Fall 2003 Texas Psychologist

Fall 2003 Fall 2003 Volume 54, Issue 3

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w w w . a m e r i c a n p r o f e s s i o n a l . c o m

Claire Jacobs, PhD Editor David White, CAE Executive Director FALL 2003

Robert McPherson, PhD Director of Professional Affairs Lynda Keen Membership Manager/Bookkeeper Sherry Reisman Director of Conventions & Non-Dues

VOLUME 54, ISSUE 3

Features 8

Session Recap: 2003 Legislature Joey Bennett, Legislative Consultant

TPA BOARD OF TRUSTEES Deanna Yates, PhD President

10 Two Mothers, Two Murderers Lakshmy Parameswaran, MA

C. Alan Hopewell, PhD President-Elect Paul Burney, PhD President-Elect Designate Walter Cubberly, PhD Past-President Board Members Ron Cohorn, PhD Patrick Ellis, PhD Richard Fulbright, PhD Charlotte Kimmel, PhD Joseph C. Kobos, PhD Suzanne Mouton-Odum, PhD Roberta L. Nutt, PhD Dean Paret, PhD Elizabeth L. Richeson, PhD Ollie Seay, PhD Jarvis Wright, PhD

12 A Practical Guide to Risk Assessment Mary Alice Conroy, PhD

26 Evaluating Competence to Stand Trial: The Rules Have Changed Mary Alice Conroy, PhD

Departments 2

FROM THE PRESIDENT Deanna Yates, PhD

EX-OFFICIO BOARD MEMBERS Richard M. McGraw, PhD Federal Advocacy Coordinator

4

FROM TPA HEADQUARTERS: TPA Leaders and Staff Prepare for the Sunset Process

Melba J. T. Vasquez, PhD CAPP Representative

David White, CAE, Executive Director

Jerry R. Grammer, PhD Texas Psychology Foundation President

7

Fort Worth Area Psychological Association Update

Mary Martin Student Division Director

9

TPF Donations

PUBLISHER

9

Sunrise Fund Contributors

Rector Duncan & Associates P.O. Box 14667 Austin, Texas 78761 512-454-5262 Stephanie Shaw Managing Editor

28 LAW: More on Sexual Exploitation and the Duty to Report Sexual Abuse

by Any Mental Health Service Provider Sam A. Houston

Jared Hensley Advertising Sales Julie Mangano Art Director The Texas Psychological Association is located at 1011 Meredith Drive, Suite 4, Austin, Texas 78748. Texas Psychologist (ISSN 0749-3185) is the official publication of TPA and is published quarterly.

www.texaspsyc.org FALL 2003

30 New Members 31 PSY-PAC Contributors 33 Classified Advertising 33 Advertisers’ Index Texas Psychologist

1

FROM THE PRESIDENT

Presidential Briefing The 78th Texas Legislative session is over, and although we did not do as well as we had hoped, we did learn a great deal about the process. The bill which TSBEP had asked us to submit — a rather uncontroversial bill that gives our State Board the power to subpoena records during investigations — was passed. On the other hand, the bill giving prescriptive authority to psychopharmacology-trained psychologists did not get out of committee this time around. We did not ask for a vote because we did not think we had the votes needed for it to pass out of committee.

which is recommending to President Bush

Commission meetings over the past year, I

that more and better mental health services

felt the strong push toward medication as

be provided, it is very disheartening for me

the treatment for mental disorders. There is

to have my state totally drop psychological

a good deal of evidence supporting

services.

medication’s efficacy. There is, of course,

I can assure you that TPA is working to

also an evidence base for the efficacy of

get those services reinstated. However with

psychotherapy — even though it is not as

the budget shortfall, it will not be an easy

easy to do psychological research and, as we

task. The Texas Medical Association and

all know, what works in a research study

Texas Hospital Association were able to

does not always translate to the clinical

fund a study that showed the overall loss of

setting. What works in a clinical setting is

revenues to the state if their services were

not easy to prove in a 10-week research

dropped. We, however, do not have the

study.

budget to hire a top research firm to show the

overall

benefits

of

With the move to evidence-based

providing

treatment, I fear that psychologists may

psychological services to the uninsured. The

ultimately be left out of the health care

Deanna F. Yates, PhD

notion that the poor will have no choice in

system entirely, if we do not obtain

T PA P r e s i d e n t

their treatment, but instead be provided

prescriptive authority. The Commission

hile we were continuously

only medications, is a difficult pill to

went to great lengths to identify mental

monitoring other bills, a bill

swallow (pardon the pun).

health as a part of overall health care and not

W

that cuts optional services

I do not know how many psychologists

a separate entity. Still, many psychologists

from Medicaid and CHIPS passed through

in Texas work with Medicaid and/or CHIPS

feel that psychology should remain separate

the legislature at the 11th hour. Optional

patients, so I do not know how much this

from health care. I can only hope that in the

services include, among other things, all

change alone will affect psychologists. I do

process of keeping psychology “pure,” we do

psychological services. This means that

fear that this will set the stage for Medicare

not lose psychology altogether.

persons on Medicaid over the age of 21 and

and private insurers to follow suit.

This past year on the Commission has

children covered under the CHIPS program

Ultimately, psychological services could be

been an exhausting but very rewarding

will no longer be entitled to psychological

relegated to a fee-for-service arrangement.

experience. Although the commissioners

services after September 1, 2003. After a

During many of the Presidential

have not seen the final report that will be

year’s work on the Presidential Commission, 2

Texas Psychologist

FALL 2003

presented to the President — probably within the next few weeks — I am hoping that it will receive a warm reception and that its goals will be implemented. Along with the 15 appointed commissioners, the Commission also had the input of seven exofficio members, all of whom play a large role in the mental health system at the federal level. One such person, who I might add was extremely helpful to us, was Charles G. Curie, MA, ACSW. Mr. Curie is the administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA).

As

administrator

of

SAMHSA, Mr. Curie reports to Health and Human

Services

Secretary,

Tommy

Thompson, and leads the $3.2 billion agency responsible for improving the the nation’s substance abuse prevention,

Then when paying, $27 will be deducted from any program you select, including our $27 courses!

addictions treatment, and mental health

(One use per customer • Good through November 15, 2003)

accountability, capacity, and effectiveness of

services.

Mr. Curie was invaluable to the work of the Commission, and I know you will enjoy his presentation as the keynote speaker at TPA’s 2003 Annual Convention. We have tried to make this year’s convention, which will be held at the Westin Galleria in Dallas,

attractive

to

everyone. The

impressive Galleria, “a city under glass,” offers instant access to more that 200 exclusive shops (in case you have time to shop), two dozen restaurants, and other entertainment options, including a multiscreen movie theatre and an indoor ice rink.

The theme of the convention — Access to Care: Children, Minorities and the Poor — will have separate tracks in many areas including:

children,

forensics,

school,

multicultural

ethics, access,

neuropsychology and psychopharmacology, to name just a few. I hope you will join me in meeting with your colleagues, taking part in the many Continuing Education opportunities,

and

New home study articles now availablefrom TPA

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FALL 2003

Texas Psychologist

3

FROM TPA HEADQUARTERS

TPA Leaders and Staff Prepare for the Sunset Process David White, CAE Executive Director

As we end the 78th Legislature, we reflect on one of the most unusual and bizarre sessions we have seen in years. The Texas Legislature’s main focus was to tackle the $10 billion budget shortfall, along with tort reform. Who will ever forget the political maneuvering that took place when the Republicans pushed for redistricting? Who didn’t see our Democrats being interviewed on national television from Oklahoma? The consensus at the Capitol was that this was a very “weird” session. For a more complete recap of this session, please turn to page 8 and read the article by Joey Bennett, TPA’s Legislative Consultant.

As we end this session, we immediately

succeed or fail in Austin. Your message will

turn our attention to the next session and

be heard and will set the foundation for

the state’s review of the Psychologists

psychology-friendly legislation, if you have

Practice Act. In the previous issue of the

that

Texas Psychologist, I reviewed the process

hometown.

personal

relationship

in

your

that we follow to manage our Sunset

The TPA leadership has developed a

process. TPA’s Sunset Committee continues

game plan that includes visiting every LAS

to meet and make proposed changes to the

within the next 12 months in order to

Practice Act that will improve and advance

educate you on the development of our

the profession in the competitive health

Sunset legislation and to learn what you are

care market.

doing in your hometown. These visits are

TPA LEADERS Austin Ollie Seay, PhD San Antonio Dee Yates, PhD - President Joe Kobos, PhD Houston Walt Cubberly, PhD – Past-President Suzanne Mouton-Odum, PhD Pat Ellis, PhD

TPA’s leadership understands how

structured for two-way communication —

important these next two years will be as we

we will share with you, and you have the

position ourselves legislatively around this

opportunity to share with us. Your input

issue. Many issues could arise during this

will help shape the policy and direction the

process that could change how you practice

association chooses in the future. In

or even how you will be regulated and by

addition, we will set up special listserves

whom. Therefore, our focus is to educate

and newsletters that will continually keep

you on what is happening and to gain your

you apprised of the progress we are making

Conroe

feedback on certain issues.

on this front.

