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RETURNING YOUR CLIENT TO COURT:

THE SLATER METHOD: AN EDUCATIONAL TOOL

TO RESTORE COMPETENCE TO STAND TRIAL

IN MENTALLY RETARDED DEFENDANTS

Department of Mental Health, Retardation and Hospitals (MHRH)

Eleanor Slater Hospital (ESH)

Cranston, Rhode Island

This packet was developed by the Eleanor Slater Hospital of the Rhode Island Department of

Mental Health Retardation and Hospitals and should not be reproduced in full or in part without

the expressed consent of Eleanor Slater Hospital. Copyright Eleanor Slater Hospital.

Returning Your Client to Court:

An Educational Tool to Restore Competence to Stand Trial in Mentally Retarded Persons

istmrtt.doc

TABLE OF CONTENTS

Section Page

I. INSTRUCTIONAL MANUAL 1-17

A. Purpose of this Tool 1

B. Types of Impairments of Clients with Mental Retardation 2

C. How to Interview a Person with Mental Retardation 4

D. How to Use the Training Workbook 6

E. Flow Sheet for Workbook Modules 9

F. Summary of Training Workbook 10

G. What Happens When Your Client Returns to Court 11

H. Glossary 12

I. Sample Treatment Plan (for hospital use only) 14

0 WORKBOOK 18-32

A. Module 1 18

B. Module 2 20

C. Module 3 22

D. Module 4 24

E. Module 5 26

F. Photographs 28

III. ANSWER SHEETS 33-37

IV. REFERENCES 38-39

Note: Although the developmental disabilities (DD) population is not limited to persons with

mental retardation (MR), this packet uses the phrase MR instead of DD because the legal system

uses the term MR. Use of this packet to train a client does not mean that they have been

diagnosed with mental retardation. Instead, they may have some other form of DD, may have a

non-DD cognitive impairment, or are believed to have lower than average intellectual

functioning.

The pronoun “he” is used for consistency and because the majority of MR incompetent to

stand trial criminal defendants are male. However, we recognize that a minority of MR

incompetent to stand trial criminal defendants are female.

This packet was prepared by: Barry Wall, MD, Director, Forensic Service; Brandon Krupp, MD,

Director, Adult Psychiatric Service; and Tom Guilmette, PhD, neuropsychologist.



Page 1

I. INSTRUCTIONAL MANUAL

A. Purpose of this Training Tool

Purpose of inpatient training program: Clients are sometimes sent to Eleanor Slater

Hospital (ESH) because they are viewed by the court or by the examining physician as being

incompetent to stand trial (IST). When a mentally retarded incompetent to stand trial (MR-IST)

client is admitted to your unit, Rhode Island law says that the purpose of hospitalization is to

make them competent to stand trial (CST), if possible. The law assures that no one gets pushed

through the courts without clearly understanding what is going on. Some, but not all, MR-IST

clients can become competent to stand trial after receiving education about the trial process and

being prepared for what to expect in court. This packet is designed to help you assist your client

to return to court competent to stand trial as soon as possible. How long the client stays in the

hospital depends on how quickly they pass examinations that show that they have become

competent to stand trial.

Purpose of outpatient training program: Even when viewed by the court or by the

examining physician as being incompetent to stand trial, arrangements can sometimes be made to

keep an MR-IST client out of the hospital (see above) and out of prison. If adequate supervision

can be achieved outside the hospital, the person can receive educational programming to restore

them to competency as quickly as possible. The advantages to outpatient education include:

avoiding more intensive confinement that can foster regressive behavior; diminishing the client's

anxiety about the learning process; and providing education by staff that the client already knows

and trusts.

What does incompetent to stand trial mean? It usually means one or more of the

following:

1). The client does not understand the charge and potential consequences; and/or,

2). The client does not understand the trial process; and/or,

3). The client is not able to participate in his/her defense.

You can help your client become competent to stand trial by asking them questions

focusing on and helping them learn more about:

1). The criminal charge(s) against them and the potential consequences; and/or,

2). The trial process; and/or,

3). How to cooperate with their attorney.

This packet will help you be able to interview your client, discuss their case with them,

and educate them to better their understanding of what will happen when they go to court.



Page 2


B. Types of Impairments in Mentally Retarded Persons

Mental retardation often impairs a person's ability to function in more than one way.

