Eric B. Elbogen and Robert Graziano
Research has shown aggression toward others is a problem in a subset of military veterans. Predicting this kind of aggression would be immensily helpful in clinical settings. To our knowledge, there currently are no risk assessment tools or screens that have been validated to specifically evaluate acute violence among veterans. This chapter reviews what we do and do not know about violence in veterans so that clinicians who are making decisions about acute violence can be informed by the existing scientific knowledge base. Examining these empirically supported risk and protective factors using a systematic approach may optimize clinical decision making when assessing acute violence in veterans.
Cynthia Cupit Swenson and Sarah L. Logan
Child maltreatment is a significant global public health problem that impacts children’s health and mental health while young but also can follow them into adulthood, potentially carrying forward patterns of abusive parenting. To effectively manage and eliminate child maltreatment, a uniform definition of abuse and neglect must be developed for proper monitoring of prevalence. Reporting laws and protection of children should be followed with care, and evidence-based prevention strategies and interventions should be disseminated widely. At present, research on treatment of abuse and neglect has produced several models that are scientifically supported and rated as evidence based. Sufficient research has been conducted for the field to practice within the bounds of science. However, further research is needed on implementation of evidence-based treatments.
Adam J. E. Blanchard, Catherine S. Shaffer, and Kevin S. Douglas
Professionals often utilize some form of structured approach (i.e., decision support tool or risk assessment instrument) when evaluating the risk of future violence and associated management needs. This chapter presents an overview of decision support tools that are used to assist professionals when conducting a violence risk assessment and that have received considerable empirical evaluation and professional uptake. The relative strengths and weaknesses of the two main approaches to evaluations of risk (actuarial and structured professional judgment) are discussed, including a review of empirical findings regarding their predictive validity. Following a summary of commonalities among the tools, this chapter provides a brief description of 10 decision support tools focusing on their applicability and purpose, content and characteristics, and available empirical research. Finally, the chapter concludes with a discussion of several critical considerations regarding the appropriate use and selection of tools.
Joah L. Williams, Melba Hernandez, and Ron Acierno
Elder abuse and neglect are serious problems affecting tens of thousands of older adults each year. In this chapter, we discuss elder abuse in its various forms (including emotional, physical, and sexual abuse, financial maltreatment, and neglect) and provide recommendations for screening and prevention relevant to health-care providers working with geriatric populations. We further highlight clinical and contextual issues pertinent to screening for elder abuse and to its prevention, followed by a review of information regarding emergency management and care in cases of suspected or confirmed elder abuse. We conclude with a discussion about mandated reporting laws and community-based intervention strategies. We hope that this chapter will improve providers’ knowledge of the prevalence and consequences of elder abuse and strengthen the willingness to screen for and intervene in situations where an older adult may be the victim of elder abuse or neglect.
Daniel C. Murrie and Sharon Kelley
Although concerns about violence risk emerge regularly in routine clinical practice, many clinicians feel underprepared to assess and manage violence risk. One problem is that the rich knowledge base underlying violence risk assessment has largely remained in the specialties of forensic psychology and psychiatry, where it has been less familiar to clinicians in general practice. In this chapter we review the legal and ethical parameters that guide clinician appraisals of violence risk, and then we summarize the foundational knowledge and techniques—from both the forensic psychology approach and the emerging field of threat assessment. By integrating basic knowledge and practices from these specialized disciplines, clinicians can more comfortably incorporate violence risk assessment and management into their routine care for patients, better infuse risk assessment into the start of treatment, monitor risk over the course of treatment, and respond appropriately to any threats of violence that emerge.
Rosalind D. Cartwright
Sleep medicine has extended into two areas with legal implications: 1) public policy regarding work-related accidents caused by excessive sleepiness and 2) harm done during partial arousals from sleep. In the first, excessive daytime sleepiness, harm is caused by the defendant falling asleep during a waking activity. In the second, partial arousals from sleep, such as sleepwalking, harm occurs when the accused behaves as if awake while still partially sleeping. Accidents due to excessive daytime sleepiness are often the result of insufficient time spent sleeping. This has led several countries to regulate allowable working hours. Aggressive and sexual assaults during sleepwalking have resulted in improved diagnostic specificity. A sleep expert’s role as witness in these new areas includes validation of the diagnosis and testimony pertinent to responsibility for a sleep-related, unmotivated, nonconscious act. This role is controversial based on the ability of the expert to judge an accused’s state of mind during an unwitnessed event remote in time and the explanatory model they employ.
