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EVALUATOR CHALLENGES IN JUVENILE COMPETENCY EVALUATIONS: REPORT WRITING & ATTAINMENT RECOMMENDATIONS IVAN KRUH, PH.D. FORENSIC & CLINICAL PSYCHOLOGY –

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Presentation on theme: "EVALUATOR CHALLENGES IN JUVENILE COMPETENCY EVALUATIONS: REPORT WRITING & ATTAINMENT RECOMMENDATIONS IVAN KRUH, PH.D. FORENSIC & CLINICAL PSYCHOLOGY –"— Presentation transcript:

1 EVALUATOR CHALLENGES IN JUVENILE COMPETENCY EVALUATIONS: REPORT WRITING & ATTAINMENT RECOMMENDATIONS IVAN KRUH, PH.D. FORENSIC & CLINICAL PSYCHOLOGY – OSSINING, NY DSAMH Annual Forensic Examiner Training October 17, 2013

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3 Competency to Proceed – Utah Law Juvenile Court Act (Chapter 6) 78A-6-105(30). Definitions. Not competent to proceed means that a minor, due to a mental disorder, intellectual disability, or related condition as defined, lacks the ability to (a) understand the nature of the proceedings against them or of the potential disposition for the offense charged; or (b) consult with counsel and participate in the proceedings against them with a reasonable degree of rational understanding.

4 Competency to Proceed – Utah Law Juvenile Court Act (Chapter 6) 78A (7). Juvenile Competency. In conducting the evaluation and in the report determining if a minor is competent to proceed as defined in Subsection 78A-6-105(30) the examiner shall consider the impact of a mental disorder, intellectual disability or related disorder on a minors capacity to: (a) comprehend and appreciate the charges or allegations; (b) disclose to counsel pertinent facts, events, or states of mind; (c) comprehend and appreciate the range and nature of possible penalties, if applicable, that may be imposed in the proceedings against the minor; (d) engage in reasoned choice of legal strategies and options; (e) understand the adversarial nature of the proceedings; (f) manifest appropriate courtroom behavior; and (g) testify relevantly, if applicable.

5 Conceptualizing Competency to Proceed Several models to operationalize legal standard A four factor general model summarizes them Factual Understanding Basic, concrete knowledge of the legal process Rational Appreciation Accurate beliefs about what is understood about court Assisting Counsel Ability to participate with and meaningfully aid defense counsel in developing and presenting the defense Legal Decision Making Ability to consider legal alternatives and reach adequately contemplated legal choices

6 Evaluation Model (Grisso, 2003) Functional Are there deficits? Causal What is their cause? Contextual How will any deficits impact this defendant in their case? Conclusory Are the deficits adequately impairing to meet the legal test? Remedial (Attainment) Can the deficits be remediated?

7 Report Writing Evaluator Challenges in Juvenile Competency Evaluations

8 Forensic Evaluation Reports Everything of importance to forensic psychological assessment culminates in the experts report. (Gagliardi & Miller, 2007, p. 539).

9 Primary Purposes of Forensic Evaluation Reports Inform attorneys and legal decision-makers so that sound legal decisions can be reached. Create a legal record Current Case Judicial Assessment of Veracity of Conclusions Informs Attorney Decision to Challenge Conclusions If so, allows for Meaningful Cross-Examination Structures Direct Examination Reference Resource for Examiners in Testimony Appellate Process Future Cases Examinee is Involved In

10 Primary Purposes of Forensic Evaluation Reports The Forensic Audience Forensic evaluations are consumed by others who may have no background in mental health Document must be understood by legal professionals and by general public Greater need to educate – on clinical issues and sometimes even legal issues! If attorneys are confused, issues may not be addressed well, or at all, in court

11 Secondary Uses of Forensic Evaluation Reports Reduce the need for expert testimony Professional record of potential clinical value Mechanism for examiners analysis Modeling for professional colleagues

12 High Quality Forensic Evaluation Reports Report Writing

13 Common Report Writing Errors (Grisso, 2010) Reviewed reports of ABPP Applicants failed by the expert panel reviewing their work 36 psychologists / 62 reports Psychologists already passed in depth written exam Identified Top 10 List of most common errors ports.pdf

