Each intern is expected to complete three four-month rotations. Interns must select at least one treatment rotation. Rotation sites at Western State Hospital include the Community Forensic Evaluation Services, Inpatient Forensic Evaluation Services, Gage Center of Forensic Excellence (formerly the Center for Forensic Services), and Civil Center of Excellence. Additional rotation sites include the Child Study and Treatment Center and the Special Commitment Center.
Competency Evaluation Rotation
Interns on the Competency Evaluation Rotation work directly with forensic evaluators in the interview and testing process. Interns are expected to write a minimum of 10 formal forensic evaluation reports, under supervision, during this rotation. The Competency Evaluation Rotation is divided into two sites (IFES and CFES), and interns may be stationed at one or both sites during their rotation:
Community Forensic Evaluation Services psychologists evaluate a large percentage of the pre-trial referrals from Western Washington courts, typically in local correctional facilities. However, CFES evaluations can be conducted in hospital settings, attorney offices, or courthouses, depending on the specific situation.
The Inpatient Forensic Evaluation Services serves up to 240 patients. IFES psychologists evaluate pre-trial defendants who have been ordered to undergo competency restoration or who require clinical observation in a hospital setting.
While interns’ primary focus will be on competency evaluation, they will also have the opportunity to participate in the following:
- Evaluations of mental state at the time of the alleged offense (e.g., sanity, diminished capacity)
- Evaluations of dangerousness (a required component of mental state evaluations and some competency evaluations)
- Administration/interpretation of psychological tests
- Observation of involuntary commitment hearings
- Observation of expert testimony in court trials
Forensic Risk Assessment Rotation
Interns on the forensic risk assessment rotation work directly with forensic evaluators to conduct evaluations of hospital patients who have been adjudicated not guilty by reason of insanity. These evaluations assess for future risk of violence and provide recommendations for treatment and risk management. Interns will also conduct interviews with patient treatment team members (e.g., therapists, social workers, psychiatrists, and physicians). Interns are expected to write a minimum of three to four forensic risk assessments, under supervision, during this rotation. Interns will gain experience with actuarial and structured professional judgment assessments as well as other risk-relevant measures (e.g., VRAG-R, HCR-20v3, SAPROF, PCL-R). Depending on supervisor availability, interns may have the option of combining the forensic risk assessment rotation with the NGRI treatment rotation.
Other opportunities available in this rotation may include:
- Attending a meeting of the hospital’s Risk Review Board, a group of hospital personnel who review patient cases for advancement to higher privileges, conditional release from the hospital, and/or final discharge
- Observing expert testimony/depositions
- Conducting additional testing (e.g., diagnostic, personality, etc.)
- Being involved in policy-making processes
- Attend court hearings related to patient petitions for increased privileges and/or discharge
Inpatient Competency Restoration Treatment Rotation
The Fort Steilacoom Competency Restoration Program is a residential treatment facility operated by the Department of Social and Health Services. FSCRP serves up to 30 male defendants opined as not competent to stand trial and ordered to undergo competency restoration treatment by their superior district or municipal court. FSCRP is located on the grounds of Western State Hospital but is an independent program. Interns on the inpatient competency restoration treatment rotation work directly with psychologists, psychology associates, social workers, recreation and athletic specialists, psychiatric prescribers, and other members of a multidisciplinary team to monitor and treat the barriers to competency identified in patients’ most recent competency evaluations. The psychology intern will master the Breaking Barriers Competency Restoration Program curriculum and will enhance their skills in treating serious mental illness in a forensic population. Specific assessment and research opportunities may also be available depending on the intern’s interests and supervisor's availability. While the primary focus of the rotation will be to learn and facilitate competency restoration treatment groups, other opportunities during the rotation may include:
- Observing outpatient competency restoration treatment services
- Shadowing forensic navigators
- Supervision of a practicum or undergraduate student
- Providing competency restoration training to staff
- Providing secondary supervision to master’s level clinicians
- Collaborating with clinical staff and OFMHS Quality Assurance to develop additional competency restoration treatment activities and programming
- Meeting with Trueblood vs. DSHS court monitors (at the monitors’ request)
Not Guilty by Reason of Insanity Treatment Rotation
The Western State Hospital Gage Center of Forensic Excellence has eight treatment wards that serve a variety of forensic patients. Approximately 140 NGRI patients are housed at WSH. The center also provides ongoing treatment for this population through the Treatment and Recovery Center. Interns choosing the NGRI treatment rotation conduct group and individual therapy for NGRI patients, under the supervision of a licensed psychologist, with the primary goal of helping mitigate the patient’s risk of future violent behavior. Interns work within a multidisciplinary team that includes a psychologist, psychiatrist, social worker, physician, RNs, LPNs, pharmacists, recreational and occupational therapists, and other support personnel. They consult with other treatment team members for purposes of identifying treatment needs and placement options, participate in treatment team meetings, and assist in the development of treatment plans. They may also have the opportunity to support patients as they integrate into the community through staff-escorted community outings. Depending on supervisor availability, interns may have the option of combining the NGRI treatment rotation with the forensic risk assessment rotation.
