Assessment Summaries

Clinical assessment may be undertaken for various reasons and to answer a variety of important questions.
For the clinical psychologist working in a hospital, clinic, or other clinical setting, tools of assessment are frequently used to clarify the psychological problem, make a diagnosis, and/or design a treatment plan.
Does this patient have a mental disorder? and If so, what is the diagnosis?
In many cases, tools of assessment, including an interview, a test, and case history data, can provide those answers.
Before or after interviewing a patient, a clinician may administer tests such as a Wechsler intelligence test and the MMPI-2-RF to obtain estimates of the patient’s intellectual functioning and level of psychopathology.
The data derived may provide the clinician with initial hypotheses about the nature of the individual’s difficulties, which will then guide the interview.
Alternatively, test data can confirm or refute hypotheses made on the basis of the clinical interview.
Interview and test data will be supplemented with case history data, especially if the patient will not or cannot cooperate.
The clinician may interview people who know the patient—such as family members, co-workers, and friends—and obtain records relevant to the case.
The tools may be used to address questions such as
What is this person’s current level of functioning? How does this level of functioning compare with that of other people of the same age?
What type of treatment shall this patient be offered?
How can this person’s personality best be described?
Which treatment approach is most effective? or What kind of client tends to benefit most from a particular kind of treatment?

The diagnosis of mental disorders

An objective of clinical assessment is to diagnose mental disorders.
Diagnostic and Statistical Manual (DSM), which presently is the DSM-IV-TR (where IV stands for “fourth edition,” and TR stands for “text revision”; American Psychiatric Association, 2000).
DSM-IV-TR names and describes all known mental disorders and (includes a category called Conditions not attributable to a mental disorder that are a focus of attention or treatment).
A DSM-IV-TR diagnosis immediately conveys a great deal of descriptive information about the nature of the behavioral deviance, deficits, or excesses in the diagnosed person.
Some clinical psychologists (behaviorally oriented clinicians), have expressed dissatisfaction with DSM-IV-TR —> manual is firmly rooted in the medical model.

However, because the items are so transparent and the test outcome is so easily manipulated by the testtaker, it is usually recommended that the BDI-II be used only with patients who have no known motivation to fake good or fake bad.
Further, because the BDI-II contains no validity scales, it is probably advisable to administer it along with other tests that do have validity scales, such as the MMPI-2-RF.

Whether assessment is undertaken for general or more specific diagnostic purposes, it is usually good practice to use more than one tool of assessment to meet the assessment objective.
The phrase used to describe the group of tests administered is test battery.

The psychological test battery

Test battery: group of tests administered together to gather information about an individual from a variety of instruments.
Personality test battery refers to a group of personality tests.
The term projective test battery also refers to a group of personality tests, though this term is more specific because it additionally tells us that the battery is confined to projective techniques (such as the Rorschach, the TAT, and figure drawings).
If the type of battery referred to is left unspecified, or if the clinician refers to a battery of tests as a standard battery, what is usually being referred to is a group of tests including one intelligence test, at least one personality test, and a test designed to screen for neurological deficit
Each test in the standard battery provides the clinician with information that goes beyond the specific area the test is designed to tap. E.g. a test of intelligence may yield information not only about intelligence but also about personality and neurological functioning. etc.

CULTURALLY INFORMED PSYCHOLOGICAL ASSESSMENT

Culturally informed psychological assessment: an approach to evaluation that is keenly perceptive of and responsive to issues of acculturation, values, identity, worldview, language, and other culture-related variables as they may impact the evaluation process or the interpretation of resulting data.
When planning an assessment in which there is some question regarding the projected impact of culture, language, or some related variable on the validity of the assessment, the culturally sensitive assessor can do a number of things.
One is to carefully read any existing case history data —> Such data may provide answers to key questions regarding the assessee’s level of acculturation and other factors useful to know about in advance of any formal assessment.
Family, friends, clergy, professionals, and others who know the assessee may be able to provide valuable information about culture- related variables prior to the assessment.
In some cases, it may be useful to enlist the aid of a local cultural advisor as preparation for the assessment
Potential for disagreement about what constitutes culturally competent assessment.
Prior to the formal assessment, the assessor may consider a screening interview with the assessee in which rapport is established and various culture-related issues are discussed.
During the formal assessment, the assessor keeps in mind all the cultural information acquired, including any customs regarding personal space, eye contact etc.