Three areas of deficits are especially relevant to competency to stand trial: cognitive

impairments; impairments in communication; and emotional/behavioral impairments.

(Appelbaum, 1994)

1). Cognitive impairments: Cognitive skills are those needed to carry out activities

involved in intellectual functioning, such as remembering, perceiving, judging, and

reasoning. Persons with mental retardation may have cognitive deficits such as:

a). Attentional impairments. Clients can have problems paying attention because of

attending to the wrong stimulus. (Longhurst, 1975) Clients may have difficulty

resisting irrelevant distractions, particularly in noisy rooms. This may make it

difficult for them to maintain proper focus during courtroom proceedings or during

meetings with their attorneys.

b). Memory impairments. Persons with mental retardation often have difficulty

remembering information. Often, their poor memory is because they never realized

the information was important for them to know. (Luftig, 1982) Don't be surprised if

your client forgets what you taught him only a couple of days ago. It can take him

much longer to remember newly learned information, so you may have to go over the

same material many times to ensure retention.

c). Impaired logical reasoning and problem solving abilities. Clients with mental

retardation can have deficits in reasoning, foresight and strategic thinking. This may

make it difficult for the client to plan legal strategy with their attorney. For example,

if a client is charged with burglary (a more serious charge than breaking and

entering), they need to be able to tell their attorney that they broke into the building

in order to keep warm but had no intention of stealing (if this is the truth). This

differentiation in criminal intent could make the client eligible to enter a plea bargain

for breaking and entering (a lesser charge) instead of burglary.

d). Decreased ability to learn from mistakes. Clients may be intellectually inflexible

and have a tendency to rely on familiar, and often unsuccessful, strategies and

behaviors (see below).

2). Impairments in communication. Clients with mental retardation can have

communication problems, for a number of reasons:

a). Poor articulation. For example, a client may pronounce the word "judge" as

"George." This type of impairment may make it difficult for courtroom personnel to

understand what the client is saying.

b). Limited vocabulary. For example, the client may understand and use the word

"lawyer," yet they may not know the word "attorney." In this instance, the court may

believe that the client does not understand the function of an attorney when the client

really understands the attorney's role.

c). Impaired syntax.



Page 3


B. Types of Impairments in Mentally Retarded Persons (continued)

d). Difficulty answering questions. The client may have trouble putting into words

concepts that they really understand. The court may erroneously believe that the client

does not understand what is going on in court.

e). Inability to read or write. The client may pretend to read a paper and say that they

understand it. However, you will not know whether the client can really read unless

you test them by asking them to read aloud.

f). Mimicking responses or answers to questions. Clients can have a tendency to

answer "yes" to questions, especially when they do not understand the question or if

they do not know the answer to the question. (Sigelman, 1981) They can also have a

desire to get your approval, and this can enhance their suggestibility. If the client

repeatedly says, "yes, I understand" in the courtroom, they may not really understand

what is happening.

3). Emotional/behavioral impairments: Persons with mental retardation can respond to

stress with a limited repertoire of emotional responses and behaviors, including:

a). Passivity and withdrawal. They may see themselves as dominated by others and can

lack a feeling of control over their own environment. These feelings of helplessness

can lead to acquiescence in an attempt to please authority. They often yield to social

pressures even if required to give an answer they know is wrong. (Sigelman, 1981) For

example, if the judge asks the client, "Do you understand?" during court proceedings,

the client may respond by saying, "Yes" even though they do not understand what is

going on.

b). Angry outbursts. They may have difficulty inhibiting their anger, leading to

disruptive outbursts in the courtroom. This may result in physical acts to express anger,

frustration and stress. For example, a MR-IST client may repeatedly stand up and yell

in court as a way of expressing their frustration.

The three deficit areas listed above often interact with each other to compound the client's

impairments. For example, if a MR-IST client is mainly looking for positive feedback from you

in a desire to please you, they might shift attention away from the discussion about court and

instead just focus on looking to you for approval. A full discussion of impairments in trial-related

competencies of MR clients can be found in the two Appelbaum articles (Appelbaum, 1994 and

Appelbaum and Appelbaum, 1994).



Page 4


C. How to Interview a Person with Mental Retardation

1. Use simple language. (e.g. - Don't use the term "prosecuting attorney" unless they know

what it means. An acceptable substitute may be the lawyer on the other side or "the bad

lawyer.")

