Evidence-based practice for evaluation of competency to stand trial cannot be considered without first providing a clinical context and legal framework. Clinically, the movement toward empirically based assessments has created important advances, some limitations, and substantial resistance. 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. 41, p 31). Early evaluators were employed typically in The figures reveal that this is not supported, revealing a flaw in the test. Unfortunately, this approach was unsuccessful for the appreciation scale; the authors simply assigned cut scores to the three categories, based on their own hypotheses regarding delusional thinking. Competency to Stand Trial Evaluation Tests and Screening Instruments Forensic practitioners should supplement the previous analysis with careful reviews from other researchers and scholars. For example, standardized observations of attorney-client interactions would be valuable. I do give you my consent to release this report to any appropriate party. The following is the information given to me by the defendant regarding his legal history. Anderson and Hewitt (2002) reported only an 18% success rate, a finding supported by other studies (Pinals, 2005; Wall, Krupp, & Guilmette, 2003). The Daubert standard provides a legal framework for evidence-based practice in the forensic arena. Reliabilities and Error Rates of the Three Competency Measures. 19,20. The ampersand macro command is easily set up with these steps: In the Press new shortcut key dialogue box, type Ctrl + j (hold Control key while typing j), In the Find What box, tap the ampersand (shift + 7). Especially useful for court reports and subsequent testimony is the 95 percent confidence interval. 37, p S43). For this final project, I will be examining the topic of Competency to Stand trial or (CST). With professional experience and expertise, practitioners can make informed decisions in selecting the appropriate competency measure to evaluate specific competency-related situations. The defendant & denies any history of criminal charges other than the above. The template includes the standard elements of competency and criminal responsibility reports. If the text is deleted, it is highlighted and deleted or is deleted by holding down the delete key. 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. The defendant is & free of psychosis, depression, mania, and confusion. Legally, the concept of fitness to stand trial is fixed and absolute. (1978) as a screening device to screen out those defendants who were clearly competent. As well, assessments of juveniles are increasingly becoming more common, but the issues of concern focus more on developmental factors like maturity (Ryba, Cooper, & Zapf, 2008) rather than mental illness (see Kruh & Grisso, 2009; Roesch & Viljoen, 2016; Warren et al., 2009). As a simple reminder, the CAST-MR has been validated only in defendants with mental retardation; it should not be used for mentally disordered defendants, with or without mental retardation. The defendant related to me in a & normal fashion during today's examination. Therefore, the following analysis examines the construct validity of competency measures in light of their specific applications to defendant categories. Once the issue is raised, the trial court will typically request an evaluation. The colors of the American flag are, & red, white and blue. We do not capture any email address. With reference to forensic concerns, can the concept be empirically tested and does the research have the potential to disprove the conclusion? Because of small sample sizes and large variability, they provide the following caution: only a gross estimate can be made of the degree to which CAST-MR total scores discriminate between groups found to be competent versus those found to be incompetent (Ref. The lower limit for unimpaired persons is 22.38 words. 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). We must tackle directly the professional objections to evidence-based practice. State laws typically do not specify what should be contained in a report, although the Utah statute is a clear exception. An interesting finding was that agreement dropped to 61% in reevaluations of defendants undergoing restoration after being found incompetent. Does the defendant have the ability to plan a legal strategy? Beyond this critically important discussion, the relevance of a measure must also consider its appropriateness for the intended population (i.e., impaired defendants). Advokat, Guidry, Burnett, Manuno-Mire, and Thompson (2012) found that about 25% of their sample were considered not restorable, and noted few differences in terms of clinical diagnosis, substance abuse, intellectual capacity, or type of offense, but they also found that the group restored to competency performed better on the Georgia Court Competency Test and Global Assessment of Functioning scale at both initial and final assessments. It is offered in this way to standardize the elements included and excluded in a report on competency and criminal responsibility. What is the quality of the anticipated manner in which the defendant will relate to his attorney? With regard to calculations, 5 + 6 =, & 11; 5 6 =, & 30; 5 6 =, & 1. Thus, there will be a brief examination of adults and juvenile competency to stand trial. Rather, the MacCAT-CA asks the examinee to consider a hypothetical case about two men (Fred and Reggie) and their involvement in a serious, almost deadly, assault following an altercation while playing pool. It is one of the many educational programs1 and publications that establish the standards for forensic psychiatry reports. Furthermore, evaluators in the past rarely took into account the specific demands of a defendant's case. Competence to stand trial is the phrase that U.S. criminal courts have traditionally used to designate the set of legal concerns that will be discussed herein. As mentioned earlier, this template streamlines the mechanics of writing reports. Almost all incompetent defendants are returned to court within a year, with only a small percentage found to be unresponsive to treatment and thus not restorable. The purpose of this evaluation was to determine his competence to stand trial and his criminal responsibility (insanity) regarding his current criminal charges. An interesting feature of the MacCAT-CA is that that an education component is built into the measure. Although not a perfect match, this last scale is most closely aligned with factual understanding. 