There is no standard report format, but a number of sources provide guidelines that forensic evaluators can reference (Otto, DeMier, & Boccaccini, 2014; Zapf & Roesch, 2009). What about the gross incongruencies criticism of the ECST-R of Melton and his colleagues32? This lack of . Competence Assessment for Standing Trial for defendants with Mental Retardation (CAST-MR) assesses the competence of defendants with intellectual deficits (Everington & Luckasson, 1992). al. Lessons from Slade et al. Golding and Roesch (1988) defined the open-textured, context-dependent nature of the construct of competency to stand trial: Mere presence of severe disturbance (a psychopathological criterion) is only a threshold issueit must be further demonstrated that such severe disturbance in this defendant, facing these charges, in light of existing evidence, anticipating the substantial effort of a particular attorney with a relationship of known characteristics, results in the defendant being unable to rationally assist the attorney or to comprehend the nature of the proceedings and their likely outcome. The word processing format allows the user to modify the template to create a document that suits his or her personal style. In contrast, questions for the assist defense scale include preliminary information that increases the average length to 46.9 words. The report template is designed to expedite the process of creating reports. It is set up as a default template. Because many defendants are found incompetent due to a psychosis, psychotropic medication is the most frequent type of treatment. Although the newest measure, the ECST-R is the only one of these competency measures to be reviewed by the well-respected Mental Measurements Yearbook.45,46 By combining these sources, practitioners will become knowledgeable regarding the strengths and limitations of competency measures. Criminal trial competency is raised substantially more often than other pretrial forensic assessment issues such as criminal responsibility. The notion that defendants must be capable of assisting in their defense and participating in the legal process can be traced to at least the 14 century, when Common Law courts refused to proceed against defendants considered to be incompetent as a result of mental disorder or mental defect (Poythress, Bonnie, Monahan, Otto, & Hoge, 2002). & Yes. criteria in competency to stand trial assessments should be relevant to the defendant's situation and to the legal definition of competency. In fact, this approach is embraced by the AAPL Task Force in its summary statement about competency measures: Instead, psychiatrists should interpret results of testing in light of all other data obtained from clinical interviews and collateral sources (Ref. American . The defendant is & able to carry on a normal conversation and answer questions appropriately. Cognitive deficits should also be a focus of an evaluation. The foregoing discussion focused on the congruence between competency measures and the Dusky standard. Competence is also a consideration when a defendant chooses to represent him or herself (referred to as proceeding pro se). Specifically, they suggested that to Representative items are Jack felt that the judge _____ or If the jury finds me guilty _____. Each item is given a score of 2 (competent), 1 (questionable), or 0 (incompetent), and scores below 20 would identify possible incompetent defendants, who would then be referred for further assessment, usually in an inpatient setting. In their studies of reports of competency evaluators in Utah, Skeem et al. When that spot is completed, then Ctrl + j moves the cursor to the next cursor stop where dictation is entered. & He denies any history of significant illness such as & cancer, & heart disease, & diabetes, or & epilepsy. The CAST-MR comprises 50 verbally administered questions that assess basic legal concepts, skills to assist defense, and understanding of case events. For scientific validity to be relevant, it must be sufficiently tied to the facts of the case (Ref. After I enter his answer at that cursor stop, I type Ctrl + j, and so forth. Serially subtracting $7.00 from $100, 93, 86, 79, 72, 65 &. Competency to Stand Trial and Mental Illness (DHEW Pub. Similar findings were found in an Alabama study by Zapf, Hubbard, Cooper, Wheeles, and Ronan (2004), who examined reports in forensic facilities and found that while the majority of them covered factual understanding issues, over 90% offered no information about the appreciation or reasoning abilities of the defendants being evaluated for competency. He & denies feeling slowed down. Bonnie and Grisso (2000) estimated some 60,000 annual evaluations, a figure that was a substantial increase over prior estimates (Hoge et al., 1997). If someone said to the defendant that the grass is always greener on the other side of the fence, that person would be trying to say, &. The Jackson decision raises the issue of whether it is possible to predict which incompetent defendants are unlikely to be restored. Researchers