Most authorities agree that the preferences of children under the age of 5 are too unreliable and too influenced by recent experiences to be accorded much weight.

However, if intelligence test data indicate that the child who is chronologically 5 years old is functioning at a higher level, then those preferences may be accorded greater weight.

This is particularly true if evidence attesting to the child’s keen social comprehension is presented to the court.
Some methods that can be useful in assessing a child’s parental preference include structured play exercises with dolls that represent the child and other family members, figure drawings of family members followed by storytelling about the drawings, and the use of projective techniques such as the TAT and related tests
Specially constructed sentence completion items can also be of value in the assessment of parental preferences. For example, the following items might be useful in exam- ining children’s differing perceptions of each parent:
- If I do something wrong, my father .
- It is best for children to live with .
The data-gathering process for the evaluation begins the moment the child and the parent(s) come into the office. The assessor takes careful note of the quality of the inter- action between the parent(s) and the child.
The child will then be interviewed alone and asked about the nature and quality of the relationship.
If the child expresses a strong preference for one parent or the other, the assessor must evaluate how meaningful that preference is.

CHILD ABUSE AND NEGLECT

A legal mandate exists for many licensed professionals to report child abuse and child neglect when they have knowledge of it.

Physical signs of abuse and neglect

Although psychologists and other mental health professionals without medical credentials typically do not have occasion to physically examine children, a knowledge of physical signs of abuse and neglect is important.
Many signs of abuse take the form of physical injuries.
During an evaluation, these injuries may be described by abused children or abusing adults as the result of an accident.
The knowledgeable professional needs a working familiarity with the various kinds of injuries that may signal more ominous causes.
g. the case of injury to the face. In most veritable accidents, only one side of the face is injured. It may therefore be significant if a child evidences injury on both sides of the face—both eyes and both cheeks.
Physical signs that may or may not indicate neglect include dress that is inappropriate for the season, poor hygiene, and lagging physical development.

Emotional and behavioral signs of abuse and neglect

Fear of going home or fear of adults in general and reluctance to remove outer garments may be signs of abuse.
Other possible emotional and behavioral signs of abuse include:
- unusual reactions or apprehension in response to other children crying
- low self-esteem

extreme or inappropriate moods
aggressiveness
social withdrawal
nail biting, thumb sucking, or other habit disorders

Possible emotional and behavioral signs of neglect include frequent lateness to or absence from school, chronic fatigue, and chronic hunger.
Age-inappropriate behavior may also be a sign of neglect —> result of a child taking on many adult roles with younger children owing to the absence of a caregiver at home.
Possible emotional and behavioral signs of sexual abuse in children under 8 years of age may include fear of sleeping alone, eating disorders, enuresis, encopresis, sexual acting out, change in school behavior, tantrums, crying spells, sadness, and suicidal thoughts.
These signs may also be present in older children, along with other possible signs such as memory problems, emotional numbness, violent fantasies, hyperalertness, self-mutilation, and sexual concerns or preoccupations, which may be accompanied by guilt or shame.
Interviews, behavioral observation, and psychological tests are all used in identifying child abuse.
However, professionals disagree about the appropriate tools for such an assessment, particularly when it involves identifying sexual abuse.
One technique involves observing children while they play with anatomically detailed dolls (ADDs), which are dolls with accurately represented genitalia.
Sexually abused children may, on average, engage ADDs in more sexually oriented activities than other children, but differences between groups of abused and nonabused children tend not to be significant.
Human-figure drawings are also used to assess sexual and physical abuse, though their accuracy in distinguishing abused from nonabused children is a subject of debate
Questionnaires designed for administration to a child who may have been abused or to adults such as teachers or parents who know that child well have been explored, although no thoroughly validated instruments have been developed to date.
In short, no widely accepted, reliable, and valid set of techniques for the assessment of sexual abuse is available.

