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It is important to have an awareness of why a psychologist chooses certain tests to include in an assessment battery. It is also important to understand how a forensic psychological risk assessment is conducted differently from other types of psychological clinical assessments. Understanding these differences sets the stage for much of your learning in the weeks to come.

In this Discussion, you will review the Learning Resources and apply your knowledge to the case.

To prepare

· Review the case study provided in Chapter 5 of the course text.

· Review the Learning Resources.

· Consider the following questions:

What did the psychologist consider when he chose the specific test instruments?

o Why did the psychologist utilize the Personality Assessment Inventory (PAI)?

o Since the counsel on the case did not request a risk assessment, why did the forensic psychologist choose to utilize the Psychopathy Checklist-Revised (PCL-R) along with the Psychopathic Personality Inventory-Revised (PPI-R) and the Static-99?

o Why is it important that a forensic psychology practitioner, who does not administer test instruments, have an understanding of these test instruments in his or her work?

Post a response to the following, based on the case study:

· Provide a brief summary of the case.

· Explain what role the forensic psychology professional played in selecting the forensic risk assessment instrument used in the case.

· Explain characteristics of the assessment that make it effective for this case.

· Explain the implications regarding the selection of the assessment instrument and its impact on the outcome of the case.

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BOOK REVIEW

In Psychological Profiling: An Evolving Forensic Science (Fort Walton
Beach, FL: Precision Influence Technologies Publication. 2011), Dr.
Frank Goldstein aims to provide the reader with an overview of the
theory and practice of forensic psychological profiling, providing
a general foundation of political profiling, criminal profiling, and
forensic psychological profiling. Dr. Goldstein has written exten-
sively on psychological operations, information operations, and
human factors analysis. In fact, his book, Psychological Operations
Principles and Case Studies, is the premier text on psychological op-
erations in the U.S. and abroad. With contributors from the field of
forensic psychology and chapters written by Dr. Goldstein himself,
Psychological Profiling provides both the novice and experienced
psychological profiler with a wealth of useful information.
Divided into four sections, this book gives a broad overview of the
many aspects of psychological profiling, each section providing a win-
dow into specific profiling areas. The first section of the book focuses on
laying a basic foundation for profile assessment, covering what it takes
to develop a successful psychological profile. This includes a refresher
of basic traits, temperaments, and cognitive and affective domains and
how they relate to psychological assessment and profiling.

Book Review by Wendy Briggs
260 pages • ISBN 978-0-9836466-0

Section two gives an outline and methodology for conducting group
psychological assessment, including religious and country profiling.
Dr. Goldstein provides readers with questions the profiler needs to
answer to effectively understand an organization or group, and what
to look for when gathering data to develop an accurate country or
group profile. Chapter seven provides insight into the often overlooked
religious component to profiling by giving a brief history of United
States involvement in other nations, and the role religion has played
in the outcomes of that involvement.
Section three takes the reader through the steps of actually de-
veloping and writing a profile/assessment, providing key questions
for the profiler to use in his or her evaluation. This section focuses
on showing profilers how to create the most common form of
assessment provided to investigators, the “snap-shot” assessment.
Several examples of “snap-shots” of political figures are provided.
It gives a brief explanation of why it is important to measure ef-
fectiveness of the profile after each case, but leaves finding the
strategies on how to do this up to the reader. Chapters eight and
nine are perhaps the most useful chapters of the book, providing
step-by-step instructions on how to create a “snap-shot” analysis
of a subject through typical means.
Section four gives an overview of Psychological Operations
(PSYOPS), also known as Military Information Support Operations
(MISO), and how it has used psychological assessments for group
and country profiles. This section also breaks down the operational
facets of PSYOPS and shows where a psychological profiler fits into
that structure. The last half of this section provides information that
would be of particular interest to those working with local law en-
forcement. Chapters fifteen through seventeen provide foundational
information for jury profiling, interacting with lawyers, testifying
in court, and conducting psychological autopsies.
The book also provides an extensive glossary of profiling lan-
guage suggested by the profiling students at Marymount University
where Dr. Goldstein is currently on staff. The glossary provides the
reader with a fuller explanation of subjects related to the psycho-
logical profiling field. The appendices provide examples of actual
psychological profiles (both group and individual) produced by
professional profilers.
Forensic psychology is a relatively new science. Therefore, few
instructional books on the subject are available. Of those that are
on the market, few give such a practical overview of this burgeon-
ing science as Goldstein’s Psychological Profiling. While some books
focus mainly on criminal investigations or the philosophy of foren-
sic psychology, Psychological Profiling provides the information and
practical instruction needed for actually conducting the many dif-
ferent kinds of psychological profiles. While some prior knowledge
of psychology and criminology seems to be expected of the reader,
Psychological Profiling does a fairly good job of providing an accessible
and easy-to-understand overview of the potentially overwhelming
field of psychological profiling. The practical methodology provided
makes this book a valuable resource for any forensic psychologist to
have on his or her shelf. n

psychological
profiling:
An Evolving Forensic Science

By Frank L. Goldstein, PhD

submit your book for review today!
FOR MORE INFORMATION, CONTACT THE EdITOR AT:
The Forensic Examiner® • 2750 E. Sunshine • Springfield, MO 65804
OR AT: editor@ac fei.com • 800.592.1399

Fall 2013 THE FORENSIC EXAMINER® 73

Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.

