MacArthur Competence Assessment Tool-Criminal Adjudication Research Articles

The association between specific competence-related abilities and competence restoration treatment

ABSTRACTInpatient competence restoration treatment comes with enormous costs in terms of civil liberties, but also significant financial costs to the state/institution responsible for providing the treatment. The present investigation was designed to evaluate the utility of a commonly used competence assessment instrument, the MacArthur Competence Assessment Tool – Criminal Adjudication (MacCAT-CA), in identifying individuals who may require more tailored, lengthier, and/or more intensive treatment. The sample included 93 men and women who were administered the MacCAT-CA during an inpatient hospitalization for competence restoration treatment in the United States. All of the patients were restored to competence within the study period, ranging from 3 to 32 months of inpatient hospitalization. Results suggest that performance on the MacCAT-CA was associated with hospitalization length, with total scores as the greatest predictor of response to treatment. Sensitivity and specificity estimates are discussed in terms of their utility in identifying patients most at-risk for extended hospitalization, with the authors arguing that instruments like the MacCAT-CA can be used in a practical manner of identifying patients who might require greater or more intensive treatment.

The MacArthur Competence Assessment Tool-Criminal Adjudication: Factor structure, interrater reliability, and association with clinician opinion of competence in a forensic inpatient sample.

Adjudicative competence is the most frequently referred evaluation in the forensic context, and it is because of this that periodic evaluation of competence assessment instruments is imperative. Among those instruments, the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) has demonstrated adequate psychometric properties suggesting its utility in informing the forensic inquiry. The purpose of the current study was to further investigate the psychometric properties and ultimate utility of subscale scores using archival data from a sample of 103 male and female forensic patients who were hospitalized for competence restoration treatment. Results of the present study suggested adequate internal consistency and good model fit for the factor structure. Interrater reliability was evaluated by comparing the absolute agreement of scores derived from 2 independent research assistants for each of the subscales; 2 of the 3 subscales fell within the acceptable range given established interpretative benchmarks for forensic assessment. Of particular interest was that the Appreciation subscale, while heralding the lowest intraclass correlation coefficient, explained the largest proportion of variance in clinician opinion relative to the other 2 subscales. In other words, the most subjective subscale (as evidenced by the lowest intraclass correlation), explained the largest proportion of variance in ultimate opinion. The authors argue that, although these results are an important consideration in these assessments, they are neither surprising nor entirely problematic when considering the case-specific nature of the inquiries on the subscale, as well as the subjectivity of scoring criteria for each of the Appreciation items. (PsycINFO Database Record

Competence-related abilities and psychiatric symptoms: An analysis of the underlying structure and correlates of the MacCAT-CA and the BPRS.

The current study used confirmatory factor analysis to examine the factor structures of two instruments commonly used in the assessment of competency to stand trial--the MacArthur Competence Assessment Tool--Criminal Adjudication (MacCAT-CA) and the Brief Psychiatric Rating Scale (BPRS). Results revealed support for the three-subscale factor structure of the MacCAT-CA defined by the authors of the instrument; for a slightly altered three-factor structure defined by Zapf, Skeem, and Golding (2005, Psychological Assessment, 17, 433-445); and for the four symptom clusters of the BPRS as defined by Hedlund and Vieweg (1980, Journal of Operational Psychiatry, 11, 48-63). In addition, exploratory factor analysis of all 24 items of the BPRS revealed a five-factor structure. Correlations between psychiatric symptoms, symptom clusters, and competence-related abilities were also examined using the previously identified and the newly identified factor structures of the MacCAT-CA and the BPRS. Significant relations between symptoms and psycholegal abilities are discussed.

Examining the effectiveness of an intervention designed for the restoration of competency to stand trial

This study examined the effectiveness of the Fitness Game, an intervention created for the restoration of competency to stand trial. Of 28 participants who completed either the experimental or control intervention at Hawai'i State Hospital (HSH), it was found that both groups had significant pretest to posttest improvements on Understanding and Appreciation subsets of the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA). However, there was no statistically significant difference between the groups on competency measures, indicating that the Fitness Game was not significantly more effective at restoring competency than non-legal programming. In other words, individuals committed to a psychiatric hospital for care and treatment were as likely to improve as those receiving additional specialized competency restoration treatment.

