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CONFIDENTIAL PSYCHOSOCIAL EVALUATION Date 10/xx/22 Children One Name Ted Lasso Education High School Diploma DOB 4/26/57 SSI Yes Age 65 Insurance Medicaid Current Housing Arrangement Incarcerated – previously residing in shelter system Current Prescribed Psychotropic Medication Depekene (an anticonvulsant – for mood stabilizing) Prolixin (an antipsychotic) Medication Prescribed By Correctional Health Services IDENTIFYING AND REFERRAL INFORMATION Mr. Ted Lasso is a 65-year-old, Italian Jewish male who stands charged in New York County Supreme Court with one count of Robbery in the 1 st Degree (PL 160.15(4), one count of Robbery in the 3 rd Degree (PL 160.05), and Petit Larceny (PL 155.25). Mr. Lasso was referred to Manhattan Mental Health Court (MMHC) by the District Attorney’s office for the purpose of a psychological evaluation and to determine appropriateness for Alternative to Incarceration (ATI) court monitoring. METHOD OF ASSESSMENT - Clinical interview with XXXr, Clinical Director, on 10/06/2022 - Clinical interview with XXX, on 10/05/2022 - Tests administered: 1. Historical-Clinical-Risk Management-20, Version 3 (HCR-20 V3 ) 2. Structured Assessment of Protective Factors for Violence Risk (SAPROF) - Record review: 1. Arrest record, dated 2/21/2022 2. Criminal Complaint, dated 3/4/2022 3. Correctional Health Services records, dated 4/5/2021 through 8/5/2022 CONFIDENTIALITY Mr. Lasso was informed of the purpose of the assessment and the limits of confidentiality. Specifically, it was explained that the information obtained during the evaluation was not confidential, as it will be included in a report that will be seen by the District Attorney and the Court. Mr. Lasso stated that he understood the limits of confidentiality. PERTINENT BACKGROUND INFORMATION
The following background information was obtained from a review of all available records and Mr. Lasso’s own report. Social History: Mr. Lasso reported that he was born in Yonkers, New York and raised in the Bronx, New York. According to CHS records, Mr. Lasso mentioned that he is one of five children with one of his brothers being deceased. Mr. Lasso stated that he was raised by both of his parents, as well as his older sister and younger brother. Mr. Lasso reported his childhood as “good” and denied any difficulties with reaching his developmental milestones. He stated that his parents were married for 35 years before his father died in 1987. He reported that his mother died in 1997. Mr. Lasso described his parents' marriage as “good”, noting that his father worked long hours as a butcher while his mother was a homemaker. He denied witnessing any violence or abuse at home and reported receiving physical discipline, “once in a blue mood”, from his mother who would smack him on his hand with a spatula. Further, he highlighted his mother as the primary individual whom he received affection from. When reflecting on his father, Mr. Lasso became tearful, and remarked “I miss my father.” Overall, he described getting along well and having positive relationships with both of his parents. When asked about his current relationships with his older sister and younger brother, he mentioned that he has been able to stay in contact with both of his siblings and was able to speak with both his brother-in-law and sister over the phone last week. Specifically, he highlighted that his brother-in-law and sister comprise his main source of social support. Prior to his current incarceration, he stated that he has been street homeless, and was residing in a shelter on Ward’s Island. Before being street homeless, he reported residing with his brother-in-law in Staten Island. Mr. Lasso stated that he first started dating when he was 14 years old, and that this relationship lasted a few years before ending. He reported getting married in 1977 which ended in divorce in 1981. Mr. Lasso stated the dissolution of his marriage resulted from his wife’s infidelity. As a result of this marriage, he reported having a daughter, aged 44. Regarding his relationship with his daughter, Mr. Lasso stated “I haven’t spoken to her in years.” Of note, per CHS records, Mr. Lasso reported having a son who died by suicide. Following his divorce, he reported experiencing several short-term relationships with the most recent being around the time of the instant offense. He stated these relationships have often ended due to challenges resolving disagreements. Currently, Mr. Lasso reported having some friends from his stays at various shelters and highlighted having a best friend whom he has known all of his life. He reported last speaking to his best friend “a year ago”, prior to his most recent incarceration. Mr. Lasso reported being raised as a Catholic and that he