evaluator challenges in juvenile competency evaluations: report writing & attainment...
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EVALUATOR CHALLENGES IN JUVENILE COMPETENCY EVALUATIONS:
REPORT WRITING & ATTAINMENT RECOMMENDATIONS
IVAN KRUH, PH.D.FORENSIC & CLINICAL PSYCHOLOGY – OSSINING, NY
DSAMH Annual Forensic Examiner TrainingOctober 17, 2013
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.
Competency to Proceed – Utah Law
Juvenile Court Act (Chapter 6) 78A-6-1301(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 minor’s 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.
ConceptualizingCompetency 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
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?
Report Writing
Evaluator Challenges in Juvenile Competency Evaluations
Forensic Evaluation Reports
Everything of importance to forensic psychological assessment culminates
in the expert’s report. (Gagliardi & Miller, 2007, p. 539).
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
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
Secondary Uses of Forensic Evaluation Reports Reduce the need for expert testimony Professional record of potential clinical
value Mechanism for examiner’s analysis Modeling for professional colleagues
High Quality Forensic Evaluation Reports
Report Writing
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
http://www.abfp.com/pdfs/certification/GuidanceforImprovingForensicReports.pdf
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
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
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
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
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
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 18-24 words 8th or 9th grade reading level Use active voice, not passive Avoid typos, errors, and grammatical mistakes!
Clarity: Organization
Report Writing
Forensic Report Organization
Introductory MaterialWhy 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 evaluationWhat the examiner wanted to do, but was unable
Description of how this information was obtained
Identify source(s) – and credibility of source(s)!
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
OpinionsWhat 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
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; Youth’s Understanding of Notification;
Others’ Understanding of Notification; Signing of Notification Form(s)
Scope & Process of Evaluation Specific Issues of Concern; Examiner’s Understanding and/or
Conceptualization of Competency
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
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 Data Remedial
Opinion & Contextual Opinion & Supporting Data Supporting Data Conclusory Opinion & Supporting Data
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
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.
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)
Utah Juvenile Competency Evaluation Report Template
Report Writing
Forensic Report Templates Can ENHANCE REPORT ORGANIZATION Serve as a Memory Aide for Best
Practices Enhance Report Writer’s Efficiency
“Plugging in” new information Enhance Report Reader’s Efficiency
Finding information Enhance Report Quality
Forces thinking about key issues
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
Use of the Template
Text Fields
Notes to Evaluator (Bracketed and Italicized)
[Click here and type text]
{Delete this paragraph if the opinion clearly supports a finding that the youth is competent. }
Headings
Name: [Click here and type text] Court: [Click here and type text] DOB: [Click here and type text] Judge: [Click here and type text] Age: [Click here and type text] Defense Attorney: [Click here and type text] Case No.: [Click here and type text] Prosecuting Attorney: [Click here and type text] Evaluator: [Click here and type text] Date(s) of Youth Interview(s): [Click here and type text]
The competency evaluation reflected in this report was conducted pursuant to court order in accordance with the provisions of UAC 78A-6-1302(14)(a). This document has been released only to individuals as legally authorized. That is, it has been released to the Court, the prosecuting
attorney, the defense attorney, and the Department of Human Services to assist in current decision-making. Any other use of this report is done so at the discretion of the Court and/ or the
discretion of the Department of Human Services.
NAME: [Click here and type defendant’s name] DOB: [Click here and type date of birth]
Case No.: [Click here and type cause number] date
Reason for Referral
In a [Click here and type text] Court order issued on [Click here and type text] and received on [Click here and type text], [Click here and type text]was ordered to submit to an evaluation of his competency to proceed to trial. The order is in reference to charges of [Click here and type text]. According to the Prosecutor’s documents, the state alleges that on or about [Click here and type text]. The respondent was arrested on [Click here and type text] at [Click here and type text]. Since that time [Click here and type text]. Doubt as to the juvenile’s competency to proceed was raised by [Click here and type text] based on [Click here and type text].