Teaching adolescents and adults about adjudicative proceedings: A comparison of pre- and post-teaching scores on the MacCAT-CA.

The current study investigated whether teaching was associated with improved legal understanding among adolescents and adults. Participants included 927 youth and 466 young adults, who completed the MacArthur Competence Assessment Tool-Criminal Adjudication, the Massachusetts Youth Screening Instrument-Second Version, and the Wechsler Abbreviated Scale of Intelligence. Adolescents aged 13 and younger were less likely than older individuals to improve with teaching. IQ score was positively associated with improvements following teaching, and individuals from ethnic minority groups showed greater improvements following teaching than non-Hispanic Caucasians. The implications of these findings are discussed.

Use of Video Conferencing for Psychiatric and Forensic Evaluations

This study investigated whether the quality of results from video interviews is comparable with that of in-person interviews. Interrater reliabilities for two video conference interview conditions were compared with those for in-person interviews with the Brief Psychiatric Rating Scale-Anchored Version and the MacArthur Competence Assessment Tool-Criminal Adjudication, given to 72 forensic inpatients. The video conditions included in-person and remote interviewers. In the first condition, an in-person interviewer administered the instruments, with remote observation and scoring. The second condition entailed remote administration and an in-person observer. The third condition used an in-person interviewer and observer. Good to excellent reliabilities resulted from all conditions with intraclass correlations of .69 to .82. Results suggest that providers can expect remote interviews to provide clinical information similar to that obtained by in-person interviews.

Factor structure and validity of the MacArthur Competence Assessment Tool--Criminal Adjudication.

Examination of the available literature regarding the development of the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) reveals 2 theoretical factor structures on which the MacCAT-CA was based: one in which 3 lower-order constructs are proposed (understanding, reasoning, appreciation) and one in which 2 higher-order constructs are proposed (competence to assist counsel and decisional competence). Confirmatory factor analyses were conducted with the MacCAT-CA's original normative sample (N = 729) to test both the relative fit of these 2 theoretical factor structures and models that combine the 2 factor structures. Analyses were also completed to examine the convergent and discriminant validity of the MacCAT-CA. Results are discussed in terms of the strengths and weaknesses of the nomothetic nature of the MacCAT-CA.

Can inhaled steroids mend a broken heart in chronic obstructive pulmonary disease?

This study examines the competence-related abilities of 120 psychiatrically hospitalized male juveniles age 10 to 17 years, using the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), the Brief Psychiatric Rating Scale-Anchored (BPRS-A), the Massachusetts Youth Screening Instrument (MAYSI), the Kaufman Brief Intelligence Test (K-BIT), and discharge diagnoses derived from file review. The findings indicate significant age-related differences across adolescence with a relatively strong performance for most of the youths on the competence measure. While intellectual and psychiatric factors were found to contribute substantially to deficits in legal decisional ability, they were modulated by age and the developmental factors associated with it. These findings, replete with caveats concerning both the dimensional structure of competence as measured by the MacCAT-CA and the interplay with the mental status and developmental factors affecting it, underscore the multifarious nature of legal decisional capacity in youths of varying ages. The relevance of these findings to the structuring of restoration services and the application of legal theory to the competence standard in juvenile court are discussed.