Test Usage in Four Common Types of Forensic Mental Health Assessment

Jennifer L. McLaughlin and Lisa Y. Kan
Sam Houston State University

Without established standards of care for different types of forensic mental health assessment, practice
surveys can provide information about current trends among evaluators and gauge how “typical” practice
follows best practices. This study provides an update on the use of assessment tools in evaluations of
response style/malingering, competency to stand trial, mental state at time of alleged offense, and
nonsexual violence risk. Almost all forensic evaluators (n � 102) indicated that they use assessment tools
to some extent when conducting these types of forensic mental health assessment. Of the 4 instrument
types—multiscale inventories, forensic assessment/relevant instruments, cognitive/neuropsychological
instruments, and projective techniques—evaluators reported using multiscale inventories at higher rates
in evaluations of mental state at time of offense and forensic assessment/relevant instruments at higher
rates for the other 3 issues. Projective techniques were used the least often across all forensic issues. We
also considered how evaluator variables relate to differences in test usage. Finally, we compare our
results with those of previous practice surveys and discuss the implications of these findings.

Keywords: forensic assessment, practice survey, psychological testing

In forensic mental health assessments (FMHAs), evaluators
assess relevant psychological and legal constructs with the primary
goal of assisting the trier of fact, whether it be a judge or jury, in
addressing specific legal questions (Heilbrun et al., 2003). FMHAs
involve obtaining, interpreting, and integrating multiple data
sources, including record review, clinical interviews, and testing
(Melton, Petrila, Poythress, & Slobogin, 2007; Zapf & Roesch,
2009). Clinical interviews may be structured or unstructured, and
testing may use clinical assessment instruments (e.g., cognitive
and neuropsychological tests, personality inventories), forensically
relevant instruments (FRIs; i.e., those that measure clinical con-
structs related to legal issues, such as response style and psychop-
athy), or forensic assessment instruments (FAIs; i.e., those that
directly measure legal constructs, such as functional abilities re-
lated to adjudicative competence; Melton et al., 2007; Otto &
Heilbrun, 2002). Institutions may require the use of particular
procedures or tests for specific forensic questions, and some states
have firm guidelines on particular assessment procedures. For

example, Texas requires specific components in sex offender risk
assessments, including a sex offender screening tool (Tex. Gen.
Laws ch. 62, § 1.01, 2005). Finally, evaluators must be able to
support their techniques in court according to the jurisdiction’s
standard of evidence.

However, most forensic evaluations do not have statutory re-
quirements that dictate the approach evaluators must take (Zapf &
Roesch, 2009), not all evaluators work in institutions with proce-
dural guidelines, and courts often lack sufficient knowledge to
determine whether evidence is scientifically sound (Melton et al.,
2007). FMHA scholars and practitioners have provided some
guidance in terms of identifying training needs and professional
competencies (e.g., DeMatteo, Marczyk, Krauss, & Burl, 2009;
Varela & Conroy, 2012) and developing practice resources. There
are multiple authoritative texts on conducting FMHAs (e.g., Hei-
lbrun, Grisso, & Goldstein, 2009; Melton et al., 2007; Otto &
Weiner, 2013; Packer, 2009; Weiner & Hess, 2006), and the
Oxford University Press publishes the series “Best Practices in
Forensic Mental Health Assessment” (Heilbrun et al., 2009). The
American Psychology–Law Society (AP-LS) and the American
Academy of Forensic Psychology, two primary professional orga-
nizations in the field, recently updated the Specialty Guidelines for
Forensic Psychology (American Psychological Association,
2013b), which provide guidance for the “complete specialty prac-
tice area” (p. 8), rather than any specific type of FMHA, unlike
those published by the American Academy of Psychiatry and the
Law (Giorgi-Guarnieri et al., 2002; Gold et al., 2008; Mossman et
al., 2007). The only FMHA-specific practice guidelines published
by the American Psychological Association (APA) are on child
custody evaluations and evaluations of child protection matters
(APA, 2010, 2013a; Heilbrun & Brooks, 2010). Importantly, “best
practices” and guidelines are generally aspirational and nonbind-
ing versus the minimally acceptable level of practice legally en-
forced in standards of care (Heilbrun, DeMatteo, Marczyk, &
Goldstein, 2008; Slobogin, Rai, & Reisner, 2008).

JENNIFER L. MCLAUGHLIN is a clinical psychology doctoral student at Sam
Houston State University where she also earned her masters degree. Her
clinical and research interests include multicultural issues in forensic
psycholog

LISA Y. KAN received her PhD in clinical psychology from Sam Houston
State University. She is currently an assistant professor and member of the
doctoral program faculty in the Department of Psychology and Philosophy
at Sam Houston State University. Her research interests include multicul-
tural and practice issues in forensic psychology.
THIS ARTICLE IS BASED on Jennifer L. McLaughlin’s masters thesis. Portions
of this research were presented at the 2013 annual conference of the
American Psychology Law Society.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Lisa Y.
Kan, Department of Psychology and Philosophy, Sam Houston State
University, Campus Box 2447, Huntsville, TX 77341-2447. E-mail:
kan@shsu.edu

