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psychological forensic report writing
International Journal of Law and Psychiatry 49 (2016) 214–220
Contents lists available at ScienceDirect
International Journal of Law and Psychiatry
Psychiatric/ psychological forensic report writing Gerald Young York University, Glendon Campus, Toronto, Ontario, Canada
a r t i c l e
i n f o
Available online 29 October 2016 Keywords: Forensic reports Ethics Codes Rules of evidence Admissibility
a b s t r a c t Approaches to forensic report writing in psychiatry, psychology, and related mental health disciplines have moved from an organization, content, and stylistic framework to considering ethical and other codes, evidentiary standards, and practice considerations. The first part of the article surveys different approaches to forensic report writing, including that of forensic mental health assessment and psychiatric ethics. The second part deals especially with psychological ethical approaches. The American Psychological Association's Ethical Principles and Code of Conduct (2002) provide one set of principles on which to base forensic report writing. The U.S. Federal Rules of Evidence (2014) and related state rules provide another basis. The American Psychological Association's Specialty Guidelines for Forensic Psychology (2013) provide a third source. Some work has expanded the principles in ethics codes; and, in the third part of this article, these additions are applied to forensic report writing. Other work that could help with the question of forensic report writing concerns the 4 Ds in psychological injury assessments (e.g., conduct oneself with Dignity, avoid the adversary Divide, get the needed reliable Data, Determine interpretations and conclusions judiciously). One overarching ethical principle that is especially applicable in forensic report writing is to be comprehensive, scientific, and impartial. As applied to forensic report writing, the overall principle that applies is that the work process and product should reflect integrity in its ethics, law, and science. Four principles that derive from this meta-principle concern: Competency and Communication; Procedure and Protection; Dignity and Distance; and Data Collection and Determination. The standards or rules associated with each of these principles are reviewed. Crown Copyright © 2016 Published by Elsevier Ltd. All rights reserved.
Forensic report writing in psychiatry, psychology, and allied disciplines in mental health is more than an act of writing to influence the court because it must follow ethical and practice principles, aside from following recommended style and formatting. The most important principles relate to being impartial and not advocating for the referral source. The best manner of achieving this goal is to follow the general ethical principles of one's profession, particularly as they apply to forensic work. The first section of this paper presents the landmark integration on forensic report writing as developed in Heilbrun's forensic mental health assessment approach (FMHA; Heilbrun, 2001; Heilbrun, DeMatteo, & Marczyk, 2004; Heilbrun, Grisso, & Goldstein, 2009). Then, it considers psychiatric ethics, in particular, in relation to forensic report writing. The second part of the paper considers more recent psychological approaches to forensic report writing (the work of Grisso, Otto and colleagues, Karson), as well as psychological ethics in their recommendations in helping in forensic report writing and the role of Federal Rules of Evidence (FREs) and related state rules. The last part of the paper considers some original personal suggestions on forensic report writing, including recommendations related to five
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http://dx.doi.org/10.1016/j.ijlp.2016.10.008 0160-2527/Crown Copyright © 2016 Published by Elsevier Ltd. All rights reserved.
new ethical principles that I have proposed for the American Psychological Association's “Ethics Code” on principles and standards (hereinafter referred to as the Ethics Code). In the end, the forensic report needs to reflect the overarching principle of Integrity in Ethics, Law, and Science in particular. To conclude the paper, I elucidate four major principles, each with two components (Competency and Communication; Procedure and Protection; Dignity and Distance; and Data Collection and Determination), that are subsumed by this meta-principle, and that subsume in turn the multiple standards and rules that they involve. 1. Forensic report writing 1.1. Forensic mental health assessment Heilbrun et al. (2004) applied Heilbrun's (2001) principles of FMHA to constructing forensic reports. Heilbrun (2001) had identified 29 broad principles of FMHA, and Heilbrun et al. (2004) noted that 22 of them apply to forensic report construction (actually, they applied 23 of them, and I collapsed two of the 23 in the following list). In the following, I review these 22 principles and applications to forensic report writing, as proposed by Heilbrun et al. (2004), but arrange them differently after rephrasing them to the degree possible.
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1. Use plain language; use minimally technical jargon/language; use definitions as required. Use headings in reports. 2. In the first section of a forensic report, identify the relevant legal question and forensic issues. 3. Give the referral source (e.g., by court, attorney) and indicate how required authorization/ informed consent has been obtained, if applicable. 4. Indicate one's degree and licensure/board certification, in order to support that one's professed area of expertise is within one's area of competence. Provide a summary of qualifications and note that a CV is available upon request. 5. Describe the context of the assessment (e.g., was it reasonably quiet, private, distraction-free?). 6. Describe how the evaluee was notified of the evaluation's purpose and the need for informed consent, doing the same in communicating with any third parties/ collaterals. 7. Indicate how the evaluee's understanding of the purpose of the evaluation was assessed, the degree of that understanding, and communication of any associated limits of confidentiality. 8. The tone of the report should reflect that the evaluator has been impartial (not hyperbolic or argumentative, for example). 9. Use the most appropriate model to guide data gathering, interpretation, and communication. For example, select model 1: describe any mental disorder, residual functional abilities, and their causal connection; or select model 2: describe functional, contextual, causal, interactive, judgmental, and dispositional characteristics (Morse, 1978; Grisso, 1986, respectively). 10. Use multiple source of information for each area assessed (e.g., selfreport, psychological test data, collateral interviews and records). 11. Use reliable and valid data gathering methods to provide relevant information. 12. Document relevant history and prior functioning in areas relevant to ongoing clinical condition and functional capacities that speaks to the legal question(s) at hand. 13. Clinical characteristics need to be evaluated with reliable and valid measures for the purposes at hand, while weighing their results in relation to other sources of information. 14. Assess legally relevant behavior with the data gathered from the multiple sources used, e.g., functionality. 15. Assess response style (e.g., malingering) using third party information to check consistency with self-reported information (preferring the former when inconsistency is found). 16. To check response style (significant exaggeration or minimization of problems) and accuracy of self-report, use tests sensitive to response style. 17. Use case-specific (idiographic) evidence in assessing/describing current clinical condition/functional abilities in relation to history of any symptoms and demonstrated capacities before the event or moment in time at issue in order to address causal connection and legal issues. 18. Use nomothetic evidence the same way, i.e., describe psychological test results, structured instrument results, and results of any other specialized tools that apply to the question at hand. 19. The reports should clearly relate information/ data/ facts to the sources used in the assessment. 20. Use scientific reasoning in causally relating clinical conditions and functional abilities, i.e., choose the interpretation with the most supporting evidence and least disconfirming evidence, or indicate if it is difficult to decide and why. 21. Avoid addressing the ultimate legal question, although presenting conclusions about forensic capacities is appropriate. In the context of psychological injuries, addressing any functional disability is expected, for example. 22. In describing findings and limits, think ahead to possible crossexamination; i.e., be careful, impartial, and thorough in presenting data and reasoning, including evaluating alternative explanations.
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1.2. Comment The list of 22 principles in forensic report writing elucidated by Heilbrun et al. (2004), which had been constructed based on the principles of forensic mental health assessment in Heilbrun (2001), stands as a cornerstone in the area. However, the list by Heilbrun (2001) on principles in forensic mental health assessment has been superseded by a more integrative one in Heilbrun et al. (2009). This revised version of the principles of forensic mental health assessment has not been applied to forensic report writing. Heilbrun et al. (2009) organized an expanded list of 38 principles in forensic mental health assessment in terms of seven “general” principles, and they are disparate, relating to competence and the need for honesty and objectivity. Their next set of nine principles is referred to as preparatory. The principles in this set include a range of topics, related to the referral source, the evaluee, and the guiding model to be used in the assessment and report. In the next category of data collection, for which there are eight more principles, not only are the issues of reliability and validity paramount, but also topics such as getting authorization are mentioned. For data interpretation and its seven principles, one finds principles related to assessing response style, using idiographic and nomothetic evidence, using scientific reasoning, and the issue of answering the ultimate issue. In the last principles related to communication and testimony, the provisos include conducting proper assessments and attributing information gained from them to the correct sources in the assessments. Note that comparison of the list of 29 principles of FMHA in Heilbrun (2001) and the 38 in Heilbrun et al. (2009) indicates that most additions related to general principles, such as the need for honesty and objectivity. Also, some additions relate to effective report writing and testimony, such as attributing information to their sources in the assessment. Finally, in Heilbrun et al. (2009), some of the original 29 principles were slightly modified, such as the one on ultimate issues, which now allows for consideration of whether they should be addressed. In this integrated work on various sources on the foundations of FMHA, Heilbrun et al. (2009) re-emphasized that, in interpreting assessment data, forensic assessors need to use scientific reasoning as they assess the causal connection between evaluees' clinical condition and functional ability. I note that this principle speaks to the notion that the scientific process should characterize all aspects of the forensic examination in mental health (Young, 2014a), from collecting data, to choosing instruments, to arriving at legally relevant opinions. However, a qualification in this regard follows. In the psychological injury context, as compared to the criminal context, the forensic evaluator needs to show not only the link between psychological condition and functional effect, but also the link between the event or traumatic stressor at issue and the resultant psychological condition and legally relevant functional impairment, if any. A further point to consider on Heilbrun et al.’s (2004) list of principles in forensic report writing is that it is doubtful that the list represents principles, per se, such as those in various ethical codes. Typically, these lists of principles are brief, for example, numbering five and four, as found, respectively, in the American Psychological Association's (2002, 2010) and the Canadian Psychological Association's (Canadian Psychological Association, 2016) ethics codes. Second, they are more global in nature than the forensic principles of report writing found in Heilbrun et al. (2004). Therefore, a major goal of the present article is to elucidate overarching principles in forensic report writing that are more global and fewer in number compared to prior lists. This will require a hierarchical approach so that the putative principles in prior lists can be placed at lower levels of the hierarchy, just as many standards and rules are placed under the umbrella of a few principles in ethics codes in the profession.
