Assessment in Forensic Psych

Forensic Report Writing Marc J. Ackerman Wisconsin School of Professional Psychology As the area of specialization of forensic psychology broadens its horizons, it will become increasingly more difficult for clinical psychologists to avoid participating in the forensic arena. As a result, clinical psychologists may be asked to write reports about therapeutic intervention or evaluations in divorce, personal injury, competency, abuse, or criminal proceedings. In this article, the author addresses the issues that the clinical psychologist needs to understand in writing reports that may be utilized in forensic settings. How these reports are affected by the American Psychological Association Ethics Code (APA; 2002), the audience receiving the report, the subject matter of the report, and dissemination of the information are all discussed in this article. © 2005 Wiley Periodicals, Inc. J Clin Psychol 62: 59–72, 2006.

Keywords: report writing; forensic; ethics In this article, I address issues for the forensic psychologist to consider when writing reports; this is not meant to be a theoretical or model-driven work. Most forensic psy- chologists who have been practicing for more then 20 years were initially trained as clinical psychologists; formal forensic psychology programs did not exist at that time.

Hence, they later acquired their forensic knowledge through a number of different means.

Furthermore, with the widespread impact of forensic psychology it is unlikely that a clinical psychologist will never have contact with the forensic world. Clinical psycholo- gists work therapeutically with children of divorce, divorcing or divorced couples, crim- inals postincarceration, victims of personal injury accidents, victims and perpetrators of all forms of maltreatment, and the geriatric population that may or may not be determined civilly incompetent, to name a few. In all of these areas, the clinical psychologist may be required to write a report or provide follow-up with important forensic implications.

The author would like to acknowledge Andrew Kane, PhD, Anthony Kuchan, PhD, Kathy Rusch, PhD, Ned Rubin, PsyD, Kathy Schoendorf, PsyD, and Ken Smail, PhD, for their help in preparing this article.

Correspondence concerning this article should be addressed to: Marc J. Ackerman, 5900 N. Port Washington Road, Suite #150, Milwaukee, WI 53217; e-mail: [email protected] JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 62(1), 59–72 (2006) © 2006 Wiley Periodicals, Inc.

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20200 A report is written as a process to convey information to the reader. In doing so, the writer must consider who is reading the report, the content that the report should discuss, and who is requesting that the report be written. When a forensic psychological evalua- tion is performed, the evaluator should not engage in the evaluation process until the evaluator is aware of what questions the referral source wishes to have answered. It is anticipated that the report will answer the questions that the referral source has asked.

The report can be written in a number of acceptable formats. There are certain types of information that must be included in the report. To assume that there is only one correct way, and all others are incorrect, does a disservice to the process. When writing the report, the report should be written in a manner that increases the likelihood that it will be read in its entirety. Furthermore, the writer should recognize that there is a dif- ference between written language and spoken language. When a report is too informal, it loses its appeal and its professional impact; it may be viewed as less credible by the reader.

As a treating clinical psychologist it may be necessary to include professional jargon in a report that may not be understood by the reader of the report in the forensic setting.

As a result, it is generally a good idea to define clinical terms in your report if it is to be utilized in a forensic setting.

Report Structure There are two basic forms that can be used when reporting results of a forensic evalua- tion. The first format would best be described as a test-by-test chronology, where the writer simply discusses each test, one at a time in the Test Results section, and reports on those results. The second approach is an integrated approach that addresses conceptual concerns about the individual’s functioning in a number of different realms and draws from various test results and collateral contacts to support those conceptual hypotheses being generated. Furthermore, a combination of these approaches can be utilized result- ing in a test-by-test chronology followed by a summary integration. The integrated approach provides a more readable report that can be more useful in the forensic setting.

Daubert Standard The 1993 Supreme Court case Daubert v. Merrill Dow Pharmaceuticals ( Daubert v. Mer- rill Dow, 1993) set a new standard for expert testimony and expert reporting. It replaced the Frye standard as put forth by the Supreme Court in 1923. As a result, the “junk science” contributions to expert testimony and reporting are supposed to be eliminated.

The Daubert standard states:

1. Is the hypothesis testable?

2. Has the test been peer reviewed?

3. Is an error rate available?

4. Is there general acceptance in the scientific community?

Not all states have adopted the Daubert standard as part of state law. It is essential to determine whether or not the state in which your practice is located is a Daubert state.

