School Psychology Services - Parental Consent Form: Fill & Download for Free

Clinical trials as we understand them today are a fairly recent invention, starting with the 1947 UK Medical Research Council's study of streptomycin for tuberculosis treatment, the 1st randomized clinical trial (1).Informed consent is of even more recent vintage. Dwelling at the intersection of law and medicine, birthed by the former, imposed on the latter, informed consent and clinical medicine have had an uneasy relationship from the beginning. While landmark cases started shaping its legal doctrine already in the 19th and early 20th century, informed consent's post-WWII legal lineage in the US is easy to track, with milestone rulings starting in the 1950s through to the 1970s (2, 3, 4),The 1957 Salgo v. Leland Stanford Jr. University Board of Trustees (2) established the precedent of patient self-determination with the judge coining the phrase, informed consent, in his jury instruction, the 1st known instance of its explicit use.The 1960 Natanson v. Kline (3) established the negligence standard, as in the physician having an inherent duty to make a reasonable disclosure of risks and hazards of treatment or face possible malpractice liability.The 1972 Canterbury v. Spence (4) established the reasonable person standard, i.e., the need to disclose what any reasonable person would consider necessary and sufficient to know.According to Ruth R. Faden, Tom L. Beauchamp and Nancy M.P. King, who published the definitive text-book on it in 1986 (5), how informed consent was planted in clinical medicine, how it grew, in other words its clinical medicine lineage, that's largely lost to time. This is perhaps an unavoidable difference because medicine already walks an uneasy tightrope between patient autonomy and welfare. Absence of early peer-reviewed medical studies only emphasizes the initial reluctance with which clinical medicine incorporated informed consent, and is also emblematic of the unease with which the two co-exist. Part of the reason for this unease is the perennial existence of grey areas.Why perennially grey areas? Because the young, the elderly, the frail, the poor, the poorly educated, the intellectually impaired, and the seriously ill are a part of us, a part of us that's much more dependent and thus much more vulnerable to manipulation. As Robert Q. Marston, the then-Director of the US NIH noted in an influential speech on the subject of informed consent, 'Whether or not consent is in fact informed is admittedly difficult to assess. We often are in an uncertain situation in which inadequate information, communication problems, and the inability of the subject to comprehend-or to read-or to listen-can be misleading' (6).Pre-informed consent Clinical Medicine helps understand why it's Important, nay Critical, in Clinical TrialsAs recently as 1964-1966, a study in the US found that >50% of physicians, 53% to be exact, thought it was 'ethically appropriate for a physician not to tell a cancer patient that she had been enrolled in a double blind clinical trial of an experimental anticancer drug and was currently receiving a placebo' (5, page 89).Two of the most prominent egregious abuses in human medical research, namely, Nazi human experimentation during the Holocaust and the Tuskegee Syphilis Study* certainly cast a long shadow, necessitating clear, formal, legally binding guidelines for human experimentation. While case law verdicts helped shape the legal framework for informed consent, the cultural framework, at least in the US, arose from several other cases that drove public debate, illuminated gaps in physician understanding of informed consent, and highlighted the roles and responsibilities of research committees and funders. Careful examination of the details and circumstances of some of these prominent cases helps drive home why informed consent is not only important but indeed critical. Two of several prominent US examples that were crucial in fleshing out informed consent as it exists today are elaborated here.The Jewish Chronic Disease Hospital CaseConducted at the Jewish Chronic Disease Hospital (JCDH) in Brooklyn, New York, and funded by Sloan-Kettering Institute for Cancer Research, the American Public Health Service and the American Cancer Society. With 10 years of research on anti-cancer immune responses under his belt, in July 1963, chief investigator Dr. Chester M. Southam convinced the hospital medical director Emmanuel E. Mandel to permit injection of a suspension of foreign, live cancer cells into 22 JCDH patients.The research question? Do cancer patients reject cancer transplants or not? Obviously comparison with response of cancer-free patients, the controls, was also required.The informed consent aspect? Some were informed orally they were involved in an experiment, but not that they would be injected with live cancer cells. No written informed consent.The final insult to injury, some patients were incompetent to give informed consent.The non-cancer patients, i.e., the controls, weren't informed either that they were getting injected with live cancer cells.The grounds? Might unnecessarily agitate the participants.The defense? That it was customary in medical research that consent 'not be documented even in far more dangerous research' (5, page 161), something that sounds utterly indefensible in the year 2015.As the New York Post reported in 2013, three young physicians, Drs. Avir Kagan, David Leichter and Perry Fersko, courageously went against the prevailing status quo and refused to participate in this study (7). They also brought it to the attention of attorney William Hyman, one of JCDH's Board of Directors, who filed a suit to access hospital records to learn more about the study (8). Hyman's concerns ranged from potential patient abuse, potential reputation damage to the hospital and its possible liability. The Hyman-driven review revealed (5, page 162),The study wasn't presented to the hospital's' research committee.Physicians directly responsible for patient care of subjects involved in the research weren't consulted about the cancer cell injections.Three physicians who had been consulted by Dr. Mandel were against the research arguing 'subjects were incapable of giving appropriate consent'.In 1966, the Board of Regents of the State University of New York censured Drs. Southam and Mandel, finding them guilty of deceit, fraud and unprofessional conduct, writing in its judgment (5, page 162, 9, see Regent' decision from 10 below),'A physician has no right to withhold from a prospective volunteer any fact which he knows may influence the decision. It is the volunteer's decision to make. . . . There is evidenced in the record in this proceeding an attitude on the part of some physicians . . . that the patient's consent is an empty formality. Deliberate nondisclosure of the material fact is no different from deliberate misrepresentation of such a fact. . . . The alleged oral consents that they obtained after deliberately withholding this information were not informed consents and were, for this reason, fraudulently obtained'.The Willowbrook State School CaseAn institution on Staten Island, New York, it was then classified in a manner unthinkable today, a mere 60 years