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). The macro reduces a command of several keystrokes to one of a single keystroke. Recall of these events is likely to be helpful in competency cases in which amnesia plays a central role. For two scales (FAC and RAC), such ratings would show only moderate impairment, which is typically associated with competent defendants. This historical perspective provides an essential insight: the foundation for evidence-based forensic practice was established while the American Academy of Psychiatry and the Law (AAPL) and its counterpart, the American Academy of Forensic Psychologists, were still in their infancies. Because many defendants are found incompetent due to a psychosis, psychotropic medication is the most frequent type of treatment. Forensic practitioners should decide which is most relevant to a particular competency evaluation. The practice has evolved to assess first if a defendant has a psycholegal ability incapacity and if so, whether the defendants mental status (mental illness or intellectual deficit) is causally connected to that incapacity. The keyboard can be used to get to the next ampersand. Page 6 In her second evaluation, Susan E. Rushing, M.D., J.D., a forensic psychiatrist, found The ECST-R was developed specifically for the purpose of evaluating the Dusky prongs. While the McGarry criteria help to structure CST evaluations, both individual McGarry criteria determinations and ultimate restoration opinions rested largely in evaluators' subjective ratings of defendants' abilities. There was considerable variation in opinions about incompetency, as the rates of incompetency determinations ranged from 0% to 62%. Of mostly historical interest, first-generation measures have limited data on their psychometric properties, a lack of normative data, and poor correspondence to the relevant legal standard.38 Although reviews of these measures are readily available,39 this article focuses more selectively on three published competency measures. A macro command must be programmed so that the computer will respond to the Ctrl + j command. Charles Sell was a dentist who was charged with fraud and attempted murder. We have found the MacCAT-CA especially useful in competency cases in which the defendant has expressed an interest in serving as his or her own attorney. The standardized results, while only one component of competency evaluations, achieve four major objectives by systematizing the evaluation of key points, reducing the subjectivity in recording competency-related information, providing normative comparisons, and demonstrating the inter-rater reliability of observations and findings. & Yes. He refused to consent to treatment, and the treatment facility attempted to force medication involuntarily. When that spot is completed, then Ctrl + j moves the cursor to the next cursor stop where dictation is entered. The role of the defendant's attorney is, &. A small group of 10 professionals (lawyers, administrators, and forensic psychologists) rated the appropriateness of the CAST-MR content. Forensic psychiatry reports that are helpful to courts are clearly written and orderly. The Competency Screening Test (CST) was constructed by McGarry et. 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. Cognitive deficits should also be a focus of an evaluation. Competence for execution is an infrequently raised competence issue, and the reader is referred to Zapf (2016) for a review and discussion. Consistent with the American Academy of Psychiatry and the Law Practice Guideline, it recommends the integration of competency interview findings with other sources of data in rendering evidence-based competency determinations. Reports are commonly prepared by dictating or typing, with standard paragraphs inserted at appropriate places. The items are scored on a 3-point scale with a score of 2 indicating full understanding of the item. With Daubert used as the conceptual framework, this section examines competency measures as evidence-based practice. Helpful reports give the court unambiguous conclusions with which it can either agree or disagree. The sovereign citizen beliefs held by the defendants were identified from the court reports, and each element was used as a search term on Google, to find additional information about each belief. In Indiana v. Edwards (2008) the U.S. Supreme Court held that a higher standard may be required for pro se competence (PSC) than for competence to stand trial (CST), but provided little guidance for the trial court judge. The MacCAT-CA is composed of 22 items that are organized into three scales: understanding (8 items), reasoning (8 items), and appreciation (6 items). The method makes use of currently available computer technology. Does the defendant have an appreciation of the range and nature of the possible penalties he faces? If no text modification is needed, then Ctrl + j is typed again to move the cursor to the next ampersand. Basic Legal Concepts is the one most closely aligned with Dusky's factual understanding, whereas skills to assist defense uses hypothetical examples to evaluate the consult-with-counsel prong. 2324). The defendant is able to repeat & 7 digits forward and & 4 digits backward. For feigning, the ECST-R uses Atypical Presentation (ATP) scales that are organized by content (i.e., ATP-Psychotic and ATP-Nonpsychotic) and purported impairment (i.e., ATP-Impairment). The purpose of these competency measures is to provide standardized data to assist practitioners in reaching empirically based conclusions about elements of competency to stand trial. Be that as it may, a brief disclosure from the first author is in order. The ECST-R demonstrates high internal consistency, with alpha coefficients for the competency scales ranging from .83.89 and alpha coefficients for the feigning scales ranging from .63.87. Obviously, the group of hospitalized legally incompetent defendants should theoretically evidence clinically significant impairment, given their combined psychiatric and legal status. The role of the prosecuting attorney is &. Mental Health and Legal Implications of Access to the Outdoors during Incarceration, Victim Intoxication and Capacity to Consent in Sexual Assault Statutes across the United States, Preserving Immunity for Reporters of Medical Child Abuse, by The American Academy of Psychiatry and the Law, Appendix: Forensic Psychiatry Report Template, American Academy of Psychiatry and the Law. The method makes use of currently available computer technology. Does the defendant manifest self-serving motivation or self-defeating motivation? As summarized in Table 2, trained practitioners are able to achieve a high level of inter-rater reliability on each measure, with exceptional estimates for the CAST-MR (r = 0.90) and ECST-R (r = 0.93 and 0.996). The mouse can be used to access the macro command. 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. The feigning scales were developed by using two primary detection strategies: rare symptoms and symptom severity. If I can address any further issues for you, or clarify any questions, I will be glad to do so in writing or on the record. Daubert reviews have also considered several forensic measures for which the adequacy of their psychometric properties has been debated: competency to confess measures23,24 and the Mental State at the Time of the Offense scale.25,26. 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