An Examination of Competency Restoration in a South Florida Community-Based Setting

An Examination of Competency Restoration Training in a South Florida Community-based Setting by Josephine J. Tang, M.S. Doctor of Philosophy, Nova Southeastern University, 2010 Dr. David Shapiro, Chairperson The deficiency in competency restoration programs according to the literature (Grudzinskas & Clayfield, 2004) is that this intervention only provides a limited treatment to satisfy the legal requirements. There is also lack of research that examines the efficacy of treatment for incompetent defendants and the duration of competency restoration (Nicholson & McNulty, 1992). The present study examined a competency restoration program for pre-trial individuals. Those (BAP group) who received psychotherapy, competency restoration training, and medication were compared with those (BA group) who did not receive psychotherapy to determine which group will obtain competency faster and maintain it longer. The survival analyses did not find any significant difference between the groups in regard to duration of competency. Propensity scores were based on the logistic regression of psychotherapy on other covariates. Psychotherapy was not statistically significant in three way analyses. When all covariates were unadjusted, the hazard ratio was 2.09 (p = 0.13). When using the propensity score as a continuous variable, the hazard ratio was 1.75 (p = 0.70) and when using the propensity score in quintiles, the hazard ratio was 1.84 (p = 0.42). The probability is that participants in the BAP group are twice as likely to obtain competency as participants of the BA group. Although this result did not reach a significant level, the effect size is meaningful. The three analyses yielded similar results and identical direction. Logistic regression was used to examine the correlation between the treatment time and being judged incompetent among the individuals who were initially judged competent. Individuals of the BA group had slightly lower odds of being judged competent and later to relapse than those in the BAP group. Relapse of competency occurred more frequently in individuals diagnosed with psychotic symptoms, low intellectual functioning, and/or neurological deficit. The findings suggested that severe and persistent mental disorder is a chronic condition that requires long-term care and consideration for more comprehensive treatment