Paul Burney, PhD – President-Elect Designate

We have developed a plan that will focus

You might already know the TPA leaders

our educational activities to the 21 local

who will guide this organization through

chapters we have around the state.

this process, but I would like to introduce

Therefore, if you are not a member of your

them to you once again. However, this time

local chapter — JOIN. If you are not a

I want to focus on their home city and

member of TPA — JOIN. Organized

encourage you to call upon them if you live

psychology at the local level is paramount

in or around their city. Contact information

to the success and advancement of the

for each is located at www.texaspsyc.org/-

profession. The relationship established by

displayboard.cfm.

you and your Local Area Society (LAS) with politicians is key when potential laws 4

Texas Psychologist

Beaumont Charlotte Kimmel, PhD El Paso Betty Richeson, PhD

San Angelo Jarvis Wright, PhD Big Spring Ron Cohorn, PhD Fort Worth Alan Hopewell, PhD - President-Elect Dallas area Roberta Nutt, PhD Richard Fulbright, PhD

FALL 2003

FALL 2003

Texas Psychologist

5

Dean Paret, PhD

the American Psychological Association, Lynda Keen

TPA Staff

past president of the Houston Psychological

Lynda is the

Association, and former chair of the

As important as these volunteers are to

lady who has all the

Council of Counseling Psychology Training

the organization, the staff is equally

answers regarding

Programs. He has been inducted into the

important. I feel I have the best staff of any

your membership.

National Academies of Practice and is a

psychological association in the country.

She currently serves

recipient of the American Psychological

Our team is dedicated to this organization

as TPA Member-

Association’s

and spends endless hours providing quality

ship Coordinator

recognition of his state and national

services to our members. It is my honor to

and is the one

advocacy contributions on behalf of

introduce you to your team.

responsible

for

ensuring

that

your

Karl

Heiser

Award

in

psychologists and their patients.

membership is current and that you

Dr. Bob’s main focus is to assist you if

RENEW! She also develops membership

you have any questions about your practice.

Sherry is the

recruitment programs and works closely

To name a few, he has addressed questions

backbone of this

with many of our membership-related

about subpoenas, insurance reimburse-

association. She has

committees. When she is not focusing on

ment, HIPAA and supervision. Dr.

been with TPA for

membership, Lynda serves as our accounts

McPherson has also become the expert in

six years and is

receivable manager and administrative

HIPAA requirements. He has presented

currently serving as

assistant. Lynda has been with TPA for two

more than 10 HIPAA workshops in the

TPA’s Director of

years and accomplishes all of this while only

past 8 months assisting our members by

Convention

working part-time!

telling them what they must do in order to

Sherry Reisman

and

Non-Dues Reve-nue. As her title indicates,

Lynda graduated from the University of

comply with this regulation. He is TPA’s

Sherry is responsible for putting together

Texas and is married to Randy Keen. They

institutional memory and visionary. If you

TPA’s very successful Annual Convention.

have two children — Jennifer and Matt.

think all of this is enough, there’s more! Dr.

Another primary duty for her is to

Jennifer recently graduated from high

Bob’s main job is professor and chair for the

identify and develop non-dues revenue

school and Matt is a senior in high school.

Department of Educational Psychology at

sources for the association. Her main

Lynda is currently considering pursuing her

the University of Houston, which he has

attention in this area has been continuing

doctoral degree in psychology.

served since 1995.

education for psychologist in the form of

Dr. McPherson earned his doctoral

CE workshops and home studies. As if this

Bob McPherson,

degree in Counseling Psychology from the

did not keep her busy enough, Sherry is

PhD

University of Houston in 1987 and is

also our Web administrator and oversees all

We know him

married to Dr. Ann Hodges, a practicing

the publications that TPA develops. Finally,

as “Dr. Bob.” Dr.

psychologist in Houston. Bob has three

if you ever call the TPA office, you most

Bob has been part

children — Sarah, 22;

likely will have the opportunity to visit with

of the TPA staff for

Rachel, 5.

Sherry as she answers the phone and assists

three years as TPA’s

many members. Needless to say, if you need

Director of Pro-

anything or want to know anything about

fessional

Affairs.

that we do at TPA is done by myself and

TPA, Sherry will have the answer (or can

Dr. Bob has been a

this team. For such a small staff, we are

get it for you)!

member of TPA for 19 years! He has served

committed to being the BEST state

Sherry graduated from the University of

the association for the past 11 years,

psychological association in the country!

Texas and is married to Mark Reisman.

performing the duties as president in 1997

We want you to be a part of that too. Join

While they have not yet started a family,

and joining the staff in 2000. He was

TPA and let us help you! ✯

they do have two dogs and four cats, which

recently

monopolize their free time when they are

representative to the APA Council and will

not watching Longhorn sports of every

begin

kind!

Additionally, Dr. McPherson is a Fellow of

6

Texas Psychologist

elected his

term

John, 10; and

Well, there you have it. Yes, everything

to in

serve

as TPA’s

January

2004.

FALL 2003

Fort Worth Area Psychological Association Update Kate Wyatt, PhD, President of the Fort Worth Area Psychological Association, has been busy with a number of FWAPA projects. A recent workshop on “Therapy with Male Clients” was presented by Gary Brooks, PhD, and was well-attended.

Dr. Brooks used multimedia presentations to demonstrate socialization norms for males, and also addressed both individual and couples therapies. In addition, FWAPA is experimenting with a novel idea for a social activity that includes “psychological bonding” at plays held in the local Circle Theater. Those attending hope this will provide an avenue of interaction and socialization in a somewhat different venue.

FWAPA is also playing a leading role with a new consumer group, The Mental Health Connection. This group, whose impetus was the Wedgwood mass murders by a mentally ill resident, represents a number of local mental health agencies and resources

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presentations by consumers who voiced their pain and frustration at the failings and shortcomings of mental health services, three presentations were provided by Managed Care representatives.

Representative Charlie Geren was among the political representatives who were present. Incoming Mayor Mike Moncrief, a long-time champion of mental health issues, has pledged his support to the group. FWAPA will petition TPA to continue its membership in a

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As part of the coordination and interaction planned between these agencies and mental health experts in the Fort Worth area, tentative plans are being made for FWAPA to hold a joint Christmas/Holiday program and/or social event with psychiatry.

Finally, Dr. Wyatt and others were off to France to attend Carol Stalcup’s workshops on “Positive Creativity and Psychological Resilience,” which she had previously presented to the FWAPA local area society.

What interesting events would you like to brag about for your local area society? Let us know what your group is doing and we will be happy to let others around the state know. (They might even copy you!) E-mail Sherry Reisman at admin@texaspsyc.org.

FALL 2003

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www.AngerBusters.com Texas Psychologist

7

Session Recap: 2003 Legislature Joey Bennett, Legislative Consultant

The biggest issue going into, and subsequently throughout, the session was the budget. Lawmakers faced a $10 billion shortfall; however, in the end lawmakers passed a no new taxes budget of $117 billion for the 2004-2005 biennium. This budget embodies a one-time reduction in state general revenue from $60.7 billion to $58.2 billion. The remainder of the budget is from federal revenue sources.

C

losing the $10 billion gap was dependent on several revenue-generating and cost-saving measures. House Bill 2292 by Representative Arlene Wohlgemuth was a bill to rewrite and reorganize health and welfare programs. It is expected to save the state $1 billion over the biennium. Appropriations Committee Chair, Talmadge Heflin, passed a supplemental appropriations bill that cut state agency budgets for the current year by seven percent and yielded an additional $1.4 billion for this biennium. Another $4 billion is expected to come from management efficiencies and other non-tax revenue sources such as the Rainy Day Fund.

In the area of Health and Human Services, which consumes about one-third of the budget, the cost is $39.7 billion, with $14.7 billion of that in state funds. Medicaid programs received $19 billion in all fund monies and will be prepared to serve five million people for the upcoming biennium. The budget assumes CHIP eligibility standards to remain at 200 percent of the federal poverty level, with over 700,000 children served in the biennium.

Another major issue addressed by the Legislature included lawsuit reform. This legislation helps health care professionals with their liability issues and helps curb abusive and frivolous lawsuits.

Also, homeowners insurance reform passed to help lower the skyrocketing homeowners insurance rates, and a landmark transportation bill was passed that creates methods of financing to maximize our ability to build highways and infrastructure.

As far as our industry in particular, we believe it was a very good session. We were able to successfully pass House Bill 2132 by Representative Bill Zedler, which grants subpoena power to the Board of Examiners of Psychologists — a tool desperately needed by the Board to help police our industry. We also successfully fought off any attempts by rival professions to encroach on our profession and level of education.

As far as the issue of prescriptive authority for doctoral-level psychologists, we did make some

8

Texas Psychologist

progress. In past sessions, we were never granted a hearing at the committee level. This session, we had a successful hearing on House Bill 3451 by Representative Rick Noriega in front of the House Public Health Committee on April 30.

We have a very busy interim in front of us. During this Sunset process, our entire Practice Act is to be reviewed, scrutinized, and subsequently considered during the legislative process with possible changes suggested to our act and profession.

This process is extremely important, which is why we have been preparing for the Sunset review for over a year.

FALL 2003

Sunrise Fund Contributors 4/1/03 – 6/25/03 l James Crawford, PhD Jerry Grammer, PhD Tom Kubiszyn, PhD Richard McGraw, PhD Lee Morrison, PhD

a

2003

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Also included in registration fee: exhibits, receptions, breaks and luncheons.

Registration Online registration at www.texaspsyc.org is now open. Programs to be mailed in August.

Sponsorship opportunities are still available.

For more information, call:

888/872-3435 or 512/280-4099 FALL 2003

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Texas Psychological Foundation Donations l

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Texas Psychologist

9

Two Mothers, Two Murderers Lakshmy Parameswaran, MA

Andrea Yates and Clara Harris, two very different women from the quiet Houston suburb of Clear Lake, garnered our attention as a nation for the same deeply disturbing reason — they murdered their loved ones. In the summer of 2001, Yates methodically drowned, one by one, her five small children in a bathtub. A year later, in July of 2002, Harris purposely ran over her husband of eleven years in a hotel parking lot and killed him.

