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We report the results of a test of a structural model reflecting the longitudinal relationships of psychosocial problems among youths involved in a Center for Substance Abuse Treatment funded clinical trial for juveniles that participated in a diversion program. The project is evaluating the efficacy of an intensive 16-week case management service to youths and their families. The present study examines the continuity of (1) psychosocial problems, measured as a latent variable comprising family problems, peer problems, and educational problems, (2) drug involvement, use, and effects, and (3) self-reported delinquency for baseline and approximately 1-year follow-up interview data for 165 and 137 youths, respectively. The results support existing literature indicating that once problem behaviors are established at an early age, they have a strong likelihood of persisting over time. Implications for policy and intervention service needs are discussed. [ABSTRACT FROM AUTHOR]

We report the results of the relationship of lifetime and past year drug involvement to psychosocial functioning among youths entering a Juvenile Arbitration Program (a diversion program) in the 13th Judicial Circuit, who enrolled in a Center for Substance Abuse Treatment funded study. The project is a clinical trial evaluating an innovative intervention service providing sixteen weeks of intensive case management services to youths and their families. The present study examines baseline interview data for 165 youths who entered the Juvenile Arbitration Program between June 2002 and July 2003 and agreed to participate in the project. The results indicate that drug involvement is a significant issue among the youths we studied, and is related to functioning problems in a number of key areas of their lives. Indeed, the greater their drug involvement, the more psychosocial problems they report experiencing. These findings contradict public opinion that youths placed in diversion programs have relatively few problems. Policy implications based on these results are discussed. [ABSTRACT FROM AUTHOR]

Poythress, Edens, and Lilienfeld (1998) recently reported a moderately strong correlation between Hare's (1991) Psychopathy Checklist-Revised (PCL-R) and a newly developed self-report measure of psychopathy, the Psychopathic Personality Inventory (PPI) of Lilienfeld and Andrews (1996), in an ethnically diverse sample of 50 inmates from a youthful offender prison. The present study reports follow-up data regarding disciplinary infractions in this sample and examines the utility of the PCL-R and PPI for identifying those at risk for institutional misbehavior. Generally modest, but statistically significant, correlations were obtained between both measures and indices of aggressive institutional behavior. Multiple regression analyses revealed that both measures accounted for common variance in the criterion but that neither accounted for significant unique variance. Results are discussed in terms of the clinical utility of these measures in populations of young offenders. [ABSTRACT FROM AUTHOR]

States differ widely in their delivery of pretrial forensic evaluation services, in terms of organizational structure and training requirements of forensic examiners. It was hypothesized that defendants adjudicated incompetent to proceed in states using community-based, private-practitioner systems would show less impairment on a competence assessment measure, the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), than defendants adjudicated incompetent in states using traditional, inpatient systems. It also was hypothesized that mean MacCAT-CA scores for incompetent defendants from states requiring forensic training/certification would be lower than for defendants from states lacking such requirements. Results indicated significant differences across the four types of service delivery systems examined. However, planned comparisons revealed no differences between a state using a traditional, inpatient model and a state employing a community-based, private-practitioner model. Analyses examining the effects of mandatory forensic training failed to support the hypothesis that training requirements result in the adoption of higher thresholds for determining incompetence. [ABSTRACT FROM AUTHOR]

A set of measures assessing abilities related to legal standards for competence in the adjudicative process were administered to mentally-disordered criminal defendants with diagnoses of schizophrenia, affective disorder, other psychiatric disorders, and to criminal defendants without diagnosed mental disorder. Mentally-disordered defendants were recruited from two groups: those who had been committed for restoration of competence and those who had been identified by jail personnel as mentally ill. Significant impairments in competence-related abilities were found for approximately half of the defendants with schizophrenia. Defendants with schizophrenia scored lower on measures of understanding, reasoning, and appreciation related to the adjudication process. The association between symptoms and competence-related abilities was explored within diagnostic groups. Conceptual disorganization was found to be inversely correlated with performance on all measures in both defendants with schizophrenia and those with affective disorders. For other psychotic symptoms, differing patterns of correlations were found in the two major diagnostic groups. The implications for policy designed to safeguard the rights of defendants to be tried while competent are discussed. [ABSTRACT FROM AUTHOR]

Ethnic and racial minorities are often under-represented in research. There is considerable speculation that Blacks, in particular, are discouraged from research participation because of researcher improprieties in the U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee (aka the Tuskegee Syphilis Study [TSS]), a 40-year (1932-1972) study in which investigators withheld medical treatment from African-American men infected with syphilis. We debriefed 281 offenders who declined participation in a research study to assess the extent to which knowledge of the TSS impacted their decisions not to enroll. Relatively few (44/281; 15.6%) reported awareness of the TSS. Half (n = 22) of these "aware" individuals could cite factually accurate information about the TSS, and only four individuals indicated that awareness of TSS had "somewhat" influenced their decision to not participate. Findings suggest that the legacy of the TSS played a relatively minor role in these offenders' decisions to decline research participation., (2011 John Wiley & Sons, Ltd.)