Regardless of whether or not your state is a Daubert state, I take the position that all forensic psychologists should act as if they are reporting or testifying under the Daubert standard. The basic message that should be taken from the Daubert standard is that it is no longer acceptable to say something is true based merely on anecdote or simply because it 60 Journal of Clinical Psychology, January 2006 Journal of Clinical PsychologyDOI 10.1002/jclp is the opinion of the expert. Although Kumho v Carmichael (1999) allows for testimony based on experience, it is still safest for a clinical psychologist writing a report to put nothingin it that cannot be supported by research or professional literature. Eventually everything clinical psychologists do will need to meet the Daubert standard or a facsimile of the Daubert standard.

Report Length There are basically three different report lengths that can be utilized when writing reports; they are brief reports, standard reports, and comprehensive reports.

Brief Forensic Reports Brief forensic reports, by definition, are relatively short. They will generally be one to three pages in length, and will only address the important issues in a superficial summary manner. Although short, the brief report should still include recommendations.

Standard Forensic Reports The standard forensic report is likely to be anywhere from 2 to 10 pages in length, depending upon the number of areas that need to be addressed. The standard report will detail background information, test results, and summary and conclusions, including the most relevant data needed to address the issues.

Comprehensive Forensic Report The comprehensive forensic report is written to include virtually every piece of relevant information without much editing or censoring on the part of the writer. One of the features that can be found in a comprehensive report is the actual quoting of research that supports the hypotheses or conclusions that the writer has presented. Although placing this information in the report may provide the opposing attorney questions for cross- examination, it is my belief that leading with strength and putting the information in the report is preferable. These reports can be as long as 30 to 50 pages. They become par- ticularly useful in the forensic arena when the writer is attempting to generate hypotheses that support the position that the clinician or evaluator has taken and reporting relevant research that acknowledges the validity of the hypotheses stated, and when extensive records need to be reviewed.

When an attorney cross-examines a psychologist about a report, the attorney will not only be interested in what is in the report, but what the psychologist has left out of the report. As a result, forensic psychologists must be prepared to defend why certain pieces of information were withheld from the report, especially if they would be considered important pieces of information.

Audience There are basically three different audiences who will receive forensic reports. They include mental health professionals, non-mental health professionals, and nonprofession- als. The mental health professions would include individuals with mental health train- ing across all mental health professions with the anticipation that the reader is going to Forensic Report 61 Journal of Clinical PsychologyDOI 10.1002/jclp understand the terminology and professional jargon associated with mental health reports.

The non-mental health professionals would include individuals who have professional training but in areas other than mental health, such as teachers, lawyers, judges, and other professional groups. Nonprofessionals would then include all other individuals, such as parents or the person being evaluated.

Mental Health Professionals Reports written exclusively for mental health professionals will need to include diagnos- tic labels, the use of mental health terminology, and the report of actual scores on the various tests that were administered. The assumption can be made by the writer that the terms will be understandable to the reader, and do not need to be defined.

Non-Mental Health Professionals It is generally advisable in writing reports to non-mental health professionals that actual scores and subtest names not be included as they would provide information that may not be understood or could be misused by the reader. Generic labels can be utilized, such as “the Inkblot Test” or “tests of cognitive functioning.” However, some non-mental health professionals are clearly knowledgeable about psychological testing. As a result, it may be acceptable in these cases to provide specialized language. Diagnostic considerations should also be included in these reports, along with relevant recommendations.

Harvey (this issue, 2006, pp. 5–18) argues that all clinical reports should be highly readable. However, the technical terminology and legal language that is required in foren- sic reports may make it necessary to include this information, and thus, make the report less readable to nonprofessionals. As a result, there would be a difference between what would be expected in a general clinical report and a forensic report.