T

hese were two ordinary mothers, living suburban American lives.

Both were educated and married to educated men, both acted under the pressures of extremely painful personal circumstances, and both are now serving time for murder.

As a counselor specializing in women’s growth and empowerment issues, I feel that Yates and Harris would have made a typical client for any psychotherapist. Week after week, a therapist would have sat with them and explored ways for them to garner their inner strength, communicate clearly and emphatically with their mates, accept things they could not change, and develop strategies to “manage” their problems.

The notes on both women would have had the following terms: feels insecure and inadequate as a woman; has strong desire to please; feels desperate and out of control.

The significant difference might have been: Yates — a white female bound by traditional views on women’s role, marriage, and children; and Harris — independent and well-acculturated Colombian.

In a profession that strives to empower women like Yates and Harris, no therapist — and certainly not a female one — would disagree that both women deserved unconditional support, respect, and understanding from their husbands. Still, I doubt any counselor could have predicted the extent to which the two women would go, crossing the fine line between desperation and destruction.

10

Texas Psychologist

Yates’ heinous act raised a number of difficult issues, including post-partum depression and a tradition-bound Christian lifestyle. In the national coverage that followed, Yates came across distraught and stoic. We saw her pale face framed by stringy, disheveled hair and her empty eyes, jarring even through her eyeglasses. We learned of the former nurse’s married life oscillating between pregnancies, newborns, teaching home school and hospitalization for bouts of depression, which included two attempts at suicide. For some time, she even lived in a converted bus with four children, one a newborn. Unquestionably, this was a lonely, demanding, and exasperating lifestyle — one that even the strongest among us would find overwhelming.

Contrary to Yates’ life of round-theclock diapers and feeds, Harris, the mother of twin four year old boys, had the strength of her dental practice and the luxury of a nanny it afforded her. On television, this former beauty queen appeared neat and professional with unruffled hair tucked away at the nape of her neck. The heartwrenching part of her story was the extent to which she was willing to go to hold on to her unfaithful husband. In spite of her personal achievements, she felt the need to spy, follow, and confront her cheating husband, before killing him in vengeance.

Reports narrated her willingness to tan her body, enroll in a gym to lose weight, and even undergo breast augmentation surgery for his pleasure — a state of mind not

difficult to comprehend by those who have experienced the rejection of love.

Irrespective of their varying circumstances, the level of disappointment, sorrow, and outrage I feel toward these two women is the same. I feel that Yates did not need more children but more physical, emotional, and psychiatric care. I wish Harris had taken stock of her personal assets before she allowed herself to be consumed by passion and jealousy. Above all, I regret that there was not a therapist to pull them out of their sinking hopelessness early enough to avoid the calamities that followed.

The five Yates children — belonging to the most precious lot among us — did not deserve to die so cruelly at their mother’s hand. As for Harris, having an affair is not a death-deserving act in America, regardless of how despicable an act it is. Yes, women can feel trapped and suffocated by their loved ones, enough to visualize death. It is at such times, when women are most vulnerable, that those in the counseling profession are challenged to guide them to take back their lives.

As a female therapist, I feel it is especially gratifying when we can root for those who are girlfriends, wives, and mothers like us, because we understand how they feel, think, and act. During the final showdown with their loved ones, Yates and Harris ceased being the typical clients who could be empowered to be who they once were and crossed over to join a group we call murderers. ✯

FALL 2003

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A Practical Guide to Risk Assessment Home Study Mary Alice Conroy, PhD Diplomate in Forensic Psychology American Board of Professional Psychology

Directions: To receive continuing education credit for psychologists, licensed psychological associates, licensed professional counselors, and licensed social workers for this TPA sponsored home study assignment, you must: 1) 2) 3)

Read the article in its entirety; Take the test at the end of the article; Mail the test along with $25 (TPA Members) or $50 (Non-TPA Members) to the TPA Central Office at: 1011 Meredith Drive, Ste. 4, Austin, TX 78748.

R

isk assessment is the contemporary term for an estimation of the level of risk an individual presents for certain types of violent behavior. In Texas, assessment of risk is required for traditional civil commitment, evaluation of sexual predator evaluations, sentencing phase evaluations in death penalty cases, evaluations for juvenile transfer to adult court, and various decisions regarding detention of those found incompetent for trial and not guilty only by reason of insanity. Risk assessment may also be important in cases involving probation or parole decisions, the use of diversion programs, domestic violence intervention, termination of parental rights, fitness for duty in potentially hazardous occupations, and certain types of malpractice litigation.

This chapter is intended to impart very practical information regarding what courts have said about risk assessment, issues in deciding to perform a risk assessment, essential data collection, methodology, and issues of risk management.

The View from the Bench Courts have generally relied on mental health professionals to provide information regarding the risk individuals pose to society. In 1983, this practice was challenged in the case of Barefoot v. Estelle.

Mr. Barefoot, sentenced to death for 12

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murder in a Texas court, contended that psychiatrists have no unique tools or ability to predict dangerousness. An amicus curiae brief filed by the American Psychiatric Association supported this position. Data were presented suggesting that these predictions were wrong as often as twothirds of the time. However, the U.S. Supreme Court ruled that not allowing psychiatrists to testify in this regard would be tantamount to “disinventing the wheel.”

The justices went so far as to note that psychiatrists were not always wrong — only wrong most of the time.

Since Barefoot, both psychiatrists and psychologists have continued to provide assessments of violence potential to the judiciary. Thankfully, the scientific data relevant to such predictions has grown and the standards for admitting expert testimony have tightened. In the case of Daubert v. Merrill Dow Pharmaceuticals (1993), the U. S. Supreme Court declared the judge to be the “gatekeeper” to assure that experts who testified were, in fact, experts and that their evidence was scientific. An expert was to be qualified by knowledge, skill, experience, training, or education — and not simply by degree or profession. The Court suggested criteria a judge might apply in assessing the evidence presented and methodology employed by experts:

1. Does it reflect a theory that has or can be tested?

2. Has it been subjected to peer review or publication?

3. Has a potential error rate been established?

4. Has it been accepted by the relevant scientific community?

In 1995, Texas courts embraced the essence of Daubert in the case of E. I. Dupont & Co. v. Robinson. Since that time, so-called “Daubert challenges” have become common in hotly contested cases, and “Daubert hearings” are sometimes held before judges prior to allowing the expert to testify before the jury.

In the case of Kumho v. Carmichael (1999), the U. S. Supreme Court made an FALL 2003

additional ruling in this regard. In this case, the Court said that not only the presentation of scientific data was at issue, but the methodology employed was subject to scrutiny if an expert performed some type of evaluation.

The Decision to Conduct a Risk Assessment Before agreeing to conduct a risk assessment, several issues should be clarified: 1. Over what period of time is the risk to be assessed? (This could be a lifetime or it could be the time an individual will be on bond.)

2. Is the risk in a structured or unstructured environment? (This is a critical distinction in a death penalty evaluation.)

3. What will be the individual’s likely circumstances?

4. Is there leeway to alter these circumstances (e.g., can conditions be placed upon the release)?

5. Is the decision-maker concerned only about a particular type of violence (e.g., sexual violence, spousal abuse, child abuse)?

6. Is the issue confined to physical violence or is it intended to mean criminal recidivism in general?

7. Must the particular risk be linked to a mental illness or mental abnormality?

Once circumstances have been fully clarified, the evaluator should give careful consideration to potential ethical pitfalls.

First and foremost, the mental health professional needs to examine whether he or she has the specific competencies needed for the evaluation. Risk assessment is becoming very specialized and an extensive literature has developed. (A brief list of major references is included in Appendix A.) Instruments have been developed to assess risk for specific types of violence in target populations and any evaluator should be familiar with these tools. (A brief

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catalogue is included in Appendix B for reference.) Cultural competence should be considered in deciding whether the clinician is sufficiently experienced with the population represented. If the mental health professional is uncertain regarding his or her expertise, consultation is strongly recommended.

Ethical guidelines require that evaluators avoid a conflict of interest or a potentially harmful dual relationship. One of the most common problems in this area occurs when a mental health professional serves as the forensic evaluator and the subject’s therapist. In general, forensic risk assessments should not be performed by the treating professional. A therapist should maintain an alliance with the patient, while a forensic evaluator should be unbiased.

Collecting Research and Collateral Data Prior to contact with the person to be evaluated, both nomothetic and idiographic data can be assembled. This should include relevant research data on factors predictive of the particular type of risk being assessed in the particular population represented by the individual.

Factors with protective value should not be overlooked. The database on risk assessment is exploding exponentially, and the clinician should actively seek the most current literature or risk serious embarrassment in the courtroom. Web sites are now available devoted to various areas of risk assessment. Key sites to explore include, but are not limited to: 1. www.macarthur.virginia.edu (the mentally ill offender) 2. www.hare.org (the psychopathic offender) 3. www.sgc.gc.ca (the sex offender) Exploring idiographic data involves seeking out collateral information about the individual to be assessed. Collateral information is not simply helpful, it is

essential in performing a risk assessment!

Much of the risk assessment research has been conducted in Canada — one reason being that the Canadians have developed an extensive record-keeping system.

