Presented by: Reneau Kennedy Hawaii Adult Mental Health Division

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