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 program 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 addressing 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 the 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, placements, and supervision. Forensic psychiatry fellows have opportunities for extensive involvement as forensic psychiatric consultants to state hospitals, county jails, juvenile justice agencies, dependency courts, coroners’ offices, and other agencies that interrelate with mental health and the law. In addition, psychiatry fellows have numerous opportunities to serve as expert witnesses in psychiatry and law for superior courts, mental health court, and county probation department, and other local and state government agencies.
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 & Dependency law
- Mental health law
- Correctional psychiatry
- Seminar in special issues in psychiatry and law
- Seminar on landmark mental health cases
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.
Each forensic psychiatry fellow has a minimum of six supervisors at any given time. The psychiatric supervisors are USC 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 the supervisors’ varied skills and expertise in psychiatry and law.
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 involve psychiatric-legal issues for the criminal, civil, juvenile and dependency 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.
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. They also teach medical students at the Keck School of Medicine of USC. 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.
Forensic psychiatry fellows have opportunities for field involvement in correctional psychiatry and forensic evaluations and treatment of mentally ill defendants in the Los Angeles County jail. In addition, each forensic psychiatry fellow serves, under supervision, as a consultant to the Mental Health Court Clinic.
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.
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 the 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 Psychiatric Outpatient Clinic. The adult and adolescent inpatient psychiatric 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 Health Services provides unique opportunities for understanding the delivery of mental healthcare to underserved patients in the Los Angeles County jail system. Forensic psychiatry fellows serve as consultants to the county Mental Health Court on a daily basis. Forensic psychiatry fellows also serve as consultants to the L.A. County Office of the Medical Examiner-Coroner.
Goals and Criteria
The forensic psychiatry fellow 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:
- 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
- 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
- Levels of care
- Collecting necessary historical and current information for the development of an appropriate treatment plan
- Use of appropriate pharmacotherapy
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:
- 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 the evaluation
- Relevant historical information
- Focused mental status examination
- Review of different 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
- 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
- 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
- Diversion from the criminal justice system
- 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 substance use disorders
- Psychological autopsy
- Assessment of decision-making competencies
- Assessment of “best interests of the child” in child custody/dependency cases
- 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:
- 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
- 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
- Using 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
- 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 of USC libraries
- USC Gould School of Law libraries
- Lexis-Nexis and other electronic journals
- Computer-processing equipment and access to Internet
- Video and audio recording equipment
- One-way mirror observation rooms
- Faculty members involved in research at 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:
- Develop the ability to listen to, and understand and communicate effectively with the evaluee
- Verbally communicate effectively with attorneys and third-party agencies
- Verbally communicate opinions effectively in testimony and/or mock trials
- Demonstrate the ability to communicate forensic data and opinions in written format through forensic reports
- Communicate effectively 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:
- Codes of ethics that apply to forensic psychiatry, such as the American Academy of Psychiatry and the Law, American Medical Association, and the American Psychological Association
- Legal and ethical principles relevant to the treatment and evaluation of individuals
- Assent and consent by forensic in forensic subjects, including those in correctional settings
- Sensitivity to cultural differences that may affect treatment or evaluation
- 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:
- 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
- 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 methods of forensic psychiatry fellows by faculty include:
- Direct observation of evaluation and treatment performed by the forensic psychiatry fellow
- Individual and 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 fellow of each lecture
- Direct feedback by the forensic psychiatry fellow 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 October 1, 2019
PGY5 Yearly: $75,244.51 Monthly: $6,270.38
|Bonus||$4,000 per fellow for housing purposes|
|Meals||$10 per meal, $28 per day at LAC+USC Medical Center; meals are reimbursed during off-campus rotations|
|Parking||Available at no cost at LAC+USC Medical Center|
|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 feloows 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|
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. The applicant 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). The applicant should submit this form to their 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). The applicant should submit this form to the training director of their 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 psychiatrists familiar with the applicant and their work. These letters must be submitted directly by the psychiatrists writing them and not forwarded by the applicant.
- Photocopy of the applicant’s current California medical license (required for training), or if none, a statement by them affirming their eligibility for the license. They must have their 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 the applicant’s current DEA certificate
- Photocopy of the applicant’s basic cardiac life-support training certificate
- Recent work product by the applicant (e.g., admission summary, discharge summary or forensic case report)
- Passport-sized photograph
Applications are accepted May 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 psychiatry fellows. However, the decision to invite an applicant will not be made until all the above materials have been received and reviewed. If the applicant has any questions about our program, please call our office.
Email or mail the required application materials and documents to:
USC Institute of Psychiatry, Law, Behavioral Science
P.O. Box 86125
Los Angeles, CA 90086-0125
Tim Botello, MD, MPH
Keck School of Medicine at USC
USC Institute of Psychiatry, Law, and Behavioral Science