later, namely, as a place for 'defective children'. Originally designed to house 3000, by 1963 it housed >6000. With the children's severe developmental impairments amplified by poor oversight, large numbers weren't even properly toilet trained. Unsurprisingly, such conditions not just predisposed to but also facilitated easy spread of fecal-borne infections. For example, in 1954, many children contracted hepatitis (presumably hepatitis A) within 6 to 12 months of living at Willowbrook.In 1956, Saul Krugman and colleagues started a series of experiments to develop an effective prophylactic. Funded by the US Armed Forces Epidemiological Board, the US Army Medical Research and Development Command, the Health Research Council of the City of New York, and several committees at New York University School of Medicine, including its Committee on Human Experimentation, they deliberately infected newly admitted patients with isolated hepatitis virus strains. Of the 10,000 children admitted to Willowbrook after 1956, ~ 750 to 800 were sent to Krugman's special hepatitis unit. Wards of the state never included in the studies, the children's parents had given written consent. At first, parents were informed by either letter or personal interview. Later, informed consent entailed groups discussions with parents of prospective parents.From the beginning, these studies were on the radar of Henry K. Beecher. With a decidedly murky ethical background himself, nevertheless, by the 1960s he'd emerged a pioneer of informed consent with his publication in 1959 of 'Experimentation in Man'. Beecher first listed the Willowbrook study in 1966 as one of 22 'ethically dubious' experiments. His repeat highlighting of this study in his 1970 book, Research and the Individual, brought the matter to the public's attention. Criticism gained momentum with the theologian Paul Ramsey joining in and with Stephen Goldby publishing a sharply critical letter in the Lancet in April 1971 (11), with the full support of the Lancet editors who publicly apologized for having previously overlooked the issue of informed consent.Such public scrutiny forced the researchers to defend themselves in the public arena. Their defense? Since most of the children recruited in the study would contract hepatitis anyway, they weren't placed in greater danger compared to the other institutionalized children. Optimal isolation, better attention, administered the best available anti-hepatitis therapy then available, the researchers asserted that their attempt to give the selected children sub-clinical hepatitis infections would immunize them against specific hepatitis viruses (12). That's not all. Influential editors of several prestigious medical journals, namely JAMA, NEJM, Journal of Infectious Diseases, agreed with this defense, arguing such research was valuable for understanding hepatitis, had potential value to such institutionalized children, had sufficient consent provisions, didn't expose the children to unnecessary risks and was performed by competent investigators (13).The rebuttal? The studyIncreased the children's later life risk for chronic liver disease.Unlike other Willowbrook residents, study children didn't receive protective doses of gamma globulin (14).Both process and legitimacy of consent obtained for the study were also easy to challenge. Consent forms used suggested the children would receive a vaccine against the virus, some parents were only contacted by letter. A key change happened in late 1964. Willowbrook became so overcrowded that new patient admissions ceased while Krugman's special research unit continued accepting children whose parents 'volunteered' them for the study, suggesting implicit coercion into the study as a means for parents getting their children admitted to Willowbrook (15). Study reviewers and we ourselves could easily conclude that social pressures under which such parents gave their consent, especially post-1964, undermined their ability to act in the best interests of their children.As Faden, Beauchamp and King note in their book (5, page 164), while Krugman's research unit was eventually closed, debate about the ethics of the Willowbrook study never resolved satisfactorily (16) and we see remarkable parallels regarding the ethics of informed consent issues here and in the 2009 PATH-ICMR HPV (Human Papilloma Virus) clinical trial**, ***. In both, the subjects of research were minors and parents/guardians offered informed consent on their behalf, one of the perennial grey areas I referenced earlier.The Road to Today's Informed Consent Becomes ClearerWith such recent examples of egregious medical research abuses as the backdrop, in 1973, Robert Q. Marston, the then-Director of the US NIH made an influential speech (6) that highlighted the central role of informed consent in clinical trials, 'That the committee determine that the rights and welfare of the subjects involved are adequately protected, that the risks of an individual are outweighed by the potential benefits to him or by the importance of the knowledge to be gained, and that informed consent is to be obtained by methods that are adequate and appropriate', and that 'if, in a specific case, I were forced to choose between the individual and the general welfare of society, I would choose to protect the individual'.He emphasized (6) that review committees that oversee human experimentation needed to strictly adhere to three basic criteria, namely,' Protection of the rights and welfare of the subjects.Weighing of risks against benefits.Determination that informed consent is to be obtained by methods that are adequate and appropriate.'In the US, it was in 1981 that the Judicial Council of the American Medical Association (AMA) first took an explicit stance on Informed Consent (5, page 96),'INFORMED CONSENT.The patient's right of self-decision can be effectively exercised only if the patient possesses enough information to enable an intelligent choice. The patient should make his own determination on treatment. Informed consent is a basic social policy for which exceptions are permitted (1) where the patient is unconscious or otherwise incapable of consenting and harm from failure to treat is imminent; or (2) when risk-disclosure poses such a serious psychological threat of detriment to the patient as to be medically contraindicated. Social policy does not accept the paternalistic view that the physician may remain silent because divulgence might prompt the patient to forego needed therapy. Rational, informed patients should not be expected to act uniformly, even under similar circumstances, in agreeing to or refusing treatment'.And this is more or less the landscape we've operated in ever since, with adequate and appropriate methods for obtaining informed consent remaining a perennially grey area, especially as clinical trials globalize and involve research subjects with vastly different cultural, linguistic and educational norms.Bibliography1. Marshall, Geoffrey, et al. "Streptomycin treatment of pulmonary tuberculosis: a Medical Research Council investigation." BMJ 2.4582 (1948): 769-782.2. Salgo v. Leland Stanford Jr. University Board of Trustees, 317 P.2d 170, 181 (1957).3. Natanson v. Kline, 350 P.2d 1093, 186 Kan. 393, 186 Kansas 393 (1960).4. Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972).5. Faden, Ruth R., Tom L. Beauchamp, and Nancy M. King. "A history and theory of informed consent." (1986). Oxford University Press.6. Marston, Robert Q. "Medical science, the clinical trial and society." Hastings Center Report 3.2 (1973): 1-4.7. The New York Post, Allen M. Hornblum, Dec 28, 2013. NYC's forgotten cancer scandal8. MATTER OF HYMAN v. Jewish Hosp., 15 N.Y.2d 317, 206 N.E.2d 338, 258 N.Y.S.2d 397 (1965).9. Katz, Jay, Alexander Morgan Capron, and Eleanor Swift Glass. Experimentation with human beings: The authority of the investigator, subject, professions, and state in the human experimentation process. Russell Sage Foundation, 1972.10. Langer, Elinor. "Human Experimentation: New York Verdict Affirms Patient's Rights." Science 151.3711 (1966): 663-666.11. Goldby, Stephen. "Experiments at the Willowbrook state school." The Lancet 297.7702 (1971): 749.12. Krugman, Saul, Joan P. Giles, and Jack Hammond. "Infectious hepatitis: Evidence for two distinctive clinical, epidemiological, and immunological types of infection." Jama 200.5 (1967): 365-373.13. Is Serum Hepatitis Only A Special Type of Infectious Hepatitis? JAMA. 1967;200(5):406-407. doi:10.1001/jama.1967.03120180094017.14. Annas, George J., Leonard H. Glantz, and Barbara F. Katz. Informed consent to human experimentation: The subject's dilemma. Ballinger Pub. Co., 1977.15. Goldman, Louis. "The Willowbrook Debate." World Med 7 (1971): 23-25.16. Ingelfinger, F. J. "Ethics of experiments on children." New England Journal of Medicine 288.15 (1973): 791-792.More details on the journey to, the process of, and grey areas in informed consent available in these answers:* Tirumalai Kamala's answer to Do you believe placebos are morally permissible? Why or why not?** Tirumalai Kamala's answer to Should we have an international forum to resolve clinical trial mishaps?*** Tirumalai Kamala's answer to Is it true that Bill Gates faced trial in India for illegally testing tribal children with vaccines?Thanks for the A2A, Kritika Gupta.

Pupils at Carlisle Indian Industrial School, Pennsylvania c. 1900 (American Indian boarding schools - Wikipedia)The Dakota expression for child, wakan injan, can be translated as “they too are sacred,[1] ” according to Glenn Drapeau, Ihanktonwan Dakota and a member of the Elk Soldier Society on the Yankton Sioux Reservation in South Dakota. “To us, children are as pure as the holy, moving energy of the universe,” he says, “and we treat them that way.”[2]When it comes to the colonizers' treatment of First Nations Peoples — more commonly referred to as Native Americans, Indian boarding school history represented a new phase of decades of discrimination. Instead of violently forcing Native Americans from their lands or slaughtering them on the battlefield, Indian boarding schools were developed during the mid-19th century as a means to assimilate Indian tribes into the "American way of life."[3] Run by the Bureau of Indian Affairs, boarding schools taught Native American boys and girls English reading, writing, and speaking in an attempt to erase indigenous languages and traditions.[4] History, science, mathematics, and, perhaps most importantly, Christianity, were taught to make young Native Americans think and reason like religious-minded citizens of a democratic society.Col. Richard H. Pratt (American Indian Boarding Schools Haunt Many)Two hundred years ago, on March 3, 1819, the Civilization Fund Act ushered in an era of assimilationist policies, leading to the Indian boarding school era, which lasted from 1860 to 1978.[5] The act directly spurred the creation of the schools by putting forward the notion that Native culture and language were to blame for what was deemed the country’s “ Indian problem”[6]Early in the history of American Indian boarding schools, the U.S. government argued that Indians were savages who should be compelled to send their children to schools by whatever means necessary.[7] Later the government recommended increased Indian control over education at the schools. A report in the late 1880s defended the early days of the schools.According to Col. Richard Pratt's speech in 1892:"A great general has said that the only good Indian is a dead one, and that high sanction of his destruction has been an enormous factor in promoting Indian massacres. In a sense, I agree with the sentiment, but only in this: that all the Indian there is in the race should be dead. Kill the Indian in him, and save the man."[8]Most Native Americans were not treated like free citizens inside or outside of the schools; daily life in a Native American boarding school could be emotionally and physically confusing, stressful, and abusive. Not all experiences were the same, however, and some students later recounted making good friends, meeting future spouses, and using school to find a way to balance Native heritage with Anglo-style education.[9] By the time most of the boarding schools closed during the late 20th century, they'd taken on many new forms, but the ‘civilizing’ mission that governed their creation never changed.Many of the former boarding school residents prefaced their stories by saying “'I've never told anybody my story. I've never told my kids. I've never told my grandkids. I had to think about these stories all my life about what happened to me. I don't want my kids to have to think about it or know about it”.[10]Before admittance into the boarding dormatories, students were striped of their traditional long hair.[11] Officials claimed shorter hair helped alleviate lice problems, but long hair was an immediately recognized symbol of the child's savagery. Long hair has a deep and spiritual meaning in indigenous cultures. To many, it serves as an extension of a person’s mind, reflective of its strength and beauty. [12] The hair length and style also distinguish between different indigenous nations.[13]For their part, Native Americans traditionally cut their long hair as a sign of mourning, and the loss of this symbolic possession when they arrived at the schools had negative psychological connotations.[14] Symbolically, the cutting of a person’s hair by an enemy indicated an act of humiliation and forced submission.http://getboulder.com/5117-2/Young men's heads were shaved in military'style buzz cuts, while girls recieved bobs.[15] One Lakota woman recalled how she reacted when she heard her hair was going to be cut:I remember being dragged out, though I resisted by kicking and scratching wildly. In spite of myself; I was carried downstairs and tied fast in a chair.I cried aloud, shaking my head all the while until I felt the cold blades of the scissors against my neck, and heard them gnaw off one of my thick braids. Then I lost my spirit... Not a soul reasoned quietly with me, as my own mother used to do; for now I was only one of many little animals driven by a herder.[16]This wasn't the only possible humiliation students experienced. According to personal accounts, students were given Western-style baths in tubs of scalding hot water, sometimes three at a time.[17] Not every student was lucky enough to bathe with water, however. Stories circulated of new boarders being given a kerosene baths by the matrons at Stewart Indian School in Nevada.