14 Common Report Writing Errors (Grisso, 2010) #10: Improper test uses Use of inappropriate tests Misinterpretation of test data #9: Language problems Use of jargon lacking meaning to judges & juries Use examples or descriptions to illustrate #8: Over-reliance on a single source of data Did not pursue corroborating sources of information when they were needed

15 Common Report Writing Errors (Grisso, 2010) #7: Data and interpretation mixed Reader unable to differentiate fact and inference #6: Inadequate data The referral question, case circumstances, or final opinion required additional types of data that were not obtained, were not reported, and for which absence was not explained. #5: Failure to consider alternate hypotheses Data could support alternative interpretations, but report did not explain how they were ruled out

16 Common Report Writing Errors (Grisso, 2010) #4: Irrelevant data or opinions Data and/or opinions included in the report were not relevant for the referral questions Violates due process, self-incrimination, and/or dignity #3: Organization problems Information was presented in a disorganized manner (lacked a reasonable logic for its sequence) #2: Forensic purpose unclear The legal standard, legal question, or forensic purpose was not stated, not clear, inaccurate, or inappropriate Recommendation: Quote the relevant statute

17 Common Report Writing Errors (Grisso, 2010) #1: Opinions without sufficient explanations Major interpretations or opinions were stated without sufficiently explaining their basis in data or logic

18 Keys to High Quality Forensic Mental Health Reports (Grisso, 2008; 2012) Relevance Speaks directly to the question asked by the court – and no more. Credibility Explains why the reader should believe the examiner. Accurate and Objective Factual Basis Expertise on Issues at Hand Facts and Opinions are Distinguished Links Made Between Facts and Opinions to Explain Opinions Rejection of Competing Opinions Also Explained Clarity Is written clearly so as to be understood by the reader. Writing Style Sequencing & Organization

19 Clarity: Writing Style Avoid or explain jargon and colloquialisms Write scientifically, not over-dramatically Avoid language that suggests a bias Use quotes liberally – let the source(s) speak Clearly identify sources for facts Clearly differentiate facts and opinions Write in a manner that is readable (Grisso, 2008) Use words of fewest syllables (utilize > use; necessities > needs) Sentences of words 8 th or 9 th grade reading level Use active voice, not passive Avoid typos, errors, and grammatical mistakes!

20 Clarity: Organization Report Writing

21 Forensic Report Organization Introductory Material Why the examiner conducted this evaluation Identifying and referral information Legal question(s) being addressed Informed Consent / Notification of Rights Methods Used and Sources Relied Upon What the examiner did to conduct the evaluation What the examiner wanted to do, but was unable Description of how this information was obtained Identify source(s) – and credibility of source(s)!

22 Forensic Report Organization Observations, Assessment Results & Other Data What the examiner discovered by conducting the evaluation Relevant mental states, capacities, abilities, knowledge, &/or skills relevant to the legal question Opinions What the findings of the evaluation mean in relation to the reason for the evaluation Proposed causal connection between facts obtained and the legal question Interpretations & Conclusions Limits of the Interpretations & Conclusions If necessary, address different versions of the facts

23 Juvenile Competency to Proceed Report Organization Identifying Information & Evaluation Referral Juvenile: Name; Date of Birth; School Grade; Case # Evaluation: Date Interviewed; Date of Report Referral Question: Specific Charges; Referral Source; Reason for Competency Concerns Notification or Preparation of Participants Contents of Notification; Youths Understanding of Notification; Others Understanding of Notification; Signing of Notification Form(s) Scope & Process of Evaluation Specific Issues of Concern; Examiners Understanding and/or Conceptualization of Competency

24 Juvenile Competency to Proceed Report Organization Procedures or Database or Information Sources Interview of Youth: Date; Duration; Location; Conditions Psychological Testing: Test Name; Date Administered; Subject of Administration Records Reviewed: Type; Source; Date Span Interviews Conducted: Type; Subject; Date(s); Duration Validity Concerns : Data Source; Specific Concerns; Management of Concerns Unobtained Data: What was Pursued and Not Obtained; Why it was Pursued; Limits Caused by No Access

