two pints of vodka and took a
number of tranquillizers. He had been forced to sleep in his car as he had been thrown out of his
room by his landlady after his son let her dog out and it was killed. The following day he drove
two friends of his son to visit a girl, and on the way, they encountered a second girl whom the
boys knew. After picking her up, they drove the girl across state lines to Missouri, where the two
adolescent boys raped her. Dusky attempted to rape the girl but was unable. He later could not
remember what had occurred.
After his arrest, Mr. Dusky was admitted to the U.S. Medical Center for Federal Prisoners
in Springfield, Missouri for an evaluation of his competency and sanity. Based upon this
evaluation, Dr. L. Moreau opined that Mr. Dusky was “oriented to time, place, and person” and
was denying a “complete memory of the day of the offense.” A second evaluation by the
psychiatric staff, signed by Joseph C. Sturgell, MD, observed that Mr. Dusky had initially
stabilized following his admission to the hospital but had then begun to experience hallucinations
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with emergent beliefs that he was being framed for the offense. This assessment concluded that
Mr. Dusky was mentally ill with a diagnoses of schizophrenia and that, because of this illness, he
was unable to properly understand the proceedings against him and to adequately assist counsel
in his defense.
Mr. Dusky was tried, found guilty, and sentenced. The outcome was appealed and
affirmed by the United States Court of Appeals for the Eighth Circuit. However, upon review by
the Supreme Court of the United States, the Court concluded that “a federal court in which
criminal proceedings are pending to make a finding regarding the mental competency of the
accused to stand trial, may not make a determination that an accused is mentally competent
merely because he is oriented to time and place and has some recollection of events; the test
must be whether the accused has sufficient present ability to consult with his lawyer with a
reasonable degree of rational understanding and whether he has a rational as well as a factual
understanding of the proceedings against him.”
To determine if an individual is not guilty by reason of insanity one must determine the
state of mind of the individual at the time the offense was committed. They must be so mentally
disordered at the time they committed the crime, that they cannot be held responsible for their
actions. The law assumes that a mental disorder has such an effect on the individual that they
have lost their free will or ability to use proper judgement thus forcing them into inappropriate
actions. It is also important to remember that the term insanity is a legal one and not a
psychiatric or psychological term (Bartol & Bartol, 2011).
On January 3, 1999, Andrew Goldstein pushed Kendra Webdale, a young writer, into the
path of an approaching N Train in New York, killing her. He is a man with a history of
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schizophrenia and claimed to hear voices, believed someone had dissected his brain, that his
genitalia had enlarged from consuming contaminated food, and someone named Larry stole his
feces and ate them with a knife and fork. In the prosecutor’s argument, they accused Goldstein of
premeditatedly killing the woman as she closely resembled Stephanie H., a stripper who on
previous occasions sexually frustrated him. They claimed that Goldstein was using schizophrenia
as a false account of his actions.
The reason this case drew much controversy is because Goldstein was committed to the
hospital for a total of 13 times in the course of 1997 and 1998. Each one of his commitments was
done voluntarily, and he once even requested for permanent hospitalization. However, each time
he was turned away and was put in the waiting list for hospitalization, despite his efforts to
commit himself. The tragedy in this case was that the system was firm in their stance to cut costs
and had failed to protect the people. After a gridlock in his first trial, the second jury found him
guilty and convicted him of second degree murder. In the wake of the crime, public outage led to
the introduction of a state law called Kendra’s Law, which allows the right for families to
demand involuntary hospitalization for their relatives. Controversy continued as some say that
the law was irrelevant in this case as Goldstein voluntarily requested for hospitalization. Finally
in 2006, Golstein admitted that he was aware of his actions when he killed Kendra Webdale; just
shy of his pending third trial and finally laying the case to rest.
Risk of dangerousness is used to assess the probability that an individual will engage in
harmful behavior should they be found innocent and released (Bartol & Bartol, 2011). It is key
Running head: Comprehensive Examination
22
to note here that this is not the clinician stating that they know for sure that the individual in
question will be violent. This is a prediction based on past patterns of behavior.