considers himself religious. Further, he mentioned engaging with chaplain services while incarcerated at Rikers Island. Educational and Employment History: According to available records and self-report, Mr. Lasso stated that he graduated high school and received his diploma in 1975. He described getting along well with his teachers and peers. During school, he reported obtaining mainly B's in his classes, as well as being involved in school activities (e.g., bowling team). He denied any significant issues during his time at school and denied receiving any suspensions or expulsions. Furthermore, he denied experiences of being bullied or bullying others. After graduating from high school, he stated that he attended trade school to study photography, and obtained a certificate of completion within 16 months. 2
In terms of his employment history, Mr. Lasso reported holding his first job at 12 delivering newspapers. Since then, Mr. Lasso described maintaining several jobs mainly as a gas station attendant. He mentioned that his most recent employment was selling ice at a gas station, which he held for eight years, before being deemed ineligible to work as a result of being diagnosed with a severe mental illness. Following his diagnosis of a severe mental illness, he stated receiving social security disability insurance (SSDI). He currently reports receiving SSDI payments of $712 per month. Trauma History: Mr. Lasso reported sexual abuse at 12 years old, in which he stated “Guitar teacher touched my testicles.” He expressed that he did not share this with his parents at the time this occurred; however, he said that he shared this experience with his mother several years later. Medical History: According to available CHS records and self-report, Mr. Lasso’s medical history is significant for a diagnosis of corneal leukoma central vision in his left eye. He reported that he is blind in his left eye. Mr. Lasso stated being allergic to haldol and that he will faint if he takes it. He reported past injuries including receiving stitches on his head and sustaining four broken ribs. Mr. Lasso also mentioned losing consciousness after a physical altercation, approximately three years ago, and waking up several hours later in hospital. Additionally, he reported a broken finger (5th digit) on his left hand. Substance Use History: Mr. Lasso reported K2 (synthetic cannabinoid) as his drug of choice, which he mentioned first using around the age of 59. He mentioned using K2 a “few times a week”, with his last usage in January 2022. Mr. Lasso reported that he started drinking alcohol and using cannabis when he was 14 years old. Regarding his alcohol use, he stated that he would drink alcohol every week when he was younger. He reported last using alcohol two years ago and noted that he would drink around “6-8” mixed drinks and engage in risky behaviors while intoxicated. With respect to his cannabis use, he stated using cannabis twice a day with his last use on the day of the instant offense. Mr. Lasso also reported a history of brief experimentation using crack cocaine, phencyclidine, and heroin. When asked whether his substance use has ever affected his employment or interfered with his relationships, Mr. Lasso stated “No.” He reported his longest period of sobriety being seven years and that he was able to maintain this length of sobriety because of his active involvement in programming and treatment groups at the time. Per available CHS records, Mr. Lasso is reported to have completed a detox program at St. Vincent’s Hospital in 2022. Mr. Lasso also mentioned being involved with alcoholics anonymous (AA) and narcotics anonymous (NA) programming, which he reported some benefit from. However, he also mentioned that he did not complete this programming. Psychiatric History: According to available records and Mr. Lasso’s self-report, he reported his first contact with mental health professionals occuring around the age of 17. Specifically, he noted that this was close to the time when the “son of Sam '' was at large and he started getting “paranoid”. Mr. Lasso stated being first hospitalized at Bronx Psychiatric Center in 1978. Further, he reported hospitalizations at Harlem Valley Psychiatric Center in the early 1980s, which was followed by additional hospitalizations at Rockland Psychiatric Center and Creedmoor Psychiatric Center. In total, Mr. Lasso stated that he has been hospitalized around “60 to 70 times”. Per CHS records, Mr. Lasso was also hospitalized at Kirby Psychiatric Center in 3
