Forensic Psychiatry Fellowship

Providing outstanding, advanced training and experience in forensic psychiatry

The Forensic Psychiatry Fellowship Program was developed for psychiatrists who have completed an accredited residency training in general or child/adolescent psychiatry and wish to obtain specialty training in forensic psychiatry.

The goal of the fellowship program is to enhance professional expertise in dealing with legal issues involving significant mental health factors by improving psychiatrists’ abilities to provide professional assistance to the U.S. justice system.

The USC Institute of Psychiatry, Law and Behavioral Science, which oversees the program, was founded in 1965 and is an integrated part of the USC Department of Psychiatry and Behavioral Sciences. The institute conducts teaching, training and research in psychiatry and the law.

The ACGME-accredited, full-time, one-year fellowship program consists of 40 hours a week of lectures, seminars and supervision. Forensic psychiatry fellows have opportunities for extensive involvement as forensic psychiatric consultants to state hospitals, county jails, state or federal prisons, juvenile justice agencies, family courts, coroners’ offices, and other agencies that interrelate with mental health and the law. All forensic psychiatry fellows have numerous opportunities to serve as consultants and expert witnesses in psychiatry and law for the superior and federal criminal courts, family law court, mental health court, juvenile court, and county and federal probation as well as insurance companies and local and state government agencies.

Coursework

Courses specifically designed for forensic psychiatry fellows include:

  • Biological factors and sociological determinants of crime and delinquency
  • Civil law
  • Criminal law
  • Family law
  • Federal criminal law
  • Juvenile law
  • Mental health law
  • Seminar in correctional psychiatry
  • Seminar in special issues in psychiatry and law
  • Seminar on landmark mental health cases
  • Video seminar

Course lecturers are drawn from institute faculty and other USC forensic psychiatrists and psychologists as well as judges, public and private attorneys and professionals from other forensic-related disciplines.

Supervision

Each forensic psychiatry fellow has a minimum of six supervisors at any given time. The psychiatric supervisors are fellowship trained and certified by the American Board of Psychiatry and Neurology with added qualifications in forensic psychiatry. All supervisors are on the faculty of the Keck School of Medicine of USC. Supervisors are rotated so that forensic psychiatry fellows will benefit from supervisors’ varied skills and expertise in psychiatry and law.

Caseload

The forensic psychiatry fellows conduct one treatment group per week for mentally disordered offenders. Each forensic psychiatry fellow is also assigned an average of two forensic court cases per week, and their forensic psychiatric opinion is given in a written report. These cases deal with psychiatric-legal issues for the criminal, civil, juvenile and family courts as well as various administrative hearings. In addition, each forensic psychiatry fellow has the opportunity to testify on a weekly basis with supervision in the largest Mental Health Court in the country.

Teaching

Each forensic psychiatry fellow receives an academic appointment, whereby they have an opportunity to teach and supervise general psychiatry residents of the LAC+USC Department of Psychiatry in psychiatry and law. Clinical case conferences are held where the forensic psychiatry fellow presents, to faculty and the professional community at large, a forensic case that demonstrates their knowledge and application of clinical material to legal issues. Fellows may have an opportunity to conduct a psychological autopsy for the Los Angeles County Department of Medical Examiner-Coroner.

Fieldwork

Forensic psychiatry fellows have opportunities for field involvement in correctional psychiatry and forensic evaluations of mentally ill defendants in Los Angeles County jail. In addition, each forensic psychiatry fellow serves, under supervision, as a consultant to the Mental Health Court Clinic.

Resources

The institute has an extensive library that includes educational videos and DVDs on forensic psychiatric issues. All other libraries (e.g., medical school, law school) within the USC system are available for the fellows’ use. Fellows are provided with individual offices and desktop computers for word-processing activities and Internet/research access.

Facilities

The Forensic Psychiatry Fellowship Program benefits from access to diverse locations for optimizing clinical, educational and research activities. Most clinical psychiatric services are based at LAC+USC Medical Center, which houses the Psychiatric Emergency Service, Consultation-Liaison Service and Medical-Psychiatric Inpatient Unit; an adjacent clinic tower houses the Adult Outpatient Clinic. The adult and adolescent inpatient services are provided at the Hawkins Mental Health Building, where patients are evaluated for civil commitment hearings. Partnership with the Los Angeles County Department of Mental Health provides unique opportunities for understanding the delivery of mental healthcare to underserved patients in the Twin Towers Correctional Facility. Forensic psychiatry fellows serve as consultants to the county Mental Health Court on Monday and Wednesday mornings. Forensic psychiatry fellows also serve as consultants to the L.A. County Office of the Medical Examiner-Coroner.

Goals and Criteria

The forensic psychiatry resident is expected to have acquired six forensic psychiatry core competencies by the completion of the program.