and practitioners are likely to find this a valuable resource in evaluating forensic measures. Bonnie noted that prohibiting incompetent defendants from proceeding with trial is essential to preserve the dignity of the judicial process, the reliability or accuracy of the courts verdict, and the autonomy of defendants to make key decisions about their case. This section will provide a brief overview of possible FAIs that clinicians can use when evaluating competency. The defendant's behavior in today's examination was & calm and cooperative. For the third scale (CWC), it is theoretically possible to score in the severe range based only on ratings of 2. &. The patricidal tendency of researchers to diminish the contributions of seasoned practitioners may play a relevant role. The IFI was revised (Golding, 1993) and in its current form, the Interdisciplinary Fitness Interview-Revised taps 31 relatively specific psycholegal abilities organized into 11 global domains, addressing issues such as the iatrogenic effects of psychotropic medications (Riggins v. Nevada, 1992), a defendants decisional competency to engage in rational choice about trial strategies, decisions to represent oneself, and decisions about whether to plead or go to trial. He is & able to sit still. The MacCAT-CA also includes several items about defendants' views and actions toward their attorneys. The number of legs on a horse is, & 4. If the defendant is found guilty, the maximum sentence he faces is, &. Treatment staff reported that his condition precluded his understanding the nature of charges against him and participating in his defense, and stated that there was no treatment that could help Jackson learn minimal communication skills. Does the defendant have the ability to appraise the legal defenses available to him? While cautioning that the CAST-MR is only one part of the competence assessment, we note that the mean total score for the defendants with mental retardation was 25.6 for incompetence versus 37.0 for competence. Although the CST appears to be a reliable instrument (Nicholson et al., 1988; Randolph, Hicks, & Mason, 1981), concerns have been raised about its high false-positive rate because the majority of defendants screened as incompetent are later found to be competent in subsequent evaluations (Nicholson & Kugler, 1991). Unlike the MacCAT-CA, which restricts its normative data to presumably competent participants, the ECST-R includes both competent and incompetent defendants in its normative group, thereby mirroring the entire population that it is intended to evaluate. Evaluations for competency to stand trial are distinguished from other areas of forensic consultation by their long history of standardized assessment beginning in the 1970s. The CAST-MR test manual provides little guidance for making classification of competent and incompetent defendants with mental retardation. As part of a special issue of the Journal on evidence-based forensic practice, this article examines three published competency measures: the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), the Evaluation of Competency to Stand Trial-Revised (ECST-R), and the Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR). Competency to stand trial is a concept of jurisprudence allowing the postponement of . List the sources of the data on which the evaluation is based. The defendant does have criminal charges pending against him. He was represented by counsel and convicted of the attempted murder and battery charges. Gatowski and her colleagues,17 in a national study of 400 state trial court judges, found that most judges (i.e., ranging from 88% to 93%) believed that the individual Daubert guidelines were useful in deciding the admissibility of scientific evidence. His appetite is & good. Beyond this critically important discussion, the relevance of a measure must also consider its appropriateness for the intended population (i.e., impaired defendants). This survey of forensic mental health experts studied potential PSC criteria. The minimum sentence he faces is, &. The template includes the standard elements of competency and criminal responsibility reports. Calculated as the standard error of measurement (SEM), each competency measure produces small SEMs, indicating a high level of accuracy (Table 2). Researchers sometimes overestimate the ability of their standardized measures to evaluate complex clinical constructs. & Yes. It describes relevance as a matter of fit; scientific validity is not sufficient unless it fits the specific matter under consideration by the trial court. The attorney on the other side of the defendant's case is called, &. While the bulk of the article addresses research findings, the next two paragraphs outline the equally important topic of professional attitudes. He is & able to put his thoughts into words. The Presidents in reverse order are, Bush, Clinton, Bush, &. Forensic practitioners should decide which is most relevant to a particular competency evaluation. For example, after asking the examinee if