Forensic Psychiatry

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Complexity of case

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 2.3 Perform a general psychiatric interview and mental status exam
• □ME 2.3 Assess the acute risk of harm to self or others
• □ME 2.3 Develop a formulation of the case
• □ME 2.5 Propose an initial management plan
• □ME 5.2 Apply policies and procedures to work safely in forensic psychiatry settings

Communicator

• □COM 1.2 Convey empathy, respect, and compassion
• □COM 2.2 Demonstrate a clear structure for, and manage the flow of the encounter

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Communicator

• □COM 5.1 Document all relevant findings in an organized and concise manner
• □COM 5.1 Document the impression and plan
• □COM 5.1 Ensure text is clear and comprehensible without significant typographical and grammatical errors
• □COM 5.1 Complete clinical documentation in a timely manner

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.3 Apply knowledge of the ethical principles of Forensic Psychiatry
• □ME 2.3 Advise regarding the limits of confidentiality
• □ME 2.3 Advise regarding the right not to participate or answer specific questions

Communicator

• □COM 1.2 Convey the purpose and process of an assessment
• □COM 3.1 Use appropriate language and avoid medical jargon
• □COM 3.1 Use strategies to verify and validate the understanding of the evaluee
• □COM 5.1 Document the consent discussion in an accurate and complete manner

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Collaborator

• □COL 2.1 Treat team members with respect
• □COL 1.3 Communicate clearly with other health professionals

Professional

• □P 1.1 Demonstrate punctuality
• □P 1.1 Complete assigned responsibilities

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Type of observation

1. ●direct
2. ●case review

Fit to stand trial

1. ●yes
2. ●no

Involuntary treatment recommended

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 2.3 Advise regarding the limits of confidentiality
• □Part A: ME 1.3 Apply knowledge of Canadian legislation and relevant case law
• □Part A: ME 2.3 Gather information about the legal issue
• □Part A: ME 2.3 Gather relevant collateral information
• □Part A: ME 2.3 Focus the encounter, performing it in a time-effective manner without excluding key elements
• □Part A: ME 2.3 Select and interpret the results of standardized testing
• □Part A: ME 2.3 Apply the criteria for Fitness to Stand Trial
• □Part B: ME 1.4 Address relevant medico-legal questions and competing hypotheses with supporting rationale

Communicator

• □Part A: COM 2.1 Use effective interviewing skills
• □Part B: COM 5.1 Use an accepted logical structure for forensic psychiatry reports
• □Part B: COM 5.1 Document the case, providing relevant details in a concise and logical manner
• □Part B: COM 5.1 Ensure text is clear and comprehensible without significant typographical and grammatical errors
• □Part B: COM 5.1 Select language and terminology that is appropriate for the intended audience
• □Part B: COM 5.1 Complete the report in a timely manner

Professional

• □Part A: P 4.1 Employ practices that optimize safety and minimize occupational risk

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

NCR

1. ●yes
2. ●no

Medical Expert

• □Part A: ME 2.3 Advise regarding the limits of confidentiality
• □Part A: ME 1.3 Apply knowledge of Canadian legislation and relevant case law
• □Part A: ME 2.3 Gather information about the legal issue
• □Part A: ME 2.3 Gather relevant collateral information
• □Part A: ME 2.3 Select and interpret the results of standardized testing
• □Part A: ME 2.3 Assess the impact of co-morbid medical, psychiatric and developmental issues or substance abuse on criminal responsibility, including possible dissimulation
• □Part A: ME 2.3 Apply the criteria for NCRMD
• □Part B: ME 1.4 Address relevant medico-legal questions and competing hypotheses with supporting rationale

Communicator

• □Part A: COM 2.1 Use effective interviewing skills
• □Part B: COM 5.1 Use an accepted logical structure for forensic psychiatry reports
• □Part B: COM 5.1 Document the case, providing relevant details in a concise and logical manner
• □Part B: COM 5.1 Ensure text is clear and comprehensible without significant typographical and grammatical errors
• □Part B: COM 5.1 Select language and terminology that is appropriate for the intended audience
• □Part B: COM 5.1 Complete the report in a timely manner

Leader

• □Part A: L 4.1 Complete the assessment in a timely manner

Professional

• □Part A: P 4.1 Employ practices that optimize safety and minimize occupational risk