2. Speak slowly, clearly, and calmly. Do not raise your voice or push the client too hard.

Increasing the client's anxiety will only make it harder for them to learn.

3. Use concrete terms and ideas.

4. Avoid questions that give part of the answer within the question (leading questions). [Note:

During module training, there will be times when you will be instructed to ask questions that

contain previously learned material.]

5. Ask open-ended questions. Depending on the client's abilities, try to phrase questions to

avoid "yes" or "no" answers. Answers to open-ended questions can be harder to understand

than yes-no responses, but simple reliance on yes or no answers may lead to the assumption

that the client has understood the answer when she really may not understand the question at

all. (Appelbaum and Appelbaum, 1994)

6. Repeat questions from a slightly different perspective. This will help you make sure that the

client is not merely parroting back answers.

7. Proceed slowly and give praise and encouragement.

8. Avoid frustrating questions about time, complex sequences or reasons for behavior. (e.g.

Don't ask, "What date were you arrested?" or "How long ago was that?" unless you know that

they can tell time and can keep track of dates.)

9. Of course, you would never make fun of the person because you know that they will sense it

and become less cooperative. But also be sure that you do not show any frustration that you

may have toward the client.

10. Highlight important information to improve memory retention. (For example, say, "Now pay

attention. What I'm about to say is very important and you need to remember this... [then

provide the information].")

11. Repeat important information. This also helps with memory retention.

12. Cut down on distractions. (e.g. Don't interview them in the day room of a busy ward).

13. If a client does not communicate effectively or responds inappropriately to questions, give

them direct, explicit feedback. (e.g. "No, that's not right" or "You're saying it too fast - slow

down.")



Page 5


C. How to Interview a Person with Mental Retardation (continued)

14. Be careful not to nod your head "yes" or "no", or to give other nonverbal cues that may

inadvertently aid the client in answering the question.

15. It may be best to take short breaks. Clients often do better learning material with multiple,

short sessions rather than a few, long sessions.



Page 6


D. How to Use the Training Workbook

1. CONTENT OF THE WORKBOOK:

The workbook is divided into five educational modules. The modules are designed to

help you ask questions and therefore teach your patient about the legal process. Because the

impairments in competency to stand trial abilities are specific to each patient, you need to know

the specific impairments that your client has. Then, you can tailor the educational sessions to

focus on your client's weaknesses. A member of the Forensic Service will meet with you to

discuss your client's specific impairments and will give you a training session on the use of this

manual before you get started.

The five modules are:

Module 1: Purpose of Training; Review of Charges, Pleas, and Potential Consequences

Module 2: Courtroom Personnel

Module 3: Courtroom Proceedings, Trial, and Plea Bargain

Module 4: Communicating with Attorney, Giving Testimony, and Assisting in Defense

Module 5: Tolerating Stress of Proceedings

Each module lists sample questions represented in bold type that you can ask the client.

You are encouraged to make up new questions to keep the client from memorizing the questions;

however, remember that each module session is designed to assess very specific content areas.

Try to keep this in mind and not veer too far off topic as you vary the questions. Examples of

satisfactory answers to questions are listed in parentheses.

You will use a separate answer sheet to record two things: the client's responses; and your

assessment of the quality of the client's response. By doing this, you can document the progress

that the client is (or is not) making. For example, after meeting with someone for several

sessions, you may document an improvement by writing something like: "At first, Ms. Smith

thought that all the lawyers in the courtroom were there to help her. After a week of talking about

the courtroom process, she now understands that the prosecution will try to put her in jail."

Pages 20-24 of this packet contain ten photographs that can assist you in working with

the client. Use these photos to ask them who sits where in court and then have them describe

what each character does. Use the photos of witnesses to make up stories about what a witness

might say about them, or what the client might say if they serve as a witness.



Page 7


D. How to Use the Training Workbook (continued)

2. THE TRAINING PROCESS

There are many ways to evaluate a person's understanding of material presented to them;

this training workbook focuses on two ways of assessing such understanding. First, this packet

attempts to get the client to demonstrate their understanding of a concept by putting it into their

own words. Asking people to rephrase what has been taught to them is a good way to assess their

understanding of the material. (Grisso 1986)

The second way of assessing understanding used in this workbook is to ask direct

questions whose answers rely on processing the information that you taught the client during

phase I. It is sometimes difficult to have a person with mental retardation answer open-ended

questions spontaneously. Furthermore, recognition of information learned previously when cued

by a question is easier for everyone than spontaneous recall. For these reasons, each module gives

understanding-based training questions to help you probe for and assess your client's

understanding of the information.

