Court-Ordered Psychological Evaluations and Processes

COURT-ORDERED

EVALUATIONS

Presented by:

Dr. Tonya Martin and Dr. Danielle Todaro

Fort Bend County Behavioral Health Services

Dr. Martin

PSYCHOLOGICAL AND

IDD EVALUATIONS



Evaluations designed to provide

information regarding history,

psychological diagnoses, substance

abuse issues and clinical

recommendations to the court



NOT

 competency to stand trial

evaluations



DO NOT 

provide recommendations

regarding punishment/sentencing

decisions

PSYCHOLOGICAL EVALUATIONS



Previous mental health evaluation and

treatment records



Texana/MHMRA treatment records



Records from psychiatric

hospitalizations(local and state hospitals)



Private psychiatrist/psychologist records



Current medications



Educational records (IDD evaluations)



Contact info for collateral sources

(parents, spouse, children, etc.)

WHAT TO PROVIDE THE EXPERT



Review all available records



Detailed clinical interview with

defendant



Background history



Mental status exam



Consultation with collateral sources

EVALUATION PROCESS



Psychological testing is sometimes included to

help provide additional clinical information



Testing alone can not be used to render a

diagnosis or clinical opinion



Examples of commonly used tests:



Intellectual 

(WAIS, WISC, WASI)



Adaptive functioning 

(Vineland, SSSQ)



Personality/clinical 

(MMPI, MCMI, PAI)



ADHD/Anger measures 

(Conner’s, ARES)



Memory

 (WMS, Rey 15 Item, BETA-4)



Response Style 

(M-FAST, TOMM, SIMS)

EVALUATION PROCESS



Evaluation Template



Specific Issues of Examination



Disclosures (court-ordered evaluation)



Current Allegations



Sources of Information



Background and Demeanor of Defendant



Relevant History (as self-reported by defendant,

obtained from collateral sources and available

records)



Family



Academic



Employment



Substance abuse



Legal



Trauma



Psychiatric and Medical

PSYCHOLOGICAL EVALUATIONS



Current Mental Status Examination



Behavior/Demeanor



Orientation



Attention/Concentration



Memory



Mood



Affect



Thought Content



Thought Process



Perception



Insight

PSYCHOLOGICAL EVALUATIONS



Results of Testing



Diagnostic Impressions



Summary



Recommendations

PSYCHOLOGICAL EVALUATIONS

DSM-5: INTELLECTUAL

DEVELOPMENTAL DISORDER (IDD)



No longer identified as Mental Retardation in

the DSM



Main Criteria



To receive diagnosis need to have 

significant

impairment in



Intellectual functioning



Adaptive functioning



No longer determined solely by IQ score



Those w/ true serious impairment in intellectual

& adaptive functioning fall lower 2% of

population



Scores in both areas must be extremely low

ADAPTIVE FUNCTIONING



What is it?



How well a person copes with demands in life



How independent they are from caregivers/adults



The performance of daily activities required for

personal and social sufficiency



How do we measure it?



ABAS-3



Vineland-3



SSSQ



Not as reliable



Leaders in IDD research say should not use unless

no other measure accessible

IDD EVALUATIONS



Tend to be shorter than psychological

evaluations



Clinical Interview



More focus on areas involving intellectual and

adaptive functioning



School



Regular questions + more specific information

surrounding special education services



School records are a MUST



Family



Their responsibilities at home



Is help needed?



Do they help younger siblings (adequately)?



Employment



To & from work on own?



Work performance and ability to do job

alone



Still ask questions about psychiatric history

IDD EVALUATIONS

IDD EVALUATIONS



Testing



Intellectual



Comprehensive measure is best: WISC-V, WAIS-IV



If have results from prior screening measures, include

that-> to monitor his capacities over time-> highly

likely to be a prior screening measure



Adaptive



ABAS-3 & Vineland-3 = best practice for measure of

adaptive functioning



Summary/Clinical Impressions



Brief



Opinion on IDD



Treatment Recommendations

Dr. Todaro

COMPETENCY TO STAND

TRIAL EVALUATIONS



It is 

NOT

 a general psychological or

diagnostic evaluation



It is 

NOT

 an assessment of criminal

responsibility (sanity)



It is 

NOT

 a forensic assessment that

addresses dangerousness



It does 

NOT

 offer recommendations

for punishment/sentencing

COMPETENCY TO STAND TRIAL

EVALUATION



Article 46B.003: 

A defendant is presumed

competent to stand trial and shall be found

competent to stand trial unless proved

incompetent by a preponderance of the evidence



In TX, A person is incompetent to stand trial if the

person does not have:



Sufficient present ability to consult with the person's

lawyer with a reasonable degree of rational

understanding 

and/or



Rational as well as factual understanding of the

proceedings against the person

INCOMPETENCY



“

Incompetence and mental illness

are not synonymous” (Grisso, 2014)



A defendant may be psychotic,

manic, depressed or intellectually or

developmentally disabled 

and still

be competent to stand trial

INCOMPETENCY

WHO CAN CONDUCT COMPETENCY

EVALUATIONS?



