An evaluation of procedures for assessing competency to stand trial

In a field experiment involving 120 defendants at Bridgewater State Hospital in Massachusetts, the authors evaluated three instruments for assessing competency to stand trial: the Competency Screening Test (CST), Competency Assessment Instrument (CAI), and Interdisciplinary Fitness Interview (IFI). The CST (a paper-and-pencil test) was administered by a research assistant and scored by trained graduate students. Lawyers, psychologists, and social workers were recruited and trained in the use of the other instruments, then assigned as individuals (CAI) or teams (IFI) to conduct interviews and assess subjects. The performance of the project interviewers was compared against two yardsticks: (1) actual decisions reached by the regular Bridgewater staff, and (2) a consensus of two nationally respected experts who reviewed the cases and formed independent competency judgments. Both the CAI and IFI performed well under these conditions, indicating that one-time interviews by well-trained persons can lead to accurate competency decisions in the majority of cases. The authors conclude that hospitalization for competency assessment is rarely necessary.     

Feigning incompetency to stand trial

The vulnerability of competency to stand trial instruments to malingering was previously unexamined. In this study, the Georgia Court Competency Test (GCCT) was administered to offenders asked to feign incompetency; their results were compared to controls and pretrial defendants (both competent and incompetent). Offenders appeared to be able to simulate incompetency and tended to score lower on the GCCT than their truly incompetent counterparts. For the detection of simulators, a newly developed Atypical Presentation scale for the GCCT showed promise. In addition, several strategies were explored that included simulators' failure of very simple items (i.e., floor effect) and variable success on items of increasing difficulty (i.e., performance curve). Optimal cutting scores are presented for forensic clinicians to screen defendants for feigned incompetency.     

A validation study of the Competency Screening Test

This study was designed to assess the utility of the Competency Screening Test (CST) as a method of determining competency to stand trial. Fifty male residents of a state forensic unit were administered the CST. These residents were later interviewed by the Forensic Team who determined whether they were competent to stand trial. The CST correctly predicted the competency recommendations of the Forensic Team in 82 percent of the 50 cases. These data are consistent with previous research, and suggest that the CST should be further investigated as a preliminary screening instrument in the determination of competency to stand trial.     

Detection of malingering in competency to stand trial evaluations

A simulation design with multiple contrast groups was used to test the effectiveness of two instruments, the Structured Interview of Reported Symptoms (SIRS) and the Georgia Court Competency Test—Mississippi State Hospital (GCCT-MSH) in detecting malingering of competency to stand trial. Thirty simulators were compared with 23 incompetent defendants, 25 competent defendants, 30 offender controls, and 7 suspected malingerers on both instruments. Results revealed that the simulators and suspected malingerers scored significantly higher on all of the SIRS primary scales and significantly lower on the GCCT-MSH than the three comparison groups. The SIRS had an overall hit rate of 97.8% using three or more primary scales as the criterion for malingering. Information concerning the simulator's strategies of deception is presented.     

An Evaluation of Malingering Screens with Competency to Stand Trial Patients: A Known-Groups Comparison

The assessment of malingering is a fundamental component of forensic evaluations that should be considered with each referral. In systematizing the evaluation of malingering, one option is the standardized administration of screens as an initial step. The current study assessed the effectiveness of three common screening measures: the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001), the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2004), and the Evaluation of Competency to Stand Trial-Revised Atypical Presentation Scale (ECST-R ATP; Rogers, Tillbrook, & Sewell, 2004). Using the Structured Interview of Reported Symptoms (SIRS) as the external criterion, 100 patients involved in competency to stand trial evaluations were categorized as either probable malingerers (n=21) or nonmalingerers (n=79). Each malingering scale produced robust effect sizes in this known-groups comparison. Results are discussed in relation to the comprehensive assessment of malingering within a forensic context.     

