Gross Negligence Manslaughter in Healthcare: Time for a Restorative Justice Approach?

This article explores the merits of employing a restorative justice approach in cases of gross negligence manslaughter involving healthcare professionals, in line with the recent policy turn towards developing a just culture in addressing episodes of healthcare malpractice within the National Health Service in England. It is argued that redress for victims and rehabilitation of offenders should operate as key values, underpinning the adoption of a restorative justice approach in such cases. It would also be vital that a structured pathway was designed that established suitable protocols and safeguards for both victims and offenders taking account of problematic issues such as the informality of the process, power asymmetries between parties, and the context in which the offence took place. Taking all such matters into account, we propose that consideration be given to establishing a pilot involving the use of restorative justice in cases of gross negligence manslaughter involving healthcare professionals, which would be subject to judicial and stakeholder oversight to ensure transparency and accountability, which in turn could inform future policy options.

[Assessment of the maturity of juvenile and young adult offenders according to §105 of German juvenile law: a developmental psychology perspective]. / Die Reifebeurteilung Heranwachsender nach § 105 JGG und der Umgang mit jungen erwachsenen Straftäterinnen und Straftätern aus entwicklungspsychologischer Sicht.

Assessment of the maturity of juvenile and young adult offenders according to §105 of German juvenile law: a developmental psychology perspective Abstract. Since 1953, according to § 105 of the German JGG (Jugendgerichtsgesetz/Juvenile Court Act), it has been possible to convict offenders aged 18.0 y-20y 11 mo either as juveniles or as adults, depending on their developmental status. Yet unambiguous criteria defining the individual stages of development are available neither to judges nor to experts. Thus, for this age group this may lead judges to make arbitrary decisions impairing the right of equal treatment before the law in Germany. In the absence of clear criteria for assessing maturity, experts nearly always recommend judging such offenders as juveniles. Recent findings from the neurosciences and developmental psychology show that not only juveniles but adolescents and young adults up to the age of 25y usually have significant potential for development. After an overview of the legal practices pertaining to juveniles in Germany and throughout Europe, we propose alternatives for the individual assessment of maturity.

The Building Bridges project: Linking disconnected service networks in acquired brain injury and criminal justice.

People with acquired brain injury (ABI) are overrepresented in prison populations across many countries. An effective service response to reduce this trend requires collaboration between the ABI and criminal justice (CJ) sectors. The Building Bridges project piloted a novel professional development model designed to increase cross-sectoral knowledge and collaboration between the ABI and CJ sectors. A total of 178 service providers from Victoria, Australia, participated in six professional development forums that included content about ABI, policing, disability and legal supports, and correctional/post-release services. Participants came from the disability, criminal justice, and health and community service sectors. Using a pre-test-post-test design with 6-month follow-up, data were obtained via a project-specific questionnaire evaluating knowledge and behaviour change among participants. Statistically significant gains in knowledge were shown at post-test and maintained at follow-up. Work-related behaviours addressing ABI/CJ issues had increased significantly within both sectors at follow-up compared to the 6 months prior to the forum. Carefully constructed professional forums improved cross-silo collaboration in the ABI/CJ sectors. This pilot project illustrates effective use of existing service resources, and highlights training as an important part of a raft of initiatives needed to address the overrepresentation of people with ABI in the CJ system.

Meeting the Needs of Justice-Involved People With Serious Mental Illness Within Community Behavioral Health Systems.

The overrepresentation of people with serious mental illness in the criminal justice system is a complex problem. A long-standing explanation for this phenomenon, the criminalization hypothesis, posits that policy changes that shifted the care of people with serious mental illness from psychiatric hospitals to an underfunded community treatment setting resulted in their overrepresentation within the criminal justice system. This framework has driven the development of interventions to connect people with serious mental illness to needed mental health and substance use treatment, a critical component for people in need. However, the criminalization hypothesis is a limited explanation of the overrepresentation of people with serious mental illness in the criminal justice system because it downplays the social and economic forces that have contributed to justice system involvement in general and minimizes the complex clinical, criminogenic, substance use, and social services needs of people with serious mental illness. A new approach is needed that focuses on addressing the multiple factors that contribute to justice involvement for this population. Although the authors' proposed approach may be viewed as aspirational, they suggest that an integrated community-based behavioral health system-i.e., intercept 0-serve as the focal point for coordinating and integrating services for justice-involved people with serious mental illness.