Friendship and Adolescent Problem Behavior: Deviancy Training and Coercive Joining as Dynamic Mediators
Thomas J. Dishion, Hanjoe Kim, and Jenn-Yun Tein
This chapter examines the interpersonal influence of friendships in the amplification of problem behavior during adolescent development. Two dynamic influence processes are described: deviancy training and coercive joining. The actor–partner interdependence model (APIM) framework is applied to videotaped observations of adolescent friendships, looking at selection and influence processes underlying the amplification of problem behavior through deviancy training and coercive joining dynamics. As such, it is revealed that antisocial youths tend to bring in antisocial friends, a finding consistent with results from several other studies. Together, selection and influence processes contribute to the degree of deviancy training and coercive joining. The amount of observed deviancy training predicts future antisocial behavior, whereas coercive joining uniquely predicts escalations to more serious forms of violence. Implications of these findings are discussed for developmental and intervention science, with the explicit goals of preventing and reducing problem behaviors in childhood and adolescence.
Homicide-suicide entails a homicide followed by the perpetrator’s suicide within one week. The incidence of homicide-suicide in the US was 0.23% per 100,000 in 2013 (about 5% of all US homicides). In Western Europe and other low violence countries, such as Japan, homicide-suicides make up a much higher proportion of all homicides. Subtypes are filicidal, spousal (including jealous and declining health subtypes), familial, and extrafamilial homicide-suicide. Spousal homicide-suicides are the most common, yet extrafamilial homicide-suicides receive the most media attention, despite their rarity. Related phenomena include mass murder, victim-precipitated suicide (“suicide by cop”), politically motivated homicide-suicide, and suicide in violent offenders. We review several conceptual models of the etiology of homicide-suicide, namely developmental, dynamic, biological, and cognitive models, and draw implications from the current state of knowledge about homicide-suicide.
Elizabeth K. Reynolds and Linda C. Mayes
Adolescence is the time between the beginning of sexual maturation and adulthood, typically bounded by the ages of 13 to 19 years. One construct that holds a central place in many theories of development and psychopathology is impulsivity. Impulsivity has been considered to play an important role in normal behavior as well as linked to several problematic behaviors that are present or arise during adolescence. Impulsivity, considered to be a multidimensional construct, has been defined and measured in a variety of ways. This chapter will discuss the definitions of impulsivity, measurement (including self-report and behavioral tasks), developmental course, behaviors and disorders in which it is implicated, and future directions.
Sytske Besemer and Joseph Murray
In this essay, the authors provide an overview of theories and empirical studies on the relation between incarceration and reoffending and describe effects of parental incarceration on criminal behavior of children. How does incarceration affect offending behavior when a person leaves prison? Rigorous scientific evidence is lacking, but available empirical data suggest that incarceration has either a null or criminogenic effect on reoffending. How are children of those incarcerated affected by their parent’s prison sentence? Although several theoretical mechanisms of adverse effects have been suggested, including social transmission, economic and psychological strain, and stigmatization, research addressing such mechanisms is scarce. Available evidence points to parental incarceration as a risk factor for poor adjustment outcomes among children, with effects partly caused by caretaker stress and weakened family bonds.
Kevin S. Douglas, Tonia L. Nicholls, and Johann Brink
Violence perpetrated by persons with serious mental illness (SMI), although certainly not the norm among this group, is of clinical and legal import in numerous legal settings. Among these are civil commitment, forensic psychiatry (insanity acquittees), and the criminal justice system. In this chapter, we provide a critical review of interventions and their empirical support that are used to reduce violence among persons with SMI. Promising findings support the use of cognitive behavioral, social learning, and cognitive skills approaches that are consistent with the Risk-Need-Responsivity (RNR) approach to crime and violence prevention. Anger management remains a promising, focused intervention with reasonable support in the literature. Dialectical behavioral therapy (DBT) has substantial general support. Community-based mandatory service programs such as outpatient commitment and mental health courts appear effective. Finally, the evidence base for the violence-reducing effect of certain psychotropic medication, particularly clozapine, is promising yet inconsistent.
Interventions in Forensic Settings: Juveniles in Residential Placement, Defendants in Drug Courts or Mental Health Courts, and Defendants in Forensic Hospitals as Incompetent to Stand Trial
Kirk Heilbrun, Naomi Goldstein, David DeMatteo, Allison Hart, Christina L. Riggs Romaine, and Sanjay Shah
Interventions for criminal justice–involved populations have been an increasing focus of theoretical and research attention, and have also been recognized as among the “next frontier” of priorities for the forensic mental health professions. In this chapter, we present a description of three different kinds of interventions with criminal justice populations. These interventions—for adjudicated delinquents, defendants diverted into specialized courts, and defendants hospitalized as incompetent to stand trial—represent a range of population ages, traditional versus relatively new modalities, and stages of the juvenile/criminal justice systems. Perhaps surprisingly, the more established of these interventions (juvenile placement and forensic hospitalization) have relatively less empirical data regarding their effectiveness than do the newer drug and mental health court modalities. In this chapter, we summarize the evidence that does exist, describe existing and recommended practices where indicated (unfortunately, often without the assistance of effectiveness data), and draw conclusions regarding our future research needs in light of this discussion.