Issues in reporting child abuse and neglect

A claim of child abuse when in fact there has been no such abuse is also a tragedy—one that can scar irrevocably an accused but innocent individual for life.
It is incumbent on professionals who undertake the weighty obligation of assessing a child for potential abuse not to approach their task with any preconceived notions because such notions can be conveyed to the child and perceived as the right answer to questions
Children from the ages of about 2 to 7 are highly suggestible, and their memory is not as well developed as that of older children.
It is possible that events that occurred after the alleged incident—including events referred to only in conversations

—may be confused with the actual incident

Risk assessment

In an effort to prevent child abuse, test developers have sought to cre- ate instruments useful in identifying parents and others who may be at risk for abusing children.

The Child Abuse Potential Inventory (CAP) has demonstrated impressive validity in identifying abusers.

The Parenting Stress Index measures stress associated with the parental role.
Parents are asked to reflect on their relationship with one child at a time.
Some of the items focus on child characteristics that could engender stress, such as activity level and mood.
Other PSI items reflect potentially stressful aspects of the parent’s life, such as lack of social support and marital problems
The test’s authors report internal consistency reliability coefficients ranging from .89 to .95 for factors and total scores.
Test-retest reliability coefficients range from .71 to .82 over three weeks and from .55 to .70 over a one-year interval
With respect to the test’s validity, parents who physically abuse their children tend to score higher on the PSI than parents who do not
What are the appropriate uses of measures like the CAP and the PSI?
Although positive relationships exist between child abuse and scores on the tests, the tests can- not be used to identify or prosecute child abusers in a legal context (Gresham, 1989).
Because child abuse is a low base-rate phenomenon, even the use of highly reliable instruments will produce many false positives.
For some parents, high levels of stress as measured by the PSI may indeed lead to physical abuse; however, for most parents they will not.
Some parent–child relationships, such as those involving children with disabilities, are inherently stressful
Still, most parents manage to weather the relationship without inflicting any harm.
Some parents who experience high levels of stress as a result of their relationship with a child may themselves be harmed—and stressed even more—to hear from a mental health official that they are at risk for child abuse.
For that reason, great caution is called for in interpreting and acting on the results of a test designed to assess risk for child abuse.
On the other hand, high CAP or PSI scores may well point the way to an abusive situation, and they should alert concerned professionals to be watchful for signs of abuse.
A second appropriate use of such scores concerns the allocation of resources designed to reduce parenting stress.
Parents who score high on the CAP and the PSI could be given priority for placement in a parenting skills class, individualized parent training, child care assistance, and other such programs.
If reducing the stress of the parent will reduce the risk of child abuse, everything that can possibly be done to reduce the parental stress should be attempted.

The Psychological Report

A critical component of any testing or assessment procedure is the reporting of the findings.
What constitutes an organized and readable report will vary as a function of the goal of the assessment and the audience for whom the report is intended.

Psychological reports may be as different as the reasons for undertaking the assessment.

Reports may differ on a number of variables, such as the extent to which conclusions rely on one or another assessment procedure and the specificity of recommendations made, if any.

The Barnum Effect

The Barnum effect: the finding that people tend to accept vague personality descriptions as accurate descriptions of themselves

In general, persons who are mentally retarded, psychotic, or suffering from a debilitating neurological disorder are persons held to be incompetent to stand trial.

It is possible for a person to be mentally retarded, psychotic, or suffering from a debilitating neurological disorder—or all three—and still be found competent to stand trial.

