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Article Title
Developing Consensus for Culturally Informed Forensic Mental Health Assessment: Experts’ Opinions on Best Practices
Authors
Abstract
Objective: Individuals with minoritized identities are overrepresented in legal system contexts; thus, forensic mental health professionals conduct evaluations of examinees with a diversity of identities. Professional and ethical guidelines direct that these evaluations be completed in a culturally informed manner, yet many professionals still identify a need for specific guidance on how to do so. In the present study, we sought to establish consensus regarding best practices in incorporating culture into forensic mental health evaluations. Hypotheses: Given the exploratory nature of this research, no formal hypotheses were tested. We expected that participants would concur that some practices are important to completing culturally informed forensic evaluations. Method: We recruited two samples. Nine people with joint expertise in cultural considerations and forensic evaluations participated in a Delphi-type poll. More than half reported a minoritized racial/ethnic identity, and all identified as a man (56%) or woman (44%). Experts were surveyed regarding importance (two rounds) and relevance (one round) of recommended practices. They contributed seven additional relevant practices. Twenty-one board-certified forensic psychologists completed a one-time survey of their perceptions of best practices. These psychologists primarily identified as White (90%), and most did not identify as Hispanic or Latine (80%). They all identified as men (45%) or women (55%). This sample was asked to rate the importance of a list of practices refined during the Delphi-type poll. Results: The majority of practices were considered important or very important by experts and board-certified psychologists. Consensus is most clear for 28 practices with means, medians, and modes all in the “important” to “very important” range at all time points. Conclusions: There is wide agreement on the importance of particular methods for incorporating cultural considerations in each phase of the forensic evaluation process. Forensic psychologists can use this information to self-evaluate and improve their practice and to inform training.
Keywords
forensic mental health assessment, culture, cultural competence, cultural humility
Summary of Research
The central goal of this study is to establish consensus recommendations that are universally applicable across a range of forensic mental health assessment contexts. The research employs a modified Delphi approach involving expert input and iterative feedback rounds to discern best practices in conducting culturally informed forensic assessments.
A significant focus of this research is on the concept of cultural competence, defined as the understanding of how cultural factors shape a person's worldview, practices, and social interactions. This understanding is essential in providing effective and ethical services in forensic psychology. Moreover, it is a continuous learning process throughout a professional's career. This concept is reinforced by the American Psychological Association (APA) ethical principles and specialty guidelines, which underline the importance of recognizing and respecting clients' diverse cultural, individual, and role differences.
Furthermore, the research underscores the ethical obligation of forensic evaluators to consider the sociocultural identities of those they assess, aligning with the standards and principles outlined in the APA's moral code. It emphasizes the critical role of cultural humility, acknowledging that there is always more to learn about the cultural factors affecting both the examiner and the examinee.
In addition to emphasizing the need for cultural competence, this research recognizes the significance of general and specific guidelines for culturally informed practice. It highlights the ongoing process of self-reflection, urging forensic psychologists to remain informed about the scholarly advancements concerning the impact of various identities and to maintain a commitment to providing assessment services free from bias.
Furthermore, this study endorses an active role for psychologists in combating biases against individuals with minoritized identities, in alignment with recent APA resolutions addressing issues such as racial injustice. This proactive approach is particularly pertinent in forensic practice, where evaluators must be vigilant in identifying and mitigating potential sources of bias throughout the assessment process.
The research highlights the urgency for establishing transparent, evidence-based guidelines that promote culturally inclusive forensic practice. It aims to bridge this gap by developing a set of consensus recommendations that comprehensively address each stage of the forensic mental health assessment process, ensuring it is conducted in a culturally informed and sensitive manner. This holistic approach acknowledges the complex interplay between cultural factors and forensic psychology practice and strives to promote more ethical, practical, and unbiased evaluations.
Translating Research into Practice
Meeting the Needs of Forensic Evaluators: The research indicates an intense desire among forensic evaluators to receive more guidance on conducting culturally informed evaluations. This highlights an opportunity to enhance forensic psychology practice by providing the necessary training and resources to meet this demand. Ensuring that professionals have access to the tools and knowledge required for culturally sensitive assessments can significantly improve the quality of forensic evaluations.
Establishing Best Practices: The study's identification of practices with solid support across various stages of the Forensic Mental Health Assessment (FMHA) process offers a foundation for establishing best practices in culturally informed forensic assessments. These practices can serve as essential guidelines for forensic psychologists, enhancing the consistency and effectiveness of their evaluations.
Universal Consensus Practices: Practices with near-universal consensus, such as the importance of considering the limits of one's competence based on an examinee's identity before accepting a referral, should be integrated into forensic evaluators' training and ongoing practice. These practices are directly linked to ethical standards and can contribute to the ethical conduct of assessments.
Focus on Examinees with Limited English Proficiency: There is a strong consensus on practices related to limited English-proficient examinees, emphasizing the need for selecting well-trained and neutral translators. Proper communication and understanding are critical in these cases, ensuring that assessments are accurate and culturally sensitive.
Cultural Awareness in Assessment Tools: The research highlights the importance of continually adapting assessment tools to be culturally sensitive and relevant for individuals with diverse sociocultural identities. This underscores the ongoing need to develop culturally informed. assessment instruments to enhance the quality of forensic evaluations.
