Forensic Fellowship Program Experiences 2007-2008

CLINICAL

1. John Howard Pavilion DC Department of Mental Health (DC-DMH)

This is your main inpatient forensic experience.  The goal is to become proficient in the forensic criminal assessment of a diverse patient population.  Criminal mental responsibility, competency, dangerousness, pre-release determinations, treatment, and administration are areas of exposure.  Opportunities for teaching psychiatry residents and medical students are available. Fellows will complete four full pre-trial evaluations per month as well as quarterly competency monitoring evaluations on a panel of forensic inpatients.

Saint Elizabeths Hospital Forensic Inpatient Service at John Howard Pavilion is a 200-patient maximum security evaluation and treatment facility.  The three-unit pretrial service accommodates 75 to 80 defendant-patients, 15 to 20% of whom are females.  Diagnoses include schizophrenia, other psychotic disorders, mood disorders, polysubstance abuse and dependence and a wide variety of personality disorders as well as other Axis I and Axis II diagnoses.  The remaining units provide treatment to post-trial patients hospitalized following “Not Guilty by Reason of Insanity” rulings.  Saint Elizabeths Hospital also houses the outpatient services for continuing care of the patients placed into the community under conditional release provisions.

The Fellows will spend the majority of their time at the pretrial unit where they will predominantly evaluate defendant-patients facing criminal charges, for competency to stand trial, criminal responsibility, along with performing risk assessments for dangerousness for the court.  The fellows will function as a part of the ward management team and participate in diagnostic case conferences.  They will have the opportunity to testify at hearings for competency, responsibility, risk assessment and civil commitment.  As a member of the treatment team, they will closely interact with clinical psychologists, post-doctoral psychology interns, social workers and, on needed basis with case managers.  They will also have teaching responsibilities for the general psychiatry residents during their rotations and medical students during their clerkship in the unit.  The fellows will also rotate in the post-trial wards where they will evaluate the patients for violence risk assessment and readiness for conditional release; they may testify in court for the release process on an as needed basis.  During the rotation at the forensic outpatient services, the fellows will provide continuing care for the patients under conditional release.

Legal Services Branch

The goal of this site is to learn to do rapid astute criminal competency assessments at the court or at the DC jail, write a concise report to the court, with accurate recommendations. Fellows will learn to work under very tight time deadlines.

Most of the actual clinical work is performed either at the Superior Court, or at the District of Columbia Jail. Legal Services branch at the D.C. Superior Court, provides for initial psychiatric evaluation of the detained and incarcerated population for assessment of competency to stand trial and referral of possibly incompetent population to inpatient or outpatient forensic services for further evaluation and competency restoration

DC DMH Assessment Center

Fellows have a required part-time rotation for six months at this facility centered next to the Family and Juvenile Court. The assessment Center provides psychological, educational and psychiatric evaluation of minors referred by the court for a wide variety of reasons.

During this rotation, the case load for fellows will consist of approximately one to two evaluations per week with the generation of court reports. The fellows will provide court testimony when their case opinions are challenged.  They will be supervised by a full-time psychiatrist with fellowship training in both forensic psychiatry and child and adolescent psychiatry for one hour every other week.

General Hospital and Psychiatric Hospital Consultation Service

The fellows will learn to evaluate issues of competency to make medical decisions, address issues of involuntary treatment, the role of advanced directives, assessment of dangerousness, suicidality, and civil commitment laws.

Private Practice

A clinical consultant to this program will meet regularly with the fellows.  The goal is to explore, review, and consult on matters, generally civil in nature, brought to our civilian consultant.  This opportunity adds supervision.

DIDACTICS

1. Georgetown Seminar in Forensic Psychiatry

This 40+ - session seminar provides the main core of the didactic program.  Comprehensive study of federal and state legal systems, “landmark cases” and the role psychiatry plays in the justice system. The course will cover the interface between clinical psychiatry and both the criminal and civil legal systems. Course topics will include basic legal concepts, legal research, and topics unique to forensic psychiatry such as competency to stand trial, assessment of dangerousness, and all other topics related to the RRC-required subjects. All pertinent topics are reviewed.  Landmark legal cases are supplemented by readings.  Attendance is mandatory.  The goal is to prepare for subspecialty certification through comprehensive exploration of a wide range of forensic topics (See attached). There will also be a supplemental seminar at John Howard to look at clinical and interdisciplinary topics related to social policy, ethics, law and mental health.

2. Clinical Case Conference

This weekly meeting provides staff and fellows the opportunity to present and discuss clinical cases.  The goal is deliberation leading to opinions, supervision, and teaching.  Case conferences will be held at both Georgetown Hospital and the John Howard Pavilion. This will include case presentations by the residents and faculty, demonstrations by faculty, individual on-going seminars on cases. Fellows have primary responsibility to ensure case presentation although other staff members are also encouraged to present their forensic cases. Fellows will also participate fully in Review Board conferences for post-trial insanity acquitees, and Diagnostic conferences for pretrial detainees.

3. Presentation of Forensic Psychiatry in the Media

This seminar will be held in the evening once monthly to examine, and view, cinematic representations, television reporting, fictional depictions of the work or the forensic mental health clinician.

4. Journal Club

This seminar is held once every quarter.  The fellow(s) will select an article of interest, distribute to staff, and lead a discussion.  The goal is to facilitate exposure to sub-specialty literature and current trends in the field of forensic psychiatry.

5. Independent Scholarly Research Topic

This seminar is held once every other month. Fellow(s) will lead a discussion about a relevant forensic psychiatry topic of his or her choice.  Examples include history of forensic psychiatry, workplace violence, guilty but mentally ill statutes, etc.  Please consult the program director for any questions or possible topics.

ROTATIONS

Block A (4 Months)

Fellow A: Jul, Aug, Sep, Oct

Fellow B: Nov, Dec, Jan, Feb

Fellow C: Mar, Apr, May, Jun