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UMMS Fellowship in Forensic Psychiatry

Rotation Sites

Worcester Recovery Center and Hospital

Successor facility to Worcester State Hospital: a 290 bed, state of the art facility of the Massachusetts Department of Mental Health, in Worcester, MA

Duration/Time: July-Dec; 3 days/week
Supervisor: Paul Noroian, MD
Goals: achieve a broad knowledge of the legal standards and clinical issues involved in court-ordered evaluations on a state hospital court evaluation unit and forensic consultations within a state hospital run by the Department of Mental Health; conduct various types of court-ordered evaluations and forensic clinical consultations and risk assessments; prepare reports and when needed provide expert testimony.

Bridgewater State Hospital

A 275 bed forensic facility of the Massachusetts Department of Correction, in Bridgewater, MA

Duration/Time: Jan-June; 3 days/week
Supervisor: clinical – Kyle Walker, M.D.; Dan Comiskey, M.D.; Forensic: TBD
Goals: achieve a broad knowledge of the legal standards and clinical issues involved in court-ordered evaluations on a state hospital court evaluation unit and forensic consultations within a state hospital run by the Department of Correction; conduct various types of court-ordered evaluations and forensic clinical consultations and risk assessments; prepare reports and when needed provide expert testimony; Gain experience in the psychiatric care and treatment of persons involved in the criminal justice system.

Cambridge Court Clinic

Duration/Time: 3 months; 1 day/week
Supervisor: Adeliza Olivero, M.D.
Goals: Gain an understanding of the legal standards and practice issues involved in adult court clinic-based criminal and civil forensic evaluations, while working in a fast-paced environment and providing expert testimony in most cases.

Boston Juvenile Court Clinic

Duration/Time: 3 months; 1 day/week
Supervisor: Danielle Audet Khanna, PsyD
Goals: Gain an understanding of the legal standards and practice issues involved in juvenile court clinic-based evaluations while working in a busy court, conducting evaluations, preparing reports and providing expert testimony.

Mentally Ill/Problematic Sexual Behavior – Clinic at the Massachusetts Mental Health Center in Boston, MA

Duration/Time: 2 months; 1 day/week
Supervisor: Mass Mental Health Clinic – James Feldman, M.D./ Mass Treatment Center – TBD.
Goal: provide treatment for individuals with mental illness and problematic sexual behaviors, consultations about appropriateness of chemical castration and other treatments and evaluations of sexually inappropriate behaviors, need for treatment.

UMMS Forensic Evaluation Service

Duration/Time: varies
Supervisor: varies
Goal: Conduct consultations involving issues such as psychiatric disability, guardianship, Asylum applications, sexual misconduct, psychological injury, malpractice, criminal matters, and violence risk assessment; Prepare reports based on evaluations conducted; Provide expert testimony when warranted.

Consultations/Case Discussions with UMMS Ethics Office

Duration/Time: Elective
Supervisor: UMMS Psychiatry Faculty
Goal: Involvement with UMass Memorial Medical Center’s Ethics/Treatment Issues Committee. Ethics consult cases are discussed retrospectively. Through this elective, fellows attend the medical center’s Ethics/Treatment Issues Committee meetings and gain experience with general medical ethics and ethical issues arising in a tertiary-care teaching hospital. Opportunities for scheduled case discussions are also available with faculty form the Ethics Consultation Team and with the Treatment Issues Committee. Residents pursuing this elective may also have opportunities to teach ethics to medical students and psychology trainees.

Evaluation Types

Criminal

  • Competence to stand trial (s. 15a and 15b)
  • Criminal responsibility (s. 15a and 15b)
  • Aid in sentencing (s. 15e)
  • Evaluation of need for care and treatment for prisoners (s. 18a)
  • IFRA (risk assessment)
  • Mentally Ill-Problematic Sexual Behavior (MI/PSB) 
  • Evaluation if involuntary treatment of substance use disorders (s.35)
  • Termination of parental rights/Care and Protection 
  • Delinquency assessment

 Civil

  • Civil Commitment (s. 7/8)
  • Substituted Judgment (s. 8B)
  • Fitness for duty
  • Psychic harm
  • Medical malpractice
  • Disability evaluations
  • Community risk assessments
  • Guardianship
  • Sexual misconduct
  • Malpractice

Court Experience

  1. Fellows testify about 5-10 times during their fellowship on issues of competence to stand trial, commitment and substituted judgement for involuntary medications. Testimony preparation occurs with counsel prior to court hearing and supervisor will be available in court for review. Generally, court hearings occur on Wednesdays at (depending on the rotation):
    1. Worcester District Court sitting at Worcester Recovery Center and Hospital
    2. Brockton District Court sitting at Bridgewater State Hospital

  2. Additionally, twice a year, fellows have the opportunity to participate in mock trials. The goal is to help fellows improve their skills as expert witnesses with the opportunity for constructive discussion of their testimony. Mock Trial testimony is observed by faculty and constructive feedback is reviewed with each fellow.
    1. Trial Advocacy (Expert Witness) Workshop by Harvard Law School (January)
    2. UMMS Mock Trial (April)
      1. Fellows receive a video of their testimony including faculty's comments.

  3. When faculty members have relevant testimonies in outside court, fellows are able to participate should their schedule allow.

Clinical Experience

Bridgewater State Hospital (BSH)

Fellows will have a case load of 5-6 patients on one of the evaluation or continuing care units at BSH during their 6-months rotation, in parallel with their role as court ordered forensic evaluator. 

Moonlighting

Fellows can have clinical privileges (if interested) at WRCH or BSH to have moonlighting shifts after hours and on weekends, with approval of the fellowship program director.

Supervision and Evaluations

While specific faculty members will be assigned to work with the fellow, the fellow will have access to consult or work with various faculty depending on their interest/need:

  1. Forensic evaluations, including interviews, report writing and court testimony
  2. Scholarly project
  3. Court clinic
  4. Clinical cases (consider therapy patient(s))

The fellows’ work and progress are monitored through the year on evaluations and reports. They will receive increasing independence as their competencies improve.  

Methods to monitor the program and evaluate program quality and fellow performance include monitoring of patient logs, and a computerized evaluation system designed to give comprehensive feedback to fellows and faculty during the year.