Civil Forensic Assessment

1. Chapter 3 Civil Forensic Assessment

2. Criminal vs. Civil Law

3. Criminal vs. Civil Law

4. Overview • Civil Commitment • Parenting Capacity • Child Maltreatment

5. Civil Forensic Assessment: Major Domains of Practice Health • Focus on evaluating nature and severity of psychological impairment (for cause or outcome) • Special legal issues: • Civil commitment • Competence to consent to treatment • Personal injury

6. Civil Forensic Assessment: Major Domains of Practice Children & Families • Evaluations focus on legal issues related to interests of children and families in conflict • Special legal issues: • Parenting capacity • Guardianship • Risk for maltreatment

7. Civil Forensic Assessment: Major Domains of Practice Employment and Education • Evaluations appropriate/inappropriate infringement of rights • Special legal issues: • Fitness for duty/reasonable accommodation • Discrimination and harassment • Workplace violence • Disability

8. Civil Commitment Involuntary treatment or hospitalization of people on ground they pose a risk to themselves or others on account of mental disorder (Winick, 2008)

9. Civil Commitment: Procedures • Mental Disorder: a disorder of the mind that seriously impairs a persons ability to react appropriately to the person’s environment or to associate with others (MHA s. 1) and • A physician certifies that the person requires treatment, care, supervision, and control in or through a designated facility to prevent that person’s substantial mental or physical deterioration or for the protection of the person or patient or the protection of others, and cannot be admitted as a voluntary patient (MHA s. 22) • 1 certificate for 48 hours and 2 certificates for up to 30 days ( may be renewed)

10. Civil Commitment: Procedural Safeguards • Involuntary treatment/commitment infringe rights & freedoms • Triggers s. 7 of the Charter of Rights and Freedoms • Everyone has the right to life, liberty, and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice

11. Civil Commitment: Procedural Safeguards • Upon admission, patients have the right to be notified of (MHA s. 34(2)) • Their s. 10 rights (Charter) • Right of review • Right of appeals • Right to a second medical opinion on the treatment plan

12. Civil Commitment: Legal Authority • Parens patriae powers: Power to act as guardian for physically/mentally ill & make decisions about welfare • Care and treatment are the basis of the authority • Deference to mental health professionals • Includes involuntary treatment • Exclude those who cannot be treated • Police powers: • Power to control those who threaten public order • Public protection is the basis of the authority • Greater involvement of legal system in decisions • No authority to treat involuntarily • Include all person who are dangerous

13. Civil Commitment: Outcomes and Alternatives • May be effective in short term (containing risk, managing symptoms) • Interferes with establishing effective treatment relationships • Alternatives • Outpatient commitment • Net widening • May not be effective • Psychiatric advance directives • Express preferences in advance • Of no force and effect under MHA in B.C. • Provision of better voluntary services

14. Mental Disorder • Psychologists play role in assessment of MDs for civil commitment • Challenges: • Legal definitions of mental disorder • Law is interested in current vs. lifetime diagnoses (current are less reliable) • Not all MDs are assessed/diagnosed with equal reliability/validity • Not all forms of MD are relevant to civil commitment

15. Risk of Harm • Definition of nature/degree of harm varies across jurisdictions • Difficult to speculate about future • Harms must be legally relevant • Psychological tools may assist in risk assessment • Actuarial instruments (e.g., STATIC-99; COVR) • Structured professional judgment instruments (e.g., HCR-20; SVR-20)

16. Causal Nexus • Mental Disorder may be associated with risk of harm, but this is not always the case • Most people with MD do not commit serious violence; • Relationship between risk for harm and most forms of MD is small (Choe, Teplin, & Abram, 2008) • Assessments must be individualized • Can be difficult to assess causal-nexus • Requires sound explanation and rule-out of other plausible explanations

