Forensic psychology: Part 1: Policy documents

Acknowledgement is extended to Terry Sawatsky, Arden Thurber and Liz Baylis of Correctional Service of Canada, and Nancy Stable forth of the National Parole Board. They participated in the review of psychological services and integrated the information into policy documents.

1. To ensure the provision of psychological services to offenders in order to assist them with the resolution of mental health problems and behavioural disorders and to help them learn and adopt socially acceptable behaviour patterns and to prevent or attenuate their relapse following intervention.

2. Psychological services for offenders shall be available at all institutions and CSC shall facilitate access to essential psychological services for offenders under conditional release in the community. Services shall include:

• assessment;
• therapeutic intervention;
• crisis intervention; and
• program development, delivery and evaluation.

3. Psychological services provided for essential mental health needs shall be comparable to those available in the surrounding community.

4. All psychological services shall focus on the needs of the offender, specifically the behaviour that contributed to criminal activity, on the assessment risk posed by the offender and on strategies to reduce and/or manage risk.

5. All psychological services shall be delivered in accordance with professional standards in the community and compatible guidelines established by CSC, including those services rendered by psychologists under contract.

6. The psychologist is one member of the Unit based multi-disciplinary team responsible for the management of the offender's case.

7. All assessment shall focus on offender risk, need and responsivity and on the management of risk, utilizing a variety of scientifically validated assessment methodologies in an integrated process.

8. As an integral part of the Intake Assessment process, all offenders shall be screened on admission by appropriate personnel to determine which among them require more in-depth assessment. Offenders shall be re-assessed during and following treatment and following any significant crisis situation. Certain offenders will require pre-release assessments.

9. The referral and completion of pre-release assessments shall be such that they are available in time to be incorporated in reports to decision-makers at times of eligibility.

10. The pre-release assessment report must provide an evaluation of the level of risk posed by the offender, provide options for the management of risk and an identification of problems which might be encountered that would increase the risk. If the offender is being considered for release, the report shall also include specific recommendations concerning the continuing need for intervention in the community, including but not limited to psychological services.

11.The psychologist shall remain continually aware that he/she is a consultant to the decision-maker in the evaluation of options rather than the decision maker him/herself.

12. Assessments and interventions shall be both culturally and gender sensitive.

13. Intervention shall be provided in priority to those offenders who require it most, with higher risk/ higher need offenders receiving more intensive treatment. Problem behaviour directly related to criminality and essential mental health needs shall be primary treatment targets.

14. Psychologists will identify treatment targets in keeping with applicable research literature (such as sexual deviation; substance abuse; anger/aggressive behaviour; criminal attitudes, values and beliefs; poor social skills; interpersonal problem solving; empathy deficits; and impulsivity).

15. The delivery of treatment should be matched to methods proven to be effective with offenders, subject to ongoing program development and innovation.

16. Interventions shall be theoretically and empirically based. Programs require clearly articulated admission criteria and individual participants require specific treatment objectives, methods for attaining goals and a strategy for measuring treatment gains. Issues of treatability, frequency of contact and likely consequences of relapse must also be addressed.

17. Treatment shall be aimed at symptom reduction, skill acquisition, the identification of high risk situations, viable coping strategies for offenders and relapse prevention.

18. Documentation must be maintained relating to treatment activities. In addition, psychologists shall submit treatment progress reports and/or treatment summaries as appropriate, in consultation with case management staff.

19. Psychological reports prepared by CSC employees belong to and are under the control of CSC. CSC also has control of psychological reports prepared by outside consultants under contract with CSC where, under the contract, these reports belong to CSC.

20. Under the Privacy Act, personal psychological information can not, as a general rule, be disclosed without the consent of the individual to whom it relates. However, the Privacy Act recognizes a number of exceptions to this general rule.

21. Pursuant to one exception, personal information may be used for the purpose for which it was collected. Thus, relevant personal psychological information will be fully disclosed within CSC for the purposes of case management including release decision-making and the supervision or surveillance of the offender in the institution or the community.