[18]Stewart Indian School in Nevada.Many students experienced extreme homesickness, running away from school. Sometimes their parents forced them to return.[19] When Theodore Fontaine arrived home after running away from the Fort Alexander school near Winnipeg, Manitoba, his mother said he had to go back. He told her he would run away again, but his mother won out in the end and Fontaine went back to Fort Alexander.[20]Sometimes runaways were sent back to school by tribal agencies when they approached their homes on reservations.[21] Using the authorities to force students to go to school was common. US Indian Agent John S. Wtedard highligh the attitude behind compelling students to attend:"The parents of these Indian children are ignorant, and know nothing of the value of education, and there are no elevating circumstances in the home circle to arouse the ambition of the children”.[22]John P. Williamson of the Dakota Agency agreed, claiming, "Compulsion through the police is often necessary, and should this be required during the coming year, it will be heroically resorted to, regardless of results."[23] Numerous agents resorted to the alternative tactic of witholding rations from the families of runaway students.[24]Top: A group of Chiricahua Apache students on their first day at Carlisle Indian School in Carlisle, Pa. Bottom: The same students four months later. (American Indian Boarding Schools Haunt Many)In addition to the physical changes Native students endured upon arrival, they were also forced to choose an Anglo name. They were not allowed to keep their birth names because officials struggled with pronounciation and considered them symbolic of paganism.[25]Sometimes students were given a selection of names listed on a board, but because they could not read English, they simply chose one at random.[26] Other students were given names by school officials, often from the bible.[27] The English and Judeo-Christian origin of many of the names served multiple purposes, as a name change was part of the larger transformation students were expected to undergo.Photo: Unknown/Wikimedia Commons/Public DomainStudents were discouraged from speaking First Nations languages, some more harshly than others. One boarder from Acoma Pueblo recalled trying to speak Acoma as a child but dealing with "the outright threats of corporal punishment, ostracism, and the invocation that it would impede our progress towards Americanization."[28] During rare occasions when students were allowed to speak Native languages, profanity was never tolerated and punished harshly.[29]Many of the American Indian Code Talkers attended boarding schools and many have memories of being punished for speaking their native languages. John Brown, Jr., a Navajo Code talker, remembered:They tell us not to speak in Navajo language. You’re going to school. You’re supposed to only speak English. And it was true. They did practice that and we got punished if you was caught speaking Navajo.[30]They also remembered how the schools were run like military organizations[31] and how this later made it easier for them to adapt to life in the American military.We even had to march to school, march to chow, march everywhere, to church. It was still kind of military basis. So when we were in the service everything just came natural, physically and morally and everything. —Merrill Sandoval, Navajo Code Talker, National Museum of the American Indian interview, 2004[32]However, many students continued to develop subversive ways to speak to one another in Native languages.[33]Intermediate” students inside a classroom at an American Indian boarding school in Beaulieu, Minnesota, c.1900. (A brief history of American Indian boarding schools)Teaching Native Americans to speak, write, and read English was at the core of the white colonizers' educational model. It was believed that once students learned English, described by Commissioner of Indian Affairs T.J. Morgan as "the language of the greatest, most powerful and enterprising nationalities beneath the sun," they would assimilate more quickly and with greater ease.[34]Students were also taught history, some math and science, politics, and the fundamentals of democracy, and Christianity — all from a white, Eurocentric position.[35] In addition to classroom teachings, students received vocational training. Boys were introduced to Western-style farming and animal husbandry practices, while girls were trained in home economics and other domestic tasks.[36] Many children educated at the schools were then serviced out to work for and with white families.[37]Female student at the Sherman Institue are pictured in the Domestic Science class in 1915. (The Sherman Institute of Riverside, California: A History in Photos)As a cost-saving measure, the federal government eventually turned much of the boarding-school system over to churches, primarily the Catholic Church, which used it to help expand its empire throughout the West.[38] Churches, abbeys, convents and monasteries were built on or near reservations, and religious orders were founded and flourished.Christianity permeated every aspect of life and learning at an Indian boarding school. From the names students took or were given to the enforcement of strict moral codes to using the Bible itself as an educational text, students were immersed by Christian teachings.[39] In addition to regular church services, students attended Sunday school classes and were forbidden from practicing their cultural religions.Dining Hall at Carlisle Indian School, 1899 (Seperated by gender, here Native American students sit down to a...)Students at Indian boarding schools were introduced to dining halls complete with knives, spoons, forks, and tablecloths — the likes of which many had not used before.[40] Meals consisted of new foods like corn flakes, chipped beef, and corn beef hash.[41] When students were given a chance to relax or participate in sports, they played football, baseball, and basketball. These games were used to encourage teamwork among the students, but ironically also reinforced traditional Native American ideas of group consciousness. At the Phoenix Indian School, students participated in band, performing in parades and even at public events against whites.[42]Sometimes students would watch movies. On one occasion, students were "treated" to a movie about cowboys and indians at Sherman Indian Institute in Riverside, CA.[43] One Navajo student remembered the experience: "Here we're getting all our people killed, and that's the kind of stuff they showed us."[44]Many Indian boarding schools were decried for abusing their students. In addition to punishments for speaking tribal languages, running away, or failure to follow the strict regulations imposed upon them, students could be subjected to long hours of manual labor, malnourishment, or deprived of medical care.[45] Diseases and illnesses were common, with breakouts of measles, pneumonia, and tuberculosis.[46] Many school administrators believed that the students’ independent spirit had to be broken in order for them to accept a new way of life. Students who did not adhere to school schedules and regulations received strappings (whippings) as well as humiliation in front of peers.One fact that many may not be aware of is the fact that Native Americans had a good education system before being forced to attend boarding schools. They even had one of the first women's colleges.