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2. Psychiatric forensic report writing
list; (i) occupational history; (j) psychosocial history; (k) mental status exam; (l) discussion; and (m) opinion.
2.1. Ethics 2.3. Comment Resnick and Soliman (2012) repeated many of these themes found in the work of Heilbrun and colleagues, and emphasized the need to follow the four key principles of the AAPL's (American Academy of Psychiatry and the Law) ethical guidelines for the practice of forensic psychiatry (AAPL, 2005). These four key ethical principles involve: maintaining confidentiality, getting consent, being honest and striving for objectivity, and having the necessary qualifications. Resnick and Soliman (2012) added that four principles of effective writing involve: clarity, simplicity, brevity, and humanity (e.g., avoid pejoratives). The common pitfalls in forensic report writing listed by the authors include advocating for the referral source. The AAPL (2005) ethics guidelines elaborates that the “adversarial nature” of most legal “processes” constitutes “special hazards” for bias and “danger of distortion” of opinion. The AAPL (2013) supplement on ethical questions and answers emphasizes that the AAPL (2005) ethics guidelines are “grounded in respect for persons and striving for objectivity.” The principles of medical/psychiatric ethics of the American Psychiatric Association (APA, 2013) also emphasize physician “responsibility” to patients, society, and so on, as well as honesty “in all professional interactions.” Consistent with the theme of the present work, the psychiatric ethical principles maintain that the doctor “shall continue to study, apply, and advance scientific knowledge.” Martinez and Candilis (2011) provided the following ethical principles for guiding forensic report writing: respect of persons; respect for privacy and confidentiality; respect for consent processes; and commitment to honesty and striving for objectivity. Griffith, Stankovic, and Baranoski (2011) added that forensic psychiatrists need to identify the limits of their reports, or else their authors could be viewed even as so-called hired guns. These psychiatric sources on ethics in forensic practice refer to biases that might affect the evaluator. However, other sources underscore the vigilance needed in dealing with bias in the evaluee, e.g., in possible deception and malingering. In this regard, Scott and McDermott (2011) noted that psychiatric reports need to consider possible malingering. For example, Resnick (1997) and Hall and Hall (2006) have provided useful guidelines for detecting malingered psychosis and malingered PTSD, respectively. As for testing for negative response bias and malingering in disability evaluations other chapters in Gold and Vanderpool (2013), by Stejskal (2013), and by Scott and McDermott (2013) have provided useful information, as has Young (2014a). Gold (2013) noted the distinction among diagnosis, impairment, and disability. Although diagnostic assessment incorporates functional evaluation, she noted that psychiatric diagnoses are not designed to furnish the necessary information required of legal and administrative systems dealing with disability claims. The diagnosis involved might include symptoms that impair functionality and cause disability, but the label by itself does not provide grounds for concluding that a disability is present. 2.2. Format Gold (2013) provided an outline for forensic disability report formatting, while integrating in this regard the work of Buchanan and Norko (2011), Gold et al. (2008), Melton, Petrila, Poythress, and Slobogin (2007), Piechowski (2011), and Silva, Leong, and Weinstock (2003). She noted that there is no one standard format, but generally any such report should include the following elements: (a) identification (evaluee, referral source); (b) referral question; (c) informed consent matters; (d) all sources of information listed; (e) course (history) of current mental health problems; (f) prior mental health history; (g) substance abuse history; (h) medication
Forensic report writing from a psychiatric perspective is a process that needs to be steeped in ethics generally, such as in getting informed consent and protecting confidentiality. At the same time, the critical issues of objectivity and honesty stand out. The evaluator should avoid biases yet be tuned to detect them in the evaluee, as in malingering. Overall, a scientifically-informed approach to forensic report writing can help. There are a host of rules and guidelines, such as in formatting and communication style, which have been recommended, as well. 3. Psychological principles and practice in forensic report writing In the above, psychiatric ethics in relation to forensic report writing have been presented. In the following, the article turns to how psychological ethics may apply 3.1. Ethics Allan and Grisso (2014) proposed that the ethical principles as described in the American Psychological Association's Ethics Code (2002, 2010) forms an adequate basis for communicating forensic findings and opinions. However, they included the caveat that they “must be interpreted within the law” in the jurisdiction at hand. The first of the five Ethical Principles in the code concerns beneficence/ non-maleficence, and they maintained that it is an overarching principle for the other four, so they did not apply it to the question of forensic report writing. The next principle in the American Psychological Association's Ethics Code concerns fidelity and responsibility, for example, honoring obligations. In the forensic context, this means that reports should meet clearly all legal requirements (e.g., in noting the referral source and referral questions). Allan and Grisso (2014) next considered the American Psychological Association's Ethical Principle of integrity for the task of forensic report writing. In this regard, the forensic report writer should avoid exaggeration and misrepresentation (for example, overstatement, or poorly redescribing nomothetic research for implications for the case at hand). Allan and Grisso (2014) continued that forensic report writing also should be guided by the American Psychological Association principle of respecting the rights and dignity of people. For example, the assessor should not include personal information about the examinee that is not relevant to the referral question. According to the American Psychological Association's Ethics Code, justice and fairness refers to treating people equitably and justly. In forensic mental health assessments, this means using a just process with appropriate methods Following Grisso (personal communication to DeMier), DeMier (2013) listed six principles in forensic report writing: (a) stick to the forensic (referral) question; (b) report only what is required; (c) separate facts and inferences; (d) provide explanations that indicate why the specific inferences had been made; and (e) explain competing opinions or conclusions and why they had been rejected. 3.2. A practical approach Otto, DeMier, and Boccaccini (2014) proposed a general approach to mental health forensic report writing and other forms of testimony. To begin, they emphasized that experts need to be “objective, independent and unbiased” (Guideline 1.02; American Psychological Association, 2013). For example, Otto et al. (2014) referred to the importance of knowing local laws, rules, and customs. Then, they referred to FRE 702 that requires that an expert use “scientific, technical, or other specialized knowledge” to gather sufficient facts/data based on reliable
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principles and methods and their reliable application. The next Federal Rule cited by Otto et al. (2014) is Federal Rule of Civil Procedure (FRCP) 26(a), which specifies that reports must include the reasons for all opinions provided in a report. Otto et al. (2014) next addressed the contents of forensic reports. All sources used in the report should be documented (and ones requested but not obtained should be documented, as well). In their penultimate chapter in forensic report writing, Otto et al. (2014) listed 10 applicable points, some of which are enumerated here. (a) First, forensic reports should provide the factual bases for opinions offered (American Psychological Association, 2013) (Section 11.03). (b) Second, the report must distinguish facts, inferences, and opinions (following Grisso, 2012). Otto et al. (2014) added that the forensic specialty guidelines go further by indicating that the opinions proffered should be related to the legal issues and facts in a case and the relationship explained (Section 11.02). (c) Otto et al. (2014) continued that the forensic report should identify presumptions and assumptions. For example, the report should clarify matters that seem equivocal in the available evidence. As for communicating well, in oral testimony and cross-examination, Otto et al. (2014) recommended four evidence-based principles: credibility, clarity, clinical knowledge, and certainty.
3.3. Others Other work adds to our understanding of the approach needed to forensic report writing. Melton et al. (2007) provided general guidelines for forensic report writing. Examination of their guidelines suggests that they advocated for accuracy and economy in writing forensic reports. For example, the report should: give information that is neither overkill nor underkill and minimize clinical jargon. [I would add minimize legal jargon, too.] Weiner (2014) advised the forensic report writer to determine the required focus. For example, the FRCP (U.S. Government, 2010) indicate that the proffered report to court must include: (a) a complete statement of all opinions expressed and their basis; (b) the facts/data considered; (c) exhibits; (d) qualifications, including all publications authored by the expert in the previous 10 years; (e) prior cases in the previous four years in which the expert had testified; and (f) the fee for the service provided to the court.
3.4. An evidence rules approach Karson (2015) used the Federal Rules of Evidence (2013) as a counterpoint to forensic report writing by pointing out the evidentiary objections that might be made in court to certain aspects of proffered reports. For example, FRE 401 defines legal relevance as a combination of the evidence being material to the case at hand and helpful to the trier of fact (helping them understand something that an ordinary person would not understand). Under FRE 401, one could object to data in the report that might be considered irrelevant to the legal matter at issue. Also, the data require sufficient foundation or they should be excluded as irrelevant. [Also, see Erard (2016) for a cogent example.] Rule 403 concerns excluding relevant evidence if it is unfairly prejudicial to the judicial decision to be made, with its prejudicial value outweighing its probative value. A report could have a too evident prejudicial aspect in this regard, leading to objection. Rule 404 concerns the relationship between nomothetic (general) science and idiographic (case-specific) information. For example, a person might have a certain personality attribute according to a test algorithm, but this does not mean that the trait had been present on a particular occasion. Objections can be raised when a mental health expert does not stick to the point that a test score simply shows how a person tends to behave (e.g., on a test of malingering).