The present study assessed the psychometric properties and construct validity of two self-report measures of psychopathy in a male-college sample: the Levenson Psychopathy scales (LPS; Levenson, Kiehl, & Fitzpatrick, 1995) and the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996). Both the LPS and the PPI demonstrated good internal consistency, although selected items from the PPI correlated weakly with their respective factor scores, suggesting the need for further investigation of the factors' item content. The PPI showed stronger validity than the LPS in terms of convergent and discriminant validity of its factor scores and factor associations with two criterion variables, aggression, and anxiety. Overall, the current study provides greater support for the use of the PPI over the LPS in studies investigating psychopathic traits in nonclinical and nonforensic samples.

The authors examined the relation between self-report psychopathy measures and official records of offending in four samples of justice-involved youth (total N = 447). Psychopathy measures included the Antisocial Process Screening Device (APSD) and a modified version of the Childhood Psychopathy Scale (mCPS). Measures of offending included the total number of preadmission arrest charges for three samples (n = 392) and the total number of offenses in the year following release for two samples (n = 138). Neither measure was a strong correlate of preadmission offenses. Although mCPS scores were associated with postrelease offending in one sample, effects for the APSD were observed only when reoffending was conceptualized as a dichotomous variable, indicating a lack of robustness in this association. The findings suggest caution in the use of self-report measures of psychopathic features for decision making with respect to issues of delinquency risk among justice-involved youth.

Increasing numbers of youths are being tried in criminal court because of statutory measures that have decreased the use of judicial review as the primary mechanism for transfer. The relative immaturity of adolescents suggests that transferred youths might have impaired competence-related abilities compared to adults. To test this hypothesis, we compared the competence-related abilities and developmental characteristics of a sample of direct-filed 16-17-year-olds charged in criminal court in the state of Florida (Direct File sample) to a sample of 18-24-year-old adults charged in criminal courts (Adult Offender sample) and to a separate sample of 16-17-year-olds charged in juvenile court (Juvenile Court sample). Results indicated that there were few differences between the Direct File youths and Adult Offenders. The differences that were observed suggested that the Direct Filed youths performed slightly better than the Adult Offender group and the Juvenile Court youths charged in juvenile court. These findings suggest that as a group, 16-17-year-old Direct File adolescents do not have significant deficits in competence-related abilities due to age or immaturity.

Objective: Patterns of rediversion in two postbooking jail diversion programs in Florida were examined to better understand the extent to which diversion programs served repeating clients. Rediversion occurs when a former or current diversion program participant is booked into jail on a new charge and diverted once again through the same diversion program., Methods: Data from 18 months of consecutive entries into the Hillsborough County jail diversion program (N = 336) and Broward County mental health court (N = 800) were examined., Results: Similar rediversion patterns were observed for the two diversion programs. About one-fifth of those who were diverted during the 18-month study period were rediverted at least once. Nearly half of those who experienced rediversion did so within 90 days of their initial diversion. Although fewer than 6 percent were rediverted two or more times, these individuals accounted for a disproportionately large number of overall diversions and were rediverted more quickly than those with only one rediversion., Conclusions: The diversion programs examined here appear to be experiencing a level of repeating clients similar to that observed in other pathways for accessing mental health treatment.

Questions on multiple modes of mandated community treatment (e.g. outpatient commitment, advance directive, representative payee, and special housing) were included in two studies of persons with mental illness, using a mail survey of Medicaid enrollees receiving SSI and interviews conducted as part of an evaluation of a specialty mental health court. Results indicate that the majority of individuals reported no experience with any forms of mandated community treatment. However, respondents from the two samples who had been subject to community mandates reported comparatively similar experiences. Additional studies of the prevalence of mandated community treatment are necessary to garner expanded information regarding the use of such mandates. In addition, future studies must assure that the language employed to query individuals regarding such mandates is clearly understood by respondents, as certain terms (e.g. "outpatient commitment") may mean different things to different respondents., (Copyright 2003 John Wiley & Sons, Ltd.)