[47] Rather than preparing students for life after schooling was complete, a mixture of willful neglect and abuse negatively impacted many residential school students for the rest of their lives. Some Native leaders tried to convince the government to establish schools on the reservation rather than shipping their children away from them."It will not cost so much to give us schools at home on our own lands, and it will be better for our children and our people, too. You now educate our children in the East, and fit them for your life full of civilization, and then send them back to us, who have no civili-zation. You spend a great deal of money, and make our people very unhappy”.[48]Neah Bay Indian School at Bahada Point on the Straits of Fuca, Washington Territory, ca. 1876–1896 (Indian boarding schools teach manual labor)Some tribes consented to or even promoted on-reservation boarding schools[49] , especially on reservations where the great distances between settlements made day schools impractical. For example, the Pit River Indians in northern California asked the government "to establish an Indian boarding school at or near [the] village (Fall River Mills), it being a common centre to which they could all, within a circuit of fifty miles, send their children. If such a school cannot be had they earnestly desire two district schools about fourteen miles apart."[50]In 1928, the Meriam Report concluded that children at federal boarding schools were malnourished, overworked, harshly punished and poorly educated.[51]“Nearly every boarding school visited furnished disquieting illustrations of failure to understand the underlying principles of human behavior. Punishments of the most harmful sort are bestowed in sheer ignorance, often in a sincere attempt to be of help. Routinization is the one method used for everything; though all that we know indicates its weakness as a method in education. If there were any real knowledge of how human beings are developed through their behavior, we should not have in the Indian boarding schools the mass movements from dormitory to dining room, from dining room to classroom, from classroom back again, all completely controlled by external authority; we should hardly have children from the smallest to the largest of both sexes lined up in military formation; and we would certainly find a better way of handling boys and girls than to lock the door to the fire-escape of the girls' dormitory.[52]Even the education students received was criticized, with a call for employing more qualified and skilled personnel at the schools. The report also found young students were subjected to inappropriate manual labor that violated child labor laws.[53] Former students later came forward with allegations of sexual abuse as well, many at the hands of the Catholic Church.[54]It Happened Here: Indian boarding school established at Fort SimcoeThe schools, which slowly started to reform in the 1930s, were not just an American phenomenon. Australia and Canada operated similar institutions, also intended to indoctrinate and “civilize” their native peoples.[55]More than 40 years after the Meriam Report criticized government boarding schools, a report known as the Kennedy Report declared Indian education a national tragedy.“Apparently, many of the teachers still see their role as that of "civilizing the native." BIA administrators believe that Indians can choose only between total "Indianness" --whatever that is — and complete assimilation into the dominant society. Thus, the goal of BIA education appears to direct students toward migration into a city while at the same time it fails to "prepare students academically, socially, physchologically, or vocationally for urban life. As a result, many return to the reservation disillusioned, to spend the rest of their lives in economic and intellectual stagnation."[56]The negative information and revelations about Indian boarding schools resulted in a Pan-Indian movement during the 1970s and 1980s.[57] Advocacy and community-building among Native American populations during the late 20th century has only begun to help many former students face the painful legacy of the schools themselves.Increasingly, the damage from that early abuse, loneliness and lack of love is being seen as a major factor in ills that plague tribes today, passed from one generation to the next and manifesting in high rates of poverty, substance abuse, domestic violence, depression and suicide.[58] As awareness of the enduring harm grows, tribes and others in Washington and nationwide are reaching out in new and varied ways to elders, their children and their children’s children in hopes of repairing the damage.150,000 aboriginal, Inuit and Métis children were removed from their communities and forced to attend residential schools (https://www.google.com/amp/s/www.cbc.ca/amp/1.702280)In Canada, the federal government recently reached a record $5 billion settlement under which some 80,000 former students are eligible for an average of $28,000 — more if they were sexually or physically abused.[59]The father of Washington state Rep. John McCoy, D-Tulalip, was fluent in the tribe’s language but refused to teach it, saying “they beat it out of me” at boarding school.[60] In 2005, McCoy helped win passage of a bill that encourages Washington school districts to teach native history and culture and to consult tribes in developing that curriculum.[61] Ten years later, the bill was amended changing what was once encouraged to mandatory. As of 2018, McCoy has continued to push for legislation on a federal level, making the legacy and history of the First Peoples mandatory in each and every school.Footnotes[1] When Ancestors Weep[2] South Dakota Boarding School Survivors Detail Sexual Abuse[3] Brutal Realities of Everyday Life on the Trail of Tears[4] Brutal Realities of Everyday Life on the Trail of Tears[5] Mar. 3, 1819 | Congress Allocates Funds to 'Civilize' Native American People[6] Death by Civilization[7] American Indian Boarding Schools Haunt Many[8] American Indian Boarding Schools Haunt Many[9] American Indian Boarding School Experiences: Recent Studies from Native Perspectives[10] 'I've never told anyone': Stories of life in Indian boarding schools[11] Boarding School memories haunt Lakota man [12] The Significance Of Hair In Native American Culture[13] hair length indicative of indian tribes[14] They Called Me Uncivilized[15] http://getboulder.com/5117-2/[16] They Called Me Uncivilized[17] Boarding School Blues[18] American Indian Boarding Schools Haunt Many[19] https://www.google.com/url?sa=t&source=web&rct=j&url=https://minds.wisconsin.edu/bitstream/handle/1793/66821/Peterson.pdf%3Fsequence%3D8%26isAllowed%3Dy&ved=2ahUKEwjI-PvS7eroAhUEDKwKHUjtDaAQFjAJegQIAxAB&usg=AOvVaw2d8uRh0EZxyPO-TIdzyG3C[20] Broken Circle[21] Tribal Nations Demand Answers About the Fate of Indigenous Children Who Disappeared at U.S. Boarding Schools[22] American Indian Boarding Schools Haunt Many[23] A Brother to the Sioux (Winifred W. Barton)[24] Annual Report of the Department of the Interior[25] Assimilation and Indian