High or very high recidivism risk? The possibilities of recidivism risk assessment under the Polish SVP law (the Act of 22 November 2013). / Wysokie czy bardzo wysokie ryzyko recydywy? Mozliwosci oceny kategorii ryzyka recydywy sprawców na potrzeby Ustawy z 22.11.2013.

The paper presents an analysis of possibilities of performing recidivism risk assessment under the Act of 22 November 2013 on the treatment of people with mental disorders posing a threat to life, health or sexual freedom of others. The Act allows, among others, the post-penitentiary isolation of persons posing a threat. The risk assessment at "very high" level is one of the key elements taken into account in adjudication of this procedure.The first part presents basic information on the recidivism risk assessment procedure: types of risk factors and different approaches to recidivism risk assessment. Then, three main limitations related to the assessment under the Act were discussed. These are: (1) the problem of the scope of the predicted events, (2) the problem of differentiation between the upper sub-categories of recidivism risk, (3) the problem of the lack of full Polish adaptations of recidivism risk assessment instruments. In consequence of these limitations, the risk assessment under the Act has lower precision. The problem of the lack of Polish adaptations can be solved with validation of the appropriate instruments. However, the other two challenges result directly from the provisions of the Act and cannot be faced with its current form. Therefore main conclusion of the paper focuses on the need to take into account the discussed limitations by experts, officials participating in the proceedings and the institutions issuing decisions. Risk assessment should be based on the measurement of all types of recidivism risk factors, including primarily static and then stable dynamic ones.

Perceptions of the effectiveness of health care for probationers.

PURPOSE: This study aims to investigate the views of commissioners, providers and criminal justice staff on how effective current health-care provision is at meeting the health needs of people on probation. Understanding perceptions of what constitutes effective provision, where barriers are encountered and where improvements could be made is an important step towards improving access to care for this hard-to-reach group. DESIGN/METHODOLOGY/APPROACH: The research was part of a wider study. This paper focusses on findings from case studies conducted via semi-structured telephone interviews with 24 stakeholders in a purposive sample from six geographical areas of England. Interviews were conducted by researchers from a variety of backgrounds and an individual with lived experience of the criminal justice system. Data were analysed using thematic analysis. FINDINGS: Participants provided examples of effective health-care provision, which largely involved multi-agency partnership working. It was apparent that there are many barriers to providing appropriate health-care provision to people on probation, which are underpinned by the complexity of this population's health-care needs, the complexity of the health-care landscape and problematic commissioning processes. PRACTICAL IMPLICATIONS: Improvements are needed to provide appropriate and accessible health care that meets the needs of people on probation, thereby reducing health inequalities. These include shared targets, improved funding, clearer pathways into care and giving probation a voice in commissioning. ORIGINALITY/VALUE: To the best of authors' knowledge, this is the first study of commissioner, provider and criminal justice staffs' views on the effectiveness of current health-care provision at meeting the health needs of people on probation.

Translating clinical findings to the legal norm: the Defendant's Insanity Assessment Support Scale (DIASS).

Insanity definition and the threshold for satisfying its legal criteria tend to vary depending on the jurisdictions. Yet, in Western countries, the legal standards for insanity often rely on the presence of cognitive and/or volitional impairment of the defendant at crime time. Despite some efforts having been made to guide and structure criminal responsibility evaluations, a valid instrument that could be useful to guide forensic psychiatrists' criminal responsibility assessments in different jurisdictions is lacking. This is a gap that needs to be addressed, considering the significant forensic and procedural implications of psychiatric evaluations. In addition, differences in methodology used in insanity assessments may also have consequences for the principle of equal rights for all citizens before the law, which should be guaranteed in the European Union. We developed an instrument, the Defendant's Insanity Assessment Support Scale (DIASS), which can be useful to support, structure, and guide the insanity assessment across different jurisdictions, in order to improve reliability and consistency of such evaluations.

Neuroscience and mental state issues in forensic assessment.