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3.5. Comment Taken together, the FREs define what qualifications an expert should have to meet court admissibility requirements and also the nature of the evidence they can proffer to court. The FREs often have state counterparts in the U.S. They reflect the Supreme Court of the United States' decisions on the nature of good, acceptable science, compared to poor or junk science (the “Daubert trilogy”: Daubert v. Merrell Dow Pharmaceuticals, Inc., 1993; General Electric v. Joiner, 1997; and Kumho Tire Ltd. v. Carmichael, 1999). They refer to sound methods and their application, so that reliable, relevant data forms the basis for interpretations and conclusions in reports or other testimony. Although the Daubert trilogy refers to using appropriate specialized techniques or knowledge as mental health experts conduct assessments for their forensic reports, the critical test for mental health experts is the scientific one. Procedural and test validity used in assessments at the basis of forensic reports are informed by research on best practices, for example. Also, in the case of mental health experts, when presenting scientific evidence, the logic needed to make informed inferences, interpretations, conclusions, and opinions for court and related purposes must be a grounded in sound science. This is reflected in the multiple advisories to use all the reliable and relevant evidence in these regards and to support the proffered opinion by showing how the preponderance of the evidence is consistent with it, whereas only some evidence fits alternate hypotheses. 4. Integration of the literature review on forensic report writing The review of the literature on forensic report writing that has been undertaken started with the landmark approach of Heilbrun et al. (2004) and continued with perspectives in psychiatry and psychology. Based on the work of Heilbrun (2001) on forensic mental health assessment, Heilbrun et al. (2004) had elaborated 22 principles of forensic report writing, but I consider them more like standards than principles. Heilbrun et al. (2009) re-organized and added to the original 29 principles in forensic mental health assessment of Heilbrun (2001) so that there are now 38 of them. The psychiatric field has emphasized the basics in terms of format and principles, such as being ethical and impartial, adhering to standards, and being scientific, while protecting the rights of evaluees, yet considering the possibility of malingering and related biases. Recently, the psychological field has considered forensic report writing especially in terms of the Ethics Code of the American Psychological Association (2002, 2010), the 2013 Forensic Specialty Guidelines of that association, and U.S. Rules of Evidence, especially federal (e.g., Allan & Grisso, 2014; Karson, 2015; Otto et al., 2014). The approach to forensic report writing of forensic mental health assessment in the work of Heilbrun and colleagues has been complemented by these and other approaches in the present review and, collectively, they indicate the following. First, the overriding principles of honesty, objectivity, impartiality, and avoiding the pitfalls of the adversarial divide stand out, as in Resnick and Soliman (2012), as well as the AAPL (2005, 2013), Allan and Grisso (2014), the APA (2013), Otto et al. (2014), etc. Second, the roles of law and of science are emphasized in conducting appropriate forensic reports in psychiatry and psychology. For law, this has been underscored in Allan and Grisso (2014) and Otto et al. (2014), in particular. For science, the authors who referred to it as a foundation to forensic report writing include the APA (2013) and Karson (2015), in particular. As for other principles that seem evident for forensic report writing, many sources cited in this present review refer to the need to meet thresholds for competency to practice and the need to use competent procedures (e.g., Gold, 2013; Resnick & Soliman, 2012). The former refers to being trained appropriately, having the referral question fall within the scope of one's forensic skills, etc. Competent procedures refer to using the appropriate tools for the referral question at hand,
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considering issues concerning them, such as psychometric and conceptual aspects of reliability and validity, or relevance to the court and being helpful to it, and so on. Also, many of the sources refer to the need to communicate appropriately to the audience at hand. This refers to using the correct format and also it refers to being accurate, economical, persuasive, clear, avoiding jargon and pejorative terms, etc. (e.g., Otto et al., 2014; Resnick & Soliman, 2012). Further, many of the sources discussed on forensic report writing have referred to the need to respect and to protect the rights of the evaluee. This refers especially to protecting confidentiality and getting the needed authorizations from the person. Almost all sources referred to in the paper have mentioned in one way or another data collection and data interpretation. Perhaps it boils down to the Daubert trilogy decisions on admissibility of evidence to court – in essence, the procedures used in court-related assessments must be reliable and valid so that deriving inferences/ opinions/ hypotheses/ interpretations/ conclusions are based on the facts/ data/ information obtained in using them, as are the justifications and reasoning used to arrive at them (no matter which way they tend to fall). For reports to be defensible, also, they should consider all possible alternatives and the facts/ data/ information that might be aligned in support of them. 5. New approaches to principles in forensic report writing In the following, I present new ideas on principles in forensic report writing based on publications that I have authored related to ethics and good practice in forensics. The prior work that has been reviewed has not tried to find a principle in forensic report writing that is superordinate to other ones. However, in this regard, I refer to being ethical and to adopting a scientific approach as cardinal for effective (and defendable) forensic reports writing. This theme partly derives from my work in Young (2014a, 2014b, 2016), in which I propose five new ethical principles that should be added to the five extant principles of the American Psychological Association's Ethics Code (2002, 2010). These five principles relate to: (a) law, (b) science, (c) assessment generally, (d) assessment of negative response bias/feigning/malingering, and (e) ethics as a system. Granted, some of these topics are considered throughout the American Psychological Association's Ethics Code, but I argue they should be emphasized by separating them as specific principles. Also, unlike the APA Ethical Standards, which are mandatory to follow, the five extant Ethical Principles are considered aspirational and subject to professional judgment and contextual factors. In my opinion, such aspirational principles can be improved by further specification, which justifies their elaboration by adding five new principles to them. The following elaborates on these five new principles and then gives examples in relation to forensic report writing. 5.1. New principles in psychological ethics (a) Although forensic mental health practice requires intimate knowledge of legal and court workings, and although the ethical dangers in this type of work is heightened, the extant codes of mental health professional practice do not consider law as a factor in a separate ethical principle (e.g., American Psychological Association, 2002, 2010; Canadian Psychological Association, 2016). (b) Also, although science forms the basis of psychological practice, in general, and forensic practice (including assessment and report writing) in particular, science is not recognized explicitly within the APA Ethical Principles. (c-d) Assessment is critical to psychological practice, whether in terms of getting a coherent picture of a clinical presentation, formally assessing an examinee for forensic purposes, and so on. Yet,
assessment is not involved in a separate APA Ethical Principle. (c) Our tools distinguish us from other mental health professionals, and we should ensconce their value in a separate ethical principle related to their use. (d) Similarly, we have specialized tools to detect malingering, feigning, and related negative response biases, and another ethical principle on assessment should relate to use of such tools in forensic and related assessments (Bush, Ruff, & Heilbronner, 2014). [Note that because I am suggesting general principles for ethical forensic assessment and report writing, I refrain from naming specific tests that can be used to detect feigning, malingering, etc., but see Young (2014a) and the Institute of Medicine (IOM, 2015)]. (e) Finally, ethics constitutes a dynamic and changing system involving the interaction of examiner, examinee, and context (e.g., court, third party payor, medical system). Therefore, its principles should be flexible and contextual, rather than fixed and unchangeable.
Next, I consider how forensic report writing could be undertaken more prudently should the extant mental health ethics codes explicitly recognize these five suggested additions to the American Psychological Association's Ethical Principles. For example, law is represented by the examples of needing to know the applicable laws in one's jurisdiction and knowing the referral question. Science is considered as primary in FRE 702 (both in methods/principles and their judicious application). Assessment is represented by the examples concerning method, as well, and the need to have a full set of reliable relevant data in assessments, which speaks to the need for comprehensiveness in assessment. Respondent validity testing is recommended now not only for neuropsychological examinations (Bush et al., 2005; Heilbronner et al., 2009) but also for any disability and related forensic-type examination (Bush et al., 2014). Finally, ethics as a system refers to the examples of a need for impartiality due to systematic influence on forensic examiners. Presently, the actual wording of the proposed five new ethical principles involves the following (Young, 2016). 1. Ethics and science are mutually interacting and regulatory. 2. Psychological practice is based on intimate knowledge of all aspects of applicable law and court functioning, including practice regulatory ones. 3. The ethical use of any assessment procedure/ tool involves knowing their strengths and acknowledging their limits, principles that apply also to test construction and use. 4. The ethics that apply to psychological practice, in general, and forensic-related practice, in particular, apply to use of procedures aimed at determining the credibility of presentation, poor effort, etc. (such as SVTs/ PVTs; symptom validity tests; performance validity tests), and the factors that might influence them. 5. Ethics is a system involving learned sources, the person, and context, all of which are dynamically changing. Note that even if not adopted in any revision of the ethics code, they stand as relevant guides to mental health forensic report writing. 5.2. More on practical approaches Another model developed recently for forensic work concerns the 4 Ds, which offers a general perspective on how professionals should conduct themselves in the forensic area of psychological injury and law (Young & Brodsky, 2016). These 4 Ds cover the areas of: Dignity, Distance, Data, and Determination. The four principles involved would apply to any forensic context. The first two principles concern the right attitude to adopt in conducting forensic assessments (behaving with dignity and keeping distance from the adversarial divide). The next two principles concern: obtaining valid evidence scientifically in assessments and arriving at judicious determinations using these data. Note that the 4 Ds proposed as principles of forensic practice are quite
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similar to the headings used by Heilbrun et al. (2009) in the organization of their revised integrated principles of forensic mental health assessment, which are the categories of general principles, preparation, data collection, data interpretation, and communication/ testimony.
5.3. Comment The recent work on the topic of mental health report writing is varied and does not lead to one preferred approach. It would appear the area needs a new model that is hierarchical in nature, with some meta-principles or overarching concepts, and then some intermediate principles, leading to various standards or guidelines that can be related to them. A term that seems particularly applicable as an overarching principle in forensic report writing is “Integrity in Ethics, Law, and Science, or Ethical, Legal, and Scientific Integrity.” This term should stand at the apex of the hierarchical approach in understanding forensic report writing, with other levels subsumed to it. This overriding principle would subsume second-order principles of: Competency and Communication; Procedure and Protection; Dignity and Distance; and Data Collection and Determination. The first principle provides the preamble for the others in terms of establishing the basis to proceed with the assessment at hand and the appropriate format and language to use in the report. The second principle indicates the required quality of the forensic assessment and consequent report to meet acceptable professional standards. The third principle refers to the need for honesty, objectivity, and so on. Finally, the fourth one refers to the scrupulous care needed in gathering a full set of reliable, relevant data and to interpret them as required according to the scientific process and the legal question at hand.