17. Parenting Capacity Parenting capacity evaluations psychological assessments of people’s suitability to act as caregivers for children • Relevant when rights & responsibilities in childrearing are in conflict • Parents rights conflict with their responsibilities • Rights of parents conflict with each other (custody/access disputes) • Rights of parents conflict with rights of children • Rights of parents conflict with other interested parties (e.g., family members, police, child protection agencies)

18. PC Evaluations: Legal Issues

19. The Practice of Parenting Capacity Evaluations • Evaluators had trouble respecting “best interests of child” principle in practice • Tendency to advocate rather than take neutral/objective stance • Use of traditional procedures vs. specialized procedures • Failed to make specific recommendations • Guidelines for Child Custody Evaluations in Divorce Proceedings (APA, 1994)

20. Parent Capacity Evaluations Changes since Guidelines publication • Evaluators act more frequently as neutral, court-appointed evaluators • Evaluations are taking more time (21 to 24 hours on average) • More use of specific tests & time spent reviewing documentary evidence • Increased evaluation/specific recommendations re: custody & access in light of child needs

21. Parenting Capacity Evaluations Ongoing challenges • Many evaluators do not pay attention to legal context/address legal criteria • Insufficient scientific support for psychological tests used in PC evaluations • Decisions about parenting capacity are value-laden

22. Child Maltreatment

23. Child Maltreatment • Abusive acts divided into three categories • Physical abuse involves actual, attempted, or threatened injury of a child • Sexual abuse involves actual, attempted, or threatened sexual contact that is inappropriate due to the perpetrator’s age or relationship to a child. • Emotional abuse involves actual, attempted, or threatened psychological or social harm of a child. • Child neglect • the omission of acts that deliberately or recklessly threaten the well being of children

24. Child Maltreatment • Heavily influenced by cultural considerations • “Violation of community standards” • Acts or omissions considered child maltreatment when they are culturally abnormal or deviant • Impact of culture can make it hard to distinguish between harsh discipline and child maltreatment

25. Child Maltreatment • Major public health issue with serious consequences • Effects depend on severity and chronicity, age, child-abuser relationship, family SES, available support to family • Effects include physical injuries ranging from minor to death • Psychological injuries with effects persisting into adulthood • Can lead to long term utilization of services for victims

26. Child Maltreatment • Prevalence is difficult to estimate • Definitional problems • Under reporting • National Child Abuse & Neglect Data System: • >3.6 million reports/905,000 substantiated cases • Reporting rate of 47.8 per 1,000 children per year • Victimization rate of 12.1 per 1,000 children • 64% neglect; 16% physical abuse; 9% sexual abuse; 7% psychological abuse; 15% other • 90% perpetrators parents, >1,500 deaths • Rate changes over time

27. Child Maltreatment Staggering economic consequences • National costs estimated at $258 million per day, $90 billion dollars per year (PCAA, 2001) • Colorado (Gould & O’Brien, 1995) • Investigations/welfare services/placements $190 million per year • Programs and services $212 million per year • Canada – direct and indirect costs of 135,000 cases in 1998 >$15 billion

28. Mandatory Reporting • Governments have a mandate to protect children from harm—to prevent and to respond to reports • Legal duty to report suspected child maltreatment • s. 14 of the BC Child, Family, and Community Services Act • United Nations Convention on the Rights of the Child outline the civil, political, economic, social, and cultural rights of children

29. Assessing Risk for Child Maltreatment • Reports of maltreatment must be investigated • Prevention of maltreatment requires decision maker to reach opinion – based on findings of risk assessment – about risk for harm and necessary interventions • Intervention plans must specify services to be delivered and level of intrusiveness/intensity

30. Assessing Risk for Child Maltreatment • Must determine unique needs of the child and whether parents are able to meet those needs • Must consider factors associated with perpetration of child abuse and neglect • Process should be structured to insure risk factors and intervention targets are considered systematically across cases • Guidelines for evaluations published by APA (1998)

31. Assessing Risk for Child Maltreatment • Controversy concerning adequacy of risk assessment instruments • Many instruments, though none generally accepted or well validated • Some work on CAP inventory, but has limitations