Effects of Online Distance Learning on Violence Risk Knowledge and Competencies.

Behavioral health professionals are charged with providing effective outpatient services while addressing patient and public safety, yet training in empirically-informed violence risk assessment strategies remains inaccessible. The authors developed and evaluated an online distance learning (ODL) course on clinical risk assessment targeting frontline providers and trainees in the United States. The ODL consisted of three modules: confidentiality, duty to third parties, and clinical assessment of violence risk. We evaluated the response characteristics and reach among different disciplines, as well as training satisfaction, change in knowledge, self-perceived competence, and self-reported impact on practice at six-week follow-up among 221 learners. Self-perceptions of competence and knowledge in the focal areas increased immediately after completing the training; self-perceived competence increased again by a significant margin at six-week follow-up. Participants reported a moderate-high positive impact of the training on practice.

A Multi-Site Survey of General Psychiatry Residents' Forensic Training.

The authors surveyed general psychiatry residents across the United States to better understand residents' experiences with forensic training and to identify variables with the greatest impact on residents' exposure to, comfort with, and desire to learn more about forensic populations and settings. The survey inquired about these topics and the forensic psychiatry resources available at residents' training institutions. Respondents (n = 129) spanned eight of ten U.S. census regions. Residents' comfort with forensic psychiatry was low, whereas desire to learn was high. Residents' number of exposures and comfort increased with greater forensic experience in residency. Fewer than half of residents had completed a forensic rotation, were required to complete a forensic rotation, or had robust forensic resources available to them. Residents who had completed a dedicated forensic rotation had significantly greater forensic exposures and comfort; a finding that remained significant even after controlling for participants' PGY status. Among residents pursuing fellowship training, residents interested in forensic fellowship had more exposures during residency. This study represents the first published effort to survey general psychiatry residents from multiple residency programs regarding their forensic experiences in training. These results have implications for educators interested in developing broader exposure to and comfort with forensic psychiatry.

A Review of Forensic Fellowship Training: Similar Challenges, Diverse Approaches.

OBJECTIVE: As the specialty of forensic psychiatry and the numbers of justice involved individuals with mental illness continue to grow, forensic education is receiving more attention. To add to this discussion, the authors reviewed current training practices in forensic psychiatry fellowship programs. METHODS: As part of a project funded by the state legislature looking at psychiatry and psychology training, with special focus on state hospital partnerships, the authors interviewed and surveyed forensic psychiatry fellowship program directors and conducted site visits to select programs. Given the mandate, special attention was given to programs with state hospital and psychology training affiliations. RESULTS: The literature and fellowship directors identified several key features and challenges for forensic training programs. Forensic fellowships focused primarily on evaluations and consultations but differed in their offerings related to training in treatment, scholarship, and particular types of evaluations. Common concerns included maintaining adequate funding, variety of training experiences, adequate faculty time, and adequate institutional support. Directors described cultivating institutional support by demonstrating mutual benefit as particularly important for securing resources. CONCLUSION: Forensic fellowships operational during the 2016-2017 academic year offered a range of forensic training activities, but experienced common challenges such as inadequate funding and faculty supervision. Empirical studies are needed to evaluate the relationship between programmatic offerings, the noted challenges, and acquired competencies.

Teaching Forensic Concepts to Residents Using Interactive Online Modules.

Psychiatrists without specialty forensic training routinely encounter forensic questions and treat justice-involved patients, which underscores the importance of adequate forensic training in general psychiatry residency. Some programs may face challenges providing adequate forensic instruction due to a lack of local forensic psychiatrists or other forensic resources. Novel training approaches are needed to fill this gap. This article describes the development, dissemination, and preliminary impact of two online learning modules designed to teach general psychiatry residents about basic forensic psychiatry principles: confidentiality and the duty to third parties. The modules are based on adult learning theory and synthesize clinically relevant vignettes from historically significant legal cases. We disseminated the modules nationally with built-in pre-tests and post-tests. The module responses demonstrate three significant themes: the modules reached learners across the United States; even advanced residents had relatively low subject matter knowledge prior to module completion; and module completion was associated with a significant improvement in resident learners' knowledge of these two topics. This work shows one potential avenue for filling gaps in forensic education within general psychiatry training, although further studies are needed to appreciate the impact of such educational interventions on clinical practice.

Practice Resource for Forensic Training in General Psychiatry Residency Programs.

Full Document: Alonso-Katzowitz JS, Cardasis W, Cerny-Suelzer CA, et al: Practice Resource for Forensic Training in General Psychiatry Residency Programs. Journal of the American Academy of Psychiatry and the Law Online Supplement 2019, 47 (1). Available at: http://www.jaapl.org/content/47/1_Supplement.

Creating a State-Academic Partnership to Advance a Forensic Teaching Service: Benefits and Barriers.

In Washington State, like many states, there is a shortage of forensically trained mental health clinicians to work with criminal justice-involved individuals. At the direction of the state legislature, a collaborative project was undertaken by the University of Washington, the state Department of Social and Health Services, and a state psychiatric hospital to develop a proposal for a jointly sponsored forensic teaching service. The authors reviewed the literature, surveyed and interviewed forensic psychiatry and psychology training directors, and conducted site visits of selected training programs that offer multidisciplinary training or have affiliations with state hospitals. The authors conducted focus groups of additional stakeholders, including clinicians and patients in forensic settings, to better understand the needs in Washington. The authors report on several common benefits and barriers to establishing forensic teaching services. Other states and forensic programs may find this article useful in identifying common considerations for forensic mental health teaching services.

The Benefits of Required Forensic Clinical Experiences in Residency.

OBJECTIVE: The growth of forensic psychiatry has spurred efforts to improve forensic psychiatry training in general psychiatry residency. The Accreditation Council for Graduate Medical Education requires that residencies provide an experience that "exposes" residents to forensic issues, but leaves the specifics to individual programs. However, there is growing need for psychiatrists to understand the unique circumstances of individuals with mental illness involved in the criminal justice system. METHODS: The authors developed a new mandatory forensic rotation for general psychiatry residents and conducted a pilot study to assess its impact on residents' interest and comfort working with criminal justice-involved patients, interest in forensic fellowship, and knowledge of available resources for consultation and supervision. RESULTS: Rotation completion was associated with a significantly increased interest in working with forensic populations and pursuing forensic fellowship, but no changes in residents' level of comfort or knowledge of supervisory and consultative resources. CONCLUSIONS: This study adds to the growing body of literature describing the benefits of expanding forensic education for residents.

The Barriers and Benefits to Developing Forensic Rotations for Psychiatry Residents.

Psychiatry residents' experiences in forensic psychiatry vary greatly across the country, and many psychiatry programs meet the Accreditation Council for Graduate Medical Education requirements for a forensic experience through general psychiatry rotations (e.g., on a consult-liaison service) or classroom-based activities. Forensic clinical experiences during psychiatry residency are important for preparing future general psychiatrists for practice with justice-involved patients, generating interest in forensic psychiatry, and easing the transition from "healer to evaluator" for future fellows. Unfortunately, residency programs interested in expanding their forensic training may face many challenges because of current regulatory frameworks, the nature of forensic practice, and competing demands within residency training programs. This article describes these challenges, and the experience of the authors at one institution with developing a novel forensic experience in a criminal justice diversion setting. The authors conclude with some practical considerations for educators interested in developing forensic experiences at their institutions.