精神病人受审能力评定标准的制订

目的制订符合中国刑事法律体系的精神病违法者受审能力评定标准。方法根据自己的法医精神病学实践,结合国外已有的标准和中国刑事法律,研究者首先创建了称为“受审能力评定表”的评定工具,然后在实践中运用该工具;最后通过诊断性实验,对该工具的信度、效度及实用性进行了检验。结果该工具的分半信度和同质性信度分别为0.9366和0.9213,工具评定与专家评定的一致性为0.704,除了敏感性为0.6097,其他所有的诊断性指标均大于0.80。结论受审能力评定表具有较好的实用性。     

Restoration of competency to stand trial: Assessment with the Georgia Court Competency Test and the Competency Screening Test

Evaluations of the Georgia Court Competency Test—Mississippi Version Revised (GCCT-MSH) and the Competency Screening Test (CST) have supported their use with pretrial defendants in initial assessment of competency to stand trial. The present study evaluated the efficacy of these measures, as well as the Texas Competency Instrument, with an inpatient sample of defendants involved in a competency restoration program. Both measures were factor analyzed in an attempt to replicate previously identified factor structures. Neither factor structure was replicated; however, a distinct factor structure was identified for the GCCT-MSH. The relationships among sociodemographic variables, clinical variables, current symptomatology, and competency status (as measured by the GCCT-MSH) were evaluated using discriminant function analyses. The best predictors of GCCT-incompetency in this sample are a diagnosis of either a psychotic disorder or a nonpsychotic affective disorder as well as a low measured IQ. Current symptomatology, as measured by the SCL-90-R, was not an effective predictor of competency status.     

A Clinical Study of Competency to Consent to Hospitalization and Treatment in Geriatric Inpatients*

Abstract: This study used a Competency Questionnaire modified for medical surgical patients (CQ‐Med). Twenty‐nine patients (ages 65–94 years) admitted to a geriatric medicine unit were studied. Along with the CQ‐Med, patients were administered several WAIS‐R subtests, the Blessed Dementia Scale (BDS), and Mini Mental State Exam (MMSE). Additionally, a blind forensic evaluation for competency to consent to hospitalization and treatment was performed for the purpose of validation of the CQ‐Med. Results of the study found that, as expected, increased age was correlated with decreasing performance on the CQ‐Med and decreased findings of competence by clinical exam. However, there was great variability within each age group, demonstrating individual differences in the progress of declining competency. CQ‐Med scores also correlated well with the WAIS‐R subtest raw and scaled scores. Scores on the MMSE and BDS were less well correlated. The CQ‐Med may be a useful adjunct in assessing declining competency in geriatric patients.     

Competency to be a witness: a major child forensic issue

Competency of a child witness is a changing area of case law and forensic psychiatry practice. This article summarizes the basic legal and clinical aspects of determination of competency of the child witness to testify. Guidelines for such forensic examinations are detailed. Case examples are described that highlight major clinical issues in these examinations.     

Domains of competency to stand trial

Attempts to improve the clinical rigor of competency to stand trial evaluations have resulted in the development of several psycholegal measures. Among the most widely used of these measures are the Competency Screening Test (CST), the Fitness Interview Test (FIT), and the Georgia Court Competency Test—Mississippi State Hospital Revision (GCCT-MSH). To examine the theoretical domains of the competency construct as assessed by these measures, a series of exploratory factor analyses were performed combining previously reported data on the FIT and GCCT-MSH with a new outpatient sample of 353 court referrals. For the CST, data from a previous sample were compared to the original validation study. Of the three measures, only the GCCT-MSH showed evidence of stable, independent factors. A comparison of the GCCT-MSH to theDusky standard suggested a need to further develop empirical measures to better represent underlying constructs related to the defendant-attorney relationship and defendant's participation in his or her defense.     