Tatiana Tarasoff was a student at the University of California, Berkeley, under the
leadership of the Regents of University of California (Regents) (defendant). She and her fellow
student, Prosenjit Poddar, briefly shared a romantic interaction on New Year’s Eve 1968. After
that, Tarasoff was unresponsive to Poddar’s advances and dated other men. This all aggravated
Poddar, and he went to see Dr. Lawrence Moore, a psychologist employed at the university’s
medical center. Poddar confessed to Moore that he intended to kill Tatiana. Moore diagnosed
Poddar as suffering from a mental disorder and recommended he be involuntarily committed for
a short time. Poddar was released, however, after he appeared rational. Moore’s boss allegedly
told him not to have any further involvement with the case. At no point did anyone associated
with the Regents warn Tatiana or her parents of possible danger. On October 27, 1969, Poddar
killed Tatiana in her home. Tatiana’s parents, the Tarasoffs (plaintiffs) brought suit against the
Regents alleging they were negligence in failing to warn them of the danger to Tatiana. The trial
court held for the Regents, and the Tarasoffs appealed.
Assessment, Research, and Evaluation
A.
The tests used in the determination of the defendants’ condition in the psycho-legal issues
are important as there is the determination of the effectiveness of the issues that they face. The
tests include the intelligence tests where there is analysis of the personality of the defendant.
The judgement on the alertness of the patient assists in the focus on the Jason vocabulary where
there is focus on the symptoms of the insanity levels (Govaerts et al., 2013). Using a multi-axial
Running head: Comprehensive Examination
23
diagnosis is important in the determination of all the hypotheses of the diagnosis and this helps in
getting the divergence of the environments.
I previously mentioned all of the assessment tools that I would use in determining Inmate
Austin’s mental state and what would be best for him with regards to his treatment plan. I do
however, think that further tests should be conducted to include intelligence testing to determine
his understanding of the events surrounding his case and his future release and treatment options.
This will further help determine the effectiveness of the psycho-legal issues that Inmate Austin is
facing. He is due to get out of prison in June 2019 thus a plan must be put in place to ensure that
he continues his treatment for sex offending and he must be given help to find appropriate
housing. Even though Inmate Austin has attended sex-offender treatment, it is advised that he
start a new program and join group sessions. With regards to housing I would have him involved
in a program that also provides housing in which the resident can be monitored until such time
that Inmate Austin has proven that he is no longer a threat to reoffend. He will also need
adequate access to healthcare due to his emphysema, bronchitis, and hypertension. In addition to
his medical needs, he will also need monitored for the medications he has been prescribed to
ensure the he continues with the protocol set for him in the prison system.
B.
The nature of the crimes committed by Inmate Austin deal with child sexual abuse
therefore I would like conduct research in this area. It was noted that Inmate Austin also
suffered from sexual abuse at the hands of his grand-father and at one point it appears that there
was penetration. I would like to know if there is a correlation between those who have been
sexually abused and if they become sexual predators themselves. What is the correlation
between the two events? I have laid out my entire research process below to include the abstract,
Running head: Comprehensive Examination
24
statement of the problem, purpose of the study, research question and hypothesis, theoretical
framework, and operational definitions.
Abstract
Does abuse in childhood cause individuals to become child sex offenders as adults? The
goal of this study will be to determine if there is a connection with sexual abuse in their
upbringing, having an impact on an individual becoming a child sex offender as an adult. In
order to conduct such an experiment, a nationwide search will be conducted in order to find an
adequate number of individuals to interview and have them fill out questionnaires. This research
will delve into the pasts of these individuals who have experienced sexual abuse as children and
see if that abuse contributed to their inappropriate sexual desires as adults. The overwhelming
evidence from this experiment will show a relationship between sexual abuse as a child and
abuse that was perpetrated by the adult child sex offender.
Statement of the Problem
There are so many individuals that have suffered some type of sexual abuse at the hands
of close family members, friends, or even outsiders. This type of abuse has profound effects on
the individual. Some individuals suffer from depression, suppress the event, act out
inappropriately sexually, and others may go on to become sexual predators themselves. What
has happened to the sexually abused child that caused them to grow up and commit sexual abuse
against others when they know how this can feel and how it impacts an individual’s life? Does a
child grow up to become a child sex offender due to genetics or is it due more to their
environment and upbringing?
