Empirical Methods for Empirical Methods for Assessing CSTAssessing CST
Kimberly MillerKimberly Miller
Forensic NeuropsychologyForensic Neuropsychology
June 8June 8thth, 2006, 2006
Dusky StandardDusky Standard
Competency defined as:Competency defined as: Ability to assist lawyer in own defenseAbility to assist lawyer in own defense RATIONAL as well as FACTUAL RATIONAL as well as FACTUAL
understanding of proceedings against understanding of proceedings against him/herhim/her
What does rational mean?What does rational mean?
Florida Rules of Criminal Procedure Florida Rules of Criminal Procedure 3.211 A3.211 A
In considering competence to proceed, examining experts shall consider In considering competence to proceed, examining experts shall consider and include in their report defendant’s capacity to:and include in their report defendant’s capacity to:
Appreciate allegations against him/herAppreciate allegations against him/her Appreciate possible penaltiesAppreciate possible penalties Understand adversary nature of legal Understand adversary nature of legal
processprocess Disclose to counsel facts pertinent to the Disclose to counsel facts pertinent to the
proceedingsproceedings Manifest appropriate courtroom behaviorManifest appropriate courtroom behavior Testify relevantlyTestify relevantly
Link between Incompetence and Link between Incompetence and Mental DiseaseMental Disease
Expert must show:Expert must show: Incompetence due to mental illness or Incompetence due to mental illness or
retardationretardation Must specify how this illness affects Must specify how this illness affects
competencycompetency
Competency Screening TestCompetency Screening Test
22-item sentence completion task: “When 22-item sentence completion task: “When I go to court, the lawyer will…”I go to court, the lawyer will…”
Time: ~25minTime: ~25min Each item scored on 3-point scale in terms Each item scored on 3-point scale in terms
of competency reflected in responseof competency reflected in response Designed to be used as screener, with Designed to be used as screener, with
Competency Assessment Instrument as a Competency Assessment Instrument as a follow-up semistructured interview (13 Qs follow-up semistructured interview (13 Qs about legal knowledge and case specifics)about legal knowledge and case specifics)
Competency Screening Test: ProsCompetency Screening Test: Pros
Good as general screener to recognize Good as general screener to recognize those who are clearly competentthose who are clearly competent
Excellent inter-rater reliability (70-85%; Excellent inter-rater reliability (70-85%; see Nicholson, Robertson, Johnson, & Jensen, 1988see Nicholson, Robertson, Johnson, & Jensen, 1988))
Good agreement with forensic Good agreement with forensic examiners (71-86% correctly classified; examiners (71-86% correctly classified; see Nicholson, Robertson, Johnson, & Jensen, 1988see Nicholson, Robertson, Johnson, & Jensen, 1988))
Competency Screening Test: ConsCompetency Screening Test: Cons
Criticized for subjective scoring and Criticized for subjective scoring and idealized view of legal systemidealized view of legal system
Many validity concerns: high false Many validity concerns: high false positive rate, inconsistent factor positive rate, inconsistent factor structures (structures (reviewed in Melton et al., 1997reviewed in Melton et al., 1997))
Fitness Interview Test- Revised Fitness Interview Test- Revised (FIT-R)(FIT-R)
70 questions divided into 3 main areas:70 questions divided into 3 main areas: Ability to understand nature of the proceedings/ Ability to understand nature of the proceedings/
knowledge about criminal procedureknowledge about criminal procedure Ability to understand the possible Ability to understand the possible
consequences of proceedingsconsequences of proceedings Ability to communicate with counsel/assist in Ability to communicate with counsel/assist in
own defenseown defense Evaluator rates on 3-point scale level of Evaluator rates on 3-point scale level of
impairmentimpairment Designed as a screenerDesigned as a screener Time: ~ 30minTime: ~ 30min
FIT-R: ProsFIT-R: Pros
Inter-rater reliability across 4 Inter-rater reliability across 4 professions: for most items in .80- .9 professions: for most items in .80- .9 range, overall score reliability .98 range, overall score reliability .98 ((Viljoen, Roesch, Zapf, 2002Viljoen, Roesch, Zapf, 2002))
Good convergent validity with Good convergent validity with MacArthur Competency Assessment MacArthur Competency Assessment Tool (Tool (Zapf & Roesch, 2001Zapf & Roesch, 2001))
Good sensitivity and negative predictive Good sensitivity and negative predictive power: identified 82% of individuals power: identified 82% of individuals clearly CST (clearly CST (Zapf & Roesch, 1997Zapf & Roesch, 1997))
FIT-R: ConsFIT-R: Cons
Designed for Canadian jurisdictionsDesigned for Canadian jurisdictions No normsNo norms No scoring criteriaNo scoring criteria Other cons???Other cons???
