The assessment of competency for execution: An overview

Competency for execution is a legal competency that is an integral part of the capital punishment process in the United States. With the rapidly increasing population under death sentence, the issue of competency for execution is likely to be raised with increasing frequency in the coming years. This creates some compelling ethical issues for the mental health professions. The questions of whether mental health professionals should provide assessment of competency for execution and, if so, how the assessment should be performed, are issues of immediate urgency.     

Competency to be executed: A therapeutic jurisprudence perspective

This Article analyzes the concept of competency to be executed. It examines the Supreme Court's 1986 decision in Ford v. Wainwright, discussing both its Eighth Amendment and procedural due process determinations. It then considers the standard that should be applied in determining competency in this context and the procedures that the states should utilize to insure a fair determination consistent with due process. The article then considers the perplexing problem of whether an incompetent death row prisoner may assert a constitutional or statutory right to refuse treatment designed to restore him to competency for execution, examining both the constitutional and therapeutic implications of involuntary treatment in this context.     

Competency to stand trial: Legal and clinical issues

A fundamental principle of criminal law is the right of defendants to a fair trial. Courts have long recognized that an essential component of this fairness doctrine is the ability, or competency, of defendants to participate in their defense. Mental health professionals have been extensively involved in assisting the courts in the evaluation of competency to stand trial. Three aspects of competency to stand trial in criminal cases are reviewed: the legal criteria defining competency to stand trial, the clinical assessment of competency, and the treatment of defendants found incompetent to stand trial.     

The Evaluation of Parental Fitness in Termination of Parental Rights Cases: A Functional-Contextual Perspective

This article highlights issues involved in carrying out evaluations for termination of parental rights cases and suggests caution for mental health professionals doing such evaluations. It argues that current models of parenting that come from the child development and child maltreatment fields are too narrow in their focus to act as a foundation for such evaluations and are often based on research with select groups in our society making them open to bias. Similarly, it is argued that traditional assessment measures are limited in their utility for responding to the kinds of relational and basic care questions asked in such evaluations. A functional-contextual model is offered as an alternative with examples of potentially useful measurement strategies. With such a frame as a starting point, the field might progress to providing more useful information to courts. Future research directions to improve this practice arena are discussed.     

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.     

Conscientious objection and emergency contraception

This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested.     

Philosophical conceptions of rationality and psychiatric notions of competency

Psychiatrists are frequently called upon to make assessments of the rationality or irrationality of persons for a variety of medical-legal purposes. A key category is that of evaluations of a patient's capacity to grant informed consent for a medical procedure. A diagnosis of mental illness is neither a necessary nor a sufficient condition for a finding of incompetence. The notion of competency to grant consent, which is a mixed psychiatric-legal concept, shares some features with philosophical conceptions of rationality, but differs from them in a number of important respects. This article describes the actual practice of psychiatrists when making such judgments, along with the standards of competency they employ. A comparison is made between those notions of competency and predominant philosophical conceptions of rationality.     

Ethical Issues in Accounting and Economics Experimental Research: Inducing Strategic Misrepresentation

Forensic psychologists face a variety of ethical issues in conducting evaluations. One such issue is attorney presence during a forensic evaluation. In forensic evaluations, it is necessary to use standardized procedures while also attending to the rights of the individuals being assessed. This article examines the neuropsychological literature on extraneous influences in evaluations including effects of attorney presence. Then the article discusses the limited knowledge about attorney presence during forensic evaluations, addresses attorney motivations for being present during an evaluation, and considers attorney presence in the context of ethical mandates. Finally, suggestions are offered for forensic clinicians confronted with attorneys who wish to be present during assessments.     

Both Sides of the Coin: Randomization from the Perspectives of Physician-Investigators and Patient-Subjects

Randomization is the “gold standard” design for clinical research trials and is accepted as the best way to reduce bias. Although some controversy remains over this matter, we believe equipoise is the fundamental ethical requirement for conducting a randomized clinical trial. Despite much attention to the ethics of randomization, the moral psychology of this study design has not been explored. This article analyzes the ethical tensions that arise from conducting these studies and examines the moral psychology of this design from the perspectives of physician-investigators and patient-subjects. We conclude with a discussion of the practical implications of this analysis.     

Putting the power of behavior analysis in the hands of nonbehavioral professionals: Toward a blueprint for dissemination†

Behavior analysts have much to offer nonbehavioral professionals who work with the communities that we serve. Successful dissemination of behavior-analytic technologies to these professionals could potentially improve their practice. Although the literature contains some exemplary examples of successful dissemination, our discipline would benefit from a blueprint for conducting this important work. In this article, I share our experiences disseminating behavioral technologies to educators, law enforcement officers, and health care providers who engage with neurodiverse individuals. These experiences form the basis of a recommended blueprint for dissemination, which awaits empirical support. After describing this tentative blueprint, I provide suggestions for future research on how best to disseminate our technologies to nonbehavioral professionals, the ideal content of those dissemination activities, and the conditions under which professionals may be more likely to embed our technologies into their best practices.     

When is a mental health professional competent to assess a person's decision to hasten death?

As the country continues to debate the legality of aid-in-dying, it appears inevitable that at some point there will be a need for mental health professionals to be involved in assessments of individuals asking for a hastened death. I designed this article to provide a set of guidelines that will allow both mental health professionals and potential consultees to determine if a professional has the training and expertise necessary to be a competent consultant.     