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Professional Psychology: Research and Practice © 2014 American Psychological Association
2014, Vol. 45, No. 2,

128

–135 0735-7028/14/$12.00 DOI: 10.1037/a0036318

128

mailto:kan@shsu.edu

http://dx.doi.org/10.1037/a0036318

Without clear standards of care, how can forensic psychologists
assure that their practice is “competent enough”? A likely resource
is other forensic evaluators to identify how colleagues and peers
typically conduct a specific type of FMHA. This might be done
through education, training, consultation, supervision, or literature
review. Practice surveys are particularly relevant, as they identify
current trends among evaluators, which can inform standards of
practice and care (Heilbrun et al., 2008), as well as highlight
potential problems.1 In addition, such surveys can describe what is
generally acceptable to the field (e.g., Lally, 2003), the basis of
evidence admissibility in Frye v. United States (1923) and a
component of the admissibility standards in Daubert v. Merrell
Dow Pharmaceuticals (1993).

We focused on test usage because, unlike clinical interviews and
record review, there is less consensus on whether and which tests
should be used in some types of FMHA (Giorgi-Guarnieri et al.,
2002; Heilbrun & Collins, 1995; Lally, 2003; Melton et al., 2007).
For example, clinical assessment instruments measure a person’s
current cognitive, personality, or psychological functioning. Such
information may have limited relevance in evaluations of criminal
responsibility/mental status at time of alleged offense (MSO). This
type of FMHA involves the assessment of the defendant’s
thoughts, beliefs, and behaviors before, during, and immediately
following the alleged offense to determine whether (and to what
extent) the defendant’s understanding of the nature and/or wrong-
fulness of his or her actions was impaired as a result of a mental
disease or defect (Melton et al., 2007; Packer, 2009). Thus, it is the
defendant’s prior functioning that is of primary interest in MSO
evaluations, not his or her current functioning. Competency to
stand trial (CST) evaluations, while present focused, require a
specific assessment of the defendant’s current ability to demon-
strate a factual and rational understanding of the legal proceedings,
as well as the ability to consult effectively with counsel (Melton et
al., 2007; Zapf & Roesch, 2009). Clinical assessment instruments
do not directly measure these functional abilities.

Self-report studies, however, suggest that evaluators consider
acceptable, and often incorporate, the use of multiscale inventories
and intelligence measures in forensic evaluations, including those
for MSO and CST (Archer, Buffington-Vollum, Stredny, & Han-
del, 2006; Borum & Grisso, 1995; Lally, 2003). In particular, all
psychologists in one study (Borum & Grisso, 1995) reported some
use of clinical instruments; in contrast, 36% and 46% reported
never using FAIs in their CST and MSO cases, respectively.
Interestingly, rates of test usage are substantially lower when they
are based on a review of FMHA reports. Heilbrun and Collins
(1995) found that only a minority of reports by psychologists
included any testing (13% of inpatient and 41% of outpatient
evaluations). Warren and colleagues (Warren, Murrie, Chauhan,
Dietz, & Morris, 2004; Warren et al., 2006) too found that tests
were used in only approximately 17% of CST and 22% of MSO
evaluations conducted in Virginia.

On the other hand, there is widespread support for the use of
measures in violence risk assessments, a type of FMHA in which
evaluators might be asked to estimate the likelihood of future
violent behaviors within a specified timeframe, identify risk and
protective factors, and recommend risk management strategies
(e.g., Conroy & Murrie, 2007; Heilbrun, 2009; Skeem & Mo-
nahan, 2011). Risk assessments can provide relevant information
in various decisions, such as those for civil commitment and

sentencing (Viljoen, McLachlan, & Vincent, 2010). Scholars have
made significant progress in the development of risk assessment
approaches and instruments in the past decades, and the fallacies of
using an unstructured approach are well documented (see Camp-
bell, French, & Gendreau, 2009). Both actuarial and structured
professional judgment approaches involve the use of assessment
tools that specify which and how risk factors are considered
(Heilbrun, Yasuhara, & Shah, 2010). Indeed, some experts suggest
that evaluators will likely need to defend why they did not use an
instrument when conducting a risk assessment (Conroy & Murrie,
2007; Viljoen et al., 2010). Even when using specific instruments
is inappropriate (e.g., due to mismatch between evaluee and nor-
mative sample; APA, 2002, 2013b), a structured approach is so
important that evaluators should “structure” their assessments
through systematic consideration of empirically identified or per-
sonally relevant risk factors (Heilbrun et al., 2009). Recent surveys
indicate that evaluator opinion and practice are in line with these
recommendations. Lally (2003) found that an FAI, specifically the
Psychopathy Checklist—Revised (PCL–R), is the only “recom-
mended” instrument for violence risk assessments. Likewise, Vil-
joen and colleagues (2010) reported that more evaluators used risk
and psychopathy assessment tools almost all or all the time com-
pared with tests for psychopathology or cognitive abilities.

