Question for those who complete forensic evaluations

[bigdreamer3]

Hi everyone,

So I am about four months into my residency year and trying to figure out whether my supervisor's expectations are too high for my experience level, or if I am perhaps not cut out to be an evaluator. I work in an office and my primary job is to complete forensic evaluations that are court-ordered. Prior to starting this job, I had never completed these types of evaluations. It is expected that I will testify in court. I utilize a forensic interview, records, testing, and sometimes collateral information. An interview takes between 3-4 hours and testing takes another 3-4. The evaluations take place over one day, but I usually do not do my own testing. On any given week, I complete up to 4 evaluations (usually 2 due to no-shows), 1-2 feedback sessions, and I supervise a practicum student. Plus administrative work and meetings with staff. The reports are between 15-18 pages. My job offer was with the agreement that I would complete eight full reports per month. My supervisor expects me to hit this number no matter how busy my weeks are. I have repeatedly struggled to meet this goal, sometimes having to write 10-12 hours a day at the end of the month to still not meet my monthly goal. I usually finish 6 or 7 reports, then the final 1 or 2 the first week of the next month. I feel terrible I'm not succeeding at my role. My supervisor has been alone in their private practice for roughly 10 years. About 4 years ago, they started taking on residents but as far as I know, do not have additional supervisory experience. Earlier this week, I was called into their office and essentially berated for 20 minutes about how I have not fulfilled my commitment to finish 8 reports despite how well I "sold myself" during the interview. It was particularly confusing because I have consistently been given feedback that conceptually, my reports are amongst the best they've read. There was much more to it, but I'm essentially just trying to get a realistic idea about everyone's workload.

So, what are your expectations? Workload?

Thanks.

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[PsyDr]

Let me break it down for you from another perspective:

The testing is a complete red herring. You don’t do it, so those hours are meaningless.

That means 1-4 days a week you interview someone for half a day (total = 15hrs). Then you supervise 1-3 students for 2hrs (total = 6hrs). That’s 21 hrs of work a week. There’s 19hrs you have to write 8 reports, and you can’t keep up. I’d be mad too.

Tips:

1) shorten your reports. The less material you write down, the less opposing counsel has to attack you. Psychologists are taught this wordy academic style that is off putting to everyone except psychologists.
2) use templates. I don’t care that it looks like you’re using a template, all legal work is a template.
3) Buy dragon naturally speaking. It’s like $300, and worth every penny.
4) read other people’s reports and note their style.
5) write a very rough draft, move to the next one, and then return to the first one. Obsessing about phrasing can severely slow you down.

 

[bigdreamer3]

I can't really shorten the reports, as they're in my supervisor's template/style. But I am working to shorten my interview and boil down the gathered information to only what's most important. I'll look into that software, thanks!

 

[PsyDr]

I can't really shorten the reports, as they're in my supervisor's template/style. But I am working to shorten my interview and boil down the gathered information to only what's most important. I'll look into that software, thanks!

If you're REALLY stuck, take a report from your supervisor. Look at EACH sentence. Understand the purpose and structure of EACH sentence. Then overwrite EACH sentence with your information. This will take a fair amount on a weekend, but it will likely help immensely. You HAVE to quadruple check the reports if you do it this way. It is EXTREMELY prone to errors.

Example:

"NAME is a YEAR OLD, RACE, GENDER who is currently charged with CRIME. HE/SHE was referred to PRACTICE for PURPOSE by PERSON. "

 

[ClinicalABA]

I have and will occasionally use Dragon Naturally Speaking. You need to "train" it well and be sure to PROOFREAD carefully (i.e., go beyond relying on spell/grammar check), as it can have a tendency to throw in some unintended things. I remember reviewing a Dragon dictate report that indicated that the client would "repetitively climb up and down on cheerleaders." It was a report on a toddler who repetitively climbed "CHAIRS AND LADDERS." Enunciation is important after all!

I second PSYDR advice to do that word-for-word thing with a supervisor's report. Also, even if you can't change report style/template now, thing about how you will do so in the future when time is more likely to be equal to YOUR money. On the whole, psychologists (particularly those in training and early career) over interpret/apply tests and write WAYYYYYYYY to much. Parsimony is such a valuable concept.

