Psychology, Crime & Law

ISSN: 1068-316X (Print) 1477-2744 (Online) Journal homepage: https://www.tandfonline.com/loi/gpcl20

Perceptions and use of videoconferencing in

forensic mental health assessments: A survey of
evaluators and legal personnel

Ashley B. Batastini, Madison Pike, Megan A. Thoen, Ashley C. T. Jones, Riley

M. Davis & Esteisy Escalera

To cite this article: Ashley B. Batastini, Madison Pike, Megan A. Thoen, Ashley C. T. Jones, Riley
M. Davis & Esteisy Escalera (2019): Perceptions and use of videoconferencing in forensic mental
health assessments: A survey of evaluators and legal personnel, Psychology, Crime & Law, DOI:
10.1080/1068316X.2019.1708355

To link to this article: https://doi.org/10.1080/1068316X.2019.1708355

Published online: 23 Dec 2019.

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PSYCHOLOGY, CRIME & LAW
https://doi.org/10.1080/1068316X.2019.1708355

Perceptions and use of videoconferencing in forensic mental

health assessments: A survey of evaluators and legal
personnel
Ashley B. Batastinia, Madison Pikea, Megan A. Thoenb, Ashley C. T. Jonesa,
Riley M. Davisa and Esteisy Escalerab
a
School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA; bDepartment of
Environmental Toxicology, Institute for Forensic Science, Texas Tech University, Lubbock, TX, USA

ABSTRACT ARTICLE HISTORY

The use of videoconferencing (VC) to conduct forensic mental Received 21 June 2019
health assessments (FMHA) is increasing. Yet, little is known about Accepted 6 November 2019
its acceptability among clinicians or legal professionals. In Study 1
KEYWORDS
(N = 156), forensic evaluators were asked about their use of VC, Videoconferencing; forensic
reasons for its use, and opinions about the validity, usefulness, mental health assessment;
ethics, and legality of its use. An estimated one-third of evaluators provider perceptions; legal
have used VC in the past. Although evaluators overall expressed perceptions
moderate concern over the ethics and legality of use, prior
experience appeared to mitigate concerns. Younger practitioners
were also more open to using VC. Reduced costs for courts was
the most frequently endorsed benefit associated with VC, while
restricted ability to administer psychological testing and potential
technological problems were seen as the biggest disadvantages.
In Study 2 (N = 27), attorneys and judges were surveyed about
frequency with which they encounter VC for FMHA and their
perceptions about the validity of those assessments. Findings
indicated legal personnel expressed rather negative views without
having much first-hand experience of VC, including concerns
about establishing rapport and technical difficulties. These studies
have implications for whether VC will be adopted more frequently
in FMHA.

Forensic mental health assessments (FMHA) are a specialized type of evaluation com-
pleted by qualified mental health professionals for purposes of providing necessary infor-
mation – typically to courts – to aid in making decisions related to various psycho-legal
issues (Heilbrun, 2001). FMHA may be useful in a number of civil and criminal contexts
including adjudicative competency, criminal responsibility, prediction of general and
sexual violence risk, child custody and parental fitness, and personal injury cases. Accord-
ing to current regulations, psychiatrists, licensed clinical and counseling psychologists,

CONTACT Ashley B. Batastini ashley.batastini@usm 118 College Drive, 5025, Hattiesburg, MS 39406, USA
Communication regarding this manuscript can be directed to Ashley B. Batastini, Ph.D., 118 College Drive, Hattiesburg,
Mississippi 39406, Ashley.batastini@usm.edu, 601-266-6479. Madison Pike graduated from USM in 2019 and is currently
a medical student at in the College of Osteopathic Medicine at William Carey University. Esteisy Escalera graduated from
TTU in 2019 and is now affiliated with Atlantis Health Services in El Paso. We thank Michael E. Lester and Alexandra Repke
for providing oversight on portions of this manuscript.
© 2019 Informa UK Limited, trading as Taylor & Francis Group
2 A. B. BATASTINI ET AL.

and, in some cases (e.g. child custody) social workers, qualify as forensic mental health care
professionals competent to perform FMHAs depending on the education and experience
required to address a particular question (Heilbrun, 2001).

Meeting increasing demands

FMHA require specialized training and skills. In most cases, a doctoral degree with super-
vised pre- and/or post-doctoral experiences in forensic settings is required. As with special-
ists in other professions, the unique set of skills needed to perform FMHA may limit the
availability of qualified providers in a given location. The scarcity of providers is especially
problematic in rural areas where access to specialty providers in general can also be hin-
dered by geography (Schopp, Johnstone, & Merrell, 2000). However, the need for FMHA in
these areas is quite large (Ryba, Cooper, & Zapf, 2003; Thomas, Ellis, Konrad, Holzer, & Mor-
rissey, 2009). In fact, the demand for FMHA is disproportionate to the number of providers
able and/or willing to conduct them (Antonacci, Bloch, Saeed, Yildirim, & Talley, 2008;
Deslich, Thistlethwaite, & Coustasse, 2013). For example, approximately 60,000 compe-
tency evaluations are requested annually along with other types of evaluations performed
by trained professional evaluators, but over three quarters of the United States (mostly
rural) has a severe shortage of mental health professionals capable of performing these
evaluations (Ryba et al., 2003; Thomas et al., 2009).
There are many potential consequences for the shortage of FMHA evaluators. If few
local providers are available, they may be overburdened with referrals, thereby creating
longer wait-times and delaying court proceedings. Long wait times for FMHA due to inac-
cessibility or unavailability of qualified evaluators may violate statutorily defined time-
frames for the completion of such evaluations and can also cause concern over the civil
liberties (e.g. right to a speedy trial) of the defendants waiting to be evaluated.
In Mississippi, for example, long wait times for FMHA and subsequent treatment have
received national media attention. As recently as March 2018, U.S. News reported on
several cases in which requests for FMHA were made by the defendants’ attorneys
nearly a year before the evaluation took place (Downard, 2018). The lack of providers in
rural areas also often means transporting defendants to forensic mental health care pro-
fessionals (or vice versa), which involves increased travel costs (for taxpayers or the defen-
dant) as well as increased risk associated with transporting potentially dangerous
defendants. Seeking FMHAs from professionals farther away also reduces the efficiency
of scheduling attorney-present evaluations; with VC, attorneys can join in from their
offices or other private location (Luxton & Lexcen, 2018; Luxton, Lexcen, & McIntyre,
2019). Having an attorney present during the interview is a right often afforded to defen-
dants, but waiting for one to travel in-person adds time and billed hours. Problems secur-
ing and paying for FMHA evaluators may give jurisdictions, especially those with fewer
resources and lower budgets, more incentive to simply drop charges.