22. Pursuant to a second exception, personal information may be disclosed where authorized by law. Thus, pursuant to subsection 25(1) of the Corrections and Conditional Release Act, psychological information that is relevant to release decision making or the supervision or surveillance of offenders must be given at the appropriate time to the National Parole Board, provincial governments, provincial parole boards, the police and any body authorized by CSC to supervise offenders. Pursuant to subsection 25(3), psychological information must be shared with the police where CSC believes on reasonable grounds that an inmate who is about to be released on warrant expiry poses a threat to any person after release and where that information is relevant to the perceived threat.

23. Pursuant to this second exception, the Corrections and Conditional Release Act also contains a number of provision concerning offender access to information including psychological information. Subsection 23(2) requires that, on request, inmates be given access to the same information as would be disclosed under the access and privacy legislation. Section 27 requires that an inmate who is entitled to make representations about a decision under Part I of the Act about that inmate or to reasons for that decision be given the information that will be or was considered in making the decision or a summary thereof unless, except in the case of disciplinary matters, disclosure can be refused for reasons of safety, security or to protect a lawful investigation. Section 141 requires that, subject to certain limited exceptions like those relating to section 27, an offender be given all the information to be considered by the National Parole Board in reviewing that offenders case or a summary thereof.

24. Regions shall establish procedures to evaluate and monitor the quality of psychological services provided to offenders. As a minimum, such procedures shall include:

• institutionally/district developed measures of timeliness of response to requests for service, timeliness of completion of required reports and volume of work performed;
• psychologists identified as having a functional supervision responsibility, on a ratio no greater than one for every seven psychology positions in a region, who shall advise the Deputy Wardens/District Director on the quality of work performed by institutional/ district psychologists and psychologists under contract, and to provide professional guidance and support to those psychologists by:
  • being available for consultation;
  • conducting an annual review of a reasonable sample of each psychologist's case files;
  • visiting each site at least twice per year to assess the strengths and weaknesses of the psychology service and share those findings with the psychologists and their line supervisor.
• regionally identified external psychologists, with recognized qualifications and affiliations, who are prepared to serve as members of external review committees when situations arise which require such a review of the work of a given psychologist.

25. Newly appointed psychologists, including contract psychologists, shall be provided with orientation training focusing on psychological services within the Correctional Service of Canada as well as ongoing opportunities for continuing education. Prior to the expiration of the probationary period for indeterminate psychologists, the psychologist providing functional supervision shall provide comprehensive assessment of quality of work to the Deputy Warden or District Director.

Research relating to forensic and clinical psychology has increased dramatically over the past several decades. In order to assist psychologists working in corrections to incorporate research findings into their assessment activities, the following guidelines have been developed with the support of the Correctional Service of Canada. The guidelines are intended to assist in clinical decision-making during the assessment process, while maintaining sufficient flexibility to allow psychologists and their clients to choose among available options.

Overall, the goal of these guidelines is to improve the quality of psychological assessments. The elaboration of the guidelines has been undertaken with the support of a range of practitioners, researchers and academics, with ongoing reflection regarding ethical and legal issues and consultation with professional associations.

It is an accepted principle that practice guidelines are subject to review and revision, reflecting advances in forensic and clinical psychology and related disciplines.

1. Psychologists seek to clarify referral questions in undertaking assessments.

2. Psychologists undertake assessments as systematic evaluations of specific referral questions relating to practical issues.

3. Psychologists utilize an appropriate range of information in undertaking assessments. Information gathering typically includes file reviews (e.g. police, case management, medical), clinical interviews, psychological testing, collateral sources (e.g. preventive security) and occasionally behavioural assessment.

4. Any absence of corroborating information or contradiction is noted in reports.

5. Psychological assessment reports will generally not include data reported on a test by test basis. Rather, findings will be summarized and integrated by the clinician.

6. The assessment report should be written in language understandable to the layman, with findings, conclusions and recommendations clearly stated.

7. Psychologists are conscious of length when writing reports, address referral questions in a focused manner and transmit only information which can be expected to be helpful to the reader.

8. Psychologists seek to ensure that their assessments fairly reflect cultural and gender differences through participation in awareness training, identification of areas of confusion in assessment practice, consultation, and, where necessary, referrals to specialists.