Nonprofessionals A report to nonprofessionals should be carefully written, guaranteeing as much as pos- sible the likelihood that the report is not going to be misunderstood, misinterpreted, or misused. As a result, it is rarely appropriate to include test scores, subtest names, or test items in reports written to nonprofessionals. Diagnostic considerations should also be included only when there is sufficient explanation for the reader of what these diagnostic labels mean. Tests should be referred to in generic terms, such as “tests of cognitive functioning” and “tests of personality functioning.” One of the most difficult tasks in writing reports for forensic settings is when the writer recognizes that it is likely to be read by mental health professionals, non-mental health professionals, and nonprofessionals. It is clear, under these circumstances, that a balanced approach is most likely to be the safest. The report should be written to an audience of non-mental health professionals who do not have much sophistication in the mental health areas. Language describing tasks should be written in such terminology that a mental health professional would be able to recognize what is being addressed without actually giving the name of the test or subtest. For example, when talking about cognitive test results, a mental health professional is going to understand that describing the “general fund of knowledge” subtest refers to the information subtest, and the “prac- tical judgment” subtest refers to the comprehension subtest and so on.

62 Journal of Clinical Psychology, January 2006 Journal of Clinical PsychologyDOI 10.1002/jclp Diagnostic Considerations It is essential for the report writer to understand the standard of practice in his or her jurisdiction. Many forensic psychologists take the position that a diagnostic impression or considerations section of a report has no place in a forensic psychology report. They state that diagnostic considerations are reserved for clinical reports and not forensic reports.

Furthermore, the type of testing administered in a forensic report may not lead to provide sufficient information to result in a diagnosis.

Ethical Considerations The American Psychological Association Ethical Principles of Psychologists and Code of Conduct (2002) deals exclusively with the concept of privacy and confidentiality. You should be familiar with sections 4.01 through 4.07 which discuss confidentiality issues in detail (APA, 2002, pp. 1066–1067).

Discussions have addressed the concept of exceptions in confidentiality as it relates to traditional report writing. In a forensic case, the subject must be instructed that the results of the evaluation arenotconfidential and will be disseminated to a number of different sources. If this is indeed the case, the report should reflect that this information has been conveyed to the subject.

Many psychologists choose to state at the beginning of their report that the informa- tion is considered to be confidential and should not be disseminated to other individuals without written permission. Some authors simply state “confidential” or “privileged” information at the top of the report, while other authors will have an entire paragraph, which states the statutory requirements of their state regarding the concept of confidentiality.

The APA recognizes that any time a report is written, even with a waiver of confi- dentiality, there is an intrusion into the individual’s privacy. As a result, the report should only include information that is germane to the purpose for doing the evaluation in the first place. Superfluous information should be avoided along with potentially damaging information that is not relevant to the topic at hand. Gratuitous recommendations, those that address issues not requested as part of the evaluation, are unwelcome.

Maintenance of Records From section 6.0, Maintenance of Records of theAmerican Psychological Association Ethical Principles of Psychologists and Code of Conduct(2002): Psychologists maintain confidentiality in creating, storing, accessing, transferring, and dispos- ing of records under their control, whether these are written, automated, or in any other medium.

Psychologists maintain and dispose of records in accordance with law and in a manner that permits compliance with the requirements of this Ethics Code. ( p. 1068) The American Psychological Association has developed record-keeping guidelines (APA, 1993). The guidelines adopted in 1993, state that a complete record must be kept for 3 years after the last contact with the client, followed by keeping a complete record or a summary for another 12 years. When minor children are involved, the records must be kept for 3 years after the child reaches the age of full legal age. One of the most efficient ways of keeping a summary of the record between years 3 and 12 would be to keep the report itself. If a standard or comprehensive report has been written, it most likely will not be necessary to keep any other information in the chart beyond year three to remain in compliance with the APA Record Keeping Guidelines. Forensic Report 63 Journal of Clinical PsychologyDOI 10.1002/jclp A recent publication from the American Psychological Association (Benjamin & Gollan, 2003) advocates a number of professional practices that are contraindicated by state laws, the American Psychological Association Code of Ethics, and standards of practice. Even though the text is published by psychologists’ parent organization, it is considered bad practice to follow some of the recommendations that Benjamin and Gol- lan (2003) support, including their suggestions of destroying documentation that forms the basis of portions of the report. This is a dangerous practice that could lead to lawsuits or disqualification of a report or a witness.

There will be times that psychologists are allowed to disseminate confidential infor- mation with the written consent of the individual if mandated by law. The two most- obvious circumstances in which this may be the case would be in child or elderly abuse reporting and duty or warn and protect-type situations.

