PSYCHIATRISTS, PSYCHOLOGISTS, & SOCIAL WORKERS

Evaluating
Can I perform a forensic evaluation on a patient I am treating?
How is forensic evaluation different from clinical evaluation?
What questions should I ask during a forensic examination?
Consider malingering and minimization!

Writing
How are forensic reports different from clinical reports?
How can I write an effective forensic report?

Testifying
Remember your role in court!
Be prepared!
Your testimony starts with your report.

Coaching
What is forensic report coaching?
How does forensic coaching work?
Do I have to reveal that I received coaching?
How do I start?

Templates
How to use report templates.

Can I perform a forensic evaluation on a patient I am treating?

The first question to consider, when you are asked to evaluate a patient for legal purposes, is whether you can ethically perform the service. Many attorneys do not realize that clinical and forensic roles conflict and that clinicians generally should not render legal opinions on their own patients. When you perform a forensic evaluation, you must serve the interests of justice rather than the interests of your patient, and you must approach the evaluation with a degree of objectivity and skepticism that is not customary in clinical care.

If an attorney asks you for a legal opinion on your own patient, you should suggest that he or she hire an independent forensic psychiatrist or psychologist instead. You can steer the attorney in the right direction while demonstrating your ethics and familiarity with the forensic process so that the attorney considers retaining you on future cases.

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How is forensic evaluation different from clinical evaluation?

A forensic evaluation is focused on answering a legal question and may not be as expansive as a general clinical interview. Forensic examinations may last only one to several hours, in contrast to clinical evaluations that may take place over weeks of observation. You will probably spend more time reviewing records and writing your report than you spend interviewing the subject. On the other hand, your interview may delve deeply into areas that are pertinent to the legal question (such as intent and capacity) but that are typically not explored in clinical care.

You should always start the forensic evaluation by informing the subject of the purpose of the examination and limits to confidentiality. You should stress that you are a doctor by profession but have been hired to perform an independent evaluation to answer a legal question, not to provide medical or psychological treatment.

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What questions should I ask during a forensic examination?

A forensic examination, similar to a clinical examination, should start with an exploration of the subject’s chief complaint, history, and mental status. I recommend you print out an interview template like the one I use to make sure you cover all important areas and have clear documentation in the event that your notes are entered into evidence.

Each legal issue will require a different line of questioning. For example, if the issue is competency to stand trial, you will ask the defendant about his charge, maximum sentence, roles of court personnel, and potential defense strategies. These questions would be irrelevant if the issue were insanity or guardianship. You can study the specific report template for your legal issue and note what sort of information needs to be gathered and incorporated into the report. You may also want to review other references pertinent to your legal issue.

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Consider malingering and minimization!

One sign of an inexperienced forensic evaluation is a report that takes the subject’s account entirely at face value. The possibility of malingering needs to be considered in nearly every forensic evaluation. Most defendants and most plaintiffs in disability or emotional harm cases have some inherent motivation to exaggerate or fake mental illness in order to reduce punishment or maximize damages. On the other hand, subjects of civil commitment and involuntary treatment proceedings are inherently motivated to minimize mental illness. Your interview must explore the clinical credibility of the subject’s report as well as any discrepancies compared to other sources of evidence. Keep in mind that some degree of malingering may exist alongside genuine illness, and you may need to sort out the relative contribution of each.

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How are forensic reports different from clinical reports?

Forensic reports are analogous to clinical reports in organization, with sections corresponding to the history of present illness, history, course of treatment, mental status examination, diagnostic tests, diagnosis, and formulation. Forensic reports differ from clinical reports primarily in that the intended audience is composed of laypersons -- judges, juries, and attorneys -- rather than other clinicians.

Because the audience for your report has no medical or psychiatric knowledge, you should not use professional jargon without defining what the terms mean. And the clinical significance of your observations will not be obvious unless you explain it. Whereas clinical documentation is often sloppy and full of abbreviations, forensic reports should be written clearly and in proper English to make a good impression and avoid obfuscation.

Forensic reports also differ from clinical reports in their conclusions. Clinical reports culminate in treatment recommendations; forensic reports culminate in a legal opinion. The forensic opinion is formed by applying your clinical formulation to the legal question at hand. You will need to understand and bridge the gap between clinical concepts (symptoms and disorders) and legal concepts (insanity, incompetence, disability).

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How can I write an effective forensic report?

A forensic report is well-written if it clearly communicates your findings. A well-written and convincing report may lead to the satisfactory resolution of a case without further deposition or testimony on your part.

The skill of forensic report writing can be taught and mastered. You can begin to learn to write forensic reports by using the templates below and studying my forensic report writing tips. I have also listed a number of other report writing resources. You can also contact me for coaching on a particular report and apply what you learn to future cases, with or without my assistance.

Download forensic report writing tips (PDF 6384 KB)

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Remember your role in court!

Most clinicians are terrified the first time they are called to testify in court. Nothing in your clinical training prepares you for the adversarial setting of the courtroom, where your communication skills, clinical judgment, and reasoning are tested under fire in front of a neutral, but skeptical, judge or jury.