Running head: Comprehensive Examination
25
Purpose of the Study
The purpose of this study is to delve into the sexual abuse that may have been suffered by
the known sex offender as a child to see if this event or events is what caused the child to grow
up and themselves become sex offenders. First and foremost, the sex offender will be defined
with regards to their upbringing, who they sexually assault, and why they feel compelled to
commit such heinous crimes. For the most part, child sex offenders find victims that they know
or are close to. If you look at the typical profile of a child sex offender, most of them have
experienced some type of abuse or trauma throughout their childhood. It is of utmost importance
to determine if this abuse and trauma contributes to an individual becoming a child sex offender
once they become adults. If signs of sexual abuse can be caught early on in a child’s life, there is
the possibility that these individuals can get the help they need and avoid becoming sex
offenders themselves.
Research Question and Hypothesis
Research Question: Is there a relationship between child molestation and sex offending in
adulthood?
Hypothesis: Abuse suffered as a child has an impact on how the individual will act and behave
as an adult to include becoming a child sex offender.
Theoretical Framework
Sexual abuse is defined as any sexual activity, practice or instruction which either meets
the criminal definition or is unhealthy for a child considering his/her age and level of
development. Criminal activity is defined as “committing or allowing to be committed any
Running head: Comprehensive Examination
26
illegal sexual act upon a child including incest, rape, fondling, indecent exposure, prostitution, or
allowing a child to be used in any sexually explicit visual material.” For example, one offender
was forced to sleep in the same bed with his mother until he was 13 years old and was forced to
watch her have sex with men (Flowers, 2000).
Operational Definitions
Childhood or child is anyone from birth to 17 years of age.
Child sexual abuse includes engaging in sexual activities with a child (whether by asking or
pressuring, or by other means), indecent exposure (of the genitals, female nipples, etc.), child
grooming, or using a child to produce child pornography.
A child sex offender performs an act of child abuse in which an adult or older adolescent uses a
child for sexual stimulation
Leadership, Consultation, and Ethics
A.
The psychologist may endorse a particular value to some degree along a continuum.
Forensic psychologists have a responsibility to evaluate the degree to which their personal moral
positions are consistent with those of the larger society and the organizations with which they are
involved. To the extent possible, they should attempt to understand their biases and the potential
impact that their values and biases have on their professional and ethical decision making.
Psychologist also draw on personal values other than those reflected in a model of professional
ethics, such as their religion or cultural background. It is critically important that forensic
psychologists, whose work often involves matters laden with moral and values implications,
Running head: Comprehensive Examination
27
attempt to understand the potential influences of their personal beliefs on their professional
behavior.
The main ethical consideration in this case is that of dealing with a known and repeat
child sex offender. Personal bias can play a big role in how one interacts with someone with this
type of background. I must remove my personal bias and preconceived notions from the
equation and deal with the psycho legal question at hand. I cannot effectively perform my duties
and give the best attention to Inmate Austin if I do not treat him fairly and deal solely with the
question at hand. If I do not eliminate my perception of child sex offenders, I will be ineffective
in coming up with a treatment plan and the best alternatives for Inmate Austin should he be
released from prison. It is my duty to come up with a treatment plan that will ensure that Inmate
Austin is setup for success when he leaves the correctional setting. This includes follow-up care,
a progressive child sex offender program for rehabilitation, and helping him find housing and
proper medical care. These are the areas that will help Inmate Austin from becoming a repeat
offender.
Interpersonal Effectiveness
A.
Ethical challenges in the consideration of ethnic and cultural diversity pose considerable
difficulty for psychologists, as they cut across practice settings, age ranges, and
psychopathological conditions. These challenges are faced not only by psychologists
representing dominant U.S. demographics but also by those psychologists who are members of
the minority groups with whom they work, as many psychological measures were not developed
Running head: Comprehensive Examination
28
with such variations in mind and were not standardized on diverse groups or specific populations
(Bush, Connell, & Denney, 2013).
Psychologic al functioning is influenced by one’s sociocultural background. Despite
commonalities that exist among members of the same races, ethnic backgrounds, and cultures,
considerable intragroup differences exist. The psychological evaluation must include a thorough
exploration ot the examinee’s unique racial and ethnic identity and cultural background. Failure
to consider factors such as race, nationality, place of birth, immigration status, the level at which
the culture of origin is maintained, perception of health care institutions and professionals,
cultural factors in family roles and interactions, and significance of religious influences may
result in significant misunderstanding of the examinee and an increased potential for error in
psycho legal opinions. Failure by examiners to consider their own feelings toward, and
understanding of, members of different groups may also contribute to misunderstanding of the
examinee’s psychological functioning (Bush, Connell, & Denney, 2013).
