Integrating People, Context, and Technology in the Implementation of a Web-Based Intervention in Forensic Mental Health Care: Mixed-Methods Study.

BACKGROUND: While eMental health interventions can have many potential benefits for mental health care, implementation outcomes are often disappointing. In order to improve these outcomes, there is a need for a better understanding of complex, dynamic interactions between a broad range of implementation-related factors. These interactions and processes should be studied holistically, paying attention to factors related to context, technology, and people. OBJECTIVE: The main objective of this mixed-method study was to holistically evaluate the implementation strategies and outcomes of an eMental health intervention in an organization for forensic mental health care. METHODS: First, desk research was performed on 18 documents on the implementation process. Second, the intervention's use by 721 patients and 172 therapists was analyzed via log data. Third, semistructured interviews were conducted with all 18 therapists of one outpatient clinic to identify broad factors that influence implementation outcomes. The interviews were analyzed via a combination of deductive analysis using the nonadoption, abandonment, scale-up, spread, and sustainability framework and inductive, open coding. RESULTS: The timeline generated via desk research showed that implementation strategies focused on technical skills training of therapists. Log data analyses demonstrated that 1019 modules were started, and 18.65% (721/3865) of patients of the forensic hospital started at least one module. Of these patients, 18.0% (130/721) completed at least one module. Of the therapists using the module, 54.1% (93/172 sent at least one feedback message to a patient. The median number of feedback messages sent per therapist was 1, with a minimum of 0 and a maximum of 460. Interviews showed that therapists did not always introduce the intervention to patients and using the intervention was not part of their daily routine. Also, therapists indicated patients often did not have the required conscientiousness and literacy levels. Furthermore, they had mixed opinions about the design of the intervention. Important organization-related factors were the need for more support and better integration in organizational structures. Finally, therapists stated that despite its current low use, the intervention had the potential to improve the quality of treatment. CONCLUSIONS: Synthesis of different types of data showed that implementation outcomes were mostly disappointing. Implementation strategies focused on technical training of therapists, while little attention was paid to changes in the organization, design of the technology, and patient awareness. A more holistic approach toward implementation strategies-with more attention to the organization, patients, technology, and training therapists-might have resulted in better implementation outcomes. Overall, adaptivity appears to be an important concept in eHealth implementation: a technology should be easily adaptable to an individual patient, therapists should be trained to deal flexibly with an eMental health intervention in their treatment, and organizations should adapt their implementation strategies and structures to embed a new eHealth intervention.

Forensic Interviews for Child Sexual Abuse Allegations: An Investigation into the Effects of Animal-Assisted Intervention on Stress Biomarkers.

The use of therapy animals during forensic interviews for child sexual abuse allegations is a recommendation by the Therapy Animals Supporting Kids Program to help ease children's discomfort during the forensic interview process. Based on this recommendation, this study incorporated a certified therapy canine into the forensic interview process for child sexual abuse allegations. This study investigated changes in salivary cortisol, immunoglobulin A, blood pressure, and heart rate as a result of forensic interview phenomenon (e.g., outcry) incorporating animal-assisted intervention versus a control condition in children (N = 42) interviewed for alleged child sexual abuse. The results supported significantly greater heart rate values for the control group (n = 23) who experienced sexual contact and/or indecency than the experience of aggravated sexual assault compared to no difference in HR for the intervention group (n = 19). The results suggest that the presence of the canine in the forensic interview may have acted as a buffer or safeguard for the children when disclosing details of sexual abuse. In the intervention group, children's HR was lower at the start of the forensic interview compared to the control group. Finding an effect of having a certified handler-canine team available during the forensic interview on physiological measures of stress has real-world value for children, child welfare personnel, and clinical therapists. It is suggested that animal-assisted intervention be expanded to children facing other types of trauma and to treatment programs for child survivors of sexual abuse.

Modelo Holístico de Evaluación de la Prueba Testifical (HELPT) / A holistic model for the evalutation of the testimony (Helpt)

En este trabajo se presenta una propuesta de protocolo de evaluación de las declaraciones e identificaciones realizadas por posibles víctimas de delitos. El protocolo, denominado HELPT, se enmarca en un enfoque holístico de evaluación de la prueba testifical que considera todos los posibles factores de influencia: de codificación, de retención y de recuperación. Entre estos factores resultarán relevantes a) la capacidad para testificar de las víctimas, donde se tienen en cuenta los procesos cognitivos de atención, percepción, memoria y lenguaje; b) las características específicas del delito; c) los antecedentes del hecho evaluado y sus consecuencias; d) otros factores que pudieran afectar a la calidad y exactitud de las declaraciones e identificaciones, como el número de veces que la víctima tuvo que contar lo ocurrido, los métodos empleados para obtener el relato y posibilidades de sugestión. El método contempla procedimientos específicos de análisis exhaustivo de los expedientes y de formulación y contrastación de hipótesis (Scott y Manzanero, 2015), de evaluación de la competencia para testificar (Contreras, Silva y Manzanero, 2015) y de obtención de las declaraciones (González, Muñoz, Sotoca y Manzanero, 2013)