Protection of Test Integrity Much has been written in recent years about protection of test integrity. It is the forensic setting in which this tends to become the greatest problem. Clinical psychologists writing reports for the forensic setting need to be familiar with the subtle nuances associated with this issue (see also Groth-Marnat & Horvath, this issue, 2006, pp. 73–81; Michaels, this issue, 2006, pp. 47–58). However, due to copyright laws, the APA Code, and contracts signed with test publishers, disseminating information that would compromise the test integrity can cause both legal and ethical problems for the examiner.

Release of Test Data Section 9.04, Release of Test Data of the 2002 APA Code states:

The termtest datarefers to raw and scale scores, client/patient responses to test questions or stimuli, and psychologists’ notes and recordings concerning client/patient statements and behav- ior during an examination. Those portions of test materials that include client/patient responses are included in the definition oftest data. Pursuant to a client/patient release, psychologists providetest datato the client/patient or other persons identified in the release. Psychologists may refrain from releasing test data to protect a client/patient or others from substantial harm or misuse or misrepresentation of the data or the test, recognizing that in many instances release of confidential information under these circumstances is regulated by law. ( p. 1069) Maintaining Test Security Section 9.11, Maintaining Test Security of the 2002 APA Code states: The termtest materialsrefers to manuals, instruments, protocols, and test questions or stimuli and does not includetest dataas defined by Standard 9.04, Release Test Data. Psychologists make reasonable efforts to maintain the integrity and security oftest materialsand other assessment techniques consistent with law and contractual obligations, and in a manner that permits adherence to this Ethics Code. ( p. 1069) To include these materials in a report could result as copyright law violations.

Based on what the 2002 Code tells us, there is no room in any forensic report for the inclusion oftest dataortest materials as defined by the Code. The only time that test data should be included in a report is if it is going to be read exclusively by mental health professionals. Otherwise, it may be a violation of sections 9.04 and 9.11 especially because 64 Journal of Clinical Psychology, January 2006 Journal of Clinical PsychologyDOI 10.1002/jclp non-mental health professionals and the general public are likely to misuse or misrepre- sent the data or the test.

Data One of the basic tenets of psychological assessment is to collect data for decision making.

However, once the data have been collected, it is up to the writer of the report to deal with the data appropriately. Many of the issues about data are addressed in the 2002 APA Code. It is noted that for an adequate report to be written, there is a need for data to be collected. Many sources of data can be included in this process, such as psychological tests, interviews, or collateral records (school, medical, criminal, legal). Not only is it necessary for the psychologist to obtain as much data as needed to render the appropriate recommendations, but it is also essential that this be done as parsimoniously as possible.

The extensive use of collateral contacts and collateral records is unique to forensic report- ing. Most often, a clinical evaluation will not require the necessity of collateral inter- views. However, a forensic evaluation typically places heavy reliance on such contacts.

Requirement to Report All the Data Once the data have been collected, it is essential for the writer of the report to include all of the relevant information whether it supports the writer’s ultimate hypotheses and rec- ommendations or not. For a psychologist only to include those pieces of information that supports the position taken or the ultimate recommendations to be made subjects the psychologist to a claim of bias. This is referred to as confirmatory bias or confirmatory distortion. Unfortunately, there are many situations where psychologists inadvertently or unknowingly become biased. In the forensic setting, bias can be demonstrated when an individual is being asked to write a report for one side or the other. For example, reports have been seen where a psychologist will describe one parent’s Minnesota Multiphasic Personality Inventory-2 ( MMPI-2) profile as being marginally valid and the other parent’s MMPI-2 profile as being invalid, when the L, F, and K scores are essentially the same.

Confirmatory bias is more difficult for a clinical psychologist to avoid than for a forensic psychologist. Often the clinical psychologist will be a therapist and thus serving as an advocate for the client or patient. Therefore, it is likely that the clinical psychologist will write the report from the perspective of supporting the outcome of what the client or patient desires. Even though this may not originally have been a forensic report, it may end up being used in a forensic setting. The clinical psychologist is likely to only have met with one person in a multi-person legal case, hence, the writer must qualify any recommendations with the understanding that not everyone has been seen or every voice heard on a particular issue.

