The Art of Interview & Assessment. Presented By: Ryan West, MS, CFI Certified Forensic Interviewer Body Language Expert

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1 Presented By: Ryan West, MS, CFI Certified Forensic Interviewer Body Language Expert

2 improve clinical interview & assessment of suspected opioid users Identify drug-seeking behaviors and those in denial control for influencing variables Note: Learning how to properly conduct a professional interview while reading body language cues is much like learning a new language. You can t learn Spanish in one day, it takes time and practice.

3 The United States constitutes only 4 percent of the world s population, yet Americans consume approximately how much of the world s opioid supply? 24%, 47%, 68%, 86% 1

4 In 2014, what percent of active heroin users were also abusing pain pills? 35%, 40%, 45%, 50% 1

5 Pain Pill Use 4.3 million current users, 12 and older 2014 NSDUH reports

6 NSDUH reports

7 Improving the Clinical Interview & Assessment

8 What s the GOAL of the opioid user? To obtain as much of their drug as possible? ~

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10 What drives the lie? Perceived Ability of Interviewer to Detect Truth Past Successes Degree of Guilt about Incident Degree of Guilt about Lying Reward/Punishment for Failing/Succeeding

11 STATEMENT ANALYSIS Truthful Rich in Details First Person Proper Introduction Possessions No Gaps in Time Appropriate Emotions Denies Before Asked Dishonest Lack of Details Deviates First Person Improper Introduction Lack of Possessions Missing Time No Emotions Denies to Direct Questions

12 Drug-seeking Behaviors Calls or comes in after peak hours States their Rx has been lost or stolen Has to be seen right now Traveling through town, visiting relatives or friends Feigns physical or psychological problems Specific about which drugs work and which do not High-pressure, elicits guilt and sympathy Uses their child or elderly person No interest in their diagnosis Exaggerates medical problems Reluctant to share personal data/medical history OR provides textbook symptoms

13 What s the GOAL of the opioid user? To obtain as much of their drug as possible? ~ What s the GOAL of the medical provider? To help the patient suffering from addiction?

14 Methods of Communication

15 Ordinarily, interviewers detect truth and lies by analyzing the manifested behaviors of GUILT & FEAR

16 STATEMENT ANALYSIS CONTINUED Uncheckable Sources Focusing on Irrelevant Points Excessive Politeness, Respectfulness, or Helpfulness Delay in Responses Physical Cover-ups Memory Problems (Selective Good Memory, Selective Forgetfulness) Repeating the Question Responding with a Question Hanging Sentences Minor Admission Gallows Laughter Political Answers Emphasizes Truthfulness and Honesty

17 How to handle the case Confirm demographical information, electronically if you must Conduct a thorough examination consistent with the condition Request photo I.D. and/or social security number Contact reported practitioners or previous hospitals Write Rx s for very limited quantities Ask CONTROL QUESTIONS *** If you feel something is wrong based on your experience, it very likely IS. In this case, DO NOT - take the patient s word, investigate - dispense drugs to get rid of or silence the patient - accuse the patient of drug addiction; sympathize with their condition, not their demonstrated behaviors

18 What about denial? Commonly seen in abusers and geriatric populations Designed to protect the ego of the patient, not provoke yours Seeds planted by the provider are commonly reaped by the patient much later

19 Controlling for Influencing Variables

20 Symptoms of Type 1 Diabetes Frequent urination Increased appetite, sometimes extreme hunger Weight loss Blurred vision Suppressed immune system, increased illnesses Increased thirst Nerve pain

21 Symptoms of Drug & Alcohol Use Preoccupation of using or thinking about using the substance Using to self-medicate feelings of stress, anxiety, or depression Feelings of guilt or shame Need more of the substance to achieve the same high Loss of control Using to avoid withdrawal Change in relationships with family and friends Lies, Stealing, Spending $$$

22 Know Your Emotions

23 Humans are hard-wired to detect fake or disinterested non-verbal signals. Training is not required to communicate nonverbally. It is required for cognitive processing. Our actions are often guided by our beliefs, not our intentions.

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25 Reaction/Response Exercise Patient s Attitude Aggressive Analytical Anxious Angry Argumentative Arrogant Bored Condescending Confused Defensive Displeased Fearful Frustrated Inattentive Nervous Pensive Puzzled Scared Skeptical Surprised Suspicious Superior Provider s Reactions Aggressive Frustrated Calm / Submissive Curious Annoyed Annoyed Frustrated Angry Concerned Frustrated Concerned Calm / Submissive Frustrated Angry Calm / Submissive Curious Angry Calm / Submissive Frustrated Condescending Annoyed Annoyed Patient s Attitude Provider s Responses Aggressive Calm Analytical Interested Anxious Assertive Angry Authoritative Argumentative Deflective Arrogant Bored Condescending Confused Defensive Displeased Fearful Frustrated Inattentive Nervous Pensive Puzzled Scared Skeptical Surprised Suspicious Superior

26 Above all else, after each patient interaction, I want the patient to FEEL Comfortable Confident in my ability Safe Valued Empowered Encouraged/Inspired Heard Excited Relieved Any others??? THINK I am competent I am trustworthy I genuinely care of their wellbeing Their medical needs were thoroughly addressed BHS is the place to go! BHS is not a vending machine for pain pills Any others???

27 Gazing 6

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31 Keep Hands Visible

32 How s your stance?

33 Proxemic Zones

34 Avoid Body Blocking

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38 Minimize Movement

39 Minimize the following 1) Bouncing 2) Shifting 3) Rocking 4) Tapping 5) Fidgeting

40 Maintain a Natural Low Tone

41 Our voices go up when nervous or stresssssssed! 1) Speak only on the out breath 2) Breathe through your stomach 3) Look slightly down when thinking

42 Q U E S T I O N S???

43 R E S O U R C E S - Practical Aspects of Interview & Interrogation 2 nd Ed Wicklander and Zulawski - Effective Interviewing & Interrogation Strategies 3 rd Ed Gordon and Fleisher - You Say More Than You Think J. Driver - Emotions Revealed P. Ekman (self-help) - Liespotting - Meyer - Humintell.com Ryan West, MS, CFI Certified Forensic Interviewer rwest@greenbriar.net (724)