Remote mechanisms as a solution: pros and push-backs

Given presenting demands and barriers to FMHA, the field should entertain alternative
and cost-effective options for increasing access to FMHA experts. One such option involves
expanding the delivery format of certain components of FMHAs beyond traditional in-
 PSYCHOLOGY, CRIME & LAW 3

person settings to include remote virtual technologies (Harley, 2006). The emerging field
of telemental health (often referred to as telepsychiatry or telepsychology depending on
the type of services provided) has been defined as, ‘using telecommunication modalities,
including teleconferencing software, hardware, and supporting infrastructure, to provide
mental health care’ (Deslich et al., 2013, p. 80). Prior research supports the assumption that
remote services can improve access to assessments and demonstrate cost efficiency
(Deslich et al., 2013). A 2007 study by O’Reilly et al., for example, found that the use of tele-
psychiatry drastically improved cost efficiency by alleviating extraneous costs like accom-
modation and travel expenses thus decreasing the average cost per visit by $50 a visit
(O’Reilly et al., 2007).
Because a number of rural areas have been federally designated as having a shortage of
mental health professionals (Gustafson, Preston, & Hudson, 2009), telemental health has
grown increasingly in recent years to address this need (Richardson, Frueh, Grubaugh,
Egede, & Elhai, 2009) and some statistics estimate 6% of all telehealth programs are
focused on mental health specifically (Aboujaoude, Salame, & Naim, 2015). In fact, it
was previously projected the integration of technology into mental health sectors
would be the largest expanding initiative by 2022 (Norcross, Pfund, & Prochaska, 2013).
Using telemental health services is especially useful as it offers greater accessibility to pro-
fessionals for rural consumers who, without this technology, would either not receive ser-
vices, spend time on waitlists for the few providers available in their area, or face increased
costs and lost wages for travel to distant offices or clinics. With FMHA, the benefits are
similar; the availability of remote options for FMHA may increase the likelihood that indi-
viduals will move more quickly through the judicial system without violations to their
rights or creating potential threats to public safety.
Often telemental health involves videoconferencing (VC; i.e. real-time, audiovisual tech-
nology) to connect the evaluee with a professional who is able to provide that specific
service even from miles away (Batastini, McDonald, & Morgan, 2013). While not extensive,
there have been a number of studies examining the use of VC in forensic contexts. A 2006
study concluded that provider ratings of psychological functioning assessed via VC were
reliably similar to ratings following in-person assessments (Lexcen, Hawk, Herrick, & Blank,
2006). Furthermore, research by Manguno-Mire et al. (2007) demonstrated high consist-
ency between competency decisions made via VC and in-person using the Georgia
Court Competency Test. In their 2016 meta-analysis, Batastini and colleagues found
small effect sizes suggesting that telepsychology outcomes including mental health symp-
toms, therapeutic processes, program engagement, program performance, and service
satisfaction were largely comparable to in-person for criminal justice and substance
abusing clients.
Despite potential benefits of telecommunications such as VC to FMHA, there remains
the question of whether and to what extent providers will embrace this technology in
their work. Given the increasing attention on remote technology in FMHA (e.g. Luxton
& Lexcen, 2018), there are likely a number of professionals who are already incorporating
VC, yet the extent to which it is being used and for what purposes is not known. In the
practice of telepsychology more generally, previous studies have observed different
factors that affect the probability of using VC to perform mental health assessments.
For example, length of time in the field and the amount of training using this type of tech-
nology have been found to significantly increase the probability that a professional will
4 A. B. BATASTINI ET AL.

use VC (Simms, Gibson, & O’Donnell, 2011). Another study conducted by Jameson and col-
leagues in 2011 sought to examine mental health care providers’ opinions on use of VC
through in-depth group interviews and surveys. This study found provider attitudes
toward VC was generally positive; however, they reported a lack of space, resources,
and training for VC use. How often and for what purposes VC was used in their practice
varied widely across providers, with pharmacological treatment being the most
common use. The authors proposed that more information on the technology could
help alleviate these worries (Jameson, Farmer, Head, Fortney, & Teal, 2011).
Hesitation from providers, including forensic evaluators, may be related to concerns
about the inability to properly observe important client behaviors that provide information
on interpersonal communication skills or how certain clients, such as older adults who may
be less familiar with technology or those who are experiencing persecutory delusions, will
respond (Batastini, King, Morgan, & McDaniel, 2016; Magaletta, Fagan, & Peyrot, 2000). In a
pilot study conducted by Magaletta and colleagues in 1998 within the Federal Bureau of
Prisons, psychiatrists and psychologists were questioned about their experience using VC.
Most respondents initially expressed some hesitation in using VC but agreed that their
fears were reduced over the course of its implementation. One provider, for example,
anticipated struggling to establish rapport with the inmate, but later admitted this
concern was unfounded (Magaletta, Fagan, & Ax, 1998). Despite resistance from providers,
several studies suggest that VC is generally well-received by forensic and correctional
clients (Brodey, Claypoole, Motto, Arias, & Goss, 2000; Magaletta et al., 1998).
Although VC is useful, previous research highlights the fact there are potential pro-
blems that need to be considered. A 2001 survey of psychologists’ satisfaction after in-
person therapy sessions versus VC therapy highlighted the most notable barrier was tech-
nical difficulties that sometimes led to delays in sessions; however, they noted these issues
were not extremely significant and were eventually resolved (Simpson, 2001). Some
researchers also have identified possible ethical and/or legal problems with telemental
health. For example, licensure and insurance coverage could become complicated if the
mental health care professional’s practice is in another state from where the client is
located, and mental health professionals working within a forensic or correctional
context should be aware of the specific protocols at the site where they are providing ser-
vices (Shore et al., 2018). Despite these issues, the benefits of VC appear to outweigh the
potential disadvantages, if appropriate steps are taken to ensure provider competency in
the use of designed technologies and adherence to proper data security and storage.

Remote FMHA in a legal context

Because FMHA inherently takes place in the legal arena, the perspectives of legal pro-
fessionals – namely, those who request FMHA and those who may be privy to the
results of FMHA within a Court of Law – must also be considered alongside those of for-
ensic experts. No data exist on the perceptions of conducting forensic assessments via VC
from a legal standpoint. Specifically, research is needed on the opinions of attorneys’ and
judges’ regarding the advantages and disadvantages of VC, and potential legal challenges
if VC is use for this purpose. Before widespread implementation of FMHA via VC, forensic
evaluators need to be aware of potential challenges and legal issues that may arise during
their expert testimony, as this may influence their decision to conduct evaluations in this
 PSYCHOLOGY, CRIME & LAW 5

manner (either at all or in certain types of cases) and how they prepare for testimony. In
addition, too many open opportunities for attorneys to discredit VC could determine
whether courts offer VC as an option for conducting court-ordered evaluations. For
example, it is possible that a judge could rule an expert’s testimony subsequent to a
VC-derived evaluation as inadmissible for failing to meet the required standard of being
the ‘product of reliable principles and methods’ (Federal Rules of Evidence, 2017, Rule
702). Such a ruling may be even more likely if the evaluator experienced technical difficul-
ties during the interview or attempted to administer testing that could not be adequately
adapted remotely. In an inadmissibility ruling, the retaining attorney’s legal strategy and/
or the credibility of the evaluation could collapse.
Additionally, all evidence related to FMHA via VC must meet the Daubert Standard of
scientific validity – specifically,
(1) whether the theory or technique in question can be and has been tested; (2) whether it has
been subjected to peer review and publication; (3) its known or potential error rate; (4) the
existence and maintenance of standards controlling its operation; and (5) whether it has
attracted widespread acceptance within a relevant scientific community. (Daubert v. Merrell
Dow Pharmaceuticals Inc., 1993)

While the use of VC in FMHA could arguably meet these standards, some courts may dis-
agree. Until FMHA via VC can be viewed as meeting the requirements of the Federal Rules
of Evidence and the Daubert standard, it is possible that reports and any related testimony
could be deemed inadmissible. Because of the influence of these standards on the practice
of forensic mental health, the perceptions of legal professionals and forensic experts are
equally important for making informed decisions about the use of remote assessment
approaches.