Securing records in Texas may be more challenging. To perform a valid assessment, there must be sufficient information to verify key facts. Official documents may contain errors, and contradictions should be clarified. Attorneys may wish to be helpful, but are frequently unaware of what is needed. Making specific requests for documents and suggesting sources can be productive. Examples of records and possible sources include: 1. Presentence investigations, and reports of prior functioning while under supervision (probation officer) 2. Information, indictment, police reports, and witness statements for current and past offenses (district attorney) 3. Reports of institutional behavior (TDCJ, TYC, county jail) 4. Past criminal record (district attorney, probation officer) 5. Report of past mental health treatment or evaluations (defense attorney, hospitals, clinicians)

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6. Reports of special programs attended, such as substance abuse or sex offender treatment (defense attorney, TDCJ, TYC, program providers) 7. School records, especially in the case of youthful offenders (defense attorney) 8. Collateral interviews with family members or caregivers (generally check with the attorney before proceeding)

Methodology Clinical and Actuarial Methods

A debate continues to rage in the field between those who favor a strictly actuarial approach and those who defend the role of clinical judgment. Vernon Quinsey and his colleagues, who have done some of the major research in the development of actuarial approaches, have argued that clinical judgment should be completely supplanted by actuarial instruments, because actuarial approaches are too good to risk contamination by unreliable clinical judgment (Quinsey, Harris, Rice, & Cormier, 1998). On the other hand, Thomas Litwack has argued vociferously that the day will probably never come when actuarial instruments can be applied to single individuals without the careful application of the clinician’s judgment (Litwack, 2001). Karl Hanson (1998) holds a more conciliatory view, suggesting the application of a guided actuarial approach, adjusting the weight given to both as the research becomes more sophisticated. John Monahan and his colleagues in the MacArthur risk assessment studies have generally supported this view, arguing that it clearly cannot be said that all of the variables potentially related to risk have been uncovered, nor that they should be given the same weight for every individual (Monahan et al., 2001). It is even possible that well-researched variables

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involving violence may have paradoxical effects for a specific person.

Beyond Traditional Approaches Consent or disclosure. In clinical work,

the informed consent of the patient or guardian is often the first essential step. If an evaluation is court-ordered or required by statute, however, the individual may have few choices — the evaluation must be completed with or without consent. In such cases, an evaluation disclosure may be more

most desirable and defensible approach.

There are circumstances, however, when an interview is not a viable option — either because the individual is incapable of participating, uncooperative, or advised by his or her attorney not to speak. Extensive, reliable records may nonetheless make it possible to conduct a thorough risk assessment. The reverse is not the case, however — one cannot complete a risk assessment relying only on the individual’s self-report. If an interview is not conducted, this should be clearly explained in subsequent reports or testimony.

Traditional psychological test batteries.

The traditional psychological test battery, often composed of personality and cognitive tests, may be of limited value in a risk assessment. Such instruments may be helpful in confirming a particular diagnosis, if one is required. Broad, general personality inventories (e.g., the MMPI-2, the MCMI-III, the PAI), however, have not been validated to predict violence, either general or specific. Problems arise when forensic evaluators confirm long-held “myths” about test results or suggest illusory correlations.

Specialized risk assessment instruments. Recently, some instruments have

honest and appropriate than an informed consent. If, on the other hand, the evaluation is being conducted at the request of an attorney or probation officer, the person’s informed consent is needed. In either case, the individual under evaluation should be informed of the identity and professional affiliation of the evaluator, the purpose of the evaluation, the limits of confidentiality, who is likely to have access to the evaluation results, and the potential consequences of the evaluation. They should also be given a clear statement that the evaluator is not a treating clinician.

The inter view. Ordinarily, ethical standards require that an interview of the individual under evaluation be conducted as part of the assessment. It is certainly the

been developed specifically designed to predict violence risk. These are generally constructed in one of three formats: 1) the structured interview, 2) an actuarial device consisting of variables chosen based upon regression analysis, and 3) the decision-tree approach. (See Appendix B) Instruments of this type have some distinct advantages in the courtroom. They can provide an anchor onto which an evaluator may graft more idiographic data.

Such instruments have almost invariably been published and peer-reviewed, which can be helpful if faced with a Daubert challenge. It is often possible to grossly compare offenders by level of risk using these methods. For example, the Violence Risk Appraisal Guide (VRAG) divides the population into nine risk levels, ranging from the highest (in which virtually the

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entire sample reoffended) to the lowest (in which almost none of the norm group reoffended.)

The limitations of these devices, however, must also be considered. For valid results, they universally require accurate, extensive records. Courts are sometimes confused by statistical information or may put unwarranted faith in numbers.

Selection and proper use of a risk assessment instrument requires a thorough understanding of certain statistical concepts (e.g., ROC curves, sensitivity, specificity, positive predictive power.) Each instrument has been normed on a select population that may not match the individual being evaluated. Finally, most rely almost exclusively on static variables (things that are historical and will not change with time.) Thus the instruments themselves tend to be static and insensitive to change over time or to varying levels of immediate risk.

Diagnosis. Precise diagnoses may be helpful (or even required) in the process of

a risk assessment; however, diagnoses have very limited value in actually assessing risk.

The limitation of diagnoses include two specific caveats noted in the DSM-IV-TR: 1) clinical diagnoses often do not equate to what the legal community views as mental disorder or mental abnormality, and 2) no diagnosis carries with it specific implications regarding degree of behavioral or volitional control.

Current research does provide support for some basic premises regarding mental disorder and risk for violence. Some relationship between mental disorder and violence has been found to exist (Monahan & Steadman, 1994). Substance abuse is a critical factor to consider and generally more predictive of violence than major mental illness (Steadman, Mulvey, Monahan, Robbins, Appelbaum, Grisso, Roth, & Silver, 1998). A personality disorder diagnosis is more predictive of violence than any of the major mental illnesses (Hodgins, 2000). Base rates of violence within any diagnostic category

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(Appelbaum, Robbins, & Monahan, 2000; Appelbaum, Robbins, & Roth, 1999; Monahan & Steadman, 1994).

Hallucinations, particularly command hallucinations, have also been studied with mixed results (Hersh & Borum, 1998; McNeil, Eisner, & Binder, 2000; Monahan & Steadman, 1994; Rudnick, 1999).

For a diagnosis to be relevant to a risk assessment, the connection between the psychopathology and violence displayed by the individual must be explored. Critical questions include: 1) Was the individual’s behavior consistent with a delusional belief?; 2) Is there evidence the person was experiencing command hallucinations concurrent with past violence?; 3) Were there obvious motives for the violence unrelated to the mental abnormality?; 4) Did all of the individual’s past violence seem to stem from the mental disorder?; and 5) To what extent did substance abuse contribute to the events?

Psychopathy. Although not a diagnostic category included in the DSM-IV-TR, the construct of psychopathy has been found to have strong, positive predictive power relative to future violent behavior.

Psychopathy must be clearly distinguished from Antisocial Personality Disorder. It is a much more restrictive category that goes back to Hervey Cleckley’s conceptualization of the “as if ” personality. Robert Hare (1991, 1996, 1999) has devoted much of his long career to refining and clarifying the construct.

In study after study, psychopathy has been found to be among the best predictors of future violent behavior (Hemphill, Hare, & Wong, 1998; Salekin, Rogers, & Sewell, 1996; Serin & Amos, 1995). Correlates of psychopathy include both general and violent recidivism, institutional maladjustment, and poor treatment response. Metaanalyses of recidivism studies have shown psychopathic offenders to be three times as likely to be reconvicted and four times as likely to commit a violent offense again (Hemphill et al., 1998). The MacArthur

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Violence Risk Study found psychopathy more predictive of violence than any of the other 133 variables included in the study (Skeem & Mulvey, 2001).

Psychopathy has been found to be predictive of violence even when diagnosed in conjunction with substance abuse or a major mental illness (Hill, Rogers, & Bickford, 1996; Rice & Harris, 1992).

The Psychopathy ChecklistRevised (PCL-R), developed by Robert Hare, is currently the “gold standard” in assessing psychopathy, but care should be exercised in its use. Specialized training is strongly recommended for evaluators using the PCL-R. It is essential that the person being assessed is representative of the populations on which the instrument has been researched. Although predictive of general institutional maladjustment, the PCL-R has not been demonstrated to predict risk for violence within a structured environment. Finally, a low PCL-R score does not indicate low risk — only that it is one risk factor not present.

The situation. Level of risk may vary markedly with the situation. It is important to determine the period of time over which one is expected to assess risk and whether future circumstances are likely to be similar to those in which past violence occurred.

The degree of available structure and support should be considered. Access to potential victims may make a difference.

Finally, the availability of effective treatment and the likelihood the individual will comply with treatment should be assessed.

Risk Management Beyond risk assessment, the forensic evaluator may be called upon to establish specific plans for the management of risk.

In such cases, the goal of treatment in this context is not the reduction of the person’s

distress, but rather the reduction of risk.

Well applied, this concept stresses the protection of society along with the least restrictive environment for the offender.

The task is challenging, and several principles of sound risk management have been developed to assist the forensic evaluator: 1) Risk factors should be identified and linked specifically to the risk management strategies proposed.

2) Consideration should not be limited to medical or psychological interventions.

3) Effective plans generally identify a central entity charged with on-going monitoring and enforcement.

4) Communication between treatment providers and the monitor needs to be clearly outlined and limits to confidentiality need to be specified.

5) Mechanisms should be in place to allow for immediate intervention when necessary to assure public safety.

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6) There must be a balance between individual rights, the need for treatment, and public safety.

7) The subject of the plan should be involved in the planning process.

8) Services and conditions proposed must be reasonably available.

9) Factors that contribute to risk, but are not amenable to change, should also be identified to the decision-making authority.

10) A mechanism for regular reassessment should be in place.

Risk Assessment Reports A risk assessment report should follow the general principles that apply to any good forensic report. It should include an explanation of the referral and documentation of the confidentiality disclaimer. All procedures and sources of information (including documents and any collateral interviews) should be included.

Focus should be on the specific issue at hand and extraneous information should be excluded. Complete and clear explanations should be given for any conclusions drawn.