Supervising Humanistic-Existential Psychotherapy: Needs, Possibilities

The competency movement within professional psychology, evidence-based practice concepts, and the trend toward incorporating psychological services as a component of an integrated care approach within health care settings are major developments in the changing landscape of psychotherapy practice that have important implications for psychotherapy supervision. This article examines each of these developments as they relate to conducting psychotherapy supervision from a humanistic-existential perspective. The current status of supervision guided by a humanistic-existential framework is described, followed by exploration of needs and possibilities for the future evolution of the supervision approach in light of developments in the field.     

Humans as Scientists: Scientists as Humans

This article discusses how constructivist psychology might contribute to studies of the history and philosophy of science. I suggest that this would be a fruitful topic for graduate research and provide a brief analysis of what would be required to model the construct systems involved in the Priestley-Lavoisier controversy over the roles of phlogiston and oxygen in calcification. I also suggest that the rich literature and conceptual frameworks of science studies can contribute significant enhancements to constructivist psychology.     

Transformational Leadership and Athlete Satisfaction: The Mediating Role of Coaching Competency

Drawing on social cognitive theory, we examine the relationship between coaches’ transformational leadership and athletes’ evaluations of coaches’ coaching competency. We also investigate how coaching competency can mediate the positive effect of coaches’ transformational leadership on athletes’ satisfaction. Using path analysis with bootstrapping techniques, we analyzed 397 competitive volleyball players to test our research model. Our results revealed that (a) coaches’ transformational leadership has a positive effect on coaching competency, and (b) coaching competency mediates the positive effect of coaches’ transformational leadership on athletes’ satisfaction. Implications for coach education and sport psychology in terms of theory and research are discussed.     

The insanity defense: Legal standards and clinical assessment

Although the insanity defense is used infrequently, it has received significant attention from legal and mental health professionals. In this article, we review the historical development of insanity defense standards and describe the standards currently employed in the United States. We present a model for evaluating a defendant's mental nonresponsibility, and we briefly discuss the legal standards and procedures for the assessment of insanity acquittees for release. Throughout the article, we discuss some scientific, ethical, and jurisprudential issues associated with the insanity defense and nonresponsibility evaluations.     

Politics on the move: The democratic control of the design of sustainable technologies

This article examines how “design rationality” could help remediate the controversy over environmental degradation. Drawing on the case of designing sustainable forms of traffic management, it argues that this will only be effective to a limited degree. “Policy conversation” does indeed take place but within a coalition of actions that pushes a particular set of solutions. This facilitates due procedure but erodes political legitimacy, thus potentially reproducing an intractable controversy. The article suggests a five-phase model of democratic control as an alternative. He primarily works in the field of sociology of technology and environment. He is presently involved in a research project on the social redefinition of mobility, analyzing the translation of sustainable development into new institutional arrangements.     

Child custody evaluations: Fair and unfair professional practices

Mental health professionals are frequently called upon to conduct psychological evaluations of the adult parties and minor children in contested child custody actions. Whether Court-appointed or as an agreed examiner, the professional's essential role is that of expert consultant to the court. He or she can only assist the trier of fact by conducting an evaluation that is fair, impartial and objective, that protects the personal and legal rights of all parties, and that is consistent with professional and ethical standards. Ethical principles require the mental health professional to accept the burden of responsibility for protecting and preserving the clients' rights and welfare throughout the evaluation period, from the initial referral to the rendering of recommendations.     

Ethical Considerations for Providing In-Home Mental Health Services for Homebound Individuals

The number of homebound individuals in the United States is on the rise, causing health-care professionals to expand in-home health services to help meet the increased demand. Due to the prevalence of feelings of isolation and depression in this population, it is imperative that mental health professionals join this effort to increase access to mental health services. Delivering psychotherapy in clients’ homes presents many advantages to these homebound individuals, but there is a dearth of literature addressing how therapists should handle unique ethical issues that arise in this type of setting. This article addresses ethical considerations and guidelines for in-home provision of mental health services. General ethical issues related to home-based psychotherapy include boundaries, confidentiality and privacy, competency, insurance coverage, and autonomy. Issues pertaining to different categories of homebound individuals, including persons with agoraphobia, chronic illnesses, and older adults, are then discussed in turn. Recommendations on how to best manage these issues by applying the American Psychological Association’s, the American Counseling Association’s, and the National Association of Social Workers’ Ethics Codes are provided.     

MMPI-2 and MCMI-III characteristics of parental competency examinees

The MMPI-2 (Butcher et al., 2001) and the MCMI-III (Millon, Davis, & Millon, 1997) may contribute to understanding psychological functioning in parental competency examinees. In this study, we sought to identify MMPI-2 and MCMI-III characteristics of this population. We collected data regarding 127 individuals who underwent court-ordered parental competency evaluations. Although test results were generally consistent with findings from the child custody literature, MMPI-2 results indicated the highest Validity scale elevation on the L scale in contrast to the K scale elevations that have often been reported in the custody literature.     

DOING COMPETENCIES WELL: BEST PRACTICES IN COMPETENCY MODELING

The purpose of this article is to present a set of best practices for competency modeling based on the experiences and lessons learned from the major perspectives on this topic (including applied, academic, and professional). Competency models are defined, and their key advantages are explained. Then, the many uses of competency models are described. The bulk of the article is a set of 20 best practices divided into 3 areas: analyzing competency information, organizing and presenting competency information, and using competency information. The best practices are described and explained, practice advice is provided, and then the best practices are illustrated with numerous practical examples. Finally, how competency modeling differs from and complements job analysis is explained throughout.