Legal and Forensic Issues

Legal and forensic issues in child and adolescent psychiatry are frequently intertwined with clinical, research and ethical issues in day-to-day practice. The articles below highlight the important considerations when performing a forensic versus a clinical evaluation as well as the legal and ethical issues raised by genetic research. CAPs have a duty to be knowledgeable and seek consultation regarding legal and forensic issues that present and may be beyond their expertise.

Forensic Psychiatry

  1. Kraus LJ, Thomas CR, Bukstein OG, Walter HJ, Benson RS, Chrisman A, Farchione TR, Hamilton J, Keable H, Kinlan J, Schoettle U, Siegel M, Stock S, Ptakowski KK, Medicus J. Practice parameter for child and adolescent forensic evaluations. J Am Acad Child Adolesc Psychiatry. 2011 Dec;50(12):1299-312. doi: 10.1016/j.jaac.2011.09.020. PubMed PMID: 22115153.
  2. Robinson J. The experience of the child witness: Legal and psychological issues. Int J Law Psychiatry. 2015 Sep-Dec;42-43:168-76. doi: 10.1016/j.ijlp.2015.08.022. Epub 2015 Sep 4. Review. PubMed PMID: 26343312.
  3. Sher L. Forensic psychiatric evaluations: an overview of methods, ethical issues, and criminal and civil assessments. Int J Adolesc Med Health. 2015 May;27(2):109-15. doi: 10.1515/ijamh-2015-5001. Review. PubMed PMID: 25411982.
  4. Thomas CR. Epigenetics and Child Psychiatry: Ethical and Legal Issues. Behav Sci Law. 2015 Oct;33(5):644-52. doi: 10.1002/bsl.2207. Epub 2015 Sep 11. Review. PubMed PMID: 26358684.
  5. Wills CD. DSM-5 and neurodevelopmental and other disorders of childhood and adolescence. J Am Acad Psychiatry Law. 2014;42(2):165-72. PubMed PMID: 24986343.

Abuse and Neglect Reporting

At times, the ethical principle of confidentiality will conflict with other critical ethical principles. These conflicts might arise when a child and adolescent psychiatrist (CAP) obtains information concerning suspected child maltreatment (i.e., child abuse or neglect). This information that might be needed to end child maltreatment and protect children. Each state has a system in place to receive and respond to reports of suspected child maltreatment. CAPs are expected to know what standards apply in their state of practice and must report any form of suspected child maltreatment that falls within those standards.

  1. Drake B, Jolley JM, Lanier P, Fluke J, Barth RP, Jonson-Reid M. Racial bias in child protection? A comparison of competing explanations using national data. Pediatrics. 2011; 27(3): 471-8. doi: 10.1542/peds.2010-1710. Epub 2011 Feb 7. PubMed PMID: 21300678.
  2. Lareau CR. Attorney work product privilege trumps mandated child abuse reporting law: the case of Elijah W. v. Superior Court. 2015. Int J Law Psychiatry. 2015,2015;42-43:43-8. doi: 10.1016/j.ijlp.2015.08.006. Epub 2015 Sep 26. PubMed PMID: 26404507.
  3. Newton AW, Vandeven AM. The role of the medical provider in the evaluation of sexually abused children and adolescents. J Child Sex Abus. 2010 Nov;19(6):669-86. doi: 10.1080/10538712.2010.523448. Review. PubMed PMID: 21113834.
  4. Pietranoio AM, Write, Gibson KN, Alldred T, Jacobson D, Niec A. Mandatory reporting of child abuse and neglect crafting a positive process for health professionals and caregivers. Child Abuse Negl. 2013; 37(2-3):102-9. doi: 10.1016/j.chiabu.2012.12.007. Epub 2013 Jan 19. PubMed PMID: 23337443.
  5. Schilling S, Christian CW. Child physical abuse and neglect. Child Adoles Psychiatric Clin N AM 2014; 23:309-19, ix. doi: 10.1016/j.chc.2014.01.001. Epub 2014 Feb 18. Review. PubMed PMID: 24656582.

Involuntary Commitment - Inpatient Psychiatry

When treating children and adolescents, involuntary commitment for psychiatric care is complicated by having to consider the opinions of the parents and the youth. While youth can be hospitalized voluntarily if their parents agree, having the child or adolescent disagree with the plan does complicate the situation. Assent/consent are major issues as well as best interests/no harm and development. Given that some populations are more likely to be involuntarily committed, advocacy and justice should always be considerations.

  1. Georgieva I, Vesselinov R, Mulder CL. Early detection of risk factors for seclusion and restraint: a prospective study. Early Interv Psychiatry. 2012 Nov;6(4):415-22. doi: 10.1111/j.1751-7893.2011.00330.x. Epub 2012 Jan 25. PubMed PMID: 22277018.
  2. Golubchik P, Server J, Finzi-Dottan R, Kosov I, Weizman A. The factors influencing decision making on children's psychiatric hospitalization: a retrospective chart review. Community Ment Health J. 2013 Feb;49(1):73-8. doi: 10.1007/s10597-012-9487-0. PubMed PMID: 22294510.
  3. Pelto-Piri V, Kjellin L, Lindvall C, Engström I. Justifications for coercive care in child and adolescent psychiatry, a content analysis of medical documentation in Sweden. BMC Health Serv Res. 2016 Feb 19;16:66. doi: 10.1186/s12913-016-1310-0. PubMed PMID: 26893126; PubMed Central PMCID: PMC4759758.
  4. Turunen S, Välimäki M, Kaltiala-Heino R. Psychiatrists' views of compulsory psychiatric care of minors. Int J Law Psychiatry. 2010 Jan-Feb;33(1):35-42. doi: 10.1016/j.ijlp.2009.10.007. Epub 2009 Nov 10. PubMed PMID: 19906428.