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Back-Door Forensic Evaluations - A Multitude of Problems

I turn away many, many referrals and requests for evaluations. The most frequent reason I will not accept a referral or an evaluation is because the person calling (person to be evaluated, referring attorney, or referring agency) wants what we (forensic psychologists) refer to as a BFE. A back-door forensic evaluation. BFEs usually happen because of three reasons. 1) Error in the referral and/or scheduling process (lack of asking adequate questions prior to scheduling or 2) Deception by the referring source or the person being evaluated (most likely because they want their insurance to pay for the evaluation) or 3) A lack of understanding regarding the difference between Treatment Oriented and Forensic Mental Health Evaluations.

Health insurance covers (sometimes) Treatment Oriented Mental Health Evaluations. The evaluation is specifically for diagnostic clarification and treatment recommendations. The evaluation is referred by another provider or solicited by the person to be evaluated. There is not an expectation of answering legal questions, going to court, or opining to any possible forensic or psycho-legal question. Additionally, Treatment Oreinted evaluations fall under HIPAA and the Privacy Act. Any record review is usually brief and the purpose of the evaluation is, again, for treatment. Practice Standards are those for the practice of clinical practice / treatment. The person being evaluated is the client and therefore is often involved in guiding the process.

Forensic Mental Health Evaluations are for the purpose of answering a psycho-legal question. Some of these questions may include: What is the likelihood the child has been abused? Is this parent a fit parent? What is the extent of psychological damages? What are the risk and protective factors for future child abuse, sex offender recidivism, etc? Is the person capable of proceeding with trial? How is the child affected by the current custodial schedule? The list goes on.

The questions posed for the purpose of some type of legal involvement. While diagnosis and treatment recommendations may be (and very often are) a part of the evaluation, that is not the primary purpose of the evaluation. There are real implications for record ownership (the court, the requesting agency, the requesting attorney). FMHA's are guided by Forensic Psychology practice standards and ethical standards, which are different (and sometimes in opposition to) clinical treatment standards. The client is not the person being evaluated. The client is the referring or the retaining agency. Additionally, FMHAs typically require a much more thorough record review, possible collateral information, and different processes and procedures. Insurance companies will not cover the cost of a FMHA. If a provider is billing insurance for an FMHA, they can be subject to an insurance fraud investigation.

To request a Treatment Oriented assessment for the purpose of a FMHA does the person being assessed a disservice. It can causes significant problems for the legal case, and can lead to ethical and practice violations on the part of the evaluator.

Unfortunately, most providers and attorneys do not receive substantial specific training in screening in and screening out Treatment Oriented versus FMHAs. This is not a fault of either profession, but rather a fundamental difference between training and roles. I hope this post helps to clarify some of the differences.

Questions? Feel free to contact me.

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