1. Empirical Methods for Assessing CST Kimberly Miller Forensic Neuropsychology June 8 th, 2006

2. Dusky Standard Competency defined as: Competency defined as: Ability to assist lawyer in own defense Ability to assist lawyer in own defense RATIONAL as well as FACTUAL understanding of proceedings against him/her RATIONAL as well as FACTUAL understanding of proceedings against him/her What does rational mean? What does rational mean?

3. Florida Rules of Criminal Procedure 3.211 A In considering competence to proceed, examining experts shall consider and include in their report defendant’s capacity to:  Appreciate allegations against him/her  Appreciate possible penalties  Understand adversary nature of legal process  Disclose to counsel facts pertinent to the proceedings  Manifest appropriate courtroom behavior  Testify relevantly

4. Link between Incompetence and Mental Disease Expert must show: Expert must show: Incompetence due to mental illness or retardation Incompetence due to mental illness or retardation Must specify how this illness affects competency Must specify how this illness affects competency

5. Competency Screening Test 22-item sentence completion task: “When I go to court, the lawyer will…” 22-item sentence completion task: “When I go to court, the lawyer will…” Time: ~25min Time: ~25min Each item scored on 3-point scale in terms of competency reflected in response Each item scored on 3-point scale in terms of competency reflected in response Designed to be used as screener, with Competency Assessment Instrument as a follow-up semistructured interview (13 Qs about legal knowledge and case specifics) Designed to be used as screener, with Competency Assessment Instrument as a follow-up semistructured interview (13 Qs about legal knowledge and case specifics)

6. Competency Screening Test: Pros Good as general screener to recognize those who are clearly competent Good as general screener to recognize those who are clearly competent Excellent inter-rater reliability (70-85%; see Nicholson, Robertson, Johnson, & Jensen, 1988 ) Excellent inter-rater reliability (70-85%; see Nicholson, Robertson, Johnson, & Jensen, 1988 ) Good agreement with forensic examiners (71-86% correctly classified; see Nicholson, Robertson, Johnson, & Jensen, 1988 ) Good agreement with forensic examiners (71-86% correctly classified; see Nicholson, Robertson, Johnson, & Jensen, 1988 )

7. Competency Screening Test: Cons Criticized for subjective scoring and idealized view of legal system Criticized for subjective scoring and idealized view of legal system Many validity concerns: high false positive rate, inconsistent factor structures ( reviewed in Melton et al., 1997 ) Many validity concerns: high false positive rate, inconsistent factor structures ( reviewed in Melton et al., 1997 )

8. Fitness Interview Test- Revised (FIT-R) 70 questions divided into 3 main areas: 70 questions divided into 3 main areas: Ability to understand nature of the proceedings/ knowledge about criminal procedure Ability to understand nature of the proceedings/ knowledge about criminal procedure Ability to understand the possible consequences of proceedings Ability to understand the possible consequences of proceedings Ability to communicate with counsel/assist in own defense Ability to communicate with counsel/assist in own defense Evaluator rates on 3-point scale level of impairment Evaluator rates on 3-point scale level of impairment Designed as a screener Designed as a screener Time: ~ 30min Time: ~ 30min

9. FIT-R: Pros Inter-rater reliability across 4 professions: for most items in.80-.9 range, overall score reliability.98 ( Viljoen, Roesch, Zapf, 2002 ) Inter-rater reliability across 4 professions: for most items in.80-.9 range, overall score reliability.98 ( Viljoen, Roesch, Zapf, 2002 ) Good convergent validity with MacArthur Competency Assessment Tool ( Zapf & Roesch, 2001 ) Good convergent validity with MacArthur Competency Assessment Tool ( Zapf & Roesch, 2001 ) Good sensitivity and negative predictive power: identified 82% of individuals clearly CST ( Zapf & Roesch, 1997 ) Good sensitivity and negative predictive power: identified 82% of individuals clearly CST ( Zapf & Roesch, 1997 )

10. FIT-R: Cons Designed for Canadian jurisdictions Designed for Canadian jurisdictions No norms No norms No scoring criteria No scoring criteria Other cons??? Other cons???