9. Psychologists strive to identify and develop culturally acceptable styles of service delivery in response to identified offender needs.

10. Prediction must take account of both clinical and actuarial estimates of risk. Reliance on clinical factors alone is insufficient and fails to reflect the accepted standard that actuarial (statistical) estimates are a valid anchor for prediction.

11. While overlap exists between predictors of general and violent recidivism, actuarial estimates of risk of general recidivism are insufficient to predict violent recidivism.

12. The use of personality and intelligence testing for the purpose of risk prediction is of limited practical value. However, such testing may be useful in the assessment of the dynamics of a case and/or the development of risk management strategies.

13. Psychologists must demonstrate how they arrive at their prediction by referencing key aspects of the offender's history as well as personality and situational variables.

14. Psychologists should be specific about the particular behaviour(s) predicted, the time frames for their predictions, the possible influence of situational variables on risk and any limitations on the accuracy of the predictions they offer.

15. Psychologists demonstrate professional sensitivity to their obligation to provide neutral assessments of risk. Accordingly, where psychologists have undertaken an intervention with an offender, they will evaluate their ability to provide neutral assessments of risk and, where necessary, request review of the treatment report by an independent psychologist or request an independent psychological assessment of risk.

16. Intervention requires clearly articulated treatment objectives.

17. Treatment reports comment on the frequency of contact, the degree of achievement of treatment objectives, the likely consequences of relapse and future needs.

18. Treatment reports provide comment on recommended risk management and relapse prevention strategies.

19. Actuarial measures are used to identify those offenders who need concentrated attention whereas measures of dynamic risk point to problems associated with failure on release that should form the basis of an intervention strategy.

20. Assessments in the community focus on specific problems affecting relapse among specific types of offenders.

21. Assessments in community must be part of an assessment and intervention strategy continuum. Community based psychological assessments must consider previous treatment and behaviour during incarceration and provide a dear link to treatment and supervision planning in the community.

22. In undertaking risk management for higher risk cases, a combined approach using both intensive supervision and clinical services should be considered.

23. Psychologists recognize that dynamic risk factors change over time and may be predictive of risk to reoffend.

24. Psychologists participate in specialized training activities in order to enhance their competency in the assessment and treatment of sexual aggressors.

25. In addition to assessment techniques utilized for non-sexual offenders, phallometric assessment of sexual deviance, including age-gender preference, is recommended.

26. Recommendations for involvement in treatment focus on the appropriate level of program intensity, as well as treatment targets such as cognitive distortions about sexual offending, identification of the crime cycle, poor social skills, anger problems, empathy impairment, deviant arousal, and substance abuse. Occasionally, referrals to psychiatry may be appropriate for a review of intervention options involving sex drive reducing agents.

27. Psychologists demonstrate their appreciation for the importance of relapse prevention following intervention.

28. Psychologists take account of pre-treatment levels of deviant sexual arousal, where available, in risk assessments for both child molesters and rapists.

29. Psychologists seek an understanding of an offender's crime cycle and high risk indicators during the assessment process and during intervention and respond with appropriate risk management strategies.

30. Psychologists seek to facilitate continuity in sex offender programming across security levels, from maximum to minimum security and community follow-up.

31. Psychologists are sensitive to the therapeutic and secondary effects of medications as they influence the offender's presentation during the assessment process.

32. Psychologists are selective in their use of diagnostic information for risk assessment and risk management purposes. Mental disorder inconsistently correlates with violent recidivism, but may be an important consideration in risk management (i.e. compliance with medication).

33. Psychologists demonstrate an understanding of the relative weight which should be given to mental disorder in the prediction of violence and of general recidivism.

34. In the assessment of the offender with a major mental disorder, psychologists are attentive to the coexistence of personality disorders and substance abuse.

35. Psychologists refer offenders to psychiatrists and other physicians where medical assessment and/or intervention appears warranted in the provision of essential health care or effective risk management.

36. 'While psychologists recognize that diagnoses may be of assistance in treatment planning, they strive to outline the functional implications of disorders in their assessments.

37. Psychologists demonstrate awareness that cognitive processing limitations may impact on an offender's institutional adjustment, upon his/her ability to benefit from programming and treatment and upon his/her interactions with others as well as vocational and educational aptitudes.

