Forensic Addiction Services / Forensic Drug Diversion Clinic
Primary placement at the Forensic Drug Diversion (ForDD) Clinic in the Yale Division of Law and Psychiatry offers training in both the areas of assessment and evidenced-based interventions for offender populations diverted from corrections and 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 Department of Mental Health and Addiction Services. Fellows have the opportunity to work with internationally recognized experts in both substance use research and forensic psychiatry. This placement affords experiences in evidenced-based clinical interventions, forensic substance dependency assessments, and research.
PRIMARY PLACEMENT - A full year, 30 hour per week primary placement, combined with one of the following secondary placements: Adult Community Mental Health Services / 34 Park Street; Child & Adolescent Services / West Haven Mental Health Clinic
OR - A full year, 45 hour per week primary placement including 15 hours of Forensic Addiction Service Research (based on availability of funding).
SECONDARY PLACEMENT - Forensic Addiction Services is not offered as a secondary placement.
Number of Fellows
Primary Placement: 2
The mission of the Forensic Drug Diversion Clinic is to provide best practice procedures and to offer evidenced-based therapies to substance abusing clients with criminal justice involvement. The goal is to decrease substance use and recidivism rates among substance dependent populations with criminal justice involvement while promoting pro-social behaviors and increasing the overall health of this population.
The Forensic Drug Diversion Clinic is an outpatient treatment clinic serving men and women who are referred by the judicial system for treatment of substance abuse. Services offered include diagnostic evaluation, crisis management, pharmacotherapy, 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.
The treatment team consists of psychologists, social workers, nurses, and psychiatrists. Several of the team members also work with the New Haven Office of Court Evaluations, which is part of CMHC and the Yale Division of Law and Psychiatry, to perform competency to stand trial and substance dependency evaluations and provide subsequent court testimony.
The Law and Psychiatry Division, based in the Department of Psychiatry at Yale University, provides education, forensic evaluations, clinical services, consultation and research related to forensic psychiatry and psychology (i.e., the use of psychiatric/psychological expertise to help resolve legal questions). Consulting on legislation and policy at the state and national level, the Division maintains a national reputation for excellence in the practice of forensic psychiatry. It attracts high profile cases, exceptionally qualified faculty, and talented students through its reputation as a premier program, providing expert consultation and evaluations in criminal and civil cases, creative and effective policy development, and quality education.
Fellows carry a caseload of approximately 10 clients and will be expected to evaluate 2-3 new clients per week. The learning objectives are to: hone skills in CBT and MET interventions; build an effective therapeutic alliance with clients while conducting drug screens and communicating regularly with the courts; improve assessment and case formulation skills; improve case management and referral skills; and develop skills in integrated addiction and trauma/aggression-centered therapies. Fellows will have the opportunity to conduct both individual therapy and gender-specific group treatments. Trainees will also have the opportunity to observe and participate in criminal defense cases at a local public defender's office for one half of their training year.
The training opportunity at ForDD can provide an enriching experience for fellows coming from training backgrounds in either substance use or forensic psychology. For fellows who come from a substance use background, this internship provides the opportunity to learn about the interaction between substance use disorders and illegal behaviors. Up to 80% of addicted populations have criminal justice involvement, and fellows with prior substance use training gain essential understanding of the interplay between addiction and criminal justice through engagement with the courts, probation, and parole. For fellows coming from a primarily forensic background, this internship allows fellows to gain experience providing evidence-based substance use treatment. Substance use disorders are highly prevalent in criminal justice settings and thorough understanding of substance use diagnosis and evidenced-based treatment is necessary when providing treatment or conducting research in forensic psychology. The ForDD program allows an exciting opportunity for trainees from either background to diversify their clinical and research skills and to enhance these skills through work with a unique and diverse clinical population. Additional forensic training is available to fellows interested in observing and participating in evaluations conducted for the public defender’s office of local courts.
Fellows attend weekly ground rounds with forensic psychiatry experts in the Yale Division of Law and Psychiatry. During grand rounds they will be able to listen to presentations on diverse forensic topics including: Not Guilty by Reason of Insanity (NGRI) cases; competency to stand trial evaluations; risk assessments; and political asylum cases. These presentations are occasionally accompanied by videotapes of the evaluations. Additional topics covered during weekly rounds include statutes covering forensic substance dependency evaluations, theories regarding treatment of individuals with antisocial personality disorder, and child abuse statutes and reporting.
During the first semester, fellows learn about competency to stand trial evaluations, review competency evaluation reports, and have the opportunity to observe subsequent testimony. During the second semester, fellows will have the option of completing one full testing battery with a forensic client. By the second semester fellows may have a few clients who have chosen to remain in treatment to work on issues beyond those that the courts have required, and this will allow fellows the opportunity to intensify the therapeutic work with these clients.
The following evidence-based practices (EBPs) are used in this placement setting. Fellows generally have exposure to most of these EBPs though do not necessarily receive training or supervised experience in all of them. The EBPs include: cognitive behavioral therapy (CBT) for addiction, motivational enhancement therapy (MET) for addiction, relapse prevention, and integrated substance abuse and domestic violence (SADV) therapy. Training in EBPs occurs through site specific clinical trainings that occur at the beginning of the fellowship year, ongoing supervision on EBPs by clinical supervisors, weekly staff meetings that address treatment planning, and a book and DVD library for use by all trainees and staff.