Names[26] Cultural assimilation of Native Americans - Wikipedia[27] Boarding School Blues[28] https://www.google.com/amp/s/www.history.com/.amp/news/how-boarding-schools-tried-to-kill-the-indian-through-assimilation[29] Pipestone[30] Native Words Native Warriors[31] Boarding School Blues[32] Native Words Native Warriors[33] US Indian Boarding School History - The National Native American Boarding School Healing Coalition[34] American Indians of the Pacific Northwest Collection :::[35] Colonized Schooling Exposed[36] Pipestone[37] Native American History and Culture: Boarding Schools[38] Boarding schools: A black hole of Native American history[39] American Indians of the Pacific Northwest Collection :::[40] Native American History and Culture: Boarding Schools[41] No More “Die Bread”: How Boarding Schools Impacted Native Diet and the Resurgence of Indigenous Food Sovereignty[42] The Phoenix Indian School Band, 1894-1930[43] American Indian Boarding Schools Haunt Many[44] The Sherman Institute of Riverside, California: A History in Photos[45] Punishment and Abuse[46] Native American History and Culture: Boarding Schools[47] Boarding school seasons : American Indian families, 1900-1940[48] Statistics of Indian Tribes, Agencies and Schools[49] The Schools That Tried—But Failed—to Make Native Americans Obsolete[50] The Journal of the Assembly, During the ... Session of the Legislature of the State of California[51] Digital History[52] The Problem of Indian Administration; National Indian Law Library, Native American Rights Fund (NARF)[53] Laws allowing U.S government to force Native American children into boarding schools still in force[54] South Dakota Boarding School Survivors Detail Sexual Abuse[55] https://www.google.com/amp/s/www.cbc.ca/amp/1.702280[56] https://www.google.com/url?sa=t&source=web&rct=j&url=https://files.eric.ed.gov/fulltext/ED034625.pdf&ved=2ahUKEwjDtr704ujoAhXXG80KHbP2Dr8QFjABegQIBRAB&usg=AOvVaw1rwIN1fn96ToRfHho94v_W[57] The Last Indian War: Reassessing the Legacy of American Indian Boarding Schools and the Emergence of Pan-Indian Identity[58] http://Increasingly, the damage from that early abuse, loneliness and lack of love is being seen as a major factor in ills that plague tribes today, passed from one generation to the next and manifesting in high rates of poverty, substance abuse, domestic violence, depression and suicide. And as awareness of the enduring harm grows, tribes and others in Washington and nationwide are reaching out in new and varied ways to elders, their children and their children’s children in hopes of repairing the damage.[59] Why 2,800 children's names were made public[60] Tribes confront painful legacy of Indian boarding schools[61] McCoy's bill to help teachers implement Native American history in classrooms passes off Senate floor - Sen. John McCoy - Washington State Senate Democrats

A2A. (See, I promised that I’d come back and give a thorough answer!)Some housekeeping:First, I have UN-MERGED this question. Someone had merged it with “what do forensic psychiatrists do?” I have reversed the merge because the questions are not the same. We may do similar things, but hardly the same.Second, as I stated in my comment to the OP above, there are actually quite a few questions along this line already answered on Quora, but the answers vary considerably from useless to thorough. And, there are more that are useless than thorough. I would say that Dr. Brams’ answers on this topic are always spot on, and I see that she has also provided an answer here. So I’ll add my two-cents, along side hers.Third, please consider that my answer will be long winded because I am providing my answer based on my unique training as both lawyer and psychologist.On to my answers…So… your client would be whom?I would agree that the biggest difference between neuro/clinical/counseling psychology and forensic psychology is the client. Rather than a doctor/patient relationship, the relationship obligation is USUALLY to the court. But this isn’t always the case either. Sometimes it’s a correctional facility. Sometimes it actually IS the patient themselves. For example, in a small town you may have been treating a patient for 1+ years, and then be called to court. In that case things get tricky, but your obligation remains to your patient; even though you may be a forensic psychologist, your duty in that unique situation is to your patient. However, usually, the court has referred to you, and the court is expecting that you are making psychological conclusions that will benefit it - the court. As you might expect, this invites some consent issues with patients. The issue of consent is a bit different in forensic cases.So… where would you work?You could be (as is most often the case) in private practice. I would certainly argue that private practice is the most lucrative option. In other words, there is money to be made in private practice. However, rare is the newly minted graduate that hangs out a shingle and starts a practice as a forensic psychologist! To get into private practice you’d need either very specific post-gradate training in the field of forensics, or need to have a working relationship with a seasoned forensic psychologist. However, it isn’t impossible. If you were in a small town (as I am) and the judges know that you are available, and if you have adequate supervision to conduct forensic assessments, you might very well be able to build a practice from the ground up. However, most forensic psychologists have years and years - decades even - of building up time in courtrooms, familiarizing themselves with the system and the concepts. I also know at least a handful of psychologist/attorneys… so that’s certainly another fast-track to understanding the overlap. I discuss the unique legal services a Ph.D./J.D. can offer, way down below.You might also work only in a correctional facility and never see a court room, however most of these folks would consider themselves “correctional psychologists.” Additionally, a forensic psychologist may spend most of their time in a state hospital. For example, Terrell State Psychiatric Hospital in Texas has a forensics wing, where adults are housed who are either waiting to stand trial on competency issues, or who have been found NGRI or some variation thereof (not guilty by reason of temporary insanity). I’ll note, however, that this defense is not very often successful.Lastly, you can technically be a forensic psychologist that works primarily in research and public policy - although this is much less common. This person would spent a lot of time researching and publishing on forensic psych science, or, might be a faculty at a university’s psychology department, be a forensic faculty member at a medical school’s forensics residency program, or possibly on the faculty of a law school.The simple answer: usually time split between office/courtroom/airplane/car.So… what would you actually be doing?Unfortunately, the term “forensic psychology” is such a massive umbrella that if you were to see “Ryan R. Cooper, Ph.D. | Forensic Psychologist,” you’d haven’t a clue what the hell I ACTUALLY did. By far, the most common thing a forensic psychologist “does” is psychological evaluation.Mental State. This would be anything from determining whether a