Identifying which defendants are at increased risk to repeat a return to competency (RTC) program would allow more resources to be allocated toward those who have the greatest need, thus reducing the cost associated with repeating the program. This study found that defendants diagnosed with a psychotic disorder and who had three or more previous psychiatric hospitalizations were at much greater risk to repeat the program. Those with a psychotic disorder but without multiple psychiatric hospitalizations, however, were less likely to repeat the RTC program. In addition, the researchers found that the use of psychological instruments, both forensic assessment instruments (FAIs) and traditional assessments, did not make a significant difference in whether a case was contested. This is the bottom line of a recently published article in the Journal of Forensic Psychology Practice. Below is a summary of the research and findings as well as a translation of this research into practice.
Featured Article | Journal of Forensic Psychology Practice| 2016, Vol. 16, No. 2, 61-73
Jail-Based Restoration to Competency: An Investigation of Program Recidivism and Contested Competency Cases
Cassandra Valerio, MA
Judith V. Becker, PhD
While jail-based restoration to competency (RTC) programs are becoming more common, research on these programs and defendants who complete them is limited. The present study investigated characteristics of defendants who have completed a jail-based RTC program more than once to determine what factors differentiate them from those who completed the program only once. This study also investigated whether the use of psychological tests in competency to stand trial (CST) evaluations reduced the number of competency cases that are contested. Several predictors of RTC program repetitions were identified. However, no differences in number of contested cases were found in CST evaluations that used assessment instruments compared to evaluations where no assessment was used.
Competency to stand trial; adjudicated competency; restoration to competency; jail-based restoration to competency; forensic evaluation.
Summary of the Research
“While competency restoration has traditionally been performed in a hospital setting, the expense and sometimes long delays associated with hospital-based restoration has led to the development of jail-based RTC (restoration to competency) programs in several states…As…noted in a meta-analysis of CST literature, research in this area has primarily examined characteristics of competent and incompetent defendants (e.g., psychiatric diagnosis, ethnicity, sex, criminal charges) and the performance of defendants on both traditional psychological tests and tests specifically designed to assess competency. Two related, although understudied, areas of research of interest in this RTC program are issues related to (a) defendants who are ordered to complete the RTC program more than once, and (b) the use of assessment instruments in CST evaluations as a means to reduce contested competency cases (p.61-62).”
“The current study aims to contribute to the body of CST literature by addressing a gap in research related to (a) defendants who repeat RTC programs and (b) use of assessment instruments to reduce contested competency cases…Specifically, it is hypothesized that repetition of the RTC program evaluated in the present study will be predicted by a diagnosis of a psychotic disorder and previous psychiatric hospitalizations. Research regarding the relationship between various demographic variables and CST have been somewhat mixed; however, it is not clear whether demographic characteristics of defendants are related to repetition of the RTC program. Therefore, the current study will also explore whether defendants’ ethnicity, sex, and age are predictive of repeating the RTC program (p.65-66).”
“The current study also aims to determine whether the use of assessment instruments in CST evaluations is helpful in reducing the number of contested competency cases. For this study, a contested competency case will be defined as a case in which a motion for a contested competency hearing was filed. It is hypothesized that the use of assessment instruments, both forensic and traditional, will reduce the number of contested competency cases compared to cases in which no assessment instrument is used (p.66).”
“In the present study, data from a southwestern Arizona county’s Restoration to Competency program were analyzed to determine whether (a) characteristics of defendants at risk to repeat the program could be identified, and (b) whether the use of psychological assessments in competency-to-stand-trial evaluations could reduce the number of contested competency cases within the program…Interestingly and contrary to the study hypothesis, defendants with a psychotic disorder but without multiple psychiatric hospitalizations were less likely to repeat the RTC program. The lower number of hospitalizations among these defendants may reflect generally better functioning and thus a lower risk of program repetition. Similarly, younger defendants may be less likely to have a lengthy hospitalization history (p.71).”
“The second goal of the present study was to investigate whether the use of assessments in CST evaluations reduced the likelihood that a competency case would be contested. Consistent with previous research, the present study found that the majority of psychologists used assessment instruments in CST evaluations, although many fewer psychiatrists utilized an assessment instrument. Furthermore, the majority of assessments used were FAIs specifically intended to assess competency rather than more general psychological constructs. However, contrary to the study’s hypothesis, the use of psychological assessment instruments (both FAIs and traditional assessments) did not make a significant difference in whether a case was contested. This null finding may be a reflection of the small sample size available for this analysis. Alternatively, this finding could indicate that the use of assessments in CST evaluations is not a significant determinant of whether a case is contested (p.71).”
Translating Research into Practice
“…Few studies report specific components of the restoration process. Previous researchers found that more than half of studies did not report restoration procedures…Other RT programs may benefit from treatment outcome research to determine what specific components of restoration work for which defendants and why…(p.72).” Clinicians might consider adding a description of the competency restoration process and procedures to their evaluation reports to further elucidate this process.
“Future research could also further investigate the use of assessment instruments in CST evaluations…For example, attorneys’ perceptions of these evaluations may moderate the relationship between assessment use and contested case status. That is, the use of assessments may reduce contested competency cases, but only among attorneys with favorable attitudes toward psychological assessments. Research investigating attorneys’ knowledge of and attitudes toward competency assessments would be useful in elucidating this relationship (p.72).”
“Given the growing number of jail-based RTC programs, more research is needed to investigate these programs and develop ways to make them work more efficiently. Additional research in this area will benefit not only the programs themselves, but also the large number of defendants served by these programs (p.72).”
Other Interesting Tidbits for Researchers and Clinicians
“Future research could expand upon the present findings regarding characteristics of defendants at higher risk to repeat the RTC program. While several predictive characteristics were identified, there are likely may other relevant variables that contribute to a defendant’s likelihood of repetition, including additional demographic or offense-related characteristics such as family characteristics, community access to mental health services, and homelessness. Further, the present study investigated only whether the presence of a psychotic disorder contributed to program repetition. Future studies could investigate whether other psychiatric disorders also increase risk, including bipolar disorder or personality disorders (p.72).”
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