Core Competency #1: Patient Care

Fellows will be able to provide patient care in the forensic setting that is compassionate, appropriate and effective for the treatment of psychiatric disorders. Fellows are expected to:

  1. Demonstrate the ability to perform and document a comprehensive forensic history and examination of a forensic patient in a forensic inpatient and outpatient setting, including conducting the following assessments, which are particularly relevant to the forensic population:
    • Risk assessment of danger
    • Suicide risk assessment
    • Assessment of malingering
    • Assessment of amenability to treatment
  2. Demonstrate the ability to develop and implement an appropriate treatment plan in a forensic inpatient and outpatient setting. Awareness of the special clinical and legal considerations in a forensic setting include:
    • Consideration of safety and security measures in a forensic setting
    • Levels of care in forensic setting
    • Collecting necessary historical and current information for the development of an appropriate treatment plan in a forensic setting
    • Use of appropriate pharmacotherapy in a forensic setting
    • Use of appropriate psychotherapies in a forensic setting

Core Competency #2: Medical Knowledge

Fellows will be able to demonstrate medical/legal knowledge relevant to the practice of forensic psychiatry and apply this knowledge to forensic evaluations. Fellows are expected to:

  1. Conduct a competent forensic non-treatment evaluation of an individual and develop a well-reasoned forensic psychiatric opinion. The evaluation should contain a personal interview of the subject that includes:
    • Statement regarding limits of confidentiality, the role of the evaluator, the issues to be addressed, and the nature and scope of evaluation
    • Relevant historical information
    • Focused mental status examination
    • Review of collateral sources of information, including collateral informants and record review
    • Knowledge regarding the relevant legal standard, application of the data to the relevant legal standard, and development of a rational and logical forensic opinion
  2. Demonstrate knowledge regarding a risk assessment of danger in forensic psychiatric evaluations, to include:
    • Risk factors related to dangerousness
    • Appropriate collateral sources to consider in the assessment of danger
    • Familiarity with actuarial measures for risk assessment
  3. Demonstrate knowledge necessary to evaluate a variety of defendants in the criminal justice system, to include knowledge such as:
    • Competency to stand trial
    • Criminal responsibility
    • Sentencing evaluations
    • Evaluation of sex offenders
    • Fitness evaluations for juveniles
  4. Demonstrate knowledge of a variety of assessments in the civil justice system, to include:
    • Worker’s compensation/personal injury
    • Assessment of civil commitment for involuntary hospitalization and narcotic addiction
    • Psychological autopsy
    • Assessment of decision-making competencies
    • Assessment of “best interests of the child” in child custody/dependency
  5. Demonstrate knowledge of legal issues relevant to the practice of general and forensic psychiatry, to include:
    • Record-keeping and confidentiality
    • Basic principles of substantive and procedural law
    • Landmark mental health cases
    • Duty to warn
    • Mandatory reporting laws
    • Competency to refuse medical treatment

Core Competency #3: Practice-Based Learning and Improvement

Fellows will be able to investigate and evaluate their patient care practices, the process by which they conduct forensic evaluations and reach a forensic opinion, the assimilation of scientific evidence, and the integration of the law in forensic evaluations, treatment and consultation. Fellows are expected to:

  1. Analyze practice experience and perform practice-based improvement activities using a systematic methodology, to include:
    • Submitting forensic work for peer review
    • Maintaining a record of forensic evaluations and rendered opinions (patient log)
    • Participating in quality assurance and improvement activities related to delivery of patient care in a forensic setting
  2. Develop appropriate skills in obtaining up-to-date scientific and legal information to assist in the treatment and evaluation of forensic patients, to include:
    • Accessing legal information from relevant landmark cases, statutes, institutional regulations and attorneys
    • Utilizing forensic practice parameter guidelines relevant to the practice of forensic psychiatry
    • Using information technology to access online medical and legal information, and support own education
  3. Use the following available resources:
    • Institute of Psychiatry and Law Library
    • Department of Psychiatry Residency Library
    • LAC+USC Medical Center Library
    • Keck School of Medicine libraries
    • USC Gould School of Law libraries
    • Computer-processing equipment and access to Internet
    • Video and audio recording equipment
    • One-way mirror observation rooms
    • Faculty members involved in research in the USC Institute of Psychiatry and Law
    • Medical and professional staff at the Los Angeles County Department of Medical Examiner-Coroner

Core Competency #4: Interpersonal and Communication Skills

Fellows will be able to demonstrate interpersonal and communications skills that result in effective information exchange and learning with patients, patients’ families and professional associates. Fellows are expected to:

  1. Develop the ability to listen to, understand and communicate effectively with the evaluee
  2. Effectively verbally communicate with attorneys and third-party agencies
  3. Effectively verbally communicate opinions in testimony and/or mock trials
  4. Demonstrate the ability to communicate forensic data and opinions in written format through forensic reports
  5. Effectively communicate with non-psychiatric clinicians and others involved in disposition and management (e.g., correctional officers)

Core Competency #5: Professional and Ethical Behavior

Fellows will be able to demonstrate an adequate understanding of expectations for professionalism and ethical behavior in the practice of forensic psychiatry, including topics such as:

  1. Codes of ethics that apply to forensic psychiatry, such as the American Medical Association, American Psychological Association and American Academy of Psychiatry and the Law
  2. Legal and ethical principles relevant to the treatment and evaluation of individuals
  3. Assent and consent to research in forensic subjects, including those in correctional settings
  4. Sensitivities to cultural differences that may affect treatment or evaluation
  5. Observation and interactions with representatives of the legal system

Core Competency #6: Systems-Based Care

Fellows will be able to demonstrate awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources of optimal value. Fellows are expected to:

  1. Demonstrate adequate knowledge of systems-theory principles as they apply to forensic psychiatric evaluation and treatment. Such systems may include:
    • Correctional mental health systems
    • Court systems
    • Mental health systems
    • Legislative and regulatory systems
  2. Demonstrate skills in communication with and providing consultation to multiple systems. Examples of these skills may include:
    • Interaction with multiple systems in a consultation role
    • Collaboration with various treatment and legal professionals in a variety of forensic and non-forensic settings
    • Maintaining perspective on dual-agency issues in various systems
    • Utilization of “least-restrictive environment” within the above systems

Evaluation

Evaluation methods of forensic psychiatry fellows by faculty include:

  • Direct observation of evaluation and treatment performed by the forensic psychiatry resident
  • Individual supervision/group supervision
  • Pre- and post-written tests on mental health/legal issues
  • Quarterly written evaluations of forensic psychiatry fellow’s performance

Evaluation methods of faculty by forensic psychiatry fellows include:

  • Written evaluations by the forensic psychiatry resident of each lecture
  • Direct feedback by the forensic psychiatry resident at weekly administrative meetings
  • Semi-annual written evaluations by the forensic psychiatry fellows of the program, supervisors and teachers

Salaries and Benefits

Fellows are employees of the Los Angeles County. Fellows’ salaries are determined in negotiations among the county’s legal bargaining unit, the Council of Interns and Residents, and the county’s Department of Health Services.

Salary as of July 1, 2015

PGY5   Yearly: $67,160.40  Monthly: $5,596.70

Benefits

Bonus $2,000 for interns progressing to a second year in a county facility
Meals $10 per meal, $25 per day at LAC+USC Medical Center; meals are reimbursed during off-campus rotations
Parking Available at no cost at LAC+USC Medical Center
White coats Provided
Vacation 24 days paid vacation each year
Sick leave 8 days per year, of which 3 may be used for personal leave
Professional liability insurance Provided (Los Angeles County self-insures)
Maternity leave Available — most residents use sick leave, vacation time and limited unpaid leave
Parental leave Available as required by the Family and Medical Leave Act of 1993
Medical/dental benefits Choice of several offered plans; family coverage available at additional cost
Life insurance $2,000 term policy is provided; additional insurance may be purchased

 

Application

Forensic psychiatry fellowship positions are intended for physicians who will have completed all training requirements in general psychiatry or child and adolescent psychiatry. The Forensic Psychiatry Fellowship Program provides an excellent mix of didactic education, supervision and clinical experience. Forensic psychiatry fellows receive salaries and benefits from the County of Los Angeles.

The following materials are required:

  • Residency application form (download as Word doc)
  • Fellow applicant information form (download as Word doc)
  • Curriculum vitae
  • Citizenship/visa status. You must be a U.S. citizen or permanent resident, or eligible for a J-1 visa.
  • Medical school dean’s report (download as Word doc). Submit this form to your dean to complete. They may use this form or (preferably) may substitute a “dean’s letter” instead. The completed letter/form must be sent to us directly by the dean’s office and not sent via the applicant. Please ask that a transcript also be included.
  • Training program director’s report (download as Word doc). Submit this form to the training director of your internship or residency program to complete and return to us directly.
  • United States Medical Licensing Examination (USMLE) transcript
  • Personal statement
  • Three letters of recommendation from physiciansfamiliar with you and your work. These letters must be submitted directly by the physicians writing them and not forwarded by the applicant.
  • Photocopy of your California medical license (required for training), or if none, a statement by you affirming your eligibility for the license. You must have your California medical license prior to starting the forensic psychiatry residency. For details regarding licensure in California please refer to the Medical Board of California website.
  • Photocopy of your DEA certificate
  • Photocopy of your basic cardiac life-support training certificate
  • Recent work product (e.g., admission summary, discharge summary or forensic case report)
  • Passport-sized photograph

Applications are accepted June 1 – September 1. Completed applications are screened and the selection committee determines who is interviewed. Face-to-face interviews are part of the application process. Applicants selected for interviews will have the opportunity to meet with members of our faculty and current forensic psychiatrist fellows. However, the decision to invite an applicant will not be made until the above materials have been received and reviewed. If you have any questions about our program, please call our office.

Email or mail the required application materials and documents to:
Mary Goodbeer
Program Coordinator
USC Institute of Psychiatry and Law
P.O. Box 86125
Los Angeles, CA 90086-0125
(323) 409-4942
goodbeer@usc.edu

Tim Botello, MD, MPH
Keck School of Medicine at USC
USC Institute of Psychiatry, Law, and Behavioral Science
(323) 409-4942
botello@usc.edu