Other potential opportunities on this rotation include:
- Conducting psychological testing
- Assessing for suicide risk
- Developing new groups/curricula
- Attending meetings of the hospital’s Risk Review Board
- Attend court hearings related to patient petitions for increased privileges and/or discharge
Psychiatric Treatment and Recovery Center Rotation
The Civil Center of Excellence serves approximately 600 patients, ranging in age from 18 to 90. It consists of 20 wards, each with a population of about 30 patients. The primary diagnoses of PTRC patients are schizophrenia, schizoaffective disorder, and major mood disorders. Patients are directly admitted to these wards after an initial evaluation and treatment in a community hospital. The Civil Center also houses the Habilitative Mental Health Unit, which serves 24 people with developmental disabilities who require intensive, structured behavioral interventions.
The Civil Center population offers interns a unique opportunity to work with adults exhibiting a wide variety of psychological/psychiatric illnesses and a range of severity levels. In addition to working alongside a licensed psychologist, interns participate on a multidisciplinary treatment team consisting of a psychiatrist, social worker, the physician assigned to medical care, RNs, LPNs, a pharmacist, recreational and occupational therapists, and other support personnel. Specific rotation experiences can usually be tailored to accommodate interns' interests and educational/experiential needs.
Psychology interns serving a Civil Center of Excellence rotation are expected to:
- Conduct group and individual psychotherapy for selected patients
- Become knowledgeable about the civil commitment process and assist in preparing court petitions for involuntary commitment and/or conditional releases
- Observe involuntary commitment hearings
- Participate in multidisciplinary diagnostic evaluations of patients with mental, emotional, and/or organic dysfunction
- Administer, score, and interpret psychological tests and write comprehensive reports
- Develop specific behavioral treatment programs for designated patients, consulting with treatment team members and nursing staff to ensure consistent approaches to patient care
Child Study and Treatment Center
The Child Study and Treatment Center is a state and federally-funded, TJC-accredited, long-term inpatient psychiatric hospital established to treat children and adolescents who cannot be served in less restrictive settings. CSTC serves children from throughout Washington and is the only state-operated children’s psychiatric hospital in Washington. CSTC has a 65-inpatient bed capacity on four cottages (units). On-grounds elementary and secondary schools provided by Clover Park School District are an integral part of the treatment model. All WSH interns are invited to attend monthly seminars and the CSTC Journal Club (even if they are on another rotation). Opportunities for individual and group therapy with youth on the other cottages are available. Interns use office space in a shared setting with practicum students and post-doctoral fellows.
Camano Cottage (ages 5-12): This cottage uses a cognitive behavioral milieu based on a developmental teaching/developmental therapy model. The program emphasizes family involvement (family therapy, multiple family group treatment). Youth are reinforced for demonstrating positive behavior and working towards concrete, measurable goals. All children are assigned an individual therapist and provided with applicable evidence-based therapies. Interns on Camano meet twice weekly with individual clients and co-facilitate treatment groups.
Ketron Cottage (ages 12-14): This cottage uses a cognitive-behavioral model with a focus on a strong community. Ketron youth participate in psychoeducation and recreation therapy groups where they learn and practice skills to be more effective with interpersonal interactions and manage emotions and maintain safe behavior. Much effort is spent helping youth generalize improvement to home environments with home visits and regular passes. Interns on Ketron meet at least once weekly with individual clients and co-facilitate treatment groups.
Orcas Cottage (ages 14-17): This cottage includes two programs. The General Program is for older adolescents who have demonstrated safe behavior and are able to participate in off-cottage programming including school, recreation, and community outings. The Close Attention Program is for older adolescents who, due to their own functioning or legal status, are allowed less access to potentially dangerous items and receive most of their care on-cottage. Dialectical behavior therapy, social skills, and human sexuality groups are examples of the patient education and patient therapy groups offered. Interns on Orcas meet at least once weekly with individual clients and co-facilitate treatment groups.