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As for the many standards and rules found in Heilbrun's work and the others cited in this article, they can be arranged under these four superordinate principles in forensic report writing, as described in Table 1, in which critical examples are given in this regard. Note that, in Table 1, I consider all the principles of forensic mental health assessment that have been presented in Heilbrun's work (2001–2009), and not just those mentioned at the outset in Heilbrun et al. (2004). [Also, note that, despite my qualms that Heilbrun and colleagues are not describing principles, per se, in their lists, but just standards or rules that should be subsumed under superordinate principles, at times I need to keep their terminology to avoid confusion.] 6. Conclusions Psychiatric/ psychological forensic report writing involves more than organizing the appropriate sections, giving the appropriate content, and using the appropriate style in reports proffered to court. It is not a templated activity with a few course rules to follow in order for the report to meet acceptable admissibility thresholds. The latter are determined by federal or local state rules of evidence, which address court decisions such as the Daubert trilogy. One approach to writing forensic reports is to rely on these evidentiary standards as guides. Other relevant guides have been published, such as those by mental health professional associations, e.g., the American Psychological Association forensic specialty guidelines. The most inclusive set of principles might lie in the ethics codes of professional associations, such as those of the American Psychological Association and Canadian Psychological Association. However, these codes appear to need revision themselves. Moreover, they lack overarching principles that can organize them. As for other approaches, the concept of the 4 Ds needed in forensic practice have proved important in how I structured the myriad standards and
Table 1 Principles and standards in forensic mental health assessment and in forensic report writing according to the overarching principle of integrity in ethics, law, and science. Principle Examples (subcomponent) Competence and communication Competence Obtain appropriate education, training, experience; have adequate knowledge of forensic mental health assessment; assure not practicing outside of competence fields Communication Be accurate, economical, effective; use plain language; use minimally technical jargon/language; use definitions as required; use headings in reports; control the message Procedure and protection Procedure Apply correct forensic mental health procedures; assess in the appropriate context, e.g., private; select of the best tools for the legal question at hand, e.g., in terms of reliability and validity, having appropriate norms; aim for meeting admissibility standards to court according to applicable laws in the case at hand for methods (e.g., the Daubert trilogy); i.e., assure proper tools and data/fact/information gathering Protection Obtain appropriate authorization from all parties involved; proceed on the basis of having obtained voluntary informed consent, unless contraindicated by court order or otherwise not required Dignity and divide Dignity Main proper respect of the evaluee and of the standards of forensic mental health assessment; conduct oneself with honesty and objectivity; consider that bias works both ways, with evaluees possibly engaging in negative response bias, feigning, gross exaggeration, malingering, and the like; do not attribute malingering or use any related term just based on test results but after considering the whole file; for example, include using third party information to check consistency with self-reported information (preferring the former when inconsistency is found). Divide Avoid the pull of biases in the adversarial divide; be impartial and unbiased and check for same throughout; watch for confirmation bias and others that might apply Data collection and determination Data collection Be careful, comprehensive, and thorough; use the most appropriate model to guide data gathering, interpretation, and communication; use multiple source of information for each area assessed (e.g., self-report, psychological test data, collateral interviews and records), with all tools and methods being both reliable and valid; address functional issues related to the legal question(s) at hand, or other behaviors related to the question(s); diagnoses constitute supplementary information, unless otherwise required; clinical characteristics are related to the purposes at hand, and evaluated through all sources of information Determination Separate data/information/facts from inferences/hypotheses interpretations/opinions, and conclusions and their justifications; use scientific reasoning and procedures throughout (e.g., considering all options and gathering information that fits each one, logically selecting the best one after using this logical procedure, or, using scientific findings to choose the best tools and tests for the task at hand and using the most recent reliable and relevant research and conceptualization in science in interpreting the full set of reliable and relevant data that had been gathered in the assessment); use case-specific (idiographic) evidence in assessing/describing current clinical condition/functional abilities in relation to history of any symptoms and demonstrated capacities [before the event or moment in time at issue] in order to address causal connection and legal issues; use nomothetic evidence the same way, i.e., describe psychological test results, structured instrument results, and results of any other specialized tools that apply to the question at hand. The reports should relate clearly information/data/facts to the sources used in the assessment; address ultimate legal questions as allowed, appropriate, and required, e.g., on disability, on forensic capacities
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rules into a coherent model of a reduced set of principles (Young & Brodsky, 2016; Dignity, Distance, Data collection, Determination). These four principles in forensics, respectively, refer to conducting oneself with dignity and with a prudent distance from the adversarial divide, as well as being comprehensive in data gathering and interpreting judiciously the data. They have helped elaborate a new model of forensic report writing that is hierarchically organized, with a meta-principle related to ethics, science, and law, then the four Ds, and finally the multiple principles on Forensic Mental Health Assessment as applied to psychiatric/ psychological forensic report writing. References Allan, A., & Grisso, T. (2014). Ethical principles and the communication of forensic mental health assessments. Ethics & Behavior, 24, 467–477. American Academy of Psychiatry and the Law (2005). Ethics guidelines for the practice of forensic psychiatry. Retrieved from http://www.aapl.org/ethics.htm American Academy of Psychiatry and the Law (2013). Ethics questions and answers opinions of the AAPL committee on ethics Retrieved from http://www.aapl.org/docs/ pdf/Ethics%20Questions%20and%20Answers.pdf American Psychiatric Association (2013). The principles of medical ethics with annotations especially applicable to psychiatry. Arlington, VA: American Psychiatric Association. American Psychological Association (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060–1073. American Psychological Association (2013). Specialty guidelines for forensic psychology. American Psychologist, 68, 7–19. Buchanan, A., & Norko, M. A. (2011). The psychiatric report: Principles and practice of forensic writing. Cambridge, MA: Cambridge University Press. Bush, S., Ruff, R., & Heilbronner, R. (2014). Psychological assessment of symptom and performance validity, response bias, and malingering: Official position of the Association of Psychological Advancement in Psychological Injury and Law. Psychological Injury and Law, 7, 197–205. Bush, S. S., Ruff, R. M., Troster, A. I., Barth, J. T., Koffler, S. P., Pliskin, N. H., ... Silver, C. H. (2005). Symptom validity assessment: Practice issues and medical necessity. Archives of Clinical Neuropsychology, 20, 419–426. Canadian Psychological Association (2016). The Canadian code of ethics for psychologists (fourth edition ). Ottawa, ON: Canadian Psychological Association. Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S. Ct. 2786 (1993). DeMier, R. (2013). Forensic report writing. In R. K. Otto (Ed.), Forensic psychology (pp. 75–98) (2nd ed ). Hoboken, NJ: Wiley. Erard, R. (2016). If it walks like a duck: A case of confirmatory bias. Psychological Injury and Law, 9, 275–277. Federal Rules of Evidence. (2013). 28 U.S.C. §§ 101–1103. Federal Rules of Evidence. (2014). 28 U.S.C. §§ 101–1103. General Electric v. Joiner, 522 U.S. 136 (1997). Gold, L. H. (2013). Menstal health disability: A model for assessment. In L. H. Gold, & D. L. Vanderpool (Eds.), Clinical guide to mental disability evaluations (pp. 3–35). New York: Springer Science + Business Media. Gold, L. H., & Vanderpool, D. L. (2013). Clinical guide to mental disability evaluations. New York: Springer Science + Business Media. Gold, L. H., Anfang, S. A., Drukteinis, A. M., Metzner, J. L., Prince, M., Wall, B. W., ... Zonana, H. V. (2008). AAPL practice guideline for the forensic evaluation of psychiatric disability. Journal of the American Academy of Psychiatry and the Law, 36, S3–S50. Griffith, E. E. H., Stankovic, A., & Baranoski, M. V. (2011). Principles of writing: Writing a narrative. In A. Buchanan, & M. A. Norko (Eds.), The psychiatric report: principles and practice of forensic writing (pp. 68–80). New York: Cambridge University Press. Grisso, T. (1986). Evaluating competencies: Forensic assessments and instruments. New York: Plenum Press. Grisso, T. (2012, November). Forensic reporting writing. Continuing education workshop offered at the American Academy of Forensic Psychology Workshops, Las Vegas, Nevada.