APA General Principle D states that all individuals are entitled to access to and benefit
from psychological services of equal quality. Psychologist must be proactive in ensuring that
biases and limitations of competence do not interfere with the provision of their services.
Standard 2.01b, Boundaries and Competence, requires sensitivity to the impact of culture,
disability, and other diversity factors on one’s professional competency. (Bush, Connell, &
Denney, 2013)
Standard 9.02b, Use of Assessments, requires psychologists to use assessment
instruments that have established validity and reliability for use with members of the population
that the patient represents. Standard 9.02c states that psychologists should use measures that are
appropriate given the patient’s language preference and competence, unless use of an alternative
Running head: Comprehensive Examination
29
assessment is relevant to the examination. Standard 9.06, Interpreting Assessment Results,
requires psychologists to “take into account” the various factors that may affect the accuracy of
their interpretations. However, because of the number of potentially invalidating factors, “in
some situations”, it is impossible to determine if the interpretations made by psychologist under
these circumstances could be valid (Bush, Connell, & Denney, 2013).
It is important to look at the cultural and demographic variables when dealing with
Inmate Austin. He is a 78-year-old widowed, Caucasian male who was raised in a rural area of
Illinois. He comes from a low socioeconomic background and classifies himself as having been
poor. He and his brother were both abused by the parents. Inmate Austin also discusses having
been pursued in a sexual manner by his own grandfather and at one point was sexually assaulted
by him. It is important to remember that he is an older gentleman who comes from a different
time than I myself. I must take into consideration that I am dealing with a senior citizen and be
respectful of his past and his ways. He is also a Caucasian individual and I must take into
consideration any cultural aspects of his culture. He further states that he comes from a low
socioeconomic background and has a limited education as he dropped out of school his junior
year in high school. All assessments done on Inmate Austin must be done considering his
educational background.
He also has a history of abuse by his parents and grandfather which may cause him to
retreat somewhat. As he has shown in the vignette, he is not someone who likes to talk about the
more difficult subjects and events in his life. It is imperative that I establish repoire with him so
that he will feel comfortable opening up to me and delving into the tougher issues.
I want to make sure that I do not let my personal bias interfere with my treatment of
Inmate Austin. He is a known child sex offender and this brings up some negative feelings in
Running head: Comprehensive Examination
30
most individuals to include myself. I must also consider that he was also sexually violated when
he was a child which may have contributed to his current actions and behaviors.
Running head: Comprehensive Examination
31
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.).
Degiorgio, L., & Lindeman, H. (2012). Sex Offender Assessment Using the Sexual Adjustment
Inventory (SAI). Journal of Community Corrections, 22(1), 9. Retrieved from
http://search.ebscohost.com.libproxy.edmc.edu/login.aspx?direct=true&db=p6h&AN=852
05018&site=eds-live
Parsons, O. (2016). Sexual Abuse : Intervention, Coping Strategies and Psychological Impact.
Hauppauge, New York: Nova Science Publishers, Inc. Retrieved from
http://search.ebscohost.com.libproxy.edmc.edu/login.aspx?direct=true&db=nlebk&AN=1226250
&site=eds-live
Tully, R. J., Chou, S., & Browne, K. D. (2013). A systematic review on the effectiveness of sex
offender risk assessment tools in predicting sexual recidivism of adult male sex offenders.
Clinical Psychology Review, 33, 287–316. https://doiorg.libproxy.edmc.edu/10.1016/j.cpr.2012.12.002
Willis, G. M., & Johnston, L. (2012). Planning helps: The impact of release planning on
subsequent re-entry experiences of child sex offenders. Journal of Sexual Aggression,
18(2), 194–208. https://doi-org.libproxy.edmc.edu/10.1080/13552600.2010.506576
MA Forensic Psychology Comprehensive Exam
The MAFP Comprehensive Examination questions will be accessible on the morning of the examination
date.
