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Slide 1: 

CLINICAL-QUANTITATIVE PSYCHOLOGICAL EVALUATION

THE PROBLEM : 

THE PROBLEM EXAMINER BIAS UNRELIABLE EXPERT WITNESS TESTIMONY

MEASUREMENT ERROR : 

MEASUREMENT ERROR MEDICAL TESTS SUCH AS X-RAYS AND LAB RESULTS DNA

THE QUESTION : 

THE QUESTION Why does psychiatric and psychological expert witness testimony have low credibility? How do mental health experts, supposedly following a scientific method and being objective, arrive at opposing viewpoints?

THE ANSWER : 

THE ANSWER EXAMINER BIAS TRAINING PERSONAL BACKGROUND REFERRAL SOURCE

BIAS DUE TO TRAINING : 

BIAS DUE TO TRAINING Many theories of personality and theoretical approaches Many treatment modalities Education-Different universities Professional work experience Bias toward own view of understanding & fixing the problem e.g. Surgeons recommend surgery, Psychiatrists recommend medication, Physical therapists recommend therapy, etc.

BIAS DUE TO PERSONAL BACKGROUND : 

BIAS DUE TO PERSONAL BACKGROUND Personal bias Family, subculture. race, age, gender, world view, sexual preference, etc Idiosyncrasies Not detailed oriented Irrational Narcissism and believe self is right

REFERRAL SOURCE : 

REFERRAL SOURCE BIAS DUE TO REFERRAL SOURCE'S NEED INSTITUTIONAL NEEDS INSURANCE COVERAGE BUDGET CONSIDERATIONS PATIENT’S SEEKING OWN ANSWER ATTORNEYS

LEGAL SYSTEM : 

LEGAL SYSTEM ADVERSARIAL: THESIS - ANTITHESIS COMPROMISE MULTIPLE BIASED OPINIONS EXPENSIVE AND NOT CONCLUSIVE JURY’S RECOGNIZE PROBLEMS WITH PSYCHIATRIC TESTIMONY AND OPPOSING OPINIONS.

Slide 17: 

RESEARCHED BASED EVALUATION IS MORE THAN APPLYING READING IN AN IDIOSYNCRATIC MANNER.

Slide 18: 

VALIDITY IS NOT IN THE TEST BUT IN THE EXAMINER.

PROBLEMS WITH DSM : 

PROBLEMS WITH DSM DSM CRITERIA ARE TOO SUBJECTIVE CRITERIA ARE A VOTE ON REALITY DIAGNOSES ARE NOT SUFFICIENTLY RELIABLE

IS PSYCHOLOGY A SCIENCE? : 

IS PSYCHOLOGY A SCIENCE? MILITARY ADVERTISING POLLING

VALIDITY : 

VALIDITY Face validity Appeal to authority Construct Validity Predictive Validity

THE CLINICAL & QUANTITATIVE APPROACH : 

THE CLINICAL & QUANTITATIVE APPROACH ACTUARIAL METHOD-PAUL MEEHL STRUCTURED CLINICAL JUDGEMENT

Slide 23: 

Insurance companies use the actuarial method to determine probable life span for life insurance.

ACTUARIAL SYSTEM : 

ACTUARIAL SYSTEM ACCURATE DIAGNOSIS Saves time Saves money and administrative resources Saves suffering of patient

THE SOLUTION : 

THE SOLUTION DATA BASED CLINICAL-QUANTITATIVE EVALUATION EXPERT SYSTEM CONSENSUAL VALIDATION OF EXPERT PANEL CRITERION BASED DECISION MAKING ONGOING RESEARCH

INADEQUATE DATA COLLECTION : 

INADEQUATE DATA COLLECTION STANDARDIZED DATA COLLECTION IS MORE THAN FOLLOWING AN OUTLINE HISTORY MENTAL STATUS EXAMINATION

Slide 28: 

BRAIN SOCIALIZATION STRESS

BIOGRAPHICAL QUESTIONNAIRES : 

BIOGRAPHICAL QUESTIONNAIRES COMPLAINTS BACKGROUND MENTAL STATUS EXAMINATION DISABILITY QUESTIONNAIRE PERSONAL INJURY QUESTIONNAIRE

PSYCHOMETRICS : 

PSYCHOMETRICS Neuropsychology: IQ, Achievement, Neuropsychological Tests Personality: MMPI, BECK, SCL, Rorschach, sentence completion, TAT, and etc.