The present studies

To date, no studies have specifically surveyed forensic clinicians on their current use of VC
and perceptions of specific benefits and consequences. Likewise, the perceptions and
experiences of legal personnel, such as judges and attorneys, have received virtually no
attention in the literature. Yet, the opinions of these professionals significantly impact
whether and the extent to which VC will be used and adopted for FMHA purposes. This
paper presents findings from two separate surveys provided to respondents from these
professional communities. The information gathered was designed to provide a clearer
understanding about where mental health evaluators and the attorneys who retain or
cross-examine them stand on the use of VC in conducting FMHA.
Study 1 sought to identify a definitive trend in forensic professionals’ current use and
perceptions of using VC to address psycho-legal issues. Using an anonymous online sur-
veying tool (i.e. Qualtrics), FMHA evaluators were asked about their use of VC technology
to address various referral questions, reasons for its use, and opinions about the accuracy
of VC, its potential usefulness, and any ethical or legal concerns with its use. In addition to
gathering descriptive data on use and perceptions, Study 1 also allowed for comparisons
between FMHA evaluators who reported previous experience using VC and those without.
It was hypothesized that experience with VC would be associated with more positive per-
ceptions regarding its validity, ethicality, and legality. Given that younger individuals tend
to report greater comfort with technology (Barbovschi, Macháčková, & Ólafsson, 2015), it
6 A. B. BATASTINI ET AL.

was also expected that age would predict evaluators’ willingness to use VC for FMHAs.
Results of qualitative analyses were expected to reveal a mix of opinions regarding VC
for this purpose; however, it was generally anticipated that evaluators would feel more
positively about the ability of VC to mitigate court-related logistical barriers (e.g. wait
times), but express more concern related to actual assessment procedures. Knowing for-
ensic evaluators’ thoughts about telemental health will inform strategies to address poss-
ible problems with the technology or common areas of concern within the profession, as
well as highlight areas of service within forensic practice where this modality of assess-
ment is particularly useful. Provider perspectives may also help normalize the use of VC
and understanding how existing hesitancies toward VC can be overcome.
Using a similar design, Study 2 surveyed attorney and judges’ opinions on the advan-
tages and disadvantages, and potential legal challenges of the use of VC for conducting
FMHA. Similar to Study 1, we expected mixed responses, with legal personnel being gen-
erally less concerned about the use of VC to overcome systemic barriers and more con-
cerned over its viability in court. The purpose of Study 2 was to provide more
information, even if preliminary, for both forensic examiners and the legal community
regarding the potential advantages, disadvantages, and challenges to the use of telecom-
munication for forensic evaluations.

Study 1
Method
Participants
Participants were recruited from December 2017 to March 2018 through relevant pro-
fessional listservs and email list (e.g. Psych-Law List, membership list of the American Psy-
chology-Law Society), search-engine generated email lists of forensic psychologists and
psychiatrists, and personal contacts of the first and third authors. While the exact
number of professionals who were initially contacted for participation is unknown (i.e.
some listserv membership statistics were unavailable and the extent of overlap across
lists or number of inactive emails within lists cannot be feasibly determined), it is estimated
that the recruitment email was sent to at least several hundred forensic practitioners. The
AP-LS membership list alone, for example, includes over 1000 emails. Participants were eli-
gible if they practiced in the area of forensic mental health either as a psychologist (e.g.
counseling psychologist, clinical psychologist), psychiatrist, or doctoral-level trainee.
Because this study was focused on both use and perceptions of use, previous experience
using VC was not a requirement for participation.
After removing six participants due to missing data, the final sample for this survey
included 156 forensic mental health practitioners (including trainees) ranging from 23
to 75 years old (M = 49; SD = 14.42). Most participants identified as female (55.7%) and
Caucasian (94.3%). This sample primarily consisted of clinical psychologists (61.4%), but
other specialties such as counseling psychology (13.6%) and psychiatry (0.7%) were rep-
resented. A majority of the participants stated their highest degree obtained was a
Ph.D. (64.5%; 24.3% held a Psy.D.) and practiced within the United States (96.2%). Partici-
pants were also asked to state whether or not they were currently under the supervision of
a licensed psychologist. Out of the 20 respondents who responded to this item, 9
 PSYCHOLOGY, CRIME & LAW 7

participants (45%) identified as supervised trainees. Past use of VC to perform assessments

was not a requirement to participate in the survey; however, approximately one third of
the sample used VC previously in the context of FMHA. See Table 1 for frequencies and
percentages of participant demographics.

Materials
This survey was created using Qualtrics, an online surveying platform. The questionnaire
included both open and closed ended questions. For the purpose of this study, VC was
defined as the use of real-time audio/visual equipment to communicate with another
person or party over a distance. Participants were provided several examples of VC ser-
vices, including FaceTime, Skype, Microsoft Lync, Cisco WebEx, GoToMeeting, and
Polycom.
Participants were first asked: ‘Have you ever used telecommunications or videoconfer-
encing of any kind in the context of completing a forensic mental health evaluation?’ If a
participant responded yes, they were asked a series of questions about how often they use
VC to perform certain types of forensic assessments (e.g. risk assessments, adjudicative
competency evaluations, or child custody assessments). To assess the context in which
respondents typically used VC, participants were given a Likert-type scale ranging from
‘Never’ to ‘Always or Almost Always’ and asked to rate how often they used VC to
perform various types of forensic assessments. They also were given the option to
denote they did not perform this type of evaluation in their practice, so their answer
could be distinguished from someone who performed those assessments but does not
use VC to do so. Participants who endorsed using VC for a particular type of assessment

Table 1. Participant demographics for study 1 and study 2.