Au MAFP Comp Exam Spring A 2019
Argosy University Comprehensive Examination
MA Forensic Psychology
Spring A 2019
Thursday, January 31, 2019 –Wednesday, February 6, 2019
(Note exams submitted after 11:59 pm EST will receive an N/C)
Case Vignette for Comprehensive Examination
Please read the vignette carefully. Based on information provided in the vignette, please
compose a well-written and organized response to each of the questions that follow:
Task Identification:
You are the forensic mental health professional being asked to conduct a prison discharge
evaluation with recommended services and referrals as needed. Along with addressing the
questions below. The report will be submitted to the appropriate mental health professional
supervisor and correctional administration staff member.
Interview and Background Information
Family History:
Inmate Austin is a 78-year-old, widowed, Caucasian male. He reported he was born in “down
state Illinois” (rural area). Inmate Austin stated he was raised in a home with both parents,
maternal grandfather and siblings. Inmate Austin described the area he was raised in as a “small
sized town.” Inmate Austin recalled his childhood by stating he was “born during the after effect
time period of the Depression” referring to the fact he was “a pre-baby boomer” and his family
was; therefore, “poor” when he was growing up. He stated his father was a “railroad man” as
well as “an alcoholic.” Inmate Austin reported his mother was a seamstress who worked in a
“woman’s clothing factory.” He described his parents as a couple that “fought like cats and
dogs” and stated he witnessed his mother give his father a black eye. Additionally, Inmate
Austin reported his parents would “curse each other out” and explained this made him “feel
sad.” He stated his father died from organ failure related to his alcoholism and his mother died
from a heart attack. Although Inmate Austin could not recall when his parents passed away, a
review of his Illinois Department of Corrections (IDOC) Master File revealed his father died
when Inmate Austin was age 35 and his mother passed away when Inmate Austin was 53
respectively.
Inmate Austin reported he is the second oldest of six children stating all of his siblings are
approximately one year apart. He stated he has three sisters and two brothers but was only able
to recall the names of two of his siblings. He reported he did not get along with his oldest sister
when they were growing up because he felt his dad spoiled her and he would be punished if he
even “said a cross word to her.” Additionally, Inmate Austin stated he and all of his siblings
“quarreled frequently.” Inmate Austin reported he does not have current contact with any of his
siblings because he is “locked up and [I] don’t want contact with them.” When Inmate Austin
was asked when was the last time he had contact with his siblings he stated, “I do not want to
discuss that!”
Inmate Austin revealed he is currently a widow. He stated he was married for 30 years, until his
wife died in 1999 from a “virus in the Mississippi River Valley caused by a fungus” and was
visibly upset when he spoke about not being able to attend her funeral. He denied any domestic
violence in the relationship but did report that he “had a mouth and was dominant.” Inmate
Austin reported having five children, three sons and two daughters; however, was unable to
remember their names. He stated he was unable to recall when any of them were born except
they were all currently in their 50’s. Inmate Austin described his relationship with his children
as “non-existent currently.” He added he did provide support for them when they were young
and had contact with them while they were growing up and described having a close relationship
with his children when they were younger. When Inmate Austin was questioned about the
described distance relationship with his children he stated, “…that is something we will not
discuss today either! Let’s just say I have family, but we are not close and when I finish serving
my time here I have nowhere to go. How about you focus on finding me somewhere to live once
they let me go from here rather than asking questions that can’t help me!”
Social, Educational and Employment History:
Inmate Austin indicated he was an “average, everyday child” and believed he reached all
appropriate developmental milestones at the average age; although he could not recall for
sure. He stated he attended school regularly because “it was something to do” and did not attend
“special classes for the slow kids either” during school. However, he reported he “hated it” and
“didn’t fit in socially because [he] was too independent.” Inmate Austin stated he was “very,
very short on friends,” suggesting he only had a few friends in his life. He stated he dropped out
of school during his junior year “to help his parents support the family.” Inmate Austin stated he
received his GED from Regan Junior College in 1957.