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Focus

1. ●stabilization
2. ●rehabilitation
3. ●reintegration

Risk

1. ●acute
2. ●chronic
3. ●low
4. ●medium
5. ●high

Setting

1. ●inpatient
2. ●outpatient

Medical Expert

• □ME 2.3 Perform ongoing assessments of the patient’s condition and risk
• □ME 2.3 Assess and monitor patient adherence and response to medication and/or treatment
• □ME 2.3 Assess risk of self-harm or harm to others
• □ME 2.5 Make decisions regarding the appropriate level or setting of care
• □ME 2.5 Provide a dynamic plan for risk mitigation, rehabilitation and reintegration

Communicator

• □COM 1.2 Attend to the therapeutic alliance
• □COM 1.2 Recognize and respond to factors influencing the patient’s reactions to the physician and others
• □COM 4.3 Support the patient in gaining a better insight into their issues and making informed decisions regarding their health

Collaborator

• □COL 1.2 Work effectively with other health care professionals

Leader

• □L 3.1 Support and educate members of the team about adherence to risk management plans

Health Advocate

• □HA 1.1 Facilitate patient access to resources and services

Professional

• □P 3.1 Fulfil and adhere to the laws governing patients under the jurisdiction of the Criminal Code Review Board

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Reason for evaluation

1. ●fitness
2. ●NCR
3. ●violence risk
4. ●correctional
5. ●sexological
6. ●civil
7. ●YCJA
8. ●other evaluation

Complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □Part A: ME 2.3 Gather relevant information from interview(s), file review and/or collateral sources
• □Part A: ME 2.3 Select and interpret the results of investigations
• □Part A: ME 2.3 Integrate all relevant data to develop a case synthesis
• □Part A: ME 1.4 Develop a forensic psychiatry opinion, applying Canadian jurisprudence

Collaborator

• □Part A: COL 1.3 Consult with other professionals, including social workers, criminologists, and psychologists as relevant

Professional

• □Part A: P 4.1 Employ practices that optimize safety and minimize occupational risk
• □Part A: P 1.1 Demonstrate a commitment to objectivity and honesty

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Reason for evaluation

1. ●fitness
2. ●NCR
3. ●violence risk
4. ●correctional
5. ●sexological
6. ●civil
7. ●YCJA
8. ●other evaluation

Medical Expert

• □ME 1.3 Apply knowledge of Canadian legislation and relevant case law
• □ME 1.4 Articulate complexities in the case analysis, such as limitations, areas of uncertainty, and competing hypotheses

Communicator

• □COM 5.1 Document the case, providing relevant details in a concise and logical manner
• □COM 5.1 Document the forensic opinion in a logical well-supported manner
• □COM 5.1 Prepare reports that are well written
• □COM 5.1 Complete the report in a timely manner

Professional

• □P 1.1 Demonstrate a commitment to objectivity and honesty

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Setting

1. ●review board
2. ●capacity board
3. ●court
4. ●tribunal
5. ●other setting

Mock trial

1. ●yes
2. ●no

Complexity

1. ●low
2. ●medium
3. ●high

Medical Expert

• □ME 1.3 Apply knowledge of Canadian legislation and relevant case law
• □ME 1.3 Apply knowledge of criminal, civil, and tribunal procedures and the rules of evidence

Communicator

• □COM 1.5 Use non-verbal behaviours to convey respect, poise, professionalism, and credibility
• □COM 5.1 Convey information about the case clearly and concisely, including evidence-informed opinions and conclusions
• □COM 5.1 Select language and terminology that is appropriate for the intended audience
• □COM 5.1 Respond to questions and cross examination in an appropriate manner

Health Advocate

• □HA 2.3 Minimize stigma and the criminalization of the mentally ill through education of the court, correctional personnel, and others

Professional

• □P 1.2 Prepare for testimony, reviewing all relevant data
• □P 1.1 Project a professional demeanour, including attire appropriate for the setting
• □P 1.1 Demonstrate respect for the administration of justice, the duty to protect others, social responsibility, and striving for objectivity and honesty
• □P 1.2 Demonstrate an appreciation of the limits of one’s own expertise