In addition, experts suggest that every FMHA, regardless of the
referral question, should include an assessment of response style or
malingering (Frederick, 2012; Melton et al., 2007; Zapf & Roesch,
2009). This type of assessment aims to determine whether evaluees
are feigning, exaggerating, or minimizing symptoms of cognitive
deficits, psychopathology, or functional abilities, for an external
gain they would not otherwise be granted (e.g., lesser sentence,
mental health treatment, early discharge; Frederick, 2012). The
potential consequences of misclassifying honest or dishonest re-
sponders are serious (D’Amato & Denney, 2008; Rogers, Vitacco,
& Kurus, 2010; Simon, 2007), and researchers have developed
multiple tools to increase evaluators’ ability to accurately assess
response style. Currently, a wide range of assessment tools is
available, either as individual measures or as validity scales within
other instruments (Boone, 2009; Heilbronner, Sweet, Morgan,
Larrabee, & Millis, 2009; Rogers et al., 2010), for different target
behaviors (e.g., psychopathology, cognitive functioning; Freder-
ick, 2012). Thus, experts recommend the inclusion of empirically
supported instruments in assessment of response style or malin-
gering (Frederick, 2012; Heilbronner et al., 2009; Nussbaum,
Hancock, Turner, Arrowood, & Melodick, 2008). Despite these
recommendations, it is unclear how often evaluators use instru-
ments to assess response style or malingering. Lally (2003) found
that his respondents considered both the Minnesota Multiphasic
Personality Inventory—2 (MMPI–2) and the Structured Interview
of Reported Symptoms (SIRS) as “recommended” instruments,
and Archer et al. (2006) reported that the SIRS and Test of
Memory Malingering (TOMM) were the most popular among
specialized tools for malingering.

This study provides an update on the use of tests or assessment
tools in four common foci in FMHAs—response style/malinger-
ing, CST, MSO, and risk for future nonsexual violence. We also

1 For a thorough discussion of the relationship between standards of
practice and standards of care, see Heilbrun et al. (2008).

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129TEST USAGE IN FMHA

examined whether and how evaluator variables relate to test usage.
Specifically, we hypothesized that test usage would be higher
among evaluators who completed their degree more recently and
those who completed a postdoctoral fellowship in forensic psy-
chology because they are more likely to be aware of the recent
advances in test development for FMHAs (Heilbrun et al., 2008;
Viljoen et al., 2010). In addition, we hypothesized that test usage
would be higher among those who practice in one of the 17 states
that specifically require FMHA training (Heilbrun & Brooks,
2010).

Method

Participants

Forensic evaluators (N � 115) in professional psychological
practice consented to participate in the online survey. Of these, 103
completed at least the demographic section of the survey. One
respondent indicated that her clinical practice did not involve any
FMHAs; thus, her responses were dropped from all analyses. In
the final sample (n � 102), most participants identified as Cauca-
sian (91.2%) and had earned a PhD (75.5%), on average, 14.24
years (SD � 11.60) before. The majority (84.3%) reported com-
pleting some formal training in forensic psychology, either through
a postdoctoral fellowship (45.1%) or state/institution-required
training (70.6%). In addition, 52% reported practicing in a state
that requires training in FMHA and 16.7% reported receiving
board certification from the American Board of Forensic Psychol-
ogy (ABFP). Participants reported working in a variety of settings,
with the most endorsed setting a state/federal institution (44.1%).
See Table 1 for additional participant demographics.

Procedure

The data were collected as part of a larger study on evaluator
beliefs, personality, and test usage (McLaughlin, 2013). We iden-
tified potential participants through three methods and recruited
them through e-mail. First, the primary author contacted the Web-
master of AP-LS, who sent an initial recruitment e-mail to all
nonstudent members of AP-LS, followed by a second e-mail 2
weeks later. Second, the primary author individually e-mailed
psychologists who received board certification from ABFP, using
the publicly available e-mail directory. Lastly, we asked potential
participants to distribute the survey information to their colleagues.
Potential participants needed to have a graduate degree in psychol-
ogy, be in professional practice (i.e., not currently completing a
postdoctoral fellowship), and have conducted an evaluation ad-
dressing at least one of the four forensic issues in the previous 6
months.

The recruitment message provided a brief description of the
overall study, inclusionary criteria, contact information, and a link
to the online materials on Survey Monkey. The link directed the
participants to the confidentiality and consent agreement, and they
were required to provide informed consent before beginning the
survey.

We were unable to estimate the response rate for several rea-
sons. AP-LS did not provide the number of nonstudent members in
its e-mail directory, and not all nonstudent members engage in
forensic practice. We have no information about the number of

invitations sent by participants, and some likely received multiple
invitations, for example, from a colleague and e-mails from AP-
LS. Our final sample size is comparable to those of other practice
surveys (Borum & Grisso, 1995; Lally, 2003).

Materials

The online survey included three sections. The first section
included demographic questions regarding the participants’ per-
sonal characteristics (e.g., age, race, gender), graduate training,
and training and practice in forensic psychology. Specifically,
participants estimated the portion of their practice devoted to
conducting forensic evaluations and the number of times they
addressed each of the four forensic issues (i.e., response style/
malingering, CST, MSO, risk for nonsexual violence), as well as
other types of FMHA, in the past year. The second section (not
presented here) consisted of the Goldberg Five-Factor Markers
(Goldberg, 1992) personality measure. The third section included
four subsections, one for each forensic issue, that asked about the
evaluators’ perceptions of the use of four types of instruments.
Examples of multiscale inventories (e.g., MMPI–2, MMPI–2—
Restructured Form, Millon Clinical Multiaxial Inventory, Person-