Summary of Opinions
Clinical Summary
Diagnostic Opinions
{Summarize the juvenile’s clinical presentation based on history, current mental status, and testing. Discuss at symptom level as support for diagnostic impressions provided below. Include conclusions of assessment of malingering/response style. State clearly if there is a mental disorder and/or intellectual disability or related condition that is present.}
Summary of Opinions
Opinions About Competency to ProceedIt is the opinion of this evaluator that [Click here and type text] is currently competent/not competent to proceed to adjudication. This is because he/she does/does not understand the nature of the proceedings against him/her with a reasonable degree of rational understanding and/but does have the capacity to consult with counsel and participate in the proceedings against him/her with a reasonable degree of rational understanding. He/she presents with severe deficits in areas including [Click here and type text] and/or moderate deficits in areas including [Click here and type text]. It is this evaluator’s opinion that these deficits are due to [Click here and type text]. It is expected that these deficits will impact the adjudication of [Click here and type text]’s case in that [Click here and type text]. {If relevant, discuss medications as follows} [Click here and type text]is currently taking medications that include [Click here and type text] which seems to support/detract from his/her competency because [Click here and type text]. These opinions are offered to assist the court in reaching the ultimate determination regarding competency to proceed and the appropriateness of pursuing attainment services.
Summary of Opinions
Opinions About Attainment of Competency{Delete this paragraph if the opinion clearly supports a finding that the youth is competent. }
Should the court find [Click here and type text] not competent, competency attainment services may be considered. It is the opinion of this evaluator that, with appropriate services, [Click here and type text] is likely to/may/is not likely to achieve competent functioning within one year. {If successful attainment in one year is not anticipated, describe duration expected for successful attainment.} The types of interventions that seem most likely to improve relevant areas of functioning include [Click here and type text]. {IMPORTANT: Do not make prescriptive statements about an attainment treatment plan. Rather, provide guidance about broad interventions that are expected to help alleviate the underlying cause(s) of the identified deficits, such as “an education program” or “consideration of medication to target attentional limitations”.} It should be noted that there is limited research on juvenile competency attainment and research-based predictions about the likelihood of successful attainment are not possible at this time; rather, the opinion provided here is based on clinical judgment. It is appreciated that the ultimate determination regarding the appropriateness of competency attainment services rests with the court.
Evaluation Data
Explanation of Evaluation Procedures and Process
Interview(s) of Juvenile Assessment(s) of Juvenile Parent Report Legal Information Additional Information
This evaluation was conducted pursuant to UAC 78A-6-1302(14)(a). The opinions contained in this report were formulated using the following procedures and information sources.
Records were also requested of [Click here and type text], but these were not provided at the time the current evaluation report was due to the court. The absence of this information impacts the current evaluation in the following ways: [Click here and type text]. Should these records be received prior to the disposition of this matter and should they alter any of the opinions contained herein, an addendum to this report shall be forwarded to the court as soon as possible.
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 Juvenile’s 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
Prior to the evaluation contact with [Click here and type text] and his caregivers, they were informed of the nature of the evaluation and the limited confidentiality inherent. Specifically, they were informed of the following issues:
Evaluation Data
Statement of Forensic WarningWhen asked to explain his/her understanding of the notification and the purpose of the evaluation, [Click here and type text] stated, “[Click here and type text].” Through several comprehension questions, his understanding of the notification was judged to be [Click here and type text] as he/she responded correctly to [Click here and type text] of [Click here and type text] questions. [Click here and type text] stated that he/she agreed to participate in the evaluation. Both [Click here and type text] and [Click here and type text] signed a form agreeing that he/she had been notified of the purpose of the evaluation. [Click here and type text] observed the entirety of the notification and/or the evaluation.
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
Pertinent developmental and social history was constructed using the data sources listed above. There was (was not) general consistency across data sources. {If not consistent, explain the pattern of the discrepancy.} Therefore, the information presented below appears to be reliable and valid (or, compromised in the sense…).
