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Course

Competence to Stand Trial Evaluations: Beyond the Basics | June 8-9, 2026 | VIRTUAL

11 CEUs

$350 Enroll

Full course description

ILPPP

The Institute of Law, Psychiatry, and Public Policy presents:

Competence to Stand Trial Evaluations: Beyond the Basics | June 8-9, 2026 from 11:00AM-5PM EST | Virtual

$350.00 Standard Registration | $180.00 DBHDS/CSB (discount code below)

Click here for an agenda.

Summary

Almost every U.S. state is struggling to meet the demand for competence evaluations, and most are struggling to maintain a workforce of well-trained competence evaluators. This two-day, live online training is designed for those who have some knowledge or experience with competence evaluations, and will also benefit from more training in some of the more challenging issues. 

Speakers

Speakers for this training include:

  • Virginia Barber-Rioja, PhD
  • Neil Gowensmith, PhD
  • Lauren Kois, PhD
  • Daniel Murrie, PhD
  • Chriscelyn Tussey, PsyD, ABPP

Training Overview

Day 1:

Competence Evaluation is Functional and Contextual: A Brief Refresher and Beyond

Evaluations of Competence to Stand Trial (CST, or adjudicative competence) are the most common form of forensic evaluation. Yet research reviews of competence reports consistently reveal weaknesses in the wide-scale practice of CST evaluation—even among experienced evaluators. This session quickly reviews the basics, including how the functional and contextual nature of competence shapes every additional consideration. We guide evaluators in thorough CST assessment and report writing, with an emphasis on adequately addressing all Dusky criteria. We focus on the areas evaluators tend to under-address, and on areas in which practice guidelines remain somewhat ambiguous.

Assessing Rational Understanding

This session will focus on assessing rationality—i.e., the “rational understanding” specified in the Dusky decision as well as ability to assist counsel in a rational manner—in competence to stand trial evaluations. Research reveals that many evaluators give these required components of competence little attention in interview and report. This session will begin with a video exercise, which will prompt exercises and discussion addressing threats to rational understanding. 

Common Errors in Competence Evaluations: Lessons from Large-Scale Reviews, and Ethical Considerations

This session is based on a systematic, empirical review of more than 2,000 CST reports submitted from three states. The reports were analyzed using a uniform coding rubric that was independently created using practice guidelines from existing coding rubrics, academic literature, and best practice guidelines. This study reviewed a large sample of reports to better understand overall report quality, common practices, common errors, and areas for further training. During the session, participants will review some of the most common errors seen in this multi-state review and consider relevant ethical and practice guidelines.

Day 2:

Making the Call: Determining Unrestorability in Criminal Defendants

Deciding that a criminal defendant cannot be restored to competence is one of the most consequential—and least standardized—judgments in forensic mental health. Clinicians are asked to make this call without best practice guidance or a methodologically rigorous research literature to reference. This workshop addresses that gap by synthesizing the available evidence and presenting two practical frameworks for clinical reasoning. 

Drawing on relevant case law, forensic and "civil" clinical research evidence, and applied reasoning, this workshop walks participants through the decision-making process from initial restoration admission through the determination of unrestorability. Topics include: legal standards governing unrestorability opinions, methodological limitations of the restoration empirical literature, the difference and utility of evidence-based versus evidence-informed research, clinical and diagnostic indicators associated with treatment-resistant restoration failure, the role of adequate restoration efforts before a finding of unrestorability can be made, documentation practices, and strategies for communicating opinions clearly in reports and court proceedings. Case-based discussion will ground the material in real-world complexity. 

Cultural Competence and Assessment of Competence

Many competence evaluations feature defendants whose cultural backgrounds—whether ethnicity, race, religion, language, or other—differ greatly from the evaluator’s. Conducting forensic mental health assessment requires structural competence or an understanding of the societal forces that have shaped the American legal system. Mental health professional organizations have established cultural competence as a key component of clinical practice in general, and forensic assessments in particular (APA, 2003; 2005, 2013, 2017). The need for cultural competence in Competency to Stand Trial evaluations (CST) has also been established by the courts (State of Washington v. Sisouvanh, 2012; State of Washington v. Ortiz-Abrego, 2017). However, translating the goals of cultural competence into concrete practice guidelines in forensic assessment remains an elusive task that can even present potential ethical dilemmas when applied to CST

Cultural competence in CST requires not only developing skills and knowledge about the impact of cultural factors in clinical/forensic presentations, but also self-awareness (e.g., cultural humility) and consideration of the evaluator’s personal identity and biases. This training provides an overview of the principles of cultural competence as applied to CST evaluations, including an overview of professional guidelines, challenges and dilemmas; as well as pragmatic recommendations with respect to how to approach the evaluation, clinical interview, diagnostic formulation, report writing, and testimony.