A proposed protocol for evaluating the statements and identifications made by the potential victims of crimes is presented in this paper. The protocol, called HELPT, is part of a holistic approach to evaluating the testimony that takes into account all possible factors of influence: encoding, retention and recovery. Among these factors, the following will be relevant: a) the ability of victims to testify, as well as cognitive processes of attention, perception, memory and language; b) the specific characteristics of the offence; c) the history of the event and its consequences; d) other factors that might affect the quality and accuracy of the statements and identifications, such as the number of times the victim had to tell what happened, the methods used to obtain the story and possibilities of suggestion. The method includes specific procedures for exhaustive analysis of the testimonies and for the formulation and testing of hypotheses (Scott & Manzanero, 2015), the evaluation of the competence to testify (Contreras, Silva, & Manzanero, 2015) and the obtaining of statements (González, Muñoz, Sotoca, & Manzanero, 2013)

Assessment of problematic sexual interests with the penile plethysmograph: an overview of assessment laboratories.

Phallometric testing, or penile plethysmography (PPG), is an objective measure of sexual arousal for males. While extensive research on the reliability and validity of PPG has promoted its reputation as the "gold standard" of objective measurement of sexual arousal, there is a lack of standardization of stimulus sets and interpretation of results between sites. This article describes the laboratory protocol employed for PPG at the Royal Ottawa Mental Health Centre's Sexual Behaviours Clinic (SBC) in Ottawa, Ontario, as well as those used by the Sexual Behaviors Clinic and Lab (SBCL) in the Community and Public Safety Psychiatry Division (CPSPD) of the Department of Psychiatry and Behavioral Sciences at Medical University of South Carolina (MUSC) in Charleston, South Carolina. The need for standardization in both testing protocol and stimuli use across sites are highlighted.

Interviewing child witnesses: the effect of forced confabulation on event memory.

Age differences in rates of forced confabulation and memory consequences thereof were assessed using a recall task similar to real forensic interview procedures. Children viewed a target video and were tested with the same 18 questions immediately afterward and 1 week later. Of the 18 questions, 12 were answerable; the 6 unanswerable questions referred to information not in the video. Participants in the voluntary confabulation condition had a "don't know" response option; those in the forced confabulation condition did not. Although 6-year-olds and 9-year-olds were equally likely to provide a response to an unanswerable question initially, 1 week later 9-year-olds were significantly more likely than 6-year-olds to repeat their initial confabulated responses. These findings suggest that pressing child witnesses to answer questions they are initially reluctant to answer is not an effective practice, and the consistency of children's responses over time is not necessarily an indication of the accuracy of their eyewitness memory.

What is needed to deliver collaborative care to address comorbidity more effectively for adults with a severe mental illness?

OBJECTIVE: Innovative models of care for people with a severe mental illness have been developed across Australia to more effectively address comorbidity and disability by enhancing the collaboration between clinical and non-clinical services. In particular, this review paper focuses on collaboration that has occurred to address comorbidities affecting the following domains: homelessness; substance addiction; physical ill-health; unemployment; and forensic issues. METHOD: The identification of relevant collaborative care models was facilitated by carrying out a review of the published peer-reviewed literature and policy or other published reports available on the Internet. Contact was also made with representatives of the mental health branches of each Australian state and territory health department to assist in identifying examples of innovative collaborative care models established within their jurisdiction. RESULTS: A number of nationally implemented and local examples of collaborative care models were identified that have successfully delivered enhanced integration of care between clinical and non-clinical services. Several key principles for effective collaboration were also identified. Governmental and organisational promotion of and incentives for cross-sector collaboration is needed along with education for staff about comorbidity and the capacity of cross-sector agencies to work in collaboration to support shared clients. Enhanced communication has been achieved through mechanisms such as the co-location of staff from different agencies to enhance sharing of expertise and interagency continuity of care, shared treatment plans and client records, and shared case review meetings. Promoting a 'housing first approach' with cross-sector services collaborating to stabilise housing as the basis for sustained clinical engagement has also been successful. CONCLUSIONS: Cross-sector collaboration is achievable and can result in significant benefits for mental health consumers and staff of collaborating services. Expanding the availability of collaborative care across Australia is therefore a priority for achieving a more holistic, socially inclusive, and effective mental health care system.

The promises and perils of non-invasive brain stimulation.

