Medico-legal assessments

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psych844

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Any of you on here do such assessments? Is it worth the increase in income?
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I have many colleagues that do. The pay is nice, but most of them started mid-careerish. You have to know your ****. As for the worth it part, I guess it depends on whether or not you enjoy the work. There are dozens of ways you can make extra money with a PhD in psych, whether or not you enjoy the work you do is a whole different ballgame.
 
WisNeuro said:
I have many colleagues that do. The pay is nice, but most of them started mid-careerish. You have to know your ****. As for the worth it part, I guess it depends on whether or not you enjoy the work. There are dozens of ways you can make extra money with a PhD in psych, whether or not you enjoy the work you do is a whole different ballgame.
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It just seems potentially more dangerous (ie safety), and as a result more stressful i'd take it?
 
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psych844 said:
Any of you on here do such assessments? Is it worth the increase in income?
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I review psychiatric short-term disability claims and workers comp claims for several managed care organizations.
 
Any medical job has a degree of risk attached, I'm sure that there may be a slight uptick in the medico-legal department, but I don't personally know anyone who has had an issue. It is more stressful, but I would say that is more because you may have to defend any and every statement you make depending on what type of forensic work you do.
 
The money is typically very good (depending on the area/type of assessment), though I second the caution about being mid-career/really knowing your craft. I'll add to that being fellowship trained, boarded, and receiving formal mentorship to learn the ins and outs.
 
Therapist4Chnge said:
The money is typically very good (depending on the area/type of assessment), though I second the caution about being mid-career/really knowing your craft. I'll add to that being fellowship trained, boarded, and receiving formal mentorship to learn the ins and outs.
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Any idea on a salary range, at least in regards to people you know?
 
psych844 said:
Any idea on a salary range, at least in regards to people you know?
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Most of this happens is PP, so there is no salary. Just depends on how much you work and what your rates are.

Those doing forensic evals in institutional settings, on average, make more than most general psychologists, although not that much more really.
 
Yeah, widely variable. I have friends who do it part time for a few extra thousand dollars a year, and I know people who do it for a career and make 200k+. The forensic field is just as heterogeneous as psych in general. Also, people on the higher end of the pay scale tend to spend a good deal of time in court. That's where the high pay is. That is also where you better have a very good background in research and legal statutes and precedents.
 
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Generally, the more litigious the work, the greater one’s ability to charge / bill at your own rate (i.e., child custody, sex-offender risk assessment, death penalty mitigation, post-conviction relief evaluations). However, if you want to become a hired gun and make $5000 per case while also losing your respect and integrity, this is also an option (although not one that I endorse; eventually you'll stop getting referrals). I just testified in a murder trial last week where the defense hired a “colleague” who opined that the defendant was not responsible because his moral insanity and history of reaction formations led him to be fearful for his life and subsequently act in self-defense [self-defense is not a psycholegal issue, mh professionals are in no business proffering opinions on it]. The eval itself was a page. A PAGE!!!! You might laugh, but all he has to do is win over some jury members, none of whom are likely scientists and actively engaging in hypothesis testing, and that dude gets another referral. Juries sometimes eat that flowery and dynamic theory BS stuff up.

Overall, I’ve found that the most successful evaluators in my area have experience doing the evaluations, nuanced understandings of case law, relevant research/ psychometric understanding, and are good at selling themselves. The last point is probably the most important I would say to their respective practices. None of them are published or having any intention of conducting research for that matter. They just put out consistent/ ethical work products and can talk to lawyers without sounding like an academic.
 
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BuckeyeLove said:
Generally, the more litigious the work, the greater one’s ability to charge / bill at your own rate (i.e., child custody, sex-offender risk assessment, death penalty mitigation, post-conviction relief evaluations). However, if you want to become a hired gun and make $5000 per case while also losing your respect and integrity, this is also an option (although not one that I endorse; eventually you'll stop getting referrals). I just testified in a murder trial last week where the defense hired a “colleague” who opined that the defendant was not responsible because his moral insanity and history of reaction formations led him to be fearful for his life and subsequently act in self-defense [self-defense is not a psycholegal issue, mh professionals are in no business proffering opinions on it]. The eval itself was a page. A PAGE!!!! You might laugh, but all he has to do is win over some jury members, none of whom are likely scientists and actively engaging in hypothesis testing, and that dude gets another referral. Juries sometimes eat that flowery and dynamic theory BS stuff up.