Georgia Court Competency Test Georgia Court Competency Test (GCCT-MSH)(GCCT-MSH)
Revised from original GCCTRevised from original GCCT 21 questions assessing knowledge of 21 questions assessing knowledge of
criminal procedure, current changes, criminal procedure, current changes, relationship with attorneyrelationship with attorney
Time: ~ 20 minTime: ~ 20 min
GCCT-MSH: ProsGCCT-MSH: Pros
High test-retest reliability, inter-rater High test-retest reliability, inter-rater reliability, and internal consistency reliability, and internal consistency (Nicholson, 1992)(Nicholson, 1992)
Good criterion validity: 82% Good criterion validity: 82% agreement with classification by agreement with classification by forensic staff (forensic staff (Nicholson, Robertson, Johnson, Nicholson, Robertson, Johnson,
& Jensen, 1988& Jensen, 1988)) Quick screenerQuick screener
GCCT-MSH: ConsGCCT-MSH: Cons
Assesses factual knowledge about Assesses factual knowledge about legal system, but not legal system, but not rational/decisional knowledgerational/decisional knowledge
Susceptible to malingering: Gothard, Susceptible to malingering: Gothard, Rogers, & Sewell added Atypical Rogers, & Sewell added Atypical Presentation ScalePresentation Scale
Take home message: screener only, Take home message: screener only, to augment competency assessmentto augment competency assessment
Competence Assessment for Competence Assessment for Standing Trial for Defendants with Standing Trial for Defendants with
Mental Retardation (CAST-MR)Mental Retardation (CAST-MR) Designed to overcome problems with using Designed to overcome problems with using
open-ended questions with MR defendantsopen-ended questions with MR defendants 50 items: 40 multiple choice basic legal 50 items: 40 multiple choice basic legal
concepts/ skills to assist defense, 10 MC of concepts/ skills to assist defense, 10 MC of defendant’s specific casedefendant’s specific case
Normed on 4 groups: not MR, MR but not Normed on 4 groups: not MR, MR but not referred for evaluation, MR- CST, MR- ISTreferred for evaluation, MR- CST, MR- IST
Time: ~30-40 minTime: ~30-40 min
CAST-MR: ProsCAST-MR: Pros
Excellent internal consistency, inter-Excellent internal consistency, inter-rater reliability, test-retest reliability rater reliability, test-retest reliability ((Everington, 1990Everington, 1990))
Agreement with forensic examiners: Agreement with forensic examiners: 63-72% (decent)63-72% (decent)
CAST-MR: ConsCAST-MR: Cons
Probably easy to fake incompetencyProbably easy to fake incompetency No research into impact of No research into impact of
malingering on resultsmalingering on results
MacArthur Competency MacArthur Competency Assessment Tool- Criminal Assessment Tool- Criminal Adjudication (MacCAT-CA)Adjudication (MacCAT-CA)
22 items in 3 domains: 22 items in 3 domains: General legal General legal understandingunderstanding ReasoningReasoning about legal relevance about legal relevance AppreciationAppreciation (legal factors applied to one’s (legal factors applied to one’s
own case)own case) Scores for first two domains involve case Scores for first two domains involve case
vignettevignette Appreciation domain involves individual’s Appreciation domain involves individual’s
own circumstancesown circumstances Time: 30-60 minTime: 30-60 min
MacCAT-CA: ProsMacCAT-CA: Pros Has standardized administrationHas standardized administration Criterion scoringCriterion scoring Normed on a large competent/ incompetent, Normed on a large competent/ incompetent,
mentally ill/healthy forensic sample (over 700 mentally ill/healthy forensic sample (over 700 people), large age range, 6 states, not just people), large age range, 6 states, not just CaucasiansCaucasians
Manual has cut-off scores, sensitivity, specificity, Manual has cut-off scores, sensitivity, specificity, NNP, PPPNNP, PPP
Good inter-rater reliability (.75-90; Good inter-rater reliability (.75-90; Poythress et al., Poythress et al.,
19991999)) Good internal consistency (~ .8; Good internal consistency (~ .8; Otto et al., 1998Otto et al., 1998)) Takes into consideration both decisional and Takes into consideration both decisional and
factual knowledgefactual knowledge
MacCAT-CA: ConsMacCAT-CA: Cons
Low IQ individuals or those with poor Low IQ individuals or those with poor mental flexibility may have difficulty mental flexibility may have difficulty with case vignette portionwith case vignette portion
This may also reduce real-life utility This may also reduce real-life utility of measureof measure
Discussion QuestionDiscussion Question
Can neuropsych measures alone be Can neuropsych measures alone be used to determine CST?used to determine CST?
Case exampleCase example
Discussion QuestionDiscussion Question
Can neuropsych measures add Can neuropsych measures add anything to a traditional competency anything to a traditional competency evaluation? If so, what?evaluation? If so, what?