Non-invasive brain stimulation promises innovative experimental possibilities for psychology and neuroscience as well as new therapeutic and palliative measures in medicine. Because of its good risk-benefit ratio, non-invasiveness and reversibility as well as its low effort and cost it has good chances of becoming a widespread tool in science, medicine and even in lay use. While most issues in medical and research ethics such as informed consent, safety, and potential for misuse can be handled with manageable effort, the real promise of brain stimulation does raise one prominent moral worry: it may lay the foundation of reliable, precise and stable manipulations of the mind. This article addresses this worry and concludes that it is not the possibility of manipulation, but the shift in our understanding of our mind which stands in need of careful consideration.

Enhancing witness memory with techniques derived from hypnotic investigative interviewing: focused meditation, eye-closure, and context reinstatement.

Due to several well-documented problems, hypnosis as a forensic interviewing tool has been largely replaced by the cognitive interview; however, the latter is problematic in time and complexity. This article builds on previous research showing that some procedures used in traditional hypnotic forensic interviewing might still be useful in developing alternative procedures for use in investigative interviewing. Two experiments are described that include a focused meditation with eye-closure technique with similarities to conventional hypnotic induction but without the label of hypnosis. In the first, focused meditation was comparable to a context reinstatement, or revivification, technique in facilitating memory in children aged 6 to 7 without increasing errors or inflating confidence. In the second, when used in combination with context reinstatement, focused meditation was resistant to the effects of misleading information in adults. Implications are discussed.

The use of paraphrasing in investigative interviews.

OBJECTIVE: Young children's descriptions of maltreatment are often sparse thus creating the need for techniques that elicit lengthier accounts. One technique that can be used by interviewers in an attempt to increase children's reports is "paraphrasing," or repeating information children have disclosed. Although we currently have a general understanding of how paraphrasing may influence children's reports, we do not have a clear description of how paraphrasing is actually used in the field. METHOD: The present study assessed the use of paraphrasing in 125 investigative interviews of allegations of maltreatment of children aged 4-16 years. Interviews were conducted by police officers and social workers. All interviewer prompts were coded into four different categories of paraphrasing. All children's reports were coded for the number of details in response to each paraphrasing statement. RESULTS: "Expansion paraphrasing" was used significantly more often and elicited significantly more details, while "yes/no paraphrasing" resulted in shorter descriptions from children, compared to other paraphrasing styles. Further, interviewers more often distorted children's words when using yes/no paraphrasing, and children rarely corrected interviewers when they paraphrased inaccurately. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Investigative interviewers in this sample frequently used paraphrasing with children of all ages and, though children's responses differed following the various styles of paraphrasing, the effects did not differ by the age of the child. The results suggest that paraphrasing affects the quality of statements by children. Implications for investigative interviewers will be discussed and recommendations offered for easy ways to use paraphrasing to increase the descriptiveness of children's reports of their experiences.

Children's eyewitness memory: a comparison of two interviewing strategies as realized by forensic professionals.

A critical issue for developmental psychology is how to obtain accurate and complete eyewitness memory reports from preschoolers without offering suggestions that might result in false allegations. We examined effects of two interviewing strategies (police/verbal interviews and clinician/prop-assisted interviews) on young children's reports about a medical examination. A total of 58 4-year-olds participated in the study, which conformed to a 2 (Interview Type)x2 (Number of Interviews) factorial design. Analyses revealed that interviewers spent less time off topic and asked more free recall questions in the police/verbal interviews than in the clinician/prop-assisted interviews. Compared with police/verbal interviews, clinician/prop-assisted interviews resulted in significantly more correct rejections and commission errors in children's memory reports. However, on a final free recall test, error rates were comparable across conditions. Higher child verbal intelligence predicted memory accuracy in police/verbal interviews, and greater parental attachment anxiety predicted children being asked a higher number of misleading questions. The study provides new insights into interview techniques that promote preschoolers' accurate eyewitness reports.

Propuesta del uso de la hipnosis como método diagnóstico en procedimientos forenses: A propósito de un caso con trastorno de conversión / Hypnosis as a diagnostic tool in forensic procedures. Report of a case with conversion disorder

Una vez superados los prejuicios existentes en torno a la hipnosis, de un tiempo hasta ahora se tiende a introducir de manera creciente su aplicación en el ámbito de la psicoterapia, amparado en gran medida por estudios encaminados a conocer sus bases neurofisiológicas. A raíz de un caso diagnosticado de trastorno de conversión, se propone la aplicación de la hipnosis como herramienta complementaria y eficaz de estudio pericial (AU)

After overcoming every prejudice surrounding hypnosis, a tend is emerging in order to introduce its application in psycotherapy, due to many studies published to know the neurophysiological bases of hypnosis. We present a case, affected of conversion disorder, where hypnosis was used as a complementary and effective tool for expert study into legal matters (AU)

Interrogative pressure in simulated forensic interviews: the effects of negative feedback.