Hall, C. W., & Hall, C. W. (2006). Malingering of PTSD and diagnostic considerations, characteristics of malingerers and clinical presentations. General Hospital Psychiatry, 28, 525–535. Heilbronner, R. L., Sweet, J. J., Morgan, J. E., Larrabee, G. J., Millis, S. R., & Participants, C. (2009). American Academy of Clinical Neuropsychology consensus conference on the neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist, 23, 1093–1129. Heilbrun, K. (2001). Principles of forensic mental health assessment. New York: Kluwer Academic/Plenum. Heilbrun, K., DeMatteo, D., & Marczyk, G. (2004). Pragmatic psychology, forensic mental health assessment, and the case of Thomas Johnson: Applying principles to promote quality. Psychology, Public Policy, and Law, 10, 31–70. Heilbrun, K., Grisso, T., & Goldstein, A. M. (2009). Foundations of forensic mental health assessment. New York: Oxford University Press. Institute of Medicine (2015). Psychological testing in the service of disability determination. Washington, DC: National Academic Press. Karson, M. (2015). What can the rule of evidence teach us about writing forensic reports? Psychological Injury and Law, 8, 1–10. Kumho Tire Ltd. v. Carmichael, 526 U.S. 137 (1999). Martinez, R., & Candilis, P. J. (2011). Principles of writing: Ethics. In A. Buchanan, & M. A. Norko (Eds.), The psychiatric report: Principles and practice of forensic writing (pp. 56–67). New York: Cambridge University Press. Melton, G. B., Petrila, J., Poythress, N. G., & Slobogin, C. (2007). Psychological evaluations for the courts: A handbook for mental health professionals and lawyers (3rd ed.). New York: Guilford Press. Morse, S. (1978). Crazy behavior, morals, and science: An analysis of mental health law. Southern California Law Review, 51, 527–654. Otto, R. K., DeMier, R. L., & Boccaccini, M. T. (2014). Forensic reports and testimony: A guide to effective communication for psychologists and psychiatrists. Hoboken, NJ: Wiley. Piechowski, L. D. (2011). Evaluation of workplace disability (best practice in mental health assessment). New York: Oxford University Press. Resnick, P. J. (1997). Malingered psychosis. In R. Rogers (Ed.), Clinical assessment of malingering and deception (pp. 47–67) (2nd ed ). New York: Guilford. Resnick, P. J., & Soliman, S. (2012). Planning, writing, and editing forensic psychiatric reports. International Journal of Law and Psychiatry, 35, 412–417. Scott, C. L., & McDermott, B. (2011). Special issues: malingering. In A. Buchanan, & M. A. Norko (Eds.), The psychiatric report: Principles and practice of forensic writing (pp. 240–253). New York: Cambridge University Press. Scott, C. L., & McDermott, B. (2013). Malingering and mental health disability evaluations. In L. H. Gold, & D. L. Vanderpool (Eds.), Clinical guide to mental disability evaluations (pp. 155–182). New York: Springer Science + Business Media. Silva, J. A., Leong, G. B., & Weinstock, R. (2003). Forensic psychiatric report writing. In R. Rosner (Ed.), Principles and practice of forensic psychiatry (pp. 31–36) (2nd ed.). New York: Oxford University Press. Stejskal, W. J. (2013). Psychological testing in workplace disability evaluations. In L. H. Gold, & D. L. Vanderpool (Eds.), Clinical guide to mental disability evaluations (pp. 127–154). New York: Springer Science + Business Media. U.S. Government (2010). Federal rules of civil procedure. Washington, DC: U.S. Government Printing Office. Weiner, I. B. (2014). Writing forensic reports. In I. B. Weiner, & R. K. Otto (Eds.), Handbook of forensic psychology (pp. 711–732) (4th ed ). Hoboken, NJ: Wiley. Young, G. (2014a). Malingering, feigning, and response bias in psychiatric/ psychological injury: Implications for practice and court. Dordrecht, Netherlands: Springer Science + Business Media. Young, G. (2014b). Psychological injury and law II: Implications for mental health policy and ethics. Mental Health Law & Policy Journal, 3, 418–470. Young, G. (2016). A broad ethics model for mental health. Ethics, Medicine, and Public Health, 2, 220–237. Young, G., & Brodsky, S. L. (2016). The 4 Ds of forensic mental health assessments of personal injury. Psychological Injury and Law, 9, 278–281.
Contents lists available at ScienceDirect
International Journal of Law and Psychiatry
Psychiatric/ psychological forensic report writing Gerald Young York University, Glendon Campus, Toronto, Ontario, Canada
a r t i c l e
i n f o
Available online 29 October 2016 Keywords: Forensic reports Ethics Codes Rules of evidence Admissibility
a b s t r a c t Approaches to forensic report writing in psychiatry, psychology, and related mental health disciplines have moved from an organization, content, and stylistic framework to considering ethical and other codes, evidentiary standards, and practice considerations. The first part of the article surveys different approaches to forensic report writing, including that of forensic mental health assessment and psychiatric ethics. The second part deals especially with psychological ethical approaches. The American Psychological Association's Ethical Principles and Code of Conduct (2002) provide one set of principles on which to base forensic report writing. The U.S. Federal Rules of Evidence (2014) and related state rules provide another basis. The American Psychological Association's Specialty Guidelines for Forensic Psychology (2013) provide a third source. Some work has expanded the principles in ethics codes; and, in the third part of this article, these additions are applied to forensic report writing. Other work that could help with the question of forensic report writing concerns the 4 Ds in psychological injury assessments (e.g., conduct oneself with Dignity, avoid the adversary Divide, get the needed reliable Data, Determine interpretations and conclusions judiciously). One overarching ethical principle that is especially applicable in forensic report writing is to be comprehensive, scientific, and impartial. As applied to forensic report writing, the overall principle that applies is that the work process and product should reflect integrity in its ethics, law, and science. Four principles that derive from this meta-principle concern: Competency and Communication; Procedure and Protection; Dignity and Distance; and Data Collection and Determination. The standards or rules associated with each of these principles are reviewed. Crown Copyright © 2016 Published by Elsevier Ltd. All rights reserved.
Forensic report writing in psychiatry, psychology, and allied disciplines in mental health is more than an act of writing to influence the court because it must follow ethical and practice principles, aside from following recommended style and formatting. The most important principles relate to being impartial and not advocating for the referral source. The best manner of achieving this goal is to follow the general ethical principles of one's profession, particularly as they apply to forensic work. The first section of this paper presents the landmark integration on forensic report writing as developed in Heilbrun's forensic mental health assessment approach (FMHA; Heilbrun, 2001; Heilbrun, DeMatteo, & Marczyk, 2004; Heilbrun, Grisso, & Goldstein, 2009). Then, it considers psychiatric ethics, in particular, in relation to forensic report writing. The second part of the paper considers more recent psychological approaches to forensic report writing (the work of Grisso, Otto and colleagues, Karson), as well as psychological ethics in their recommendations in helping in forensic report writing and the role of Federal Rules of Evidence (FREs) and related state rules. The last part of the paper considers some original personal suggestions on forensic report writing, including recommendations related to five
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http://dx.doi.org/10.1016/j.ijlp.2016.10.008 0160-2527/Crown Copyright © 2016 Published by Elsevier Ltd. All rights reserved.
new ethical principles that I have proposed for the American Psychological Association's “Ethics Code” on principles and standards (hereinafter referred to as the Ethics Code). In the end, the forensic report needs to reflect the overarching principle of Integrity in Ethics, Law, and Science in particular. To conclude the paper, I elucidate four major principles, each with two components (Competency and Communication; Procedure and Protection; Dignity and Distance; and Data Collection and Determination), that are subsumed by this meta-principle, and that subsume in turn the multiple standards and rules that they involve. 1. Forensic report writing 1.1. Forensic mental health assessment Heilbrun et al. (2004) applied Heilbrun's (2001) principles of FMHA to constructing forensic reports. Heilbrun (2001) had identified 29 broad principles of FMHA, and Heilbrun et al. (2004) noted that 22 of them apply to forensic report construction (actually, they applied 23 of them, and I collapsed two of the 23 in the following list). In the following, I review these 22 principles and applications to forensic report writing, as proposed by Heilbrun et al. (2004), but arrange them differently after rephrasing them to the degree possible.
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1. Use plain language; use minimally technical jargon/language; use definitions as required. Use headings in reports. 2. In the first section of a forensic report, identify the relevant legal question and forensic issues. 3. Give the referral source (e.g., by court, attorney) and indicate how required authorization/ informed consent has been obtained, if applicable. 4. Indicate one's degree and licensure/board certification, in order to support that one's professed area of expertise is within one's area of competence. Provide a summary of qualifications and note that a CV is available upon request. 5. Describe the context of the assessment (e.g., was it reasonably quiet, private, distraction-free?). 6. Describe how the evaluee was notified of the evaluation's purpose and the need for informed consent, doing the same in communicating with any third parties/ collaterals. 7. Indicate how the evaluee's understanding of the purpose of the evaluation was assessed, the degree of that understanding, and communication of any associated limits of confidentiality. 8. The tone of the report should reflect that the evaluator has been impartial (not hyperbolic or argumentative, for example). 9. Use the most appropriate model to guide data gathering, interpretation, and communication. For example, select model 1: describe any mental disorder, residual functional abilities, and their causal connection; or select model 2: describe functional, contextual, causal, interactive, judgmental, and dispositional characteristics (Morse, 1978; Grisso, 1986, respectively). 10. Use multiple source of information for each area assessed (e.g., selfreport, psychological test data, collateral interviews and records). 11. Use reliable and valid data gathering methods to provide relevant information. 12. Document relevant history and prior functioning in areas relevant to ongoing clinical condition and functional capacities that speaks to the legal question(s) at hand. 13. Clinical characteristics need to be evaluated with reliable and valid measures for the purposes at hand, while weighing their results in relation to other sources of information. 14. Assess legally relevant behavior with the data gathered from the multiple sources used, e.g., functionality. 15. Assess response style (e.g., malingering) using third party information to check consistency with self-reported information (preferring the former when inconsistency is found). 16. To check response style (significant exaggeration or minimization of problems) and accuracy of self-report, use tests sensitive to response style. 17. Use case-specific (idiographic) evidence in assessing/describing current clinical condition/functional abilities in relation to history of any symptoms and demonstrated capacities before the event or moment in time at issue in order to address causal connection and legal issues. 18. Use nomothetic evidence the same way, i.e., describe psychological test results, structured instrument results, and results of any other specialized tools that apply to the question at hand. 19. The reports should clearly relate information/ data/ facts to the sources used in the assessment. 20. Use scientific reasoning in causally relating clinical conditions and functional abilities, i.e., choose the interpretation with the most supporting evidence and least disconfirming evidence, or indicate if it is difficult to decide and why. 21. Avoid addressing the ultimate legal question, although presenting conclusions about forensic capacities is appropriate. In the context of psychological injuries, addressing any functional disability is expected, for example. 22. In describing findings and limits, think ahead to possible crossexamination; i.e., be careful, impartial, and thorough in presenting data and reasoning, including evaluating alternative explanations.