Neuroscience has already changed how the law understands an individual's cognitive processes, how those processes shape behavior, and how bio-psychosocial history and neurodevelopmental approaches provide information, which is critical to understanding mental states underlying behavior, including criminal behavior. In this paper, we briefly review the state of forensic assessment of mental conditions in the relative culpability of criminal defendants, focused primarily on the weaknesses of current approaches. We then turn to focus on neuroscience approaches and how they have the potential to improve assessment, but with significant risks and limitations.

Latinx Youth in First Contact with the Justice System: Trauma and Associated Behavioral Health Needs.

This study examines the prevalence of trauma exposure and its association with psychiatric symptoms, substance use, and sexual activity among First-Time Offending, Court-Involved Non-Incarcerated (FTO-CINI) Latinx youth. Latinx youth (N = 181), ages 12-18, were recruited from a family court in the Northeastern region of the United States as part of a longitudinal cohort study of 423 FTO-CINI youth. Baseline data on trauma exposure and symptoms, psychiatric symptoms, substance use (alcohol/marijuana), and sexual activity among the Latinx sample were analyzed by age, gender, and offense type (status versus delinquent). Almost three-quarters of Latinx FTO-CINI youth reported lifetime trauma exposure. Almost half of Latinx youth reported lifetime marijuana use, 30% reported lifetime alcohol use, and 33% reported lifetime sexual activity. Females reported higher rates of internalizing symptoms and greater affect dysregulation. Trauma-exposed youth were more likely than their non-exposed peers to have reported more externalizing symptoms; trauma-exposed females compared to trauma-exposed males reported more severe internalizing symptoms. Latinx FTO-CINI females may have different behavioral health needs than their male counterparts. Court-based screening and assessment practices should attend to the specific behavioral needs of this unique, underserved population.

Understanding Sex Offender Community Supervision: A Mixed Methods Approach.

The process of transitioning from prison to the community poses unique challenges for those who have been convicted of sexually based offenses. Due to the realities associated with the unique challenges facing these individuals, the community supervision process fluctuates along the correctional continuum which polarizes rehabilitative and control. The current study examines how this fluctuation relates to both the supervision process and correctional outcomes. Furthermore, the literature suggests five specific checkpoints along this continuum which are measured both qualitatively and quantitatively. The five checkpoints are Social Reintegration, Community Reentry, Status Maintenance, Statutory Compliance, and Risk Management. Overall, all five checkpoints are included in some way in the community supervision process; and analyses show significant links between the checkpoints and correctional outcomes.

Factors Related to Rape Reporting Behavior in Brazil: Examining the Role of Spatio-Temporal Factors.

The reporting of rape to police is an important component of this crime to have the criminal justice system involved and, potentially, punish offenders. However, for a number of reasons (fear of retribution, self-blame, etc.), most rapes are not reported to police. Most often, the research investigating this phenomenon considers incident and victim factors with little attention to the spatio-temporal factors of the rape. In this study, we consider incident, victim, and spatio-temporal factors relating to rape reporting in Campinas, Brazil. Our primary research question is whether or not the spatio-temporal factors play a significant role in the reporting of rape, over and above incident and victim factors. The subjects under study are women who were admitted to the Women's Integrated Healthcare Center at the State University of Campinas, Brazil, and surveyed by a psychologist or a social worker. Rape reporting to police was measured using a dichotomous variable. Logistic regression was used to predict the probability of rape reporting based on incident, victim, and spatio-temporal factors. Although we find that incident and victim factors matter for rape reporting, spatio-temporal factors (rape/home location and whether the rape was in a private or public place) play an important role in rape reporting, similar to the literature that considers these factors. This result has significant implications for sexual violence education. Only when we know why women decide not to report a rape may we begin to work on strategies to overcome these hurdles.

Risk assessment and juvenile resentencing: A critical analysis.

Recent United States Supreme Court decisions in Miller v. Alabama (2012) and Montgomery v. Louisiana (2016) have created the need to resentence individuals who received a sentence of mandatory life without parole (LWOP) for offenses committed when they were younger than 18 years old. Neither of these decisions explicitly cite reoffense risk as a sentencing criterion, but a careful reading of the reasoning in these cases suggests that such a risk should be among the considerations addressed by resentencing courts. If so, important theoretical and scientific questions are raised about the nature of risk assessment tools, in particular the distinction between static and dynamic risk factors. Additionally, the novelty of LWOP resentencing raises further questions about the applicability of these tools to individuals who have been incarcerated for long periods of time. We address these questions, call for additional research on dynamic risk factors, and offer recommendations for professionals involved in these types of assessments.

