Transcript Ethical Assessment of Licensed Mental Health Professional*s

Ethical Issues and forensic psychological practice using
the DSM-5 Quadrant with Juvenile Fire Setting and Bomb
Making
{
Ronn Johnson, Ph.D. ABPP
University of San Diego
Agenda
•
OVERVIEW OF JUVENILE FIRE SETTING & BOMB MAKING…ETHICS
OF COMPETENCE
•
UNDERSTANDING JUVENILE FIRE SETTING AND BOMB MAKING
* EVALUATING ONE’S SELF
* CASE STUDIES AND ETHICAL CONSIDERATIONS
*Q & A
ETHICAL Professional issues in JFSB

Assessment of JFSB experiences for MH
Professionals

IAFF and the JFSB National Data base effort

Current status of JFSB and mental health programs
nationally
Why do we need an ethical
assessment of mental health
professionals competencies
for JFSB?
SOURCES FOR ETHICAL PRACTICES FOR MENTAL
HEALTH PROFESSIONALS
ACA CODES OF ETHICS and Standards of Practice
2014
 C.2. Professional Competence

C.2.a.Boundaries of Competence
Counselors practice only within the boundaries of their
competence, based on their education, training, super
vised experience, state and national professional
credentials, and appropriate professional experience…
National association of social work (NASW)



1.04 Competence
(a) Social workers should provide services and represent themselves as
competent only within the boundaries of their education, training,
license, certification, consultation received, supervised experience, or
other relevant professional experience.
(b) Social workers should provide services in substantive areas or use
intervention techniques or approaches that are new to them only after
engaging in appropriate study, training, consultation, and supervision
from people who are competent in those interventions or techniques.
AMERICAN PSYCHOLOGICAL ASSOCIATION (APA)

2.01 Boundaries of Competence
(a) Psychologists provide services, teach and
conduct research with populations and in
areas only within the boundaries of their
competence, based on their education,
training, supervised experience, consultation,
study or professional experience.
Specialty Guidelines for Forensic
Psychology

2.01 Scope of Competence
When determining one’s competence to provide services in a
particular matter, forensic practitioners may consider a
variety of factors including the relative complexity and
specialized nature of the service, relevant training and
experience, the preparation and study they are able to devote
to the matter, and the opportunity for consultation with a
professional of established competence in the subject matter
in question. Even with regard to subjects in which they are
expert, forensic practitioners may choose to consult with
colleagues.
Which hat are you wearing?
Forensic vs. Clinical
Clinically, one accepts a juvenile’s description
of the circumstances
Forensically, accused juveniles have reasons
to lie:

proclaim innocence
 The devil made me do it
Legal Standards
Arson is defined in the California Penal Code (CPC) 451
State
and 452.
 CPC451: A person is guilty of arson when he or she
willfully and maliciously sets fire to or burns or causes
to be burned or who aids, counsels, or procures the
burning of, any structure, forest land, or property.


CPC452: A person is guilty of unlawfully causing a
fire when he recklessly sets fire to or burns or
causes to be burned, any structure, forest and or
property.
Three forensic psychological Competency
Questions

Why should licensed mental health
providers be concerned about JFSB?

What does the research reveal about JFSB?

What are the myths associated with JFSB?

.
FACTS
ABOUT
JFSB
More than 50% of the individuals adjudicated for arson
were under the age of 18
56,300 Reports from 2005-2009
110 Civilian Deaths Annually
880 Civilian Injuries Annually
$286 Million in Damages Annually
Up to 96% of JFS Cases Involve the Intentional Setting of a
Fire
STATISTICS ON JFSB
As many as 6.8% of juveniles arrested for arson are under the age of 10.
The crime of arson has the highest rate of juvenile involvement.
Arson is the 2nd leading cause of all fatal home accidents.
Fire setting is the largest cause of home deaths among children.
Almost 34% of the victims of child-‐set fires are the children themselves.
Caution: These federal statistics provided by FEMA may be low, because
many fires that cause only minor damage or injury often go unreported by
Parents and agencies.
Empirical support for JFSB
Previous involvement in fire-setting behavior was found to
be the best single predictor of recidivistic fire-setting.
 Recidivists were noted to have greater levels of interest in
fire and fire-related activities
 Recidivists displayed more covert antisocial behaviors, and
were more likely to be male and older than non-recidivists.
 Recidivists also reported poorer social skills and higher
levels of family dysfunction than other fire-setters.

