Current Trends in the Assessment of Competency to Stand Trial at State Inpatient Facilities Authors: Crystal Mueller,

1. Current Trends in the Assessment of Competency to Stand Trial at State Inpatient FacilitiesAuthors: Crystal Mueller, Reneau Kennedy, Mio Taga Presented by: Reneau Kennedy Hawaii Adult Mental Health Division Forensic Mental Health Services Chief Honolulu, HI rckenned@amhd.health.state.hi.us

2. Definition of Competency to Stand Trial Dusky v. U.S. (1959) defendant must have: �sufficient present ability to consult with his attorney with a reasonable degree of rational understanding,� and �a rational as well as factual understanding of the proceedings�

3. Assessment of CST An estimated 60,000 competency evaluations are completed each year (Bonnie & Grisso, 2000) How are these evaluations performed?

4. Methods of Assessment of CST Clinical judgment (interviews) Traditional Psychological Assessment Instruments (IQ and personality tests) Competency Specific Instruments (CAI, CST, FIT, IFI, GCCT, MacCAT-CA)

5. Goals of Study To determine what methods were most frequently used to assess CST at state inpatient facilities To determine the method for assessment of CST

6. Participants State Inpatient hospitals were identified from NASMHPD website, Sept. 03 Research assistants phoned facilities to identify if they were adult facilities that work with CST clients Survey sent to 151 state inpatient facilities A copy of survey also sent to NASMHPD forensic contact in each state

7. Participants After two mailings, 104 of 151 facilities responded 22 facilities did not work with CST consumers 82 facilities had CST consumers (43 states & DC) Results based on 72 facilities that assessed CST (39 states & DC)

8. �Mark all instruments used to assess CST� CAI GCCT IFI MacCAT-CA CST CADCOMP MMPI IQ Clinical Interview (standardized) Clinical Interview (non-standardized) Other. Please list ____________________

9. Results Facilities selected approximately 4 items Responses were analyzed based on 3 methods: clinical interview, traditional assessment tools, & competency specific instruments

10. Clinical Interview 67 facilities (93%) used clinical interview 54 used non-standardized interviews 32 used standardized interviews 19 facilities used both

11. Traditional Assessment Instruments 43 facilities (60%) used a Traditional Assessment Instrument 39 used IQ testing 35 used MMPI

12. Competency Specific Instruments 49 facilities (68%) used a competency specific instrument 38 used MacCAT-CA 17 used CAST-MR 11 used CAI 10 used CST 9 used GCCT IFI & CADCOMP used at 1 facility each

13. Trends in Assessment 33 facilities (46%) used all three methods to assess CST 22 facilities (31%) used two of three methods to assess CST 16 facilities (22%) used one method (14 used interview alone) 1% could not be categorized

14. Study Weaknesses Based upon self-report of facilities & of individual completing questionnaire, may be based on estimates or best-guesses Does not reveal frequency of assessment (at admission, once per month, etc.) or if methods varies based on initial or re-evaluation Do not know training or expertise of individuals assessing CST at inpatient facilities

15. Works in Progress Fitness restoration at 77 inpatient facilities List of Manualized Fitness Restoration materials Detection of malingering at inpatient facilities

16. DISCUSSION