Additional literature is available addressing issues specific to communication about violence risk (Heilbrun, O’Neill, Strohman, Bowman, & Philipson, 2000; Monahan, 2003; Monahan & MacGregor, 2000).

Washington, DC: American Psychological Association.

Barbaree, H. E., Seto, M. C., Langston, C., & Peacock, E. (2001). Evaluating the predictive accuracy of six risk assessment instruments for adult sex offenders.

Criminal Justice and Behavior, 28, 490-521.

Bonta, J., Law, M., & Hanson, R. K. (1998). The prediction of criminal and violent recidivism among mentally disordered offenders: A meta-analysis.

Psychological Bulletin, 123, 123-142.

Cooke, D. J., Forth, A. E., & Hare, R. D. (Eds.). (1998). Psychopathy: Theory, research, and implications for society. Boston: Kluwer Academic Publishers.

Cunningham, M. D., & Reidy, T. J. (1998). Antisocial Personality Disorder psychopathy: Diagnostic dilemmas in

classifying persons of antisocial behavior in sentencing evaluations. Behavioral Sciences and the Law, 16, 333-351.

Doren, D. M. (2002). Evaluating sex offenders: A manual for civil commitment and beyond. Thousand Oaks, CA: Sage Publications.

Douglas, K. S., & Webster, C. D. (1999). Predicting violence in mentally and personality disordered individuals. In R. Roesch, S. D. Hart, & J. R. P. Ogloff (Eds.), Psychology and Law (pp. 175-239).

NY: Kluwer Academic Publishers.

Grann, M., Belfrage, H., & Tendstrom, A. (2000). Actuarial assessment of risk for violence: Predictive validity of the VRAG and the historical part of the HCR-20.

Criminal Justice and Behavior, 27, 97-114.

APPENDIX A Appelbaum, P., Robbins, P., & Monahan, J. (2000). Violence and delusions: Data from the MacArthur Violence Risk Study. American Journal of Psychiatry, 157, 566-572.

Appelbaum, P., Robbins, P., & Roth, L. (1999). A dimensional approach to the study of delusions. American Journal of Psychiatry, 156, 1938-1943.

Ashford, J. B., Sales, B. D., & Reid, W. H. (Eds.). (2001). Treating adult and juvenile offenders with special needs.

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Grove, W. M., & Meehl, P. E. (1996).

Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures: The clinical-statistical controversy. Psychology, Public Policy, and Law, 2, 293-323.

Hanson, R.K. (1998). What do we know about sex offender risk assessment?

Psychology, Public Policy, and Law, 4, 50-72.

Hanson, R. K., & Bussiere, M. T. (1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies.

Journal of Consulting and Clinical Psychology, 66, 348-362.

Legal and Criminological Psychology, 3, 99119.

Hare, R. D. (1999). Without conscience: The disturbing world of the psychopaths among us. NY: Guilford Press.

Harris, G. T., Rice, M. E., & Cormier, C. A. (2002). Prospective replication of the Violence Risk Appraisal Guide in predicting violent recidivism among forensic patients.

Law and Human Behavior, 26, 377-394.

Heilbrun, K. (1997). Prediction versus management models relevant to risk assessment: The importance of legal decision-making context. Law and Human Behavior, 21, 347-359.

Hare, R. D. (1996). Psychopathy and antisocial personality disorder: A case of diagnostic confusion. Psychiatric Times, February, 39-41.

Heilbrun, K., Dvoskin, J., Hart, S. D., & McNeil, D. (1999). Violence risk communication: Implications for research,

Hare, R. D. (1998). The Hare PCL-R: Some issues concerning its use and misuse.

policy, and practice. Health, Risk, and Society, 1, 91-106.

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Heilbrun, K., O’Neill, M., Strohman, L., Bowman, Q., & Philipson, J. (2000).

Expert approaches to communicating violence risk. Law and Human Behavior, 24, 137-148.

Hemphill, J. F., Hare, R. D., & Wong, S. (1998). Psychopathy and recidivism: A review. Legal and Criminological Psychology.

3, 139-170.

Hersh, K., & Borum, R. (1998).

Command hallucinations, compliance, and risk assessment. Journal of the American Academy of Psychiatry and the Law, 26, 353359.

Hill, C. D., Rogers, R., & Bickford, M. E. (1996). Predicting aggressive and socially disruptive behavior in a maximum security forensic hospital. Journal of Forensic Sciences, 41, 56-59.

Hogkins, S. (Ed.). (2000). Effective prevention of crime and violence among the mentally ill. Dordrecht, the Netherlands: Kluwer Academic Publishers.

Janus, E.S., & Meehl, P. E. (1997).

Assessing the legal standard for predictions of dangerousness in sex offender commitment procedures. Psychology, Public Policy, and Law, 3, 33-64.

Litwack, T. R. (2001). Actuarial versus clinical assessments of dangerousness.

Psychology, Public Policy, and Law, 7, 409443.

McNeil, D. E., Eisner, J. P., & Binder, R. L. (2000). The relationship between command hallucinations and violence.

Psychiatric Services, 51, 1288-1292.

Monahan, J. (2003). Violence risk assessment. In A. M. Goldstein (Ed.).

Handbook of Psychology, Volume 11: Forensic

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Psychology (pp. 527-540). NY: John Wiley & Sons.

Monahan, J., & Steadman, H. (Eds.).

(1994). Violence and mental disorder: Developments in risk assessment. Chicago: University of Chicago Press.

Monahan, J., Steadman, H., Silver, E., Appelbaum, P., Robbins, P., Mulvey, E., Roth, L., Grisso, T., & Banks, S. (2001).

Rethinking risk assessment: The MacArthur Study of mental disorder and violence. NY: Oxford University Press.

Quinsey, V. L., Harris, G. T., Rice, M. E., & Cormier, C. (1998). Violent offenders: Appraising and managing risk. Washington, DC: APA. Rice, M. E., & Harris, G. T. (1992). A comparison of criminal recidivism among schizophrenic and nonschizophrenic offenders. International Journal of Law and Psychiatry, 15, 397-408.

Rogers, R. (2000). The uncritical acceptance of risk assessment in forensic practice. Law and Human Behavior, 24, 595-605.

Rudnick, A. (1999). Relationship between command hallucinations and dangerous behavior. Journal of the American Academy of Psychiatry and the Law, 27, 253257.

Salekin, R. T., Rogers, R., & Sewell, K. W. (1996). A review and meta-analysis of the Psychopathy Checklist and Psychopathy Checklist-Revised: Predictive validity of dangerousness. Clinical Psychology: Science and Practice, 3, 203-215.

Serin, R. C., & Amos, N. L. (1995). The role of psychopathy in the assessment of dangerousness. International Journal of Law and Psychiatry, 18, 231-238.

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Seto, M. C., & Barbaree, H. E. (1999).

Psychopathy, treatment behavior, and sex offender recidivism. Journal of Interpersonal Violence, 14, 1235-1248.

APPENDIX B

Skeem, J., & Mulvey, E. (2001).

Psychopathy and community violence among civil psychiatric patients: Results from the MacArthur Violence Risk Assessment Study. Journal of Consulting and Clinical Psychology, 69, 358-374.

A. Hare Psychopathy Checklist-Revised (PCL-R)

Slovic, P., Monahan, J., & MacGregor, D. G. (2000). Violence risk assessment and risk communication: The effects of using actual cases, providing instruction, and employing probability versus frequency formats. Law and Human Behavior, 24, 271-296.

Steadman, H., Mulvey, E., Monahan, J., Robbins, P., Appelbaum, P., Grisso, T., Roth, L., & Silver, E. (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry, 55, 393-401.

Swanson, J., Borum, R., Swartz, M., Monahan, J. (1996). Psychotic symptoms and disorders and the risk of violent behavior in the community. Criminal Behavior and Mental Health, 6, 317-338.

Webster, C. D., & Jackson, M. A. (Eds.). (1997). Impulsivity: Theory, assessment, and treatment. NY: Guilford Press.

Weiner, I. B. (1999). Writing forensic reports. In A. K. Hess & I. B. Weiner (Eds.). The Handbook of Forensic Psychology (pp. 501-520). NY: John Wiley & Sons.

RISK ASSESSMENT INSTRUMENTS

This instrument was developed by Robert Hare and his colleagues to assess the psychopathic personality, as characterized

by Hervey Cleckley, and not necessarily the antisocial personality envisioned in the DSM-IV. It is a combination of interview and a review of collateral information. It generally takes several hours to complete.

To assure reliability, the author recommends rather extensive training before using the instrument, which includes attending a three-day workshop, completing some videotaped test cases, and taking a written test. This is one of the few instruments on the market with very promising predictive validity regarding violence.

Reference Hare, R. D. (1996). Psychopathy: A clinical construct whose time has come.

Criminal Justice and Behavior, 23, 25-54.

Source Multi-Health Systems, Inc. 908 Niagara Falls Blvd.

North Tonawanda, NY 14120-2060 Web Address www.hare.org

B. HCR-20 The Historical/Clinical/Risk Management Scheme was developed on the basis of an earlier instrument (the Dangerousness Behavior Rating Scale). It is a checklist rather than a test and includes twenty items: ten historical, five clinical, and five

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future risk management. It was designed for clinicians working with persons suffering from mental and personality disorders, whether or not they also have criminal histories. It correlates moderately with the PCL-R and the VRAG but does measure slightly different constructs.

Source Webster, C. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). HCR-20: Assessing risk for violence (version 2).

Vancouver: Mental Health, Law, and Policy Institute, Simon Fraser University.

Reference Webster, C. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). Assessing risk of violence to others. In C. D. Webster & M. A. Jackson (Eds.). Impulsivity: Theory, assessment, and treatment (pp. 251-277).

