PhD/PsyD ITP evals

[psydstudent2020]

I am prepping for my first ITP evaluation. I made my template of what I will ask based on the evaluations I’ve observed, however, I would like to see others as well. Does anyone have a list of questions they ask for ITP evaluations that they would like to share? And no we don’t use an instrument where I work.

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[GradStudent2020]

What is an ITP evaluation?

 

[psydstudent2020]

What is an ITP evaluation?

Competence to stand trial


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[GradStudent2020]

Competence to stand trial


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Ah, ok. No real advice except avoid George Denkowski’s approach. ; )

 

[psydstudent2020]

Ah, ok. No real advice except avoid George Denkowski’s approach. ; )

LOL. At least I know my first eval can’t be any worse than that


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[StellaB]

I’ve never heard of these called ITP evals (incompetent to proceed, I’m guessing). At any rate, because the rational prong is more difficult (and I would argue, more important) to assess, my questions are highly dependent on the reason for the declaration of doubt, plus the defendant’s own statements and the details of the police report. The goal is to determine whether they rationally grasp the charges against them (so, ask what they’re charged with, what the evidence is against them, what elements does a prosecutor have to prove for someone to be found guilty of [their alleged crime]. Then I want to know what kind of defense strategy they’re planning and why, and I test the limits for flexibility. They need to demonstrate that they understand the nature and purpose of the proceedings. Follow-up on any delusional or paranoid sounding statements. Ask what they think of lawyers in general, and if they think theirs is trustworthy, and why, etc.

Then, obviously, the basic factual trial info.

Are you planning to do any malingering screeners? It’s generally considered best practice to at least include a screen such as the M-FAST.

 

[BuckeyeLove]

I tend to do a thorough clinical interview, assessing their ability/capacities to talk with me, as well as their ability to follow discussion, give-and-take of conversation, etc. 9 times out of 10, if they can do that and do it like a modal human, they are good to go. also 9 times out of 10, you're going to know pretty early on if they aren't good to go, that is unless they have a delusional disorder and you haven't yet poked the proverbial bear. I wrap up usually with my forensic questions, largely factual stuff at first, then pushing further into their capacity for reason/rationality in thinking about their case (i.e., hypothetical plea bargaining scenarios, legal strategizing, etc.). If I am doing a second opinion or a private case, I tend to use the maccarthur, as the psychometrics are sound, and I know the story about fred and reggie by heart lol. The ECSTR is solid as well, and i tend to direct newer evaluators to it, as it is a bit more straight forward, also has a solid little feining test at the end. For some reason it was really popular when i was on fellowship. There are a lot of sample competency interviews if you do a google search, most aren't horrible.

 

[deleted957633]

I have completed competency evaluations with my supervisor at a past practicum. We always used psychological assessments in addition to clinical interview and I would feel very uncomfortable without any empirical data to back up my clinical judgment. We would typically give an MMSE or MoCA, WRAT-IV (this was before the 5 came out), WASI, MMPI-2-RF or MCMI-IV, ILK, and MFAST. Occasionally a TOMM if effort was in question. This, along with clinical interview, formulated our opinion on competency and I have a hard time believing a statement of expert evaluation would hold up in court without empirical data to support it. I would strongly question and advise against using no assessment data in a competency evaluation.

 

[erg923]

and I have a hard time believing a statement of expert evaluation would hold up in court without empirical data to support it. I would strongly question and advise against using no assessment data in a competency evaluation.

Psychiatrist's testimony?

 

[deleted957633]

Psychiatrist's testimony?

I'm only speaking from a psychologist standpoint and the state standard that I was trained on within the state hospital I worked at. Can't speak for psychiatrist testimony.

 

[WisNeuro]

Depends on which competency/capacity is in question. For example, medical decision making capacity, no cognitive testing is needed, or particularly useful in the vast majority of situations.

 

[deleted957633]

Depends on which competency/capacity is in question. For example, medical decision making capacity, no cognitive testing is needed, or particularly useful in the vast majority of situations.

True! I would say though COMPETENCY in a forensic setting is different than CAPACITY though they are often used interchangeably. capacity for various decision making abilities is different than being competent to understand the charges being brought against you or having criminal responsibility at the moment of the crime which is often the question in state hospital/forensic settings. For sure would not give a various battery of assessments for medical decision making capacity or even global decision making other than maybe a MoCA for orientation and some scenario/hypothetical questions. competency is asking a different question though which requires a different data set that can't always be accessed via interview alone. We know clinical judgment is not always 100% so its good to have collateral data especially when something like incarceration is at stake with the potential for ulterior motives in feigning responses.

 

[WisNeuro]

Oh, capacity and competency are different species, no doubt. We deal with the capacity side of things in the hospital, I have to do legal education to referring docs all the time when they want a guardianship/competency evaluation.