Not all biases are negative biases. It is important for the forensic report writer to recognize his or her biases and acknowledge them as such. For example, a forensic psy- chologist may be biased against 50/50 placement schedules or overnight visitations for children under one year of age. If such a bias is recognized, the report writer should acknowledge it in the body of the report.

Computer-Generated Reports Computer-generated reports proliferated in the last decade. The pioneers in the use of computer-generated reports were National Computer Scoring (now Pearson Min- Forensic Report 65 Journal of Clinical PsychologyDOI 10.1002/jclp netonna, MN ) and The Caldwell Report (an MMPI-2 report) utilized with the MMPI and later the MMPI-2. However, dozens of tests now include the availability of computer scoring and computer interpretation. Some of the most widely used computer-generated information comes from the MMPI-2, Exner’s Rorschach Interpretation Assistance Program ( RIAP-5), and the various Wechsler Scales. Unfortunately, the value derived from these computer-generated reports is often overshadowed by the misuse of the infor- mation contained therein. Too many psychologists merely lift paragraph-by-paragraph information contained in the computer-generated reports and include them in their own reports even though cautions are given by the developers of these computerized reports (see Groth-Marnat & Horvath, this issue, 2006, pp. 73–81). A representative example of this is the caution generated on the MMPI-2 report, which states: This MMPI-2 interpretation can serve as a useful source of hypotheses about clients. This report is based on objectively derived scale indices and scale interpretations that have been developed in diverse groups of patients. The personality descriptions, inferences, and recom- mendations contained herein need to be verified by other sources of clinical information because individual clients may not fully match the prototype. The information in this report should most appropriately be used by a trained, qualified test interpreter. The information contained in this report should be considered confidential.

Furthermore, psychologists, when lifting this information from the computer- generated reports, rarely quote or reference the computer-generated report as the source of the information, which could thus be considered plagiarism. When this occurs, there is a lack of understanding on the part of the psychologist that this information is to be utilized to generate hypotheses at the discretion of the evaluator, and not to serve as the exclusive report itself. The computer-generated report should not be used as a substitute for clinical expertise. Furthermore, the 2002 APA Code addresses this issue in section 9.09. Those who support this argument would state that because we do not know what the cut-off scores used to generate stem statements in the computerized report, we do not have sufficient knowledge to know whether to support that statement or not. Pearson or other similar companies are not likely to share this information, which may be considered a trade secret or proprietary information.

The Basic Forensic Report Report Heading The report heading should identify the basic demographic information necessary. At min- imum, the subject’s name, birth date, and date (s) tested should be included. Some indi- viduals also like to include the address, name, or names of parents (when the child is a minor), and other relevant demographic information. This can be placed in the upper left-hand corner or upper right hand corner of the first page of the report. It is just below or just next to the heading of the report that a confidentiality statement would go if needed. The statement could be as simple as typing in capital letters “ PRIVILEGED AND CONFIDENTIAL” or involved as including a fully stamped paragraph that out- lines the federal or state confidentiality laws, identifying the relevant information and the law by number.

Reason for Referral The most important component of the psychological evaluation and report is the reason for referral. No evaluation can be performed if the psychologist does not know why the 66 Journal of Clinical Psychology, January 2006 Journal of Clinical PsychologyDOI 10.1002/jclp referral has been made, no questions can be answered, and therefore, no report can be written. As a result, this section should start out with text “Sally Smith was referred for a complete psychological evaluation by the Honorable John T. Smith for the purpose of determining whether she was competent to stand trial or not.” The report should also begin with a statement to the effect of “As a psychologist duly licensed to practice in the State of ________, I do hereby certify that I evaluated the above name individual at the request of the Honorable John T. Smith. Furthermore, any opinions generated in this report are done so to a reasonable degree of psychological certainty.” Also, the questions that the referral source wished to have answered should be included in the reason for referral section.

Background Information This section can vary considerably based on whether the examiner is writing a brief report, standard report, or comprehensive report. The background information section could be anywhere from a few lines to up to 30 pages in length.