38. Psychologists undertake screening, assessments and/or referrals for cognitive and/or neuropsychological assessment where offenders demonstrate significant functional problems relating to verbal comprehension, impaired social interaction, behavioural outbursts, poor memory, impaired concentration, difficulties with orientation, or a failure to learn adequately in academic or vocational settings.

39. Psychologists present the functional implications of specific cognitive processing limitations for programming, offender management and relapse prevention.

40. Psychologists demonstrate awareness of the significance of substance abuse as a criminogenic factor. For many offenders, substance abuse represents a disinhibiting antecedent to criminality or the addiction is a financial problem necessitating crime.

41. In making recommendations for intervention, psychologists seek to distinguish between higher and lower needs offenders, while focusing on both chronicity and the acuteness of the addiction.

42. Psychologists emphasize education, lifestyle factors, and coping with relapse triggers in developing individually adapted relapse prevention strategies.

43. Psychologists seek to differentiate between offenders who abuse both alcohol and drugs, and those who abuse only alcohol or drugs.

44. Psychologists evaluate the manner in which males use violence to achieve control or to subordinate others.

45. Psychologists are sensitive to the need to define abuse such as to include subtle forms of abuse or psychological trauma, and not just physical violence. This area may require clinicians to carefully evaluate their own views on relationships between partners.

46. Psychologists incorporate measures which focus on offenders' attitudes towards women, egocentricism, their living situation, their social network, and external stresses.

47. Psychologists recognize that collateral from life partners is typically invaluable as offenders under report incidents.

48. The duty to warn must be an integral aspect of intervention with offenders who abuse their family. With respect to male batterers, this may mean that the limits of confidentiality be expanded to reflect psychological abuse as harm.

49. Psychologists demonstrate awareness that while suicide is a low frequency event that is difficult to predict, offenders are at higher risk relative to community groups. In particular, offenders have a much higher rate of completed suicides and suicidal behaviour, despite fairly constant observation by staff.

50. Psychologists utilize suicide risk prediction models which emphasize current ideation, degree of planning, prior history of attempts, lack of resources, stresses and the ability to cope with same as well as demographic factors such as age and gender.

51. Psychologists are aware of various forms of self injurious and suicide behaviors and respond with differential risk management strategies.

52. Assessment of suicide risk, by definition, is restricted to short-term management of a case. Typically, assessment involves clinical interviews focusing directly on intent, lethality of plan, access to chosen methods, prior history of attempts and current ideation. This may also involve psychological testing and the review of corroborating information regarding recent behaviour.

53. The use of anti suicide contracts, re-assessment and follow-up are mandatory with moderate to high risk offenders. The intrusiveness of the intervention should relate to the degree of risk and imminence of harm.

54. Intervention emphasizes the ambivalence of the majority of those-at-risk.

55. Psychologists seek personal and professional consultation following the suicide of patients under their care.

56. Psychologists provide crisis services to staff in accordance with corporate policy, however, they are reticent to provide formal ongoing services to staff in consideration of potential dual relationships and conflict of interest.

57. Psychologists respond to clients' needs effectively and accountably according to the evolving standards of the profession, and according to sound business and management practices.

58. When conducting program evaluations and research, psychologists submit proposals and implement projects in accordance with organizational requirements and applicable ethical standards.

Professional assessments by psychologists and psychiatrists can provide critical information about the mental status of an offender, and about behavioural characteristics and other risk factors which can assist the members of the National Parole Board in making conditional release decisions. Consideration of such assessments is one element of the comprehensive analysis Board members must perform in reviewing a case and making a decision about the offender's risk factors and reintegration potential. This policy will establish the type of assessments required by the Board.

Psychologists provide a range of services including assessment, therapeutic intervention, crisis intervention and program development, delivery and evaluation. The primary role of psychiatrists is diagnosis of mental illness and the treatment of the acutely and sub-acutely mental ill.

Psychological assessments may be completed for an offender at several points of the sentence. The need for a psychological assessment will be determined by behavioural characteristics of offenders, their criminal history, and features of the offence.