NY: Guilford Press.

C. JJPI-Maine Juvenile Sex Offender Assessment Protocol (JSOAP)

D. Level of Service Inventory-Revised (LSI-R)

The JSOAP is an actuarial instrument consisting of four rationally-derived factors, two historical and two dynamic. Initially designed to assess change, it is administered before and after treatment. It includes variables from the Adolescent Psychopathy Taxon Scale developed by Grant Harris and his colleagues. It is still in the research stage, but some initial findings regarding reliability and validity have been positive.

This instrument was researched and developed for use in risk and needs assessment for general offenders. It is for use with persons sixteen and older for treatment planning and placement. It consists of a structured interview and an expert-rating form and generally takes 30 to 45 minutes to complete. A screening version (LSI-R-SV) has been constructed, as well as a computer application.

Reference Prentky, R. A., Harris, B., Frizzell, K., & Righthand, S. (2000). An actuarial procedure for assessing risk with juvenile sex offenders. Sexual Abuse: A Journal of Research and Treatment, 12, 71-93.

Reference Andrews, D. A., & Bonta, J. (1995).

LSI-R: The Level of Service InventoryRevised. Toronto, Ontario, Canada: MultiHealth Systems, Inc. Source Multi-Health Systems, Inc. 908 Niagara Falls Blvd.

North Tonawanda, NY 14120-2060

Visit www.helper.com today to download your free trial version, or just call 1-800-343-5737.

Plus, if you mention code TPFA03, you’ll get 15% off your purchase of Therapist Helper software.

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E. Minnesota Sex Offender Screening Tool - Revised (MnSOST-R) The MnSOST-R is a 16-item inventory developed for use by the Minnesota Department of Corrections. As developed in 1996, it is based upon actuarial data and very different from the original MnSOST protocol developed in 1991, which was primarily based on clinical observations.

The instrument includes 12 static and four dynamic variables and was designed to be completed by persons such as case managers. Suggested cut off scores are provided and matched with expected rates of recidivism. Given this is a relatively new instrument, research has been limited and done primarily by those who developed it.

Source Minnesota Department of Corrections CD/SO Services Unit 1450 Energy Park Drive, Suite 200 St. Paul, MN 55108-5219

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Reference Epperson, D. L., Kaul, J. D., & Hesselton, D. (1998, October). Final report of the development of the Minnesota Sex Offender Screening Tool-Revised (MnSOST-R). Presentation at the 17th Annual Research and Treatment Conference of the Association for the Treatment of Sexual Abusers, Vancouver, B. C., Canada.

Source Hanson, R. K. (1997). The development of a brief actuarial scale for sexual offense recidivism (User Report No. 1997-04).

Ottawa, Ontario, Canada: Department of the Solicitor General of Canada.

Reference Hanson, R. K. (1998). What do we know about sex offender risk assessment?

Psychology, Public Policy, and Law, 4, 50-72.

F. Rapid Risk Assessment for Sexual Offense Recidivism (RRASOR) This is a brief actuarial scale created from four variables found through metaanalysis to independently predict recidivism among sex offenders. These include: prior sexual arrests (most heavily weighted), age, targeting of male victims, and whether any victims were unrelated to the offender. Taken together these variables still correlate only moderately with sex offender recidivism.

G. Sex Offender Risk Appraisal Guide (SORAG) This is a 14-factor risk assessment instrument developed by the Canadian research group responsible for the VRAG. In its current form, it includes administration of the Hare Psychopathy Checklist-Revised and the penile plethysmograph. It necessitates collection of accurate historical data, but can be

Couples Enrichment Weekend with Drs. David Schnarch & Ruth Morehouse Dallas, Texas September 19-21, 2003 9am - 5pm daily

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Texas Psychologist

21

completed without substantial cooperation by the offender. It is designed to assess the probability that a sex offender is apt to recidivate.

Reference Quinsey, V. L., Harris, G. T., Rice., M. E., & Cormier, C. (1998). Violent offenders: Appraising and managing risk. Washington, DC: American Psychological Association.

H. Spousal Assault Risk Assessment Guide (SARA) This instrument was developed by the risk assessment research group at Simon Fraser University in British Columbia. It recognizes that persons who principally assault their spouses are a heterogeneous population, but also may be quite different from those who engage in other types of assault. It is brief — twenty items and two summary ratings. It has four sections and a five level scoring system. It is not a test, per se, but rather a checklist to assure that all pertinent information is considered.

Source Kropp, P. R., Hart, S. D., Webster, C. D., & Eaves, D. (1995). Manual for the Spousal Assault Risk Assessment Guide (2nd. ed.).

Vancouver: British Columbia Institute on Family Violence.

Reference Kropp, P. R., & Hart, S. D. (2000). The Spousal Assault Risk Assessment (SARA) Guide: Reliability and validity in adult male offenders. Law and Human Behavior, 24, 101118.

I. Static-99 One of the more recent sex offender risk assessment instruments, it combines items from the RRASOR and the SACJ-Min. Studies thus far indicate that its predictive accuracy exceeds that of both the previous instruments alone. It is based completely on

22

Texas Psychologist

static variables, including prior sexual offenses, unrelated victims, stranger victims, male victims, age, never married, non-contact sexual offenses, prior sentences, current nonsexual violence, and prior non-sexual violence.

It is designed to measure long-term risk potential.

Source R. Karl Hanson, PhD Corrections Research Department of the Solicitor General of Canada 340 Laurier Ave. West Ottawa, Ontario, Canada Reference Hanson, R. K., & Thornton, D. (1999).

Static-99: Improving actuarial risk assessments for sex offenders. (User Report 9902). Ottawa: Department of the Solicitor General of Canada.

Web Address www.sgc.gc.ca J. Structured Anchored Clinical Judgment (SACJ-Min) Also known as “the Thornton,” this instrument was designed to assess the risk of sex offender recidivism on the basis of a stage approach. Stage One considers official convictions, Stage Two considers potentially aggravating factors, and Stage Three considers treatment variables (usually only available on those who have been in a sex offender treatment program.) Available research is limited and conducted primarily by the developer.

Source David Thornton Offender Behaviour Programmes Unit Room 701, HM Prison Service Abell House John Islip Street London SW1P4LH

Reference Grubin, D. (1998). Sex offending against children: Understanding the risk. Police Research Series Paper 99. London: Home Office.

K. SVR-20 The Sexual/Violence/Risk instrument was developed by the risk assessment researchers at Simon Fraser University in British Columbia.

It is a checklist designed to assess the risk of future sexual violence by examining psychosocial adjustment, past sexual offenses, and future risk management options.

Source Boer, D., Hart, S., Kropp, R., & Webster, C. (1997). Manual for the Sexual Violence Risk B 20. Simon Fraser University: Mental Health, Law, and Policy Institute, Burnaby, British Columbia.

L. Violence Risk Appraisal Guide (VRAG) This approach was developed by Christopher Webster, Grant Harris, Marnie Rice, Catherine Cormier, and Vernon Quinsey in Canada. It was originally published as the Violence Prediction Scheme.

It includes administration of the Hare Psychopathy Checklist-Revised. It has been validated primarily on populations of violent offenders.

Source Webster, C. D., Harris, G. T., Rice, M. E., Cormier, C., & Quinsey, V. L. (1994). The violence prediction scheme: Assessing dangerousness in high risk men. University of Toronto: Centre of Criminology.

M. Youth Level of Service/Case Management Inventory This is a guide developed at Carleton University to assist those tasked with the management of potentially violent juveniles.

It is divided into nine sections and includes

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prior offenses, family circumstances, education, employment, peer relationships, substance abuse, personality variables, interests, and attitudes. It is designed as an aid and not a psychometric instrument.

variables (the project used a total of 134).

Software is under development that is expected to make the approach user-friendly.

The research is specifically targeting the population with serious mental illness.

Reference Hoge, R., & Andrews, D. (1996).

Assessing the youthful offender. NY: Plenum Press.

References Monahan, J., Steadman, H. J., Silver, E., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., Roth, L. H., Grisso, T., & Banks, S. (2001). Rethinking risk assessment: The MacArthur Study of mental disorder. Oxford: Oxford University Press.

Steadman, H. J., Silver, E., Monahan, J., Appelbaum, P. S., Robbins, P. C., Mulvey, E. P., Grisso, T., Roth, L. H., & Banks, S. (2000). A classification tree approach to the development of actuarial violence risk assessment tools. Law and Human Behavior, 24, 83-100.

N. Iterative Classification Tree This is an approach being studied by the MacArthur group. Unlike most currently available risk assessment instruments, which are based upon main effects linear regression models, this approach utilizes a decision tree.

The developers argue that the typical linear regression model is a “one size fits all� approach, assuming that the same risk factors are applicable to everyone and applicable to the same degree. Using a decision tree allows the evaluator to include a wide range of

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O. Structured Assessment of Violence Risk in Youth (SAVRY)

The design of the SAVRY is modeled after existing assessment protocols for adult violence risk (e.g., the HCR-20), but the item content is focused specifically on risk in adolescents. It is composed of 24 items (Historical, Individual, and Contextual) drawn from existing research and professional literature in adolescent development and on violence and aggression in youth. An additional five protective factors are also provided.

The Individual and Social/Contextual sections emphasize dynamic risk/need factors.

Source Randy Borum, Psy.D., ABPP Department of Mental Health Law & Policy Florida Mental Health Institute University of South Florida 13301 Bruce B. Downs Blvd.