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2018 for restoration of fitness. More recently, Mr. Lasso mentioned that he was last hospitalized in January 2022, for a period of 10 days, at St. Vincent’s hospital. According to available CHS records, dated 4/5/21 to 3/11/21, Mr. Lasso presented as being internally preoccupied and self-reported non command auditory hallucinations. Additionally, he has been frequently reported as irritable, disorganized and tangential in speech, as well as exhibiting low frustration tolerance. More recent records described continued irritability; however, improvements were noted in Mr. Lasso’s behavioral control. Of note, recent records dated 3/22/22 to 8/5/22 have consistently noted that Mr. Lasso has not endorsed auditory or perceptual hallucinations; however, his thought process has continued to be disorganized and his speech often circumstantial. Historically, Mr. Lasso has been diagnosed with schizophrenia, schizoaffective disorder bipolar type, cocaine use disorder, alcohol use disorder, other hallucinogen use disorder, and cannabis use disorder. Medication trials have included Prolixin (an antipsychotic), Benadryl (an antihistamine), Depakote (an anticonvulsant), and Depekene (an anticonvulsant). According to Mr. Degannaro’s self-report, he is currently taking Prolixin and Depekene and has been 100% compliant, which is consistent with the most recent CHS records dated 8/5/22. During the current evaluation, Mr. Lasso stated that his mood has been “good”. Further, he described currently being engaged in mental health treatment at Rikers Island, where he speaks to a provider every day and engages in group programming when held. Of note, he mentioned that he likes his providers and particularly enjoys attending the music group. When asked whether he is currently diagnosed with any mental health condition, he reported being diagnosed with “schizophrenia”, which was first diagnosed in 1974. Mr. Lasso noted that he would experience paranoia, hear voices and see things, and have disorganized thinking. Presently, Mr. Lasso stated that he does not experience paranoia and does not see and hear things anymore. He reported that it has been “15 to 20 years” since he last heard voices. Mr. Lasso mentioned that his psychotropic medications help him to organize his thoughts and sleep. He also acknowledged adverse consequences, such as “thinking funny”, when he has stopped taking his medications in the past, and reported that he plans to continue taking his medications once released. Legal History and Instant Offense: According to his New York State arrest record dated 2/21/22, Mr. Lasso has a total of one felony conviction, 31 misdemeanor convictions, and three violations. He has a history of one violent felony conviction: Attempted Robbery in the 2 nd degree in 1999. Mr. Lasso has most commonly been arrested for charges of Burglary in the 3 rd degree, Petit Larceny, Criminal Possession of Stolen Property, Intent to Obtain Transportation without Paying, and Disorderly Conduct. Mr. Lasso is currently charged with Robbery in the 1 st Degree (PL 160.15(4); Class B Felony), Robbery in the 3 rd Degree (PL 160.05; Class D Felony), and Petit Larceny (PL 155.25; Class A Misdemeanor). According to the criminal complaint, Mr. Lasso is alleged to have attempted to leave a store without paying for an item of clothing and threaten to shoot a store employee who attempted to prevent him leaving with the unpaid merchandise. When asked about this arrest, Mr. Lasso stated that he was smoking marijuana at the time and “needed a couple of dollars.” MENTAL STATUS 4
Mr. Lasso is a 65-year-old, caucasian male who was interviewed by Dr. Feuer on 10/06/22. Mr. Lasso’s interview took place over the Department of Correction (DOC) Video Teleconferencing service. During the video teleconference interview, Mr. Lasso was only visible from the neck up and he wore beige jail clothing. He appeared his reported age. His hygiene appeared to be adequate; however, his hair appeared somewhat disheveled. Mr. Lasso was alert and oriented to person, place, time, and circumstance. He described his mood as “good” which was congruent with his affect. He presented initially as hurried, wanting to finish the interview quickly; however, he responded well to redirection from this examiner and appeared more comfortable as the interview continued. His overall speech was grossly normal in rate and tone but tangential at times. He denied any current self-injurious or aggressive thoughts. There was no evidence of delusional thinking; however, his thought process was often circumstantial, as he would often provide trivial or irrelevant details before circling back and answering the question. He denied any hallucinations and there was no evidence that he was actively hallucinating. He was cooperative in his responses. He did not evidence any notable challenges with attention, concentration, or short-term memory. Expressive and receptive communication was intact. Overall, his cognitive abilities appeared to be