A system of questions is presented that builds upon knowledge conveyed through each

preceding question. (Coles 1996) Questions that assess understanding are placed in the manual

after the basic knowledge questions because they require use of this knowledge in a more

sophisticated way. The problem that may occur is that by repeatedly going over the same

questions and answers, you may be demonstrating their knowledge of a greater number of details

of the same basic information, or be testing their ability to memorize answers, rather than testing

their appreciation of concepts. This is a common dilemma in assessing a person's understanding.

(Coles 1996)

The process of educating your client will occur by presenting the five educational

modules. Each module is administered in sequential order (Module 1, then Module 2, etc.) over a

variable period of time. Some clients may take only a session to complete a module, while other

clients may take many sessions to complete a module. Module training will occur in two phases.

Phase I: In the first phase of module training, you will provide knowledge-based training.

During this phase, you will give your client basic information about the legal system for them to

learn by rote. This phase of training is like cramming for a test, where you just focus on knowing

the information presented. Knowledge-based training covers all three domains of impairment

(cognitive, communication, and emotions/behavior) discussed in Section II of this packet. The

goals of knowledge-based training are listed in column A of Table 1: "Summary of Training

Program Workbook." In each module, knowledge based questions are located in column A.

During Phase I knowledge-based training, you will present knowledge-based questions only

(column A), skipping the understanding-based questions (column B).



Page 8


D. How to Use the Training Workbook (continued)

Phase II: In the second phase of module training, you will provide understanding-based training.

This is the more important phase of training. You will work to help the client understand the

meaning of the material that they learned in the first phase. Understanding the meaning of what you

have taught them is much different than simply being able to reproduce the message. It is an active

process of making sense of the information, and it ensures that the client is not merely "parroting"

back information that you have taught them. The goals of understanding-based training are listed in

column B of Table 1. During understanding based training, you will present understanding-based

questions (column B) in addition to knowledge-based questions (column A) for each module. In

this section, whenever possible, you should try your best to encourage your client to spontaneously

express their understanding of the information that you are reviewing.

Complete the modules by following the Flow Sheet (page 8). First, you will take the

client through Phase I and Phase II of all five modules to create a summary of his answers before

training to establish a baseline. Next, you will return to the knowledge-based training of Phase I

three times. After you have completed the third assessment of all five modules in Phase I, report

back to the Forensic Service. We will work together to tailor the understanding-based portion of

training. If you think that you are having trouble with one module and need help, call the Forensic

Service at 464-2013 or Dr. Wall at 464-1572. When you complete both phases and all modules

as instructed, contact the Forensic Service and we will arrange for the final phase of training, role

playing sessions in mock court.

WARNING: WHEN USING YOUR ANSWER SHEET, NEVER

WRITE DOWN A DEFENDANT'S INCRIMINATING

STATEMENTS! OBTAINING A CONFESSION IS NOT PART

OF RESTORING A PERSON'S COMPETENCE TO STAND

TRIAL.



Page 9


E. Flow Sheet For Workbook Modules

Step 1: Phases I & II, Modules 1-5: Ask and record knowledge-based training (column A)

and understanding based training (column B) for all modules to obtain a baseline.

Phase I: KNOWLEDGE-BASED TRAINING

Step 2: Phase I, Module 1: Knowledge-based training only (Column A). Go through this module a minimum of three times. When all answers are fair or good, move to the next

step.


step.


step.


step.


step.

Step 7: Call the Forensic Service (see page 7).

Phase II: UNDERSTANDING -BASED TRAINING

Step 8: Phase II, Module 1: Knowledge-based AND understanding-based training (Columns

A & B). Go through this module a minimum of three times. When all answers are

fair or good, move to the next step.













Step 13: Contact the Forensic Service when you believe that your client is ready for a "dress

rehearsal" in mock court.



Page 10


F. Summary of Training Program Workbook

Column A Column B

MR Impairment Knowledge-based training Understanding-based

training

Cognition

The client must learn:

the purpose of training

sessions. (1*)

the charges. (1)

possible pleas. (1)

potential consequences.

