The Law Commission

APPENDIX F

ASSESSMENT PROCESS IN CHILD HOMICIDE CASES

PROFESSOR BAILEY'S KEY CONCERNS AND RECOMMENDED APPROACH TO ASSESSMENT^[1]

F.1 The assessment of child defendants in homicide cases can be divided into three areas:

(1) mental health/cognitive/developmental issues;

(2) legal issues; and

(3) welfare issues.

F.2 Each area should be tackled separately and clearly described. However, all areas should be brought together in the end through a 'Needs Assessment' approach (see F.7 below).

F.3 The person conducting the assessment should have the core competencies to assess any young person under 18 years of age.

F.4 Assessment of cognitive functioning should be mandatory and should be conducted by a clinical child and adolescent psychologist.

F.5 A structured approach to assessment should be adopted (see the FACTS assessment templates at F.7 below).

F.6 There should be a behavioural analysis of problems and a full multiaxial diagnosis (see F.7 and F.14 below) so that a clinician can express an evidence-based view as to whether a young person is 'developmentally immature'.

PROFESSOR BAILEY'S SUGGESTED TESTS FOR ASSESSMENT OF CHILD DEFENDANTS

F.7 What follows is a summary of a FACTS assessment template, which provides for a structured assessment approach:

Report / Test

Assesses

Description

Outcomes

Psychology report (WISC-III and WORD)

WISC-III (Wechsler Intelligence Scale for Children – third Edition)	Cognitive functioning	Uses a number of sub-tests to examine the individual's ability to apply reason to both verbal and non-verbal problem solving. The assessment yields intelligence quotients (IQs) as well as highlighting any strengths and weaknesses.	IQ centile: subdivided into verbal IQ and performance IQ. Recommendations in final report.
WORD (Wechsler Objective Reading Dimensions)	Literacy	Uses a number of sub-tests to assess the individual's reading abilities and can be used to compare an individual's ability with actual levels of attainment.	Index scores. Recommendations in final report.
ICD-10 Multiaxial diagnosis	Mental state	Uses six different axes to examine the individual's mental state ranging from tests for clinical psychiatric syndromes to associated abnormal psychosocial situations. Axis six is a global assessment of functioning (see F.14 below).	A 'formulation': a summary of the psychiatrist's assessment.
Needs assessment	Needs	Assesses the individual's needs in relation to 24 different problem areas to determine whether those needs are not a problem, are currently met, are met in part, or are unmet.	Identifies met and unmet needs.
HoNOSCA (Health of the Nation Outcome Scales for Children and Adolescents)	Needs associated with mental disorder	Part of the 'Health of the Nation Outcome Scales' developed by the Department of Health as part of its 'Health of the Nation' strategy. Uses a set of scales to globally assess the needs of children and adolescents associated with mental disorder.	Rates each problem area on a scale of one to four (9 if unknown). Added together for a total score.
SAVRY (Structured Assessment of Violence Risk in Youth)	Risk of violence in youth	Assesses the individual against 30 different risk factors. Factors are subdivided into historical risk factors, social and contextual risk factors, individual risk factors and protective factors.	Scores for each factor and identifies 'critical items'. Risk assessment: risk to self, others and property. Conclusions and recommendations to manage risk safely and meet needs.

F.8 The following tables and lists summarise more fully the key components of each test and report incorporated in the FACTS assessment template.

Preliminary information

F.9 Prior to setting out the various tests and reports, the FACTS assessment template requires some preliminary information concerning the child's personal details, the background to his or her referral for assessment and the sources of information used in the assessment.

Background history

F.10 For the purposes of assessment, the template requires the following information on the child:

1. Family composition and history	7. Care history
2. Family functioning	8. History of substance abuse
3. Developmental history	9. Medical history
4. Childhood history	10. Psychiatric history
5. Education	11. Psychosexual history
6. Social history	12. Forensic History

Psychology report

F.11 The psychology report is prefaced by the following statement ('A' refers to the name of the child):

[A] was seen at the [place] on [date] for an assessment of intellectual ability. The aim of the assessment was to provide information on [A's] level of cognitive functioning and to assess aspects of [A's] presentation which may be suggestive of [something].

F.12 The following table sets out each component of the psychology report together with any relevant information.