Study 1 (N = 156) Study 2 (N = 27)
Frequency (%) Frequency (%)
Ever Used/Encountered VC
Yes 54 (34.8%) 1 (3.7%)
No 101 (65.2%) 26 (96.3%)
Gender
Man 61 (43.6%) 11 (40.7%)
Woman 78 (55.7%) 15 (55.6%)
Prefer not to say 1 (0.7%) 1 (3.7%)
Race
Caucasian 132 (94.3%) 22 (84.6%)
African American 1 (0.7%) 0 (0.0%)
Asian American 0 (0.0%) 1 (3.8%)
Other 7 (5.1%) 3 (11.5%)
Practicing Country
United States 130 (96%) 27 (100.0%)
Canada 4 (3%) –
United Kingdom 1 (4%) –
Pre-doctoral training
Yes 91 (65.0%) –
No 49 (35.0%) –
Post-doctoral training
Yes 75 (53.6%) –
No 65 (46.4%) –
Legal profession
Attorney – 21 (84.0%)
Judge – 2 (8.0%)
Other (e.g. law professor) – 2 (8.0%)
Note: Due to missingness, some variables have totals that are less than the total sample size reported.
8 A. B. BATASTINI ET AL.

(s) were asked why they specifically chose to use VC in that context, how helpful they
thought this technology was, and if there were there any problems that occurred when
using this technology.
All participants, regardless of experience with VC, answered questions to rate their
perceptions about the ethicality, legality, usefulness, and validity of VC for FMHA, as
well as their willingness to use VC in future evaluations, on a 0–100 sliding scale. For
ethical and legal issues, lower scores indicated less concern (0 = not at all concerned;
100 = highly concerned); for usefulness, validity, and willingness, higher scores indicated
more positive perceptions (e.g. 0 = not at all valid, 100 = highly valid). Participants were
also asked to identify possible benefits and consequences of its use in FMHA using a
‘select all that apply’ response option. The lists of available options provided to partici-
pants (see Tables 3 and 4) across both studies were developed by the first and third
authors based largely on common advantages and disadvantages cited in the literature,
as well as anecdotal experience (e.g. informal discussions with other professionals). At
the end of the survey, participants were asked a series of de-identified demographic
questions such as their race/ethnicity, gender, age, and educational background, and
professional experience to assess whether certain demographic factors affect the use
or perceptions of VC.

Procedures
Approval was received from the review board for human subjects research at the Univer-
sity of Southern Mississippi. Those interested in participating were directed to the Qualtrics
questionnaire from the email recruitment announcement. Prior to completing the survey,
participants were informed about the study’s purpose, the voluntary nature of this
research, their right to withdraw from the survey, and available compensation. Those
who elected to continue with the study following informed consent were then directed
to the full questionnaire which took approximately 15 min to complete. Following study
completion, participants were given the option to enter a random drawing for the
chance to win one of six gift cards valued at either $25 or $50. Respondents who
wished to enter the drawing were redirected to another survey form in Qualtrics where
they could enter their contact information. This contact form was kept separate from
the questionnaires used for the actual research to protect anonymity.

Table 3. What do you think are, or could be, the main benefits (if any) of using videoconferencing in
forensic assessment (select all that apply)?
Possible benefits of videoconferencing Study 1 (N = 156) Study 2 (N = 27)
Frequency (%) Frequency (%)
Reduced costs for court or state 104 (66.7%) 20 (74.1%)
Reduced wait times for defendants 90 (57.7%) 25 (92.6%)
Reduced costs for defendant/evaluee 90 (57.7%) 23 (85.2%)
Improved safety for the evaluator 80 (51.3%) 16 (59.3%)
Reduced costs for the evaluator 61 (39.1%) 22 (81.5%)
Increased evaluator productivity 57 (36.5%) 12 (44.4%)
Quicker report times; easier to meet statutory deadlines 51 (32.8%) 17 (63.0%)
Other 30 (19.2%) —
Improved safety for the community 18 (11.5%) 6 (22.2%)
There are no benefits 5 (3.2%) 0 (0.0%)
Note: Study 1 is listed in order from most to least endorsed (reduced wait times and defendant costs were identical); Study
2 is listed in the same order as Study 1 for comparative purposes.
 PSYCHOLOGY, CRIME & LAW 9

Table 4. What do you think are, or could be, the main consequences (if any) of using videoconferencing
in forensic assessment (select all that apply)?
Possible consequences of videoconferencing Study 1 (N = 156) Study 2 (N = 27)
Frequency (%) Frequency (%)
Inability to properly administer some measures 133 (85.3%) 15 (55.6%)
Risk of technical difficulties 127 (81.4%) 26 (96.3%)
Loss of important behavioral data 124 (79.5%) 17 (63.0%)
Difficulty establishing rapport 120 (76.9%) 24 (88.9%)
Risk of confidentiality breach 110 (70.5%) 17 (63.0%)
Other 21 (13.5%) —
Evaluator burnout 8 (5.1%) 2 (7.4%)
Higher costs for the court 8 (5.1%) 1 (3.7%)
Higher costs for the evaluator 8 (5.1%) 0 (0.0%)
Higher costs for defendant/evaluee 3 (1.9%) 0 (0.0%)
There are no consequences 0 (0.0%) 0 (0.0%)
Note: Study 1 is listed in order from most to least endorsed; Study 2 is listed in the same order as Study 1 for comparative
purposes.

Data analysis plan

Prior to analyses, missing cases (n = 6) were removed. All other missing data was excluded
list-wise. Therefore, analyses had sample sizes smaller than 156. Sample sizes less than 156
are specified with the results of each analysis. The data was determined to be missing at
random, as no patterns emerged in the Missing Values Analysis. However, one item (i.e.
willingness to use VC in the future) had more missing data than any other item with
35.4% missing data. Descriptive analyses were conducted on all variables of interest to
ensure assumptions necessary for inferential testing were met. To examine patterns in
usage and to test specific hypotheses regarding perceptions of use by experience, a multi-
variate analysis of variance (MANOVA) was conducted using VC experience (i.e. prior use
vs. no prior use) as the independent variable and legality, ethicality, usefulness, and val-
idity as dependent variables. To test the hypothesis that younger clinicians would reported
a greater willingness to use VC, a linear regression was conducted using age as the predic-
tor variable and willingness ratings as the predicted variable. Lastly, qualitative analyses
were conducted to examine themes in participants’ subjective responses regarding advan-
tages and disadvantages of VC use in FMHA. All quantitative analyses were performed
using SPSS; alpha values of <.05 were used to determine statistical significance. All quali-
tative analyses were performed using NVivo.

Results
Quantitative results
First, frequencies and percentages were used to determine the proportion of participants
who reported using VC for FMHA purposes and to summarize the most frequently
endorsed benefits and negative consequences providers anticipated regarding VC use.
To test the hypothesis that examiners who previously used VC to conduct FMHAs
would have fewer concerns related to its legality, ethics, usefulness, and validity than
those who had not used VC, a one-way MANOVA was conducted. For this analysis, prior
VC use (yes or no) was used as the independent variable with legality, ethics, usefulness,
and validity as the combined dependent variables. A linear regression was used to test the
hypothesis that younger examiners would be more willing to use VC than older examiners.
10 A. B. BATASTINI ET AL.

