Which Information Matters? Using Policy Capturing to Understand Psychological Recommendations of Civil Competency.

Courts rely heavily on the recommendations of mental health evaluators when making decisions about competency (e.g., Zapf, Hubbard, Cooper, Wheeles, & Ronan, 2004), including civil competency (e.g., Quickel, Demakis, & Reeve, 2017); however, very little is known about how evaluators arrive at their opinions regarding an individual's capacity. The current study assessed clinical decision-making using a policy capturing methodology. An ecologically valid sample (N = 47) of predominantly white (87.23%) and female (55.30%) clinicians who were eligible to conduct civil competency evaluations in North Carolina were recruited to examine the degree to which five key factors (functional test data, cognitive test data, personality test data, hospitalization history, and/or medication compliance) influenced clinician competency determinations. Personal insight into one's decision-making process was also measured. Consistent with previous research, functional test data was weighted most heavily in evaluator decisions, though all five factors were considered. Further analysis suggested variable levels of self-awareness of one's decision-making policies by participants depending on the factor. In addition, there was high agreement among clinicians when cases were straightforward, but perfect disagreement (half recommending competency, half recommending incompetency) among clinicians when cases were more complex. Implications for civil competency assessment and decision-making are discussed. IMPACT STATEMENT: Functional assessment data drives clinician decisions regarding civil capacity, over and above the impact of cognitive and personality test data, hospitalization history, and medication compliance. Due to high levels of court reliance on the recommendation of clinical evaluators, and the different standards of civil competency across different states and jurisdictions, understanding how evaluators arrive at competency recommendations is imperative and has clinical, legal, and ethical implications. [ABSTRACT FROM AUTHOR]