Article 46B.021: Qualifications of Experts



 Court may appoint a qualified psychiatrist or

psychologist as an expert with following

qualifications:



At least 24 hours of specialized forensic

training relating to incompetency or insanity

evaluations



Eight or more hours of continuing education

relating to forensic evaluations, completed in

the 12 months preceding the appointment



Your impressions/concerns regarding the defendant’s CST



Contact info for collateral sources (parents, spouse, etc.)



Previous mental health evaluation and treatment records



Previous CST evaluations



Texana/MHMRA treatment records



State Hospital records (if there for restoration or for

treatment)



Records from other psychiatric hospitalizations



Private psychiatrist/psychologist records



Current medications



Educational records



Social security/disability records



VA records



TDCJ Records

WHAT TO PROVIDE THE EXPERT



Review all available records



Clinical interview with defendant



Background history



Mental status exam



Competency-specific questions



Consultation with collateral sources



Psychological testing



This is done as needed-typically not in every

evaluation



CST measures are not necessary

EVALUATION PROCESS



Evaluation Template:



Qualifications of Examiner



Specific Issues of Examination



Disclosures



Current Allegations



Sources of Information



Background and Demeanor of Defendant



Relevant History



Family



Academic



Employment



Substance abuse



Legal



Psychiatric and Medical



Current Mental Status

COMPETENCY EVALUATIONS



Competency Assessment



1. The capacity of the defendant during criminal

proceedings to:



a. Rationally understand the charges against the

defendant and the potential consequences of the

pending criminal proceedings



b. Disclose to counsel pertinent facts, events, and

states of mind



c. Engage in a reasoned choice of legal strategies

and options



d. Understand the adversarial nature of criminal

proceedings



e. Exhibit appropriate courtroom behavior



f. Testify

COMPETENCY EVALUATIONS



2

. As supported by current indications and the

defendant's personal history, whether the defendant has



a. a mental illness and/or



b. is a person with Intellectual Developmental

Disability (mental retardation)



Psychotic Disorder (Schizophrenia; Schizoaffective;

Psychotic Disorder, NOS; Delusional Disorder)



Bipolar Disorder (with/without Psychotic Features)



Major Depressive Disorder (with/without Psychotic

Features)



Intellectual Disability



Autism Spectrum Disorder



Other neurological disorder

COMPETENCY EVALUATIONS



3. Whether the identified condition has lasted or

is expected to last continuously for at least one

year



History of diagnosis



Course of treatment



Serious and persistent mental

illness/intellectual disability

COMPETENCY EVALUATIONS



4. The degree of impairment resulting from the

mental illness or mental retardation, if existent, and

the specific impact on the defendant's capacity to

engage with counsel in a reasonable and rational

manner



Symptoms which may interfere



Auditory/visual hallucinations



Delusions



Thought disorder/disorganized speech



Attentional difficulties



Cognitive processing difficulties



Language difficulties

COMPETENCY EVALUATIONS



5. If the defendant is taking psychoactive or

other medication:



a. whether the medication is necessary to

maintain the defendant's competency



b. the effect, if any, of the medication on the

defendant's appearance, demeanor, or

ability to participate in the proceedings



Medication compliance/noncompliance



Side effects

COMPETENCY EVALUATIONS



Opinion on Competency to Stand Trial



In Texas, the examiner is 

required

 to provide an

opinion on competency



Must also provide whether defendant is 

likely

to be restored in the foreseeable future



Opinion may not be based solely on the

defendant's refusal to communicate during

the examination



Explain any issues on which the expert could

not provide an opinion

COMPETENCY EVALUATIONS



Either trial before judge or jury OR

uncontested finding of incompetency



On a determination that a defendant is

incompetent to stand trial, the court

shall:



Commit the defendant to a facility for

competency restoration 

OR



Release the defendant on bail to attend

outpatient restoration treatment

NEXT STEPS:

INCOMPETENCY



The court shall commit a defendant as follows:



Misdemeanors: 60 days



Felony: 120 days



One 60-day extension is allowed if defendant has not

attained competency



The defendant will receive psychiatric treatment and

competency restoration programming services



Psychoactive medications



Court-ordered medications



Recreational programming



Court education



Classes



Quizzes/tests



Mock trial



Watching videos

NEXT STEPS:

INCOMPETENCY



The head of the facility or outpatient treatment

program provider will notify the court when it is

believed that:



1. The defendant has attained competency to stand trial 

OR



2. The defendant is not likely to attain competency in the

foreseeable future



If the Court determines that an individual has been

restored to competency-proceedings continue



If the Court determines that an individual remains

incompetent:



Charges can be dismissed



Civil commitment can be pursued with or without pending

legal charges

NEXT STEPS:

INCOMPETENCY



An opinion of incompetency is 

not

equated with  innocence



Incompetency is 

not equated with

insanity



MI and IDD are 

not equated with

incompetency



Evaluation occurs over a brief span of

time

THINGS TO REMEMBER



Competency is a 

here and now 

issue



Someone who was previously incompetent

could currently be competent and vice versa



Historical information is important but may not

be relevant to current competency



Important to know if defendant was previously

determined to be not competent, not likely to

be restored



The final decision regarding 

competency to

stand trial is a legal issue

 which is ultimately

decided upon by the Court

THINGS TO REMEMBER

Dr. Todaro

FITNESS TO PROCEED

EVALAUTIONS



Sec. 55.31 Texas Family Code:



“A child alleged by petition or found to have

engaged in delinquent conduct or conduct

indicating a need for supervision who as a

result of mental illness or mental retardation

lacks capacity to understand the proceedings

in juvenile court or to assist in the child's own

defense is unfit to proceed and shall not be

subjected to discretionary transfer to criminal

court, adjudication, disposition, or modification

of disposition as long as such incapacity

endures.”

FITNESS TO PROCEED



Same as 46B:



Expert qualifications



Factors to consider in examination



Report guidelines



Unlike 46B:



Lacks capacity to understand the proceedings

in juvenile court or to assist in the child's own

defense



Fitness evaluations require an actual diagnosis

FITNESS TO PROCEED



Clinical interview with juvenile



Background history



Developmental history



Mental status exam



Specific fitness related questions



May require more than one interview

with juvenile, as their presentation can

be less stable that adult defendant

FITNESS TO PROCEED



Unlike adult CST evaluations, fitness

evaluations may require more

consultation with outside sources



Parents/guardians/caretakers



CPS



Probation/detention staff



Teachers



Mental health providers

FITNESS TO PROCEED



Diagnoses to consider in fitness evaluations will

differ from CST evaluations



Attention-Deficit/Hyperactivity Disorder (ADHD)



Autism Spectrum Disorder



Intellectual/Developmental Disorder



Mood disorders (Depression, Anxiety, Bipolar)



Psychotic disorders (less common in juveniles)



Behavioral disorders (ODD, Conduct)-less likely

to be related to fitness

FITNESS TO PROCEED EVALUATIONS



Evaluation Template:



Qualifications of Examiner



Specific Issues of Examination



Disclosures



Current Allegations



Sources of Information



Background and Demeanor of Defendant



Relevant History



Family



Developmental*



Academic



Employment



Substance abuse



Delinquency



Trauma



Psychiatric and Medical



Current Mental Status

FITNESS TO PROCEED EVALUATIONS



Diagnostic Impressions



Areas of Fitness



Rationally understand the charges against the defendant

and the potential consequences of the pending criminal

proceedings



Disclose to counsel pertinent facts, events, and states of

mind



Engage in a reasoned choice of legal strategies and

options



Understand the adversarial nature of criminal proceedings



Exhibit appropriate courtroom behavior



Testify



Ability to assist in own defense



Opinion on Fitness



Recommendations

FITNESS TO PROCEED EVALUATIONS



If child is unfit to proceed-stay court proceedings



Juvenile will likely be committed to a facility for a

period of up to 90 days for evaluation



After initial 90 days facility can confirm that the

juvenile is either fit or unfit to proceed



If the court or jury finds that the child is fit:



Juvenile proceedings resume



If the court or jury finds that the child is unfit:



Commitment proceedings



Dismissal of charges



Transfer to criminal court upon 18

th

 birthday

NEXT STEPS:

FITNESS TO PROCEED

SANITY EVALUATIONS

Dr. Martin

THE STATUTE: TEXAS



Texas Code of Criminal Procedure,

Chapter 46C



Texas Penal Code 8.01



“It is an affirmative defense to

prosecution that, at the time of the

conduct charged, the actor, as a result

of severe mental disease or defect, did

not know that his conduct was wrong.”