Evaluation Data
Pertinent Developmental & Psychosocial HistoryMental Health History:
{Consider including: Family mental health/substance abuse/criminal history. Past diagnoses and relevant symptoms. Outpatient mental health services (counseling, therapy, psychological testing) and compliance with them. Inpatient mental health services. Psychiatric medications and responses to them. History of symptoms based on clinical interviews with juvenile and/or caregiver(s). Status of symptoms and medication use on day of interview. Other forms of treatment (e.g., substance abuse programming).} [Click here and type text]
Evaluation Data
Current Mental Status General Presentation Psychomotor Activity and Speech Behavior Mood, Emotions and Affect Thought Process and Perceptual Issues Cognition and Intelligence
{Consider including: Orientation. Attention and concentration. Immediate, recent, and remote memory. Spoken vocabulary and receptive/expressive language abilities. Abstraction abilities. Basic social judgment. Fund of general information. Problem-solving capacity.}
Evaluation Data
Assessment of Response Style
Psychological Testing Past Testing
Current Testing
{Discuss the results of relevant testing administered in the juvenile’s past as obtained in records. Consider organizing results by domain (cognitive functioning; psychopathology; adaptive behavior; response style, etc.}
{Discuss the results of relevant testing administered as a part of the current evaluation process. Consider organizing results by domain (e.g.,cognitive functioning; psychopathology; adaptive behavior; response style, etc.}
Evaluation Data
Competency-Specific InterviewMethods used to assess the juvenile’s competency to proceed to trial included the following tools and/or procedures: [Click here and type text]. 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
Evaluation Data
Competency-Specific Interview
Capacity to Comprehend and Appreciate the Charges or Allegations: {Consider if juvenile: Knows the offense charged. Appreciates the degree of seriousness of that charged offense. If the juvenile initially demonstrated deficits, report if he/she was able to learn this information with education.} [Click here and type text] Level of Impairment: __ None/Mild __ Moderate __ Severe
Thoughts??
Attainment Recommendations
Evaluator Challenges in Juvenile Competency Evaluations
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?
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?
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
The Clinical and Empirical Literature
Data Useful in Answering the Remediation Questions
Clinical LiteratureJuvenile 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
Clinical LiteratureJuvenile 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
Empirical LiteratureJuvenile Competency Remediation
~ 70% Returned to Court Competent Success may depend on:
Source of deficits: Mental Illness 85-90% Intellectual Disability 50-55% Both 50-65%
Age: Younger Adolescents 60-75% Middle Adolescents 75-80% Older Adolescents 65-70%
McGaha, Otto, McClaren & Petrila, 2001
Warren, DuVal, Komarovskaya, Chauhan, Buffington-Vollum & Ryan, 2009
Empirical LiteratureJuvenile 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
Empirical LiteratureJuvenile 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 markedlyMcGaha et al., 2001
Warren et al., 2009
Empirical LiteratureChild & 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.
The Youth
Data Useful in Answering the Remediation Questions
Youth Factors to Consider in Answering Remedial Questions
Youth’s Current Functioning Developmental Status Current Mental Health Symptoms Current Mental Status Youth’s Response to Teaching During
Evaluation Youth’s Past Response to Relevant
Interventions Pharmacological Psychotherapeutic Educational
Available Attainment Services
Data Useful in Answering the Remediation Questions
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
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
21st 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
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
The Analysis
Answering the Remediation Question
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?
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 yrAvailable: 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 monthsAvailable: 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 monthsAvailable: 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 monthsAvailable: 6 months to 1 yr.
High
Maintaining Objectivity
Communicating Attainment Opinions
Answering the Remediation Questions
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).
The “Ultimate Issue” Issue
Ultimate Issue = the court’s 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.Against For
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 opinions Many 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
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 Court’s interests
“Low Probability of Success” may still be an adequately substantial likelihood
Recommending the Least Restrictive Appropriate Setting
Psychiatric Hospitalization Only if treatment of clinical issue typically
warrants it Detention
Only if youth’s risk to community or potential to abscond warrants it
Some Unique Scenarios Vast Majority of Youth Treatable in
Community
Contact Information
Ivan Kruh, PhDForensic & Clinical Psychology
P.O. Box 1754Ossining, NY 10562
PH: (845) 219-2421 [email protected]
www.DrKruh.com