defendant understands the court system and his or her role in it (that they’ve been accused, what the judge does, etc.) and this is usually known as competency to stand trial, or “competency evaluations.” Another type of evaluation is a “capacity evaluation” to determine whether the defendant had the capacity to appreciate his crime… this might be referred to as mental capacity, mental culpability, or mens rea - as opposed to actus reus - or, the act of the crime (for most crimes the state must prove the act and the mindset both… the latter is where a psychologist can help). The mental aspect required in a criminal trail, say for homicide or theft is NOT the same as that for a tortuous action, like assault/battery… and a psychologist can help with all of these areas. Negligence is another realm.Custody. Another type of evaluation commonly conducted by forensic psychologists is custody... this might be the MOST common; I’m not sure. These are usually very lengthy and are best described in this way: a hot mess. This is the sh*t that judges are like… “omg… please leave my courtroom and go let someone else hash this mess out, I can’t make heads or tails of anything.” Enter, the awesome forensic psychologist. All states that I’ve looked into have VERY strict laws surrounding the ethics of what must be included in a custody evaluation. For example, psychologist are sanctioned EVERY SINGLE MONTH in Texas for performing inadequate custody evaluations. Usually, it’s because a psychologist (or counselor) didn’t realize they were conducting a custody evaluation. But every time you get the stand and opine as to whether one parent is as fit as another (and sometimes even if you opine as to only one!), then you’re giving testimony related to custody and the ethics of custody evaluation come in. For example, you must evaluate BOTH parents, equally. You should evaluate the children as well. You cannot give an opinion having only seen one parent. Nope. Sounds like common sense, but you’d be surprised. Custody evaluations are very lengthy, require a lot of paperwork, and a lot of mental energy. For this reason, they are very EXPENSIVE. One anonymous psychologists’ “custody evaluation” I once reviewed consisted of a single MMPI-2 given to mom, and to dad, and 30 minutes of an “intake” with each. The cost was $500 to mom, $500 to dad. This is an example of how NOT to perform a custody evaluation. At the forensics firm I’m associated with, our custody evaluations are VERY extensive and consists of often 10–20 tests. I would say it is more common to see a custody evaluation cost 1000–2000 for evaluating mom, the same for dad, and about the same or slightly less per child. So a good thorough evaluation will cost more like $5,000+ for the family.Lie Detection. Though not really always in the tool belt of forensic psychologists, many do offer this service. I’ve considered getting training in this area, but don’t have the time. I am fascinated by it, but the key to being a good forensic psychologist is knowing more than how to read out results… but understanding what the hell they DO and DON’T mean. E.g., just because a lie detector says someone is lying, doesn’t mean they are; it means that their heart rate went up, and they started sweating, etc. Funny: A woman walks into the room wearing a purple dress, and leans against the wall. The Judge says to two psychologists: “what is the color of the woman’s dress?” The clinical psychologist says “purple.” The forensic psychologist says “well, all I can tell you for certain is that the front half is purple, because that’s all I can see.” That story beautifully illustrates the savvy a forensic psychologist needs to understand and explain how testing actually works!Sex Offender Evals. Exactly what it sounds like. Psychologists are often called upon to help predict - to the limited extent possible - the chances of recidivism for sex offenders. We can also help courts understand what is possible and what isn’t… for example, there is no real “cure” for pedophilia, and a psychologist can get on the stand, or meet in chambers to help explain the reality of pedophilia, or sex addiction, and such explanation can help the judge do their job better. One form of testing in this realm that remains in use (not by me fyi lol) is the penile plethysmograph. Often used to determine whether a sex offender can control their arousal, it’s most certainly a way to test the truth of a defendant saying: “I’m cured, I’m now disgusted by rape” or “ I’m cured, I’ll not longer attracted to children.” The test will absolutely verify the truth of such a statement. However a good forensic psychologist will be able to explain these limitations. For example, does getting an erection MEAN that the defendant will act on the arousal? No. Could people NOT so inclined be aroused by suggestive stimuli? Yes. So there are a lot differing opinion in the evaluation of sex offenders, and the forensic psychologist must be very familiar with all perspectives… and check their own biases at the door. Also pencil/paper tests for sexual deviancy are not that great, either, psychometrically.Police Evaluation. This is, again, not done by all forensic psychologists, and sometimes a non-forensic private practice psychologist will do this. This could entail evaluating a new police officer to determine whether they are a good candidate to serve on the force (L3 Eval in Texas). It could also entail re-evaluating a police officer to determine whether they are fit for duty after xyz event, or just after xyz number of years. The American Board of Professional Psychology (ABPP) actually offers a board certification in Police and Public Service Psychology (as well as board certification in, obviously, Forensic Psychology).Neuropsychology. This is a highly specialized area, and I only know of one psychologist that is extremely - I mean EXTREMELY - familiar with both forensics and neuropsych… and I’m lucky to count him among my list of mentors and friends. To offer neuropsych testimony, a psychologist needs to have not only the same understanding of the legal system that a forensic psychologist has, but also a savvy understanding (well beyond grad school) of the human brain and how it affects certain behaviors (and the ability to discuss it in layman’s terms!). While some non-neuropsychologists may be able to hold their own in an advanced discussion of Autism or ADHD, diagnosing a brain disorder is a big deal, and very few psychologist will make such a diagnosis without extensive neuropsych training. A neuropsychologist will be prepared to talk about Broca’s area and how it is indicated in test results… or a severe visuospatial deficit and how it affects daily living… or Theta/Beta Ratio and how it can help explain a dx of ADHD, more so than rating scales, like the Conner’s can (not very diagnostically useful, IMO).Trial Sciences. This area is not reserved to psychologists by any means. The National Association of Trial Consultants, for example, is open to LOTS of types of professionals. However, I’d say over half are probably psychologists. Trial sciences is probably more of what I’d consider the true PSYCHOLOGIZING of LAW… rather than merely offering psychological service, in a legal context. Trial sciences applies psychological