A comprehensive report would detail background information, including every facet of an individual’s life from when they were born until the time of the evaluation. There- fore, if the evaluation was being performed on an adult, the comprehensive report would include (a) developmental history; (b) school history including elementary school, mid- dle school, high school, college, and postgraduate education; (c) medical history includ- ing any unusual illnesses, the treatment and results of those illnesses; (d) work-related history including all of the related jobs that the individual has had throughout his or her life; (e) military history, if relevant; problems with the law, including charges, arrests, convictions, time served, probation; (f ) substance abuse history, if relevant; (g) counsel- ing or therapy history, if relevant, including diagnosis (es), therapists, medications used (if relevant) particularly those taken that day, outcome of treatment, time span within treatment occurred; and (h) relationship history, including boyfriends and girlfriends, fiancés, marriage (s), divorce (s), extramarital relationships, relationships with family mem- bers, including parents, siblings, and children.

Interview and Collateral Contacts This section of the report should include relevant interview material as it pertains to the referral question, such as: “Who should receive placement of the children?; What were the psychological injuries that resulted from the automobile accident?; Is the individual malingering?; Is the individual not guilty by reason of insanity?; Is the individual com- petent to stand trial?” Information obtained from collateral sources is also included in this section. The results of reviewing mental health records, legal records, court records, school records, child protective services records, hospital records, therapy records, and other relevant records are included in this section. It is safest for the psychologist not to include any information in a report that cannot be collaborated by an outside source. If not, the report should state that the information comes only from the reporter.

Reporting Test Results When reporting MMPI-2 or MCMI-III ( Millon Clinical Multiaxial Inventor) results, a statement (s) should be made about validity scale profiles and the clinical scale profiles.

With the MMPI-2, supplementary scales and content scales should also be reported. Forensic Report 67 Journal of Clinical PsychologyDOI 10.1002/jclp These can be discussed by scale names or the content that the scale is designed to mea- sure. For example, “ The MMPI-2 was administered in an effort to measure Sally’s level of personality functioning. The validity scale profile indicated that she did not attempt to portray herself in a highly favorable or unfavorable light. As a result, this is considered to be a valid indicator of her personality functioning,” or “the validity scale profile indicated that George attempted to portray himself in a highly favorable light, thus reducing the validity of the clinical and content scales. Therefore, these results may be an underesti- mate of psychological problems.” From this point, a discussion about the clinical scales would follow. The clinical scales can be identified by name, scale number, or what they are designed to measure. For example, Scale 1/Hypochondriasis Scale/Concerns about Bodily Functions. Each of the subtests of the MCMI-II or III or the remaining content and supplementary scales of the MMPI-2 can be similarly described.

When the MMPI-2 is administered there are generally critical questions that are answered in the scorable direction that are referred to as “critical items.” It is essential that the forensic examiner interview the individual about why these critical items were answered in the scorable direction in an effort to determine the extent of pathology rep- resented by these answers. It is also essential for the examiner to recognize that this serves as a personalized structured interview. Because it is an integral part of understand- ing what is occurring with the examinee, the results of the critical item interview should be included in this section of the report. However, in doing so, the examiner cannot include the actual test items in the report because this would be a breach of copyright laws. A general narrative about the content and responses of the critical items is sufficient.

The results of a Rorschach test should be scored formally according to the Exner system if it is likely to survive a Daubert challenge to admissibility in court. The Exner results should be reported from the most important to the least important based on how they are presented. For example, if the Rorschach test is not scored, a content analysis can be reported, such as Sally was guarded in her presentation on the Rorschach test and demonstrated difficulty deal- ing with her emotions. Thus, the writer must know if he or she is practicing in a Daubert state.

Furthermore, whenever she appeared to be losing emotional control, she was able to recover quickly. Indications of depression and anxiety could be found in the responses and must be addressed in any type of therapeutic intervention that is utilized, with the understanding that a current analysis may not survive a Daubert cross-examination in a Daubert state. Thus, the writer must know if he or she is practicing in a Daubert state. Diagnostic Impressions Although as mentioned earlier, it may be ill advised to include a diagnostic impression section, if one is included this section of the report should include at least Axis I and Axis II diagnoses according to the American Psychiatric Association’sDiagnostic and Statis- tical Manual of Mental Disorders(American Psychiatric Association, 2000). When report- ing a Axis V diagnosis, it may be necessary to indicate that certain Axes are deferred, especially Axis III, because the examiner may not have sufficient information.