Overall, I’ve found that the most successful evaluators in my area have experience doing the evaluations, nuanced understandings of case law, relevant research/ psychometric understanding, and are good at selling themselves. The last point is probably the most important I would say to their respective practices. None of them are published or having any intention of conducting research for that matter. They just put out consistent/ ethical work products and can talk to lawyers without sounding like an academic.
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Would I be able to ask what area you focus on? (ie child custody, etc)
 
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When I do evaluations for the court, we bill $400 an hour so it is quite a bit more profitable than my everyday work. Unfortunately, I have only done three of them in about a year. Also, it is not uncommon for psychologists working in the troubled teen industry to bill anywhere from $2500 - $4000 for a run of the mill integrated assessment battery. That's a pretty well paying gig.
 
BuckeyeLove said:
Generally, the more litigious the work, the greater one’s ability to charge / bill at your own rate (i.e., child custody, sex-offender risk assessment, death penalty mitigation, post-conviction relief evaluations). However, if you want to become a hired gun and make $5000 per case while also losing your respect and integrity...
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1. I'd rather walk on hot coals than take a child custody case.

2. $5000 is about right for a more straight-forward eval, though it's low if you have to testify. The money sounds great from the outside, but it is a lot of hard work.
 
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At least in theory I would not mind doing sex-offender evaluations, and i'm quite interested to do research in that area. Anybody know who has done the best research in this area? Schools that have this focus? As psychologists, is there much that we can do for people who are sex-offenders or is it mostly med management?
 
I'd be curious what medication there is for sex offending? Seems like a pretty conscious behavioral choice to me.
 
All I know about sex-offender evals is that they often use a plethysmyograph. I think I would rather do child custody cases or even have red hot nails stuck in my eyes than work with sex offenders. I just think that I have worked with too many victims of sexual abuse to not have strong reactions towards the perpetrators.
 
erg923 said:
I'd be curious what medication there is for sex offending? Seems like a pretty conscious behavioral choice to me.
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I'm not sure if any treatment of it is right. I know little about the treatment, but as someone who is gay, i have my doubts that it is simply behavior. It strikes me that sexual attraction seems pretty fixed and genetic. Maybe that knowledge makes us somewhat more understanding in that sense. That doesn't mean though that these people should not be charged, and if the data shows that they can't be rehabilitated, then they need to spend their life in jail. (until the point that we find a pill for it, or some other solution)
 
psych844 said:
I'm not sure if any treatment of it is right. I know little about the treatment, but as someone who is gay, i have my doubts that it is simply behavior. It strikes me that sexual attraction seems pretty fixed and genetic. Maybe that knowledge makes us somewhat more understanding in that sense. That doesn't mean though that these people should not be charged, and if the data shows that they can't be rehabilitated, then they need to spend their life in jail. (until the point that we find a pill for it, or some other solution)
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So, is there a medication that makes you not attracted/less attracted to men? Rhetorical of course....

Attraction may be largely biologic and difficult/impossible to change. But the act of rape/molestation (ie., sexual offending) is behavioral
 
erg923 said:
So, is there a medication that makes you not attracted/less attracted to men? Rhetorical of course....

Attraction may be largely biologic and difficult/impossible to change. But the act of rape/molestation is behavioral
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[/QUOTE]
Yeah, all you have done is to define what biologically means and what behavior means, but I'm questioning if it makes much sense to think about it that way. People used the same argument for homosexual behavior. Ie It is not immoral to think or be gay, it is immoral to commit the act. Well, attraction has a sexual, emotional, and other components. Sex is human nature. This isn't on the same level as deciding that you can't eat pizza because it makes you sick.
 
psych844 said:
Yeah, all you have done is to define what biologically means and what behavior means, but I'm questioning if it makes much sense to think about it that way. People used the same argument for homosexual behavior. Ie It is not immoral to think or be gay, it is immoral to commit the act. Well, attraction has a sexual, emotional, and other components. Sex is human nature. This isn't on the same level as deciding that you can't eat pizza because it makes you sick.
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If not raping a child is "hard" to resist," I'm sorry. Not sure why I should feel sympathy for that or should should become more excusable because its a "biologic drive?"
 