Kennedy, Patrick J.;Vale, Ellen L. E.;Khan, Sarah J.;McAnaney, Andrea (2006) Factors
predicting recidivism in child and adolescent fire-setters: A systematic review of the
literature. Academic Journal Academic Journal | Journal of Forensic Psychiatry
Psychology, Vol 17(1), Mar, 2006. pp. 151-164.
Competency self-audit for JFSB
Assessment of Competencies
underpinning
generic clinical
forensic skills
specific skills
needed to
conduct a risk
assessment and
diagnosis
Competence with
implementing
culturally
responsive &
evidenced based
interventions
System
competences
(fire service,
probation,
schools, juvenile
court, other
providers)
FORENSIC MENTAL HEALTH
COMPETENCY DOMAINS FOR JFSB
CORE SKILLS
FOR YOUTH
WORK
RISK ASSESSMENT
&
LAWS &
CULTURALLY
DIAGNOSIS
PUBLIC
RESPONSIVE
SAFETY
INTERVENTIONS
:
Foundational
Competency Domains: building blocks of what psychologists do
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
reflective practice
self-assessment
scientific knowledge
methods
relationships
ethical and legal standards
policy
individual
Ethnoracial factors
interdisciplinary systems
{
Rodolfa et al., (2005)
Functional Competency Domains

Knowledge, kills and values necessary to
perform the clinical forensic work required
Functional Competency Domains (cont.)

Knowledge is typically gained through one’s formal education, readings, and other
didactic experiences.

Skills are developed through supervised clinical experiences during practicum and
internship training as well as through ongoing clinical supervision and professional
development throughout one’s career.

Professional judgment should be developed through both, with ongoing efforts
made to prevent any degradation of judgment, (emotional distress, mental health
difficulties, substance abuse etc.)

Competence and the lack thereof should not be viewed dichotomously
according to the American Psychological Association’s (APA, 2002)
Guarding Against Threats to Competence

Maintaining one’s clinical forensic competence is essential

Beyond receiving additional training and updating one’s
knowledge and skills

Must also guard against factors that may degrade one’s ability
to exercise good judgment and effectively implement
knowledge and skills as well
Recent refereed
scholarship in
Police Psychology
±5
Recent refereed
Conference
Presentations
In Police
Psychology
±4
Attendance at
Police
Psychology
Conferences
Articulation of
Police
Psychology
literature/
methods
±3
±2
Membership in
Police Psych.
Assoc. or use of
current Police
Psych. Lit/Methods
±1
{
Johnson, R. (In Press). Journal of Forensic Research
Johnson, R. (In press) Journal of Forensic
Research
Assessing One’s Competence
Real knowledge is to know the extent of one's ignorance.
—Confucius



Why is it so hard for us to accurately gauge our proficiencies?
How may we explain such poor self-insight?
How can we ensure our percieved effectiveness is reality?
Dunning-Kruger Effect
Dunning-Kruger Effect
Definition: People with substantial deficits in their
knowledge or expertise have difficulty recognizing their
deficits
Double Burden of Incompetence:
1.) Deficits in skill allow person to make more mistakes.
2) Same deficits lead person to be unable to recognize they
are performing below their peers
Fig. 2. Perceived versus actual test score as a function of actual test performance.
Dunning D et al. Current Directions in Psychological Science
2003;12:83-87
Copyright © by Association for Psychological Science
Fig. 1. Perceived percentile rankings for mastery of course material and test performance as a function of
actual performance rank.
Dunning D et al. Current Directions in Psychological Science
2003;12:83-87
Copyright © by Association for Psychological Science
Conscious competence learning model
Four Stages of Competency Awareness
Conscious Incompetence
Conscious Competence
“Awhaa Moment”
Aware of learning
Unconscious Incompetence
Unconscious Competence
Unaware of deficits
“Action becomes second nature”
Masterly Level
How to Enhance Metacognition
-Unskilled and Aware