The person will be found to be incompetent if and only if she is unable to understand the charges against her and is unable to assist in her own defense.
A number of instruments have been developed as aids in evaluating whether a defendant meets the understandand-assist requirement.
g. researchers at Georgetown University Law School enumerated 13 criteria of competency to stand trial (Table 14–2).
6 of the criteria were characterised as “factual”, and 7 were characterised as “inferential”
In general, the factual criteria had to do with clinical judgments regarding the defendants ability to understand the charges and relevant legal procedures
The inferential criteria focused more on clinical judgments concerning the defendant’s ability to communicate with counsel and make informed decisions.
The Competency Screening Test employs a sentence completion format with each of 22 items relating to a legal criterion of competency to stand trial.
The test is scored on a three-point scale ranging from 0 to 2, with appropriate responses scored 2, marginally appropriate responses scored 1, and clearly inappropriate responses scored 0.
For example, consider this item: When I go to court, the lawyer will .” —> A 2-point response would be “defend me.”
Such a response indicates that the assessee has a clear understanding of the lawyer’s role.
By contrast, a 0-point response might be “have me guillotined,” which would be indicative of an inappropriate perception of the lawyer’s role.
Inter-rater reliability among trained scorers of this test = r .93. ︎

Criminal responsibility

The insanity defense has its roots in the idea that only blameworthy persons (that is, those with a criminal mind) should be punished.
Possibly exempt from blame, therefore, are children, mental incompetents, and others who may be irresponsible, lack control of their actions, or have no conception that what they are doing is criminal.
The decision in the M’Naghten case has come to be referred to as the right or wrong test, or the M’Naghten standard.
A problem with the right or wrong test is that it does not provide for the acquitting of persons who know right from wrong yet still are unable to control impulses to commit criminal acts
In clinical practice, defendants who are mentally retarded, psychotic, or neurologically impaired are likely to be the ones found not guilty by reason of insanity.
However, as was the case with considerations of competency to stand trial, the mere fact that a person is judged to be mentally retarded, psychotic, or neurologically impaired is in itself no guarantee that the individual will be found not guilty.

Other criteria, such as the ALI standards cited, must be met.

To help determine if the ALI standards are met, a number of instruments such as the Rogers Criminal Responsibility Assessment Scale (RCRAS) have been developed.
RCRAS is a systematic and empirical approach to insanity evaluations.
This instrument consists of 25 items tapping both psychological and situational variables.
The items are scored with respect to five scales: reliability (including malingering), organic factors, psychopathology, cognitive control, and behavioral control.
After scoring, the examiner employs a hierarchical decision model to arrive at a decision concerning the assessee’s sanity.
Validity studies done with this scale have shown it to be useful in discriminating between sane and insane patients/ defendants.

Readiness for parole or probation

A person with a diagnosis of psychopathy (a psychopath) is four times more likely than a nonpsychopath to fail on release from prison
A classic work by Cleckley (1976) provided a detailed profile of psychopaths.
They are people with few inhibitions who may pursue pleasure or money with callous disregard for the welfare of others.
Based on a factor-analytic study of Cleckley’s description of persons with psychopathy, Robert D. Hare (1980) developed a 22-item Psychopathy Checklist (PCL) that reflects personality characteristics as rated by the assessor (such as callousness, impulsiveness, and empathy) in addition to prior history as gleaned from the assessee’s records (such as “criminal versatility”).

Diagnosis and evaluation of emotional injury

Emotional injury, or psychological harm or damage, is a term sometimes used synonymously with mental suffering, pain and suffering, and emotional harm.
In cases involving charges such as discrimination, harassment, malpractice, stalking, and unlawful termination of employment, psychological assessors may be responsible for evaluating alleged emotional injury.
Many tools of assessment—including the interview, the case study, and psycholog- ical tests—may be used in the process of evaluating and diagnosing claims of emotional injury.
Interviews may be conducted with the person claiming the injury as well as with others who have knowledge relevant to the claim.
Case study materials include documents such as physician or therapist records, school records, military records, employment records, and police records.
The specific psychological tests used in an emotional injury evaluation will vary with the preferences of the assessor.
The reasons given for the use of specific tests and test batteries most frequently involved established norms, personal clinical experience, the widespread acceptance of the instrument, research support, and content.