 

[bigdreamer3]

How many reports do you do per week/month @PsyDr? How long did it take you to get as fast as you are?

I'm trying to get an idea of what's typical and how far behind the learning curve I might be.

 

[PsyDr]

How many reports do you do per week/month @PsyDr? How long did it take you to get as fast as you are?

I'm trying to get an idea of what's typical and how far behind the learning curve I might be.

Honestly, you won't benefit from comparing to me. I don't do what you do. And although I am better(ish), my workaholism allowed me to "front load" my experience.

You should really see if @BuckeyeLove will answer. He/she seems to be in a more "typical" forensic psychology practice.

 

[BuckeyeLove]

@bigdreamer3 , just read your post and I have a lot of a. questions, and (potentially more important) b. concerns. I'm trying to coherently and cogently get a response ready so give me a bit and I'll get back with you.

 

[BuckeyeLove]

Prior to starting this job, I had never completed these types of evaluations.

So this is a bit concerning to me. The fact that you’ve never done the work and essentially being thrown into the deep end, well… you need to be getting close supervision, mentorship, etc. If not, this is a problem. Very often these types of practices will see newly licensed folks, or even better for them, unlicensed postdocs, as bodies that they know they can use to a. save their time, b. put their efforts elsewhere, and c. you do most of the legwork. I worked at a place for 3 years where this was the case, where I was doing essentially board-certified level work and getting paid at a 1/3rd rate of a billable hour. This particular practice paid out their workers at law firm levels (1/3rdish, normal psych practices are much higher), and somehow thought they could justify it. With me it got to the point where attorneys were cold calling me and then one asked how much I was getting, I told her, and she straight up said I was getting taken advantage of and needed to get out. I did. It was the best decision I’ve made in a while.

I may have missed it, but what specific forensic psycho-legal questions are you being asked to assess in these evals? (i.e., adjudicative competency/fitness?, sanity?, violence risk?). Or are these large-scale comprehensive evals done for say…children services or an agency that the practice has a contract with, where you essentially are trying to answer a bunch of questions that caseworkers put in a referral packet. Because if you are doing the former, you shouldn’t be doing all of that testing. I’m a big believer, generally, that testing should more often than not, not be used in forensic evals. It just confuses the Courts, and usually the person doing the testing can’t usually talk about it in a relevant/coherent way if they get taken to task on it. It just tends to not add much incrementally. Records are usually way more probative than superfluous testing.

At the end of the day, people are different in terms of what they view as an acceptable workload. For me, I could not do 8 reports a week if they are huge comprehensive psychological evaluations for, let’s say, an agency (which I suspect is what you are doing). Hell, I wouldn’t be able to get all of the relevant records I would want as a sound forensic clinician within that time frame. If it was just competency/fitness…that MAY be doable, because it is a very circumscribed question you’re being asked to assess. A colleague of mine is the biggest hustler/grinder I’ve ever known, and he handles all of the frontline evals for one of the court systems near me. There’s no way I could ever do that (and most couldn’t I would argue), but this dude goes 100 mph all day every day. I know for a fact that at his practice, he and the partner also have a similar expectation to the one you are describing regarding output for their workers. And they keep it that way because if not then they get into waitlist territory, and they view that as the WORST thing in the world, because all they want is to keep their stakeholders happy.

Overall though, most of the forensic centers in my state that handle the frontline forensic evals (competency/sanity) expect that their full-time employees do 2 reports a week. Honestly, my biggest worry for you is that you are being taken advantage of, but also, you are taking on all of the risk with that level of reports being asked per week. If these evals are in any forensic arena whatsoever, every one of those reports is game for scrutiny. When you’re overwhelmed, overworked, and not feeling supported, well…all of a sudden you forget to change over a name in a template, and then bam, you submit a court report with the wrong name (this is just one example of something like this that can happen when you’re pressed/overwhelmed).

