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DSAMH Annual Forensic Examiner Training October 17, 2013

Evaluator Challenges in Juvenile Competency Evaluations: Report Writing & Attainment Recommendations Ivan Kruh, Ph.D. Forensic & Clinical Psychology – Ossining, NY. DSAMH Annual Forensic Examiner Training October 17, 2013. Competency to Proceed – Utah Law. Juvenile Court Act (Chapter 6)

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DSAMH Annual Forensic Examiner Training October 17, 2013

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  1. Evaluator Challenges in Juvenile Competency Evaluations:Report Writing & Attainment RecommendationsIvan Kruh, Ph.D.Forensic & Clinical Psychology – Ossining, NY DSAMH Annual Forensic Examiner TrainingOctober 17, 2013

  2. 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.

  3. 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.

  4. 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

  5. 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?

  6. Evaluator Challenges in Juvenile Competency Evaluations Report Writing

  7. Forensic Evaluation Reports Everything of importance to forensic psychological assessment culminates in the expert’s report.(Gagliardi & Miller, 2007, p. 539).

  8. 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

  9. 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

  10. 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

  11. Report Writing High Quality Forensic Evaluation Reports

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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!

  19. Report Writing Clarity: Organization

  20. Forensic Report Organization • Introductory Material Why 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 evaluation What the examiner wanted to do, but was unable • Description of how this information was obtained • Identify source(s) – and credibility of source(s)!

  21. 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 • Opinions What 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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.

  27. 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)

  28. Report Writing Utah Juvenile Competency Evaluation Report Template

  29. 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

  30. 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

  31. Use of the Template • Text Fields • Notes to Evaluator (Bracketed and Italicized)

  32. Headings

  33. Reason for Referral

  34. Summary of Opinions • Clinical Summary • Diagnostic Opinions

  35. Summary of Opinions • Opinions About Competency to Proceed

  36. Summary of Opinions • Opinions About Attainment of Competency

  37. Evaluation Data • Explanation of Evaluation Procedures and Process • Interview(s) of Juvenile • Assessment(s) of Juvenile • Parent Report • Legal Information • Additional Information

  38. 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

  39. Evaluation Data • Statement of Forensic Warning

  40. 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

  41. Evaluation Data • Pertinent Developmental & Psychosocial History

  42. Evaluation Data • Current Mental Status • General Presentation • Psychomotor Activity and Speech Behavior • Mood, Emotions and Affect • Thought Process and Perceptual Issues • Cognition and Intelligence

  43. Evaluation Data • Assessment of Response Style • Psychological Testing • Past Testing • Current Testing

  44. Evaluation Data • Competency-Specific Interview

  45. Evaluation Data • Competency-Specific Interview

  46. Thoughts??

  47. Evaluator Challenges in Juvenile Competency Evaluations Attainment Recommendations

  48. 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?

  49. 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?

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