Profiling

Profiling: a crime-solving process that draws upon psychological and criminological expertise applied to the study of crime scene evidence.

At the core of profiling is the assumption that perpetrators of serial crimes (usually involving murder, some sort of ritual, and/or sexual violation) leave more than physical evidence at a crime scene; they leave psychological clues about who they are, personality traits they possess, and how they think.

Hypotheses typically made by profilers from crime-scene evidence usually relate to perpetrators’ organization and planning skills and to the degrees of control, emotion, and risk that appear evident
The primary tools of assessment employed in profiling are interviews (both from witnesses and about witnesses) and case study material (such as autopsy reports and crime-scene photos and reports).

Custody Evaluations

Custody evaluation: a psychological assessment of parents or guardians and their parental capacity and/or of children and their parental needs and preferences—> usually undertaken for the purpose of assisting a court in making a decision about awarding custody

Evaluation of the parent

The evaluation of parental capacity typically involves a detailed interview that focuses primarily on various aspects of child rearing, though tests of intelligence, personality, and adjustment may be employed if questions remain after the interview.
The assessor might begin with open-ended questions, designed to let the parent ventilate some of his or her feelings, and then proceed to more specific questions tapping a wide variety of areas, including:
- the parent’s own childhood: happy? abused? the parent’s own relationship with parents, siblings, peers
- the circumstances that led up to the marriage and the degree of forethought that went into the decision to have (or adopt) children
- the adequacy of prenatal care and attitudes toward the pregnancy
- the parent’s description of the child
- the parent’s self-evaluation as a parent, including strengths and weaknesses
- the parent’s evaluation of his or her spouse in terms of strengths and weaknesses as a parent
- the quantity and quality of time spent caring for and playing with children the parent’s approach to discipline
- the parent’s receptivity to the child’s peer relationships
During the course of the interview, the assessor may find evidence that the interviewee really does not want custody of the children but is undertaking the custody battle for some other reason. E.g. custody may be nothing more than another issue to bargain over with respect to the divorce settlement.
Alternatively, for example, parents might be embarrassed to admit—to themselves or others—that custody of the children is not desired.
Sometimes a parent, emotionally scathed by all that has gone on before the divorce, may be employing the custody battle as a technique of vengeance— to threaten to take away that which is most prized and adored by the spouse.
In certain cases an assessor may deem it desirable to assess any of many variables related to marriage and family life.

Evaluation of the child

The court will be interested in knowing whether the child in a custody proceeding has a preference with respect to future living and visitation arrangements.

After the assessment, the culturally sensitive assessor might reevaluate the data and conclusions for any possible adverse impact of culture-related factors.

E.g. an assessor who happened to have administered the MMPI and not the MMPI-2 to a Chicano client might revisit the protocol and its interpretation with an eye toward identifying any possible overpathologization.

Whenever a translator is used, the interviewer must be wary not only of the interviewee’s translated words but of their intensity as well
Case study and behavioural observation data must be interpreted with sensitivity to the meaning of the historical or behavioural data in a cultural context
Ultimately, a key aspect of culturally informed psychological assessment is to raise important questions regarding the generalisability and appropriateness of the evaluative measures employed.
How can culturally informed assessment best be taught? Formal instruction should occur in the context of a curriculum with three major components: a foundation in basic assessment, a foundation in culture issues in assessment, and supervised training and experience.
In our model, a subcomponent of both the “foundation in cultural issues in assess- ment” and the “supervised training and experience” components of the curriculum is shifting cultural lenses —> In discerning the appropriate meaning, one must first entertain both sets of meanings or apply both sets of cultural lenses. Then one collects data to test both ideas. Ultimately, one weights the available evidence and then applies the meaning that appears to be most appropriate.
It is important to note that whatever decision is made, there usually exists some degree of uncertainty.
By collecting evidence to test the two possible meanings, the psychologist attempts to reduce uncertainty.
With multiple assessments over time, greater certainty can be achieved.
The notion of shifting cultural lenses is intimately tied to critical thinking and hypothesis testing. Interview data may suggest, for example, that a client is suffering from some form of psychopathology that involves delusional thinking. A shift in cultural lenses, however, permits the clinician to test an alternative hypothesis: that the observed behavior is culture-specific and arises from long-held family beliefs.

