Christopher M. Weaver

Impact of Clinical Training on Violence Risk Assessment

ajp.psychiatryonline.org With this article, the Journal inaugurates a new feature for our readers. Education in Psychiatry, like Treatment in Psychiatry, begins with a case vignette to illustrate an important problem in clinical psychiatry. However, the goal of Education in Psychiatry is to present and evaluate methods to teach students, trainees, and other psychiatrists how to treat patients with these problems.

Two-, Three-, and Four-Factor PCL-R Models in Applied Sex Offender Risk Assessments.

The authors compared 2-, 3-, 4-factor, and 2-factor/4-facet Psychopathy Checklist-Revised (PCL-R) models in a previously unpublished sample of 1,566 adult male sex offenders assessed under applied clinical conditions as part of a comprehensive state-mandated community notification risk assessment procedure. “Testlets” significantly improved the performance of all models. The 3-factor model provided the best fit to the current data, followed by the 2-factor/4-facet model. The 2-factor model was not supported.

Effects of a Late-Life Suicide Risk-Assessment Training on Multidisciplinary Healthcare Providers

Older adults are among the highest at risk for completing suicide, and they are more likely to seek mental health services from providers outside of traditional mental health care, but providers across the spectrum of care have limited training in suicide risk assessment and management and particularly lack training in suicide prevention for older adults. An educational program was developed to increase awareness and improve suicide risk assessment and management training for a range of healthcare providers who may see older adults in their care settings. One hundred thirty‐two participants from two Veterans Affairs Medical Centers participated in a 6.5‐hour‐long workshop in the assessment and management of suicide risk in older adults. Participants were asked to complete pre‐ and postworkshop case notes and report on subjective changes in knowledge, attitudes, and confidence in assessment and managing suicide risk in older adults. Participants included social workers, nurses, physicians, psychologists, and occupational therapists from a variety of care settings, including outpatient and inpatient medical, outpatient and inpatient mental health, specialty clinics, home, and community. After the workshop, participants demonstrated improvement in the overall quality of case notes (P = .001), greater ability to recognize important conceptual suicide risk categories (P = .003), and reported heightened awareness of the importance of late‐life suicide. The results suggest that educational training may have beneficial effect on the ability of multidisciplinary care providers to identify and manage suicide risk in elderly adults.

Coping among military veterans with PTSD in substance use disorder treatment

We longitudinally investigated coping among male military veterans (n = 98) with posttraumatic stress disorder (PTSD) symptomatology and a co-occurring substance use disorder (SUD) who participated in a randomized controlled trial of seeking safety (SS). Participants were randomized to SS or intensive treatment-as-usual (TAU) for SUD. Coping (active, avoidant, emotional discharge), and PTSD and SUD symptomatology were measured prior to and at the end of treatment, and at 6- and 12-month follow-ups. Among the total sample, we found that: (a) avoidant and emotional discharge, but not active, coping tended to be positively associated with PTSD and SUD symptomatology at baseline; (b) active coping increased and avoidant and emotional discharge coping decreased during the 12-month time-period; and (c) avoidant and emotional discharge, but not active, coping longitudinally covaried with PTSD and SUD symptomatology. Results suggest the utility of targeting maladaptive coping in treatments for individuals with co-occurring PTSD and SUD.

Prevalence and nature of criminal offending in a national sample of veterans in VA substance use treatment prior to the Operation Enduring Freedom/Operation Iraqi Freedom conflicts.

This study evaluated the prevalence and types of criminal arrest among 99,512 male veterans in substance use disorder (SUD) treatment across 150 VA facilities from 1998 to 2001. Participants were assessed with the Addiction Severity Index (ASI), which includes detailed information about lifetime criminal activity. A majority of the patients (58.2%) had three or more previous arrests, with 46.0% reporting one or more criminal convictions. Criminal arrests were frequent and varied. A majority of patients (69.3%) had at least one arrest that was not due to drug possession, drug sale, or intoxication. Nearly 24% reported at least one arrest for a violent crime. Patterns of arrest for specific crimes varied across SUD diagnostic categories. Screening for specific types of offending is informative and viable. Existing VA SUD treatment is a potentially underrecognized point of intervention for justice involvement among veterans.

The Need for Responsibly Pursuing Work in Juvenile Psychopathy

ABSTRACT The debate surrounding the application of the psychopathy construct to juveniles polarizes mental health professionals and must be considered within the context of (1) larger societal problems of reification and general misuse of mental health diagnoses and (2) more specific problems caused by the “forensic culture.” In supporting the responsible application of the psychopathy construct to juveniles, I review how (1) psychopathy is fast becoming a reliable and empirically validated assessment for juveniles, already equaling or surpassing more subjective evaluation processes and even other diagnostic categories; (2) the state of the science in culturally competent juvenile psychopathy assessment is positive so far, and in need of immediate empirical attention; (3) concerns about the malleability of psychopathy in juveniles are rooted in problematic assumptions; and (4) the empirical evidence regarding the cost/benefit of stigma versus clinical gain currently supports careful responsible use. I close by offering flexible decision guidelines to assist researchers and clinicians in responsibly pursuing work in juvenile psychopathy.