Forensic Evaluations and Consultative Work
The Law and Psychiatry Division receives requests for evaluations for:
- Competency to Stand Trial
- Criminal responsibility
- Pre-sentence reports
- Termination of parental rights
- Civil commitment
- Independent medical evaluations for insurance purposes
- Capacity to practice evaluations for licensing boards
- Forced medication evaluations
- Medical malpractice
- Assessment of insanity acquittees
- Psychic harm
- Risk Assessment
The Law and Psychiatry Division, through the New Haven Office of Court Evaluations (NHOCE) has responsibility for all "competency to stand trial" evaluations in the south-central part of Connecticut, involving three judicial districts, amounting to approximately 200 evaluations per year. We utilize these evaluations as the initial forensic experience for some psychiatric trainees in our program. They are also used for trainees who have not had any prior experience testifying in court.
The forensic trainees perform these evaluations individually with supervision, or as part of a forensic team consisting of a physician, a psychologist, and a social worker or a psychiatric nurse clinician. This team evaluation is authorized under Connecticut statutes to perform competency evaluations. In our experience these examinations allow the trainees a "gentle" introduction to working with attorneys, observing prisoners in jail settings, and testifying under conditions that are relatively routine.
The NHOCE provides one to two evaluations per week of this type under close supervision until there is sufficient mastery in preparation of court reports, testifying and understanding the associated theoretical material, at which time more complex cases are assigned.
A significant source of the flexibility in the program and the breadth and depth of training experience is based on the wide variety of supervised clinical and legal settings in which the trainees are immersed. Each trainee is assigned to a primary clinical forensic treatment setting and to a primary law office in which the trainee provides consultation
State Attorney's Office – New Haven Judicial District
Michael Dearington, JD, State’s Attorney
The New Haven State’s Attorney’s office is located in the New Haven courthouse, approximately 1 mile from Yale-New Haven Hospital and Connecticut Mental Health Center. One trainee spends one 1/2 day per week for their fellowship year in this required rotation. In this position, the trainee is a medical consultant for the 28 attorneys who staff the office. Medical and psychiatric issues are presented to the trainee; these include insanity defense, pre-sentencing evaluations and dangerousness assessments, child abuse cases and forced medication hearings. Trainees may also observe voir dire and trials in progress. Attorney Dearington is the primary faculty member in the New Haven office. Supervision for consultations is provided in individual and group supervision at Connecticut Mental Health Center.
State’s Attorney Office – Ansonia/Milford Judicial District
Kevin Lawlor, JD, State’s Attorney
The Milford State’s Attorney’s office is located in the Ansonia/Milford Superior Court building, approximately 15 miles from Yale-New Haven Hospital and Connecticut Mental Health Center. One trainee spends 1/2 day per week in this year-long required rotation. Medical and psychiatric issues are presented to the trainee; these include insanity defense, pre-sentencing evaluations and dangerousness assessments, child abuse cases and forced medication hearings. Trainees may also observe voir dire and trials in progress. The trainee works with a faculty of 8 attorneys. Kevin Lawlor, State’s Attorney, has overall responsibility for the trainee. Additional supervision is accomplished in the individual and group supervisions at Connecticut Mental Health Center.
Superior Court – Juvenile Matters at New Haven
Cathleen Edwards, JD, Supervising Juvenile Prosecutor
The New Haven Superior Court for Juvenile Matters is located approximately 1-1/2 miles from Yale-New Haven Hospital and the Connecticut Mental Health Center. One forensic trainee spends half a day per week in this year-long required rotation. The trainee serves as medical and psychiatric consultant for three prosecuting attorneys on issues relating to family with special needs, neglect, pre-adjudication issues, competency, dangerousness issues and other delinquency situations. The trainee may also observe adjudications and trials in progress. The primary faculty member is Cathleen Edwards, Supervising Juvenile Prosecutor. Supervision for the consultations is provided in individual and group supervision at the Connecticut Mental Health Center.
Federal Public Defender’s Office – New Haven
Paul Thomas, JD, Assistant Federal Public Defender
The Federal Public Defender's Office is located approximately 1-1/2 miles from the Connecticut Mental Health Center. One forensic trainee spends approximately one-half day per week in a year-long rotation. The trainee provides consultations to attorneys on a variety of medical and psychiatric issues pertaining to the criminal cases at the Federal Public Defender's Office. The trainee observes different aspects of the criminal justice process, e.g. jury selection, sentencing and expert witness testimony. A special feature of this placement is performing pre-sentence evaluations for federal "downward departure" hearings. Other types of evaluations include competency and various criminal responsibility issues. Paul Thomas JD, is the primary site supervisor. Additional supervision is provided in individual and group supervision at Connecticut Mental Health Center.