In reference to employment history, Inmate Austin stated he began working as “a young
child.” He reported his first few jobs were “setting pins in a bowling alley, working three to four
paper routes at the same time, and cutting grass.” After quitting school at the age of 16, Inmate
Austin reported he joined the Navy where he worked as a “torpedo man” for approximately four
years. Inmate Austin described his experience in the Navy by stating “he was on a sub that
allowed him to go into every port while they sailed down the coast of China, plus it helped me to
help my family.” He reported he received an honorable discharge. After the Navy, Inmate Austin
stated he worked for the railroad as a switchman for approximately 27 years before being injured
on the job by “cracking [his] tailbone.’ He reported during this time he “temporarily went on
SSI” but was “too proud to take it for too long.” Inmate Austin stated his last job was in retail
selling shoes, which he used to supplement his pension from the railroad. He could not recall if
he had ever been fired from a job, he stated “[I] imagine I did, probably mouthed off at a
foreman.” Additionally, he stated he “got along fair” with most of his employers and coworkers.
Psychiatric and Medial History:
Inmate Austin denied the presence of mental health issues within his family. He indicated that he
previously received mental health therapeutic services when he was in the Navy at 19 years of
age. Inmate Austin stated he “doesn’t remember much about it.” Further, Inmate Austin could
not recall if he was diagnosed with a mental disorder. He denied being prescribed medication. A
review of Inmate Austin’s Medical File revealed he is currently prescribed Remeron, Ativan,
Aricept, Vitamin B, Zocor, Prilosac, Atrovent inhaler, and Albuterol inhaler. At the time of this
report, Inmate Austin was compliant with his medications. Inmate Austin has completed several
psycho-education groups, mandatory sex-offender treatment groups, alcohol and drug treatment
groups and has received individual therapy during his current incarceration per his Medical File.
In addition, according to Inmate Austin’s Medical File, Inmate Austin completed a six-month
voluntary hospitalization for sex offender treatment in 1998 at Lincoln Hospital and a later
psychiatric hospitalization in 1999 at DeCross Hospital. When Inmate Austin was questioned
about the documented hospitalizations he stated “I do not recall the sex offender treatment and
my psychiatric hospitalization “was due to me grieving the loss of my wife.”
Inmate Austin reported a history of one suicide attempt. He stated he tried to hang himself when
his “world was coming down, the love of my life left me” Inmate Austin described the situation
as “scary, I was hearing her voice … it was crazy.” He stated he was “too chicken” to follow
through. He reported he prepared the rope and “got up on the chair but changed [his] mind right
before stepping off the chair.” No history of homicidal ideations reported by Inmate Austin.
Also Inmate Austin denies any thoughts of current suicidal and homicidal ideations. Inmate
Austin denied experiencing any current perceptual disturbances.
Inmate Austin reported currently experiencing difficulty sleeping, having nightmares, loss of
interest in pleasurable activities, a lack of appetite, feeling “inferior,” feeling lethargic with an
inability to think when lethargic, hypervigilance, having intrusive thoughts and engaging in
avoidance behavior. Per Inmate Austin’s Medical File, he has reported experiencing these
symptoms daily since 1999. However, Inmate Austin reported experiencing difficulty sleeping,
having nightmares, being hyper-vigilant, having intrusive thoughts and engaging in avoidance
behavior “since being in the Navy.” He also expressed frustration with having difficulty with his
long-term memory. Per Inmate Austin, he has difficulty “remembering the names of [his]
children and recalling the dates of various events…” in his life. A review of his Medical File
revealed that Inmate Austin has repeatedly complained about having difficulty with his memory
to both the nursing and therapeutic staff since 2007. Inmate Austin’s Medical File also notes,
there has been a significant decline in Inmate Austin’s current level of cognitive functioning,
often times Inmate Austin has been observed as being confused and disoriented by the nursing
staff and correctional officers. Per the Medical File, Inmate Austin is currently on the waiting list
for psychological testing to assess his cognitive abilities and social emotional functioning.
Inmate Austin stated he has “been on the waiting list for psych testing for years.”
According to Inmate Austin’s Medical File, he is diagnosed with emphysema, and has a history
of bronchitis, hypertension, and cardiac problems. Inmate Austin denied any history of head
injuries. He reported having one heart attack that he stated was a result of his emphysema,
which left him in a coma for three weeks. However, there was no collaborating information in
his Medical File to verify this information. Inmate Austin reported that after being in a coma he
had difficulty walking, problems with coordination and balance, and stated he must now use a
cane or else he will “go over backwards,” suggesting he is a fall risk.