Table 1
Characteristics of Participants

Variable Value

Mean (SD) age (years) 46.41 (13.44)
Gender: Female, % 51.0
Ethnicity, %

African American 2.00
Asian American 3.90
Caucasian 91.2
Hispanic 2.90
Other 2.00

Highest degree, %
PhD 75.50
PsyD 23.50
MA 1.00

Mean (SD) years since degree attainment 14.24 (11.60)
Work environment, %

Academic 16.70
State/federal institution 44.10
Hospital 24.50
Independent practice 37.30

Any forensic training, % 84.30
Forensic postdoctoral training 45.10
State/institution training 70.60

Practice in a state that requires forensic training, % 52.00
Board certification in forensic psychology, % 16.70
Mean (SD) percentage of practice devoted to

forensic evaluations (n � 100) 67.39 (32.80)
Mean (SD) number of times forensic issue was

addressed in past year
Response style/malingering (n � 99) 39.61 (107.16)
CST (n � 101) 34.12 (46.62)
MSO (n � 98) 14.12 (25.61)
Nonsexual violence risk (n � 96) 20.28 (38.11)
Other types of FMHA (n � 43) 27.53 (63.05)

Note. n � 102, unless otherwise noted. Evaluators could choose more
than one category for the variables ethnicity and work environment;
therefore, the percentages do not add to 100%. CST � competence to stand
trial; MSO � mental state at time of alleged offense; FMHA � forensic
mental health assessment.

130 MCLAUGHLIN AND KAN

ality Assessment Inventory), cognitive/neuropsychological instru-
ments (e.g., Wechsler scales, Halstead Reitan Neuropsychological
Battery, Trailmaking Test), and projective techniques (e.g., Ror-
schach Inkblot Test, Thematic Apperception Test) were the same
for each forensic issue, as evaluators might use the same instru-
ment(s) for different purposes. For instance, an evaluator might
use the MMPI–2 to assess both response style and psychopathol-
ogy as part of an MSO evaluation; in the survey, participants were
asked to endorse the use of MMPI–2 for the forensic issues
separately. Examples of FAIs/FRIs were specific for each type of
FMHA, such as the TOMM and SIRS for assessing response
style/malingering and the MacArthur Competency Assessment
Tool for CST. Participants also estimated the percentage of eval-
uations for which each type of instrument was actually used for
each forensic issue.

All participants were asked about their perceptions and practice
in assessing response style/malingering because it is considered a
part of all forensic evaluations (Frederick, 2012; Melton et al.,
2007; Rogers, 2008). For the other forensic issues, participants
only answered the respective questions if they addressed the issue
in the past 6 months. Therefore, participants could answer ques-
tions pertaining to one, two, or three additional forensic issues.

Results

Participants varied widely in the portion of their practice de-
voted to forensic evaluations, from 10% to 100% (M � 67.39%,
SD � 32.80). Response style/malingering was the most common
forensic issue addressed, with respondents reporting that they
evaluated the construct an average of 39.61 times (SD � 107.16)
in the past year, followed by CST (M � 34.12, SD � 46.62), risk

for nonsexual violence (M � 20.28, SD � 38.11), and MSO (M �
14.12, SD � 25.61). Approximately 35% reported conducting
other types of FMHA in the past year. However, seven participants
reported that they did not assess response style/malingering in the
past year, despite addressing other forensic issues, and a majority
(82.4%) indicated that they addressed other forensic issues more
frequently than they did response style/malingering.

Regarding test usage, one participant did not answer any ques-
tions regarding test usage for any of the four forensic issues and
was therefore not included in further analyses. All other partici-
pants (n � 101) reported using assessment tools to some extent.
Only one of 82 (1.2%) evaluators who assessed CST and four of
72 (5.6%) who assessed nonsexual violence risk indicated never
using any assessment tool, versus 12 of 68 (17.6%) who assessed
MSO. Mean frequencies (i.e., percentage of cases) of test usage
differed by type of assessment tool and type of FMHA (see Table
2). FAIs/FRIs were the most frequently used in evaluations of
response style/malingering, CST, and risk for nonsexual violence,
and multiscale inventories were the most frequently used in MSO
assessments. Evaluators used projective techniques the least often
across all four forensic issues.

To compare our results with previous surveys, we also cate-
gorized the frequencies of usage based on the categories in
Borum and Grisso (1995). For evaluation of response style/
malingering, more participants reported “almost always” (81–
100%) using FAIs/FRIs than other instrument types (see Table
2). The pattern was similar for CST and nonsexual violence risk
evaluations, and more participants reported they “almost al-
ways” used multiscale inventories in MSO assessments than
other instrument types.