Good clinical supervision and Mentorship
Objective & Subjective performance review
Train, Train, Train!!!
Challenges

DSM Diagnoses = symptoms cluster at the syndromal level

JFSBs can present with several sets of symptoms

Diagnostically the goal is to assess (i.e., differential diagnosis) for
a smaller & sometimes overlapping set of related symptoms that
can assist with the clinical and forensic questions involved in a
JFSB case.
Clinical Foundations of the DSM-5 Quadrant
Comorbidity in JFSB Cases:
In general, it is advisable to adhere to the principle
of parsimony when it comes to diagnoses. At the
same time it is clinically & forensically relevant to
remember that most diagnoses are not mutually
exclusive.
Using multiple diagnoses requires understanding the clinical &
forensic implications.

Multiple diagnoses are not actually independent from each other.
JFSB Comorbidity
• Having more than one DSM-5 diagnosis
does not necessarily mean that there is more than one underlying
pathophysiological process.
• The diagnoses are not entities but descriptive
building blocks, a way of communicating
diagnostic information used to select clinical or forensic options.
JFSB Comorbidity
DSM-5 Quadrant: Defined
● Four (Quadrant) Primary Mental Health Disorders that
Present with JFSB
o
o
o
o
Conduct Disorder (CD)
Autism Spectrum Disorder (ASD)
Attention-Deficit / Hyperactivity Disorder (ADHD)
Post Traumatic Stress Disorder (PTSD)
DSM-5 Quadrant: Defined
ADHD
PTSD
ASD
CD
DSM-5 Quadrant: Defined
ADHD
PTSD
ASD
CD
DSM-5 Quadrant: Defined
ADHD
PTSD
ASD
CD
DSM-5 Quadrant: Prevalence
● Conduct Disorder (CD)
o
o
JFSB are more likely to meet the criteria for CD than any other mental
health disorder (Dolan et al., 2011; Kolko & Kazdin, 1988; Sakheim & Osborn, 1994)
Juveniles exhibit more pronounced delinquent and hyperactive behavior
(Del Bove & MacKay, 2011; Kafry, 1980; Ayoub et al., 2004)
● Attention Deficit Hyperactivity Disorder (ADHD)
o
o
These juveniles exhibit high levels of antisocial behavior, criminal
activity, and substance use problems
Tend to have more difficulty in school
DSM-5 Quadrant: Prevalence
● Autism Spectrum Disorder (ASD)
o
o
Some behave in socially deviant and destructive ways (Barry-Walsh & Mullen, 2003)
Fire-related crimes are frequently associated with higher-function ASD
individuals (Haskins & Silva, 2006)
● Posttraumatic Stress Disorder (PTSD)
o
o
Impairs ability to tolerate stress
Greater accumulation of recent stressful life events (Wilder, 2007)
FATJAM Parent Interview
● FATJAM is an evidence based assessment and intervention
approach
o Cognitive behavioral framework and information collection
o target protective and risk factors to reduce threats
● Parent interview portion examines:
o changes in child’s behavior, child supervision, school behavior,
hx of abuse, firesetting behavior, previous arrests or
involvement in juvenile justice system
Case of The Cases
Case Study #1
Early one evening, a boy (15) broke into his school with the intent of burning it. He started three
separate fires in different locations to ensure that his effort would be successful. He left the school
and waited. Nothing happened. Frustrated, he returned to the school, broke in a second time, and
reignited the fires. This time his effort resulted in a multiple alarm fire which caused $3.5 million
damage to the school building.
The boy lives in an upper-middle class neighborhood in a stable home environment. He lives with his
biological mother and stepfather. His biological father is not really involved in his life, but all
indications were that this was not an issue to him. No other significant family stressors were
reported. However, it was indicated that his parents had poor parenting skills and judgment and
would often allow him to come and go as he pleased. This lack of structure and clear expectations
led to persistent school problems which resulted in his being reprimanded in school the day of the
fire. The boy stated he was angry at his teachers and wanted to burn the school down.
Case Study #2
A boy (15) admitted starting a fire by putting plastic bags, clothing, and boxes in a baseboard heater
in a spare bedroom of his home. The resulting fire caused $60,000 damage to their single-family
home.
The boy had a history of fire play and had been referred to the local juvenile firesetter program three