This study examined the relationship between psychopathy and malingering in a subsample of male prison inmates (n = 55) participating in a larger study of the clinical utility of various assessment measures in correctional settings. Participants' capacity to feign major mental illness successfully was evaluated using standard cutoff scores for the detection of malingering on a variety of instruments, including the Structured Inventory of Malingered Symptomatology (SIMS; G. P Smith & G. O. Burger, 1997), the Structured Interview of Reported Symptoms (SIRS; R. Rogers, R. M. Bagby, & S. E. Dickens, 1992), and the Personality Assessment Inventory (PAI; L. Morey, 1991). Psychopathic traits were assessed via the Psychopathic Personality Inventory (PPI; S.O. Lilienfeld & B. P Andrews, 1996). Correlations between the malingering indices and the PPI were low (-.14 to .14) and not statistically significant. These findings fail to support the clinical intuition that individuals with higher levels of psychopathy are likely to be more adept at malingering.

The Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996) is a relatively new self-report measure that has shown considerable promise as an index of psychopathic traits in both nonoffender and offender samples. The present study examined the construct validity and predictive utility of the PPI by examining its association with theoretically relevant scales of the Personality Assessment Inventory (PAI; Morey, 1991) among 60 male prison inmates, and its ability to predict institutional misbehavior in an expanded sample (n = 89). As expected, correlations with the PAI scales were highest for the Antisocial Features (ANT) and Aggression (AGG) scales (rs = .68 and .57, respectively). The PPI also predicted various forms of nonviolent and physically aggressive disciplinary infractions significantly better than chance (point biserial correlations ranging from .26 to .37).

Relatively little is known about the processes in which "successful" malingerers engage to avoid detection. This study summarizes the response strategies used by participants (N = 540) instructed to feign a specific mental disorder while completing various self-report instruments designed to detect faking. Postexperiment questionnaires indicated that those who were able to appear symptomatic while avoiding being detected as feigning (n = 60) were more likely to endorse a lower rate of legitimate symptoms, to avoid overly unusual or bizarre items, and to base their responses on their own personal experiences.

Objective: The objective of this study was to evaluate alternative procedures for improving the understanding of research consent disclosures by persons who have mental illness., Methods: Three groups participated in the study: persons with schizophrenia (N=79), persons with depression (N=82), and a healthy control group (N=80). The participants were guided through an informed consent process in which two factors were manipulated. One was the structure of the disclosure form; either a typical disclosure form involving standard dense text was used, or a graphically enhanced form was used. The other was the interpersonal process: the presence or absence of a third-party facilitator, with iterative feedback given to participants for whom a facilitator was not present. Participants' understanding of the disclosure was assessed with the use of recall tests that involved paraphrasing and recognition tests that involved multiple choice., Results: The mean understanding scores did not differ significantly between the depression and control groups, and the mean scores of the schizophrenia group were significantly lower than those of the other two groups. Neither the graphically enhanced consent disclosure form nor the presence of a third-party facilitator was associated with improved understanding. The use of iterative feedback was associated with improvement in comprehension scores in all groups., Conclusions: The use of a feedback procedure in the consent disclosure process during the recruitment of persons who are mentally ill may be a valuable safeguard for ensuring adequate understanding and appropriate participation in research.

The relations between the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996) and 4 theoretically related constructs (empathy, aggression, work ethic, and borderline personality disorder) were examined. Additionally, the relation between the PPI and heroism was explored. One hundred male inmates were administered the PPI, the Questionnaire Measure of Emotional Empathy (Mehrabian & Epstein, 1972), the Aggression Questionnaire (Buss & Perry, 1992), the Protestant Ethic Scale (Mirels & Garrett, 1971), the Self-Report for Borderline Personality Scale (Oldham et al., 1985), and the Activity Frequency Inventory (Lilienfeld, 1998). As predicted, the PPI was significantly negatively correlated with empathy and significantly positively related to aggression and borderline personality. Contrary to prediction, the correlation between the PPI and work ethic was not significant. Eight of 11 hypotheses regarding the relations of the PPI subscales to these 4 constructs were corroborated. Results support the construct validity of the PPI in a correctional sample. The exploratory analysis of the relation between the PPI and heroism revealed no significant relations.