For this analysis, practitioner age (measured continuously) served as the predictor variable
and willingness to use VC in the future was the predicted outcome.

Characteristics of videoconferencing use. Out of the 155 participants who responded to

this question, 54 participants (34.8%) used VC in the past to perform forensic evaluations.
Respondents reported using VC to address a variety of psycho-legal questions. Table 2
includes a breakdown of use by percentage and number of respondents who endorsed
using VC for each type of psycho-legal issue. The largest percentage of participants
reported using VC to conduct violence risk evaluations (27% reported previous use for
this purpose) and adjudicative competency evaluations (25.9% reported previous use),
while VC was used least often for addressing personal injury evaluations with only 3.7%
reporting previous use.

Perceptions of videoconferencing use. The most commonly selected benefit of VC was

reduced costs for courts (66.7%), followed by reduced cost for the defendant/evaluee
and reduced wait times for the defendant/evaluee (both endorsed by 57.7% of the
sample). Conversely, an overwhelming majority of respondents were concerned about
the ability to properly administer some measures (85.3%) and risk of technical difficulties
(81.4%). See Tables 3 and 4 for an ordered complete list of endorsed benefits and
consequences.
For the one-way MANOVA comparing respondents with past VC use to those without, a
check of assumptions revealed a non-significant Box’s M = (p = .760); however, the
Levene’s test of equality of variances was significant for the ratings of ethical concern
(p = .013). Therefore, Pillai’s trace is reported for the multivariate analysis. The result of
the multivariate test was significant (N = 139, F(4,132) = 3.48, Pillai’s trace = .10. p = .01,
partial η2 = .10). Univariate tests showed that perceived usefulness (M = 57.79; F(1,135) =
2.52, p = .115, Hedge’s g = .291), and ethical (M = 63.05; F(1, 135) = 3.317, p = .071, g =
−0.33) and legal (M = 63.30; F(1, 135) = 2.68, p = .104, g = −0.30) concerns of VC were
not statistically significant, with participants overall reporting at least moderate ethical
and legal concerns about the use of VC in forensic evaluations. The only statistically signifi-
cant group difference between previous users of VC and non-users was regarding the
perceived validity of the conclusions drawn from these evaluations (F(1, 135) = 12.451,

Table 2. Percentage of FMHA professionals (study 1) who endorsed using videoconferencing by

evaluation type.
Type of evaluation N/A Never Not often; seldom Sometimes Most of the time Almost always
Mental state 35.4% 56.3% 6.3% 2.1% 0% 0%
(n = 17) (n = 27) (n = 3) (n = 1)
Adjudicative comp 26.5% 44.9% 22.4% 4.1% 2.0% 0%
(n = 13) (n = 22) (n = 11) (n = 2) (n = 1)
Violence 23.4% 44.7% 21.3% 6.4% 2.1% 2.1%
(n = 11) (n = 21) (n = 10) (n = 3) (n = 1) (n = 1)
Child custody 66.0% 25.5% 6.4% 0% 2.1% 0%
(n = 31) (n = 12) (n = 3) (n = 1)
Disability 65.2% 28.3% 4.3% 0% 2.2% 0%
(n = 30) (n = 13) (n = 2) (n = 1)
Personal injury 68.1% 27.7% 0% 2.1% 2.1% 0%
(n = 32) (n = 13) (n = 1) (n = 1)
Note: Participants were instructed to mark N/A if this type of evaluation was not conducted in their practice.
 PSYCHOLOGY, CRIME & LAW 11

p = .001, g = 0.64). This suggests that individuals who had experience conducting FMHAs
via VC believed expert opinions were more valid than individuals with no VC experience.
Given these mixed univariate results, the hypothesis that VC use would be associated with
more positive perceptions about such practices was partially supported.

The effect of age on videoconferencing use. A linear regression was performed to

observe the effect of age on the likelihood of using VC for FMHA. There was not
an improvement in model fit between the null model and the prediction model (N = 89;
ß = .27, F(1, 87) = 6.64, p = .01). Practitioner age accounted for 7.1% of the variance in par-
ticipants’ willingness to use VC as part of their forensic evaluations, in that more senior
practitioners were less willing to use VC compared to younger practitioners. Thus, the
hypothesis that age would predict willingness was supported.

Qualitative results
To aggregate general themes of concern regarding VC use to conduct FMHA, a word fre-
quency analysis was first conducted using NVivo software. Of the 156 participants included
in the above analyses, 124 provided qualitative descriptions of their concerns. The word
frequency analysis revealed four overarching themes in responses, including barriers to
accurate observations during FMHA (n = 25; 20%), administering standardized psychologi-
cal testing (n = 25; 20%), building rapport (n = 21; 16.9%), and maintaining confidentiality
(n = 16; 12.9%). In addition to a word frequency analysis, participant responses and
response-fragments were organized into more detailed, telling categories to provide a
richer understanding of these concerns. Most concerns reported by participants fit into
nine major categories: restricted assessment (n = 76; 61.3%), security and privacy (n =
60; 48.4%), technology concerns (n = 26; 21%), rapport (n = 22; 17.7%), insufficient
data (n = 21; 16.9%), control over the environment or evaluation (n = 16; 12.9%), tradition
(n = 13; 10.5%), ethical concerns (n = 10; 8.1%), and admissibility in court (n = 8; 6.5%).

Restricted assessment. A large number of participants (n = 76; 61.3%) felt their assessment
of the client would be limited. Subcategories of restricted assessment emerged, such that
56 participants cited either the restricted use of psychological assessments (n = 28; 22.6%)
and/or restricted behavioral or nonverbal observations (n = 28; 22.6%) as specifically pro-
blematic. Participants also reported potential difficulties observing less obvious symptoms,
drawing a complete picture of the individual, completing thorough mental or physical
status exams, and the risk of misinterpretation or misunderstanding. Frequently used
examples of data lost included visual (e.g. because the entire person is not in camera
view), interpersonal (e.g. cannot see the person interact with correctional or hospital
staff), and olfactory information (e.g. unable to assess the person’s hygiene using smell;
‘loss of sensory data, including – literally – how the person smells’).

Security and privacy. Sixty participants (48.4%) reported concerns over security or privacy
when using VC. Responses included being unable to confirm the evaluee’s identity (e.g.
‘accurately identify the individual on the other end of the video link’), the fallibility of
the computer or Internet being used to conduct the FMHA (e.g. ‘security issues with poten-
tial unsecured browsers’), and the unknowing involvement or influence of correctional
staff or legal parties in the assessment (a situation that would be hard to manage if the
12 A. B. BATASTINI ET AL.

evaluator is obstructed in their view of the room, e.g. ‘ensure that the interviewee is not
being influenced by persons out of camera range’).

