Case Vignette for Comprehensive Examination

Case Vignette for Comprehensive Examination
Please read the vignette carefully. Based on information provided in the vignette, please compose a well-written and organized response to each of the questions that follow:
Presentation of the Problem
On a Saturday morning approximately three weeks ago, a woman called the local county sheriff’s office and reported that her “lunatic neighbor, had attempted to shoot her two sons Peter and Paul (ages 15 and 13) and her nephew Mario (age 15). The caller identified herself as Peter and Paul’s mother and claimed that the three boys had not been hit, but shots had been fired at them. She said, my son Peter broke his leg as he tried to run away from a spray of bullets that were being fired in his direction, and added that her sons and her nephew identified the shooter as Mr. Adams who lived up the hill from her in the forested area next to their new subdivision. She demanded that Mr. Adams be apprehended immediately, adding that he presented a threat to their community. Mr. Adams was arrested by the police at his home that evening. Mr. Adams has been held at the county jail for two weeks after being charged with “Aggravated Assault” for allegedly attempting to shoot three minors who were trespassing on his property. He denies responsibility for the charges. Although he admits to shooting his “high-velocity rifle” in the direction of the teenagers who were trespassing on his property, he stated stubbornly that his intention “was to scare them rich delinquent city boys away for good but never to hurt them like they are saying now.” Subsequently, the parents of all three boys pressed criminal charges claiming that their sons had been emotionally scarred and physically injured. In fact, upon investigation, it was found that the youngest (Paul), received treatment for anxiety and sleep disturbance following the incident and that Peter had suffered a broken leg and had hearing loss in his left ear.
Psychosocial History
Mr. George Huey Adams is a sixty-nine year old Caucasian man born on July 4, 1949, and raised in a rural area of Kentucky close to the Appalachian Mountains. Huey, as he prefers to be called, described himself as a real American, proudly emphasizing that he is one-eighth Cherokee on his paternal side. He stated, with evident bitterness, that neither the United States government nor the Cherokee Nation has acknowledged his Native American heritage. According to his background records, his parents, grandparents and great-grandparents were all born in Kentucky. He said that his family never had much money or property except for the land his family home has sat on for several generations.
Huey reported no prenatal, perinatal, or postnatal complications. Per self-report, all developmental milestones were reached within expected range.
He reported a relatively happy childhood for himself and his older sister until age 14, when his father died suddenly. Huey recalled that he never found out what really happened to his father and that his mother avoided talking about it. He remembered that his sister (four years his senior) had said on several occasions that their father had died because he drank too much and had stopped taking his “nerve pills.” Huey became tearful when he spoke about his father, emphasizing that he never developed the same closeness with his mother that he had enjoyed for 14 years with his father.
Huey suffered another traumatic event when he was sexually abused when he was 15. It was one incident perpetrated by an older man in the community. He kept this secret until he reached adulthood because of feelings of shame and guilt. He never developed close relationships with anyone after his father’s death and identified his older sister as the only important person remaining in his life. He eventually disclosed this traumatic event to his sister, who he described as very supportive in helping him emotionally.
After joining the United States Army, Huey earned a GED. He described Vietnam as a frightening experience which he “survived” by smoking marijuana every day. He acknowledged that he was introduced to LSD in Vietnam adding that everyone was doing it. His duties in Vietnam mostly consisted of doing clerical work. Huey indicated that the work was senseless, but preferable to having to work in the kitchen with a lot of angry people that were hard to please (his first assignment that had lasted only two weeks) or having to fight the North Vietnamese in the jungle. Huey never saw battle during his relatively brief stay in Vietnam. He said that he “felt rejected by the army” when he received an honorable discharge unexpectedly after serving only nine months of his original one-year duty in Vietnam. The things that he valued the most about his experience in the military were are that it gave him the opportunity to serve his country and to become an expert in handling a rifle.