Procedural justice theory posits that the process by which disputes are resolved influences perceptions of fairness and satisfaction with outcomes, even if the outcomes are unfavorable. Within the context of civil commitment, Tyler (1992) has suggested that enhancing respondents' perceptions of procedural justice (i.e., participation, dignity, and trust) during commitment proceedings might facilitate accommodation to an adverse judicial determination (i.e., commitment) and subsequently enhance therapeutic outcomes. The study reported here used videotapes of mock commitment hearings to examine whether patients committed for involuntary treatment are sensitive to procedural justice manipulations. Results suggest that patients are sensitive to procedural justice manipulations and, further, that such manipulations are likely to influence the patients' attitude toward psychiatric care. These findings suggest that the development of strategies to enhance patients' perceptions of procedural justice in commitment hearings may indeed have positive therapeutic implications and warrants further investigation., (Copyright 2000 John Wiley & Sons, Ltd.)

A new research instrument, the MacArthur Structured Assessment of Competencies of Criminal Defendants (MacSAC-CD), was administered to three groups of women defendants: those adjudicated incompetent and committed to forensic hospitals for treatment (n = 38), jail inmates receiving mental health treatment (n = 18) who had not been adjudicated incompetent, and randomly selected jail inmates (n = 50). Measures of the competence-related abilities of understanding and reasoning were found to have satisfactory indices of internal consistency (coefficient alpha), and all measures correlated in the expected direction with measures of global psychopathology, psychoticism, and verbal cognitive functioning. Between-group mean scores were all in the expected direction and were statistically significant for four of seven measures. No differences in MacSAC-CD performance were found in comparisons of male and female defendants who had been adjudicated incompetent, nor were differences found in the performance of male and female jail inmates.

The primary aim of this study was to evaluate the stability (i.e., consistency of patients' responses over time) of newly developed scales to measure the admission experience of psychiatric hospitalization. Eighty-four psychiatric patients involuntarily committed to a crisis stabilization unit participated. All participants were admitted under an emergency petition or ex parte order for a psychiatric evaluation. Patients were interviewed soon after admission (M = 3.33 days, SD = 1.86 days). The test-retest interval was 24-48 hours with most (83.3%) re-evaluated at 24 hours. Overall, the measures showed acceptable levels of stability (r's range from .62 to .72). Factors associated with reliable responses were lower overall psychiatric symptom severity, less severe psychotic symptoms, and mentioning the same person as an influence of perceptions about the admission experience at each assessment point.

Assessment of competence to stand trial is a common evaluation that can have substantial consequences for defendants and the criminal justice system. Despite a voluminous literature, much remains unknown. An obstacle to progress in understanding what is better termed "adjudicative competence" is the absence of structured, standardized research measures for assessment of defendants. This article presents the legal framework, assessment strategy, instrument description, psychometric properties, and construct validation of the MacArthur Structured Assessment of the Competencies of Criminal Defendants (MacSAC-CD). The measures meet or exceed accepted indices of internal consistency, and interscorer agreement. Observed patterns of correlations among measures support the underlying theoretical structure of competence-related abilities. Moreover, the MacSAC-CD distinguishes groups of competent and incompetent defendants; reflects changes in competence status; and correlates positively with clinical judgments, negatively with psychopathology and impaired cognitive functioning, and negligibly with cynicism toward the justice system.

A set of measures assessing competence-related abilities was administered to three groups of criminal defendants: a group committed for restoration of competence, a group identified by jail personnel as mentally ill but not incompetent, and a group without identified mental disorder. Data from this study were used to test key assumptions bearing on the legal criteria for adjudicative competence. The data show that among defendants able to understand the nature and purpose of the criminal proceedings, a significant proportion have an impaired ability to appreciate their situations as criminal defendants or to communicate relevant information to counsel; among defendants able to understand the proceedings and to assist counsel, a significant proportion have impaired decision-making abilities; and among defendants able to understand the nature and consequences of decisions to plead guilty or waive a jury, a significant proportion have impaired abilities to appreciate the significance of these decisions or to rationally manipulate information pertinent to making them. These findings highlight the importance of disaggregating the components of adjudicative competence.

