Fairness among clinicians: Presence of bias in forensic evaluations

Fairness among clinicians: Presence of bias in forensic evaluations

Additional, preferably early training in recognizing and mitigating potential bias is needed for forensic clinicians. This is the bottom line of a recently published article in Psychology, Public Policy, and Law. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | Psychology, Public Policy, and Law | 2019, Vol. 25, No. 4, 323–330

Forensic clinicians’ understanding of bias

Authors

Nina McLean, University of Massachusetts Medical School
Tess M. S. Neal, Arizona State University
Robert D. Morgan, Texas Tech University
Daniel C. Murrie, University of Virginia

 

Abstract

Bias, or systematic influences that create errors in judgment, can affect psychological evaluations in ways that lead to erroneous diagnoses and opinions. Although these errors can have especially serious consequences in the criminal justice system, little research has addressed forensic psychologists’ awareness of well-known cognitive biases and debiasing strategies. We conducted a national survey with a sample of 120 randomly selected licensed psychologists with forensic interests to examine (a) their familiarity with and understanding of cognitive biases, (b) their self-reported strategies to mitigate bias, and (c) the relation of a and b to psychologists’ cognitive reflection abilities. Most psychologists reported familiarity with well-known biases and distinguished these from sham biases and reported using research-identified strategies but not fictional or sham strategies. However, some psychologists reported little familiarity with actual biases, endorsed sham biases as real, failed to recognize effective bias mitigation strategies, and endorsed ineffective bias mitigation strategies. Furthermore, nearly everyone endorsed introspection (a strategy known to be ineffective) as an effective bias mitigation strategy. Cognitive reflection abilities were systematically related to error, such that stronger cognitive reflection was associated with less endorsement of sham biases.

Keywords

bias, forensic evaluation, survey, cognitive reflection

Summary of the Research

“Bias and judgment errors are problematic in any profession, but in forensic mental health assessments, errors can undermine justice. Biases may have profound implications for defendants’ lives, such as whether defendants are confined in a correctional versus psychiatric facility, how long they are confined, and the final disposition of their cases (e.g., guilty vs. not guilty by reason of insanity). […] Although biases do not necessarily lead to an inaccurate conclusion, reliance on relevant factors (as opposed to irrelevant or biasing information) increases the likelihood of reaching an objective opinion.” (p. 323)

 

“Given the potential impact of bias in legal decision-making, researchers have increasingly examined the presence of bias in forensic mental health evaluations. The primary aim of the current study was to examine the extent to which forensic psychologists are familiar with well-known biases from the broader psychology literature and strategies to mitigate the effects of bias. We explored whether psychologists could discriminate actual from sham biases and bias mitigation strategies. We also investigated individual differences between forensic mental health experts in their cognitive reflection abilities, as well as the relationship between cognitive reflection and knowledge of biases.” (p. 323)

 

“Bias is the systematic deviation from the truth, though it does not necessarily result in error. Laypersons and the legal community have long been skeptical of forensic mental health or medical experts, based on concerns they may be hired guns swayed by adversarial or financial influences. But in reality, such overt partisan bias is probably relatively rare. Instead, implicit bias—automatic bias outside of examiner awareness—is probably a more common and insidious threat to the integrity and objectivity of forensic evaluations.” (pp. 323–324)

 

“Susceptibility to implicit bias and errors in judgment is largely a consequence of mental shortcuts or heuristics that simplify cognitive processing. Like all humans, forensic examiners are susceptible to bias in their professional work. It is possible that forensic evaluators who are more knowledgeable about bias, and more open to workflow practices that minimize the effects of bias, manifest less systematic bias in their work. This project is a first step toward testing this hypothesis, exploring knowledge about common biases among psychologists doing forensic work.” (p. 324)

 

“Researchers have been working to investigate whether forensic psychologists are susceptible to bias, documenting evidence that these professionals are, of course, human and susceptible to human biases, with the goal of developing strategies to mitigate bias. […] Although many of [the] biases are well known in the literature, clinicians are more likely to identify bias in others than in their own work. This tendency to recognize bias among others but remain oblivious to one’s own biases is known as the bias blind spot, a well-known cognitive phenomena documented among laypersons and other professionals, including forensic mental health clinicians.” (p. 324)

 

“To address biases in forensic evaluations, researchers have recommended various bias mitigation strategies. Although many of these strategies are based on research in medical decision-making, they are frequently mentioned as possible methods to reduce bias in forensic mental health evaluations. One such method is sequentially documenting information gathered in interviews (rather than relying on memory for any aspect of the evaluation), which aids in alleviating selective retrieval mechanisms and the fallibility of the examiners’ memory. […] Another method is seeking disconfirming (rather than only confirming) information, as is commonplace during cross-examinations in criminal proceedings.” (pp. 324–325)

 