Jennifer R. Fanning and Emil F. Coccaro
Aggression is a behavior with evolutionary origins, but in today’s society it’s often both destructive and maladaptive. The fact that aggression has a strong basis in biological factors has long been apparent from case histories of traumatic brain damage. Research over the past several decades has confirmed the involvement of neurotransmitter function and abnormalities in brain structure and function in aggressive behavior. This research has centered around the “serotonin hypothesis” and on dysfunction in prefrontal brain regions. As this literature continues to grow, guided by preclinical research and aided by the application of increasingly sophisticated neuroimaging methodology, a more complex picture has emerged, implicating diverse neurotransmitter and neuropeptide systems (e.g., glutamate, vasopressin, and oxytocin) and neural circuits. As the current pharmacological and therapeutic interventions are effective but imperfect, it is hoped that new insights into the neurobiology of aggression will reveal novel avenues for treatment of this destructive and costly behavior.
Monica M. Fitzgerald and Nyla Nasser
This chapter provides a brief overview of empirically supported psychosocial treatments for adults who have developed serious clinical psychiatric disorders, such as posttraumatic stress disorder (PTSD), and other psychosocial and behavioral problems as a result of exposure to interpersonal victimization and violence. In this chapter, we will describe important aspects of creating a safe and therapeutic environment for victims of interpersonal violence and the evidence-based core treatment components and strategies for use with adult victims of interpersonal violence with PTSD. Finally, we will introduce three empirically supported treatment programs incorporating some or all of the core treatment components discussed. We will also discuss emerging and novel interventions for the treatment of PTSD in adults that have varying levels of theoretical and empirical evidence.
Helene Raskin White
The author explores the associations between alcohol and drug use and crime. First, general theoretical models of the substance use–crime connection, including substance use causing crime, crime leading to substance use, and a common cause model, are presented. Next, the empirical research that examines situational and global associations between substance use and crime is reviewed, and this research is tied to the explanatory models. The review indicates that the substance-using/crime-committing population is heterogeneous and there are multiple paths that lead to substance use and crime. For some individuals, acute intoxication increases the risks of violent crime; for some, the need for expensive and addictive drugs increases the risks for income-generating crime; for some, exposure to drug cultures and the drug market increases all types of crime, especially violent crime; for some, the criminal lifestyle increases substance use; and, finally, for others, common underlying characteristics (e.g., family, personality, genetics, neighborhoods) increase the risks for both substance use and crime. The author concludes with a discussion of implications for treatment and prevention and suggestions for future research.
Matthew T. Huss and Vince Flynn
The purpose of this article is to provide undergraduate instructors of courses in forensic clinical psychology with some guidance in curriculum planning and determining lecture material. To this end, after limiting the scope of this chapter strictly to the clinical application of psychology to the legal system, challenges unique to teaching a forensic psychology course are discussed; a model for an undergraduate course in forensic psychology is provided; a collection of teaching resources is gathered and made easily accessible to readers; and possible career paths related to the field of forensic psychology are described to assist instructors in providing relevant career information to interested students.
Heidi S. Resnick, Kate Walsh, and Christal L. Badour
Given the high prevalence of sexual assault within both the general population and among college student samples, professionals working in a wide range of medical and mental health care settings should be prepared to address the acute and long-term physical and psychological consequences of sexual assault. It is also important to be aware of the prevalence and service needs among victims of sexual assault who seek acute medical care. This chapter reviews data regarding the prevalence and characteristics of rape and sexual assault, approaches to assessing sexual assault history, acute and long-term victim concerns and consequences associated with rape, access to and utilization of post-assault medical care and other agency services, and prevention and early intervention approaches that may be implemented in the medical setting.
Michael R. McCart and Kristyn Zajac
This chapter provides a brief overview on the prevalence and common consequences of violent victimization among adults. It also summarizes practice guidelines for the evaluation and management of victims in the acute aftermath of an assault. Guidelines argue against delivery of debriefing interventions in the days following a traumatic event and advocate instead for the provision of Psychological First Aid or early, exposure-based protocols. Symptom-based assessments are recommended for tracking victims’ distress levels over time. In addition, for individuals who continue to experience significant distress symptoms several weeks postincident, it may be advisable to deliver an evidence-based, early cognitive-behavioral intervention.