Half a decade ago, the Zinermon court announced the need for clinicians to evaluate the competence of people with mental illness to consent to voluntary hospital admission, but the court did not specify the test of capacity that mental health professionals should use. As has occurred in other areas dealing with legal competence, there is a need for the field to develop standardized assessment procedures for evaluating capacity to consent to voluntary hospitalization. Both theoretical and practical considerations suggest that these procedures should be modeled after what S. K. Hoge has termed a "weak" model of consent. This and other studies of the ability of mentally ill persons to understand disclosed information suggest that their level of understanding may be assessed optimally with measures that utilize recognition rather than recall response elicitation formats.

The legal construct of competence to stand trial, or "adjudicative competence," is based on the premise that some mentally disordered defendants have impaired abilities when compared with most defendants and that adjudication should be barred if these competence-related abilities are significantly impaired. Where the line is drawn between sufficient and insufficient abilities has important consequences: as a result of being adjudicated incompetent, defendants may be detained and treated involuntarily and their trials will be delayed. However, no studies have systematically compared the capacities of relevant groups of defendants. In this study, 84 criminal defendants--42 of whom were hospitalized as incompetent and 42 of whom were regarded as unquestionably competent--were administered three instruments measuring capacity to understand legally relevant information. Incompetent defendants performed more poorly on all measures of understanding. Twenty-eight incompetent defendants were administered the measures a second time, after restoration to competence. Restored defendants improved their performance on all measures of understanding and their performance was similar to that of normal, competent defendants.

The U.S. House of Representatives Armed Services Committee (HASC) review of the US. Navy's investigation of the U.S.S. IOWA incident provides a case study of the problems with reconstructive psychological evaluations. The US. Navy attributed the explosion on board the U.S.S. IOWA to the intentional suicidal acts of Gunner's Mate Clayton Hartwig, a conclusion supported primarily by an Equivocal Death Analysis (EDA) conducted by the FBI. Systematic analysis of the reports of the expert panelists who consulted to the NASC reveals that 11 of the 14 panelists were critical of the conclusions reached by the Navy/FBI. There was considerable variability among the judgments of the panelists, who reached consensus only for broad categories. Because the reliability and validity of postmortem psychological reconstructions such as EDA and psychological autopsy have not been established, clinicians are urged to exercise caution in the use of such procedures and to be sensitive to ethical obligations to consumers when using such techniques.

In 1989, an explosion aboard the USS Iowa killed 47 sailors. The Navy attributed the explosion to the intentional suicidal acts of Gunners Mate Clayton Hartwig, a conclusion supported primarily by an "equivocal death analysis" conducted by the Federal Bureau of Investigation (FBI). The U.S. House of Representatives Armed Services Committee (HASC) was highly critical of the FBI's report and the Navy's conclusions, in part because of the peer review provided by 12 psychologists organized by the American Psychological Association (APA). This article (a) reviews the nature of equivocal death analysis and related reconstructive psychological evaluations, (b) describes the nature of APA's consultation and involvement with the HASC, (c) discusses the conclusions reached by the HASC and the influence of the APA panelists, and (d) suggests limitations on the use of equivocal death analysis and related procedures in light of scientific concerns and ethical considerations.

Pretrial forensic evaluations are provided for the criminal courts throughout the United States. A variety of models of service delivery exists, and these models vary in ways that are important to the organization and finding of state mental health services. The first part of this paper describes several models of service delivery, which vary primarily in terms of centrality (central state institution vs. community service provider) and the use of inpatient vs. outpatient procedures. The second part compares these models on a number of important measures, including cost and efficiency. The final section of the paper indicates the importance of specialized forensic training and describes important components of such training.

Mental health professionals often must decide whether to release a psychiatric patient who has been committed for treatment on the basis of being mentally ill and dangerous. This decision involves liability risks if the patient becomes violent after release. The author draws together several recommendations made in the literature regarding the careful development and implementation of hospital release procedures, including 1) special consultation at the policy development stage, 2) preemptive judgments regarding the adequacy of hospital policies in relation to the professional standard of care, and 3) the use of videotaped exit interviews with patients at the time of their release.

In this study 29 clinicians provided Q-sort descriptions for 36 patients' MMPI profiles prepared in the standard way or prepared according to Kincannon's (1968) Minimult or Faschingbauer's (1974) FAM. For each patient, correlations between Q sorts based on the standard profile and each short form profile were computed as a measure of interpretive similarity between the long form and short form. Correlations between Q sorts by independent raters both interpreting the long form profile served as the standard for comparison. Data analyses revealed that at least for the FAM, interpretive similarity between the short form and long form MMPI may be sufficient to warrant its clinical use for individual profile interpretation.