(1)

the role of courtroom

personnel. (2)

the purpose of going to

court. (3)

the purpose of going to

trial. (3)

The client must understand

that:

this is an adversarial

proceeding, and that they

are the accused (1,3)

they cannot be punished

just because they are

accused. (1,3)

a plea is different from a

finding. (1,3)

the case may go to trial,

but it probably won't.

(1,3,4)

a plea bargain means

giving up some rights.

(1,3)

Communication


the important of speaking

with their attorney. (4)

the importance of listening

in court. (4)

the importance of not

saying "yes" if they don't

understand something. (4)

how to testify

appropriately. (4)

The client must be able to:

understand that the

opposing counsel may try

to trip him up.

tell their story without

self-incrimination.

tell all details of their

story to their attorney.

resist leading questions

appreciate and be able to

stick to a defense strategy

Emotions & Behavior


to display appropriate

behavior (5)

to not display

inappropriate behavior (5)

Role playing sessions to

assess ability to tolerate

stress of courtroom

proceedings. (1-5)

* Numbers in parentheses denote the main module number(s) where this information is reviewed.

Module 1: Purpose of Training; Review of Charges, Pleas, and Potential Consequences

Module 2: Courtroom Personnel

Module 3: Courtroom Proceedings, Trial, and Plea Bargain

Module 4: Communicating with Attorney, Giving Testimony, and Assisting in Defense Module 5: Tolerating Stress of Proceedings



Page 11


G. What Happens when Your Client Returns to Court

At the end of this training, it is hoped that you client will become competent to assist

counsel (that is, that s/he will know and have a basic understanding of the conditions for

participating in his/her own defense), understand their charges, the potential consequences, and

understand the trial process. However, a potential problem with this training is that a client who is

provisionally competent to assist counsel may have difficulty making specific decisions that are

encountered as the process unfolds. For this reason, you may be asked to accompany your client

to court. It may become necessary for you to help the client appreciate the decisions s/he may

have to make and to communicate with their attorney.

Just as you will be training your client about how to relate to the court, we plan to inform

the judge and the attorneys about how to interact with a mentally retarded client. We inform them

that it is important to provide a safe environment for the client in order to decrease his/her level of

stress. We will also recommend that attorney/client meetings be conducted in the presence of

someone the client knows. We help attorneys understand how to ask questions to your clients. For

example, we will inform them that yes/no questions are often less valid than open-ended

questions. We will also encourage them to speak slowly, and give praise and encouragement to

help your client communicate better. We will inform attorneys about the importance of

highlighting important information to improve your client's attention and memory retention. We

will recommend that the client be allowed additional time for meetings and court proceedings to

ensure that they are able to follow the gist of the hearing. We will also identify the client's

remaining limitations after they have received this training program.



Page 12


H. Glossary

Arraignment

The United States Constitution requires that an accused person be brought before a judge

promptly. Shortly after arrest, a judge informs the defendant of the charges against him and

of his rights. The process of being formally informed of the charges is the arraignment.

Competence to stand trial

In Rhode Island courts, a defendant is competent to stand trial if he is able to understand the

character and consequences of the proceedings against him, and is able to properly assist in

his defense.

Confidentiality

The discussions between the defendant and the attorney are confidential, just as they usually

are between mental health providers and patient.

District Attorney

The district attorney is the state's lawyer. He will prosecute the defendant on behalf of the

people of the State of Rhode Island.

Evidence

Evidence is the means used in court to ascertain the truth. Evidence can be writings, letters,

or objects that have direct bearing on the case, such as a weapon. Evidence can also be the

testimony of witnesses. Evidence can be direct or indirect (circumstantial).

Felony

Felony cases carry more severe penalties than misdemeanors, and include crimes like

robbery, theft of large amounts of money, assaults, kidnapping, and murder.

Judge

The judge controls the proceedings and is responsible for the conduct of a fair trial. The

judge needs the help of others - lawyers, jurors, witnesses, and the court staff. The judge

interprets and applies the law. In the absence of a jury, the judge makes the final

determination of the case.



Page 13


H. Glossary (continued)

Jury

A panel usually composed of six or twelve men and women who decide questions and facts.

They hear the evidence and decide whether the defendant is guilty or not guilty.