Tampa, FL 33612 borum@fmhi.usf.edu

Texas Psychologist

23

A PRACTICAL GUIDE TO RISK ASSESSMENT

First Name:

Last Name:

Degree:

Mailing Address: City/State/Zip: E-mail:

Phone:

Visa/MC/Amex/Discover:

Exp. Date:__________

Check #: Signature:

Date:

Risk Assessment Review Test 1. The U.S. Supreme Court suggested specific criteria for evaluating evidence presented by experts in the case of: a.

Barefoot v. Estelle.

b.

Estelle v. Smith.

c.

Daubert v. Merrill Dow Pharmaceuticals.

d.

Kumho v. Carmichael.

2. In Texas, consideration of future risk for violence is required by law in: a.

the sentencing phase of death penalty cases.

b.

the determination of competence to be executed.

c.

all evaluations done for the juvenile justice system.

d.

child custody evaluations.

3. Research indicates that the psychopathology most predictive of future violent behavior is: a.

antisocial personality disorder.

b.

psychopathy.

c.

command hallucinations.

d.

mania.

4. Forensic risk assessments should not be performed by:

24

a.

the therapist of the person being evaluated.

b.

an evaluator who is not board certified.

c.

an evaluator of a different cultural background than the person being evaluated.

d.

an evaluator who is not trained in projective techniques.

Texas Psychologist

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5. According to the DSM-IV-TR, one reason diagnoses may be of limited value in forensic cases is: a.

diagnoses cannot be established beyond a reasonable doubt.

b.

diagnostic impressions are generally unreliable.

c.

jurors often do not understand diagnostic labels.

d.

diagnoses do not establish whether an individual has control of his or her behavior.

6. One researcher who has expressed the opinion that clinical judgment should be completely replaced by actuarial assessment is: a.

Vernon Quinsey.

b.

Robert Hare.

c.

Karl Hanson.

d.

Thomas Litwack.

7. Use of an actuarial risk assessment instrument almost always requires: a.

the availability of computer technology.

b.

extensive, accurate records.

c.

a comprehensive interview.

d.

collateral interviews with family members.

8. The most appropriate instrument to use in assessing psychopathy is: a.

the MMPI-2.

b.

the MCMI-III.

c.

the PAI.

d.

the PCL-R.

9. Research has demonstrated that: a.

there is no relationship between violence and mental illness.

b.

persons with schizophrenia are at higher risk for violence than persons who are diagnosed only with personality disorders.

c.

substance abuse is a stronger predictor of violence than schizophrenia.

d.

base rates for violence among persons with major mental illnesses exceed 50 percent.

10. Risk management is the effort to:

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a.

establish base rates for specific types of violent behavior.

b.

develop strategies to reduce identified risk factors.

c.

contain individuals identified as being at risk for violence.

d.

develop actuarial instruments that predict treatment outcome.

Texas Psychologist

25

Evaluating Competence to Stand Trial: The Rules Have Changed Mary Alice Conroy, PhD, ABPP (forensic) Sam Houston State University

During the recent legislative session, a totally revised version of the Texas Code of Criminal Procedure, was passed and signed into law by the Governor. The new requirements also apply to the evaluation of juveniles for fitness to proceed under Section 51.20 of the Texas Family Code.

Although the act does not take effect until January 1, 2004, the qualifications specified for evaluators to be appointed by the court may require some advance preparation. In addition to qualifications of experts, the new law specified elements to be evaluated, revised the reporting requirements, codified a number of ethical standards, and added to the court’s authority in restoring a defendant to competence.

Qualifications for CourtAppointed Experts The impetus for specifying qualifications came from a project that collected forensic reports completed by a variety of evaluators from various areas of the state. The quality of these evaluations varied widely, with some excellent products and some in which the evaluator seemed unaware of even the basic definition of competence to stand trial.

Research revealed 16 other states that have established various models by which they qualify forensic examiners, and a taskforce was appointed by the governor to develop requirements for Texas. This resulted in a law mandating education, licensure, and ongoing training.

To be qualified for court appointment to evaluate trial competence, the disinterested expert must be a psychiatrist or psychologist (doctoral-level) who is currently licensed to practice in the state of Texas. Training requirements can be met in several ways.

Board certification in forensic practice, either by the American Academy of Psychiatry and the Law (AAPL) or the American Board of Professional Psychology (ABPP), is

26

Texas Psychologist

sufficient. Absent of board certification, the practitioner can meet training requirements with a base of 24 hours of continuing education, relevant to this type of forensic evaluation, and six hours in the 24 months immediately preceding the appointment. There is also a “grandfathering” provision for those who have been active in forensic practice for at least five years that requires only eight hours of continuing education in the 24 months preceding the appointment.

requiring the movant to provide the indictment or information, along with supporting documents, and relevant mental health records.

Elements to Evaluate

Reporting Requirements

The standard for competence to stand trial, or fitness to proceed in the case of juveniles, remains the same, based on that articulated by the U. S. Supreme Court in the case of Dusky v. U. S. (1960). However, the law further breaks down and operationalizes the rational and factual prongs, consistent with current forensic literature. Specifically, the expert must examine the defendant’s capacity — as opposed to willingness — to: 1) understand the charges and potential consequences, 2) disclose to counsel, 3) make necessary legal decisions, 4) understand the adversarial nature of the proceedings, 5) behave appropriately, and 6) testify.

An analysis of these elements requires not only a clinical examination but access to sufficient collateral information. In this regard, the new law assists the examiner by

Previously, the statute required two reports — one containing the competence evaluation and the other outlining the mental condition, treatment recommendations, and information regarding whether the defendant would meet the state’s requirements for civil commitment. The new law allows this information to be combined into a single report. In addition to a discussion on the elements of competence, however, the evaluator must explain any linkage between these and mental deficits found in the defendant. The report must also include the reason for referral, documentation of initial disclosures made to the defendant (e.g., purpose of the evaluation, limits of confidentiality), description of procedures used in the evaluation, and treatment options. Texas law also requires the evaluator to provide an

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ultimate issue opinion or to explain why such an opinion could not be reached.

Finally, the statute specifies that copies of the report are to be forwarded to the prosecutor and the defense attorney, as well as to the judge. The ultimate issue may be decided by the judge, as the new law eliminates the absolute requirement for a jury hearing.

Ethical Concerns The new law codifies several procedures that have been considered good forensic practice for some time. It mandates that forensic evaluators will not be appointed prior to the appointment of defense counsel.

No clinician involved in the treatment of the defendant should be involved in the case as a forensic evaluator. Although a single expert can be ordered to address both competence to stand trial and sanity at the time of the offense, these issues must be addressed in separate reports. In addition, should an

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evaluator opine that a defendant is not competent to stand trial, the expert is prohibited from proceeding with a sanity evaluation until such time as the individual is restored to competence.

Restoration of Competence The statute includes detailed procedures for treatment to restore competence, reevaluation, and further commitments. It also addresses the problem of defendants who are hospitalized, restored to competence, and returned to the appropriate county for trial, but who subsequently refuse to continue psychotropic medication that is specified in the continuity of care plan. Such individuals frequently relapse in jail settings and are once again incompetent by the time the case is ready to proceed. Under the revised statute, jail personnel are required to report the refusal, and following further evaluation and a hearing, the court may order the

person to comply with the medication regimen prescribed.

Conclusions The newly minted Article 46.02 of the Texas Code of Criminal Procedure makes a number of significant changes to the way competence to stand trial examinations have been traditionally conducted. The statute is lengthy and much more detailed than space for this brief summary allows. Those involved in, or contemplating becoming involved in, such evaluations will want to read it in its entirety. Further discussion about and information regarding evaluations under the new law will be provided at the TPA Convention in the workshop addressing competence to stand trial. âœŻ

Texas Psychologist

27

LAW

More on Sexual Exploitation and the Duty to Report Sexual Abuse

by Any Mental Health Service Provider Sam A. Houston

As discussed last issue, you have a duty to report sexual exploitation by any mental health service provider. You should also be aware that there are civil and administrative penalties that may be imposed on you if you, or your employees, engage in sexual exploitation of your clients.

Chapter 81 of the Civil Practices and Remedies Code details the liability of a mental health service provider for sexual exploitation.

The statute makes a mental health service provider liable to a patient (or former patient) for damages of sexual exploitation if the patient suffers, directly or indirectly, “a physical, mental or emotional injury caused by, resulting or arising out of (1) sexual contact; (2) sexual exploitation; or (3) a therapeutic deception.”

Sexual contact includes any sexual contact, sexual intercourse, or requests for sexual relations. Sexual exploitation is defined as a “pattern, practice or scheme of conduct, which may include sexual contact that can reasonably be construed as being for the purposes of sexual arousal or gratification or sexual abuse of any person.” The term does not include obtaining information about a patient’s sexual history within accepted practice standards while treating a sexual or marital dysfunction. Therapeutic deception means “a representation by a mental health service provider that sexual contact with, or sexual exploitation by the mental health service provider, is consistent with or part of a patient’s or former patient’s treatment.”

You should also be aware, that you may be liable under this statute for any sexual exploitation by any mental health providers you employ. You may incur liability for failure to make inquiries of known former employers of that employee, within the five years prior to the date of disclosure, concerning any possible occurrences of sexual exploitation. Thus, it is advisable to make inquiries of all former employers, specifically with regard to any history of sexual exploitation.

Also, you will be held liable if you know or have reason to know that the employee engaged in sexual exploitation 28

Texas Psychologist

of a patient, and you failed to report the suspected sexual exploitation or take necessary action to stop the sexual exploitation.

In some situations, you may even be liable for the actions of former employees if a patient is injured by that former employee and the following is shown: (1) you knew of occurrences of sexual exploitation by the mental health service provider of the patient or former patient; (2) you received a specific request by an employer or prospective employer of the mental health service provider; and (3) you failed to disclose that occurrence.