Technology concerns. Technological barriers expressed by participants (n = 26; 21%) not

only focused on the quality of the technology being used (e.g. ‘technology simply is not
there yet – too much lag, etc.’), but the impact of using technology on the evaluee. For
example, some concerns described unintended effects on the evaluation mediated by
technology use (e.g. ‘potential confounds of clinical assessment related to not being
present with the client,’ or ‘unknown degree by which [VC] could limit interviewee’s
offering of information’). Others believed some unique problems could arise with some
evaluees based on their symptomology or vulnerability (e.g. ‘I also worry about the
impact on more fragile, especially paranoid, individuals of communicating via
videoconferencing’).

Rapport. Some participants cited that VC posed a threat to rapport (n = 22; 17.7%), with
most concerns stating that ‘rapport would be more difficult to establish.’ Others indicated
that interpersonal components to the assessment, such as a working relationship or the
sense of a personal presence, also would be hindered by the remote nature of VC.

Insufficient data. Separate from concerns about restricted assessment, insufficient data
refers to a more general concern of not having enough data in general to conduct a
quality assessment or make any conclusions regarding the assessment (e.g. ‘less than ade-
quate data,’ ‘you cannot tell what you have missed by using [VC], so you risk an insufficient
evaluation’). A total of 21 respondents (16.9%) provided concerns falling within this theme.

Control over evaluation environment. Concerns over the assessment environment

related most specifically to administering psychological tests (N = 16; 12.9%). However,
this subcategory was differentiated from similar responses in other subcategories by a
broader worry about maintaining control over the administration environment, rather
than the explicit influence of other people or the quality of assessment data collected.
Examples included: ‘regulation of assessment environment’ and ‘less control over the
environment in which the person being evaluated is placed.’

Tradition. When prompted to discuss concerns about VC use, some participants opted to
describe reasons why they believed it is not widely used (N = 13; 10.5%). Although these
responses did not directly answer the question, they alluded to perceptions or attitudes
held by professionals that, rightfully so or not, discouraged the regular application of
VC in FMHA. This category was labeled ‘Tradition’ because the sentiment of many
responses in this unique (and unanticipated) category suggested that professionals’
sense of consistency and tradition is what decides whether VC is used more frequently.
An example response that reflects this sentiment was, ‘culture where in person is deter-
mined to be superior.’ The sentiment that psychology as a field has unofficially agreed
in-person evaluations are the only correct way to conduct evaluations, was echoed by
others who likewise cited a preference for in-person without providing any tangible con-
cerns for why VC use is problematic: ‘the need to be face to face and real time’ and ‘the loss
of an “experiential” aspect of an assessment.’ One outlying response appeared to
 PSYCHOLOGY, CRIME & LAW 13

discourage VC use for FMHA altogether, citing pressure from the industry as the reason for
adopting what this participant felt was an unethical practice: ‘it seems like succumbing to
the bureaucratic demands of the containment industry. There are ethics issues involving
all our aspirational principles.’ Constituting about 10% of qualitative responses, ‘Tradition’
appeared to be a fringe category; however, these responses provided a unique perspec-
tive that suggest some professionals may be firmly reluctant to adopt VC no matter the
potential benefits and that tradition or what ‘feels right’ may be a more powerful predictor
of VC use than empirical findings supporting its use.

Other ethical concerns. Other ethical issues besides privacy and confidentiality also
emerged as reasons to avoid (or in some cases, engage) in VC use for FMHA (N = 10;
8.1%). Several responses in this category mentioned potential problems providing
informed consent remotely (e.g. ‘clearly obtaining consent’). Other responses reflected a
lack of ethical guidance as a reason for not using VC (e.g. ‘there need to be established
ethics and best practice procedures before I would consider it’), while only one participant
believed VC contradicted specific aspects of the relevant ethics codes. Several other
responses explicitly mentioned the APA Ethics Code as allowing for such a practice
under certain circumstances (e.g. ‘I think it is often well within ethical practice … but
only in circumstances where the quality of the evaluation does not suffer,’ ‘because the
defendant would otherwise have to wait months I believe that the beneficence, nonma-
leficence, and autonomy principles outweigh the reliability issue’).

Admissibility in court. The last, and least cited, concern with VC use in FMHA were related
to legal challenges (N = 8; 6.5%). Most responses in this category focused on evidence
admissibility (e.g. ‘admissibility in court,’ ‘Daubert challenge’); however, some clinicians
expressed concerns that VC may not follow legal standards (e.g. ‘compliance with relevant
legal standards,’ ‘interaction with rules of evidence’). Still others alluded to the possibility
that an assessment conducted using VC, although admissible and ethical, may face more
challenges during direct and cross-examination than an in-person assessment would (e.g.
‘it provides more avenues for the opposing side to take things out of context’).
Taken together, our general hypothesis that practitioners would be able to appreciate
the practical applications of VC in reducing barriers associated with the legal process
(financial, logistical) but express more concern about their ability to actually conduct
the assessment via VC was largely supported.

Discussion
Nearly one-third of forensic clinicians surveyed reported using VC in conducting a FMHA at
least once. VC was most often used in the prediction of future violence, followed by adju-
dicative competency assessments. When examining participants’ perceived benefits of VC,
reduced costs for courts was the commonly cited advantage. This result makes sense
based on previous research showing that the use of VC to provide services is more cost
effective than in-person in many settings (Deslich et al., 2013; Egede et al., 2009) and
FMHAs are often paid for by the court. However, as expected and consistent with research
on provider perceptions (e.g. Magaletta et al., 1998; Simms et al., 2011), many expressed
concerns regarding VC use. Thus, while providers understand the potential benefits
14 A. B. BATASTINI ET AL.

regarding productivity and cost effectiveness of VC, many were concerned about technical
problems that could potentially make their job more difficult as well as the consequences
of not being in the same room as the examinee, such as the inability to properly administer
some measures or fully capture relevant data.
It makes sense that mental health professionals, who are primarily trained to deliver ser-
vices in in-person settings – training that emphasizes rapport-building – would have fears
about interpersonal connectedness or losing relevant information during a remote assess-
ment. The perception that assessment administration may be hindered with the use of VC
could explain why clinicians had more moderate ratings regarding the validity of FMHA
performed via VC. The majority of participants also felt there could be some ethical or
legal issues with the use of VC in FMHA. However, it appears that concern about the val-
idity of a VC evaluation may be mitigated to some extent by experience. Furthermore,
while not statistically significantly different, those with experience tended to rate the ethi-
cality and legality of VC in FMHA more favorably than those without. Together, this pattern
of findings suggests that prior use of VC may in fact reduce hesitations. Younger age (or
perhaps generation) may also mitigate concerns about using VC, as it explained a signifi-
cant portion the variance in practitioners’ willingness to use VC in FMHA. It is possible that
age serves as a proxy for technology discomfort or skepticism, with older or later gener-
ation psychologists, who may not have ‘grown up’ in such a technology-fueled society,
feeling more committed to traditional in-person approaches.

Study 2
It was generally expected that similar patterns of concerns and benefits expressed by eva-
luators in Study 1 would be found with legal personnel for Study 2; however, more explicit
a priori hypotheses regarding these perceptions were not made given the limited litera-
ture on which to base any hypotheses.