25 Juvenile Competency to Proceed Report Organization Data Then Opinions Model Clinical and Developmental Data Competence Data Functional, Causal, Contextual, Conclusory, & Remedial Opinions Clinical Then Forensic Model Clinical and Developmental Data Mental Health and Diagnostic Opinions Competence Data Functional, Causal, Contextual, Conclusory, & Remedial Opinions Opinion And Supporting Data Model Functional Opinion & Supporting Data Causal Opinion & Supporting DataRemedial Opinion & Contextual Opinion & Supporting DataSupporting Data Conclusory Opinion & Supporting Data

26 Juvenile Competency to Proceed Report Organization Background (Clinical and/or Developmental) Relevant History: Family; Early Development; Trauma; Medical; Academic; Social/Recreational; Behavioral; Legal; Mental Health Mental Status Exam: Appearance; Attitude; Motor Functioning; Speech and Communication; Cognition; Thought Process; Affect Current Mental Health Symptoms/Domains of Immaturity Psychological Test Results: Past Testing; New Testing Opinions (Clinical and/or Developmental) Summary of Clinical and/or Developmental Data Diagnoses Assigned and Rationale for Each Diagnoses Ruled out and Manner in Which Ruled Out Domains of Developmental Immaturity

27 Juvenile Competency to Proceed Report Organization Competence to Proceed Data Dusky: Capacity to Factually Understand; Capacity to Rationally Understand; Capacity to Rationally Assist Juvenile Adjudicative Competence Interview (JACI): The Juvenile Court Trial and Its Consequences; Roles of the Participants; Assisting Counsel and Decision Making; Participation at a Juvenile Court Hearing Utah Statute: Comprehend and appreciate the charges or allegations; Disclose to counsel pertinent facts, events, or states of mind; Comprehend and appreciate the range and nature of possible penalties; Engage in a reasoned choice of legal strategies and options; Understand the adversarial nature of the proceeding; Manifest appropriate courtroom behavior; Testify relevantly.

28 Juvenile Competency to Proceed Report Organization Competence Opinions or Competence Conclusions or Competence Interpretations Functional: Summary of Competence-Related Abilities Causal: Clinical & Developmental Causes of Abilities Contextual: Potential Consequences of Deficit Conclusory: Competence Opinion Includes Rationale for Rejecting Alternative Opinions Remedial: Potential for Remediation (Attainment)

29 Utah Juvenile Competency Evaluation Report Template Report Writing

30 Forensic Report Templates Can ENHANCE REPORT ORGANIZATION Serve as a Memory Aide for Best Practices Enhance Report Writers Efficiency Plugging in new information Enhance Report Readers Efficiency Finding information Enhance Report Quality Forces thinking about key issues

31 How To Best Use Templates Templates are Suggested Guides Templates offer a Common Starting Point Templates are Never Written in Stone Templates are Not Intended to Eliminate Evaluator Style of Expression or Creativity Templates are Intended to Assist the Evaluator, Not Limit the Evaluator

32 Use of the Template Text Fields Notes to Evaluator (Bracketed and Italicized)

33 Headings

34 Reason for Referral

35 Summary of Opinions Clinical Summary Diagnostic Opinions

36 Summary of Opinions Opinions About Competency to Proceed

37 Summary of Opinions Opinions About Attainment of Competency

38 Evaluation Data Explanation of Evaluation Procedures and Process Interview(s) of Juvenile Assessment(s) of Juvenile Parent Report Legal Information Additional Information

39 Evaluation Data Statement of Forensic Warning Forensic Evaluator vs. Traditional Mental Health Prof Court is the client. Recipients of report. Juvenile and Family not recipients Report will be used to help determine Competency Court and/or DHS could use in other ways. Evaluator may testify in court Juveniles statements cannot be used to incriminate Mandatory reporting requirements Right to refuse participation despite mandatory evaluation Participation assumes assent to be audio or video taped