I.Q. = INTELLIGENCE QUOTIENT : 

I.Q. = INTELLIGENCE QUOTIENT MENTAL AGE OR MENTAL ABILITY ____________________________ CHRONOLOGICAL AGE

SYMPTOMS OF BRAIN DYSFUNCTION : 

SYMPTOMS OF BRAIN DYSFUNCTION ABSTRACTION-PROBLEM SOLVING-CONATION DECISION MAKING-FORCED CHOICE DIFFICULTY PAYING ATTENTION (TRAIL MAKING) MEMORY PROBLEMS APHASIA SEIZURES LEARNING PROBLEMS BEHAVIOR PROBLEMS LOW FRUSTRATION TOLERANCE HYPERACTIVITY AUTISTIC BEHAVIOR MENTAL RETARDATION MOTOR IMPAIRMENT MENTAL ILLNESS HALLUCINATIONS

THE PANEL : 

THE PANEL THREE TO FIVE PLUS PSYCHOLOGISTS & PSYCHIATRISTS CHOSEN RANDOMLY FROM POOL. PANEL MEMBERS DO NOT COMMUNICATE OR DISCUSS CASE-INDEPENDENT OPINIONS. PANEL MEMBERS DO NOT KNOW REFERRAL SOURCE.

EXPERT PANEL IMPROVES RELIABILITY : 

EXPERT PANEL IMPROVES RELIABILITY MORE THAN ONE EXPERT OPINION INCREASES RELIABILITY AND IMPROVES DECISION MAKING. GROUP DECISION MAKING IS BETTER THAN ONE OPINION A JURY IS MADE UP OF MORE THAN ONE PERSON TO IMPROVE DECISION MAKING.

PROCEDURE FOR PANEL MEMBERS : 

PROCEDURE FOR PANEL MEMBERS PANEL MEMBERS VIEW INTERVIEW, REVIEW RECORDS, AND REVIEW TESTS RESULTS. PANEL MEMBERS COMPLETE QUESTIONNAIRES COLLATE OPINIONS RENDER OPINION

CRITERION BASED DECISION MAKING : 

CRITERION BASED DECISION MAKING TRACK EACH PANEL MEMBERS ACCURACY TRACK OVERALL DECISION ACCURACY WITH COURT DECISION

PILOT STUDY : 

PILOT STUDY SIXTY JUVENILE AND ADULT CRIMINAL CASES QUESTIONNAIRES CRIMINALITY INDEX

STRUCTURED QUESTIONNAIRES : 

STRUCTURED QUESTIONNAIRES STRUCTURED QUESTIONNAIRES HAVE BEEN SHOWN TO HAVE GREATER RELIABILITY AND VALIDITY THAN UNSTRUCTURED DATA GATHERING.

SUMMARY : 

SUMMARY EXPERT SYSTEM MAY NOT BE BETTER THAN AN OUTSTANDING EXAMINER BUT IS BETTER THAN MOST CLINICIAN’S MOST OF THE TIME. THE “EXPERT” EXPERT IS NOT USUALLY AVAILABLE.

RESEARCHED BASED DECISION MAKING : 

RESEARCHED BASED DECISION MAKING DEVELOP SPECIFIC STATISTICAL INSTRUMENTATION PER REFERRAL BASE. NEED PATIENT POPULATION REFERRAL OVER TIME TO DEVELOP SPECIFIC STATISTICAL PROCEDURES AND REFINE DECISION MAKING. ONGOING OUTCOME RESEARCH.

WHEN TO REFER : 

WHEN TO REFER INCONSISTENT OPINIONS BORDERLINE OR AMBIGUOUS CASE ACCURATE DIAGNOSIS IS WANTED REDUCE MEASUREMENT ERROR IN USUAL CASES, THE COST IS THE SAME AS STANDARD EXAMS.

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