Cultural Aspects of the Interview

When an interview is conducted in preparation for counseling or psychotherapy, it may be useful to explore a number of culture-related issues.
ADRESSING is an easy-to-remember acronym that may help the assessor recall various sources of cultural influence when assessing clients.
The letters in ADRESSING stand for:
- age
- disability
- religion
- ethnicity
- social status (including variables such as income, occupation, and education)
- sexual orientation
- indigenous heritage
- national origin
- gender

Cultural Considerations and Managed Care

Here, a twofold reference is made to
(1) a kind of clash in cultures between that of the care-driven one of mental health professionals and the more bureaucratic, cost-savings one of managed care agencies
(2) the need for culturally informed approaches to clinical services to be built into managed care guidelines
Managed care: a health care system wherein the products and services provided to patients by a network of participating health care providers are mediated by an administrative agency of the insurer that works to keep costs down by fixing schedules of reimbursement to service providers.

SPECIAL APPLICATIONS OF CLINICAL MEASURES

The Assessment of Addiction and Substance Abuse

Assessment for drug addiction and for alcohol and substance abuse has become routine in a number of settings.
Whether an individual is seeking outpatient psychotherapy services, being admitted for inpatient services, or even seeking employment, being screened for drug use may be a prerequisite.
Such screening can take varied forms, from straightforward physical tests involving the analysis of urine or blood samples to much more imaginative laboratory procedures that involve the analysis of psychophysiological responses
Exploration of personal history with drugs and alcohol may be accomplished by means of questionnaires or face-toface interviews.
However, such direct procedures are highly subject to impression management and all the other potential drawbacks of a self-report instrument.
A number of tests and scales have been developed to assist in the assessment of abuse and addiction.
The MMPI-2-RF, for example, contains three scales that provide information about substance abuse potential.
The oldest of these three scales is the MacAndrew Alcoholism Scale (MacAndrew, 1965), since revised and usually referred to simply as the MAC-R.
This scale was originally constructed to aid in differentiating alcoholic from nonalcoholic psychiatric patients.
A number of other tests focus on various aspects of drug abuse.
The Addiction Potential Scale (APS; Weed et al., 1992) contains 39 items that substance abusers tended to endorse differently from either psychiatric patients or nonclinical samples.
The Addiction Acknowledgment Scale (AAS; Weed et al., 1992) contains 13 items that make direct and obvious acknowledgments of substance abuse.
The AAS is therefore a much more face-valid scale for substance abuse assessment than either the MAC-R or the APS.
This is so because the endorsement of the transparent items of the AAS amounts to an outright admission of drug abuse.
By contrast, the MAC-R and the APS “do not measure substance abuse directly but rather measure personality traits that often serve as pathways to substance abuse”

The Addiction Severity Index is one of the most widely used tests in the substance abuse field, with applications to intake evaluations and follow-ups as well as the identification of patient subgroups in research.

Raters assess severity of addiction in seven problem areas: medical condition, employment functioning, drug use, alcohol use, illegal activity, family/ social relations, and psychiatric functioning.