40 Evaluation Data Statement of Forensic Warning

41 Evaluation Data Pertinent Developmental & Psychosocial History Family History Developmental History Trauma History Medical History Academic History Psychosocial History Behavior History Delinquency History Mental Health History

42 Evaluation Data Pertinent Developmental & Psychosocial History

43 Evaluation Data Current Mental Status General Presentation Psychomotor Activity and Speech Behavior Mood, Emotions and Affect Thought Process and Perceptual Issues Cognition and Intelligence

44 Evaluation Data Assessment of Response Style Psychological Testing Past Testing Current Testing

45 Evaluation Data Competency-Specific Interview Capacity to Understand the Nature of the Proceedings Against Them With a Reasonable Degree of Rational Understanding Consult with Counsel and Participate in the Proceedings Against Them with a Reasonable Degree of Rational Understanding 1. Capacity to Comprehend and Appreciate the Charges or Allegations 4. Capacity to Disclose to Counsel Pertinent Facts, Events & States of Mind 2. Capacity to Comprehend and Appreciate the Range and Nature of Possible Penalties, if Applicable, that may be Imposed in the Proceedings Against the Juvenile 5. Capacity to Engage in a Reasoned Choice of Legal Strategies and Options 6. Capacity to Manifest Appropriate Courtroom Behavior 3. Capacity to Understand the Adversarial Nature of the Proceedings 7. Capacity to Testify Relevantly, if applicable

46 Evaluation Data Competency-Specific Interview

47 Thoughts??

48 Attainment Recommendations Evaluator Challenges in Juvenile Competency Evaluations

49 Juvenile Competency Evaluation Model (Grisso, 2003) Functional Are there deficits? Causal What is their cause? Contextual How will any deficits impact this defendant in their case? Conclusory Are the deficits adequately impairing to meet the legal test? Remedial (Attainment) Can the deficits be remediated?

50 Breaking Down the Remedial (Attainment) Question What deficits were identified during the evaluation that yielded the opinion of incompetence? What is the identified cause(s) of each deficit? What intervention(s) offer the best possibility of remediating those deficits? How long is successful intervention expected to take? How does that fit with statutory time-frames? What is the likelihood of successful attainment of each deficit? What is the overall likelihood of successful attainment?

51 Data Useful in Answering the Remediation Questions The Clinical and Empirical Literature The Youth: Current Functioning Past Response(s) to Intervention(s) The Nature of Available Attainment Services

52 The Clinical and Empirical Literature Data Useful in Answering the Remediation Questions

53 Clinical Literature Juvenile Competency Remediation Certain sources of CST deficits decrease the likelihood of successful attainment: Normal Developmental Immaturity Delayed Development Disorders That Are Less Responsive to Treatment Intellectual Disabilities Autism Disorders That Require Long-Term Interventions Posttraumatic Stress Disorder Receptive & Expressive Language Disorder Grisso, 2005 Otto et al., 2006 Schouten, 2003

54 Clinical Literature Juvenile Competency Remediation Successful attainment may depend on the area(s) of deficit: Factual Understanding deficits generally more remediable Appreciation, Assisting, and Decision-Making deficits generally less remediable Grisso, 2005; 2013 Peterson-Badali & Abramovitch, 1993 Viljoen & Grisso, 2007 Viljoen & Roesch, 2007

55 Empirical Literature Juvenile Competency Remediation ~ 70% Returned to Court Competent Success may depend on: Source of deficits: Mental Illness85-90% Intellectual Disability 50-55% Both50-65% Age: Younger Adolescents 60-75% Middle Adolescents75-80% Older Adolescents65-70% McGaha, Otto, McClaren & Petrila, 2001 Warren, DuVal, Komarovskaya, Chauhan, Buffington-Vollum & Ryan, 2009

56 Empirical Literature Juvenile Competency Remediation …developmental and maturity issues that are often focused upon in the discussions of juvenile competence are not as insurmountable as previously thought. …many young juveniles can be remediated in their competence- related abilities if they are provided developmentally tailored educational processes provided in the context of a consistent relationship with trained restoration counselors who meet with youth multiple times a week… …when the youth suffers from mental retardation, at times combined with severe mental illness, the impact of the interventions is far more limited… Warren, DuVal, Komarovskaya, Chauhan, Buffington-Vollum & Ryan, 2009