“Reflective thinking may help mitigate bias. Reflective thinking was described in detail by Frederick (2005), who developed the Cognitive Reflection Task (CRT) to measure the capacity to resist initial incorrect responses and override them with better, deliberative responses. The CRT presents a series of questions designed to elicit incorrect, intuitive answers, as opposed to correct, reflective responses that require more deliberation. Among those who correctly respond to the CRT items, most initially consider the incorrect intuitive answer but are able to override the intuitive incorrect response and reason through to the correct answer. Reflective reasoning may be important for other tasks that pull for quick intuitive judgments, such as clinical reasoning.” (p. 325)

 

“We examined the extent to which forensic psychologists are familiar with forms of bias frequently mentioned in the literature. To distinguish genuine recognition of actual biases from false self-reported familiarity (a social desirability effect in responding), we incorporated sham forms of biases. Likewise, we queried the extent to which forensic psychologists could recognize genuine bias-reduction strategies and distinguish them from sham bias-reduction strategies.” (p. 325)

 

The sample included 120 psychologists, with a mean age of 55.24 (SD = 11.64), predominantly Caucasian (76.3%), with a mean of 18.51 years of experience as a forensic clinician (SD = 11.08). Participant completed the Cognitive Reflection Task, indicated their familiarity with a list of biases (real and sham) and bias-reduction strategies, and responded regarding their own use of bias-mitigating strategies.

 

“In this survey of a national sample of licensed psychologists with forensic interests, psychologists generally endorsed genuine familiarity with well-known biases and research-suggested bias mitigation strategies, as predicted. However, many were less skilled at discriminating between real and misleading strategies. Similar to the case in previous findings, participants in this study (93%) overwhelmingly endorsed the use of introspection as a strategy to mitigate bias.” (p. 328)

 

“The cognitive reflection task was used to measure the ability to question one’s instincts and overcome an intuitive but potentially erroneous response by developing a more reflective response. As predicted, clinicians who were able to suppress spontaneous responses were better able to discriminate research-identified biases from shams. This suggests individual differences between clinicians that may impact bias and bias mitigation in forensic evaluations.” (pp. 328–329)

 

Translating Research into Practice

“Psychological research has demonstrated that people are unable to access higher order processing during introspection that introspection can actually function as a source of a bias blind spot. Of course, we do not claim that forensic psychologists should never attempt to self-examine their motives or their practice, but we do caution that introspection alone—that is, looking inward for bias and finding no indication of bias—is certainly not sufficient to identify or mitigate the effects of bias. Indeed, it likely serves to create a false sense of reassurance. In contrast, seeking behavioral evidence, such as examining patterns of behavior and decisions across cases, is a better method for ferreting out potential bias in one’s judgment.” (p. 328)

“These findings suggest that forensic clinicians are in need of additional training not only to recognize biases but perhaps to begin to effectively mitigate harm from biases. For example, in predoctoral (e.g., internship) and postdoctoral (fellowships), didactic training could address bias, recognizing bias and providing strategies for minimizing bias. Additionally, supervisors could address identifying and reducing bias as a regular part of supervision (e.g., by including this as part of case conceptualization). However, further research is needed to determine the types of training and workflow strategies that best reduce bias. Future studies should focus on experimentally examining the presence of biases and ways to mitigate their effects in forensic evaluations.” (p. 329)

 

Other Interesting Tidbits for Researchers and Clinicians

“What these findings cannot reveal is whether the ability to discriminate actual from sham biases (and correctly define actual biases) relates to any particular ability to mitigate such biases in one’s own judgment. Future research should address whether familiarity with biases helps clinicians actually reduce bias. Does acknowledging bias reduce actual bias? Does explicit description of strategies used to try to minimize bias have any effect on reducing actual bias? Could it backfire, instead resulting in unintentional exacerbation of bias through a process akin to moral licensing? Another important consideration is how these biases and strategies we include are not quite as clear-cut as one might like for them to be.” (p.329)

“These study findings further the understanding of forensic psychologists’ knowledge of research-identified biases and strategies; however, it is not without limitations. Of primary concern is that the biases included in this study were presented via a research study and not as part of a traditional case referral or case material. It is possible (but unlikely) that examiners fail to recognize or endorse bias-mitigating strategies in cognitive exercises such as that used in this study but adequately utilize such strategies in their forensic practice.” (p. 329)

“It is also possible (and perhaps more likely) that clinicians recognize and endorse familiarity with actual biases but fail to recognize them or effectively mitigate their effects in their actual work, consistent with a bias blind spot. In terms of the survey, a number of sham bias terms were vaguely similar to actual biases, which may have caused confusion among some participants. […] In addition, although we programmed a time limit into the survey to reduce the likelihood that participants would consult external sources for definitions or related information, we cannot rule out the possibility that some respondents might have used an Internet search engine to inform their responses.” (p. 329)

“Future studies could utilize multiple methods of recruiting participants or recruit through in-person or paper-based methods versus online recruitment in an effort to increase response rates.” (p. 329)

 

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Authored By Kseniya Katsman

Kseniya Katsman is a Master’s student in Forensic Psychology program at John Jay College of Criminal Justice. Her interests include forensic application of dialectical behavior therapy, cultural competence in forensic assessment, and risk assessment, specifically suicide risk. She plans to continue her education and pursue a doctoral degree in clinical psychology.

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