San Juan Cottage (ages 15-17): This cottage opened in November 2021, eight of the beds in this 18-bed facility are for forensic evaluation and restoration patients, while the remaining beds are for youth referred through the state’s Children’s Long-term Inpatient Programs system. The milieu program is heavily influenced by Dialectical Behavior Therapy strategies. Interns in San Juan meet at least once per week with individual clients and co-facilitate treatment groups
Forensic Services (ages 8-17): Evaluators at CSTC conduct pretrial forensic evaluations of minors for juvenile and adult courts across the state. Most evaluations produce opinions regarding clinical diagnosis, competence to stand trial, and likelihood of restoration. Interns participate in interviews, evaluations, report-writing for legal personnel, restoration to competence services for court-referred youths, and individual and group supervision. Less frequent types of evaluations (e.g., capacity to commit a crime, mental state at the time of the offense, suitability for adult criminal court, and long-term risk assessment) may also be available for interns to observe. Interns are invited to observe court testimony and attorney consults as time and interest allow. The extent of involvement in cases depends on the intern’s interests, experience, and availability.
Intern Activities: Interns at CSTC may choose to have a clinically or forensically focused rotation. At the beginning of the internship year, all interested interns are invited to a meeting with CSTC's licensed psychologist supervisors, during which interns' interests and experiences can be matched with available rotation experiences. There are also opportunities for cross-cottage experiences and participation. Licensed psychologists provide intern supervision consistent with APA requirements. However, because there is much to learn from professionals in other disciplines, informal supervision with assigned multidisciplinary treatment team members may also occur.
At the onset of the rotation, the intern and supervisor together identify specific requirements for the rotation.
The minimum expectation for Clinical Services includes:
- Testing and formal write-up of at least one comprehensive cognitive or educational assessment
- A minimum of two individual therapy cases
- Construction and implementation of at least one behavior management program
- Participation as a co-therapist in at least two psychoeducational groups
- Ongoing participation on a multidisciplinary team, including attending treatment plan meetings
- Participating in case reviews, rounds, family staffing, clinical meetings, intake evaluations, etc.
- Participation in a cottage-wide behavioral management program (milieu)
Minimum expectations for a rotation in Forensic Services include:
- Weekly participation in forensic group supervision
- Participation in observing or conducting supervised interviews with referred youth and/or their parents
- As appropriate, providing psychological testing with clinical and/or forensic measures
- Independent research of issues as needed for evaluations (e.g., relevant child and adolescent diagnosis, normal child development, best forensic practices in juvenile forensic evaluations, statutes and case law)
- As available and needed, participation in psycho-educational treatment for one juvenile found incompetent to stand trial and hospitalized at CSTC
- As available, observation of a juvenile court hearing addressing a forensic evaluation
Special Commitment Center
The Special Commitment Center provides evaluation and treatment of civilly committed sex offenders, all of whom have committed prior acts of sexual violence (e.g., rape, child molestation, incest, indecent liberties by forcible compulsion). SCC forensic evaluators conduct legally mandated annual reviews of residents to assess whether they continue to meet criteria as sexually violent predators. SCC psychologists and psychology associates provide treatment services in a secure environment, with close monitoring. The clinical program is housed on McNeil Island, while the forensic services unit is housed on the mainland in Steilacoom. Interns on the clinical rotation must regularly take a ferry from Steilacoom to McNeil Island and then a shuttle from the ferry dock to the SCC facility. This is a 40-minute commute each way.
Intern rotations at the SCC can either be within the clinical department on the island, with an emphasis on group and individual therapy, or within the Forensic Services Department, with a focus on assessment. SCC interns may also attend a weekly meeting with the senior clinical team to discuss cases and a therapist or psychologist presents a case for review.
Clinical rotation: Interns completing a clinical rotation on the island will co-facilitate sex offender treatment groups and habilitative groups such as dialectical behavior therapy, healthy relationships, social skills, etc. Interns will have the opportunity to perform cognitive, achievement, and personality assessments in order to inform treatment. Interns may also have the opportunity to provide brief, solution-focused individual therapy. Interns will be expected to complete all corresponding documentation for their resident interactions and participate in interdisciplinary treatment team meetings to discuss client progress. In this rotation, interns will also have the opportunity to participate in monthly didactics and case consultations in addition to their individual supervision.