57 Empirical Literature Juvenile Competency Remediation Studies of time-frames Very brief interventions are rarely successful Cooper, 1997 Viljoen, Odgers, Grisso, & Tillbrook, 2007 Four-Month to Six-Month Period seems Essential: Most youth ordered for attainment successfully attained by 6 months If did not attain by 6 months, likelihood of success drops markedly McGaha et al., 2001 Warren et al., 2009

58 Empirical Literature Child & Adolescent Treatment Review the treatment literature for the disorder or symptoms causing deficits. But Remember, Successful Attainment Does Not Require: Complete remission of relevant symptoms Complete cure of relevant disorders Only adequate improvement to be competent.

59 The Youth Data Useful in Answering the Remediation Questions

60 Youth Factors to Consider in Answering Remedial Questions Youths Current Functioning Developmental Status Current Mental Health Symptoms Current Mental Status Youths Response to Teaching During Evaluation Youths Past Response to Relevant Interventions Pharmacological Psychotherapeutic Educational

61 Available Attainment Services Data Useful in Answering the Remediation Questions

62 Types of Attainment Interventions Pharmacological The Psychotic Adult Model Goal: Remission of symptoms causing deficits Less Straightforward with Childhood Disorders Psychotherapeutic Less Common Model with Adults Goal: Remission of symptoms causing deficits May augment or replace pharmacology There is a literature – should be consulted However: Target in literature is not competence

63 Types of Attainment Interventions Educational The Mentally Retarded Adult Model Goal: Teaching of skills to alleviate deficits More Widely Applicable with Youth Types of Educational Curricula: Traditional Training Curricula Criticized for focus on memorization of facts 21 st Century Training Curricula Multi-Modal and Active-Learning Techniques Systematic and Explicit Instruction Focus on Development of Specific Skills Abstraction Skills with Cognitive Acceleration Communication Skills Training Social Skills Training

64 The Development Dilemma What should be done with youth who need to grow up to become competent? Courts torn on how to handle Some courts allow dismissal of charges Some with prejudice Some without prejudice Some courts continue for extended period, allow the youth to grow up, and revisit after Unique complexity of these issues in Utah

65 The Analysis Answering the Remediation Question

66 Analysis of the Remediation (Attainment) Question What are the specific functional deficits? Factual Understanding Rational Appreciation Assisting Counsel Legal Decision Making What are the sources of those deficits? A treatable mental disorder Weak cognitive skills (normal &/or pathological) Weak psychosocial skills (normal &/or pathological) What types of interventions are most likely to help each deficit? Psychiatric Interventions Psychotherapeutic interventions Educational Interventions How long is intervention expected to require for each deficit? How did youth respond to training efforts during the evaluation? How has youth responded to similar interventions in the past? What does empirical and clinical literature suggest?

67 COMPETENCE DEFICIT SOURCE(S) OF DEFICIT POSSIBLE INTERVENTIONS NEEDED / AVAILABLE TIME-FRAME LIKELI- HOOD OF SUCCESS Poor Appreciation of the Roles of Courtroom Personnel Poor abstraction skills from young age and Borderline IQ Repeated and Multi-modal teaching of concepts and discussion Need: 6 months to 1 yr Available: 6 months to 1 yr. Moderate Poor Legal Decision-Making Inattention and Distractibility from untreated ADHD Pharmacological intervention; Focused training in weighing advantages and disadvantages of decisions Need: 3 months Available: 6 months to 1 yr. High Poor Ability to Engage in Functional Conversations with Attorney Verbal processing and expression deficits from Mixed Receptive and Expressive Language Disorder Speech and Language Therapies Need: At least two months Available: 6 months to 1 yr. Moderate Poor Ability to Understand and Appreciate Plea Agreement Process Poor frustration tolerance with learning new information related to Learning Disability Progressive training in concepts related to plea agreements and repeated exposure until mastery is achieved Need: 3 to 6 months Available: 6 months to 1 yr. High

68 Maintaining Objectivity

69 Communicating Attainment Opinions Answering the Remediation Questions

70 The Forensic Mental Health Divide: Bridging the Legal & Mental Health Worlds Differences of conventions Legal System > Definitive Statements Mental Health > Degrees of Certainty Different expectations regarding advocacy Attorneys advocate for an outcome Mental health professionals advocate for a conceptualization (opinions).