To survive the ordeal, you need to remind yourself that you are in the courtroom to assist the judge and jury understand psychiatric elements of the case, not to help one side or the other win. In fact, I recommend that you turn and address your answers to the judge or jury rather than responding directly to the attorneys when you testify. You are a consultant who has expert information to share, not an agent trying to impress one side or the other. You should answer questions respectfully and informatively on cross-examination, just as you do on direct. You do not want to appear defensive and biased. Keep in mind that even the process of cross-examination is intended to help the court understand your opinion, not to undermine your integrity.

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Be prepared!

To perform well in court, you need to be prepared. If you have already written a comprehensive forensic report, you can take it to the stand, but you should refresh your memory before you testify and be able to give your diagnosis and other basic facts without having to turn and fumble through your report. You should also be aware of any additional information that has come up since you first evaluated the subject, such as intervening opinions by other experts.

The attorney who has retained you will usually want to “prep” with you before you appear in court. The attorney will tell you what questions he or she is likely to ask and will want to know how you are likely to answer. If the attorney has made incorrect assumptions about your testimony, this is the time to clarify your position, so that he or she is not surprised by your answers on the stand. You and the attorney may also try to anticipate what questions the opposing attorney is likely to ask during cross-examination, so they do not take you off guard.

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Your testimony starts with your report.

The best way to prepare for court is to write a clear and convincing forensic report. In fact, if your opinion is well-expressed, without omissions or inconsistencies, then the case may be resolved without further testimony.

I can review and coach you on a particular forensic report, with an eye towards presenting a strong case for eventual testimony. You should also explore the other testifying resources that I recommend.

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What is forensic report coaching?

The best way to learn a new skill is to be trained by an expert. If you are in fellowship (or internship) training, you are fortunate to have supervisors and mentors who review your work and foster your skills. But many clinicians without such training wish to expand their practice into the forensic arena. Forensic coaching provides you the opportunity to receive expert feedback from an experienced academic forensic psychiatrist so that you can create a convincing forensic report, gain confidence in forensic evaluation, and develop your professional skills in an exciting new direction.

Though I am a psychiatrist, I have trained many psychologists and social workers to write forensic reports. The principles are the same.

Even experienced forensic evaluators can benefit from report supervision, particularly in challenging cases. Coaching on a particular case may help you to clarify your reasoning, perfect your style, and identify unexpected vulnerabilities.

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How does forensic coaching work?

Forensic reports should be able to stand on their own. They contain within them all the data necessary to justify your opinion. Because forensic reports are so comprehensive, I can evaluate your report on its own merits without having access to the other evidence you have relied on and without being present for the examination of the subject. I have reviewed thousands of forensic reports in this fashion over more than ten years, and I can quickly spot discrepancies, missing information, and potentially confusing language. I can suggest ways you can strengthen your argument, sometimes by acknowledging the limitations of your opinion or the alternative explanations you have considered.

I supervise reports via the internet using the editing tools within word-processing software. I can make editorial changes and comments for you to consider and then accept or reject. I can also review reports in hard copy, making editorial suggestions by hand, but this is less efficient. I have been through this process of editorial supervision myself, as a book author and writer of forensic reports. It is easy and effective and can have a dramatic effect on the quality of your final product: a clear and convincingly-argued forensic report.

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Do I have to reveal that I received coaching?

Forensic coaching is a form of indirect supervision, in that I have no direct involvement in the case and no responsibility for your opinion. The report remains your own, and no one needs to know that you have received coaching, unless you are asked on cross-examination. I am not aware of anyone else who offers forensic coaching services, so I think such a question would be highly unlikely, and it could be answered unapologetically. Seeking feedback from a colleague is rightly considered a sign of diligence rather than weakness.

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How do I start?

You can begin to improve your forensic skills immediately by utilizing the resources on this web site. Download a forensic report template and my forensic report writing tips.

If you want Dr. Hicks to review your forensic report, please use the instructions in the "Word editing tools" tip sheet and send the report to the e-mail address below, after removing identifying information. Dr. Hicks will respond as quickly as possible with the cost to review your report. The cost may vary based on the length of the report, the extent of editing needed, and the format (a PDF scan is the most difficult to review, a report written using one of Dr. Hicks’ Word templates is the easiest). Payment can be made easily using Pay Pal link in the sidebar.

DrHicks@forensicmind.com

Download tips for using Word editing tools (PDF 75 KB)

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How to use report templates.

The following templates are in Word format. I have kept formatting to a minimum so that the templates are easy to use and the resulting report easy to read. I have inserted instructional comments into the templates to provide some initial guidance, and you should also review my forensic report writing tips. You can open and save these templates in other word-processing formats if you wish, but Word has easy-to-use editing tools that allow me to review your report and make suggestions, should you decide to receive forensic coaching.

If you wish to use a clean template, you can delete the instructional comments by clicking on the icon with the red X in the “reviewing” task pane and selecting “delete all comments in document.”

Templates available for download:

Criminal
Responsibility

Involuntary Committment

Personal
Injury

Disability

Guardianship

Sample
Contract

           

Fitness to
Stand Trial

Involuntary Treatment

Medical
Malpractice

Wills

Interview
Template

Sample
Report

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