Because so few folks are willing and able to work with sex offenders, it in particular seems to be an area where you can essentially do as you please and name your price. The only thing stopping you/stepping in would be ethical obligations and your own sense of morality regarding the work product. I've heard whispers of someone nearby, for example, who charges >$1500 for a relatively short eval using...interesting measure choices.
 
smalltownpsych said:
All I know about sex-offender evals is that they often use a plethysmyograph. I think I would rather do child custody cases or even have red hot nails stuck in my eyes than work with sex offenders. I just think that I have worked with too many victims of sexual abuse to not have strong reactions towards the perpetrators.
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I did work with adult and youth sex offenders. Adult assessment battery usually included MMPI-2, SORAG (VRAG if history of violence), usually a WASI or WAIS to get baseline IQ, malingering instruments if client is suspected to be faking low iq etc., and a handful of other tests and assessments depending on the case

Youth sex offenders (kids perpetrating crimes against other kids) were given CANS, MMPI-A, a series of experimental tests that we had a grant with the state to use, WISC/WASI, TOMM etc., and additional tests depending on the case

I supervised administration of computerized MMPI and other self report measures and administered many of the Wechsler assessments. My boss (PsyD) administered more extensive testing and assessment. We had a pretty good rapport with many local law firms, district attorney's, etc. and would do several forensic evaluations per month (maybe 20% of the time with sex offenders, usually up for parole or probation who we needed to assess risk of reoffense - I think the term is recidivism)
 
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erg923 said:
If not raping a child is "hard" to resist," I'm sorry. Not sure why I should feel sympathy for that or should should become more excusable because its a "biologic drive?"
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It isn't a question of sympathy, but reasoning. I'm asking you to think through what it means for something to be biological, and be connected to what in essence makes us human. (sex, emotional connections to others, etc). So the behavior in this case is not equivalent to deciding that you can't have pizza ever again because it makes you sick.
As I already said, this doesn't mean that we don't lock these people up, and that they don't possibly spend their whole life in jail, if we don't have better options. But what this knowledge can do is make us more compassionate and ethical. This kind of knowledge or understanding actually makes us more responsible for setting up a society that is more healthy.
 
Re: SO risk evals, as I've stated before, there is large contention in the recent literature regarding our ability to accurately assess prospective risk of sexually deviant behavior (due to large confidence interval overlap with these instruments) except for those individuals that are so overtly deviant that a layperson could pick them out. Subsequently, many in the field believe these instruments fail to meet Daubert. Regardless, almost all of the folks I see in the PP world doing these evaluations are continuing to use these instruments and doing well financially as a result. Re: tx of offenders...I've seen many people that provide these services in the community promoting "success rates" of 90%. What they fail to mention is that the base rate of undetected recidivism [undetected being the key word] with untreated folks in this population varies between 5 and 15 % (don't have citation handy). A 90% success rate sounds pretty good to referrals bases though (courts, attorneys, probation officers), so they end up making a killing. Gotta love playing the base rates.

@psych844, I'm currently on fellowship, so the majority of my clinical work is comprised of a variety of psycholegal competencies , criminal responsibility, diminished capacity, violence risk assessments (along with some pre-employment police evals) and expert testimony. I've had exposure to Child Custody Evaluations (CCEs) but have not formally completed any (The practice I'm joining next year has someone in the practice with whom I'll be training under potentially). Most people pay for supervision and training with these evals, at least if they want to learn to do them in a competent fashion and not lose their license / be put through a litigation nightmare. As everyone has stated though, it's pretty contentious. I'm hoping to get into the workers' compensation game potentially, in that there is a good market in the city I'm moving to post fellowship.
 
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AcronymAllergy said:
Because so few folks are willing and able to work with sex offenders, it in particular seems to be an area where you can essentially do as you please and name your price. The only thing stopping you/stepping in would be ethical obligations and your own sense of morality regarding the work product. I've heard whispers of someone nearby, for example, who charges >$1500 for a relatively short eval using...interesting measure choices.
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I don't know if i'm nuts or just really immoral, (lol) but I see no problem with dealing with these people.
 
I really appreciate all the replies, btw. I do understand the potential problems. I may not be that judgmental in a general sense, but i can certainly understand how consistently hearing stories from this segment of population can eventually wear you down.
 
Anecdotally, several of my former supervisors who have done SO work, both evaluative and treatment, have all said that they never had any problems doing the work, that was until they either a.) had children of their own, or b.) their children became the age at which many of their clients began offending against victims.
 
BuckeyeLove said:
Anecdotally, several of my former supervisors who have done SO work, both evaluative and treatment, have all said that they never had any problems doing the work, that was until they either a.) had children of their own, or b.) their children became the age at which many of their clients began offending against victims.
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That is really interesting. In the politics thread, a lot of people said similar, in essence that their political affiliation or general view of the world changed when they had their own kids.
 