Cognitive Prong only, not Volitional

Prong

SIGNS THE DEFENDANT MAY NEED

A SANITY EVALUATION



Serious 

mental illness or IDD



Client does not understand why they

were arrested and charged even after

given explanation



Explanation of offense and reasoning for

behavior not reality-based or completely

disorganized



Sanity assesses mental state 

at the time

of the offense



If you need a Sanity Eval 

don’t

 need to

file a motion for a CST Eval at the same



Chapter 46C: If CST done at a previous

time by an expert, 

the same expert 

can

do the Sanity Eval



Sanity is a 

legal decision 

ultimately

decided by the Court

THINGS TO KEEP IN MIND

WHO CAN CONDUCT SANITY

EVALUATIONS?



Article 46C.102: Qualifications of Experts



(a) Court may appoint a qualified psychiatrist or

psychologist as an expert with following

qualifications:



At least 24 hours of specialized forensic training

relating to incompetency or insanity

evaluations



 At least five years of experience in performing

criminal forensic evaluations for courts; and



 Eight or more hours of continuing education

relating to forensic evaluations, completed in

the 12 months preceding the appointment

CONDUCTING THE EVALUATION



Three types of information needed:



Historical Info about Defendant’s

Background:

 relevant to forming an opinion

about mental disorder



Current Mental Status Information: 

may be

related to defendant’s mental state at the

time of the alleged offense



Observations of Defendant’s Mental State &

Behavior: 

Around and at the time of alleged

offense



Records



Police Reports



Records on past incarcerations



TDCJ records



TJJD records



Past psychiatric treatment



County or state psychiatric hospitalizations



Texana/MHMRA Records



Substance abuse treatment records



Educational Records



Contact information for collateral sources



Family members



Friends

WHAT YOU NEED TO PROVIDE THE

EXPERT

CONDUCTING THE INTERVIEW



Interview Template



Background Information



Family & Developmental History



Abuse & Trauma History



Educational History



Social History



Employment History



Criminal History



Religious History (in some cases)



Substance Abuse History



Mental Health History



Medical History

SUBSTANCE ABUSE & THE INSANITY

DEFENSE



If defendant was under the influence at time

of the crime, 

this alone does not satisfy the

insanity defense



How do we determine this?



Client interview



Collateral records



Interviews with family members



Offense report-> collateral information about

defendant’s behavior at time of the crime

(observations of being under influence)

SUBSTANCE ABUSE AND THE

INSANITY DEFENSE



Data to collect



Patterns of use at and around the

time of alleged offense



Whether defendant was

intoxicated at the time



The last time defendant used

substances prior to the alleged

offense



Any evidence of withdrawal

symptoms in period following the

incident

SUBSTANCE ABUSE AND THE

INSANITY DEFENSE



Relationship of substance use to defendant’s

presentation of symptoms of mental illness



Data regarding episodes of psychosis, depression,

mania, paranoia, or other disorders that have

occurred in the context of alcohol or substance use



Does the defendant have hx of such symptoms,

independent of such use?



Are the symptoms exacerbated by use of alcohol

or drugs?



Are psychotic episodes induced by

alcohol/substance use, but then continue past

the period of intoxication?

CONDUCTING THE INTERVIEW



Current Mental Status Examination



Behavior/Demeanor



Orientation



Attention/Concentration



Memory



Mood



Affect



Thought Content



Thought Process



Perception



Insight

CONDUCTING THE INTERVIEW



Factors Relevant to Sanity (Texas: Cognitive Prong

only)



Events Preceding the Offense



When did the offense happen? (day, time)



What happened that day (or weeks) leading up

to offense?



Contextual Information about defendant’s

relationship to victim (if not already gathered)



Defendant’s Account of the Offense



Behaviors and mental state related to offense



Detailed account

CONDUCTING THE INTERVIEW



Defendant’s Perception of the Offense



Ask main question flat out: Whether or not he/she

thought at the time that their particular behaviors

would be considered illegal or wrong



Note: If defendant says they knew it was wrong

during evaluation, this does not “prove” it was true

at time of the offense



Seek data consistent/inconsistent with defendant’s

assertion



What were you thinking/feeling after the offense

occurred?

CONDUCTING THE INTERVIEW



What do you think might have been another way

to handle the situation(s)? 