he has criminal charges against him, I type his answer at the ampersand. can clearly be applied to forensic practice regarding important determinants for the acceptance of evidence-based practice. If they do not have the capacity in any of these areas, they may be found incompetent to proceed and the judicial proceedings are suspended until they are treated and competency is restored. recognized in the trial process. The ECST-R manual provides extensive data on the accuracy of its measurements. As some5 have noted, however, these concerns encompass A comprehensive review of the Daubert decision is far beyond the scope of this article, given the hundreds of scholarly works in the psychological, medical, and legal literatures. It is my judgment that this defendant presently & has the ability to assist in the preparation of his defense regarding the criminal action against him. Because the law has provided only vague criteria, incompetency to stand trial has tended to be equated with mental illness by both psychiatrists and members of the legal profession. The nonpsychiatric medications the defendant presently takes are &. The distance from & to & is &. He & denies feeling worthless. The difference between a bird and an airplane is &. Many patients are . Religion does & play an important part in the defendant's life. Regarding the MCMI-III, Rogers and his colleagues22 questioned the admissibility of any measure when the error rate substantially exceeded its accuracy. Parts that need no modification can be skipped. Items are scored based on the ability of the individual to relate information about his or her case in an accurate and understandable manner. While competency to stand trial is the most commonly used term, competency in the criminal trial process encompasses all stages of participation in the legal process, including pretrial, trial, sentencing, and appeals. As previously noted, a rating of 4 shows substantially impaired competency by itself, whereas a rating of 3 shows deficient competency but does not, by itself, show substantially impaired competency. He & denies that others listen in on his thoughts. Evidence-based practice cannot be achieved without standardization. Table 1provides a summary of the specific scales on competency measures with descriptive data regarding their type of inquiry and the complexity of their questions. The CAST-MR provides the broadest appraisal of factual understanding with inquiries about common legal terms and basic information regarding verdicts and sentencing. The shape of the (rectangular) picture frame on the wall is, & rectangle. Each item is rated on a 3-point scale ranging from no impairment to definite or serious impairment. Brown v. State 1960 The criteria for determining competency to stand trial in Georgia was handed down by the Georgia Supreme Court in Brown v. State (1960) two months before Dusky ruling. The presence of mental illness or intellectual deficit is a key component of a competency evaluation, but mere presence of mental illness or deficit is not sufficient for a determination of incompetence. The Appendix illustrates a template for a written report on competency to stand trial and criminal responsibility. This article has provided an overview of forensic assessment instruments that have been developed to guide this process. The defendant did sign a consent allowing me to examine him, release my findings to & you, and record the examination. Prior to my examination of him, I reviewed the several documents & you sent. Clinically significant impairment was designated as deficits at and above 1.5 SD. Murrie, Boccaccini, Zapf, Warren, and Henderson (2008) took a different approach to studying evaluator reliability by examining whether some evaluators find defendants incompetent more often than other evaluators. It is entirely possible, for example, that some defendants with a psychosis or other severe mental illness may nevertheless be able to proceed with their case if the mental illness does not impair the legal abilities necessary to go forward. Professional attitudes are an often overlooked but key component in the acceptance of evidence-based practice. The following are my thoughts regarding this case. The authors argue that an adequate competency assessment should take into account the defendant's ability to consider his available pleas rationally. What happens in a trial is, &. Some of the cursor stops are designed for easy modification. The remainder of this article assumes that practitioners will integrate case-specific (clinical interview and collateral information) with nomothetic (standardized results) data. An important consideration in establishing error rates is whether bogus (e.g., malingered) presentations will be mistaken for genuine incompetency. However, the historical divisions between psychiatry and psychology on the use of standardized assessments are gradually disappearing. They found that for the 17 cases seen by the blue-ribbon panelists, they agreed with the IFI panelists 88% of the time, with the hospital staff 