11. Georgia Court Competency Test (GCCT-MSH) Revised from original GCCT Revised from original GCCT 21 questions assessing knowledge of criminal procedure, current changes, relationship with attorney 21 questions assessing knowledge of criminal procedure, current changes, relationship with attorney Time: ~ 20 min Time: ~ 20 min

12. GCCT-MSH: Pros High test-retest reliability, inter-rater reliability, and internal consistency (Nicholson, 1992) High test-retest reliability, inter-rater reliability, and internal consistency (Nicholson, 1992) Good criterion validity: 82% agreement with classification by forensic staff ( Nicholson, Robertson, Johnson, & Jensen, 1988 ) Good criterion validity: 82% agreement with classification by forensic staff ( Nicholson, Robertson, Johnson, & Jensen, 1988 ) Quick screener Quick screener

13. GCCT-MSH: Cons Assesses factual knowledge about legal system, but not rational/decisional knowledge Assesses factual knowledge about legal system, but not rational/decisional knowledge Susceptible to malingering: Gothard, Rogers, & Sewell added Atypical Presentation Scale Susceptible to malingering: Gothard, Rogers, & Sewell added Atypical Presentation Scale Take home message: screener only, to augment competency assessment Take home message: screener only, to augment competency assessment

14. Competence Assessment for Standing Trial for Defendants with Mental Retardation (CAST-MR) Designed to overcome problems with using open-ended questions with MR defendants Designed to overcome problems with using open-ended questions with MR defendants 50 items: 40 multiple choice basic legal concepts/ skills to assist defense, 10 MC of defendant’s specific case 50 items: 40 multiple choice basic legal concepts/ skills to assist defense, 10 MC of defendant’s specific case Normed on 4 groups: not MR, MR but not referred for evaluation, MR- CST, MR- IST Normed on 4 groups: not MR, MR but not referred for evaluation, MR- CST, MR- IST Time: ~30-40 min Time: ~30-40 min

15. CAST-MR: Pros Excellent internal consistency, inter-rater reliability, test-retest reliability ( Everington, 1990 ) Excellent internal consistency, inter-rater reliability, test-retest reliability ( Everington, 1990 ) Agreement with forensic examiners: 63- 72% (decent) Agreement with forensic examiners: 63- 72% (decent)

16. CAST-MR: Cons Probably easy to fake incompetency Probably easy to fake incompetency No research into impact of malingering on results No research into impact of malingering on results

17. MacArthur Competency Assessment Tool- Criminal Adjudication (MacCAT-CA) 22 items in 3 domains: 22 items in 3 domains: General legal understanding General legal understanding Reasoning about legal relevance Reasoning about legal relevance Appreciation (legal factors applied to one’s own case) Appreciation (legal factors applied to one’s own case) Scores for first two domains involve case vignette Scores for first two domains involve case vignette Appreciation domain involves individual’s own circumstances Appreciation domain involves individual’s own circumstances Time: 30-60 min Time: 30-60 min

18. MacCAT-CA: Pros Has standardized administration Has standardized administration Criterion scoring Criterion scoring Normed on a large competent/ incompetent, mentally ill/healthy forensic sample (over 700 people), large age range, 6 states, not just Caucasians Normed on a large competent/ incompetent, mentally ill/healthy forensic sample (over 700 people), large age range, 6 states, not just Caucasians Manual has cut-off scores, sensitivity, specificity, NNP, PPP Manual has cut-off scores, sensitivity, specificity, NNP, PPP Good inter-rater reliability (.75-90; Poythress et al., 1999 ) Good inter-rater reliability (.75-90; Poythress et al., 1999 ) Good internal consistency (~.8; Otto et al., 1998 ) Good internal consistency (~.8; Otto et al., 1998 ) Takes into consideration both decisional and factual knowledge Takes into consideration both decisional and factual knowledge

19. MacCAT-CA: Cons Low IQ individuals or those with poor mental flexibility may have difficulty with case vignette portion Low IQ individuals or those with poor mental flexibility may have difficulty with case vignette portion This may also reduce real-life utility of measure This may also reduce real-life utility of measure

20. Discussion Question Can neuropsych measures alone be used to determine CST? Can neuropsych measures alone be used to determine CST? Case example

21. Discussion Question Can neuropsych measures add anything to a traditional competency evaluation? If so, what? Can neuropsych measures add anything to a traditional competency evaluation? If so, what?