Items tap various problems experienced in each of these areas within the past 30 days in addition to lifetime problems.
Estimates of the severity of the problems are derived from the scores.
Behaviour associated with substance abuse or its potential has also been explored by analogue means, such as role play.
The Situational Competency Test, the Alcohol Specific Role Play Test, and the Cocaine Risk Response Test are all measures that contain audiotaped role-play measures.
In the latter test, assessees are asked to orally respond with a description of what they would do under certain conditions—conditions known to prompt cocaine use in regular cocaine users.
One scenario involves having had a difficult week followed by cravings for cocaine to reward oneself.
Another scenario takes place at a party where people are using cocaine in the next room.
Assessees are asked to candidly detail their thinking and behaviour in response to these and other situations.
Of course, the value of the information elicited will vary as a function of many factors, among them the purpose of the assessment and the candor with which assessees respond.
One might expect assessees to be straightforward in their responses if they were self-referred for addiction treatment.
On the other hand, assessees might be less than straightforward if, for example, they were court-referred on suspicion of probation violation.
Efforts to reduce widespread substance abuse have led researchers to consider how culture may contribute to the problem and how culturally informed intervention may be part of the solution.
Recovery from drug addiction has itself been conceptualized as a socially mediated process of reacculturation that can result in a new sense of identity
An important ethical consideration when assessing substance abusers concerns obtaining fully informed consent to assessment —> substance abusers may be high or intoxicated at the time of con- sent and so their ability to attend to and comprehend the requirements of the research might be compromised.
Further, because their habit may have thrust them into desperate financial straits, any payment offered to substance abusers for participation in a research study may appear coercive.
Procedures to maximize comprehension of consent and minimize the appearance of coercion are necessary elements of the consent process.

Forensic Psychological Assessment

Forensic psychological assessment: the theory and application of psychological evaluation and measurement in a legal context.
Psychologists, psychiatrists, and other health professionals may be called on by courts, corrections and parole personnel, attorneys, and others involved in the criminal justice system to offer expert opinion.

Criminal proceedings —> concern an individual’s competency to stand trial or his or her criminal responsibility (that is, sanity) at the time a crime was committed.

Civil proceedings —> the opinion may involve issues as diverse as the extent of emotional distress suffered in a personal injury suit, the suitability of one or the other parent in a custody proceeding, or the testamentary capacity (capacity to make a last will and testament) of a person before death.

Major differences between forensic and general clinical practice —> in the forensic situation, the clinician may be the client of a third party (such as a court) and not of the assessee.
Another difference between forensic and general clinical practice is that the patient may have been compelled to undergo assessment —> assessee is not highly motivated to be truthful.
Consequently, it is imperative that the assessor rely not only on the assessee’s representations but also on all available documentation, such as police reports and interviews with persons who may have pertinent knowledge.
The mental health professional who performs forensic work would do well to be educated in the language of the law Dangerousness to oneself or others
Mental health professionals play a key role in decisions about who is and is not considered dangerous.
The individual so judged will, on a voluntary or involuntary basis, undergo psychotherapeutic intervention, typically in a secure treatment facility, until such time that he or she is no longer judged to be dangerous.
The determination of dangerousness is ideally made on the basis of multiple data sources, including interview data, case history data, and formal testing.
When dealing with potentially homicidal or suicidal assessees, the professional assessor must have knowledge of the risk factors associated with such violent acts.
Risk factors may include a history of previous attempts to commit the act, drug/alcohol abuse, and unemployment.
If given an opportunity to interview the potentially dangerous individual, the assessor will typically explore the assessee’s ideation, motivation, and imagery associated with the contemplated violence.
Additionally, questions will be raised that relate to the availability and lethality of the method and means by which the violent act would be perpetrated.
The assessor will assess how specific and detailed the plan, if any, is.
The assessor may also explore the extent to which helping resources such as family, friends, or roommates can prevent violence from occurring.
If the assessor determines that a homicide is imminent, the assessor has a legal duty to warn the endangered third party—a duty that overrides the privileged communication between psychologist and client.

Competency to stand trial

Competency in the legal sense has many different meanings e.g. competence to make a will, enter into a contract, commit a crime, waive constitutional rights, consent to medical treatment
in absentia: a defendant must be not only physically present during the trial but mentally present as well.
The competency requirement protects an individual’s right to choose and assist counsel, the right to act as a witness on one’s own behalf, and the right to confront opposing witnesses.
The requirement also increases the probability that the truth of the case will be developed because the competent defendant is able to monitor continuously the testimony of witnesses and help bring discrepancies in testimony to the attention of the court.