精神病犯服刑能力评定量表研究

目的制订符合中国法律体系的精神病犯服刑能力评定量表。方法根据鉴定实践,结合中国法律,研究者首先创建了称为“精神病犯服刑能力评定量表”的评定工具,然后再回顾性运用该工具,通过诊断性实验,对该工具的信度、效度及实用性进行了检验。结果该量表同质性信度为0.8779,量表评定与专家评定一致性为0.909,除了阴性似然比为0.0683,其他诊断性指标均大于0.80。结论精神病犯服刑能力评定量表具有较好的实用性。     

THE USE OF PSYCHOLOGICAL TESTING IN CHILD CUSTODY EVALUATIONS

Evaluation of families for purposes of assisting the court in making decisions about custody is perhaps the most complicated forensic evaluation. Mental health professionals conducting such evaluations must ensure that their evaluations validly assess areas of concern deemed relevant by the judiciary and legislature. Evaluators sometimes use psychological measures in the evaluation process, and in recent years, a number of tests designed specifically for use in child custody evaluation contexts have been developed. Because some published tests do not meet basic professional standards, child custody evaluators should carefully review any test and its supporting documentation before including it in their examination procedures. In this article, the authors discuss the rationale for using psychological tests in child custody evaluations, describe current testing practices, review and critique contemporary custody evaluation instruments, and offer a template for mental health professionals to use when considering use of a particular test.     

Use of a television crime-drama series to promote legal understanding in mentally ill, incompetent defendants: a pilot study

Videotaped material is used for educational purposes in many areas of medicine. In forensic facilities, programs designed to restore competency to stand trial (CST) in incompetent, mentally ill defendants have utilized videotaped courtroom proceedings as learning tools. This pilot study reviewed the progress of incompetent defendants (N = 15) who participated in a program that utilized videotaped segments of the television crime-drama "Law & Order", among other techniques, to promote CST in individuals deemed unfit to stand trial. The authors hypothesized that participation in at least one cycle of the Competency Restoration Group (CRG)'s curriculum would be associated with improvement in the areas of understanding, reasoning and appreciation. In order to assess whether the group was beneficial to the patient's treatment goal of competency restoration, patients were screened using the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) prior to starting the group and after completing a cycle of the group's curriculum. The Wilcoxon signed ranks test was employed to analyze the results from the pre- and post-group MacCAT-CA testing. The tests yielded significant (p < 0.005) post-test differences in the hypothesized direction for each of the three subsections: Understanding, Reasoning, and Appreciation as well as a significant post test improvement in the total MacCAT-CA scores. These results suggest that a didactic program, using a popular crime drama series, can be effective in facilitating learning in competency restoration programs. Limitations of this study include its lack of a control group and small population.     

Neuropsychological Evaluation of Competency in Criminal Forensic Contexts

Competency issues can arise at any point beginning with an individual’s initial interaction with the justice system until the same individual is facing the imposition of a sentence. Neuropsychologists are commonly introduced to the criminal arena through referrals related to competence issues, and much can be gained from understanding how cognitive and psychological functioning can impact an individual’s ability to understand and appreciate current circumstances. The present article focuses on three less frequently explored domains of competency, including competence to waive Miranda rights, competence to consent to or refuse treatment, and competency for execution. Pertinent diagnostic considerations are discussed, and relevant legal standards and ethical issues are described. Lastly, evaluation procedures for each type of competence evaluation are discussed. This primer on competency assessment offers a review of the current practices, and limitations, in this burgeoning intersection of law, brain–behavior relationships, and psychology.     

Forensic Applications of the Miller Forensic Assessment of Symptoms Test (MFAST): Screening for Feigned Disorders in Competency to Stand Trial Evaluations

Forensic evaluations must systematically assess malingering and related response styles. In the criminal forensic domain, competency to stand trial evaluations are the most common referrals. Effective screens for feigned incompetency would be valuable assets for forensic evaluations. This study evaluates the effectiveness of the Miller Forensic Assessment of Symptoms Test (MFAST) as a screen for feigned incompetency. Using a simulation design, the MFAST was tested on jail and competency-restoration samples. Most notably, recommended MFAST cut score (6) was useful for the identification of feigning cases in competency evaluations. Recommendations for forensic practice, including the advantages and disadvantages of systematic screens, are discussed.     

