Table 1

Principles of Forensic Mental Health Assessment Adjusted for Pandemic Eraa

Current Principles (n = 39)Principle Adjustments in Pandemic Era (n = 25)
    Be aware of the important differences between clinical and forensic domains.Well-accepted differences between these domains may blur in a pandemic era.
    Obtain appropriate education, training, and experience in one's area of forensic specialization.Need to become capable in communication technology in addition to substantive expertise.
    Be familiar with the relevant legal, ethics, scientific, and practice literatures pertaining to FMHA.The literature may change in multiple ways as a function of social distancing.
Check licensure and other regulations on practice across states, considering state of evaluator and state of evaluee.
    Be guided by honesty and strive for impartiality, actively disclosing the limitations of, as well as the support for, one's opinions.No change.
    Control potential evaluator bias in general through monitoring case selection, continuing education, and consultation with knowledgeable colleagues.Evaluator perceptions regarding the pandemic may affect recommendations (e.g., placement of individual).
    Be familiar with specific aspects of the legal system, particularly communication, discovery, deposition, and testimony.Add needed familiarity with technology, particularly communications technology.
Guidance regarding practice may differ between jurisdictions regarding social distancing and remote evaluation.
Keep current with pandemic-related changes to justice system (e.g., delays, release of minor offenders or pretrial defendants, changing rules at facilities).
    Do not become adversarial, but present and defend your opinions effectively.No change.
        Identify relevant forensic questions.No change.
        Accept referrals only within area of expertise.Need for content expertise may be expanded to include communications expertise, including how to communicate effectively and securely with remote technology, and the impact of remote vs. in-person communication.
        Decline the referral when evaluator impartiality is unlikely.Possible evaluator bias associated with secure placement in pandemic era.
Inability to detect subtle behavioral cues over teleconference.
Possible evaluator bias if remote technology interferes with ability to see relevant aspects of evaluees' lives.
        Clarify the evaluator's role with the attorney.No change.
        Clarify financial arrangements.There could be changes in some financial costs, particularly with expenses (technology-assisted versus mileage, waiting time).
        Obtain appropriate authorization.There may be changes in authorization involving who is admitted to secure facilities and how.
        Avoid playing the dual roles of therapist and forensic evaluator.No change.
        Determine the particular role to be played within forensic assessment if the referral is accepted.No change.
        Select the most appropriate model to guide data gathering, interpretation, and communication.Model may need revision to incorporate communication during evaluations for remotely conducted FMHA, including how information is communicated (in-person, remotely) and what is communicated (words, behavior, body language).
    Data Collection
        Use multiple sources of information for each area being assessed; review the available background information and actively seek important missing elements.Collateral interviews may more often incorporate videoconferencing.
Psychological testing might be more limited or completely unavailable.
        Use relevance and reliability (validity) as guides for seeking information and selecting data sources.Major implications: psychological tests, specialized measures, and other structured information-gathering guides will need validation research on remote administration.
Tests requiring in-person manipulation of materials will not be useful unless adapted for remote administration.
        Obtain relevant historical information.No change.
        Assess clinical characteristics in relevant, reliable, and valid ways.See above for using testing.
Also consider the scientific evidence on gathering clinical interview information in person versus remotely. Remote may be perceived as less secure.
Technological problems (freezing, skipping) may interfere with accurate appraisal.
        Assess legally relevant behavior.Consider the scientific evidence on remote administration of specialized forensic measures, including the perception of its security.
Technological problems may interfere with accurate appraisal.
Laws guiding some kinds of functional-legal capacity may change (e.g., communicating with and relating to an attorney via remote administration as part of competency-to-stand-trial evaluation).
        Ensure that conditions for evaluation are quiet, private, and distraction-free.Major implications when the evaluator cannot directly observe and appraise these.
Access to a private, quiet space and access to remote communication technology will, in part, be a function of the facility.
Must consider privacy on both sending and receiving ends.
        Provide appropriate notification of purpose and obtain appropriate authorization before beginning.For evaluees who are already suspicious or clinically symptomatic, this may not be detected and addressed as effectively via remote evaluation.
Some evaluees may be uncomfortable with or not adept at using the technology, which may result in more refusals due to discomfort with technology.
        Determine whether the individual understands the purpose of the evaluation and the associated limits on confidentiality.Consider how accurately you can determine whether someone does not understand something remotely, particularly when remote IQ/achievement testing may be limited or difficult.
Discomfort with technology might be confused with difficulty understanding notification.
    Data interpretation
        Use third-party information (TPI) in assessing response style.No change in need for TPI. TPI may become even more important if remote administration impairs reliability and validity or limits quality and amount of contact with evaluee.
        Use testing when indicated in assessing response style.Response style testing will need remote administration validation research.
Depending on privacy in the facility, defensiveness and uncooperativeness might increase.
        Use case-specific (idiographic) evidence in assessing clinical condition, functional abilities, and causal connection.No change.
        Use nomothetic evidence in assessing clinical condition, functional abilities, and causal connection.Testing norms may not be applicable to remote administration.
        Use scientific reasoning in assessing causal connection between clinical condition and functional abilities.No change.
        Carefully consider whether to answer the ultimate legal question. If it is answered, it should be in the context of a thorough evaluation clearly describing data and reasoning, and with the clear recognition that this question is in the domain of the legal decision-maker.No change.
        Describe findings and limits so that they will change little under cross-examination.Must consider limitations of findings obtained using communication technology for remote administration.
    Written communication
        Attribute information to sources.No change.
        Use plain language; avoid technical jargon.Additional need to explain the communications technology and arrangements for administration.
Consider how much you attribute aspects of the evaluee's responses to the remote vs. in-person setting.
        Write report in sections, according to model and procedures.No change.
        Base testimony on the results of the properly performed FMHA.No change.
        Prepare.No change.
        Communicate effectively.Communicating clearly and convincingly through a computer screen calls for the development of additional skills.
Experts will not have access to some feedback (e.g., others' facial expressions).
        Control the message. Strive to obtain, retain, and regain control over the meaning and impact of what is presented in expert testimony.May be more difficult for both attorneys and experts to use their current strategies toward this purpose in remotely delivered expert testimony.
Opens a major line of research, with important implications for training and practice.
  • a Adapted from Heilbrun et al.7 with permission.

  • FMHA, Forensic Mental Health Assessment.