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1.2. Comment The list of 22 principles in forensic report writing elucidated by Heilbrun et al. (2004), which had been constructed based on the principles of forensic mental health assessment in Heilbrun (2001), stands as a cornerstone in the area. However, the list by Heilbrun (2001) on principles in forensic mental health assessment has been superseded by a more integrative one in Heilbrun et al. (2009). This revised version of the principles of forensic mental health assessment has not been applied to forensic report writing. Heilbrun et al. (2009) organized an expanded list of 38 principles in forensic mental health assessment in terms of seven “general” principles, and they are disparate, relating to competence and the need for honesty and objectivity. Their next set of nine principles is referred to as preparatory. The principles in this set include a range of topics, related to the referral source, the evaluee, and the guiding model to be used in the assessment and report. In the next category of data collection, for which there are eight more principles, not only are the issues of reliability and validity paramount, but also topics such as getting authorization are mentioned. For data interpretation and its seven principles, one finds principles related to assessing response style, using idiographic and nomothetic evidence, using scientific reasoning, and the issue of answering the ultimate issue. In the last principles related to communication and testimony, the provisos include conducting proper assessments and attributing information gained from them to the correct sources in the assessments. Note that comparison of the list of 29 principles of FMHA in Heilbrun (2001) and the 38 in Heilbrun et al. (2009) indicates that most additions related to general principles, such as the need for honesty and objectivity. Also, some additions relate to effective report writing and testimony, such as attributing information to their sources in the assessment. Finally, in Heilbrun et al. (2009), some of the original 29 principles were slightly modified, such as the one on ultimate issues, which now allows for consideration of whether they should be addressed. In this integrated work on various sources on the foundations of FMHA, Heilbrun et al. (2009) re-emphasized that, in interpreting assessment data, forensic assessors need to use scientific reasoning as they assess the causal connection between evaluees' clinical condition and functional ability. I note that this principle speaks to the notion that the scientific process should characterize all aspects of the forensic examination in mental health (Young, 2014a), from collecting data, to choosing instruments, to arriving at legally relevant opinions. However, a qualification in this regard follows. In the psychological injury context, as compared to the criminal context, the forensic evaluator needs to show not only the link between psychological condition and functional effect, but also the link between the event or traumatic stressor at issue and the resultant psychological condition and legally relevant functional impairment, if any. A further point to consider on Heilbrun et al.’s (2004) list of principles in forensic report writing is that it is doubtful that the list represents principles, per se, such as those in various ethical codes. Typically, these lists of principles are brief, for example, numbering five and four, as found, respectively, in the American Psychological Association's (2002, 2010) and the Canadian Psychological Association's (Canadian Psychological Association, 2016) ethics codes. Second, they are more global in nature than the forensic principles of report writing found in Heilbrun et al. (2004). Therefore, a major goal of the present article is to elucidate overarching principles in forensic report writing that are more global and fewer in number compared to prior lists. This will require a hierarchical approach so that the putative principles in prior lists can be placed at lower levels of the hierarchy, just as many standards and rules are placed under the umbrella of a few principles in ethics codes in the profession.
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2. Psychiatric forensic report writing
list; (i) occupational history; (j) psychosocial history; (k) mental status exam; (l) discussion; and (m) opinion.
2.1. Ethics 2.3. Comment Resnick and Soliman (2012) repeated many of these themes found in the work of Heilbrun and colleagues, and emphasized the need to follow the four key principles of the AAPL's (American Academy of Psychiatry and the Law) ethical guidelines for the practice of forensic psychiatry (AAPL, 2005). These four key ethical principles involve: maintaining confidentiality, getting consent, being honest and striving for objectivity, and having the necessary qualifications. Resnick and Soliman (2012) added that four principles of effective writing involve: clarity, simplicity, brevity, and humanity (e.g., avoid pejoratives). The common pitfalls in forensic report writing listed by the authors include advocating for the referral source. The AAPL (2005) ethics guidelines elaborates that the “adversarial nature” of most legal “processes” constitutes “special hazards” for bias and “danger of distortion” of opinion. The AAPL (2013) supplement on ethical questions and answers emphasizes that the AAPL (2005) ethics guidelines are “grounded in respect for persons and striving for objectivity.” The principles of medical/psychiatric ethics of the American Psychiatric Association (APA, 2013) also emphasize physician “responsibility” to patients, society, and so on, as well as honesty “in all professional interactions.” Consistent with the theme of the present work, the psychiatric ethical principles maintain that the doctor “shall continue to study, apply, and advance scientific knowledge.” Martinez and Candilis (2011) provided the following ethical principles for guiding forensic report writing: respect of persons; respect for privacy and confidentiality; respect for consent processes; and commitment to honesty and striving for objectivity. Griffith, Stankovic, and Baranoski (2011) added that forensic psychiatrists need to identify the limits of their reports, or else their authors could be viewed even as so-called hired guns. These psychiatric sources on ethics in forensic practice refer to biases that might affect the evaluator. However, other sources underscore the vigilance needed in dealing with bias in the evaluee, e.g., in possible deception and malingering. In this regard, Scott and McDermott (2011) noted that psychiatric reports need to consider possible malingering. For example, Resnick (1997) and Hall and Hall (2006) have provided useful guidelines for detecting malingered psychosis and malingered PTSD, respectively. As for testing for negative response bias and malingering in disability evaluations other chapters in Gold and Vanderpool (2013), by Stejskal (2013), and by Scott and McDermott (2013) have provided useful information, as has Young (2014a). Gold (2013) noted the distinction among diagnosis, impairment, and disability. Although diagnostic assessment incorporates functional evaluation, she noted that psychiatric diagnoses are not designed to furnish the necessary information required of legal and administrative systems dealing with disability claims. The diagnosis involved might include symptoms that impair functionality and cause disability, but the label by itself does not provide grounds for concluding that a disability is present. 2.2. Format Gold (2013) provided an outline for forensic disability report formatting, while integrating in this regard the work of Buchanan and Norko (2011), Gold et al. (2008), Melton, Petrila, Poythress, and Slobogin (2007), Piechowski (2011), and Silva, Leong, and Weinstock (2003). She noted that there is no one standard format, but generally any such report should include the following elements: (a) identification (evaluee, referral source); (b) referral question; (c) informed consent matters; (d) all sources of information listed; (e) course (history) of current mental health problems; (f) prior mental health history; (g) substance abuse history; (h) medication
Forensic report writing from a psychiatric perspective is a process that needs to be steeped in ethics generally, such as in getting informed consent and protecting confidentiality. At the same time, the critical issues of objectivity and honesty stand out. The evaluator should avoid biases yet be tuned to detect them in the evaluee, as in malingering. Overall, a scientifically-informed approach to forensic report writing can help. There are a host of rules and guidelines, such as in formatting and communication style, which have been recommended, as well. 3. Psychological principles and practice in forensic report writing In the above, psychiatric ethics in relation to forensic report writing have been presented. In the following, the article turns to how psychological ethics may apply 3.1. Ethics Allan and Grisso (2014) proposed that the ethical principles as described in the American Psychological Association's Ethics Code (2002, 2010) forms an adequate basis for communicating forensic findings and opinions. However, they included the caveat that they “must be interpreted within the law” in the jurisdiction at hand. The first of the five Ethical Principles in the code concerns beneficence/ non-maleficence, and they maintained that it is an overarching principle for the other four, so they did not apply it to the question of forensic report writing. The next principle in the American Psychological Association's Ethics Code concerns fidelity and responsibility, for example, honoring obligations. In the forensic context, this means that reports should meet clearly all legal requirements (e.g., in noting the referral source and referral questions). Allan and Grisso (2014) next considered the American Psychological Association's Ethical Principle of integrity for the task of forensic report writing. In this regard, the forensic report writer should avoid exaggeration and misrepresentation (for example, overstatement, or poorly redescribing nomothetic research for implications for the case at hand). Allan and Grisso (2014) continued that forensic report writing also should be guided by the American Psychological Association principle of respecting the rights and dignity of people. For example, the assessor should not include personal information about the examinee that is not relevant to the referral question. According to the American Psychological Association's Ethics Code, justice and fairness refers to treating people equitably and justly. In forensic mental health assessments, this means using a just process with appropriate methods Following Grisso (personal communication to DeMier), DeMier (2013) listed six principles in forensic report writing: (a) stick to the forensic (referral) question; (b) report only what is required; (c) separate facts and inferences; (d) provide explanations that indicate why the specific inferences had been made; and (e) explain competing opinions or conclusions and why they had been rejected. 3.2. A practical approach Otto, DeMier, and Boccaccini (2014) proposed a general approach to mental health forensic report writing and other forms of testimony. To begin, they emphasized that experts need to be “objective, independent and unbiased” (Guideline 1.02; American Psychological Association, 2013). For example, Otto et al. (2014) referred to the importance of knowing local laws, rules, and customs. Then, they referred to FRE 702 that requires that an expert use “scientific, technical, or other specialized knowledge” to gather sufficient facts/data based on reliable
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principles and methods and their reliable application. The next Federal Rule cited by Otto et al. (2014) is Federal Rule of Civil Procedure (FRCP) 26(a), which specifies that reports must include the reasons for all opinions provided in a report. Otto et al. (2014) next addressed the contents of forensic reports. All sources used in the report should be documented (and ones requested but not obtained should be documented, as well). In their penultimate chapter in forensic report writing, Otto et al. (2014) listed 10 applicable points, some of which are enumerated here. (a) First, forensic reports should provide the factual bases for opinions offered (American Psychological Association, 2013) (Section 11.03). (b) Second, the report must distinguish facts, inferences, and opinions (following Grisso, 2012). Otto et al. (2014) added that the forensic specialty guidelines go further by indicating that the opinions proffered should be related to the legal issues and facts in a case and the relationship explained (Section 11.02). (c) Otto et al. (2014) continued that the forensic report should identify presumptions and assumptions. For example, the report should clarify matters that seem equivocal in the available evidence. As for communicating well, in oral testimony and cross-examination, Otto et al. (2014) recommended four evidence-based principles: credibility, clarity, clinical knowledge, and certainty.
3.3. Others Other work adds to our understanding of the approach needed to forensic report writing. Melton et al. (2007) provided general guidelines for forensic report writing. Examination of their guidelines suggests that they advocated for accuracy and economy in writing forensic reports. For example, the report should: give information that is neither overkill nor underkill and minimize clinical jargon. [I would add minimize legal jargon, too.] Weiner (2014) advised the forensic report writer to determine the required focus. For example, the FRCP (U.S. Government, 2010) indicate that the proffered report to court must include: (a) a complete statement of all opinions expressed and their basis; (b) the facts/data considered; (c) exhibits; (d) qualifications, including all publications authored by the expert in the previous 10 years; (e) prior cases in the previous four years in which the expert had testified; and (f) the fee for the service provided to the court.
