Comprehensive exam on Forensic Psychology

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Running Head: COMPREHENSIVE EXAM Comprehensive Exam Trisha R. Podsiadlo Argosy University 1 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 2 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 Running head: Comprehensive Examination 3 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 Running head: Comprehensive Examination 4 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. Running head: Comprehensive Examination 5 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 Running head: Comprehensive Examination 6 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. Running head: Comprehensive Examination 7 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 Running head: Comprehensive Examination 8 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 Running head: Comprehensive Examination 9 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 Running head: Comprehensive Examination 10 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 Running head: Comprehensive Examination 11 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. Running head: Comprehensive Examination 12 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 Running head: Comprehensive Examination 13 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 Running head: Comprehensive Examination 14 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. Running head: Comprehensive Examination 15 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 Running head: Comprehensive Examination 16 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 Running head: Comprehensive Examination 17 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 Running head: Comprehensive Examination 18 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). Running head: Comprehensive Examination 19 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 Running head: Comprehensive Examination 20 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 Running head: Comprehensive Examination 21 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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Prison Discharge Evaluation Report Outline
1. Introduction
✓ There are higher rates of physical and mental health problems in adults who are in
contact with the criminal justice system compared to the rates in the general population
and hence it is important to conduct a prison discharge evaluation so that the primary care
services can get a structured handover of a person’s ongoing and new health problems as
they take over the responsibility.
✓ Inmate Austin is presenting for a prison discharge evaluation. 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.
2. Psychological Theory and Practice
✓ Considering Inmate Austin’s history of sexually abusing young girls, history of his
crimes, attempt to commit suicide and history of drug abuse, the following tests will be
conducted on him: Columbia-Suicide Severity Rating Scale (C-SSRS), Brief Symptom
Inventory (BSI), the Minnesota Sex Offender Screening Tool-Revised (MnSOST-R), and
the Substance Abuse Subtle Screening Inventory (SASSI).
3. Legal Theory and Application
✓ Different explanations of Inmate Austin’s behavior using psychological, sociological and
biological principles of criminality.
✓ How Inmate Austin’s type of crime impacts the victim of it.
✓ Psycho-Legal Standards of competence to stand trial, duty to warn, and insanity.

4. Assessment, Research, and Evaluation
✓ Different assessment procedures to address the psycho-legal issues of competence to
stand trial, risk of dangerousness, and insanity.
✓ 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
like an adult to include becoming a child sex offender.
5. Leadership, Consultation, and Ethics
✓ Ethical and Legal Dilemmas in This Vignette. 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.
6. Interpersonal Effectiveness
✓ Diversity Factors, Cultural Considerations, or Other Demographic Variables to Take Into
Account in Rendering Diagnoses, Choosing Assessment Measures, Forming Case
Conceptualizations, and Designing the Treatment Plan for the Offender.
✓ The psychological evaluation must include a thorough exploration of the examinee’s

unique racial and ethnic identity and cultural background.
✓ A psychologist must be proactive in ensuring that biases and limitations of competence

do not interfere with the provision of their services.


Running head: MA FORENSIC PSYCHOLOGY COMPREHENSIVE EXAMINATION

MA Forensic Psychology Comprehensive Examination
Trisha R. Podsiadlo
Argosy University
Date

1

MA FORENSIC PSYCHOLOGY COMPREHENSIVE EXAMINATION

2

Table of Contents
Introduction ................................................................................................................................................. 3
Psychological Theory and Practice ............................................................................................................ 5
A.

Choice of Assessments ..................................................................................................................... 5

B.

Diagnostic Impressions (Based on the DSM-5) ............................................................................ 12

Legal Theory and Application ................................................................................................................. 16
A.

Biological, Learning, and Social Theories on Offenders ............................................................. 16

B.

Impact of Crime to the Victim of It ............................................................................................... 18

C.

Psycho-Legal Standards................................................................................................................. 21

Assessment, Research, and Evaluation ................................................................................................... 25
A. Assessment Procedures to Address the Psycho-Legal Issues of Competence to Stand Trial, Risk
of Dangerousness, and Insanity ............................................................................................................ 25
B.

Research Question and Hypothesis ............................................................................................... 27
Overview ............................................................................................................................................. 27
Statement of the Problem .................................................................................................................... 27
Purpose of the Study ........................................................................................................................... 28
Research Question and Hypothesis ..................................................................................................... 28
Theoretical Framework ....................................................................................................................... 29
Operational Definitions ....................................................................................................................... 29

Leadership, Consultation, and Ethics ..................................................................................................... 29
A.

Ethical and Legal Dilemmas in This Vignette .............................................................................. 29

Interpersonal Effectiveness ...................................................................................................................... 30
A. Diversity Factors, Cultural Considerations, or Other Demographic Variables to Take Into
Account in Rendering Diagnoses, Choosing Assessment Measures, Forming Case
Conceptualizations, and Designing the Treatment Plan for the Offender .......................................... 30
References .................................................................................................................................................. 34

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Introduction
There are higher rates of physical and mental health problems in adults who are in
contact with the criminal justice system compared to the rates in the general population. People
in prison have a prevalence of mental health issues of around ten times higher than other people
in the general population (Gudjonsson & Haward, 2016). Most prevalent issues include
personality disorder, drug abuse, anxiety, depression, diabetes, and respiratory diseases among
others. Given that been held in prison is linked to higher rates of mental problems and high
suicide rates, it is essential to conduct a prison discharge evaluation so that the primary care
services can get a structured handover of a person’s ongoing and new health problems as they
take over the responsibility. People who have been in contact with the criminal justice system
deserve equal access to healthcare as the rest of the general population, and hence the prison
discharge evaluation ensures a smooth transition. The purpose of this paper is to create a prison
discharge evaluation report on inmate Austin who is currently incarcerated in the IDOC and is
due to be discharged from the IDOC in June 2019.
Inmate Austin is presenting for a prison discharge evaluation. He is a 78-year old,
widowed, Caucasian male. The inmate grew up in rural Illinois and describes his family as being
poor. He is the second oldest of six children including three sisters and two brothers. As per
Inmate Austin, his parents were physically abusive towards him throughout his childhood and
was 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 of
school in 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 developed an alcohol problem during his

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time in the Navy and did drugs such as marijuana and mushrooms occasionally with his son. He
has a history of mental health treatment and has attended sex-offender treatment groups.
Austin was 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 has also received individual therapy.
The inmate 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 names of his children and dates of various important events in his
life. The staff has also noticed a significant decline in his current level of cognitive functioning
and often he has been observed as being confused and disoriented.
When Inmate Austin appeared for his interview, he was well groomed and dressed
appropriately. His mood was good and appeared euthymic with congruent affect in the 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 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 judgment and impulse control at the time of evaluation was fair. Inmate Austin is also of
average intellectual ability.

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Psychological Theory and Practice
A. Choice of Assessments
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
sex offender himself. In the interview, he reports that his grandfather assaulted him sexually.
Due to his proclivities to abusing young girls and history of both substance abuse and suicide, I
would conduct the Columbia-Suicide Severity Rating Scale (C-SSRS), 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. Since he has attempted suicide in the past, he 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 Columbia-Suicide Severity Rating Scale (C-SSRS) is a suicidal behavior, and
ideation rating scale developed to assess suicide risk. C-SSRS has four areas on the assessment
which include suicidal ideation, an intensity of ideation, suicidal behavior, and those who answer
questions for actual attempts (Gudjonsson & Haward, 2016). The suicidal ideation and intensity

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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 Non-Suicidal 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 is equal to
Zero.
Different scoring systems exist depending on the population. The critical 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...

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