Abuse Allegations Abuse allegations, sometimes referred to as maltreatment, include physical abuse, sexual abuse, psychological abuse, and domestic violence. The same sexual abuse case could be heard in family court as part of a divorce case, criminal court as a result of criminal 68 Journal of Clinical Psychology, January 2006 Journal of Clinical PsychologyDOI 10.1002/jclp charges for the sexual abuse, juvenile court if a protective petition has been filed, and/or personal injury court if a suit has been filed regarding damages. As a result, the report writer in abuse allegation cases is unlikely to be able to write a report that meets the criteria in all four of these courts when circumstances dictate. Therefore, it may be nec- essary to modify the original report to meet the statutory requirements necessary for the particular court hearing the case. The different courts also have different standards that need to be addressed. Family court operates under the “best interest standard”; criminal court operates under the “reasonable doubt standard”; and civil court operates under the “preponderance of evidence standard.” The writer of the report must also take the stan- dard of evidence necessary in each court into consideration when writing a forensic report.

The recommendations of a report that deals with maltreatment must address the issues relevant specifically to the abuse case, such as (a) Should there be contact between the alleged perpetrator and alleged victim?; (b) Is supervision necessary? If so, under what circumstances?; (c) Who will be the oversight agency or individual to make sure that court orders are complied with?; and (d) What review procedure should be instituted?

Ultimate Issue The ultimate issue in a particular case is the issue that the court is attempting to answer.

Examples are who should have placement of the children; was the defendant lying or not; did the abuse occur. Although there is not a separate heading in the report for “ultimate issue,” the ultimate issue should be addressed in the summary or conclusions section of the report. Based on rules of evidence, certain courts allow or expect forensic psychol- ogists to address the ultimate issue in testimony or in the report, while other courts by statutes or practice forbid psychologists to address the ultimate issue. It is essential for the clinical psychologist writing a report for a forensic setting to know what the statutory requirements are for a particular court. In criminal court, for example, the expectation is that the trier of fact (the judge or jury) will address the ultimate issue. Numerous surveys have demonstrated that approximately 75% of psychologists believe that psychologists should address the ultimate issue (Ackerman, Ackerman, Steffen, & Kelly-Poulos, 2004; Bow & Quinnell, 2001). There is a vocal minority that believes psychologists should not address the ultimate issue, but it must be remembered that they still represent a minority ( Melton, Petrila, Poythress, & Slobogin, 1997).

It is helpful to the reader to recommend specific therapists when therapy is recom- mended. Therapists–problem matching is difficult for the layperson to do. However, in certain cases, it is appropriate not to mention just one individual’s name in making rec- ommendations. To avoid the appearance of impropriety, it may be advantageous to list two or three possible recommendations of individuals who provide the type of service requested.

Signature The signature of the report should include the writer’s full name and relevant degree, as represented by the highest degree achieved. The name should not be listed as George Smith, BA, MS, PhD, but instead, George Smith, PhD. If an individual has a ABPP, that should also be included, as an ABPP or described as a diplomate in clinical psychology/ forensic psychology. Individuals may also list themselves as a licensed psychologist or a clinical psychologist or a school psychologist, but should avoid calling themselves a Forensic Report 69 Journal of Clinical PsychologyDOI 10.1002/jclp licensed clinical psychologist if their state provides only a generic license. If the state does license specialty area, identifying one’s self as a licensed clinical psychologist, licensed school psychologist, or licensed forensic psychologist would be appropriate.

Certifications can also be included following the signature, such as certified school psy- chologist, certified alcohol and drug counselor. Listing oneself as a member of the National Register of Health Service Providers in Psychology is also appropriate.

It is, however, inappropriate to identify oneself by credentials that are basically “pur- chased credentials” that require no test, specific course work, or certification to obtain the credential.

Special Considerations Civil Reports Civil forensic psychology includes, among other things, divorce cases, personal injury cases, and civil commitment cases. There are special considerations that need to be addressed in each of these areas.

Custody Cases.When the examiner writes a report in divorce cases, a separate report can be written for each individual separately evaluated, or a comprehensive report that includes sections of all of the parties. When separate reports are written, it is easier to share information when releases are sent at a later date without having to redact portions of the report that do not apply to the individual about whom the release was received (Ackerman, 2001; Gould, 1998). Furthermore, this procedure helps guard against dis- semination of information to people who should not have access to information. The recommendations section of the report should address custody, placement, vacation sched- ules, the need for therapy if necessary, and special considerations. The special consider- ations could involve whether supervised placement is necessary or not, how to deal with sexual–physical abuse allegations that may have been made, what to do with drug and alcohol concerns that may have been raised, and the need for postjudgment coparenting counseling for the parties.