After his discharge, he returned to Kentucky and settled in Louisville briefly holding several jobs as construction worker, security guard, and cook for chain restaurants. He did not like living in the city, claiming that he always felt isolated, misunderstood, and anxious. After a few years, he had saved some money and returned home to the Appalachians to live with his ailing mother who had developed serious health issues related to diabetes. The mother-and-son relationship improved significantly, and he took care of his mother until she died. During this time, Huey supported himself and his mother by relying on his savings, his mother’s pension and her Social Security benefits, his seasonal work in construction, and steady work as a handy-man. He liked to garden and to cook all of the meals. Throughout this time, Huey did not develop any close friendships, but he did enjoy going hunting by himself or with one Vietnam Veteran that he knew from his hometown.
Huey recounted that he was distraught after his mother’s death. He said he worried about how he would get by without her and what his life would be like in the future. He took his sister’s recommendation to move back to Louisville in search of a new life and to seek a well-paying job in construction. Based on his negative prior experience of living in a congested city, he chose to rent a small house in a rural area outside the city. He immediately liked the house because it sat on an acre of land with tall trees that obscured his view of the surrounding houses in the neighborhood. During this time, he met Nick who he calls the “only real love of my life.” Huey had known for many years that he was gay, but it was not until he met Nick, a biracial man four years his senior, that he fully acknowledged his sexual orientation. Nick, an electrician, moved in with him and they remained a couple for approximately five years. The relationship deteriorated once Huey insisted on moving back to his old family home in the mountains. Nick had a good job and was unwilling to relocate. Huey indicated that he was heartbroken and depressed, but that he knew he could no longer continue dealing with the congestion and traffic. He said he “needed space.”
Huey has been living alone and leading a very isolated life since he left Nick. He said that although he had faith in God, he disliked attending the local Baptist church because the preacher and the parishioners “get into my business” and “try to run my life.” He had been making repairs to the old mountain family home and spending most of his days fishing, hunting, lifting weights, attending to his garden and doing odd jobs as a handy-man. He hardly socialized with the exception of a couple of Vietnam friends that he sees occasionally to “share a beer or smoke a reefer or two.” He still misses Nick. His hopes for a reconciliation were crushed when he learned that Nick had gotten married after same-sex marriage was legalized. Huey reported feeling rejected and hopeless. After some questioning, he admitted that he had been very nervous and had been drinking and using marijuana daily during the past month before he was arrested.
According to Huey, the boys (i.e., Peter, Paul and Mario) had been trespassing and loitering on his property during the weekends (mostly on Saturdays) for the past two months. He stated that he avoided the issue as much as possible because he did not want to get into a conflict with a neighbor. Huey described himself as a peaceful man who avoids confrontation. He indicated that he had very nicely tried to reason with the boys about three times to stay off my property and respect my privacy, but to no avail. He added that he suspected the boys had been letting his chickens loose and had been walking all over his garden. He admitted that they finally caught me on a bad day, and I lost my temper, and I warned them that I was going to grab my rifle if they insisted on disrespecting me on my own piece of land. He recalled feeling aggravated and running after them while shooting his rifle close but not precisely in their direction. Huey denied that he had any intention or plan of hurting them, I just wanted to scare them away once and for all. Huey appeared emotional, overwhelmed, and even confused as he tried to recall all the details that led to the incident. He said he was having trouble remembering all the details.
Psychological/Legal History:
Huey had never been arrested before, and he denied receiving mental health treatment or being treated for emotional problems prior to the arrest. Although he denied substance use problems, he acknowledged that he had used alcohol and marijuana to ease his pain and alleviate anxiety. It is important to note that during a phone call from his sister, the forensic case manager learned that Huey had received treatment for anxiety and marijuana use at the Veteran’s Administration Hospital years ago. When he was questioned about this, Huey minimized its importance explaining that when he was actually needing help (i.e., during the nine months he served in Vietnam), no one seemed to care or offered any assistance.