Substance Use/Abuse History:
Inmate Austin reported a positive substance abuse history, including occasional drug use as an
adult. He stated he began drinking alcohol “pretty young” but stated it was “not in excess until
the Navy.” Inmate Austin explained he began drinking heavily when he was in the Navy
because it “numbed [the] experience.” Per Inmate Austin, he stated before “being locked up” he
was drinking approximately a six-pack of beer each weekend and occasionally “drank Brandy
with coffee throughout the day.” Additionally, he reported he began using Marijuana “when
[his] older kids were using it” and used about once a day for several months. He stated this was
“quite a while ago” although he could not recall approximately when but did recall discontinuing
because he “wasn’t going to spend his money on joints.” Finally, Inmate Austin stated he also
tried mushrooms once or twice when his son was using them, but only used them the one time
because “[it] was a letdown, didn’t like the feeling.” He denied any indications of tolerance or
withdrawal to any of the substances he used and denied any consequences to his drug use despite
the charges documented in his IDOC Master File related to his Marijuana use.
Trauma:
Inmate Austin reported witnessing several of his “…. fellows dying before [his] eyes while
serving in the Navy” for which he considered to be traumatic.
Abuse History/DCFS Involvement:
Inmate Austin reported a positive history for abuse, but denied any DCFS involvement. Per
Inmate Austin, throughout his childhood his parents were physically abusive towards him and his
younger brother. He stated his father “used a leather belt extensively” and his mother “slapped
[him] a lot.” Inmate Austin described the first time he felt loved was when his father “beat [him]
up one time over an argument and later asked for forgiveness.” Inmate Austin also reported
sexual “attempts” were made toward him by his grandfather. Reporting “one time he actually did
it to me,” but stated he could not recall all the details of the sexual molestation encounter. He
denied any other history of abuse.
Legal History:
Inmate Austin is currently incarcerated in the IDOC after being convicted of the Class X Felony,
Predatory Criminal Sexual Assault, specifically Sexual Penetration of a Victim (720 ILCS 5/1214) under the age of 12. He is currently serving a 15-year sentence for this conviction without
parole. According to his IDOC Master File, Inmate Austin was arrested and convicted of having
a sexual encounter with a 10-year-old female neighbor after next door neighbor reported
observing Inmate Austin “sexually penetrate the identified minor in the backyard.” Inmate
Austin is due to be discharged from the IDOC in June 2019. When Inmate Austin was asked why
he was currently incarcerated he stated “I do not want to talk about that now! Just know I have
been rehabilitated!”
Inmate Austin denied a legal history as a juvenile. However, he did admit he was caught once
for shoplifting as a child at a dime store and stated “we were really poor and I wanted to get my
mom something nice for her birthday, but I was not able, but I did not go to jail either.” Inmate
Austin could not recall if he had been in prison prior to his current incarceration, his IDOC
Master File noted four previous convictions. Inmate Austin’s Master File reported he had
previously been found guilty of two counts of Criminal Sexual Assault with Force in
1993. According to the Master File, Inmate Austin had been sexually abusing his twin granddaughters from the age of three and a half until the age of 14 when they reported being molested
by their grandfather (Inmate Austin) to their parents after one of the twin grand-daughters
became pregnant and reported the father was Inmate Austin. Inmate Austin served a five-year
sentence followed by six-months of voluntary sex offender treatment, reducing his three years of
mandatory supervision to six-months. Additionally, Inmate Austin’s IDOC Master File reported
two convictions in 2000, which included Unlawful Manufacturing of Cannabis, which was
subsequently reduced to Possession of Cannabis 10 to 30 grams and Possession of Drug
Paraphernalia. Both of these convictions included a sentence of 120 days in jail and a fine
served concurrently.
Inmate Austin’s IDOC Master File indicated he has received several disciplinary tickets with
sentence time infractions accruals during his current incarceration extending his current sentence
time by 5-years, with a discharge date now in June 2019.
Inmate Austin denied having a gang affiliation history.
Behavioral Observations & Mental Status:
Inmate Austin appeared his stated age of 78. During the interview Inmate Austin appeared with
short, well-trimmed grey hair. Inmate Austin was groomed and dressed appropriately, slightly
short in stature and slightly thin in weight. He stated his current mood was “pretty good” and
appeared euthymic with congruent affect in normal range during the evaluation. Inmate Austin
presented as an alert individual who had no apparent difficulty following conversation. He was
oriented to person and place. Inmate Austin was disoriented to time and situation. He
demonstrated a coherent and goal-directed thought process. With no evidence of a perceptual
disturbance present. Inmate Austin denied having current suicidal and homicidal ideations. His
attitude was cooperative.