基于胜任力模型的公务员选拔机制探析

随着社会对高素质公务员期望的不断提升,以考试录用为主的公务员选拔制度亟待创新。本文探索将胜任力模型引入到公务员选拔机制中,对公务员选拔前胜任力模型的构建、公务员选拔的胜任力评价与反馈、公务员选拔应用胜任力模型应注意的事项进行了探讨,以期为综合评价公务员选拔对象的能力素质、合理配置公务员任职岗位、促进公务员个体职业素质的全面提高提供思路。     

Symptom Validity Testing in Claimants with Alleged Posttraumatic Stress Disorder: Comparing the Morel Emotional Numbing Test, the Structured Inventory of Malingered Symptomatology, and the Word Memory Test

In independent medical examinations, unjustified claims of posttraumatic stress disorder (PTSD) are to be expected at an increased rate. In a prospective study, consecutive cases of patients claiming PTSD who underwent independent neuropsychiatric evaluation were analyzed. For 61 adult patients, results of three symptom validity tests (Morel Emotional Numbing Test, Structured Inventory of Malingered Symptomatology, and Word Memory Test) were available. Seventy percent of all claimants showed probable negative response bias in at least one of the three tests, 25% in all three tests. High probability of negative response bias was associated with symptom overreporting and demonstration of cognitive deficits in performance tests. The results indicate that high rates of uncooperativeness must be expected in civil forensic patients with claimed PTSD. A multi-method approach to the assessment of response distortion in PTSD claimants is indicated.     

Grounds for professional abstention in capital cases

This article responds to Brodsky's critique of the author's views on forensic evaluation of capital defendants and condemned prisoners. It discusses whether objective assessment is possible in a context where personal values are so strongly held, and whether the criteria for assessing competency of condemned prisoners are too vague to permit objective application. And it concludes that evaluations of competency of condemned prisoners to waive opportunity for leniency are more problematic than evaluations of “competency to be executed”.     

Evaluating expertise in forensic anthropology

The medicolegal system relies on the ability of experts and non-experts alike to make judgments about expertise and use those judgments to reach consequential decisions. Given the lack of standard criteria, mandatory certification, or licensure for establishing expertise required to practice forensic anthropology and testify as an expert witness, we sought to understand how individuals assess and identify expertise in forensic anthropology by using a social science tool called the Imitation Game. This tool assesses immersion in a specific area of study via discourse, with the premise that some individuals lacking expertise themselves imitate or attempt to pass as experts. For this project we recruited volunteers with varying expertise in forensic anthropology to participate in interviews which asked questions about the practice and structure of the discipline. Those interviews were transcribed, anonymized, and evaluated by other recruited individuals with varying expertise in forensic anthropology. Results found that judges who were experts in forensic anthropology performed better than non-expert judges in determining who was not an expert in forensic anthropology based on their anonymized responses; however, nearly half of the non-experts were still able to pass as experts in forensic anthropology. The difficulties in assessing expertise based on discourse interactions demonstrates the value and need for well-defined credentials and mandatory certification to practice forensic anthropology. This study demonstrates that accurately identifying expertise in forensic anthropology may be challenging for both experts and non-experts, especially when relying solely on interactional expertise rather than formal assessments of competency which directly elucidate contributory expertise.     

Developmental incompetence to stand trial in juvenile courts

Juveniles' competency to participate in delinquency proceedings has received increased attention in recent years. Developmental incompetence, whereby juveniles' incompetency is based upon their immaturity, as opposed to a mental disorder or developmental disability, is an evolving and important aspect of this area of law. The following paper reviews theories used to support the notion of developmental incompetence, as well as the extant empirical research on juveniles' competency-related abilities. Using a LexisNexis search, statutory and case laws pertaining to juvenile competency were identified across the 50 states and the District of Columbia. Only six states clearly allow developmental incompetence, whereas 17 have laws that do not include developmental immaturity as an acceptable basis of incompetence in juvenile courts. Developmental incompetence is likely to affect a relatively small proportion of juvenile cases, but has important implications for juvenile forensic practice. Recommendations are offered for forensic practitioners conducting this type of evaluation.