There are several factors that need to be kept in mind in writing a custody evaluation report. The writer should (a) avoid overpathologizing, (b) should write the report from a problem-solving perspective and not make things worse for the case, (c) should make recommendations that are practical and not “perfect world recommendations,” and (d) should state the rationale supported by research and literature that support the recom- mendations made.

When mediation occurs in divorce cases, a different type of a report is written. Gen- erally, the mediator would indicate what issues had been agreed upon by the parties. A copy of this “memo” would be sent to the parties and/or their attorneys. It is recommended that this documentnotbe signed by any of the parties because it is not a legally binding docu- ment. However, the attorneys can convert the memo into “legalese.” This document can be signed by the parties and entered into as a stipulation in court. Many states have laws that prohibit discovery of the content of mediation sessions, only the outcome.

Personal Injury Cases.There are factors in personal injury cases that do not exist in other cases. One of the most important variables to be considered is the secondary gain that the litigant may derive from a successful personal injury case. As a result, every personal injury evaluation should address the issue of possible malingering or symptom exaggeration. Each personal injury report should have a section that addresses the issue 70 Journal of Clinical Psychology, January 2006 Journal of Clinical PsychologyDOI 10.1002/jclp of malingering with the author presenting solid information as to whether or not it is likely that the litigant has malingered or feigned problems as part of the evaluation process.

Quality of life is another important issue in personal injury cases. The examiner should include a section in the report that compares the individuals premorbid quality of life with the current quality of life. Prognostic statements should be made about the likely extent of recovery from psychological problems associated with the personal injury, the likely cost of any treatment associated with the personal injury, and if necessary what type of therapy would be beneficial.

Civil Commitment Cases.A report that is written about civil commitment or civil competency should address (a) the person’s diagnosis and prognosis, (b) the individual’s capacity to care for himself or herself regarding the activities of daily living, (c) the individual’s capacity to care for property ( personal property, money, real estate), (d) the person’s ability to understand the rationale behind choices and to communicate these effectively, (e) any other factors that may affect an individual’s ability to make voluntary decisions, and (f ) whether or not they are a danger to themselves or others.

Criminal Cases.The three most likely reports written in the criminal forensic psy- chology arena involve not guilty by reason of insanity ( NGI), competency to stand trial, or waiver to adult court. It is important to understand that “insanity” is not a mental health term, but is a legal term. As a result, it is entirely possible that an individual could be diagnosed with serious mental health problems, but not meet a state’s criteria for “not guilty by reason of insanity” or incompetence regarding ability to stand trial. In insanity, competency, or waiver reports, it is essential that the writer indicate what state standards, state laws, or state regulations were used to guide the examiner in making a determina- tion. The examiner must also look for the definition in his or her state of mental disease or defect. Furthermore, it is important for the writer to know who shall and shall not receive the report by state statute. Some states also have the statutes that specifically identify categories that are to be addressed in the report itself.

All four of these types of reports involve addressing the defendant’s ability; hence, it is essential that the writer indicate how informed consent was achieved. The questions that were asked and the answers given by the defendant during the insanity interview, competency interview, and waiver interview that are relevant to the ultimate issue should be included in the report. However, unsolicited information should not be shared. For example, if the forensic psychologist is writing a not guilty by reason of insanity report, information about competency to stand trial should not be included.

Summary In summary, a forensic psychology report should be long enough to cover the information necessary, but not so long that the reader is not likely to read it. All conclusions made in the report should be supported by research literature, data, or collateral contacts and quoted if necessary. The ultimate issue should be addressed in the conclusion of the report. It should also be written at the level that is commensurate with who the reader is likely to be.

Clinical psychologists will be called upon to write reports that will be utilized in various forensic settings on an ever-increasing basis. As a result, it is important for the writer to know the audience, know the relevant legal issues to be addressed, and under- Forensic Report 71 Journal of Clinical PsychologyDOI 10.1002/jclp stand the nuances that would apply to forensic report writing that may not apply to general clinical report writing.

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