When Cognition Matters: Neuropsychology-Informed CST Evaluation

Forensic psychologists frequently conduct competence evaluations of defendants with cognitive deficits. These deficits may result from medical, neurological, and/or serious mental illness and can be relevant to competence criteria. This session will provide an overview of some common cognitive deficits and diagnoses found in competence evaluations and guidance for how to address these issues as they arise. Relevant case law, as well as ethical standards and guidelines, will be explored. Also, we will discuss a decision-making model to examine whether an evaluator is competent to perform cognitive testing, consultation is warranted, or if a referral to a neuropsychologist is indicated. We will explore pragmatic considerations when conducting forensic evaluations with a neuropsychological component, including intersectionality, test selection, and report writing. Case examples and opportunities for practical application will be integrated throughout this training session. Please note that the purpose of this program is not to teach neuropsychological assessment or provide in-depth instruction on specific tests.

Learning Objectives

After attending Day 1 of this training, participants will be able to:

  1. Describe how competence is functional, and how to address functional capacities in evaluations and reports.
  2. Describe how competence is contextual, and how to directly address contextual demands in evaluations and reports.
  3. Describe ways to assess the rational understanding capacities identified in the Dusky decision.
  4. Provide an example of how to explicitly address rational understanding, with examples or details, in a report.
  5. Describe ways of addressing ability to assist counsel, beyond asking the defendant about counsel.
  6. Identify common errors in CST reports.
  7. Apply observations of defendant's symptoms to functional impairments in competence-related skills, and a final opinion on CST criteria.
  8. Describe distinctions between relevant versus irrelevant information, particularly regarding substance abuse, criminal history, and diagnoses.

After attending Day 2 of this training, participants will be able to:

  1. Explain two systematic models to determine restorability.
  2. Analyze clinical cases to evaluate whether the threshold for an unrestorability opinion has been met, weighing research evidence, diagnostic presentation, treatment history, restoration effect, and prognostic indicators against applicable legal and ethical standards.
  3. Construct a defensible written opinion on unrestorability that accurately reflects the clinical and legal reasoning, anticipates likley challenges in court, and communicates conclusions clearly to legal decision-makers.
  4. Identify at least three common cognitive deficits and/or diagnoses found in competency populations.
  5. Describe and apply a decision-making model to address neuropsychological issues in competence evaluations.
  6. List at least three pragmatic factors that warrant consideration when conducting competence evaluations wherein cognitive deficits are relevant.
  7. Describe the importance of culturally competent practice, particularly in the context of CST evaluations.
  8. Explain historic views regarding the potential difficulties of implementing culturally competent practice (e.g., potential philosophical dilemmas) and the way in which the field has shifted in recent years toward the process of culturally competent training and practice.
  9. Identify the skills and knowledge necessary to work toward culturally competent practice.
  10. Discuss guidelines, challenges, and practical recommendations regarding cultural competence in the assessment of CST.
  11. Identify strategies by which an evaluator can conduct a CST evaluation in a more culturally competent manner.

Continuing Education

Participants can recieve 11 hours of continuing education credits (CEs) through the ILPPP, which is approved by the American Psychological Association (APA) to sponsor contining education for psychologists. ILPPP maintains responsibility for this program and its content.

Upon completion of this workshop, participants will be sent a Qualtrics survey link to evaluate the training. Personalized CE certificates will be provided at the end of the survey. While completion of the evaluation is not required to be awarded your continuing education credits, we would greatly appreciate your feedback.

Training Fees

$350.00 Standard Registration

$180.00 DBHDS/CSB employees

We recommend attending both days, but there is an option for single-day registration for those with limited schedules or needs. Please email kwh4pyd@uvahealth.org to inquire about single-day registration.

*If you are a DBHDS employee, please use your DBHDS email to register and use this discount code to get the reduced price: CSTEVALS26

Refund Policy:

Full refunds are available up to one week prior to the training date. No refunds will be issued within one week of the training. To request a refund, email Walker Hill, Training Program Coordinator, at kwh4pyd@uvahealth.org.