As of 1995, intake psychological assessments are required by the Correctional Service of Canada at intake screening, to identify criminogenic need and develop a correctional treatment plan, for offenders meeting any of the following criteria:

1. Situational adjustment problem: severe anxiety; withdrawn; panic; vulnerable and inadequate.
2. Mental health: Axis 1 diagnosis^{Footnote 1} ; prior psychiatric admission; current psychotropic medication.
3. Suicide: prior attempts; current ideation; current plan.
4. Self-mutilation: history of self-injury; current threats.
5. Persistent violence: history of three or more convictions for offenses against persons (including use of weapon when committing a robbery).
6. Gratuitous violence: excessive violence beyond that which is "required" to meet an end; evidence of sadistic behaviour or torture.
7. Sex offender: any history of convictions for sexually related offenses.
8. High need offender: severe substance abuse; organicity; offenders with mental disability, social incompetence. Any combination of needs or a single severe need (including difficulties relating to employment, marital/ family, associates, substance abuse, community functioning, personal/emotional and attitudes).

Offenders sentenced before 1995 were not subject to these criteria and may or may not have received a psychological assessment addressing such problems during their incarceration before referral, if required, for a pre-release assessment.

Psychological assessments will not normally be required for provincial offenders or offenders eligible for accelerated parole review.

I) Mandatory referral criteria for all other offenders:

• persistent violence;
• gratuitous violence;
• referrals for detention;
• conditional release reviews for offenders with indeterminate or life sentences;
• high risk sex offenders : those with two or more sexually related convictions; untreated or drop outs; deviant arousal from phallometry (paraphilia); use of a weapon.

II) Discretionary referral criteria:
Referrals will be initiated only when existing treatment summaries are not sufficient to assess progress in relation to the offender's correctional plan and/or community management strategies in the following cases:

• mental disorder;
• suicide risk (including institutional history of self-injury);
• high need (as above).

A pre-release psychological assessment will be considered to be current for a period of two years if, in that period of time, the offender has not participated in any programming to address identified behavioural needs to reduce risk. If there has been such program participation, a further assessment will be required to address the program's influence on the offender and the extent of change, if any, in the risk posed by the offender. This may be a post-treatment report if the issues of extent of change and risk are specifically addressed. If, after two years the offender has not participated in any such programming, subsequent assessments may be updates of the initial pre-release assessment.

A more recent assessment will be required if the institutional behaviour of the offender has resulted in charges related to violent behaviour.

At least one psychiatric assessment is required for any offender with a life or indeterminate sentence. This may be a thorough assessment completed for the courts. Since psychiatric assessments address mental illness or disorder and mental capacity, such assessments will provide information to CSC on intervention strategies which are needed by the offender. Reports are required on the results of any psychiatric treatment interventions with respect to any impact on the risk presented by the offender.

A new psychiatric assessment is required for offenders with a life minimum or indeterminate sentence when they first apply for any type of conditional release other than a medical or compassionate escorted temporary absence. In the case of an offender assessed as mentally disordered and requiring treatment, this pre-release psychiatric assessment will be considered current until the offender participates in the recommended treatment. Another psychiatric assessment is not required for offenders who do not meet these criteria.

A psychiatric assessment will be obtained for any offender when recommended by a psychologist.

When a mental health condition which requires medication or professional intervention to reduce the risk posed by the offender has been identified, and the offender is non-compliant, a further report will not be required and risk will be presumed not to be assumable.

The Board shall be informed when an offender is taking medication which modifies behaviour. Information about the effect of the medication, the attitude of the offender to continuing use of the medication, and possible changes in the risk posed should the offender stop using the medication is required to assist in risk assessment.

In exceptional cases, the Board may ask for a new psychological or psychiatric assessment for a particular offender if they believe it is required. This situation could arise if there are conflicting assessments on the offender's file, or when specific information on the file leads the Board members to believe such an assessment is needed for decision making purposes. Board members will give written reasons for making the request to identify the cause of their concern

In rare instances, Board members may ask the Correctional Service of Canada to obtain a report from an independent external professional. Board members will give written reasons whenever outside professional reports are requested.