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Ethical Issues and forensic psychological practice using the DSM-5 Quadrant with Juvenile Fire Setting and Bomb Making

Ronn Johnson, Ph.D. ABPPUniversity of San Diego

• 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

Agenda

Assessment of JFSB experiences for MH Professionals

IAFF and the JFSB National Data base effort

Current status of JFSB and mental health programs nationally

ETHICAL Professional issues in JFSB

Why do we need an ethical assessment of mental health professionals competencies for JFSB?

ACA CODES OF ETHICS and Standards of Practice 2014

C.2. Professional Competence

C.2.a.Boundaries of CompetenceCounselors 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…

SOURCES FOR ETHICAL PRACTICES FOR MENTAL HEALTH PROFESSIONALS

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.

National association of social work (NASW)

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.

AMERICAN PSYCHOLOGICAL ASSOCIATION (APA)

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.

Specialty Guidelines for Forensic Psychology

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

Which hat are you wearing?

Legal Standards

State Arson is defined in the California Penal Code (CPC) 451

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?

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FACTS ABOUT JFSBMore 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

55% of all U.S. arson arrests are children under the age of 18. Almost half of these arrests are children ages 15 and under.

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, becausemany 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

Competence with implementing culturally responsive & evidenced based interventions

specific skills needed to conduct a risk assessment and diagnosis

System competences (fire service, probation, schools, juvenile court, other providers)

FORENSIC MENTAL HEALTH COMPETENCY DOMAINS FOR JFSB

RISK ASSESSMENT & DIAGNOSIS

CORE SKILLSFOR YOUTH WORK

LAWS & PUBLIC SAFETY

CULTURALLYRESPONSIVEINTERVENTIONS

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Foundational Competency Domains: building blocks of what psychologists do:

1. reflective practice2. self-assessment3. scientific knowledge 4. methods5. relationships6. ethical and legal standards 7. policy8. individual 9. Ethnoracial factors10. 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

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Recent refereed scholarship in Police Psychology ± 5

Recent refereed Conference Presentations In Police Psychology ± 4

Attendance at PolicePsychology Conferences   ± 3 

Articulation of PolicePsychology literature/methods ± 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 CompetenceReal 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

“Awhaa Moment”

Conscious Competence

Aware of learning

Unconscious Incompetence

Unaware of deficits

Unconscious Competence

“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!!!

JFSB DSM-5 Diagnostic 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.

JFSB Comorbidity

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 diagnosisdoes not necessarily mean that there is more than one

underlying pathophysiological process.

• The diagnoses are not entities but descriptivebuilding blocks, a way of communicatingdiagnostic information used to select clinical or forensic

options.

DSM-5 Quadrant: Defined● Four (Quadrant) Primary Mental Health

Disorders that Present with JFSBo Conduct Disorder (CD)o Autism Spectrum Disorder (ASD)o Attention-Deficit / Hyperactivity Disorder (ADHD)o 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

CDASD

DSM-5 Quadrant: Prevalence● Conduct Disorder (CD)

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)

o Juveniles exhibit more pronounced delinquent and hyperactive behavior (Del Bove & MacKay, 2011; Kafry, 1980; Ayoub et al., 2004)

● Attention Deficit Hyperactivity Disorder (ADHD)o These juveniles exhibit high levels of antisocial behavior, criminal activity,

and substance use problemso Tend to have more difficulty in school

DSM-5 Quadrant: Prevalence● Autism Spectrum Disorder (ASD)

o Some behave in socially deviant and destructive ways (Barry-Walsh & Mullen, 2003)

o Fire-related crimes are frequently associated with higher-function ASD individuals (Haskins & Silva, 2006)

● Posttraumatic Stress Disorder (PTSD)o Impairs ability to tolerate stresso 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

collectiono 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 #1Early 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 #2A 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 #3A 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 AssociationA.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 WorkersSocial 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 Professionals4.01 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?

ReferencesDunning, 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/B978-0-12-385522-0.00005-6 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), 601- 607. 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 http://search.proquest.com/docview/1346800649?accountid=14524

ReferencesAmerican 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