Judicial appraisals of risk assessment in sentencing.

The assessment of an offender's risk of recidivism is emerging as a key consideration in sentencing policy in many US jurisdictions. However, little information is available on how actual sentencing judges view this development. This study surveys the views of a population sample of judges in Virginia, the state that has gone further than any other in legislatively mandating risk assessment for certain drug and property offenders. Results indicate that a strong majority of judges endorse the principle that sentencing eligible offenders should include a consideration of recidivism risk. However, a strong majority also report the availability of alternatives to imprisonment in their jurisdictions to be inadequate at best. Finally, most judges oppose the adoption of a policy requiring them to provide a written reason for declining to impose alternative interventions on "low-risk" offenders.

Sex Offender Management Policies and Evidence-Based Recommendations for Registry Reform.

PURPOSE OF REVIEW: The goal of this paper is to improve evidence-based sex offender management systems through an understanding of the research findings related to the stated goals and unintended consequences of such laws. RECENT FINDINGS: Assessment tools using factors derived from research studies can improve the identification of higher-risk sex offenders, so that more intensive or restrictive interventions can be tailored to those who pose the highest threat to community safety. After substantial time offense-free in the community, even higher-risk offenders become less likely to reoffend, suggesting that registration durations can be modified to utilize resources more efficiently. Several strategies for applying the evidence base to inform the utility, efficiency, and cost-effectiveness of sex offender policies include (1) use of empirically derived risk assessment tools to classify offenders and modify registration requirements accordingly, (2) removal of juveniles from registries; and (3) elimination of residence restrictions.

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders.

Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues.

The MRCI with juvenile detainees: optimizing performance or emphasizing ecological validity?

The Miranda Rights Comprehension Instruments (MRCI) are intended to be administered to legally involved youths in a setting free from distractions and stressors with the explicit goal of assessing the examinee's best understanding. However, marked disparities have been observed between juveniles' MRCI performance and their unassisted recall of a representative Miranda warning. We hypothesized that youths' very strong MRCI performance might be partially due to prompts and clarifications used whenever incomplete or ambiguous answers are provided. In this archival study, we systematically re-scored three MRCI instruments from 231 legally involved youths to evaluate their original responses (i.e., non-queried scoring). This approach is viewed as more ecologically valid because actual Miranda warnings are typically provided in a routine manner without assistance following each Miranda component. For the large majority of legally involved juveniles, only small differences were noted between standard and non-queried scoring. However, some dramatic decrements were observed, especially on the Comprehension of Miranda Rights-II (CMR-II). More specifically, 15.7% of CMR-II percentiles dropped precipitously by 60% or more, when using the non-queried scores. The results are discussed within the context of optimized performances versus ecological validity as applied to Miranda evaluations.

A Study of the Impact of Screening for Poly-Victimization in Juvenile Justice: The Rocky Road to a Successful Investigation in the Real World.

Poly-victimization during formative developmental periods represents an important focus for screening and assessment in settings and populations in which interpersonal violence is pervasive. This article describes the multistage evolution of a research project designed to empirically test a poly-victimization enhancement of a widely used and validated behavioral health screening tool for youth using retrospective and prospective archival juvenile justice system outcome data. Several operational and methodological revisions to the project's design and procedures were necessitated by barriers that arose as a result of unforeseen shifts in the host juvenile justice system's policies and personnel. The present report describes real-world challenges that face investigators working in public sector systems, and highlights the key role of establishing long-term collaborative professional relationships with personnel at all levels in those systems based on providing services and evaluation data that meet the system's core goals, responsibilities, and mission. Also highlighted are the methodological and logistical adaptations needed to successfully accomplish a project's internal objectives while striking a balance between flexibility in operational and methodological tactics on one hand, and adherence to ethical, conceptual/clinical, and methodological principles on the other hand.