 

[bigdreamer3]

Hi @BuckeyeLove,

I have some responses for you. First, yes. Prior to graduating, I had worked in institutions (prisons and state hospitals) and had some practicum exposure to different types of forensic evaluations. Before I started my residency, I had never seen or done the type of eval I'm doing now (which are for an agency answering specific referral questions provided by caseworkers).

I both do and do not get close supervision and mentorship. My supervisor is incredibly open to answering questions and they read all of my reports (and they countersign them). However, my sup views it as my job to come to them when I am struggling or having a hard time with something. They have not checked in with me about training or development in the past few months other than to express "worry" that I will not complete my 8 reports (and the requirement is 8 in a month, not a week. So essentially 150 pages of output per month). My sup often talks about how "easy" the reports should be and how each one takes them a fraction of the time it takes me. I have found that I responded to this by trying to pretend I had a handle on everything so I did not say I was struggling (even though for the past 3 months I fell short of my required number of reports). Also due to my lack of experience, I don't know exactly what I'm struggling with other than I was immediately expected to go from writing ~10 reports in a year on internship to 8 reports in one month, every month. During a follow up meeting this week, my sup said they were willing to support me to be successful but was not receptive to my concern over the tone and content of the first meeting (I did not feel it came from a place of supervisory concern for my development). Despite my difficulty with the required quantity of work, I will not be allowed to fall under 8 per month. If I continue to struggle, my sup said they would terminate my contract/fire me.

As for being taken advantage of, possibly. My supervisor does not discuss how much the reports I do garner. From asking around, I would guess that 1.5 of my reports pays for my monthly salary. My sup also covers health insurance, liability insurance, office space, does not charge for supervision, etc.

My biggest fear is that I'm creating excuses for myself. I want to be good at what I do, but I'm struggling with looking ahead to the next 8 months and trying to balance this pressure with studying for the EPPP.

Prior to starting this job, I had never completed these types of evaluations.

So this is a bit concerning to me. The fact that you’ve never done the work and essentially being thrown into the deep end, well… you need to be getting close supervision, mentorship, etc. If not, this is a problem. Very often these types of practices will see newly licensed folks, or even better for them, unlicensed postdocs, as bodies that they know they can use to a. save their time, b. put their efforts elsewhere, and c. you do most of the legwork. I worked at a place for 3 years where this was the case, where I was doing essentially board-certified level work and getting paid at a 1/3rd rate of a billable hour. This particular practice paid out their workers at law firm levels (1/3rdish, normal psych practices are much higher), and somehow thought they could justify it. With me it got to the point where attorneys were cold calling me and then one asked how much I was getting, I told her, and she straight up said I was getting taken advantage of and needed to get out. I did. It was the best decision I’ve made in a while.

I may have missed it, but what specific forensic psycho-legal questions are you being asked to assess in these evals? (i.e., adjudicative competency/fitness?, sanity?, violence risk?). Or are these large-scale comprehensive evals done for say…children services or an agency that the practice has a contract with, where you essentially are trying to answer a bunch of questions that caseworkers put in a referral packet. Because if you are doing the former, you shouldn’t be doing all of that testing. I’m a big believer, generally, that testing should more often than not, not be used in forensic evals. It just confuses the Courts, and usually the person doing the testing can’t usually talk about it in a relevant/coherent way if they get taken to task on it. It just tends to not add much incrementally. Records are usually way more probative than superfluous testing.

At the end of the day, people are different in terms of what they view as an acceptable workload. For me, I could not do 8 reports a week if they are huge comprehensive psychological evaluations for, let’s say, an agency (which I suspect is what you are doing). Hell, I wouldn’t be able to get all of the relevant records I would want as a sound forensic clinician within that time frame. If it was just competency/fitness…that MAY be doable, because it is a very circumscribed question you’re being asked to assess. A colleague of mine is the biggest hustler/grinder I’ve ever known, and he handles all of the frontline evals for one of the court systems near me. There’s no way I could ever do that (and most couldn’t I would argue), but this dude goes 100 mph all day every day. I know for a fact that at his practice, he and the partner also have a similar expectation to the one you are describing regarding output for their workers. And they keep it that way because if not then they get into waitlist territory, and they view that as the WORST thing in the world, because all they want is to keep their stakeholders happy.