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Complexity

1. ●clinical
2. ●legal/procedural

Case type

1. ●fitness
2. ●NCR
3. ●violence risk
4. ●correctional
5. ●sexual behavior disorder
6. ●civil
7. ●child or youth

Medical Expert

• □ME 1.3 Apply knowledge of the principles of correctional psychiatry, including special issues of prescribing in correctional settings
• □ME 1.3 Apply knowledge of paraphilic disorders and sexually offending behaviours
• □ME 2.3 Adapt the psychiatric assessment to the context and issues
• □ME 2.3 Assess and monitor patient adherence and response to medication and/or treatment
• □ME 2.3 Assess risk of self-harm or harm to others
• □ME 2.5 Provide a flexible management plan that considers relevant aspects of treatment complexities and risk management

Communicator

• □COM 1.2 Attend to the therapeutic alliance
• □COM 1.4 Recognize and respond to boundary, transference, and countertransference issues

Collaborator

• □COL 1.2 Work effectively with other professionals in the health care, criminal, justice, and legal systems
• □COL 3.2 Ensure communication of and continued adherence to risk management plans during patient transition to another setting or stage of care

Leader

• □L 3.1 Support team members to balance clinical care and risk management

Health Advocate

• □HA 2.3 Advocate for the ethical psychiatric treatment of those in the legal and correctional settings

Scholar

• □S 3.4 Integrate best evidence and clinical expertise into decision making

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Input from

1. ●forensic psychiatrist
2. ●nurse
3. ●social worker
4. ●occupational therapist
5. ●psychologist
6. ●case manager
7. ●peer support worker
8. ●criminologist
9. ●other team member

Collaborator

• □COL 1.2 Receive and appropriately incorporate input from team members
• □COL 1.2 Make effective use of the scope and expertise of other health care professionals
• □COL 1.2 Work effectively with other professionals in the health care, criminal, justice, and legal systems
• □COL 2.2 Navigate team dynamics
• □COL 1.2 Attend to countertransference from members of the team

Leader

• □L 3.1 Support team members to balance clinical care and risk management

Professional

• □P 1.1 Exhibit appropriate professional behaviours

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.3 Apply knowledge of the principles of risk assessment, including structured clinical and actuarial tools
• □ME 2.3 Select the appropriate risk assessment measurement tool(s)
• □ME 2.3 Administer the tool correctly
• □ME 2.3 Interpret results, incorporating knowledge of the limitations of the tool

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.5 Prioritize multiple clinical duties and other professional demands
• □ME 1.4 Perform forensic psychiatry evaluations and prepare well documented assessments and recommendations

Collaborator

• □COL 1.2 Work effectively with other professionals in the health care, criminal, justice, and legal systems

Leader

• □L 4.2 Describe remuneration models as they pertain to Forensic Psychiatry
• □L 4.1 Manage the workload within acceptable turnaround times

Professional

• □P 1.1 Exhibit appropriate professional behaviours
• □P 1.2 Demonstrate an appreciation of the limits of one’s own expertise
• □P 3.1 Fulfil and adhere to the professional and ethical codes, standards of practice, and laws governing practice

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Leader

• □L 4.2 Develop and maintain a curriculum vitae with formatting and content appropriate for use in medico-legal proceedings

Case description

Feedback provided

Next steps

Entrustment (how much supervision did this activity need?)

1. ●I had to do
2. ●I had to talk them through
3. ●I needed to prompt
4. ●I needed to be there just in case
5. ●I didn’t need to be there

Medical Expert

• □ME 1.1 Demonstrate an awareness of what is required to practice safely and effectively in the setting of future practice

Leader

• □L 4.2 Examine personal interests and career goals
• □L 4.2 Adjust educational experiences to gain competencies necessary for future practice

Scholar

• □S 1.2 Interpret data on personal performance to identify opportunities for learning and improvement
• □S 1.1 Define learning needs related to personal practice and/or career goals
• □S 3.1 Generate focused questions that address knowledge gaps
• □S 1.1 Create a learning plan that is feasible, includes clear deliverables, and a plan for monitoring ongoing achievement
• □S 1.1 Identify resources required to implement a personal learning plan

Professional

• □P 2.1 Demonstrate a commitment to maintaining and enhancing competence

Case description

Feedback provided

Next steps