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Department of Psychiatry

Department of Psychology
 

Forensic Psychiatry Fellowship

Curriculum


 
The forensic psychiatry fellowship is a 1-year ACGME approved post-general psychiatry residency sub-specialty training program sponsored jointly by the University of Colorado at Denver Department of Psychiatry and Denver Health Medical Center Behavioral Health Services.
Goals and Objectives

    1. To familiarize each Fellow with criminal, civil, administrative, and correctional aspects of forensic psychiatry, including:
          • Completion of over 50 assessments and reports involving competency, sanity, mental condition, asylum, fitness for duty, and termination of parental rights evaluations.
          • Review of American Academy of Psychiatry and Law (AAPL) Landmark cases and related literature.
          • Treatment of inmates in various correctional settings.
          • Research and publication involving contemporary forensic topics.
          • Consultation with medical/surgical patients involving forensic issues.
          • Ethical issues involved in forensic practice.
          • Participation with legal community in mock trial experiences.
    2. To provide opportunity to observe experienced forensic professionals performing evaluations, preparing reports, and testifying.
    3. To provide fellows with direct, supervised experience in performing forensic evaluations, preparing reports, and testifying in court.
    4. To provide fellows with direct experience participating in system consultation concerning forensic issues including work in correctional settings.
    5. To provide fellows with supervised experience in conducting research.

 

The program has four major parts: didactic, legal evaluations, system consultation, and clinical evaluation and treatment.

 

Didactic

The formal didactic program includes:

    1. An ongoing weekly seminar series covering the major topics in forensic psychiatry and review of AAPL Landmark cases. This series addresses legal and clinical aspects of forensic psychiatry including criminal, civil, administrative, and correctional topics. This course is organized by the Director of the program and includes invited experts from the legal and medical community.
    2. Quarterly journal club that includes forensic psychiatrists from the community and former graduates of the Fellowship.
    3. Required participation in the annual Review Course that precedes the national AAPL meeting each fall.
    4. Required attendance at the annual national meeting of the Am Academy of Psychiatry and Law.
    5. Required visit with the associate director of the program at a correctional site involved in litigation within the U.S.
    6. Participation with the University of Colorado at Denver Dept. of Psychiatry continuing education Grand Rounds.

Legal Evaluation

Fellows are trained in the preparation and completion of reports and evaluations for the civil and criminal courts and other judicial and regulatory entities. The Director and faculty include all Fellows in legal proceedings including court testimony, depositions, and consultative meetings with attorneys. Fellows participate in mock trial experiences in the role of “expert witnesses” through affiliation with the National Institute of Trial Lawyers and Denver University Law School. Fellows have access and are trained in the use of internet legal resource networks.

Criminal Evaluations

    1. Fellows complete over 35 evaluations referred from the Colorado Mental Health Institute at Pueblo (CMHI-P). These include competency to proceed evaluations, sanity and mental condition evaluations, and risk assessments for conditional release hearings involving defendants found NGRI. Most evaluations are assigned through the Institute for Forensic Psychiatry at the Colorado Mental Health Institute in Pueblo. Initially, all evaluations are supervised by the Director of the program. All reports are reviewed and edited by the Director. Most of the evaluations are done in the metropolitan Denver area jails as part of CMHI-P’s outpatient pre-trial evaluation process. Reports and testimony are critiqued by faculty based on a review of reports and direct observation of testimony.
    2. Fellows are involved in second opinions involving involuntary medication petitions in pre-adjudicated inmates and additional competency evaluations through the Denver Sheriff’s Department, Denver City and County Court system, and Denver Health Medical Center.

Civil Evaluations

    1. Seminars cover legal and clinical topics in civil litigation involving mental health issues.
    2. Community forensic psychiatrists are available as mentors and supervisors of Fellows for civil cases. The Director includes Fellows in all civil and administrative court evaluations. The Medical Director of the Colorado Physician Health Program is available as supervisor and mentor for Fellows interested in impaired professionals and the complexities of oversight by Medical Boards and other agencies.
    3. Fellows receive supervised experience in child custody and termination of parental rights determinations through the Denver Dept of Social Services and Denver Health Medical Center’s Dept. of Psychology.
    4. Fellows complete fitness for duty evaluations for the Denver Police Dept, asylum cases based on claims of torture through the UCD Refugee program, and private consultation.
    5. Fellows are required to join the Associate Director, involved as a court appointed Special Master, in class action prison or jail litigation to an out of state site.

System Consultations

Fellows attend meetings of city and state-level committees and task forces involved in forensic topics, such as the Denver Crime Prevention and Control Commission Mental Health sub-committee. Fellows consult to the consultative psychiatric services within DHMC and to inpatient and emergency services involving assessment of risks and dangerousness, capacity assessments, and guardianship. Within the Colorado Dept. of Corrections (DOC), Fellows work closely with the Chief of psychiatry in research projects including participation on “Harper” committees. Each Fellow is required to join the Associate Director of the program for several days to an out of state site where ongoing class action activity is shaping mental health treatment in a prison or jail setting. Previous site visits have included Pelican Bay in California and Jails in Texas and Louisiana.

Clinical Evaluation and Treatment

Fellows receive extensive experience in the psychiatric evaluation and treatment of inmates in the Colorado Department of Corrections and Denver County Jails. This experience includes intake evaluations and ongoing treatment. Fellows participate in tele-psychiatry clinics through the Colorado DOC mental health programs. The treatment of psychiatric patients in forensic facilities (security hospitals and correctional facilities) presents unique problems for which basic psychiatric training does not prepare a resident. These include:

    1. Providing treatment in a non-clinical system - in secure or correctional facilities, the focus is often upon security and management, while providing effective treatment for the patient's benefit. Clinicians are thus subjected to pressures and situations not encountered in private practice or in the usual civil setting.
    2. Treating patient populations not generally encountered in general psychiatric practice - Patients with severe personaltiy disorders (particularly antisocial personality), paraphilias, and impulse control disorders are common in forensic populations, and present unique diagnostic and treatment problems. Recognition of malingering and development of effective management plans will be a focus of attention during service assignments.
    3. Fellows participate in evaluations of mental health services provided in correctional systems by accompanying faculty who serve as consultants in class action litigation directed at state and county correctional systems.
    4. Fellows learn about particular legal and clinical issues of utilizing involuntary medications in jail settings.

 

Fellows may also conduct research and take electives.

 

Research Experience

Fellows are encouraged to participate in a research project which may result in peer review publications. Research projects may be data-based or scholarly reviews of the legal and clinical aspects of a particular topic. Fellows will be encouraged to participate in ongoing research projects under the direction of program faculty. The broad and diverse interests of the Forensic affiliated faculty allows for individual development in this area. The Colorado Dept. of Corrections and the Denver County Jails under the direction of the Denver County Sheriff’s Department are two sites for active research projects.

Elective Experience

Efforts are made to accommodate Fellows' special interests. Opportunities exist for some focused elective time.

Travel funds are provided for Fellows to attend the annual scientific meeting of the American Academy of Psychiatry and the Law in October. At those meetings they will take the 3-day annual Forensic Psychiatry Review Course. Fellows are also supported in the mandatory travel with the Associate Director to an out of state prison or jail site. Funds for books, other travel, and in state transportation are available. Each Fellow is provided a private office, computer, and other support technology through the Forensic Clinic at Denver Health Medical Center.