Component	Sub-components and further information
Test behaviour
Measures used	[A] was assessed using the Wechsler Intelligence Scale for Children – third edition (WISC-III) which examines the individual's ability to apply reason to both verbal and non-verbal problem-solving. The assessment yields intelligence quotients (IQs) as well as highlighting any specific strengths and weaknesses. [A's] results are detailed in the appendix and discussed here with reference to verbal and performance scores. [A] was also assessed using the Wechsler Objective Reading Dimensions (WORD). This measure assesses someone's reading abilities and can be used to compare an individual's ability with actual levels of attainment.
Summary of findings (one of two): WISC-III	At the time of testing [A] was aged [#]. The results [A] obtained are detailed in the appendix and indicate [FSIQ/PIQ/VIQ etc].

Verbal sub-tests completed by [A]:

1. Information	This sub-test measures general knowledge. It asks questions about the subject's knowledge of common events, information, objects, places and people. Questions include: "What are the four seasons of the year?" and "How many hours are there in a day?" etc. Scores on this sub-test can be influenced by alertness, opportunities, curiosity, hobbies, reading, etc.
2. Similarities	This sub-test requires individuals to recognise relationships between things and ideas. Questions start by asking, for example, "In what way are a piano and a guitar alike?". The questions increase in difficulty and require higher level abstract reasoning. For example, "In what ways are the numbers nine and 25 alike?". The test requires accurate categorisation into logical groups. Scores on this sub-test may be influenced by thinking styles, for example flexibility versus concreteness.
3. Arithmetic	This sub-test involves mental arithmetic without the use of pen or paper. Scores on this sub-test can be influenced by anxiety and the ability to work under time-pressure. Also, concentration and attention can be factors.
4. Vocabulary	This sub-test questions word meanings and assesses abilities to express meanings verbally. Again the tasks gradually increase in difficulty. For example, early questions ask "What is a hat?" and progress to questions such as "What does aberration mean?". Scores on this sub-test can be influenced by alertness, opportunities, curiosity, hobbies, reading, etc.
5. Comprehension	This sub-test requires an understanding of social rules and concepts and looks at problem-solving abilities of everyday difficulties. Scores on this sub-test can be influenced by moral development, cultural factors and thinking styles, for example, flexibility versus concreteness.
6. Digit span	This assesses short-term auditory memory. This test requires the individual to listen to and then repeat back increasingly long strings of numbers. In the first part of the test the individual repeats the numbers forwards, and in the second part of the test he or she repeats them backwards. The backward retrieval taps into auditory working memory. Scores on this sub-test can be influenced by anxiety, concentration and attention. Flexibility is required.

Performance sub-tests completed by [A]:

1. Picture completion	This involves recognising the missing parts of common objects and assesses sensitivity and alertness to detail. Scores on this sub-test can be influenced by alertness, concentration, working under time-pressure and being able to respond when uncertain.
2. Coding	This is a measure of visual motor speed. Individuals are required to copy a range of symbols that correspond to numbers. Scores on this sub-test can be influenced by a range of factors. These include visual perception problems, anxiety, concentration, motivation and persistence. Also, ability to work under time-pressure and obsessive concern with detail can be contributory factors.
3. Picture arrangement	This involves arranging a series of pictures into meaningful orders and requires anticipation of consequences to actions. Scores on this sub-test can be influenced by flexibility, creativity, working under time-pressures and cultural factors.
4. Block design	In this sub-test, blocks are arranged according to patterns. This sub-test measures ability to analyse abstract figures visually and construct them from component parts. Scores on this sub-test can be influenced by visual-spatial problems, flexibility, the ability to work under time-pressure and persistence.
5. Object assembly	In this sub-test, jigsaw-like pieces have to be put together. This test examines spatial abilities, visual motor co-ordination and persistence. Scores on this sub-test can be influenced by exposure to jigsaw puzzles, visual-perceptual problems, flexibility, the ability to work under time-pressure and persistence.
Conclusion	At the time of testing, it would appear that the result [A] obtained suggests [X]. This was evidenced across a range of sub-tests. The age-equivalents for scores range from [# to #] years.
Summary of findings (two of two): WORD	[A's] scores on the WORD assessment, which is a measure of literacy, were as follows: Basic reading: [#]%. The age equivalent is: [#] years old. Spelling: [#]%. The age equivalent is: [#] years old. Reading comprehension: [#]%. The age equivalent is: [#] years old. Are the predicted WORD standard scores significantly different to his or her actual WORD scores?
Recommendations	1. Is there a significant global delay in intellectual functioning? 2. Does he or she require: a. additional educational support? b. More timec. Breaks 3. Does he or she appear to understand a. Information formats b. Brief instructions c. Consequences of actions 4. Social understanding 5. Other services