Behavioral Observations
Huey appeared very anxious (wringing his hands, perspiring, preoccupied, and pessimistic about his future). He described himself as a “good patriotic man” who likes to mind his own business and expects others to do the same. He feels that he is being falsely accused. He said that he hopes that the forensic case manager can assist him in getting some medication to calm my nerves and help me sleep. It is important to note that Huey appears to be inconsistent as an informant. He has been fairly cooperative with the ongoing investigation but had difficulty remembering some of the events that led to his arrest.
Originally, based on his clean legal record, Huey was going to be allowed to post bail and required to report to a court hearing at a later date. Judge Douglas, who has known Huey for a long time, changed her mind at the last minute after recognizing that Huey did not appear to be acting like his normal self. The judge was concerned about his current mental state and requested an evaluation as to whether Mr. Adams has mental health or emotional problems that contributed to his aggressive behavior and to determine if he needs mental health services. A probation officer in the office told you that he wanted a copy of your report and that you needed to just keep it to yourself when you give me the report because Huey is not one of his probationers, but he knew Huey’s family and wants to try to help Huey.

Task Identification

You are the forensic case manager being asked to conduct a pre-trial evaluation with recommended services and referrals as needed. You are to act as a forensic mental health evaluator and produce a written case report addressing the questions below. The report will be submitted to the appropriate supervisor and to the judge.

Based on the vignette provided, please compose a well-written and organized response to each of the following questions. When writing your responses, please:

Psychological Theory and Practice

A. What assessments would you conduct to enhance your understanding of the problems of the person in the vignette and how would your choice of assessment(s) inform your diagnostic formation and treatment planning? Assessments may include structured or unstructured interviews, valid and reliable assessment measures, and/or formalized assessment procedures that may be conducted by yourself or by someone else referred by you.

B. Provide your diagnostic impressions (based on the DSM-5) for this individual. In narrative form, please describe how the individual meets the diagnostic criteria for the disorder(s) chosen in addition to the differential diagnostic thought process that you used to reach your hypotheses. Be sure to include any additional (missing) information that is needed to either rule out or confirm your differential diagnoses impressions.

Legal Theory and Application

A. Explain the background, current presentation, and behavior of the person in the vignette utilizing biological, learning, and social theories on offenders to support your position. Do not simply restate the background information from the vignette. Instead, provide a theoretically-based discussion to understand the criminal behaviors of the person in the vignette.

B. Consider the type of crime in the vignette and discuss how that type of crime generally impacts a victim of it. Do not limit yourself to discussing just the victim in this vignette. Instead obtain scholarly sources for information on how this type of crime can affect any victim, their family members, and other members of society.

C. Describe the psycholegal standards and/or definitions for each of the following: competence to stand trial, duty to warn, and insanity. Identify and describe one or more landmark case(s) for each standard (at least three cases total). Describe the elements or issues that a mental health professional usually focuses on when assessing a person�s adjudicative competence, risk and insanity, and any additional items that might be especially important to focus on in the provided vignette.

Assessment, Research and Evaluation

A. Describe tests or assessment procedures you would employ to address the psycholegal issues of (competence to stand trial, risk of dangerousness, and insanity). You may refer to these from the Psychological Theory and Assessment Section “A” if you already covered them there. Discuss what the anticipated conclusions would be based upon information provided in the vignette.

B. Develop a research question and a testable research hypothesis regarding offenders or the type of crime that is discussed in the vignette (such as, addiction, recidivism, criminal behavior, etc.). Explain the variables in your question and the type of research study that could answer your question as well as why that research would make a contribution to the field of forensic psychology.

Leadership, Consultation, and Ethics
A. What are the ethical and legal dilemmas this vignette introduced? What would be your immediate steps and why? Please be specific and make sure that you describe your process of ethical decision making and the solutions/consequences to which this process might lead. Your discussion should be informed by the American Psychological Association�s Ethics Code as well as the Specialty Guidelines for Forensic Psychologists.
Interpersonal Effectiveness
A. What diversity factors, cultural considerations, or other demographic variables pertaining to the person in the vignette would you take into account in rendering diagnoses, choosing assessment measures, forming case conceptualizations, and designing the treatment plan? Be sure to discuss cultural/diversity factors that could apply even if they are not explicitly mentioned in the vignette.

B. Your writing, use of citations, ability to form a logical argument, and proper APA Style, including the use of paraphrasing, will be evaluated as a measure of your interpersonal effectiveness. No response is required for “B”.

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