Table 2
Frequencies of Test Usage for Four Forensic Issues

Instrument type
Mean (SD) percentage

of cases

Categories of test usage frequency (%)a

Never
(0%)

Rarely
(1–10%)

Sometimes
(11–40%)

Frequently
(41–80%)

Almost always
(81–100%)

Response style/malingering
Multiscale inventories (n � 101) 52.21 (39.13) 9.9 17.8 14.9 25.7 31.7
FRI/FAI (n � 100) 66.44 (35.70) 2.0 15.0 10.0 25.0 48.0
C/N (n � 100) 21.41 (27.48) 30.0 28.0 22.0 15.0 5.0
Projective (n � 100) 4.86 (15.97) 81.0 8.0 7.0 3.0 1.0

CST
Multiscale inventories (n � 82) 26.80 (33.20) 29.3 25.6 13.4 19.5 12.2
FRI/FAI (n � 82) 42.83 (39.96) 11.0 25.6 20.7 13.4 29.3
C/N (n � 82) 26.62 (29.69) 12.2 30.5 36.6 9.8 11.0
Projective (n � 82) 2.52 (11.00) 87.8 7.3 2.4 2.4 0.0

MSO
Multiscale inventories (n � 68) 38.40 (39.04) 23.5 20.6 13.2 23.5 19.1
FRI/FAI (n � 68) 20.79 (34.80) 57.4 14.7 7.4 5.9 14.7
C/N (n � 68) 20.88 (26.77) 27.9 27.9 26.5 11.8 5.9
Projective (n � 68) 4.79 (15.72) 80.9 10.3 4.4 2.9 1.5

Nonsexual violence risk
Multiscale inventories (n � 72) 49.13 (40.23) 16.7 15.3 16.7 22.2 29.2
FRI/FAI (n � 72) 78.68 (32.98) 5.6 4.2 8.3 18.1 63.9
C/N (n � 70) 26.91 (31.76) 24.3 28.6 21.4 15.7 10.0
Projective (n � 70) 6.10 (16.25) 78.6 8.6 7.1 5.7 0.0

Note. Percentage of cases refers to the proportion of cases in which participants reported using the instrument type for the forensic issue. CST �
competence to stand trial; MSO � mental state at time of alleged offense; FAI � forensic assessment instrument; FRI � forensically relevant instrument;
C/N � cognitive/neuropsychological instruments.
a Values in these columns represent the percentage of respondents whose reported test usage frequency falls within that frequency category.

131TEST USAGE IN FMHA

Finally, we used nonparametric tests to examine whether and
how test usage differed based on completion of postdoctoral train-
ing in forensic psychology, state requirements for FMHA training,
and recency of degree attainment, to accommodate the nonnormal
distributions of the test usage data (see Table 3). We focused on
the use of multiscale inventories, FAIs/FRIs, and cognitive/neuro-
psychological tools given that only a few evaluators reported using
projective techniques. To minimize the risk of Type I error, we set
a more stringent statistical significance level at p � .001 (using
Bonferroni correction [Warner, 2008], based on dividing the stan-
dard statistical significance level of p � .05 by 36 comparisons).

There were no significant differences in test usage based on
evaluators’ postdoctoral training in forensic psychology or states’
requirements for forensic training. The only significant finding
involved years since degree attainment, which was negatively
correlated with the use FAIs/FRIs in nonsexual violence risk
assessments (rs � �.38, p � .001, one-tailed).

Discussion

In this study, our primary goal was to describe evaluators’ test
usage of four common types of FMHA— response style/malin-
gering, CST, MSO, and nonsexual violence risk. In general, the
reported use of each instrument type averaged about 50% or less,
regardless of the forensic issue. Two notable exceptions are the use
of FAIs/FRIs in evaluations of response style/malingering and
nonsexual violence risk; evaluators reported they used FAIs/FRIs
in an average of 66% and 79% of their cases, respectively. This is
encouraging, given the accumulating empirical support for these
structured assessments for evaluating response style and violence
risk (e.g., Conroy & Murrie, 2007; Rogers, 2008; Skeem & Mo-
nahan, 2011). Furthermore, the occasional use of other instrument
types, such as multiscale inventories and cognitive/neuropsycho-

logical measures in CST evaluations, is consistent with the lack of
consensus on the usefulness of such clinical assessment instru-
ments in FMHAs (Giorgi-Guarnieri et al., 2002; Melton et al.,
2007). On one hand, clinical assessment instruments do not spe-
cifically address the psycholegal issue at hand, whether it be CST,
MSO, or risk of nonsexual violence. On the other, they do offer
structured approaches to assess clinical constructs, such as psy-
chopathology and intelligence, which can be relevant to FMHAs.
Their use might be particularly appropriate when evaluators are
required to offer a rationale for observed functional impairments
(e.g., a defendant cannot consult with defense counsel because of
severe intellectual disability; Mossman et al., 2007) or when they
need to clarify diagnoses to provide appropriate treatment recom-
mendations.

More disconcerting, however, is the result that a majority of
participants indicated that they assessed other forensic issues more
frequently than response style/malingering, despite the fact that
various experts (Frederick, 2012; Melton et al., 2007; Rogers,
2008) consider response style an integral part of all forensic
evaluations. Our respondents simply might have misunderstood
the instructions to count each forensic issue separately if they
address multiple ones in the same evaluation. Or they might have
worked in settings in which different evaluators are responsible for
different aspects of forensic evaluations, although this is unlikely
to be true for most of the respondents. A less innocuous reason is
that evaluators are indeed omitting assessment of response style in
forensic evaluations, which is arguably inconsistent with best
practices.

