Feedback in forensic mental health assessment

A guide to feedback in forensic mental health assessment.

“…Our purpose here is to go further than previous literature reviews and offer evaluators a systematic set of considerations to guide their decision making about providing feedback to forensic evaluees. These considerations complement those recently offered by Brodsky and Goldenson (2022) and have the added benefit of offering additional structure for evaluators' decision making. The considerations below are grounded in sources of ethical guidance and the results of research conducted with three focus groups of forensic evaluators, described below.…”

“…Alternatively, focus group participants also reported that providing specific feedback about why an evaluator concluded an evaluee did or did not meet insanity criteria, or why a piece of information an evaluee divulged resulted in greater concerns about violence risk, could lead the evaluee to change the information they share in a subsequent or second opinion evaluations. Indeed, it might well be these types of considerations that led Brodsky and Goldenson (2022) to observe that probative feedback can interfere with legal process and conclude that "offering unsolicited opinions on probative issues during the assessment is likely problematic and best avoided" (p. 7). Although sometimes second (or third, etc.)…”

“…First, it might improve the quality of the evaluation by facilitating rapport with the evaluee or increasing their engagement. For instance, Brodsky and Goldenson (2022) indicate that interpersonal or behavioral feedback (e.g., "I can see how difficult this is for you") can enhance rapport and redirect distracted evaluees. In addition, offering feedback provides an opportunity for the evaluator to gather more clinical data, for instance, the evaluee's understanding of a feature of their presentation that might otherwise be ambiguous (e.g., limited eye contact), the evaluee's understanding of the information provided to them (e.g., regarding the legal process, relevant to competence to stand trial), their reaction to clinical information (e.g., a diagnosis, relevant to their insight, which can inform risk assessments), or their response or change in presentation after hearing an evaluator's concerns about exaggeration or feigning.…”

“…After all, as many focus group participants observed, FMHA evaluations are not the final step in the process (the ultimate resolution of the legal issue or case is). Resolving the issue of spoiling requires evaluators to foresee, or reasonably anticipate, potential downstream consequences of providing feedback so that they do not compromise their responsibilities to their clients (Brodsky & Goldenson, 2022; Heilbrun, 2001; Heilbrun et al, 2009). One possibility is that feedback arms the evaluee with new information leading them to change their presentation or jeopardize the validity of subsequent evaluations.…”

“…The results from the survey also suggested that the majority of evaluators (61.6%) were not regularly including a section in their notification practices about feedback not going directly to the evaluee, nor did they believe that it was an essential element of a participant's understanding about the evaluation process (86.3%). Brodsky and Goldenson (2022) expanded upon this research by aptly noting that feedback is not a unitary construct and that decisions about different types of feedback warrant different sets of considerations. They distinguish examinee-solicited feedback from unsolicited examiner feedback and divide the latter into three levels.…”