AcronymAllergy said:
The only thing stopping you/stepping in would be ethical obligations and your own sense of morality regarding the work product. I've heard whispers of someone nearby, for example, who charges >$1500 for a relatively short eval using...interesting measure choices.
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When you say "work product", you are referring to the fact that we don't have any great measures to asses risk for example?
 
psych844 said:
When you say "work product", you are referring to the fact that we don't have any great measures to asses risk for example?
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I actually wasn't even getting that specific with it. I was more speaking to just the report and assessment in general, and that both can vary widely based on numerous factors (including the practitioner's competence and ethical/moral compass). That is, with SO work in particular, because there are so few people seemingly offering it, one might be more able to "get away with" a shoddy product simply because it's the only game in town and you're working with an especially marginalized segment of the population.
 
AcronymAllergy said:
I actually wasn't even getting that specific with it. I was more speaking to just the report and assessment in general, and that both can vary widely based on numerous factors (including the practitioner's competence and ethical/moral compass). That is, with SO work in particular, because there are so few people seemingly offering it, one might be more able to "get away with" a shoddy product simply because it's the only game in town and you're working with an especially marginalized segment of the population.
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Sadly, you are probably right.
 
Any idea about schools that have a forensic focus or specifically researchers that focus on sex offenders?
 
Also a Q for you neuropsych guys. Theoretically I like this area (helping people who are suffering with dementia, etc) but through my undergrad I was least interested in studying things like memory. It also seems to me that it is also quite possibly the most difficult specialty in psychology. Is it difficult to pick up all the concepts?
 
The "helping" part for dementia eval is 95% assessment and recommendations with some education for the patient and the family. Some ppl do follow up counseling, but tat seems to be in the minority.
 
Therapist4Chnge said:
The "helping" part for dementia eval is 95% assessment and recommendations with some education for the patient and the family. Some ppl do follow up counseling, but tat seems to be in the minority.
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Someone did mention that in the past. (might have been WiseNeuro, though maybe through PM). I think he said that a large part of the help is explaining to families what is going on and giving recommendations.
 
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If you want to be good in the field, it is difficult to pick up the concepts. The boarding process is difficult, and is becoming essential. Especially if you want to do medico-legal stuff at a higher level. If you're not interested in neuroanatomy, psychometrics, and staying abreast of the new neuro research, I would advise against it. I love all of those things, so it's not much of a problem for me.
 
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psych844 said:
Someone did mention that in the past. (might have been WiseNeuro, though maybe through PM). I think he said that a large part of the help is explaining to families what is going on and giving recommendations.
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That is exactly it.

Staying up on the literature is extremely important to ensure continued competence. IMHO the best neuropsychologists have a solid foundation as a psychologist, are well grounded in psychometrics and neuroanatomy, and have a well defined core area(s) of practice. In my practice 90% of my cases are mTBI, TBI, and certain non-Traumatic Brain Injury (resections, anoxia, etc). I see other cases, but I feel like I have the most to offer to the above groups. In community practice there tends to be more variety of cases, which some clinicians prefer; I'd rather refer out.
 
PSYDR said:
Edited: It's very stressful and expensive.
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You are referring specifically to medico-legal? Is it much more expensive than any other assessment heavy practice?
 
Yes to both questions. In medico-legal work, there are many more expenses. Here are a few additional expenses that I can think of off the top of my head: training for report prep, expert witness testimony training, legal interactions training, expert witness books, law books, access to legal databases, AMA books, attending CLE conferences (legal conferences) to update knowledge as the law changes, buying old tests to review others' work, buying tests you have no intention of ever using to review others' work, specialty software, travel (which should eventually be reimbursed), at least 5 extremely nice suits and pairs of shoes, attorney fees to set up contracts and informed consent documents, an attorney retainer fee, purchasing obscure articles to journals or book chapters that are referenced in opposing reports, etc. I would also wager that I buy and read more journals and books in the field than most.

You also need a sufficient bankroll to fund the wait time between producing the work product and getting paid. You get a retainer, and then do the work. Some attorney groups then drag their heels in paying you. I've had mid 5 figures in the wind for 6-12 months several times.
 
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I think the sum of what psydr is trying to tell you is that you shouldn't go into the heavy duty medico-legal work lightly. It is extremely challenging on a variety of levels.

It's a thing that a lot of people think they can do, but very few can do well and make a good living out of.
 
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Any of you neuropsych guys work with people who have brain tumors or stroke? Is it interesting working with this segment? Which population is most interesting to work with?
 
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