71 The Ultimate Issue Issue Ultimate Issue = the courts legal question Is there a substantial probability that the minor may attain competency in the foreseeable future? Ultimate Issue Issue = unresolved debate about whether forensic clinicians should answer it. AgainstFor Answering is the domain of the judge because the answer is a legal, social, moral matter – not clinical The court is aware any opinion is only advisory. Some laws forbid these opinionsMany laws allow and many judges demand these opinions Current science is not precise enough to answer these questions Science has advanced so that reasonable answers can be given

72 Communicating Attainment Opinions If may be found competent, use if-then statement Opinions based on clinical judgment Explicitly inform the court Remind yourself! Make Opinion Reasoning Explicit Detail different response estimates with multiple deficits Highlight the complexity when relevant Do your best to offer reasonable guidance… …but also be clear about the limits of what can be said Remember: Your interests Courts interests Low Probability of Success may still be an adequately substantial likelihood

73 Recommending the Least Restrictive Appropriate Setting Psychiatric Hospitalization Only if treatment of clinical issue typically warrants it Detention Only if youths risk to community or potential to abscond warrants it Some Unique Scenarios Vast Majority of Youth Treatable in Community

74 Contact Information Ivan Kruh, PhD Forensic & Clinical Psychology P.O. Box 1754 Ossining, NY PH: (845)

75 Opinions Guided by Evaluation Model Functional What deficits, if any, were revealed by the CST interview responses and observations? How can the youths functioning during the evaluation be corroborated and conceptualized? Causal Are symptoms of a mental illness causing CST deficits? Are cognitive deficits causing CST deficits? Are developmental factors causing CST deficits? Are there nonclinical and nondevelopmental explanations for apparent deficits? Are there multiple causes of CST deficits interacting with one another?

76 Opinions Guided by Evaluation Model Contextual Is the case being adjudicated in criminal or juvenile court? How complex will the adjudication be? In what ways? Do the defense attorneys characteristics matter? Do the characteristics of the courtroom matter? Do the youths caregivers make a difference? Conclusory Is an ultimate issue opinion appropriate? Is there additional guidance that can be offered to the court?

77 The Ultimate Issue Issue Ultimate Issue = the courts legal question Is he competent to stand trial? Ultimate Issue Issue = unresolved debate about whether forensic clinicians should answer it. AgainstFor Answering is the domain of the judge because the answer is a legal, social, moral matter – not clinical The court is aware any opinion is only advisory. Some laws forbid these opinionsMany laws allow and many judges demand these opinions Current science is not precise enough to answer these questions Science has advanced so that reasonable answers can be given

78 Opinions Guided by Evaluation Model Remedial (Attainment) Can any of the deficits be remediated? What interventions can remediate the relevant deficits? Where and how can the appropriate remediation services be accessed? How long is successful intervention expected to take?

79 Model Attainment Services Florida (Established 1997): Juvenile Incompetence to Proceed (JITP) Program Outpatient Services: Statewide Network of Independent Providers Meet with Clients up to 25 hours/month Services Tailored to Youth Needs Psychoeducation Groups/Medication/Case Management/ Counseling Inpatient Services: Secure Juvenile Forensic Facility Psychiatric, Psychological & Medical Assessments/Treatment 50-Minute Competency Training Class, 5 Days/Week Lectures / Videos / Games / Mock Trials

80 Model Attainment Services Virginia (Established 1999): Virginia Juvenile Competency Program (VJCP) 100% Community-Based Services: Specially Trained Counselors Travel to Youth Average: 3 Sessions/Week for 90 minutes each Individualized Psychoeducation Based on Set Curriculum, including Interactive CD-ROM Role-Playing & Practice of Decision-Making Case Management Mentoring


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