A patient who prevails in a suit under this statute may recover actual damages, which include mental anguish, even if no injury other than mental anguish is shown. In addition, the plaintiff may recover exemplary damages and reasonable attorneys’ fees. It is noteworthy that it is not a defense under this statute that the patient consented or that sexual exploitation occurred outside therapy or treatment sessions.

Finally, there are requirements under the Board Rules prohibiting dual relationships and requiring disclosure pursuant to law. Thus, you must take special care, in addition to maintaining your own professional relationship with your clients, to ensure that your employees maintain professional relationships. You must be ever diligent of what occurs within your practice and make certain that you candidly relate any actual knowledge of sexual exploitation, both in your duty to report and in your dealings with prospective employers of former employees.

The statute in question is Section 81.002 et al. of the Texas Civil Practices and Remedies Code.

If you have time, it would be a good idea to read through the statute and its many provisions.

Please call me at 713/650-6600 if you are interested in applying for our telephone consultation program. You can also e-mail me at shouston@crusescott.com.

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T PA M E M B E R BENEFITS w w w. t e x a s p s y c . o r g • Are you in the market for professional liability insurance?

Call TPA’s preferred vendor, American Professional Agency, 800-421-6694.

• Discounted Legal Consultation Service: Sam A. Houston 713-650-6600.

• List serve subscription for timely updates.

• Legislative support: We are your voice before the Texas State Legislature, Governor, Texas State Board of Examiners of Psychologists, and Congress.

• Professional counsel: Executive Director on staff to answer member questions and requests for information concerning professional affairs, including (but not limited to) ethics, insurance /managed care, and practice management.

• Subscription to the Texas Psychologist. Your quarterly journal is designed to provide you with the most current information about professional news and practice changes in the state.

The Texas Psychological Foundation The mission of the Texas Psychological Foundation is to fund initiatives that advance the field of psychology and research to the benefit of all Texans. An example of recent Foundation activity was the Town Hall on School Violence at the TPA Annual Convention in October, 2001. The Town Hall brought a diverse group of professionals including judges and school leaders along with teens and parents from the community to establish a framework to deal with violence in the school setting.

The Foundation accepts gifts, memorials that honor colleagues, family members and friends, and bequests from estates. Gifts or bequests may include cash, securities or insurance proceeds. The Foundation is available to assist individuals in establishing memorials or bequests from an estate. All contributions to the Foundation are tax deductible.

The Foundation accepts both general and earmarked contributions.

Earmarked donations can be made to the following designated funds: ❑ Schoenfeld-McCann-Schmidt-Ehrisman Fund for Ethics Education: Provides education in ethics in the field of psychology in the state of Texas; ❑ Rose Costello Education Fund: Provides awards for furthering education in psychology; ❑ Roy Scrivner Gay, Lesbian and Bisexual Issues Award: Provides an annual award for the best student paper on gay & lesbian research issues; ❑ Bo and Sally Family Psychology Research Award: Provides awards for research projects related to family psychology; ❑ TPA/TPF-Student Merit Research Awards: Given to one graduate student and one undergraduate student to defray costs of meritorious research projects; ❑ Alexander Award: Provides an award for the best paper submitted by a graduate student in psychobiology, psychophysiology and related areas; ❑ Manuel Ramirez III Dissertation Award for Ethnic Minority Research: Provides awards for research projects related to Minority Psychology.

Please complete the following to make a contribution or request further information: NAME

ADDRESS

CITY

ZIP

IN HONOR OF

AMOUNT OF DONATION

• Continuing education: We offer both live and home study at substantially discounted member rates.

• Fee collection service: I.C. System 800-325-6884.

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CONTACT ME TO DISCUSS A DONATION

Make check payable to Texas Psychological Foundation and mail to 1011 Meredith Dr., Ste. 4, Austin, TX 78748.

Texas Psychologist

29

New Members The following individuals joined TPA between April 1, 2003 and June 25, 2003.

TPA welcomes all of our new members.

Members

Gloria Miller, PsyD Jeffrey Napier, PsyD Joellen Peters, PhD Sonia Simon, PhD

Joan Biever, PhD Kier Bison, PhD Larry Brownstein, PhD Jenifer Burgess, PsyD Lyle Cadenhead, PhD Anitra DeMoss, PhD Sid Dickson, PhD John Golden, PhD Henry Hanna, PhD Berit Johnson, PhD Lisa Lind, PhD Alice Lottes, PhD Anne Miller, PhD

Associates Linda Allen, MS Dana Truman-Schram, MA

Crystal Hill, MS Rose Huber, BA Helena Huckabee, PhD Johannah Masters Robert Montes Ivana Radovancevic Sunetra Tarafdar Alessandra Wall, PhD Kenneth Whitton

Students Daniel Altman, MS Trisha Bement Rachael Chauncey David Gillian

Publications Susan Bridges, MA

Training Workshops presented by Dr. Donna Smith The Psychological Corporation ESC Region 1 ESC Region 2 ESC Region 3 ESC Region 4 ESC Region 5 ESC Region 6 ESC Region 7 ESC Region 8 ESC Region 9 ESC Region 10 ESC Region 11 ESC Region 12 ESC Region 13 ESC Region 14 ESC Region 15 ESC Region 16 ESC Region 17 ESC Region 20

30

Edinburg Corpus Christi Victoria Houston Silsbee Huntsville Kilgore Mt. Pleasant Wichita Falls Richardson Fort Worth Waco Austin Abilene San Angelo Amarillo Lubbock San Antonio

Texas Psychologist

10-Nov 18-Nov 4-Sep 9-Dec 10-Dec 23-Oct 30-Oct 5-Dec 2-Dec 25-Sep 23-Sep 20-Oct 17-Sep 21-Oct 15-Sep 21-Aug 8-Sep 30-Sep

11-Nov 1-Oct 15-Jan

4-Mar

3-Jun

26-Sep 28-Oct

3-Nov

4-Nov

17-Oct

27-Oct

Contact the Special Education Assessment Specialist at your Regional Service Center to register or for more information.

14-Oct

A workshop fee may be charged at some centers.

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2003 PSY-PAC Contributors April 1, 2003 – June 25, 2003 $1000

Lyle Cadenhead, PhD

Under $100

James Quinn, ThM, PhD

Elaine Calaway, PhD

Richard Fulbright, PhD

Linda Calvert, PhD

Geroge Faibish, PhD

$500-$999

Michael Duffy, PhD, ABPP

Martin Ancona, PhD Student

Houston Psychological Association

Ann Friedman, PhD

Alexandria Doyle, PhD

Charles Gray, PhD

Anette Edens, PhD

$100-$499

Sophia Havasy, PhD

Stuart Nathan, PhD

Cheryl Hall, PhD

Swen Helge, PhD

Harriet T. Schultz, PhD

Ethel Hetrick, PhD

Scott Hickey, PhD

Sam Buser, PhD

Kyle Babick, PhD

Christopher Klaas, PhD

Lois Graham, PhD

Pauline Clancy, PhD

Mark Lehman, PhD

Mark Wernick, PhD

Dean Paret, PhD

Patricia Martinez, EdD

Sylvia Gearing , PhD

Muriel Meicler, PhD

Sally Porter, EdD

Patricia Weger, PhD

Joan Anderson, PhD

Nannette Stephens, PhD

Terri Chadwick, PhD

Elizabeth Barry, PhD

Joan Weltzien, EdD

Elizabeth Fowler, EdD

Patricia Barth, PhD

Dorothy Pettigrew, PsyD

Robin Burks, PhD

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Texas Psychologist

31

TPA HAS PUBLISHED

Texas Law and the Practice of Psychology The new edition, Texas Mental Health Law: A Sourcebook for Mental Health Practitioners, is the most comprehensive book for mental health practitioners ever published. Get the latest information on supervising, ethics, subpoenas, confidentiality, and more. If you have never purchased a reference book on the laws that pertain to your practice...the time to do so is NOW!

The book costs $35.00. Order your copy today!

Please e-mail orders@bayoupublishing.com or call 800-340-2034 to order your copy!

E-mail Updates

Does TPA have your e-mail address?

If not, you could be missing out on

@

important announcements about upcoming CE opportunities and

numerous other important updates.

If you have not been receiving

announcements from us via e-mail, then we don’t have your current

address. To have your e-mail address added, send your updated address to admin@texaspsyc.org.

32

Texas Psychologist

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Minimum Professional Qualifications include a PhD or PsyD in Clinical Psychology from an APA approved training program and a Texas Psychology License. Necessary experience includes: administration of nonverbal IQ tests, diagnosis of PDD, mood/anxiety disorders, etc in early childhood, skill in use of parent guidance and coaching, crisis management with suicide and child abuse. Prefer ABPP in Neuropsychology, Texas LSSP, Fluency in Spanish and/or Sign Language may be eligible for a one-time hiring bonus. Contact Dr. Teresa Nezworski, Search Committee Chair at 214-905-3040 or nezworsk@utdallas.edu.

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week) to do assessment and treatment in nursing homes. We have 400 contracted facilities in Texas we serve, throughout the state. Visit our web site: www.vericare.com. Please send your C.V./resume to Vericare (Formerly Senior Psych Services): E-Mail: lvanderveen@vericare.com, FAX: (800) 503-3842, PHONE: (800) 508-5151.

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33

TEXAS PSYCHOLOGICAL ASSOCIATION 2003 ANNUAL CONVENTION

NOVEMBER 6 - 8 DALLAS, TEXAS THE WESTIN GALLERIA

Be sure to check out the included convention program.

For more information, call

888.872.3435 512.280.4099 or visit www.texaspsyc.org.