 

[PsyDr]

I have completed competency evaluations with my supervisor at a past practicum. We always used psychological assessments in addition to clinical interview and I would feel very uncomfortable without any empirical data to back up my clinical judgment. We would typically give an MMSE or MoCA, WRAT-IV (this was before the 5 came out), WASI, MMPI-2-RF or MCMI-IV, ILK, and MFAST. Occasionally a TOMM if effort was in question. This, along with clinical interview, formulated our opinion on competency and I have a hard time believing a statement of expert evaluation would hold up in court without empirical data to support it. I would strongly question and advise against using no assessment data in a competency evaluation.

And you know the floor age for the MoCA is 55, so you're not admitting to giving a test to inappropriate ages in the legal system.

 

[WisNeuro]

And you know the floor age for the MoCA is 55, so you're not admitting to giving a test to inappropriate ages in the legal system.

I wish the OTs in this hospital knew this, rather than giving it to every psych inpatient along with their stupid auto fill graph that label anything under 20 as "Alzheimer's"

 

[deleted957633]

And you know the floor age for the MoCA is 55, so you're not admitting to giving a test to inappropriate ages in the legal system.

Certainly not. Did I say I would give that if they did not meet the requirements for the assessment? Those were examples not an exhaustive list. Not sure why you would come here to nitpick at something that wasn’t there.

 

[deleted957633]

And you know the floor age for the MoCA is 55, so you're not admitting to giving a test to inappropriate ages in the legal system.

Are you saying adults over age 55 don't come through state hospitals needing competency evals?

 

[BuckeyeLove]

statement of expert evaluation would hold up in court without empirical data to support it.

This is just outright wrong.

 

[PsyDr]

Certainly not. Did I say I would give that if they did not meet the requirements for the assessment? Those were examples not an exhaustive list. Not sure why you would come here to nitpick at something that wasn’t there.

If you're asking why the guy who nitpicks for a living is doing so, then....

 

[deleted957633]

This is just outright wrong.

that is how I was trained to complete evals. Perhaps that was a judge preference in the state/county I worked in - I don't know because I have not worked in other settings that completes it differently. That is the standard that was set for me.

 

[boomshakalaka]

I have completed competency evaluations with my supervisor at a past practicum. We always used psychological assessments in addition to clinical interview and I would feel very uncomfortable without any empirical data to back up my clinical judgment. We would typically give an MMSE or MoCA, WRAT-IV (this was before the 5 came out), WASI, MMPI-2-RF or MCMI-IV, ILK, and MFAST. Occasionally a TOMM if effort was in question. This, along with clinical interview, formulated our opinion on competency and I have a hard time believing a statement of expert evaluation would hold up in court without empirical data to support it. I would strongly question and advise against using no assessment data in a competency evaluation.

This is a problematic stance and a good example of why someone needs more than a practicum’s worth of experience to competently conduct forensic evals. The “empirical data” supporting your opinion should come from using sound methodology., not from injecting random instruments into your eval. In fact, I would argue that using an MCMI for a FTP eval is about as unempirical as you can get. Further, using instruments such as the MMSE or MOCA just for the sake of feeling “comfortable” is equally as unsound. What purpose do they serve? Wha about validity scales? What happens when someone bombs the MMSE? How are you explaining that away?

ILK, TOMM, and MFAST are great, but not needed in every eval and designed for specific scenarios. The other instruments are only forensically relevant and give you information about what syndromes or symptoms might be present that impact various FTP-functions. The opinion should not hinge on these assessments.

 

[erg923]

Just like doing an FBA, its what is needs to be. No more, no less. The MCMI sucks psychometrically, and every psychologist should no this.

I don't do Daubert stuff/anything, but I would certainly argue that you do things/give instruments.... because you need to. Preset batteries are a receipt for problems and playing "defense" on the stand.

 

[deleted957633]

I was merely sharing my experience and the standard I was trained in. Apologies if it came off as a hard and fast “this is how you do it,” should have prefaced it with a “this is what I was told.” You can argue the psychometrics of literally any measure in any field so if that’s how this conversation is going, I’m out. This is why I don’t post on SDN often.

 

[WisNeuro]

I was merely sharing my experience and the standard I was trained in. Apologies if it came off as a hard and fast “this is how you do it,” should have prefaced it with a “this is what I was told.” You can argue the psychometrics of literally any measure in any field so if that’s how this conversation is going, I’m out. This is why I don’t post on SDN often.

You should be used to this if you have experience in the forensic world But, in all seriousness regarding the psychometric question, the MCMI is especially bad. Particularly for forensics. Those validity scales are some of the worst I have seen. It's almost impossible to invalidate that thing.

 

[PsyDr]

I was merely sharing my experience and the standard I was trained in. Apologies if it came off as a hard and fast “this is how you do it,” should have prefaced it with a “this is what I was told.” You can argue the psychometrics of literally any measure in any field so if that’s how this conversation is going, I’m out. This is why I don’t post on SDN often.

This is exactly why you should post MORE.

Getting quick and free feedback about practices that could be open to criticism, and criticism in courts being a significant threat to businesses.... that’s just an incredible opportunity to learn. Maybe you learn to modify your practices. Maybe you learn how to defend your practices better. Maybe there’s other options. In any case, that stuff that would either cost you money for professional advice OR practice in a way that’s not on the court record.