F.13 The results of the two parts of the psychology report (WISC-III and WORD) are set out in tables annexed to the assessors' report, as follows:

Cognitive functioning: WISC-III

Full scale IQ	[X] centile
Verbal IQ	[X] centile

Sub-test

Raw score	Scaled score	Age equivalent
Information
Similarities
Arithmetic
Vocabulary
Comprehension
Digit span

Performance IQ

[X] centile

Sub-testWISC-III index scores

Raw score	Scaled score	Age equivalent
Picture completion
Coding
Picture arrangement
Block design
Object assembly
Symbol search
Index	Score	Centile
Verbal comprehension
Perceptual organisation
Freedom from distractability
Processing speed

NB: average IQ range: 85 to 115; average sub-test score: eight to 12; full range: one to 19.

Literacy attainments: WORD

Scores	Basic reading	Spelling	Reading comprehension
Age equivalent
Standard score
Centile
Predicted standard score

ICD 10 Multiaxial diagnosis

F.14 What follows is a more detailed specification of the multiaxial diagnosis referred to in F.7 above.

Axis	Diagnosis
1	Clinical psychiatric syndrome
2	Specific disorders or psychological development
3	Intellectual level
4	Medical conditions

5

1. Associated psychosocial situations

1. Abnormal intrafamilial relationships Mental disorder/deviance or handicap in the child's primary support group Inadequate or distorted intrafamilial communication Abnormal qualities of upbringing Abnormal immediate environment Acute life events Societal stressors Chronic interpersonal stress associated with school/work Stressful events/situations resulting from the child's own disorder/disability

6	Global assessment of functioning

Needs assessment

F.15 This test assess [A's] needs in different areas to determine whether those needs are:

(1) not a problem: no evidence that [A] has difficulties in this area;

(2) currently met: [A] is receiving a considerable amount of help to deal with this problem area;

(3) met in part [A] is receiving some help with this problem; or

(4) unmet [A] is currently receiving little or no help for this problem area.

F.16 The following table sets out the relevant problem areas, and provides space for identifying met and unmet needs:

Problem area	Met and unmet needs
Impact of physical illness
Communication problems
Autistic features
Learning difficulties
Educational attendance
Educational performance
Destructive behaviour
Hostile behaviour to persons
Oppositional behaviour
Deliberate self-harm
Psychological distress
Inappropriate sexual behaviour
Family relationships and functioning
Peer/social relationships
Leisure/activities
Self-care
Diet/food
Living situation
Hallucinations, delusions and paranoid beliefs
Depressed mood
Cultural and racial identity
Substances misuse
Weekday occupation
Money/benefits/allowances

HoNOSCA

F.17 Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is part of the Health of the Nation Outcome Scales that originate from the Health of the Nation Strategy (Department of Health 1992). This strategy identified three targets for mental health: two concerned with the reduction of suicide and the other to significantly improve the health and social functioning of people with mental disorder. A set of scales to globally assess needs associated with mental disorder was therefore developed. These are called the HoNOSCA scales. HoNOSCA is now also a criterion of the Minimum Data Health Standard. Therefore, HoNOSCA must be carried out as part of the assessment.

Problem area

Scale (zero to four; nine if unknown)

Evidence

Section A

1. Disruptive, antisocial or aggressive behaviour
2. Over-activity attention and concentration
3. Non-accidental self-injury
4. Alcohol, substance/solvent misuse
5. Scholastic or language skills
6. Physical illness or disability problems
7. Hallucinations and delusions
8. Non-organic somatic symptoms
9. Emotional or related symptoms
10. Peer relationships
11. Self-care and independence
12. Family life and relationships
13. Poor school attendance
Section A: Total score

Section B

Lack of knowledge
Lack of information - services/management
Sections A and B: total score

SAVRY: Structured Assessment of Violent Risk in Youth

F.18 SAVRY is a structured assessment of the risk of violence in youth. It is founded on research evidence relating to violence in adolescence. It is important to remember that most youths who present as violent during adolescence do not persist in this behaviour in later life. The nature and degree of violence risk may frequently change and vary. The values assigned to the risk factors in the assessment are likely to change over time and this risk assessment represents current opinion only.

