EVALUATOR CHALLENGES IN JUVENILE COMPETENCY EVALUATIONS: REPORT WRITING & ATTAINMENT RECOMMENDATIONS...

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


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


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


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


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.


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


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


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

EVALUATOR CHALLENGES IN JUVENILE COMPETENCY EVALUATIONS: REPORT WRITING & ATTAINMENT RECOMMENDATIONS...

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