principles to the legal system itself, rather than just the defendant or the players in that system. What is this judge like… what result can we predict from her or him based on their rulings, their personal life, their demeanor? What about jury members? Do you want blue collar? White collar? Do you want parents on the jury, or bachelors? … some of this is dramatized in the HBO series Bull. I find the show to be rather boring and unbelievable. However, it has moments of truth. In fact, it’s a dramatization of Dr. Phil’s early days as a trial consultant (which is how he met Oprah, btw). While the show is BS in a lot of ways, it’s underpinnings are spot on. GOOD trial consultants will apply psychological principles to the “players” in the court. I once published an article on applying psychodynamic principles to the process of voir dire.Therapy. I’m throwing this in here, because I’ve personally had attorneys reach out to me, expecting that I can offer some magical therapy to them, since I’m familiar with “their world” in a way that a non-me therapist wouldn’t be. But the reality is this: REAL therapy requires no such familiarity. In fact, such a pre-existing schema might actually hamper therapy. I’m not sure. Would depend on the therapist’s own level of self-awareness I suppose. Now, on the other hand, a “forensic psychologist” may very well offer true individual therapy, or even group therapy, in the state facility to inmates. For example, most of the pre-doc internships in “forensic psychology” at the US Department of Corrections will have interns doing both assessment/evaluation as well as individual and group therapy in the institution.Teaching/Research. This applies to all psychologists, but forensic psychologist (in my personal opinion) are in a uniquely higher demand because they have the same training as the clinical psychology professor (they can teach personality theory, history and systems, psychometrics, etc.) but they also have this rare perspective to add on to their instruction and mentorship (particularly suited to teach courses in legal psychology, professional ethics, comprehensive assessment, etc.).You didn’t ask this, but I’ll answer it for any Quoran’s who may stumble upon this discussion:We’ve explored how psychology can spill over into law……………HOW DOES THE LAW SPILL OVER INTO PSYCHOLOGY?A psychologist who also holds a J.D. and a license to practice law can be VERY helpful to the field of psychology.First, they will make great forensic psychologists, as I’ve discussed above.Second, they MAY also be uniquely qualified to represent patients and practitioners in malpractice claims. If you were suing a psychologist (or you were a psychologist being sued) wouldn’t it make you feel better to know that your attorney was also a psychologist and understood all of the ethical principles, training models, personality theories, therapy interventions that you use in everyday practice? Hell yes!Third, they will be very helpful in dealing with insurance companies (think, whether the contract between Dr. X and Insurance X is ambiguous or clear? Did a renewed contract have adequate consideration?) and licensing boards (if a psychologist is sanctioned or in jeopardy of having their license suspended).Fourth, they will be helpful at advising on small legal matters that other attorneys would be just fine at, but psychologist/attorneys will be more empathic to. For example, should you set up your practice as a LLC? Corporation? And if so, S-Corp or C-Corp? What about your business name? Must it be registered? Should you trademark anything? If you are a research psychologist developing psychometrically sound assessment of malingering on ADHD scales, how and when do you copyright it, and should you get a patent on your process? What if it’s all online? Is that intellectual property? What if you die? Correction… lol… since you WILL die… what happens then? Have you told your patients? (Hint: all my patients know exactly what happens to their charts if I’m struck by lightening today!) If you are subpoenaed by a court to turn over your chart must you? What about your raw testing data (like raw IQ subtest scores)? What about your personal working notes? What about copyrighted test material that Pearson or PAR or MHS, the publishers, have copyrighted? If you do turn it over, can Pearson then sue you? Can you do therapy on Skype? (Hint: NO). If you find a HIPAA-compliant service (Hint: Telehealth 365 is free), can you then see people for therapy in other states using it? These are just SOME questions of a legal nature that will come up in practice.… wouldn’t it be nice if there was a psychologist out there that understood all of this, AND was a lawyer? The good news… there’s a small population of PhD/JD or PsyD/JD folks in the United States… but it’s certainly a small population.Wait… why did you un-merge the question from psychiatry?In brief, I do not believe that forensic psychiatry and forensic psychology are at all alike. The ONLY way a forensic psychiatrist gets training in the MMPI-2, MMPI-A, PAI, PAI-A, PAI-RF, all the wack rating scales that they (and we) use, and the hundred or so other tests that I keep in my office… is if they do a residency that includes psychometric training. Psychologists use a lot of measures because it’s the best we have… but we KNOW the limitations (or should). There’s a great book on this: Correcting Fallacies in Educational and Psychological Testing. A psychiatrist is not usually going to be able to explain anything other than “he had a full scale I.Q. of 97, and that’s average.” If you said, “wait, wait, what does that MEAN?” … they probably won’t know. Because they are physicians… not academic researchers trained in test construction.The way in which a psychologist makes an assessment of a person is extremely complex… we don’t spend ten years in school designing ink blots (ok, I did when I got bored once in History & Systems). And differential diagnosis is the BREAD AND BUTTER of a psychologist. It’s what we do. We live and breath “taking complex cases” and “making sense of them.” … and then “explaining the intricacies of doing so in easy-to-understand terms.” While I’m sure some psychiatrists have been trained to do this, I have never met one. Then again, I’m young and my time in the field is fairly short so far. However, I’ve networked a lot… and have not met a forensic psychiatrist who can explain the processes and psychological workings of the human mind the way a psychologist can.Probably because they study the human brain, primarily… not the psychological, sociological, philosophical, and spiritual essence of mind that better explains that brain.So… (1) I told you my answers were long-winded, but usually very informative and well-thought out. (2) This answer only scratches at the surface.I also didn’t go into the kind of money that you can earn as a forensic psychologist because I have contracts that prevent me from talking about that specifically. But is is an important aspect of deciding whether you want to go into the field of forensics.If you have any other specific questions, please let me know… I really love helping people understand our profession(s).All my best on your journey to determining where your interests lie my friend!Reach out anytime,-R.