3.4. An evidence rules approach Karson (2015) used the Federal Rules of Evidence (2013) as a counterpoint to forensic report writing by pointing out the evidentiary objections that might be made in court to certain aspects of proffered reports. For example, FRE 401 defines legal relevance as a combination of the evidence being material to the case at hand and helpful to the trier of fact (helping them understand something that an ordinary person would not understand). Under FRE 401, one could object to data in the report that might be considered irrelevant to the legal matter at issue. Also, the data require sufficient foundation or they should be excluded as irrelevant. [Also, see Erard (2016) for a cogent example.] Rule 403 concerns excluding relevant evidence if it is unfairly prejudicial to the judicial decision to be made, with its prejudicial value outweighing its probative value. A report could have a too evident prejudicial aspect in this regard, leading to objection. Rule 404 concerns the relationship between nomothetic (general) science and idiographic (case-specific) information. For example, a person might have a certain personality attribute according to a test algorithm, but this does not mean that the trait had been present on a particular occasion. Objections can be raised when a mental health expert does not stick to the point that a test score simply shows how a person tends to behave (e.g., on a test of malingering).
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3.5. Comment Taken together, the FREs define what qualifications an expert should have to meet court admissibility requirements and also the nature of the evidence they can proffer to court. The FREs often have state counterparts in the U.S. They reflect the Supreme Court of the United States' decisions on the nature of good, acceptable science, compared to poor or junk science (the “Daubert trilogy”: Daubert v. Merrell Dow Pharmaceuticals, Inc., 1993; General Electric v. Joiner, 1997; and Kumho Tire Ltd. v. Carmichael, 1999). They refer to sound methods and their application, so that reliable, relevant data forms the basis for interpretations and conclusions in reports or other testimony. Although the Daubert trilogy refers to using appropriate specialized techniques or knowledge as mental health experts conduct assessments for their forensic reports, the critical test for mental health experts is the scientific one. Procedural and test validity used in assessments at the basis of forensic reports are informed by research on best practices, for example. Also, in the case of mental health experts, when presenting scientific evidence, the logic needed to make informed inferences, interpretations, conclusions, and opinions for court and related purposes must be a grounded in sound science. This is reflected in the multiple advisories to use all the reliable and relevant evidence in these regards and to support the proffered opinion by showing how the preponderance of the evidence is consistent with it, whereas only some evidence fits alternate hypotheses. 4. Integration of the literature review on forensic report writing The review of the literature on forensic report writing that has been undertaken started with the landmark approach of Heilbrun et al. (2004) and continued with perspectives in psychiatry and psychology. Based on the work of Heilbrun (2001) on forensic mental health assessment, Heilbrun et al. (2004) had elaborated 22 principles of forensic report writing, but I consider them more like standards than principles. Heilbrun et al. (2009) re-organized and added to the original 29 principles in forensic mental health assessment of Heilbrun (2001) so that there are now 38 of them. The psychiatric field has emphasized the basics in terms of format and principles, such as being ethical and impartial, adhering to standards, and being scientific, while protecting the rights of evaluees, yet considering the possibility of malingering and related biases. Recently, the psychological field has considered forensic report writing especially in terms of the Ethics Code of the American Psychological Association (2002, 2010), the 2013 Forensic Specialty Guidelines of that association, and U.S. Rules of Evidence, especially federal (e.g., Allan & Grisso, 2014; Karson, 2015; Otto et al., 2014). The approach to forensic report writing of forensic mental health assessment in the work of Heilbrun and colleagues has been complemented by these and other approaches in the present review and, collectively, they indicate the following. First, the overriding principles of honesty, objectivity, impartiality, and avoiding the pitfalls of the adversarial divide stand out, as in Resnick and Soliman (2012), as well as the AAPL (2005, 2013), Allan and Grisso (2014), the APA (2013), Otto et al. (2014), etc. Second, the roles of law and of science are emphasized in conducting appropriate forensic reports in psychiatry and psychology. For law, this has been underscored in Allan and Grisso (2014) and Otto et al. (2014), in particular. For science, the authors who referred to it as a foundation to forensic report writing include the APA (2013) and Karson (2015), in particular. As for other principles that seem evident for forensic report writing, many sources cited in this present review refer to the need to meet thresholds for competency to practice and the need to use competent procedures (e.g., Gold, 2013; Resnick & Soliman, 2012). The former refers to being trained appropriately, having the referral question fall within the scope of one's forensic skills, etc. Competent procedures refer to using the appropriate tools for the referral question at hand,
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considering issues concerning them, such as psychometric and conceptual aspects of reliability and validity, or relevance to the court and being helpful to it, and so on. Also, many of the sources refer to the need to communicate appropriately to the audience at hand. This refers to using the correct format and also it refers to being accurate, economical, persuasive, clear, avoiding jargon and pejorative terms, etc. (e.g., Otto et al., 2014; Resnick & Soliman, 2012). Further, many of the sources discussed on forensic report writing have referred to the need to respect and to protect the rights of the evaluee. This refers especially to protecting confidentiality and getting the needed authorizations from the person. Almost all sources referred to in the paper have mentioned in one way or another data collection and data interpretation. Perhaps it boils down to the Daubert trilogy decisions on admissibility of evidence to court – in essence, the procedures used in court-related assessments must be reliable and valid so that deriving inferences/ opinions/ hypotheses/ interpretations/ conclusions are based on the facts/ data/ information obtained in using them, as are the justifications and reasoning used to arrive at them (no matter which way they tend to fall). For reports to be defensible, also, they should consider all possible alternatives and the facts/ data/ information that might be aligned in support of them. 5. New approaches to principles in forensic report writing In the following, I present new ideas on principles in forensic report writing based on publications that I have authored related to ethics and good practice in forensics. The prior work that has been reviewed has not tried to find a principle in forensic report writing that is superordinate to other ones. However, in this regard, I refer to being ethical and to adopting a scientific approach as cardinal for effective (and defendable) forensic reports writing. This theme partly derives from my work in Young (2014a, 2014b, 2016), in which I propose five new ethical principles that should be added to the five extant principles of the American Psychological Association's Ethics Code (2002, 2010). These five principles relate to: (a) law, (b) science, (c) assessment generally, (d) assessment of negative response bias/feigning/malingering, and (e) ethics as a system. Granted, some of these topics are considered throughout the American Psychological Association's Ethics Code, but I argue they should be emphasized by separating them as specific principles. Also, unlike the APA Ethical Standards, which are mandatory to follow, the five extant Ethical Principles are considered aspirational and subject to professional judgment and contextual factors. In my opinion, such aspirational principles can be improved by further specification, which justifies their elaboration by adding five new principles to them. The following elaborates on these five new principles and then gives examples in relation to forensic report writing. 5.1. New principles in psychological ethics (a) Although forensic mental health practice requires intimate knowledge of legal and court workings, and although the ethical dangers in this type of work is heightened, the extant codes of mental health professional practice do not consider law as a factor in a separate ethical principle (e.g., American Psychological Association, 2002, 2010; Canadian Psychological Association, 2016). (b) Also, although science forms the basis of psychological practice, in general, and forensic practice (including assessment and report writing) in particular, science is not recognized explicitly within the APA Ethical Principles. (c-d) Assessment is critical to psychological practice, whether in terms of getting a coherent picture of a clinical presentation, formally assessing an examinee for forensic purposes, and so on. Yet,
assessment is not involved in a separate APA Ethical Principle. (c) Our tools distinguish us from other mental health professionals, and we should ensconce their value in a separate ethical principle related to their use. (d) Similarly, we have specialized tools to detect malingering, feigning, and related negative response biases, and another ethical principle on assessment should relate to use of such tools in forensic and related assessments (Bush, Ruff, & Heilbronner, 2014). [Note that because I am suggesting general principles for ethical forensic assessment and report writing, I refrain from naming specific tests that can be used to detect feigning, malingering, etc., but see Young (2014a) and the Institute of Medicine (IOM, 2015)]. (e) Finally, ethics constitutes a dynamic and changing system involving the interaction of examiner, examinee, and context (e.g., court, third party payor, medical system). Therefore, its principles should be flexible and contextual, rather than fixed and unchangeable.
Next, I consider how forensic report writing could be undertaken more prudently should the extant mental health ethics codes explicitly recognize these five suggested additions to the American Psychological Association's Ethical Principles. For example, law is represented by the examples of needing to know the applicable laws in one's jurisdiction and knowing the referral question. Science is considered as primary in FRE 702 (both in methods/principles and their judicious application). Assessment is represented by the examples concerning method, as well, and the need to have a full set of reliable relevant data in assessments, which speaks to the need for comprehensiveness in assessment. Respondent validity testing is recommended now not only for neuropsychological examinations (Bush et al., 2005; Heilbronner et al., 2009) but also for any disability and related forensic-type examination (Bush et al., 2014). Finally, ethics as a system refers to the examples of a need for impartiality due to systematic influence on forensic examiners. Presently, the actual wording of the proposed five new ethical principles involves the following (Young, 2016). 1. Ethics and science are mutually interacting and regulatory. 2. Psychological practice is based on intimate knowledge of all aspects of applicable law and court functioning, including practice regulatory ones. 3. The ethical use of any assessment procedure/ tool involves knowing their strengths and acknowledging their limits, principles that apply also to test construction and use. 4. The ethics that apply to psychological practice, in general, and forensic-related practice, in particular, apply to use of procedures aimed at determining the credibility of presentation, poor effort, etc. (such as SVTs/ PVTs; symptom validity tests; performance validity tests), and the factors that might influence them. 5. Ethics is a system involving learned sources, the person, and context, all of which are dynamically changing. Note that even if not adopted in any revision of the ethics code, they stand as relevant guides to mental health forensic report writing. 5.2. More on practical approaches Another model developed recently for forensic work concerns the 4 Ds, which offers a general perspective on how professionals should conduct themselves in the forensic area of psychological injury and law (Young & Brodsky, 2016). These 4 Ds cover the areas of: Dignity, Distance, Data, and Determination. The four principles involved would apply to any forensic context. The first two principles concern the right attitude to adopt in conducting forensic assessments (behaving with dignity and keeping distance from the adversarial divide). The next two principles concern: obtaining valid evidence scientifically in assessments and arriving at judicious determinations using these data. Note that the 4 Ds proposed as principles of forensic practice are quite
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similar to the headings used by Heilbrun et al. (2009) in the organization of their revised integrated principles of forensic mental health assessment, which are the categories of general principles, preparation, data collection, data interpretation, and communication/ testimony.