Misdemeanors

These are cases where the defendant can be fined or sent to jail for a year or less.

Nolo Contendre (No contest)

A no contest plea means that the defendant is choosing not to fight the charges. It is

technically the same as a guilty plea. It is not a plea for mercy. You go directly to

sentencing, just as in a plea of guilty. Typically, since a no contest plea means that both sides

(before trial) have agreed upon a lighter sentence for the case, this plea is often used as a

means of plea-bargaining.

Plea

A defendant's answer to a criminal charge or indictment.

Plea bargaining

This means that an agreement is made between the prosecution and the defense. This "deal"

specifies the charges and the kind of punishment.

Preliminary hearing

The preliminary hearing is not a trial. At this hearing, the judge does not determine guilt or

innocence, but only whether there is enough evidence to require the defendant to stand trial.

Public Defender

The public defender is a lawyer hired by the state to represent defendants at no cost to them.



Page 14


I. Sample treatment plan form

(For inpatient use only) The next three pages consist of a sample treatment plan for the

problem of restoring competence to stand trial. By documenting responses to questions, you will

be able to document specific areas of improvement. More importantly, you will be able to see

where the client may still be having trouble learning about court, and you will know to shift your

focus of education to the weaker areas. Lawyers may review the records to see whether they want

to challenge our opinion about the client's capabilities. It is therefore important to document your

meetings, and the client's strengths and weaknesses, for both clinical and legal reasons.



Page 15

SAMPLE TREATMENT PLAN

ELEANOR SLATER HOSPITAL

ADULT PSYCHIATRIC SERVICES [APS]

PATIENT’S LAST NAME FIRST MI AGE DOB

[ Sample Case ] [ ] [ ] [ ] [ ]

WARD CURRENT ADMISSION CURRENT PLAN CASE

[ ] [ 3/01/97 ] [ 3/01/97 ] [ ]

PROBLEM LIST

PROBLEM DATE PROBLEM DC

#1). 3/01/97 Incompetent to stand trial

Does not understand the roles of attorneys, jury, and

witnesses.

Becomes upset and yells when discussing legal charge or

court proceedings.

Does not understand possible pleas.

#2). 3/01/97 History of mental retardation

#3). 3/01/97 Low mood, irritable mood

DSM-IV DIAGNOSIS:

Axis: I Adjustment Disorder with Mixed Disturbance of Conduct and Emotions

Axis : II Mental Retardation

Axis : III Hypertension

Axis: IV Psychosocial stressors: Lost least on apartment; ? of disposition

Axis V: Current GAF: 50

Highest GAF in the past year: 65

TREATMENT PLAN REVIEW DATES:

Review Date # 1. 6/97 Review Date # 2. 9/97 Review Date # 3. 12/97

To be totally redone at least annually

on: Date of Annual: 3/98



Page 16

SAMPLE CARE PLANS PROBLEMS AND OBJECTIVES

PROBLEM 1 : DESCRIPTION: Incompetent to stand trial

• Determined by Dr. Wall on 3/1/97; he said she yells and cries when discussing the

charges and that she lacks a basic understanding about the courtroom process.

Scheduled return to court on 4/15/97.

LONG TERM GOALS:

• The patient will be found competent to stand trial and released from the unit.

SHORT - TERM GOALS [IMMEDIATE OBJECTIVES]:

• Patient will be able to define the roles of the courtroom personnel in her own words.

• The patient will not become upset and yell when talking about court. She will

communicate without raising her voice or threatening others.

Expected achievement dates: #1 4/15/97 #2 4/15/97 #3 #4

Date: 3/97 Review Date#1 6/97 Review Date #2 9/97 Review Date #3 12/97

INTERVENTIONS: [SEE DETAILS ON THE REVERSE SIDE]

Medication: v PRN/Restraint: Individual Meetings/Activities: v

Off-Site: On Site: Community Ward Meetings:

Work Activity: Expressive Therapy: Behavior Therapy:

Meetings with Family & Significant Others: Community Activities:

Individual and Close Supervision: Other: Restoration of competency

training tool



Page 17

SAMPLE PLANS FOR

TREATMENT / INTERVENTIONS

CRITERIA FOR TERMINATION OF TREATMENT:

• The patient will be found competent to stand trial, or will be discharged as

permanently incompetent or restorable in the community if competency restoration is

not achievable within the hospital.

