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Debra A Pinals

Publications and source records attributed to Debra A Pinals.

8 recordsLinked to original sources
PubMed2006

Practical application of the MacArthur competence assessment tool-criminal adjudication (MacCAT-CA) in a public sector forensic setting.

Several instruments have been developed to assess defendants' competence to stand trial (CST). These instruments have become increasingly sophisticated mainstays of CST evaluation research. Less is known, however, about their clinical utility. Continuous quality-improvement (CQI) efforts within forensic practice are one means of helping ascertain the effectiveness and efficiency of the use of these measures, especially in public sector settings. In this article, the authors describe a CQI project examining the use of the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) on an inpatient forensic evaluation service. Results of a small, local CQI project cannot be generalized to all settings. However, from this CQI experience, the authors found the MacCAT-CA to be advantageous in assessing CST in certain defendants. Given some limitations of its practical utility, including its use with defendants putting forth poor effort, those with significant cognitive impairments, and those from various cultural backgrounds, the authors did not find that it would be an efficient practice to utilize the instrument in all CST assessments within a busy, public sector, inpatient forensic evaluation service. Having the instrument available for use as an adjunct to a clinical interview in particular cases may offer the most advantage. In addition, it is a useful tool for educating trainees about complex CST domains. This case-based CQI project reveals some basic strengths and weaknesses of the instrument and offers direction for further exploration in a systematic research study.

Adult↗
PubMed2005

Mental health training for law enforcement professionals.

The purpose of this pilot study was to determine topics of interest and preferred modalities of training for police officers in their work with persons with mental illness. Police officers across Massachusetts attending in-service mental health training were asked to rate the importance of potential mental health topics and the effectiveness of potential training modalities on a Likert-type scale. Additional data collected included the officer's experience, level of education, motivation for attendance, previous attendance of post-academy mental health training, and preferences for length, frequency, training site, and trainer qualifications. A t test was used to determine if there were significant differences (p < .05) between those who volunteered and those who were mandated to attend the training. Repeated-measures ANOVAs were used to determine if there were significant differences (p < .05) between mental health topics and lecture formats and to determine the effect of education and experience on the results. Although all topics suggested were rated, primarily, as fairly important, the topics of Dangerousness, Suicide by Cop, Decreasing Suicide Risk, Mental Health Law, and Your Potential Liability for Bad Outcomes were given the highest ratings. Role-playing was rated significantly lower than other training modalities, while Videos and Small Group Discussion had the highest mean scores. Level of prior education had no significant effect on the ratings, but officers with more experience rated the importance of mental illness as a training topic significantly higher than officers with less experience. This survey suggests that police officers are interested in learning more about working with persons with mental illness and view it as an important aspect of the job.

Adult↗
PubMed2005

Forensic psychiatry fellowship training: developmental stages as an educational framework.

As an official subspecialty of psychiatry, forensic psychiatry residency training must meet the requirements established by the Accreditation Council of Graduate Medical Education. Attendant to these requirements is the expectation that graduates demonstrate core competencies in general areas common to all medical training programs but delineated for each specialty. In forensic psychiatry, trainees must learn to move from the role of healer to objective evaluator on behalf of third parties, a task that differs from general medical care and treatment. Thus, it is important for educators to maintain awareness of the experience of trainees as they adapt to forensic psychiatry, while understanding core competency requirements. This article outlines stages of development of forensic psychiatry fellows as a model for characterizing learning objectives and for supervising trainees in forensic psychiatry fellowship programs. These stages of development include (1) transformation, (2) growth of confidence and adaptation, and (3) identification and realization. Training directors and trainees can utilize this theoretical framework as a basis on which to establish parameters for core competency attainment and supervisory and assessment methods for forensic psychiatry training.

Achievement↗
PubMed2004

Relationship between race and ethnicity and forensic clinical triage dispositions.

OBJECTIVE: Racial and ethnic disparities in the criminal justice system have been widely reported, as have racial and ethnic disparities in diagnoses and certain aspects of clinical management. This study examined the association between race and ethnicity and dispositions for pretrial defendants who were referred for forensic mental health evaluations. METHODS: Available data were reviewed for all defendants in Massachusetts who were referred to a Massachusetts court clinic from 1994 to 2001 for a screening evaluation of their competence to stand trial, their criminal responsibility, or both. Logistic regression models were developed to assess the relationship between defendants' race and ethnicity and the likelihood that they would be referred for inpatient evaluation and the likelihood that they would be evaluated within a strict-security facility. Race or ethnicity of the pretrial defendants was identified by clinicians. RESULTS: Blacks, but not Hispanics, were significantly more likely than whites to be referred for an inpatient evaluation after an outpatient forensic screening evaluation. Among male defendants, both Hispanics and blacks were more likely than whites to be referred for an inpatient evaluation in a strict-security facility, regardless of diagnoses and the level of severity of the criminal charges. CONCLUSIONS: Racial and ethnic disparities in disposition decisions exist within the forensic mental health system. These disparities, however, likely reflect numerous clinician and nonclinician variables.

Adult↗
PubMed2004

Countering countertransference, II: beyond evaluation to cross-examination.

Countertransference is a clinical term introduced by Freud in 1909. For years, despite mounting criticism, forensic psychiatrists borrowed this clinical concept to explain their emotional experiences and responses to examinees' emotions and behavior. The authors describe the impact of examinee and nonexaminee factors during evaluations and beyond, including during trial and while providing forensic testimony. The suggestion is made that using the term countertransference in forensic psychiatry can be problematic. The authors delineate the complexities of the term as related to forensic psychiatry and consider modified terms to provide a better explanation of these concepts in forensic contexts.

Adult↗
PubMed2002

Countering countertransference: a forensic trainee's dilemma.

Forensic psychiatry involves an adaptation to a role that is very different from the psychiatrist's previous clinical experiences. To render an unbiased forensic opinion, psychiatrists have to rise above their countertransference feelings. This takes years of practice and experience. The following is an account of a forensic trainee who faced several countertransference problems as he evaluated a patient charged with attempted murder. The case report is interspersed with a review of the relevant literature.

Adult↗
PubMedDate not supplied

To commit or not to commit: the psychiatry resident as a variable in involuntary commitment decisions.

OBJECTIVE: To study whether psychiatry residents' personal variables (such as age, gender, level of training, previous experience with patient suicide, or lawsuits) and their temperamental predispositions have an impact on their decisions to seek involuntary commitment. METHOD: In a prospective pilot study, all psychiatry residents in Massachusetts were surveyed using a questionnaire that assessed their risk-taking behavior and clinical vignettes of patients with risk of harm to self or others. Data were analyzed using chi-squares and t tests. RESULTS: Level of training and the residents' risk-taking behavior may be linked to their likelihood to seek involuntary commitment. CONCLUSIONS: Psychiatric residency training should address nonpatient variables that might inappropriately influence the residents' decisions to seek involuntary commitment.

Adult↗