Contextual Understanding: Practices rated less important may benefit from providing clear contextual information to explain the rationale behind recommendations. This can lead to a better understanding and acceptance of specific practices, ensuring they are implemented effectively.
Addressing Disparities and Systemic Issues: While some practices related to addressing disparities and systemic issues were rated lower in importance, recent events and a growing awareness of these concerns may warrant a reassessment. Forensic psychologists should stay updated and be open to addressing these issues in their reports when relevant.
Balancing Impartiality and Advocacy: Practices rated as less critical may relate to concerns about impartiality and neutrality in forensic psychology. However, balancing this with the imperative to provide culturally informed, evidence-based assessments is essential. Acknowledging the salient identities of examinees can lead to more accurate and fair evaluations.
Empathy and Warmth: Practices associated with empathy, warmth, and therapeutic interventions were sometimes rated lower in importance, possibly due to concerns about introducing bias. Evaluators should aim to strike a balance between empathy and objectivity, adapting their approach based on the specific needs of examinees.
Diverse Perspectives: Encouraging the inclusion of diverse perspectives in the development of forensic evaluation practices is crucial. Valuing input from professionals with a wide range of experiences and viewpoints can lead to more comprehensive and culturally sensitive evaluations.
Recognition of Varied Opinions: Forensic evaluators should acknowledge the existence of varied opinions regarding culturally informed practices and promote flexibility and adaptability in their assessments to accommodate the diversity of perspectives.
Incorporating Educational and Regional Context: When relevant to the examinee's case, gathering information about the educational system and regional context may be valuable. This context-specific approach can enhance the quality and relevance of assessments.
Expertise and Identity Sensitivity: It is essential to understand that experts' backgrounds and areas of expertise may influence their perceptions of the importance of certain practices. Promoting sensitivity to evaluators' and examinees' diverse identities and experiences can lead to more culturally competent assessments.
Cultural Factors in Treatment and Management Plans: Emphasizing the importance of considering cultural factors in treatment and management plans, mainly when working with diverse examinees, can improve the effectiveness of interventions and strategies.
Reflecting on Identities and Cultural Considerations: It is essential to encourage forensic evaluators to reflect on how their cultural identities and biases may impact the assessment process and data interpretation. This self-awareness is a fundamental aspect of culturally informed evaluations.
Consultation and Supervision: Advocating for the use of consultation and supervision, especially when evaluating individuals from diverse sociocultural backgrounds, can enhance the quality and accuracy of assessments. Seeking guidance and feedback is a valuable practice.
Consent and Notification: Ensuring that consent and notifications are provided in ways that align with the examinee's language, customs, and culture is essential. This practice respects the rights and dignity of examinees by using culturally appropriate communication.
Interpreting Behavioral Data: Recognizing the significance of culture in analyzing behavioral data, examinee attitudes, and test results is vital. Aligning with guidelines that emphasize the consideration of culture in the assessment process can enhance the quality of forensic evaluations.
Cross-Identity Sensitivity: Forensic evaluators should be sensitive to the intersection of the identities of both evaluators and examinees, recognizing that multiple identities can impact the assessment process and the evaluator-examinee relationship.
Adapting to Individual Experiences: Consider asking questions about the individual experiences of examinees rather than making general assumptions about educational systems. This tailored approach can lead to more accurate and relevant assessments.
Incorporating these implications into forensic evaluations will contribute to culturally informed, ethical, and practical assessments, enhancing the quality of forensic psychology practice.
Other Interesting Tidbits for Researchers and Clinicians
The study acknowledges that forensic evaluators need clear guidance regarding best practices for incorporating cultural considerations into the Forensic Mental Health Assessment (FMHA). The list of practices presented in Table 9, largely deemed necessary by the participating professionals, serves as a foundational resource for these practitioners. While the definition of consensus practices was based on specific criteria, evaluators are encouraged to consider all practices rated as critical. This list is expected to evolve, incorporating input and refinements from other clinicians and researchers. Forensic psychology professors and clinical supervisors can utilize it as a framework for training the next generation of evaluators. The study provides a self-report measure and a coding scheme known as the CASK-F to facilitate this process, including the final set of fundamental practices. These tools are free, allowing evaluators to assess their current practices, identify areas for improvement, and seek consultation or training as needed. The CASK-F Coding scheme can be employed to evaluate reports and assess the degree to which these practices are currently used, especially in formulation and report writing. Clinical supervisors can leverage the coding scheme to guide feedback and training for their supervisees while tracking improvements over time. Future endeavors may involve translating these recommended best practices into even more specific guidance for evaluators, ultimately assisting in producing culturally informed and high-quality FMHA. The study also recognizes the broader societal context, emphasizing the importance of psychologists using their professional roles to combat racism. Due to institutional and systemic racism, individuals with minoritized identities will continue to be overrepresented in legal system settings where forensic psychologists offer assessment and intervention services. This project aims to inform efforts to promote cultural humility. These combat biases are beyond the control of both examinees and evaluators and engage in rigorous, impartial evaluations that benefit the legal system.
