Forensic Psychiatry Curriculum and Faculty

Fellows will spend time in the veteran court rotation, where they will be involved in the relatively new legal setting of the collaborative Veterans' Treatment Court. Based on the model of the drug court, VTC was created in 2008 as a treatment diversion court, to deal with the specific legal issues of the returning veterans and to offer treatment for their psychiatric problems. The fellows will perform the forensic evaluation for eligibility, will write the reports for the court, will participate as consultants for the VTC team, and will be involved in a recommendation of treatment, as well as clinical supervision of the veterans in the program. This way they will develop the competence to coordinate work with the legal side and the health side. They will also reevaluate veterans with serious cognitive issues which cannot be reversed and will recommend to the State dismissal of the legal issues if appropriate. During this rotation, the fellows will have the opportunity to perform other forensic evaluations when consulted by the VA, such as future risk assessment, determination of different types of capacity, or other type of assessments which would create a conflict of interest for the treating physician.

Overall Rotation Goals:

1. To provide the PGY-V fellow a specialized forensic psychiatry experience with veterans in the setting of the Veteran's Justice Outreach Program.
2. To gain experience with the evaluation and treatment of persons involved with the criminal justice system, with a focus on mental health courts and forensic psychiatry.
3. To develop competence in conducting forensic evaluations of these same persons and in writing reports, treating, and participating in court staffing and dockets.
4. To develop competence and comfort in coordinating with legal and clinical entities in the evaluation and treatment of offenders.
5. To appreciate the psychiatric treatment issues pertinent to the forensic psychiatric population.
6. To gain experience in conducting other forensic evaluations in the veteran population in the consult-liaison setting and to appreciate the unique issues pertinent to patients in this setting.
7. To continue to develop skills and knowledge necessary for the competent practice of forensic psychiatry consistent with the ACGME Milestones in forensic psychiatry. 

The Competency and Sanity Unit, housed within the first-floor office suites of the Harris Center's jail based Forensic Psychiatric Services, completes evaluations of a person's competency to stand trial and/or state of mind at the time of the offense (sanity) which have been ordered by the criminal courts. Examiners may be called upon to provide testimony in those courts related to the opinions rendered in their evaluations. In keeping with the dictates of the law, the examiners on this unit are not involved in the provision of clinical care to the persons they evaluate. Initially, the fellow will pair with a forensic psychiatric examiner in order to observe how these court-ordered evaluations are completed. Later, the fellow will advance to completing evaluations under the supervision of the Evaluations team. After the evaluation, the fellow will prepare expert reports related to the presenting question under the supervision of faculty of the forensic psychiatry fellowship program. During their experience the fellow will also receive instruction regarding the state of Texas' legal standards for competency to stand trial and sanity at the time of the offense; and the manner in which forensic psychiatric evaluation differs from usual mental health practice.

Overall Rotation Goals:

1. To provide the PGY-V fellow a specialized forensic psychiatry experience with inmates in the setting of the Harris County Jail.
2. To gain experience with the evaluation and treatment of persons involved with the criminal justice system, with a focus on mental health courts and forensic psychiatry.
3. To learn about Texas' legal standards for competency to stand trial and sanity at the time of the offense and how Texas' court system functions.
4. To develop competence in conducting forensic evaluations of these same persons and in writing reports and providing testimony.
5. To develop competence and comfort in coordinating with legal and clinical entities in the evaluation and treatment of offenders.
6. To appreciate the psychiatric treatment issues pertinent to the forensic psychiatric population.
7. To continue to develop skills and knowledge necessary for the competent practice of forensic psychiatry consistent with the ACGME Milestones in forensic psychiatry. 

The Jail Based Competency Restoration program at the Harris County Jail is a joint collaboration between the Harris County Sherriff's Office and The Harris Center that utilizes a comprehensive teambased approach to assist mentally ill patients proceed through the competency restoration process in a timely, efficient, and humane manner that is commensurate with a state hospital setting standard. The program psychiatrist provides patient care such as initial psychiatric evaluations, medication management and other clinical issues that might emerge, as well as written updates to the court. A registered nurse provides regular medication monitoring in between psychiatric appointments and provides support to the psychiatrist. JBCR team members provide programming in court education, individual and group therapy, co-occurring substance abuse services, trauma-informed care, peer support services, recreational therapy, wellness and recovery groups, Case Management and Discharge Planning, specialized IDD programming, and Cognitive Remediation strategies. The fellow will pair with the program psychiatrist and JBCR team members in order to learn about the provision of this type of care and then proceed to take on more active duties in the evaluation, treatment, and management of these patients. The fellows will also have the opportunity to participate in unit programming for restoration.