years before. At that time, he had started a fire in a closet because he wanted to be a firefighter.
Later, the boy admitted to willingly causing the fire. His father had a chronic illness and it
appeared that the boy had to manage household responsibilities that he resented. He did not feel
that he was properly acknowledged for his increased responsibility. When asked about the
incident, he stated that he was angry at his parents.
Case Study #3
A girl (14) was expelled from school after she and a friend singed the hair of two other
girls by using hair spray and a lighter to make a torch. The teenager frequently was in
trouble at school. The investigator was very concerned about her lack of empathy and
remorse for her violence against the two girls. The father stated he believed that his
daughter was aware of what she was doing, and that she wanted to cause harm. He is
frustrated and tries to monitor her behavior. She was referred for further evaluation.
Working With Ethics
American Counseling Association
American Psychological Association
National Association of Social Workers
American Psychological Association
2.01 Boundaries of Competence
(a) ...provide services, teach and conduct research with
populations and in areas only within the boundaries of their
competence…
(e)…ensure competence of their work and protect
clients/patients, students, supervisees, research participants,
organizational clients and others from harm
(d)…forensic roles, psychologists are or become reasonably
familiar with judicial or administrative rules governing
roles
American Counseling Association
A.4. Avoiding Harm and Imposing Values
(a)…avoid harming their clients…or to remedy
unavoidable or unanticipated harm.
C.2. Professional Competence
(a)…practice only within boundaries of their competence.
(b)…practice in specialty areas new to them only after
appropriate education, training, and supervised
experience...ensure competence of their work and protect
others from possible harm.
National Association of Social Workers
Social Worker’s Ethical Responsibilities to Clients
1.04 Competence
(a)…provide services and represent themselves as
competent only within the boundaries of education
training, license, certification, consultation received,
supervised experience, or other relevant
professional experience.
(b)…techniques or approaches that are new to
them only after engaging in appropriate study,
training, consultation, and supervision from people
who are competent…
National Association of Social Workers
Social Worker’s Ethical Responsibilities As Professionals
4.01 Competence
(a)…accept responsibility or employment on the
basis of existing competence or intention to acquire
competence.
Basic Tools
Assessment Considerations
Dr. J-Could you throw in a couple good assessments here and
maybe a risk related speal?
Conclusion
Questions?
References
Dunning, D. (2011). The dunning-kruger effect: On being ignorant of one's own
ignorance. Advances in experimental social psychology, vol 44. (pp. 247-296)
Academic Press, San Diego, CA. doi:http://dx.doi.org/10.1016/B978-0-12385522-0.00005-6
Kruger, J., & Dunning, D. (2002). Unskilled and unaware--but why? A reply to krueger
and mueller (2002). Journal of Personality and Social Psychology, 82(2), 189-192.
doi:http://dx.doi.org/10.1037/0022-3514.82.2.189
Simons, D. J. (2013). Unskilled and optimistic: Overconfident predictions despite
calibrated knowledge of relative skill. Psychonomic Bulletin & Review, 20(3), 601607. doi:http://dx.doi.org/10.3758/s13423-013-0379- 2
Williams, E. F., Dunning, D., & Kruger, J. (2013). The hobgoblin of consistency:
Algorithmic judgment strategies underlie inflated self-assessments of
performance. Journal of Personality and Social Psychology, 104(6), 976-994.
Retrieved from
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References
American Psychological Association. (2015). Ethical principles of psychologists and code
of conduct. Retrieved from http://www.apa.org/ethics/code/
American Counseling Association. (2014). 2014 aca code of ethics. Retrieved from
http://www.counseling.org/docs/ethics/2014-aca-code-of-ethics.pdf?sfvrsn=4
National Association of Social Workers. (2015). Code of ethics of the national association
of social workers. Retrieved from http://www.socialworkers.org/pubs/code/code.asp