5.3. Comment The recent work on the topic of mental health report writing is varied and does not lead to one preferred approach. It would appear the area needs a new model that is hierarchical in nature, with some meta-principles or overarching concepts, and then some intermediate principles, leading to various standards or guidelines that can be related to them. A term that seems particularly applicable as an overarching principle in forensic report writing is “Integrity in Ethics, Law, and Science, or Ethical, Legal, and Scientific Integrity.” This term should stand at the apex of the hierarchical approach in understanding forensic report writing, with other levels subsumed to it. This overriding principle would subsume second-order principles of: Competency and Communication; Procedure and Protection; Dignity and Distance; and Data Collection and Determination. The first principle provides the preamble for the others in terms of establishing the basis to proceed with the assessment at hand and the appropriate format and language to use in the report. The second principle indicates the required quality of the forensic assessment and consequent report to meet acceptable professional standards. The third principle refers to the need for honesty, objectivity, and so on. Finally, the fourth one refers to the scrupulous care needed in gathering a full set of reliable, relevant data and to interpret them as required according to the scientific process and the legal question at hand.
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As for the many standards and rules found in Heilbrun's work and the others cited in this article, they can be arranged under these four superordinate principles in forensic report writing, as described in Table 1, in which critical examples are given in this regard. Note that, in Table 1, I consider all the principles of forensic mental health assessment that have been presented in Heilbrun's work (2001–2009), and not just those mentioned at the outset in Heilbrun et al. (2004). [Also, note that, despite my qualms that Heilbrun and colleagues are not describing principles, per se, in their lists, but just standards or rules that should be subsumed under superordinate principles, at times I need to keep their terminology to avoid confusion.] 6. Conclusions Psychiatric/ psychological forensic report writing involves more than organizing the appropriate sections, giving the appropriate content, and using the appropriate style in reports proffered to court. It is not a templated activity with a few course rules to follow in order for the report to meet acceptable admissibility thresholds. The latter are determined by federal or local state rules of evidence, which address court decisions such as the Daubert trilogy. One approach to writing forensic reports is to rely on these evidentiary standards as guides. Other relevant guides have been published, such as those by mental health professional associations, e.g., the American Psychological Association forensic specialty guidelines. The most inclusive set of principles might lie in the ethics codes of professional associations, such as those of the American Psychological Association and Canadian Psychological Association. However, these codes appear to need revision themselves. Moreover, they lack overarching principles that can organize them. As for other approaches, the concept of the 4 Ds needed in forensic practice have proved important in how I structured the myriad standards and
Table 1 Principles and standards in forensic mental health assessment and in forensic report writing according to the overarching principle of integrity in ethics, law, and science. Principle Examples (subcomponent) Competence and communication Competence Obtain appropriate education, training, experience; have adequate knowledge of forensic mental health assessment; assure not practicing outside of competence fields Communication Be accurate, economical, effective; use plain language; use minimally technical jargon/language; use definitions as required; use headings in reports; control the message Procedure and protection Procedure Apply correct forensic mental health procedures; assess in the appropriate context, e.g., private; select of the best tools for the legal question at hand, e.g., in terms of reliability and validity, having appropriate norms; aim for meeting admissibility standards to court according to applicable laws in the case at hand for methods (e.g., the Daubert trilogy); i.e., assure proper tools and data/fact/information gathering Protection Obtain appropriate authorization from all parties involved; proceed on the basis of having obtained voluntary informed consent, unless contraindicated by court order or otherwise not required Dignity and divide Dignity Main proper respect of the evaluee and of the standards of forensic mental health assessment; conduct oneself with honesty and objectivity; consider that bias works both ways, with evaluees possibly engaging in negative response bias, feigning, gross exaggeration, malingering, and the like; do not attribute malingering or use any related term just based on test results but after considering the whole file; for example, include using third party information to check consistency with self-reported information (preferring the former when inconsistency is found). Divide Avoid the pull of biases in the adversarial divide; be impartial and unbiased and check for same throughout; watch for confirmation bias and others that might apply Data collection and determination Data collection Be careful, comprehensive, and thorough; use the most appropriate model to guide data gathering, interpretation, and communication; use multiple source of information for each area assessed (e.g., self-report, psychological test data, collateral interviews and records), with all tools and methods being both reliable and valid; address functional issues related to the legal question(s) at hand, or other behaviors related to the question(s); diagnoses constitute supplementary information, unless otherwise required; clinical characteristics are related to the purposes at hand, and evaluated through all sources of information Determination Separate data/information/facts from inferences/hypotheses interpretations/opinions, and conclusions and their justifications; use scientific reasoning and procedures throughout (e.g., considering all options and gathering information that fits each one, logically selecting the best one after using this logical procedure, or, using scientific findings to choose the best tools and tests for the task at hand and using the most recent reliable and relevant research and conceptualization in science in interpreting the full set of reliable and relevant data that had been gathered in the assessment); use case-specific (idiographic) evidence in assessing/describing current clinical condition/functional abilities in relation to history of any symptoms and demonstrated capacities [before the event or moment in time at issue] in order to address causal connection and legal issues; use nomothetic evidence the same way, i.e., describe psychological test results, structured instrument results, and results of any other specialized tools that apply to the question at hand. The reports should relate clearly information/data/facts to the sources used in the assessment; address ultimate legal questions as allowed, appropriate, and required, e.g., on disability, on forensic capacities
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rules into a coherent model of a reduced set of principles (Young & Brodsky, 2016; Dignity, Distance, Data collection, Determination). These four principles in forensics, respectively, refer to conducting oneself with dignity and with a prudent distance from the adversarial divide, as well as being comprehensive in data gathering and interpreting judiciously the data. They have helped elaborate a new model of forensic report writing that is hierarchically organized, with a meta-principle related to ethics, science, and law, then the four Ds, and finally the multiple principles on Forensic Mental Health Assessment as applied to psychiatric/ psychological forensic report writing. References Allan, A., & Grisso, T. (2014). Ethical principles and the communication of forensic mental health assessments. Ethics & Behavior, 24, 467–477. American Academy of Psychiatry and the Law (2005). Ethics guidelines for the practice of forensic psychiatry. Retrieved from http://www.aapl.org/ethics.htm American Academy of Psychiatry and the Law (2013). Ethics questions and answers opinions of the AAPL committee on ethics Retrieved from http://www.aapl.org/docs/ pdf/Ethics%20Questions%20and%20Answers.pdf American Psychiatric Association (2013). The principles of medical ethics with annotations especially applicable to psychiatry. Arlington, VA: American Psychiatric Association. American Psychological Association (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060–1073. American Psychological Association (2013). Specialty guidelines for forensic psychology. American Psychologist, 68, 7–19. Buchanan, A., & Norko, M. A. (2011). The psychiatric report: Principles and practice of forensic writing. Cambridge, MA: Cambridge University Press. Bush, S., Ruff, R., & Heilbronner, R. (2014). Psychological assessment of symptom and performance validity, response bias, and malingering: Official position of the Association of Psychological Advancement in Psychological Injury and Law. Psychological Injury and Law, 7, 197–205. Bush, S. S., Ruff, R. M., Troster, A. I., Barth, J. T., Koffler, S. P., Pliskin, N. H., ... Silver, C. H. (2005). Symptom validity assessment: Practice issues and medical necessity. Archives of Clinical Neuropsychology, 20, 419–426. Canadian Psychological Association (2016). The Canadian code of ethics for psychologists (fourth edition ). Ottawa, ON: Canadian Psychological Association. Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 113 S. Ct. 2786 (1993). DeMier, R. (2013). Forensic report writing. In R. K. Otto (Ed.), Forensic psychology (pp. 75–98) (2nd ed ). Hoboken, NJ: Wiley. Erard, R. (2016). If it walks like a duck: A case of confirmatory bias. Psychological Injury and Law, 9, 275–277. Federal Rules of Evidence. (2013). 28 U.S.C. §§ 101–1103. Federal Rules of Evidence. (2014). 28 U.S.C. §§ 101–1103. General Electric v. Joiner, 522 U.S. 136 (1997). Gold, L. H. (2013). Menstal health disability: A model for assessment. In L. H. Gold, & D. L. Vanderpool (Eds.), Clinical guide to mental disability evaluations (pp. 3–35). New York: Springer Science + Business Media. Gold, L. H., & Vanderpool, D. L. (2013). Clinical guide to mental disability evaluations. New York: Springer Science + Business Media. Gold, L. H., Anfang, S. A., Drukteinis, A. M., Metzner, J. L., Prince, M., Wall, B. W., ... Zonana, H. V. (2008). AAPL practice guideline for the forensic evaluation of psychiatric disability. Journal of the American Academy of Psychiatry and the Law, 36, S3–S50. Griffith, E. E. H., Stankovic, A., & Baranoski, M. V. (2011). Principles of writing: Writing a narrative. In A. Buchanan, & M. A. Norko (Eds.), The psychiatric report: principles and practice of forensic writing (pp. 68–80). New York: Cambridge University Press. Grisso, T. (1986). Evaluating competencies: Forensic assessments and instruments. New York: Plenum Press. Grisso, T. (2012, November). Forensic reporting writing. Continuing education workshop offered at the American Academy of Forensic Psychology Workshops, Las Vegas, Nevada.
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