The psychological assessment experience for fellows includes evaluations of substance dependency and co-occurring conditions in the form of brief, symptom-focused assessments at treatment entry and key points of the treatment process. With each client, fellows will review records of prior treatment providers, consult with forensic services with which a client is engaged, utilize biochemical verification of substance use, and integrate validated assessments as indicated (e.g., criminal risk). Fellows will be provided with opportunities to observe and engage in forensic assessments in response to requests from outside referral sources (attorneys, public defender offices), including substance dependency evaluations, mitigation evaluations, psychological testing, and competency to stand trial evaluations. Fellows will complete brief assessments routinely and a minimum of two comprehensive assessments per year.
Forensic Addiction Service Research
For fellows interested in gaining additional research training, they may elect have ForDD as their full-time primary rotation, which will include 15 hours per week spent on research activities. Research activities in forensic addiction services would be centered around state- and federally-funded projects focused on needs assessment, and program development, implementation, evaluation, and dissemination. Recent and current projects involve the evaluation of medication assisted treatment in prison facilities, and implementation and evaluation of an offender re-entry program based on a collaborative care model integrating addiction and mental health care, primary health care, and peer mentorship. Fellows would receive mentored research training which may involve data collection, management, and analysis of both qualitative and quantitative data. Fellows would be provided with opportunities to publish peer-reviewed manuscripts and to communicate findings to scientific, stakeholder, and community audiences.
Fellows in this track will have the opportunity to work with clients who differ along dimensions of race, ethnicity, sex, gender, sexual orientation, socio-economic status, and age. Approximately 75% of our clients are male and approximately 25% are young adults. Our referrals come from various legal sources, and the types of charges vary greatly across clients. In addition, through our current correctional re-entry program, fellows have the opportunity to work with both male and female inmates during incarceration in preparation for their return to their communities.
Fellows participate in a weekly scholarly seminar in the Division of Law and Psychiatry. As part of this seminar, fellows are assigned to write up a recent legal case or analyze and draft a paper on a data set assessing the link between drugs and crime. The papers highlight aspects of the case and/or data that are relevant to the field of forensic psychology. Fellows work on the article with a faculty member, and are generally listed as the first author. The papers may be submitted to a peer-reviewed journal such as the Journal of the American Academy of Psychiatry and the Law. This seminar will also cover the role of psychiatry and psychology in the law, defining psychiatric illness as it relates to the criminal justice system, and presentation of psychiatric evaluations in both written and spoken formats. Further, fellows have the opportunity to observe a mock trial that demonstrates the intricacies of presenting psychological evaluations within a courtroom setting.
Fellows in this placement work with internationally known addiction researchers and are involved in grant funded clinical research focused on the development of efficacious treatments for addiction, trauma, and violence including both pharmacotherapy and psychotherapy treatment trials. Finally, fellows may also have the opportunity to attend research seminars, meetings, and writing scholarly projects with faculty associated with addiction-focused NIH-funded interdisciplinary research centers located within the Department of Psychiatry.
Sherry McKee, Ph.D., Primary Advisor
Fellows receive intensive training and supervision to assure that they are adhering to best practice procedures and are competent in administering interventions to substance abusing forensic populations. Each week, all cases currently being evaluated are reviewed and discussed by faculty and fellows together. Final dispositions and treatment recommendations are determined by utilizing the experience and clinical judgment of our multidisciplinary team. Two hours of individual supervision are provided weekly, and two additional hours are provided by the secondary placement. Fellows completing a full-time primary rotation at ForDD will receive 4 hours of individual supervision. Formal evaluations are completed three times during the year and serve as a review of progress on training goals and core competencies.
Seminars and Specialized Training
Fellows in this placement receive a three-day training in CBT and MET at the beginning of the internship year. Fellows also have the option of learning auricular acupuncture which may help to attenuate the experience of withdrawal and craving. In addition to the Law & Psychiatry seminars described above and the Core Seminar that all fellows are required to attend, there are several elective seminar series that Fellows may elect to attend which include: Law & Psychiatry elective; Division of Substance Abuse seminars; Special Populations in Addictions; Psychotherapy Research; Statistics; and Psychiatry Grand Rounds.
Strong applicants for this placement generally have experience in addiction or forensic populations. Ideally, fellows will have experience with inpatient or outpatient addiction settings with experience using evidence based approaches (e.g., MET, CBT, 12 Step Facilitation). Preferably, fellows with primary forensic experiences will also have worked in the intersection of forensics and addiction. Fellows who have matched with this placement have had future goals of clinical research and/or specialized clinical work in addiction or forensic areas.
Applicants selected for this placement must successfully pass background checks conducted by Yale University and the State of Connecticut. Since this placement requires travel between different training sites, previous fellows have considered it essential to have access to their own car.
For Further Information
Contact Dr. Sherry McKee; firstname.lastname@example.org.