Use of a Television Crime-Drama Series to Promote Legal Understanding in Mentally Ill, Incompetent Defendants: A Pilot Study

Videotaped material is used for educational purposes in many areas of medicine. In forensic facilities, programs designed to restore competency to stand trial (CST) in incompetent, mentally ill defendants have utilized videotaped courtroom proceedings as learning tools. This pilot study reviewed the progress of incompetent defendants (N = 15) who participated in a program that utilized videotaped segments of the television crime-drama "Law & Order", among other techniques, to promote CST in individuals deemed unfit to stand trial. The authors hypothesized that participation in at least one cycle of the Competency Restoration Group (CRG)'s curriculum would be associated with improvement in the areas of understanding, reasoning and appreciation. In order to assess whether the group was beneficial to the patient's treatment goal of competency restoration, patients were screened using the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) prior to starting the group and after completing a cycle of the group's curriculum. The Wilcoxon signed ranks test was employed to analyze the results from the pre- and post-group MacCAT-CA testing. The tests yielded significant (p < 0.005) post-test differences in the hypothesized direction for each of the three subsections: Understanding, Reasoning, and Appreciation as well as a significant post test improvement in the total MacCAT-CA scores. These results suggest that a didactic program, using a popular crime drama series, can be effective in facilitating learning in competency restoration programs. Limitations of this study include its lack of a control group and small population.

Adjudicative Competency in a Juvenile Population

Differences in adjudicative competency among juveniles who were either awaiting adjudication ( n= 70) or members of an age-matched control group ( n= 40) were assessed, and their scores were compared with those of an adult sample. Competency was assessed using the MacArthur Competence Assessment Tool–Criminal Adjudication, which contains three scales: Understanding, Reasoning, and Appreciation. Participants in the comparison group did not complete the Appreciation scale and were compared only on the Reasoning and Understanding scales. The scores earned by participants awaiting adjudication were significantly lower than those earned by comparison participants on the Reasoning scale ( p&lt; .05). Scores on the Reasoning and Appreciation scales were found to be related to age. When compared with adults, significant adjudicative deficits were noted among adolescents groups.

Recent interview-based measures of competency to stand trial: a critical review augmented with research data.

Forensic experts are frequently asked to conduct competency-to-stand trial evaluations and address the substantive prongs propounded in Dusky v. United States (1960). In understanding its application to competency evaluations, alternative conceptualizations of Dusky are critically examined. With Dusky providing the conceptual framework, three interview-based competency measures are reviewed: the Georgia Court Competency Test (GCCT), the MacArthur Competence Assessment Tool-Criminal Adjudication (Mac-CAT-CA), and the Evaluation of Competency to Stand Trial-Revised (ECST-R). This review has a twin focus on reliability of each measure and its correspondence to Dusky prongs. The current review is augmented by new factor analytic data on the MacCAT-CA and ECST-R. The article concludes with specific recommendations for competency evaluations.

Effects of state organizational structure and forensic examiner training on pretrial competence assessments.

States differ widely in their delivery of pretrial forensic evaluation services, in terms of organizational structure and training requirements of forensic examiners. It was hypothesized that defendants adjudicated incompetent to proceed in states using community-based, private-practitioner systems would show less impairment on a competence assessment measure, the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), than defendants adjudicated incompetent in states using traditional, inpatient systems. It also was hypothesized that mean MacCAT-CA scores for incompetent defendants from states requiring forensic training/certification would be lower than for defendants from states lacking such requirements. Results indicated significant differences across the four types of service delivery systems examined. However, planned comparisons revealed no differences between a state using a traditional, inpatient model and a state employing a community-based, private-practitioner model. Analyses examining the effects of mandatory forensic training failed to support the hypothesis that training requirements result in the adoption of higher thresholds for determining incompetence.

Psychometric properties of the MacArthur Competence Assessment Tool–Criminal Adjudication.