82% of the time, and with the courts 88% of the time, and they concluded that on the basis of these data it would be hard to argue for one criterion definition over another (p. 331). Among the broad array of criticisms, researchers have been singled out as motivated by personal and professional gain.5 An alternative view is that traditionalists are equally motivated to avert criticisms of their current clinical practices by researchers. Likewise, two McCAT-CA scales are also problematic because of their word length: understanding (mean [M] = 45.31 words) and reasoning (M = 39.88 words). The purpose of this study was to develop and validate an instrument for the assessment of competence to stand trial in criminal defendants with mental retardation. The Competency Screening Test (CST) is a screening measure for identifying clearly competent defendants and thus avoiding inpatient evaluations (Lipsitt, Lelos, & McGarry, 1971). The Fitness Interview Test-Revised (FIT-R; Roesch, Zapf, & Eaves, 2006) uses a semi-structured interview format to assess three main areas: (a) the ability to understand the nature or object of the proceedings, or factual knowledge of criminal procedure, (b) the ability to understand the possible consequences of the proceedings, or the appreciation of personal involvement in and importance of the proceedings, and (c) the ability to communicate with counsel, or to participate in the defense. 9, p 592). Evaluators may use psychological tests on occasion when it is thought to be helpful in identifying clinical constructs such as intelligence, psychopathology, or academic achievement. Court outcome is an imperfect criterion as studies show that judges routinely accept the recommendations or opinions of evaluators, with agreement rates of over 90% (Cox & Zapf, 2004; Zapf, Hubbard, Cooper, Wheeles, & Ronan, 2004). (The McGarry criteria are taken from McGarry Al, Curan WJ, Lipsett PH, et al: Competency to Stand Trial and Mental Illness. Once a competency evaluation is ordered, the evaluation itself can take place in a range of settings, including jails, forensic facilities, or if a defendant is released on bail, in an outpatient setting. For instance, interview-based competency measures are typically composed of several dozen relevant constructs that are operationally defined. The FIT-R has been shown to have high inter-rater reliability and validity in studies comparing ratings by psychologists, psychiatrists, nurses, and psychology graduate students, and comparison of judgments based on the FIT-R with institutional-based evaluations of competency (Viljoen, Roesch, & Zapf, 2002a; Zapf, Roesch, & Viljoen, 2001), and high agreement with other competency measures such as the MacCAT-CA (Zapf & Roesch, 2001) and correlations with related constructs such as intelligence and psychosis (Viljoen, Roesch, & Zapf, 2002b; Viljoen, Zapf, & Roesch, 2003). The Supreme Court revisited this issue in the case of Indiana v. Edwards (2008). The competency issue is raised when an officer of the court (defense, prosecution, or judge) has reason to believe there is a bona fide doubt as to a defendants competence. Inquiries can be either case-specific (i.e., the content focuses on the defendant's case) or hypothetical (i.e., the content is unrelated to the defendant's case). An investigation of the construct of competence: A comparison of the FIT, the MacCAT-CA, and the MacCAT-T, Future directions in the restoration of competence to stand trial, Personality Assessment in Clinical Psychology, Psychological Assessment of Older Persons. Researchers and scholars have critically evaluated whether general psychological tests meet the Daubert guidelines for admissibility. Only the parts that require changes need be modified. The following is the information given to me by the defendant regarding his history of use of drugs and alcohol. This was the case in Miles v. Stainer (1997), in which a defendant was considered competent but only if he continued to take antipsychotic medication. The shift to other settings has been driven in part by research showing that opinions about a defendants competence can be made after a relatively brief assessment (see Zapf & Roesch, 2009). The vast majority of defendants are competent to understand the charges against them, appreciate the legal consequences, make decisions about how to proceed with their cases, and able to communicate rationally with their attorneys. Those components retained an average of 6.10 on a 7.00 rating scale of their representativeness. When an elevated score exceeds the benchmark by the confidence interval, the practitioner can testify regarding a very high likelihood that the defendant meets this classification. Evaluations conducted in the legal context should always consider the possibility of malingering since there may be motivation to feign or exaggerate symptoms with the intention of being found incompetent or for establishing an insanity defense later (Vitacco, Rogers, Gable, & Munizza, 2007). 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