(Volitional Prong)



Notable Events Following the Offense 

(Volitional

Prong)



What happened after the offense?



Trying to avoid detection, cover up actions, etc.



Competency-related factors



Opinion on sanity



46C 

requires

 that the expert give an opinion on

sanity

IF ACQUITTED BY REASON OF

INSANITY



If defendant is found NGRI, does that mean they’re

“getting away” with their crime?



NO; not skirting confinement



Could end up in hospital for the rest of their life



Depending on severity of illness & dangerousness of

offense



If judge or jury rules NGRI-> determine if offense

involved dangerous conduct:



Caused serious bodily injury to another person



Placed another person in imminent danger of serious

bodily injury, or



Consisted of a threat of serious bodily injury to another

person through use of a deadly weapon

DISPOSITION FOLLOWING NGRI: NO

DANGEROUS CONDUCT



Subchapter E, Article 46 C.201



Court determines whether evidence to support

finding that the person has a mental illness or IDD

presently



If there is evidence of such:



Court orders transfer of defendant to appropriate

court for civil commitment proceedings



Determine whether person can receive court-

ordered mental health services under Health and

Safety Code Title 7, Subchapter C; or



Be committed to a residential care facility to receive

IDD services (Health and Safety Code, Title 7,

Subchapter D)

DISPOSITION FOLLOWING NGRI:

NO DANGEROUS CONDUCT



The Court may also order the person:



Detained in jail or “any other suitable place”

pending prompt initiation and prosecution of

civil proceedings



Placed in care of a responsible person on

“satisfactory security” being given for the

acquitted person’s proper care and protection



If the court does not detain or place the person

under 46C.201, the court shall release the

person

DISPOSITION FOLLOWING NGRI:

DANGEROUS CONDUCT



Subchapter F, Article 46C. 251



Step 1: Court shall order acquitted person

to be committed to evaluation of their

present mental condition and for

treatment to maximum security unit of

facility designated by department.



Commitment cannot exceed 30 days->

hearing no later than 30

th

 day after date

of acquittal

DISPOSITION FOLLOWING NGRI:

DANGEROUS CONDUCT



Step 2: Evaluation (Article 46C.252)



Presence of MI or IDD and whether it is severe



If as a result of any severe MI or IDD, person is likely

to cause serious harm to another



If as a result of any impairment, is subject to

commitment under Health and Safety Code, Title 7,

Subchapters C or D (court-ordered MH or IDD

services)



Prospective treatment and supervision options, if

any



If any required treatment and supervision can be

safely and effectively provided as outpatient or

community-based treatment and supervision

DISPOSITION FOLLOWING NGRI:

DANGEROUS CONDUCT



Step 3: Hearing to determine above (Article

46C.253)



Commit to either an inpatient facility,

outpatient/community-based setting, or court-

ordered MH or IDD services under Health and

Safety Code, Title 7, Subchapters C or D



Or Court will discharge and immediately release if

evidence fails to establish that disposition for any

of above is appropriate

DISPOSITION FOLLOWING NGRI:

DANGEROUS CONDUCT



Step 3a: Order of Commitment to Inpatient

Treatment or Residential Care (Article 46C.256)



State establishes by “clear and convincing

evidence” that:



Person has severe MI or IDD



Person as a result of MI or IDD is likely to cause

serious bodily injury to another person if not

provided treatment and supervision



Commitment = necessary to protect safety of

others



Order of commitment expires on the 181

st

 day

following date the order is issued, but is subject to

renewal

DISPOSITION FOLLOWING NGRI:

DANGEROUS CONDUCT



Step 3b: Order to Receive

Outpatient or Community-Based

Treatment and Supervision



Same criteria above, but State fails

to establish that inpatient treatment

in necessary



Renewal after one year

DISPOSITION FOLLOWING NGRI:

DANGEROUS CONDUCT



Step 4: Renewal of Orders for Inpatient

Commitment or Outpatient or Community-

Based Treatment and Supervision (Article

46C.261)



Not later than 30

th

 day before date an order

scheduled to expire-> facility or State’s

attorney may file request that order be

renewed



Request must be accompanied by re-

evaluation for mental illness within previous 30

days

DISPOSITION FOLLOWING NGRI:

DANGEROUS CONDUCT



Court shall renew order only if the court

finds that the party who requested

renewal has established by clear and

convincing evidence that continued

mandatory supervision and treatment are

appropriate



Renewal = not more than one year



Step 5: After Inpatient Commitment, court

can order outpatient or community-based

treatment and supervision (Article

46C.262)

QUESTIONS?