Treatment of Forensic Patients
Placement with the Department of Children & Families
Currently, the child psychiatry trainee spends approximately 2 days per week over the 12-month residency at Riverview Hospital. The selection for this position is dependent upon interviews and agreement by both institutions. During the length of this rotation, the Law & Psychiatry division is responsible for teaching, supervision, and formal evaluation of the trainee under the responsible attending faculty. On a quarterly basis, the trainee will be evaluated in writing by the supervising faculty.
While at Riverview the trainee is expected to meet the following educational competency goals and objectives: ability to successfully negotiate the special complexities and potential conflicts related to the conduct of therapy of adjudicated delinquents within a locked hospital setting (at least two patients for 6 months each); ability to perform dangerousness and competency to stand trial evaluations of juveniles.
Riverview Hospital for Children and Youth in Middletown is a 100-bed facility, which includes services for the treatment of youths from detention facilities across the state, and for those from the Connecticut Juvenile Training School (CJTS). Patients are mainly adolescents, usually from ages 12 to 16, with significant psychiatric diagnoses such as schizophrenia, mood disorders, conduct disorders, learning disorders, sex offending and substance abuse. Forensic training may include participation in treatment planning meetings, screening of potential patients at the 'feeder' site mentioned above, risk assessments, competency evaluations and facilitating a legal issues group.
Depending on the trainees' interests and abilities, we can focus and direct such evaluations to them. Civil and criminal cases are also referred to faculty, and the trainees may work with faculty on cases that are deemed educationally useful.
Whiting Forensic Division of Connecticut Valley Hospital
The Whiting Unit is a maximum-security facility under the aegis of DMHAS, and receives patients from several sources including:
- Other state hospitals if they are felt to be too dangerous to be managed in more open settings.
- From Department of Correction facilities if treatment needs exceed the capacity of DOC mental health services.
- Persons who are found not guilty by reason of insanity are evaluated and treated in this facility until they are deemed sufficiently safe to be released or transferred.
- Individuals found incompetent to stand trial who require maximum-security custody.
The Dutcher Unit provides treatment of insanity acquittees oriented toward community re-integration, and also serves one unit of civil patients, most of whom are previously convicted mentally ill criminal offenders, including sex offenders. Patients are adults with significant psychiatric diagnoses such as schizophrenia, mood disorders, cognitive disorders, and substance abuse.
The Forensic Clinical Training experience at Whiting consists of:
- year-long individual psychotherapy with two insanity acquittees;
- risk assessments;
- treatment refusal evaluations;
- competency assessments
Psychiatric faculty consists of eight full-time forensic psychiatrists. Supervision is done on site for at least one hour per week. On-site didactics include sessions on issues in forensic and correction settings. Supervision and didactics are coordinated by Patrick Fox, MD.
Placement at the Forensic Drug Diversion (FORDD) Clinic
Placement at the Forensic Drug Diversion (ForDD) Clinic in the Yale Law and Psychiatry Division offers training in both assessment and evidenced-based interventions for offender populations diverted from criminal justice settings into substance abuse treatment. ForDD is a satellite clinic of the Connecticut Mental Health Center (CMHC), and represents a cooperative endeavor between the Department of Psychiatry at the Yale School of Medicine and the Connecticut Department of Mental Health and Addiction Services. This placement affords experiences in evidenced-based clinical interventions, forensic substance dependency assessments, and research.
Services offered at the clinic include diagnostic evaluation, crisis management, pharmacotherapy including suboxone, case management, harm reduction, individual therapy, and group therapy (integrated domestic violence and addiction treatment, relapse prevention, women's trauma groups, young adult groups, acupuncture). Treatment plans are individually tailored to client needs and may be brief or require a longer course of treatment to address psychiatric or trauma-related symptoms.
This rotation will involve approximately 2 days per week over the 12 month residency. Fellows assigned to the clinic will be involved in the multiple aspects of clinical care. They will conduct triage evaluations at the time that patients are admitted to the clinic. They will take direct responsibility for the medication management of a subset of the patients admitted to the clinic. Fellows will have the opportunity to have therapy cases with supervision in the evidenced-based modalities offered by the clinic. There are also a number of opportunities for scholarship in the clinic. Fellows in this placement work with internationally known addiction researchers and are involved in NIH grant funded clinical research focused on the development of efficacious treatments for addiction, trauma, and violence including both pharmacotherapy and psychotherapy treatment trials.