University of VirginiaThis article describes the development of a new clinical instrument for use in assessments of adultcriminal defendants' competence to proceed to adjudication, the MacArthur Competence AssessmentTool-Criminal Adjudication (MacCAT-CA). The MacCAT-CA was derived from a more comprehen-sive research instrument (MacArthur Structured Assessment of Competencies of Criminal Defendants;Hoge, Bonnie, Poythress, Monahan, & Eisenberg, 1997) on the basis of considerations efface validityfor use in legal contexts, psychometric analyses, and advice from mental health experts who reviewedan earlier prototype. This article presents the results from an National Institute of Mental Health-sponsored validation study that investigated the psychometric properties of the MacCAT-CA.At least 25,000 criminal defendants are referred annually forevaluation of their competence to participate in legal proceed-ings (Steadman & Hartstone, 1983). Although a number ofmeasures have been specifically designed to assess defendants'capacities in this area (e.g., Competence Screening Test [CST],Lipsitt, Lelos, & McGarry, 1971; Georgia Court CompetencyTest [GCCT], Wildman et al., 1980; CADCOMP, Barnard etal., 1991; Competency Assessment Instrument [CAI], Labora-tory of Community Psychiatry, 1974; Interdisciplinary FitnessInterview [IFI], Golding, Roesch, & Schreiber, 1984; Fitnessto Stand Trial Interview, Menzies, Webster, Roesch, Jensen, R RobertA. Nicholson, Department of Psychology, University of Tulsa; JohnMonahan and Richard J. Bonnie, School of Law, University of Virginia;Steven K. Hoge, School of Law and School of Medicine, University ofVirginia; Marlene Eisenberg, Institute of Law, Psychiatry, and PublicPolicy, University of Virginia.John F. Edens is now at the Department of Psychology, Sam HoustonState University.This research was supported by the MacArthur Foundation ResearchNetwork on Mental Health and the Law, and by Grant RO1MH54517-O1A1 from the National Institute of Mental Health. We are grateful toTom Feucht-Haviar for his assistance on a pilot test of this measure.Norman G. Poythress, John Monahan, Richard J. Bonnie, and StevenK. Hoge are authors of the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) published by Psychological As-sessment Resources. Randy K. Otto, Norman G. Poythress, Robert A.Nicholson, John F. Edens, John Monahan, Richard J. Bonnie, and StevenK. Hoge are authors of the MacCAT-CA manual, also published byPsychological Assessment Resources.Correspondence concerning this article should be addressed to RandyK. Otto, Department of Mental Health Law and Policy, Florida MentalHealth Institute, University of South Florida, 13301 Bruce B. DownsBoulevard, Tampa, Florida 33612-3899. Electronic mail may be sent toorto@hal.fmhi.usf.edu.Eaves, 1984), each exhibits various limitations (Grisso, 1991;Melton, Petrila, Poythress, & Slobogin, 1997; Nicholson, 1992).Briefly, some measures were designed to serve primarily asscreening instruments (e.g., CST and GCCT) and appear mainlyto be collections of items having various legal content but littleor no underlying conceptual structure. Others (e.g., CAI and IFI)lack standardized administration and criterion-based scoring,relying instead on the judgment of the clinician to determine,on a case-by-case basis, which questions to pose to the defendantand how to rate the responses received. None is designed toprovide quantitative indexes of discrete competence-related abil-ities, nor have interpretative norms based on large, nationalsamples been developed for any of these measures.Given the pivotal role of a defendant's competence, one of themajor research initiatives of the MacArthur Foundation ResearchNetwork on Mental Health and the Law was the developmentof a standardized research instrument for evaluating criminaldefendants' psycholegal abilities related to competence to pro-ceed to adjudication. The MacArthur Structured Assessmentof Competencies of Criminal Defendants (MacSAC-CD; Hoge,Bonnie, Poythress, Monahan, & Eisenberg, 1997) was based onBonnie's (1992, 1993) comprehensive theory of legal compe-tence, and it contains measures of discrete competence-relatedabilities. Items in the MacSAC-CD were modeled after thosecreated by Grisso, Appelbaum, Mulvey, and Fletcher (1995) forthe assessment of competence to consent to treatment (see, moregenerally, Grisso & Appelbaum, 1998). Each measure in theMacSAC-CD involves standardize d administration an crite-rion-based scoring, thus reducing much of the discretionary(and potentially idiosyncratic) scoring that plagues existingmeasures.Hoge et al. (1997) recently described the MacSAC-CDand presented the primary findings from a field study that in-volved both incompetent and competent defendants as researchparticipants. The results of this field study indicated that the

Psychometric properties of the MacArthur Competence Assessment Tool-Criminal Adjudication.

Psychometric properties of the MacArthur Competence Assessment Tool-Criminal Adjudication.