Inmate Austin presented with consistent and appropriate eye contact with coherent speech that
was average in pitch and volume was normal in rate, until he was asked questions about events
or people he did not want to discuss then the volume of Inmate Austin’s speech would increase.
His attention span was intact. Inmate Austin illustrated moderate memory function difficulty.
Inmate Austin possesses poor insight into his current problems. His social judgment and impulse
control at the time of the evaluation was fair. He appeared to possess an average intellectual
ability.
Based on the vignette provided, please compose a well-written and organized response to
each of the following questions. When writing your responses, please:
•
•
Use APA (6th edition) Style, with 1-inch margins, double-spaced, 12 fonts with a
reference list at the end.
Write clearly and concisely.
•
•
•
Cite appropriate, and especially current, literature (empirical and/or theoretical).
Avoid all sexist idioms and allusions.
Remember to demonstrate your multicultural competence where appropriate.
Psychological Theory and Practice
A. What assessments would you conduct to enhance your understanding of the problems of
the person in the vignette and how would your choice of assessment(s) inform your
diagnostic formation and treatment planning? Assessments may include structured or
unstructured interviews, valid and reliable assessment measures, and/or formalized
assessment procedures that may be conducted by yourself or by someone else referred by
you.
B.
Provide your diagnostic impressions (based on the DSM-5) for this individual. In
narrative form, please describe how the individual meets the diagnostic criteria for the
disorder(s) chosen in addition to the differential diagnostic thought process that you used
to reach your hypotheses. Be sure to include any additional (missing) information that is
needed to either rule out or confirm your differential diagnoses impressions.
Legal Theory and Application
A.
Explain the background, current presentation, and behavior of the person in the vignette
utilizing biological, learning, and social theories on offenders to support your position.
Do not simply restate the background information from the vignette. Instead, provide a
theoretically-based discussion to understand the criminal behaviors of the person in the
vignette.
B.
Consider the type of crime in the vignette and discuss how that type of crime generally
impacts a victim of it. Do not limit yourself to discussing just the victim in this
vignette. Instead obtain scholarly sources for information on how this type of crime can
affect any victim, their family members, and other members of society.
C.
Describe the psycho-legal standards and/or definitions for each of the following:
competence to stand trial, duty to warn, and insanity. Identify and describe one or more
landmark case(s) for each standard (at least three cases total). Describe the elements or
issues that a mental health professional usually focuses on when assessing a person’s
adjudicative competence, risk and insanity, and any additional items that might be
especially important to focus on in the provided vignette.
Assessment, Research and Evaluation
A.
Describe tests or assessment procedures you would employ to address the psycho-legal
issues of (competence to stand trial, risk of dangerousness, and insanity). You may refer
to these from the Psychological Theory and Assessment Section "A" if you already
covered them there. Discuss what the anticipated conclusions would be based upon
information provided in the vignette.
B.
Develop a research question and a testable research hypothesis regarding offenders or the
type of crime that is discussed in the vignette (such as, addiction, recidivism, criminal
behavior, etc.). Explain the variables in your question and the type of research study that
could answer your question as well as why that research would make a contribution to the
field of forensic psychology.
Leadership, Consultation, and Ethics
A. What are the ethical and legal dilemmas this vignette introduced? What would be your
immediate steps and why? Please be specific and make sure that you describe your
process of ethical decision making and the solutions/consequences to which this process
might lead. Your discussion should be informed by the American Psychological
Association’s Ethics Code as well as the Specialty Guidelines for Forensic Psychologists.
Interpersonal Effectiveness
A. What diversity factors, cultural considerations, or other demographic variables pertaining
to the person in the vignette would you take into account in rendering diagnoses,
choosing assessment measures, forming case conceptualizations, and designing the
treatment plan? Be sure to discuss cultural/diversity factors that could apply even if they
are not explicitly mentioned in the vignette.
A. Your writing, use of citations, ability to form a logical argument, and proper APA Style,
including the use of paraphrasing, will be evaluated as a measure of your interpersonal
effectiveness. No response is required for "B".
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