Method
Participants
For Study 2, participants were eligible if they were at least 18 years of age and currently or
previously licensed to practice law in the United States. Survey recruitment was completed
primarily via snowball sampling, with an online survey (housed on the online REDCap
survey platform) being sent to various listservs with members who are judges or
lawyers. Recipients were also requested to pass the recruitment message to other attor-
neys/judges possibly interested in participating. Eighty listservs were contacted by
email or via the organization’s webpage. Of those, five responded they do not disseminate
research requests via their listservs, two confirmed they would post the request, and no
response was received from the other contacted organizations. Therefore, as with Study
1, we are unable to know how many people actually received the survey and therefore
cannot calculate an accurate response rate.
A total of 27 participants completed the survey; an additional 12 people accessed the
survey, but did not complete any questions. The mean age of the sample was 45.56 years
(SD = 11.54) and had been practicing law an average of 19 years (SD = 12.53). Of the total
respondents, 25 indicated their legal role (2 did not respond to this item), and only 16
 PSYCHOLOGY, CRIME & LAW 15

indicated their type of law practiced. Of the types of law practiced, 5 participants practiced
criminal law, 7 civil law or litigation, and 4 family law. All participants were from the U.S.,
with the majority of participants from Oregon (8; 29.6%), Texas (6; 22.2%) and Florida (4;
14.8%). Additional demographics can be found in Table 1.

Materials and procedures

Approval was received from the review board for human subjects research at Texas Tech
University. This survey was similar in design and structure to Study 1; however, questions
were adapted to be relevant to issues of importance to judges and attorneys in the context
of VC for FMHA. Specifically, questions regarding challenges that may be raised during
cross-examination or other unique concerns held by legal personnel were included.
Scaled survey items used the 0–100 response option with the same anchor points as
Study 1 (see Table 5). The recruitment message contained information about the study
and a link to a brief 10–15 min online survey. The first page of this survey contained
the consent information. At the completion of the survey, participants could elect to
enter into a drawing for 1 of 4 Amazon gift cards in the amount of $25. To maintain anon-
ymity, those electing to enter the drawing were likewise redirected to a separate survey
where they provided their contact information.

Results
Given the smaller sample size of Study 2, results presented below are descriptive in nature
and should be considered preliminary. It also should be noted that, because four partici-
pants did not indicate their legal role, two indicated their role to be that of law faculty (i.e.
neither an attorney or judge), and not every respondent answered the question regarding
the validity of conclusions from FMHA conducted via VC, the total sample size across out-
comes varies. These varying response rates are specified in-text and in Table 5 for each
question and legal role when applicable.

Table 5. Study 2: responses to survey questions related to admissibility and validity of evidence
gathered via FMHA.
Survey Question M (SD) Min Max
On a scale of 0 (Not at all willing) to 100 (Highly willing), how willing are you to accept as evidence results of a FMHA that
was conducted by VC?
Total (N = 27) 53.11 (29.08) 1 100
Judges (n = 2) 86.00 (8.49) 80 92
Attorneys (n = 21) 47.57 (28.73) 1 100
On a scale of 0 (Not at all likely) to 100 (Highly likely), how likely do you think there may be legal issues raised related to the
use of VC to conduct FHMA?
Total (N = 27) 73.30 (23.22) 3 100
Judges (n = 2) 21.50 (26.16) 3 40
Attorneys (n = 21) 77.81 (18.70) 38 100
On a scale of 0 (Not at all valid) to 100 (Highly valid), how valid to you think the conclusions drawn from the FMHA
conducted over VC tend to be?
Total (N = 25) 57.52 (24.41) 10 95
Judges (n = 2) 72.50 (10.61) 65 80
Attorneys (n = 19) 51.58 (23.95) 10 90
Notes: FMHA = forensic mental health assessment, VC = videoconferencing. Judge and attorney subtotals do not equal the
total sample because some participants did not indicate their legal role and several indicated they were law faculty. Two
respondents did not answer the item regarding validity of conclusions.
16 A. B. BATASTINI ET AL.

Experiences of videoconferencing use

Of the 27 respondents, only one participant experienced (i.e. due to being the party that
retained the expert, or due to being part of the court proceedings as the opposing counsel
or judge) the presentation of evidence from a FMHA conducted by VC, specifically noting
that in terms of frequency of experiencing the use of VC for FMHA, they ‘not often or
seldom’ encountered this modality for a Mental State (NGRI/Insanity/Diminished Capacity),
Child Custody/Parental Fitness, or Disability evaluation, and ‘never’ for a Competency to
Stand Trial or Violence Risk/Threat, or Personal Injury evaluation. No other participants
indicated experience with VC.

Perceptions of videoconferencing use

Overall, there was concern among this sample of legal professionals regarding the use of
videoconferencing for conducting FMHA. When given the option between in-person and
VC assessments, 85.2% (N = 23) of participants, including both judges in the sample, indi-
cated in-person assessments are better and more valid, while 14.8% (N = 4) believed there
would be no difference between an in-person assessment and one conducted via VC.
None indicated VC-conducted FMHA would be better. Though based on only two
responding judges perspectives, judges qualitatively appeared more willing to accept evi-
dence based on a VC-conducted FMHA than attorneys. Table 5 summarizes mean ratings
regarding perceptions of admissibility and validity pertaining to the use of evidenced
gathered via VC for FMHA purposes.
The most notable perceived benefits reported by legal personnel included reduced
wait times for defendants and reduced costs associated with the evaluation (see Table
3). When provided an open-ended response option, other noted benefits included the
‘ability to use a … more qualified examiner without having to pay for them to fly in’
(including examiners with more ‘cultural sensitivity’) and improved access to services in
more remote locations. Conversely, and similar to the forensic evaluators, the most
notable concerns or consequences of VC use included difficulty establishing rapport
with the evaluee and risk of technical difficulties (see Table 4). An additional concern
expressed by one of the respondents included ‘intimidating circumstances’ for the
examinee.

Discussion
Very few responses were received overall for Study 2, and of the 27 respondents, only 2
were judges. Thus, any firm conclusions about the opinions of legal personnel or
whether attorneys and judges differ in a meaningful way are limited. Given the low
return on our initial recruitment procedures, attorneys and judges appear to be a
difficult sample from which to collect data. Additional recruitment methods, including
mailed surveys, attending professional conferences or meetings of legal personnel, or
increasing opportunities for compensation beyong what was offered in the present
study, should be considered in the future to reach this population.
While more data is clearly needed to fully understand the opinions of attorneys and
judges, and why judges may be more amendable to the use of VC than attorneys,
results of this preliminary survey were generally consistent with the opinions of evalua-
tors, such that many expressed rather negative views without having much first-hand
 PSYCHOLOGY, CRIME & LAW 17

experience. Future research should also examine whether and how these apparent
biases can be reduced. With more data on the legal perspectives of VC for FMHA
and how those perspectives can better align with existing research, jurisdictions in
rural or lower-income areas may be more likely to request a needed evaluation,
instead of opting to dismiss criminal charges or offer quick plea agreements when an
in-person forensic assessment would be burdensome (due to the cost, unavailability
of an examiner, etc.), thus improving treatment opportunities and justice outcomes
for defendants.