F.19 The historical risk factors are mainly static in nature (and can only worsen). The social/contextual and individual risk factors are dynamic in nature and indicate potential opportunities for therapeutic interventions to reduce the risk of violence. Protective factors are similarly dynamic and represent strengths that counterbalance the adverse risk factors, and can be built upon to reduce the risk of violence. Critical items are those items that seem particularly relevant to the risk of violence in individual cases, e.g. risk associated with mental illness such as paranoid psychosis, affective disorders, and pervasive developmental disorders.

Item

Score

Critical item

Historical risk factors

History of violence
History of non-violent offending
Early initiation of violence
Past supervision/intervention failures
History of self-harm or suicide attempts
Exposure to violence in the home
Childhood history of maltreatment
Parental/caregiver criminality
Early caregiver disruption
Poor school achievement

Social and contextual risk factors

Peer delinquency
Peer rejection
Stress and poor coping
Poor parental management
Lack of personal and social support
Community disorganisation

Individual risk factors

Negative attitudes
Risk taking/impulsivity
Substance use difficulties
Anger management
Lack of empathy/remorse
Attention deficit
Poor compliance
Low interest/commitment to school

Protective factors

Pro-social involvement
Strong social support
Strong attachments and bonds
Positive attitude towards intervention and authority
Strong commitment to school
Resilient personality traits

F.20 Based on the risk items identified in the above table, the assessor is required to make a 'risk assessment', subdivided into 'risk to self', 'risk to others' and 'risk to property'. The assessor is then required to set out his or her 'conclusions and recommendations to manage risk safely and meet needs'.

CHILD DEFENDANTS: OCCASIONAL PAPER 56, ROYAL COLLEGE OF PSYCHIATRISTS

F.21 In its recent occasional paper (March 2006) on Child Defendants, the Royal College of Psychiatrists' (the 'RCP') made a number of recommendations regarding the assessment of child defendants who are facing serious criminal charges. The RCP said that:

This assessment should include both psychiatric, psychological and social work components, to give an opinion on the child's mental state, fitness to plead and diminished responsibility, to look at the welfare needs of the child and also to inform sentencing in relation to compliance with treatment.^[2]

F.22 Specifically, the RCP recommended that:

5. All child defendants facing serious criminal charges should be seen as 'children in need' in terms of the Children Act 1989 (section 17) and should be subject to an assessment of their needs using the Government's assessment framework.^[3]

…

9. There should be assessment by a clinical psychologist of all child defendants facing serious criminal charges, including murder, manslaughter, abduction, rape, arson or grievous bodily harm.

10. There should be an assessment by a child psychiatrist of all children facing serious criminal charges, including murder, manslaughter, abduction, rape, arson or grievous bodily harm.

11. The Royal College of Psychiatrists and the British Psychological Society should produce a joint statement laying out the principles of such psychiatric and psychological assessments. This statement would provide guidance for assessments of child defendants, would prevent the development of idiosyncratic psychiatric and psychological assessment methods and would provide the courts with consistent expert reports.^[4]

F.23 The RCP paper includes a chapter on 'developmental psychology and child development'. Within this chapter, the RCP discusses fitness to plead and sets out Professor Thomas Grisso's "conceptual framework for competence in juveniles … based on legal and psychological definitions of competence."^[5] Grisso's framework consists of four stages, as set out in the following table:^[6]

Understanding	Ability
1. Understanding charges and potential consequences	Ability to understand and appreciate the charges and their seriousness Ability to understand and appreciate the charges and their seriousness Ability to understand possible sentencing consequences Ability realistically to appraise the likely outcomes
2. Understanding the trial process	Ability to understand, without significant distortion, the roles of participants in the trial process (for example, judge, counsel, prosecutor, witness, jury) Ability to understand the process and potential consequences of pleading and plea bargaining< Ability to grasp the general sequence of pre-trial/trial events
3. Capacity to participate with counsel	Ability to adequately trust or work collaboratively with counsel Ability to disclose to counsel reasonably coherent description of facts pertaining to the charges, as perceived by the defendant Ability to reason about available options by weighing their consequences, without significant distortion Ability to realistically challenge prosecution witnesses and monitor trial events
4. Potential for courtroom participation	Ability to testify coherently, if testimony is needed Ability to control own behaviour during trial proceedings Ability to manage the stress of the trial