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Competency To Stand Trial - How To Assess for the Functional Objective: Semi-Structured Competency Assessment Instruments

Posted Oct 03 2008 12:52pm

Here we go, time to provide some specifics! Actually, specifics have been discussed in priorposts, but now I am going to review standard techniques and instruments utilized by experts in the assessment of competency to stand trial. Not only are these instruments utilized frequently, they are generally accepted in court as acceptable instruments. However, that does not preclude an expert from understanding what he or she is using, should the court request an explanation.

With that, I shall begin. First, I want to reiterate we are assessing a functional ability, as discussed here. Therefore, we are looking at how well a person does something or understands something, not what factors are contributing to the individual’s performance (those issues are addressed in other parts of the evaluation). To provide a different example: If I give an IQ test, by far the most relevant information that comes from such an administration is the person’s skills in various areas of cognitive functioning. What the IQ test does not do (though it can give hints, based on the patterns of the scores, but I digress) is tell you why a person may have those particular patterns. Let’s say a guy is given an IQ test, and his overall IQ is 90, but his verbal IQ is 80, while his nonverbal IQ is 105. This is important information, not only because we now have a ballpark idea of this person’s overall cognitive capacity, but we also know that his visual-spatial skills are far superior to his verbal skills (which also loads heavily on acquired knowledge, i.e. the things you learn in school). I can tell you with some confidence how well this person might do on a variety of tasks. However, I cannot tell you why there is such a large discrepancy (most people do not have a spread of almost two standard deviations between their scores). It could be the result of any number of factors - some congenital issue, a learning disability (in reading), a prior head injury (likely to the left side of his head), etc. The IQ test gives us the functional assessment, while other techniques are used to explain why the functional level is where it is.

It’s the same with competency to stand trial. The following instruments are used to assess the individual’s ability to understanding the court proceedings, and their ability to aid their attorney in their defense. Interviews, records, other assessment procedures (including IQ tests) may be used to assess why a defendant has the current skill levels in those areas that he does.

So, we’ll start with the semi-structured instruments. A semi-structured instrument is one that provides the clinician with a standard set of questions and areas to explore, but is fluid enough so that a clinician has so flexibility to assess certain areas more extensively, if necessary. The first of these is The Revised Competency To Stand Trial Assessment Instrument (R-CAI). This instrument was developed in the 1970s by psychologists Paul Lipsitt and David Lelos along with psychiatrist A. Louis McGarry, and was recently updated. It is a guide for forensic examiners to examine defendants, and obtain from them information related to 13 different sub-categories of competency. The manual provides sample questions to ask in order to get a better assessment of a defendant’s factual and rational understanding of each area. However, the R-CAI is a flexible instrument, that allows the examiner to use their skills as a clinician to ask the follow-up questions they believe are necessary to get the best picture of the defendant’s functionality. While suggestions are offered regarding how to rate the individual’s degree of competency within each of the 13 domains, this is without formal, objective criteria. Also, there is no “Total Competency” score.

The research on this instrument suggests that, in general, examiners who use it tend to arrive at similar conclusions about defendants, and that the use of R-CAI generally corresponds to the decisions made by non-examiners, particularly the judges. Usually, interviewers use the R-CAI as a true semi-structured interview, without individual ratings provided. There is nothing wrong with this, as the examiner will provide an overview of the types of responses provided in each section (if they are doing their job, anyway), as well as a clinical assessment of whether the responses meet the threshold for competency or not, and to what degree.

This is the instrument I use most frequently, though it may not be the only instrument I use. I like the flexibility of the instrument, and its face validity (i.e. the court can see exactly what it is assessing simply by looking at the questions) makes it an easy instrument to explain and understand. Of course, to use the R-CAI, the examiner needs a satisfactory understanding of the various areas of knowledge associated with competency, in order to be able to ask follow-up questions, re-word things in order to get better information, etc. One also needs to be patient with this type of assessment - when assessing competency, you are often interviewing many individuals with some level of incapacitation, regardless of whether they are competent or not. With the R-CAI, the phrasing is important, so that you get the best understanding of the defendant’s current functional abilities are. Like anything else, one gets better with practice.

Using this instrument is not, however, an automatic for me, at least not initially. If an individual is presenting with especially low cognitive skills (i.e. IQ under 70-75), I will generally begin with an instrument called the CAST-MR. That, as well as other instruments, will be covered in future posts.

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