Forensic rotation: Interns participating in the forensic rotation will learn the essential components of assessing sexual offenders, with an emphasis on SVPs. Given the high level of knowledge that is required of individuals working in this specialized area of the field, this rotation will have a strong didactic component, with an emphasis on becoming familiar with the relevant literature. The intern will have the opportunity to practice scoring actuarial risk measures, participate in case conceptualization, and observe interviews of SCC residents. However, the intern will not complete an evaluation of a resident, given the possibility of intense legal scrutiny on any such evaluation. Rather, another option will be chosen, with input from the intern, for the written component of this rotation. (This frequently takes the form of a “shadow report” written by the intern). Interns will have the opportunity to observe expert witnesses’ testimony and/or depositions. Interns will also prepare a lecture on a related topic of interest for presentation at the Forensic Services meeting.
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SAMPLE PROGRESSIVE LEARNING PLAN: COMPETENCY EVALUATION ROTATION
Objectives
1. Demonstrate minimum proficiency in competence to stand trial (CST) evaluations by:
- completing at least 10 CST evaluations from start to finish (initial or competency restoration treatment evaluations);
- describing the CST evaluation process, including sources of data to be considered;
- verbalizing reasoning of what data is appropriate for inclusion in/exclusion from the report;
- distinguishing between data, inferences, and opinions;
- articulating reasoning for opinions.
2. Involvement in a competency restoration treatment CST evaluation (prefer to complete one)
3. Involvement in mental state at the time of offense evaluation (after proficiency in CST evaluations is met or largely achieved)
4. Observe contested competency hearing and/or civil commitment hearing
CST and MSTO cases may occur through a variety of evaluation locations/situations, including:
- Outpatient jail CST evaluation
- Outpatient personal recognizance CST evaluation
- Inpatient initial CST evaluation
- Inpatient competency restoration treatment evaluation
- MTSO (sanity and/or mental state – prefer exposure to both, may be two different cases evaluation), may be inpatient, outpatient-jail, outpatient-PR
- Outpatient or inpatient developmental disability CST evaluation
Notes:
- “Involvement” means anything from observation, contact of collaterals, partial writing of the report, first author of the report
- The rotation supervisor for any case is responsible for case selection, to assure the intern is not the first author on any case that is likely to require testimony (e.g., felony assault 3)
- Proficiency is more important than the location of the evaluation
- Once proficiency is established, have intern go with other examiners for breadth of experiences with other psychologists
- Internship supervisors of IFES and CFES coordinate with each other to assure a variety of objectives-experiences are included for each intern
Weeks 1 and 2
Activities/Experiences
- Observe primary supervisor conduct a competence to stand trial evaluation
- Observe secondary supervisor (or other examiners) conduct competence to stand trial evaluation
- Review and discuss CST reports for the cases observed
- Tour and observe mental health courts
- Attend jail orientations if necessary
- Review readings with supervisor(s)
Suggested Readings
A. RCW 71.05 – Civil Commitment
B. LaBelle and Beyond: Defining Grave Disability (PowerPoint presentation, Dr. Richard Yocum)
Case: In re LaBelle (1985)
C. RCW 10.77 - Criminal Evaluations
D. Melton et al. (2007): Chapter 1 - Law and the Mental Health Professions: An Uneasy Alliance
E. Therapeutic and Forensic Roles (tables)
Articles available:
- Greenberg, S.A., & Shulman, D.W. (1997). Irreconcilable conflict between therapeutic and forensic roles. Professional Psychology: Research and Practice, 28, 50-57.
- Greenberg, S.A., & Shulman, D.W. (2007). When worlds collide: Therapeutic and forensic roles. Professional Psychology: Research and Practice, 39, 129-132.
- Heltzel, T. (2007). Compatibility of therapeutic and forensic roles. Professional Psychology: Research and Practice, 38, 122-128.
- Morse, J.F. (2008). The ethics of forensic practice: Reclaiming the wasteland.
F. Melton et al. (2007): Chapter 3 - The Nature and Method of Forensic Assessment
G. DeMier, R. (2013). Forensic report writing. In R. K. Otto (Ed.), Forensic psychology (2nd ed.)
Weeks 3 and 4
Activities/Experiences
- Conduct CST evaluation with primary supervisor
- Supervision of evaluations conducted, review of forensic psychology perspective on evaluations
- Review readings with supervisor(s)
Suggested Readings
A. Melton et al. (2007): Chapter 6 – Competency to Stand Trial
B. Frederick et al. (2014)
- Table of Contents
- Introduction to Volume
- Section 1: Standards of Competency
- Youtsey v. U.S.
- Dusky v. U.S.
- Wieter v. Settle
- Appendix A – Legal Citation
- Appendix B – Relevant Clauses and Amendments of the U.S. Constitution
C. Case: Dusky v. U.S., 362 US 402 (1960)
D. Frederick et al. (2014): Section 2 – Thresholds for Competency Examinations
- Kenner v. U.S.
