The Clinical Utility of the NAB Judgment Subtest Among Individuals Diagnosed With Schizophrenia Spectrum Disorder Within a Forensic Inpatient Setting

Executive functioning (EF) has been identified as a significant predictor in determining competence to stand trial. Individuals deemed incompetent to stand trial are provided a limited time frame before conservatorship is considered, thus, treatment providers practicing within inpatient facilities have a responsibility to efficiently identify factors that may lead to prolonged hospitalizations, in order to avoid delays in a defendant’s legal proceedings. Although previous studies have demonstrated the utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Index Score in predicting length of stay (LOS), the Neuropsychological Assessment Battery (NAB) Judgment subtest provides a measure of executive function, which is a domain not captured by the RBANS. The current study examined the relationship between both the RBANS and NAB Judgment performance as predictors of LOS among 63 individuals diagnosed with schizophrenia spectrum disorders undergoing competency restoration treatment. Additionally, sensitivity analyses were used to determine cutoff scores for individuals requiring additional competency services. Results indicated that the NAB Judgment subtest was more predictive of LOS than the RBANS Total Index Score. Additionally, a raw score of ≤9 on NAB Judgment was indicative of increased LOS. These results highlight the utility of the NAB Judgment subtest within a forensic inpatient setting.

An update on outpatient competence restoration outcomes: The Washington DC Model

This study provides an update to a previous study exploring time to restoration of adjudicative competence within an Outpatient Competence Restoration Program (OCRP). Authors examined the probability of restoration for individuals referred for outpatient competence restoration in the U.S. capital, and revisited the requirements of American Law, taking a closer look at how programmatic changes improve restoration and encourage adherence. Competence to stand trial remains a critical screening function of the judicial system to ensure that defendants have a basic understanding of courtroom procedures. Competency restoration is therefore an attempt to protect both the integrity of the system and the rights of defendants. Aggregate data from the OCRP’s previous four years of competence restoration efforts were reviewed for demographic characteristics, restoration rates, and time to restoration. Poisson regression modeling identified probability differences in restoration between sequential restoration periods. Since our initial analysis, the DC OCRP has been successful in restoring 97 of 345 participants (28.1%), with referral rates increasing from year to year. 39.2% are now restored after the 3rd round of competency restoration. Poisson regression modeling of individuals attaining competence during six successive restoration periods showed that differences for the first five rounds of restoration were not statistically significant (p = 0.418). In the 6th round, however, the difference in percentage of restored participants was statistically significant compared to previous rounds (irr = 0.32; p = 0.0001). We discuss the policy implications, especially those that suggest that the DC OCRP has improved its ability to restore competence beyond the 1st round of restoration.

Establishing a Forensic Training Clinic

The collaboration described in this chapter differs somewhat from that in other chapters. A university in Texas—Sam Houston State University—established a forensic training clinic staffed by doctoral trainees in clinical psychology and supervised by faculty members. This clinic offered services to courts in the region, primarily involving the evaluation of individuals involved in the criminal justice system on issues such as competence to stand trial, sentencing for individuals committing sexual offenses, mental state at the time of the offense, and others. This yielded valuable specialized training opportunities for graduate students, strong evaluations at a reasonable rate for courts, and an opportunity to generate funding for the university and the training program. The “collaboration,” therefore, was between the university and the court system rather than a state department of mental health; however many of the developmental and operational considerations were comparable to those described in other chapters.

The Designated Forensic Professional Program in Massachusetts

The Designated Forensic Professional Program in Massachusetts, a collaboration between the University of Massachusetts Medical School and the Massachusetts Department of Mental Health, was started in 1985 for the purpose of providing specialty training and certification to mental health professionals providing public-sector evaluations of competence to stand trial and criminal responsibility to the Massachusetts courts. The program initially certified only psychologists but was eventually expanded to include forensic psychiatrists as well. The approach involves intensive mentoring and supervision and serves as a national model for states wishing to train public sector mental health professionals in the delivery of specialized forensic evaluations.

JUDGING ANTIGONE IN OLD AGE: (NEURO)PSYCHOLOGY AND LAW IN THE TWENTY-FIRST CENTURY

Although medicine, psychology and law have a long history behind them (Frank, 1930; Kapardis, 2009), and several issues may emerge at the interface of these scientific fields, new specific disciplines have been created to fill the research gap, such as legal psychology and forensic psychology (Taylor, 2019). In this direction, forensic neuropsychology combines not only psychometric testing, but also interviews, behavioral observations, and record reviews as additional sources of information for answering cognitive functioning questions in legal and forensic settings (Fink, 2007). Additionally, the emergence of a new promising interdisciplinary field, neurolaw, explores how neuroscience and advanced techniques can be used in the legal system (Meynen, 2014; van Dongen & Franken, 2019). Although there are still a plethora of topics that are not adequately described and need further research in neuropsychology, several attempts have been made to collect data for different research questions linked to this complex field (Canter & Žukauskiene, 2019). Methods and protocols regarding the processes of criminal profiling, the examination of cognitive biases in legal decision making, interrogations and confessions, detection of deception, eyewitness memory and false memories-distortions, cognition and emotions of child witnesses, and competence to stand trial, are still not clear (Bornstein & Miller, 2016; Brewer & Douglass, 2019).