Overall Rotation Goals:

1. To provide the PGY-V fellow a specialized forensic psychiatry experience with incarcerated patients in the setting of the Harris County Jail.
2. To gain experience with the evaluation and treatment of persons involved with the criminal justice system, with a focus on mental health courts and forensic psychiatry.
3. To develop competence in conducting forensic evaluations of these same persons and in writing reports, treating, and participating in court staffing and dockets.
4. To develop competence and comfort in coordinating with legal and clinical entities in the evaluation and treatment of offenders.
5. To appreciate the psychiatric treatment issues pertinent to the forensic psychiatric population.
6. To continue to develop skills and knowledge necessary for the competent practice of forensic psychiatry consistent with the ACGME Milestones in forensic psychiatry. 

The Forensic Evaluation Unit provides psychological, psychiatric, and family assessments to children between the ages of 10 and 17 who are referred by the Harris County Juvenile Probation Department or the Juvenile Courts. These assessments aid in treatment and placement planning for youth in the criminal justice system. The fellows will gain exposure to the juvenile justice system and the unique aspects of evaluating children, such as differing stages of development and its effect on the interview, evaluation, and outcomes, parental or guardian consent, third party observation, interview styles, collateral information gathering complications (ex: access to parents, contentious custody cases), and how to evaluate for abuse. During all times on this rotation, unless the fellow has previously completed ACGME-accredited education in child and adolescent psychiatry, the fellows will be directly supervised by an ACGME board-certified child and adolescent psychiatrist for any direct clinical work.

Overall Rotation Goals:

1. To provide the PGY-V fellow a specialized forensic psychiatry experience in the juvenile justice system.
2. To gain experience with the evaluation and treatment of persons involved with the juvenile justice system, with a focus on forensic psychiatry.
3. To learn about Texas' legal standards for forensic evaluations of children and adolescents and how Texas' court system functions regarding juveniles.
4. To develop competence in conducting forensic evaluations of children and adolescents and in writing reports and providing testimony.
5. To develop competence and comfort in coordinating with legal and clinical entities in the evaluation and treatment of children and adolescents.
6. To appreciate the psychiatric treatment issues pertinent to the juvenile justice population.
7. To continue to develop skills and knowledge necessary for the competent practice of forensic psychiatry consistent with the ACGME Milestones in forensic psychiatry. 

At both the Menninger Clinic and Baylor Psychiatry Clinic, trained forensic psychiatrists conduct civil and criminal forensic evaluations. Civil cases include fitness for duty, testamentary capacity, guardianship, other capacity issues, and malpractice cases. Criminal work includes competency to stand trial and not guilty by reason of insanity. Dr. Khan conducts evaluations at the Baylor Psychiatric Clinic while Drs. Paa and Sampson conduct evaluations at The Menninger Clinic. Fellows will have the opportunity to participate in these cases as well as conducting their own evaluations under supervision for cases referred directly to our forensic fellows.

Overall Rotation Goals:

1. To provide the PGY-V fellow a specialized forensic psychiatry experience with a focus on civil forensic evaluations and a model for "private practice" criminal and civil evaluations.
2. To gain experience with the evaluation and treatment of persons involved with the criminal justice system, with a focus on mental health courts and forensic psychiatry.
3. To gain experience with the evaluation, treatment, and recommendations for persons necessitating civil forensic evaluations, such as risk assessments, fitness for duty, testamentary capacity, and guardianship.
4. To develop competence in conducting forensic evaluations of these same persons, writing reports, and providing recommendations, testimony, or treatment.
5. To develop competence and comfort in coordinating with legal and clinical entities in the evaluation and treatment of patients and evaluees.
6. To appreciate the psychiatric treatment issues pertinent to the forensic psychiatric population.
7. To continue to develop skills and knowledge necessary for the competent practice of forensic psychiatry consistent with the ACGME Milestones in forensic psychiatry.