Another finding worth additional consideration is the use of
FAIs/FRIs in nonsexual violence risk assessment. On the one
hand, it is clearly the most used instrument type for the issue, with
respondents indicating its use in approximately 79% of their cases
on average, which is consistent with practice guidelines (e.g.,
Skeem & Monahan, 2011). However, interpreted another way,
evaluators reported they did not use FAIs/FRIs in about 20% of
their cases. This might be reasonable and appropriate given that
evaluators must consider the instruments’ relevance for the partic-
ular evaluee in that particular context when determining whether
and which tests to use (APA, 2002, 2013b; Heilbrun, 1992; Varela
& Conroy, 2012). One potential reason for not using assessment
tools is the mismatch between the evaluee and the instrument’s
normative sample, which is common when working with diverse
evaluees (Weiss & Rosenfeld, 2010). As Singh, Grann, and Fazel
(2011) pointed out, normative samples for risk assessment tools
tend to be predominantly Caucasian. Correspondingly, they found
some evidence that predictive validity tended to be higher when
study samples were predominantly Caucasian in their meta-
analysis of violence risk assessment tools. In addition, many
studies on risk assessment instruments failed to provide a thorough
demographic breakdown of participants and neglected to include
the racial makeup of their participants (Gonzalez, 2013), which
makes it difficult for evaluators to determine whether the instru-
ment is appropriate for use. Problems with using risk assessment
tools also arise when there are limited records available for eval-
uees. The PCL–R (Hare, 2003), a common FRI in risk assess-
ments, relies heavily on records, to the extent that its use is allowed
without interviewing the evaluee but is discouraged if sufficient
records are unavailable. Without PCL–R results, use of other
common risk instruments is restricted, as the Historical-Clinical-

Table 3
Relationship Between Test Usage and Evaluator Characteristic

Postdoctoral
training

State-
required
training

Years since
degree

attainment

Test usage z p z p rs p

Response style/malingering
Multiscale inventories �1.20 .12 �1.24 .11 .007 .47
FAI/FRI �0.18 .43 �1.28 .10 �.14 .09
C/N �0.57 .29 �1.15 .13 .10 .17

CST
Multiscale inventories �0.75 .23 �0.32 .38 .09 .21
FAI/FRI �1.24 .11 �1.58 .06 .15 .09
C/N �1.77 .04 �1.82 .03 .05 .34

MSO
Multiscale inventories �0.71 .24 �1.44 .08 .10 .20
FAI/FRI �0.83 .21 �0.04 .49 .28 .01
C/N �0.43 .34 �1.03 .15 .29 .01

Nonsexual violence risk
Multiscale inventories �1.04 .15 �0.73 .23 .11 .18
FAI/FRI �1.84 .03 �2.61 .004 �.38� .001
C/N �0.32 .38 �0.06 .48 .03 .40

Note. CST � competence to stand trial; MSO � mental state at time of
alleged offense; FAI � forensic assessment instrument; FRI � forensically
relevant instrument; C/N � cognitive/neuropsychological instruments.
� Significant at p � .001, one-tailed.

132 MCLAUGHLIN AND KAN

Risk Management—20 (Webster, Douglas, Eaves, & Hart, 1997)
and the Violence Risk Appraisal Guide (Quinsey, Harris, Rice, &
Cormier, 1998, 2006) incorporate the PCL–R total score. Of
course, there are less defensible reasons for not using risk assess-
ment tools, including evaluators’ unfamiliarity with, or lack of
competence in, using them (Tolman & Mullendore, 2003). The
time and effort required to gather and review information neces-
sary to use these instruments might deter their use among some
evaluators. Systemic constraints, such as time limits in assessing
risk during temporary holds for involuntary hospitalizations and
lack of assessment measures provided by institutions, likely limit
test usage, regardless of evaluators’ intentions or desires to engage
in best practices.

Perhaps most unexpected was the overall lack of significant
differences on test usage based on evaluator characteristics. Con-
trary to our hypotheses, evaluators who completed postdoctoral
training in forensic psychology or practiced in states with required
FMHA training did not report significantly higher rates of test
usage. This might be due to the study’s sample, as most reported
completing some forensic training. The primary methods of re-
cruitment involved e-mailing psychologists board certified by
ABFP and members of AP-LS; therefore, respondents (regardless
of training requisites) might be equally likely to attend the orga-
nizations’ presentations on FMHAs. The only significant differ-
ence involved the use of FAIs/FRIs in nonsexual violence risk
assessments. Consistent with our hypothesis, evaluators who had
received their degree more recently were more likely to use fo-
rensic instruments. This might be attributed to their being more
aware of the recent advances in test development for FMHAs
(Heilbrun et al., 2008; Viljoen et al., 2010).

How do our results compare with previous practice surveys?
Like the psychologists in Borum and Grisso’s (1995) study, almost
all of our respondents reported using assessment tools to some
extent. The pattern of test usage across different forensic issues
(i.e., multiscale inventories more frequently used in MSO evalu-
ations and FAIs/FRIs more frequently used for the other three
issues) is consistent with Lally’s (2003) results on which tests were
“recommended” for these types of FMHA. In addition, our finding
that a majority of respondents “almost always” use FAIs/FRIs in
nonsexual violence risk assessments is congruent with Viljoen et
al. (2010).