- Pate v. Robinson
- Drope v. Missouri
- Seidner v. U.S.
Weeks 5 and 6
Activities/Experiences
- Conduct CST evaluation with primary supervisor and other examiners, as appropriate
- Supervision of evaluations conducted, review of forensic psychology perspective on evaluations
- Observe mental state at the time of offense evaluation conducted by primary or secondary supervisor
- Review/discuss mental state at the time of offense evaluation completed by supervisor(s)
- Review readings with supervisor(s)
Suggested Readings
A. Frederick et al. (2014): Section 3 – Constitutional & Judicial Considerations
- McDonald v. U.S.
- Medina v. California
- Cooper v. Oklahoma
- Godinez v. Moran
- Indiana v. Edwards
- North Carolina v. Alford
- U.S. v. Greer
B. Case: Estelle v. Smith, 451 U.S. 454 (1981)
Weeks 7 and 8
Activities/Experiences
- Conduct CST evaluation with primary supervisor and other examiners, as appropriate
- Supervision of evaluations conducted, review of forensic psychology perspective on evaluations
- Observe and/or conduct mental state at the time of offense evaluation with primary or secondary supervisor
- Review/discuss mental state at the time of offense evaluation completed by supervisor(s)
- Review readings with supervisor(s)
Suggested Readings
A. Frederick et al. (2014): Section 4 – Incompetent Defendants
- Riggins v. Nevada
- U.S. v. Brandon
- Sell v. U.S.
- U.S. v. White
- U.S. v. Valenzuela-Puentes
- U.S. v. Evans
- Jackson v. Indiana
- U.S. v. Duhon
Weeks 9 and 10
Activities/Experiences
- Conduct CST evaluation with primary supervisor and other examiners, as appropriate
- Supervision of evaluations conducted, review of forensic psychology perspective on evaluations
- Observe and/or conduct mental state at the time of offense evaluation with primary or secondary supervisor
- Review/discuss mental state at the time of offense evaluation completed by supervisor(s)
- Review readings with supervisor(s)
Suggested Readings
A. Frederick et al. (2014): Section 5 – Amnesia & Competency
- Wilson v. U.S.
- U.S. v. Swanson
- U.S. v. Borum
- U.S. v. Stevens
B. Frederick et al. (2014): Section 6 – Adjudicative Competency in Juveniles
- In re Causey
- G.J.I. v. State of Oklahoma
- In the Interest of S.H.
Weeks 11 and 12
Activities/Experiences
- Conduct CST evaluation with primary supervisor and other examiners, as appropriate
- Supervision of evaluations conducted, review of forensic psychology perspective on evaluations
- Observe and/or conduct mental state at the time of offense evaluation with primary or secondary supervisor
- Review/discuss mental state at the time of offense evaluation completed by supervisor(s)
- Review readings with supervisor(s)
Suggested Readings
A. Mental State at the Time of the Offense: Sanity and Mens Rea
- Melton et al. (2007): Chapter 8 – Mental State at the Time of the Offense
- Daniel M’Naghten’s Case (1843)
- State v. Atsbeha, 142 Wn.2d 904 (2001)
Weeks 13 and 14
Activities/Experiences
- Conduct CST evaluation with primary supervisor and other examiners, as appropriate
- Supervision of evaluations conducted, review of forensic psychology perspective on evaluations
- Observe and/or conduct mental state at the time of offense evaluation with primary or secondary supervisor
- Review/discuss mental state at the time of offense evaluation completed by supervisor(s)
- Review readings with supervisor(s)
Suggested Readings
A. Frederick et al. (2007)
- Table of Contents
- Introduction to Volume
- Introductions and Summaries from Sections:
- State and Federal Statutes in the U.S. Pertaining to Insanity
- Roots of the Insanity Defense
- Insanity and the U.S. Constitution
- The D.C. Experiment
- What is “Wrongfulness”?
- What to Do With Insanity Acquittees
- Prosecuting the Mentally Ill
- Appendix A – Legal Citation
- Appendix B – Relevant Clauses and Amendments of the U.S. Constitution
Weeks 15 and 16
Activities/Experiences
- Conduct CST evaluation with primary supervisor and other examiners, as appropriate
- Supervision of evaluations conducted, review of forensic psychology perspective on evaluations
- Observe and/or conduct mental state at the time of offense evaluation with primary or secondary supervisor
- Review/discuss mental state at the time of offense evaluation completed by supervisor(s)
- Review readings with supervisor(s)
- Completion of final intern evaluation.
- Discuss intern recommendations for Forensic Assessment Rotation