grossly intact. DIAGNOSTIC IMPRESSION Based on the results of the current evaluation, as well as collaterally obtained information and the results of diagnostic testing, the following DSM-5 diagnoses are given at this time: F20.9 Schizophrenia, multiple episodes, currently in partial remission – Based on Mr. Lasso’s reported symptoms and past psychiatric records, he meets criteria for schizophrenia. In terms of psychotic symptoms, Mr. Lasso has a history of experiencing both auditory and visual hallucinations and persecutory delusions. Additionally, his symptoms have included disorganized thinking and paranoia. These symptoms have persisted during periods of abstinence from all substances, including while in secure forensic psychiatric settings. Although his symptoms may be exacerbated by substance use, they are not caused by substances. According to available records, Mr. Lasso has not experienced any hallucinations or delusions, associated with schizophrenia, since 3/11/22. However, Mr. Lasso has continued to evidence disorganized thinking. F19.21 Other (K2) substance use disorder, severe, in early remission, in a controlled environment - Based on available records and Mr. Lasso’s reported symptoms, he meets criteria for other substance use disorder, severe. Mr. Lasso has a history of using K2 in larger amounts and over a longer period of time than intended, unsuccessful attempts to cut down his use, cravings to use K2, continued use despite persistent social or interpersonal problems, as well as continued use despite knowledge of his psychological difficulties which are exacerbated when using, and a need for increased amounts in order to achieve the desired effect. According to available records and self-report, Mr. Lasso last used K2 in January 2022. F12.21 Cannabis use disorder, moderate, in early remission, in a controlled environmen t - Based on available records and Mr. Lasso’s reported symptoms, he meets criteria for cannabis use disorder, moderate. Mr. Lasso has a history of using cannabis, up to several times a day, since adolescence and has struggled to cut down or control his use. Further, he has experienced strong urges to use cannabis and has continued to use cannabis despite having social and interpersonal problems exacerbated by his use. Similarly, he has continued to use despite knowledge of his psychological difficulties which are exacerbated when using. 5
F10.21 Alcohol use disorder, moderate, in sustained remission, in a controlled environment - Based on available records and Mr. Lasso’s history and current symptoms, he meets criteria for alcohol use disorder, moderate. Mr. Lasso has a history of consuming alcohol in larger amounts and over a longer period of time than intended, unsuccessful attempts to cut down his use, strong urges to use alcohol, recurrent alcohol use in physically hazardous situations, and continued use despite persistent social or interpersonal problems. According to available records and self- report, Mr. Lasso last used alcohol over two years ago. VIOLENCE RISK ASSESSMENT As part of eligibility for diversion, this evaluator assessed Mr. Lasso’s level of risk for violence and whether his risk can be managed in the community. This violence risk assessment is based on the interviews conducted with Mr. Lasso as well as a review of the various materials listed above. Overview of Violence Risk Assessment Method For the purpose of this report, violence is defined as actual, attempted, or threatened physical harm of another person, including intimidation or fear-inducing behavior that is nonconsensual. Violence risk assessment is the process of evaluating people to characterize the risks that they will commit violence in the future (e.g., the nature, severity, imminence, frequency, and likelihood of future violence), as well as the steps that could be taken to minimize these risks. There are two basic methods of conducting a violence risk assessment supported by empirical evidence. First, the discretionary approach, sometimes referred to as the Structured Professional Judgment approach, involves consideration of the totality of circumstances in the case at hand. This approach may involve reference to professional guidelines and typically involves the identification of static factors (those that are mostly unchangeable) and dynamic factors (those that are potentially variable with intervention), as well as factors that are relevant for risk management. The second method, the non-discretionary approach, sometimes referred to as an actuarial risk assessment, involves consideration of a limited number of factors that are combined according to a fixed and specific algorithm. It creates a statistical profile of the person that may be compared to known groups of recidivistic and non-recidivistic violent