Overall though, most of the forensic centers in my state that handle the frontline forensic evals (competency/sanity) expect that their full-time employees do 2 reports a week. Honestly, my biggest worry for you is that you are being taken advantage of, but also, you are taking on all of the risk with that level of reports being asked per week. If these evals are in any forensic arena whatsoever, every one of those reports is game for scrutiny. When you’re overwhelmed, overworked, and not feeling supported, well…all of a sudden you forget to change over a name in a template, and then bam, you submit a court report with the wrong name (this is just one example of something like this that can happen when you’re pressed/overwhelmed).

 

[Ollie123]

I have a minimal amount of forensic experience, so don't want to speak out of turn here but some general thoughts:
- Is writing <in general> a struggle for you?Worth considering if this is demands of this particular setting/style or if writing is a weakness.
- Does this place have other trainees and if so, how are they doing? If none currently but they did in the past, could you contact them?
- Are there inefficiencies in your day? Are there particular report "sections" you get stuck on? How can you streamline it?
- Is this a "patient flow" issue? i.e. Are they measuring your output by individual calendar months? Are you getting lots of no-shows on in the first part of the month and then having to squeeze it all into the latter half?

A lot depends on context here and we won't be able to get a great sense of that online. There is usually a bit of a formula to psychological reports and I doubt forensics is any exception. My very first LD eval was 15-20 pages and the report took me probably 20 hours to write. They got progressively much, MUCH faster from there once I had a few templates to work off that I was happy with. By the end, I had written a short script to merge in all the testing data automatically and could pound one out in a fraction of the time (and it was generally dead simple/mindless work). 150 pages a month would be absurd if you were generating all original content from scratch, but I presume that is not the case here. If Ii read your original post correctly, it sounds like you essentially have ~2 days of non-writing work each week, depending on whether you do your own testing that week and exactly how much admin you have. Put that way, getting the reports done in the remaining 3 days sounds extremely reasonable to me and actually pretty laid back. I could see it being a struggle initially, but not long-term...then again - I don't have complete context here so its possible I'm missing something.

 

[StellaB]

I write approximately 25 reports per month, though I already have all the collateral and the interviews are pretty short (most of the eval is collateral-bases for the state-specific type I do). I also supervise interns, teach, testify regularly, and have committee meetings, etc. Each report runs about 6-10 pages, but are pretty dense. I typically do one or two per day. I’m wondering if the issue is how much time you need to conceptualize and answer each question? Sometimes when I’m taking longer to write a particular case up, it’s because I am on the fence about answering the referral questions. If not, you may need to do some reading on ways to speed up the writing process. The workload does not seem undoable to me unless something is slowing the whole thing down a lot.

 

[Therapist4Chnge]

Report style likely has a large impact on the amount of time you are spending. I'd look at each section that you write and consider what you actually need.

I'd also suggest developing common phrasing and using sentence stems to help things flow. I did this to help with dictating more efficiently, but I still write instead of dictate certain reports and it helps there too.

I'm not sure how much you reference outside documentation, but I'm guessing it is utilized quite a bit, so those sections should likely be the same types of source info and can use the same sentence structure...

Per documentation review, Dr. Smith concluded in her consultation dated Jan 1st, 2020 "(insert quote)". This aligns with Dr. Jones' findings of "(insert quote)", though they both did not consider XYZ, which better explains ABC....

 

[psyguru]

Use a template approach and it makes it easier. Also you will get more efficient with time. Also adjust the report length/ detail to the case. I.e. a non-contentious tresspassing competency to stand trial report does not have to be a a lengthy as a death penalty case or a huge civil suit where your invoice is over $20k. Sometimes to meet a deadline or due to the $ cap, i will do a briefer letter and claim that a more detailed report can be provided upon request.

Best option is to go into private practice. You are your own boss. Charge over $250-500 an hour and find the type of cases that does not have a cap. Once you send out invoices for 2 to 5k, your situation will be different in that you can do less for more. It will take some time bulding your practice. Perhaps you could supplement it by doing therapy as well. Disclaimer: I am a forensic psychiatrist MD.