General discussion
This research sheds light on the opinions of forensic mental health care professionals
regarding use of VC for assessment purposes, as well as the acceptability within the
legal profession. While use of VC has been discussed in the context of FMHA and correc-
tional settings (see Batastini et al., 2013), no research has specifically surveyed clinicians or
legal professionals on the use and perceptions of this type of technology across various
FMHA purposes making this study the first of its kind. This research allows for a better
understanding of the extent to which actual experts use this technology and how they
view it, and this understanding is vital in determining ways to improve this technology
and its viability in practice. Results from this survey suggest that VC is used relatively infre-
quently, with just over one-third of participants in Study 1 indicating prior use and only
one participant in Study 2 being exposed to VC for FMHA. Further, many participants
felt VC could offer practical benefits (namely cost-effectiveness and reduced wait times
for defendants) that warrant further exploration of this technology and the possibility of
increased use for FMHA.
While these surveys offer several important insights into how forensic mental health
care and legal professionals use and perceive using VC to perform FMHA, there are
certain limitations that should be considered. First, data was obtained based on the
opinions of the participants and not on actual outcomes associated with VC for FMHA pur-
poses. Participant opinions were most likely influenced by personal biases and not, for
example, on findings from empirical studies showing that VC is general comparable to
in-person, even in FMHA (e.g. competency to stand trial; Manguno-Mire et al., 2007). It
could be the case that participants’ perceptions would have been more favorable
toward VC if they were exposed to existing research supporting its use in the provision
of both general and forensic mental health services.
Further, many practitioners may not be aware that practice guidelines already exist
regarding telepsychology more generally (see APA, 2013). These guidelines and other
scholarly commentary offer recommendations on issues of most concern to the present
sample. For example, Luxton, Pruitt, and Osenbach (2014) speak directly to best practices
for remote administration of psychological tests. More recently, Luxton et al. (2019) out-
lined findings, challenges, and recommendations for use of VC in pretrial assessments
of competency to stand trial. Future studies may consider examining the effects of training
and education (e.g. exposing participants to research findings or a brief training session)
on perceptions of VC in FMHA. The idea that training opportunities and exposure to VC
increase positive perceptions of VC is consistent with the recommendations of Simms
et al. (2011) following their study of provider perceptions.
18 A. B. BATASTINI ET AL.

Secondly, while a wide range of recruitment outlets was intentional to avoid a demo-
graphically-skewed sample, these studies were not racially diverse, with 94.2% of partici-
pants identifying as Caucasian in Study 1 and 84.6% in Study 2. However, a 2018 survey by
the APA found that, while the number of racial/ethnic minorities entering the psychology
workforce is increasing, 84% of practicing psychologists identify as Caucasian (Lin, Stamm,
& Christidis, 2018). Furthermore, approximately 71% of U.S. district court judges (McMillion,
2017) and 85% of lawyers (American Bar Association, 2018) are Caucasian. Therefore, while
the racial demographics of the present samples were not representative of the general
population, they do appear representative of their respective fields. It is possible that
the subfield of forensic psychology is even more discrepant. A majority (62.3%) of the
respondents in Study 1 also classified themselves as psychologists; therefore, the opinions
of forensic psychiatrists were significantly underrepresented in this study. Given the
general acceptance of VC in the medical field, including for the purpose of psychiatric con-
sultation, psychiatrists may be more open to the idea of incorporating VC into their foren-
sic practice.
Third, these studies simply surveyed use and perceptions and did not empirically
examine whether FMHA conducted via VC is comparable to the traditional in-person
approach. To date, there is limited research on the actual reliability and validity of
FMHA across VC and in-person. Therefore, further research in greatly needed to better
support VC as a viable option for this purpose, as well as to develop best practices to
reduce barriers and identify the types of examinees and/or psycho-legal questions VC
may be most appropriate. To better understand for whom VC is helpful (or not) and
under what circumstances, future evaluations of VC implementation for FMHA purposes
should also include measures of service and technology satisfaction from the perspective
of defendants, evaluators, and attorneys. This line of research is important considering that
assessment validity and proper test administration appear to be major areas of concern for
forensic mental health care professionals, especially those without experience using VC.
Additional research and established guidelines may get more forensic evaluators on
board with the idea of incorporating VC into their practice.
Lastly, and specific to Study 2, the attempts made to gather opinions from attorneys
and judges with little success highlights the challenges in getting legal professionals to
engage in the research process and share their opinions and experiences – information
that is integral to informing and improving the practice of forensic mental health. As
legal personnel will ultimately be the ones to address issues of admissibility of VC for
FMHA or challenge expert credibility based on such evaluations, their perceptions are
highly relevant to the adoption of VC in legal contexts. While we recognize that
different or more effortful recruitment mechanisms for these professionals are likely
needed to ensure adequate response rates, including better compensation, it is also poss-
ible that legal professionals see less value in participating in research opportunities or have
difficulty prioritizing their time for these purposes. We hope, at a minimum, this study will
encourage legal personnel to respond to future solicitations for their opinions.

Conclusion
It is imperative to find different ways to broaden access to forensic mental health assess-
ments due to the large demand for these assessments and shortage of providers. One
 PSYCHOLOGY, CRIME & LAW 19

option is the use of VC. These studies show that forensic evaluators and legal personnel
were able to see various possible benefits to using VC, particularly cost benefits and
reduced wait times for evaluations. Conversely, practitioners and legal personnel also,
rightfully, recognized potential problems that could arise when using VC, including tech-
nical difficulties, barriers to administering some assessment measures, and concern
regarding confidentiality. While participants as a whole viewed VC as a somewhat valid,
ethical, and legal method for performing psycho-legal assessments, there remained
some skepticism. However, it is possible that forensic clinician’s may overcome some of
their concerns with greater exposure to technology in FMHA. More research on how to
increase forensic mental health evaluators’ openness to using VC and legal personnel’s
acceptance of results from these assessments, as well as more empirical research on the
reliability and validity of this method compared to in-person, is needed before advocating
for more widespread use in forensic practice settings. Nonetheless, this study shows that
many forensic evaluators and legal personnel are open to the idea of VC. A greater accep-
tance of this technology may substantially improve access to quality forensic mental
health professionals and, subsequently, improve the timely administration of justice.

Note
1. Hedge’s g was used to account for the unequal sample size between those who used VC
before and those who did not. Hedge’s g is interpreted the same way as Cohen’s d. In all com-
parisons, prior use served as the reference group, so negative signs indicate perceptions of this
group were rated lower.

Disclosure statement
No potential conflict of interest was reported by the authors.

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