offenders. For the purpose of preparing this report, the discretionary method has been used, conducting a comprehensive violence risk assessment according to the professional guidelines outlined in Version 3 of the Historical-Clinical-Risk Management Guide (HCR-20 V3 ; Douglas, et al., 2013) and the Structured Assessment of Protective Factors for violence risk (SAPROF) measure, respectively. Below are general findings and opinions based on a systematic appraisal and consideration of the HCR-20 V3 ’s and SAPROF’s Historical, Social/Contextual, and Individual Risk Factors balanced against the Protective Factors domain. Violence Risk Factors General Physical Violence Historical Risk Factors : Mr. Lasso has several relevant risk factors for violence. He has a history of violence as an adult, including a prior violent felony, and his most recent arrest, which places him at risk for future violence. Engaging in and threatening physical violence, may have been reinforced as appropriate strategies to satisfy his need and to navigate interpersonal conflict. He also has a history of other antisocial behaviors, beginning in adolescence, including the illegal possession of a substance, as well as acts in adulthood 6
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motivated by financial or material gain, such as petit larceny, burglary, and possession of stolen property. This has antisocial behavior as a problem-solving strategy. Problems with relationships are also a risk factor for Mr. Lasso. According to his self-report, he is divorced and has had several unstable relationships since. His relationship with his daughter is estranged, as indicated by his reported lack of communication with her for over six years. Further, he appears to be somewhat socially isolated and reported last communicating with his best friend a year ago. This instability has led to emotional stress and a lack of exposure to positive interpersonal relationships, which increases his risk for engaging in violent behaviors. Current and Anticipated General Physical Violence Future Risk Factors: Protective Factors (SAPROF): Mr. Lasso has several protective factors that can help reduce his risk of violence. He developed and experienced a close bond with both of his parents in childhood, which serves as a positive influence for prosocial behavior. Mr. Lasso also expresses a positive attitude toward treatment, in addition to positive life goals such as obtaining employment, continuing treatment, finding a romantic partner, and making new friends. His increased positive attitude for treatment and positive life goals can enhance his motivation and ability to benefit from treatment. He has also been fully compliant with his psychiatric medication since his recent incarceration and has demonstrated self-control in abstaining from violent behaviors and substance use. Additionally, Mr. Lasso has managed to sustain positive relationships with several treatment providers and a commitment to abstain from gambling and using substances, which have historically been a precursor to violent offending behavior. Formulation: At the time of the instant offense, Mr. Lasso had been using cannabis on the day of his most recent arrest. Mr. Lasso was likely disinhibited, agitated, and psychiatrically decompensated due to his substance use. Mr. Lasso’s main risk factors include his substance use and treatment non-compliance. When non-compliant with treatment and using substances, he presents with an escalation of symptoms including agitation, and impulsivity. Based on the current evaluation, Mr. Lasso exhibits a high risk for substance relapse and non-violent offending behavior, as well as a moderate risk for physical violence if left untreated in the community. If Mr. Lasso were to engage in violence in the future, it is likely that it would be in the context of psychiatric decompensation due to treatment non-compliance and/or K2 and cannabis intoxication. This risk would be significantly reduced if Mr. Lasso were to engage in appropriate treatment described below. OPINION AND TREATMENT RECOMMENDATIONS Given the identified clinically-relevant factors, the availability of treatment to address these factors, and Mr. Lasso’s willingness to participate in such treatment, he is eligible for ATI through Manhattan CRAN court monitoring with the following treatment plan : Treatment – It is recommended that Mr. Lasso attend a residential Mental Illness Chemical Addiction (MICA) treatment program that provides intensive daily treatment focused on substance use as well as coping with mood related symptoms. Residential treatment would provide Mr. Lasso with structure, monitoring and regimented responsibilities to engage in treatment for his mental health and substance use disorders. This level of treatment would ensure that Mr. Lasso abstains from mood-altering substances while gaining support and coping skills to remain abstinent. He requires access to medication (with monitoring to ensure compliance) as well as intensive individual and group therapy to treat his mood related symptoms. Mr. Lasso 7