Much experimental research on interrogative pressure has concentrated on the effects of leading questions, and the role of feedback in influencing responses in the absence of leading questions has been neglected by comparison. This study assessed the effect of negative feedback and the presence of a second interviewer on interviewee responding in simulated forensic interviews. Participants viewed a videotape of a crime, answered questions about the clip and were requestioned after receiving feedback. Compared with neutral feedback, negative feedback resulted in more response changes, higher reported state anxiety and higher ratings of interview difficulty. These results are consistent with Gudjonsson and Clark's (1986) model of interrogative suggestibility. The presence and involvement of a second interviewer did not significantly affect interviewee responding, although trait anxiety scores were elevated when a second interviewer was present. The theoretical and applied implications of these findings are considered.

Supportive or suggestive: Do human figure drawings help 5- to 7-year-old children to report touch?

The authors examined the accuracy of information elicited from seventy-nine 5- to 7-year-old children about a staged event that included physical contact-touching. Four to six weeks later, children's recall for the event was assessed using an interview protocol analogous to those used in forensic investigations with children. Following the verbal interview, children were asked about touch when provided with human figure drawings (drawings only), following practice using the human figure drawings (drawings with instruction), or without drawings (verbal questions only). In this touch-inquiry phase of the interview, most children provided new information. Children in the drawings conditions reported more incorrect information than those in the verbal questions condition. Forensically relevant errors were infrequent and were rarely elaborated on. Although asking children to talk about innocuous touch may lead them to report unreliable information, especially when human figure drawings are used as aids, errors are reduced when open-ended prompts are used to elicit further information about reported touches.

The balancing act. Collaboration between frontline forensic staff and hospital administration.

1. Flexibility, creativity, and consistency are critical characteristics for both frontline staff and administrators in the delivery of treatment and care for complex forensic patients who may be difficult to manage. 2. Through collaborative efforts and ongoing communication, plans can be identified and implemented that enhance patient and staff safety and facilitate positive behavioral and rehabilitation outcomes for patients. 3. Effective partnerships among frontline staff, administration, patients, their families, labor unions, and communities contribute significantly to the effective resolution of conflicts and dilemmas in the provision of holistic care to forensic patients.

Humor as the focal point of treatment for forensic psychiatric patients.

Framed as a qualitative case study based on constructivist notions, the research being reported evaluates the Humor Group, a unique treatment modality evoking therapeutic change by engaging male forensic psychiatric patients and nursing students in humorous activities. The group's meaning for patient health was investigated by cross-analyzing data collected from patient and student questionnaires, in-depth patient interviews, and naturalistic observations made by the researcher during the group's 4-year tenure. The Humor Group structure and format are offered as guides for undertaking similar attempts to rein in humor's healing potential in other settings and with other populations.

Effects of social support on children's eyewitness reports: a test of the underlying mechanism.

Research on children's eyewitness testimony demonstrates that interviewer-provided social support given during a mock forensic interview helps children resist an interviewer's misleading suggestions about past events. We proposed and tested 1 potential mechanism underlying support effects: "Resistance Efficacy," or children's perceived self-efficacy for resisting an interviewer's suggestions. Eighty-one 6- and 7-year-old children experienced a play event, then were interviewed about the event with misleading and specific questions. Consistent with prior research, children interviewed by a supportive person were more resistant to misleading suggestions than were those interviewed by a nonsupportive person. Although Resistance Efficacy did not mediate the effects of interviewer support in the full sample, additional analyses revealed that Resistance Efficacy may be a mediator for older, but not younger, children. Contrary to predictions, children's preexisting social support reserves were not related to children's interview accuracy nor to perceived Resistance Efficacy. Implications for psychological theory are discussed, as well as implications for understanding and improving children's eyewitness reports.

Describing individual incidents of sexual abuse: a review of research on the effects of multiple sources of information on children's reports.

OBJECTIVE: For successful prosecution of child sexual abuse, children are often required to provide reports about individual, alleged incidents. Although verbally or mentally rehearsing memory of an incident can strengthen memories, children's report of individual incidents can also be contaminated when they experience other events related to the individual incidents (e.g., informal interviews, dreams of the incident) and/or when they have similar, repeated experiences of an incident, as in cases of multiple abuse. METHOD: Research is reviewed on the positive and negative effects of these related experiences on the length, accuracy, and structure of children's reports of a particular incident. RESULTS: Children's memories of a particular incident can be strengthened when exposed to information that does not contradict what they have experienced, thus promoting accurate recall and resistance to false, suggestive influences. When the encountered information differs from children's experiences of the target incident, however, children can become confused between their experiences-they may remember the content but not the source of their experiences. CONCLUSIONS: We discuss the implications of this research for interviewing children in sexual abuse investigations and provide a set of research-based recommendations for investigative interviewers.