Taken together, we conclude that assessment tools are routinely
used in these four common types of FMHA. Use of some specific
instrument types might be lower than expected or desired, but such
findings should not be considered recommended or acceptable
practice. Rather, we interpret them as indicators of areas for
improvement, either in further promotion and education of existing
measures or in development of better tools. We agree with other
scholars’ (e.g., Borum & Grisso, 1995; Conroy & Murrie, 2007;
Viljoen et al., 2010) assertion that evaluators should provide sound
rationale for their decisions not to use assessment tools in FMHAs,
especially for issues for which empirical evidence strongly support
such usage (e.g., risk assessment). There are clear preferences for
the use of certain instrument types among all four issues, partic-
ularly for the use of FAIs/FRIs in nonsexual violence risk assess-
ments. However, the use of forensic instruments in nonsexual
violence risk assessments is influenced by recency of evaluators’
degree. These results, along with evidence that evaluators might
not assess response style/malingering in all FMHAs, highlight the

importance of developing and maintaining professional compe-
tence (e.g., APA, 2002; Varela & Conroy, 2012).

Professional competence in forensic psychology includes spe-
cialized knowledge and skills, which are primarily developed at
the postdoctoral level through a variety of avenues (Forensic
Specialty Council, 2007; Otto & Heilbrun, 2002; Packer, 2008).
Formal postdoctoral fellowships, typically 1 to 2 years long, offer
intensive training and supervised experiences in forensic psychol-
ogy (DeMatteo et al., 2009). The AP-LS/APA Division 41 Website
and the Association of Psychology Postdoctoral and Internship
Centers provide directories of postdoctoral fellowships with a
forensic component. Completion of fellowships often provides the
postdoctoral students with supervised experiences necessary for
licensure in some states (DeMatteo et al., 2009), and it can lead to
early eligibility for board certification in forensic psychology
(American Academy of Forensic Psychology, n.d.; Packer, 2008).
However, the likelihood of obtaining a fellowship is very low:
Malesky and Proctor (2012) identified only 32 positions (of which
29 were funded) among 16 formal postdoctoral fellowships in
forensic psychology for 317 applicants in the year 2008–2009.

Beyond formal fellowships, practitioners can gain postdoctoral
training in forensic psychology through state certification pro-
grams or continuing education (CE) workshops (DeMatteo et al.,
2009), with supplemental supervised experience (Packer, 2008).
For example, Virginia requires evaluators to complete a 5-day
program at the Institute of Law, Psychiatry, and Public Policy to be
eligible to conduct CST and MSO evaluations with adults (Insti-
tute of Law, Psychiatry, and Public Policy, 2012). CE workshops
on forensic psychology are widely available and can be several
hours to several days long. AP-LS typically offers CE workshops
before its annual conferences, and the American Academy of
Forensic Psychology provides several intensive programs through-
out the year. Some states also require periodic recertification or a
minimum of CE hours in forensic psychology each year, which can
help evaluators stay informed about advancements in the field
(Heilbrun & Brooks, 2010).

Finally, regardless of training, experience, or recency of degree
attainment, evaluators need to maintain competence and stay
abreast of relevant literature. Evaluators can learn about the latest
research, practice recommendations, and legal developments by
attending conferences and CE workshops, joining listservs, and
reading texts or journals dedicated to forensic psychology such as
the series in “Best Practices in Forensic Mental Health Assess-
ment,” Law and Human Behavior, and Psychology, Public Policy,
and Law. Staying informed allows evaluators to maintain an em-
pirically and legally informed basis to justify their work, an inte-
gral part of competent forensic practice (e.g., Conroy & Murrie,
2007; Nicholson & Norwood, 2000).

This study has several limitations. First, we recruited partici-
pants mostly by e-mailing psychologists board certified by ABFP
and members of AP-LS. As Archer and colleagues (2006) pointed
out, these evaluators might be systematically different from those
who do not hold memberships in professional organizations and
thus might not represent the “average” forensic evaluator. Simi-
larly, there might be important, but unknown, differences between
those who agreed to participate in online research and those who
did not. Future studies should also recruit participants in person
(i.e., at conferences, workshops, work sites) and through other
means (e.g., state registry of licensed psychologists) to address

133TEST USAGE IN FMHA

these concerns. Second, we focused on the use of different instru-
ment types for different forensic issues rather than test usage
overall or specific instruments. We chose to do this to shorten the
survey and encourage participation, but we cannot identify which
instrument(s) evaluators tend to use for different purposes. Future
studies should address such questions to further inform practice
trends.

Third, we did not ask participants to provide rationale for their
use (or nonuse) of assessment tools. Evaluators should only use
instruments in cases for which there is sufficient justification
(Nicholson & Norwood, 2000), and understanding their decision-
making process can more clearly inform standards of care. Al-
though evaluators will likely benefit from the use of instruments in
most instances, there are appropriate reasons why evaluators do
not use assessment tools in every case. Just as we are concerned
about lower-than-expected test usage being erroneously consid-
ered as recommended or acceptable practice, high utilization rates
stemming from improper use of instruments should not form the
basis for standards of care either. Thus, frequency of test use is
only one of many pieces of information necessary for understand-
ing competent practice. Competent evaluators should be able to
provide explicit, thoughtful, and empirically based rationale for
their decisions, from using assessment tools to forming their con-
clusions, and future research should aim to explore such reasoning
using both quantitative and qualitative methods. This can help
better identify areas of training or development necessary to ad-
vance the field of FMHAs.

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