would benefit from a trauma-informed treatment approach that incorporates aspects of Cognitive Behavioral Therapy (CBT) for Psychosis, specifically targeting unhelpful thought patterns and developing appropriate coping strategies. Further, because his substance use is a significant and chronic life-long issue for Mr. Lasso that intertwines with his mental health symptoms, emphasis should be placed on the role his substance use has played in his mental health symptoms and life. He would also benefit from in- depth instruction and assistance in developing and implementing a thorough relapse prevention plan. In addition, it would be ideal for Mr. Lasso to attend a treatment setting that could help him to work towards his goal of obtaining employment and building a network of prosocial peers. Help with these personal goals would likely maximize Mr. Lasso’s engagement and success with treatment. If the above treatment recommendations are implemented, Mr. Lasso’s prognosis is moderately good, and his risk for violence could be substantially decreased. After a period of intensive residential treatment, Mr. Lasso may be suitable for less restrictive treatment options, although he will likely continue to need some level of monitoring and support in order to safely transition into the community and will require assistance with housing and employment. At the point in which Mr. Lasso’s residential treatment providers determine that he is suitable for a less restrictive setting, a re-evaluation should be conducted in order to determine the appropriate next steps in his treatment plan. Monitoring – Provided that Mr. Lasso is placed in an appropriate intensive residential MICA program, it would be sufficient for him to meet with a case manager or for the facility to provide an update every week. He should be tested for substances frequently (once per week) at the residential treatment facility. Once he eventually moves to a less restrictive setting, Mr. Lasso should meet with his case manager more frequently to assess his mental status and to be tested for substances several times per week. Furthermore, if Mr. Lasso’s risk of violence to himself or others increases due to treatment non-compliance, substance use, or other mental-health related factors, it is recommended that he be referred for evaluation for inpatient psychiatric hospitalization. SUMMARY Mr. Ted Lasso is a 65-year-old, caucasian American male who stands charged in New York County Supreme Court with one count of Robbery in the 1 st Degree (PL 160.15(4), one count of Robbery in the 3 rd Degree (PL 160.05), and Petit Larceny (PL 155.25). His criminal history stems primarily from instability caused by his mental health symptoms, chronic polysubstance use, in addition to medication noncompliance. These problems have contributed to functional impairments with his employment, family, and social relationships. He has a history of violence mostly related to periods of severe substance intoxication. When non-compliant with treatment and using substances, he presents with an escalation of symptoms including hallucinations, delusions, paranoia, agitation, and impulsivity, which increases his risk of violent behavior. Based on the information available, Mr. Lasso meets diagnostic criteria for schizophrenia, multiple episodes, currently in partial remission; other (K2) substance use disorder, severe, in early remission, in a controlled environment; alcohol use disorder, severe, in sustained remission, in a controlled environment; and cannabis use disorder, moderate, in early remission, in a controlled environment. Based on the results of the current assessment, Mr. Lasso would benefit 8
from a residential MICA program with a high level of structure, support, and monitoring, as well as trauma-informed treatment, with an emphasis on CBT for Psychosis that is trauma-informed, medication management, and frequent toxicology testing. If provided with the intervention described above, Mr. Lasso’s risk for future violence and offending could be substantially lowered. Limitations The accuracy of risk assessments is limited by the quality of the information on which these assessments are based. In addition, violence risk is dynamic and can change based on a variety of factors. Please contact me if new and potentially relevant information comes to light, and I can advise whether this would lead to any substantive changes in my findings or opinion. 9
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