DISCIPLINES INVOLVED IN TREATING THIS PROBLEM:

Medical/Psychiatry: v Nursing: Nurse Assistant: Psychology: v

Social Service: v Activity: Expressive Therapy: Pastoral:

MHW: Dietary: Other: v

PSYCHIATRY: Dr. Wall

• To meet with the patient twice or more prior to her return to court in order to re-

evaluate her ability to meet competency criteria; also, to prepare a written report to

the court.

PSYCHIATRY: Dr. X

• ? Mood stabilizing medication ?

• To meet with the patient 4 times per week for ten minutes.

• Training sessions using the MHRH “Preparing for Court” workbook.

• Particular emphasis will be made on defining the roles of courtroom personnel.

PSYCHOLOGY: Mr. Y., Lic S.W.




SOCIAL SERVICE: Ms. Z., M.A.






Page 18

II. WORKBOOK

A. Module 1: Purpose of Training; Review of Charges, Pleas and Potential Consequences

[Questions are examples; elaborate on them or add new questions to foster discussion.

Samples of acceptable answers are in parentheses.]

Column A:

Knowledge-based Questions

Column B:

Understanding-based Questions

1. Who sent you here? (The judge; a doctor.)

2. How come you're here? (Cause the judge

says I'm not fit for trial; Because the doctor

says I have to learn about court.)

3. A charge is the thing people say you did

that is against the law. What is your

charge? 4. What does the charge mean? (e.g. if the

charge is arson, a correct response would be,

"They said I set a fire.")

5. What did the police say you did?

6. On what date did this happen? About

what time? (If they don't understand the

concept of time, simply teach them the date of

the offense so they will have it memorized for

court.)

7. What is a crime? (It's when you do

something bad and break the law).

8. What is a plea? (It's the answer I give when

the judge asks me if I did it.)

9. You get to choose what answer (or plea)

you want to give. How many pleas can you

choose from? (Three) [If the client cannot

generate a response, offer them a multiple-

choice answer.]

A. How come you're in trouble? (Some

people say I did something bad. They say I did

a crime.)

B. Just because you're in trouble, does that

mean you go to jail? (No.) How come?

(Because I have to tell them I'm guilty or they

have to prove I'm guilty before they can punish

me. They have to prove it first.)

C. Is it a crime to steal a candy bar? (Yes.)

Why? (Because you didn't pay for it. Because

it's against the law.) [Another way to ask this

line of questioning at a later time may be: Is it

a crime to buy a candy bar? (No.) Why?

(Because you paid for it.)



Page 19

Module 1: Purpose of Training; Review of Charges, Pleas and Potential Consequences

(continued)

Column A:


Column B:


10. What are they? (Guilty; innocent or not

guilty; nolo.) [Use the word innocent if the

client repeatedly mixes up the words guilty and

not guilty]

11. What does it mean to say you're [or

plead] guilty? (When they ask me if I did it, I

tell them yes I did it.)


plead] innocent? (When they ask me if I did it,

I tell them no I did not do it.)


plead] nolo? (When they ask me if I did it, I

tell them I'll take a deal.)

14. What does it mean to be found guilty?

(The other side shows that I did it. The judge

or jury says that I really did do it.)

15. What does it mean to be found not

guilty? (The judge or jury says that I really

didn't do it. The other side couldn't show that I

did it.)

16. What would happen to you if they said

you were guilty? (I get some kind of a

punishment. I may have to go to jail.)

17. What would happen to you if they said

you are not guilty? (I get to go back to the

group home/other living arrangement).

18. What is probation? (I get to go home, but

if I do something bad I have to go back to jail.)

19. What is a sentence? (It's my punishment if

they say I did it. It's how long I have to stay in

jail or how long I have to be on probation.)

D. Why does somebody have to tell the judge

whether they are guilty, not guilty, or nolo? (Because you have to give the judge an answer

to the question before the judge or jury can

decide your case. I am answering the question

about whether I did it or not.)

E. Is what you tell the judge the same thing

as what the judge or jury finally decides?

(Is a plea the same thing as a finding

[verdict]?) (No.) Why is did not the same?

(The finding is what the judge decides about

my case. She will decide if I'm guilty or

innocent.)



Page 20

II. WORKBOOK

B. Module 2: Review of Courtroom Personnel



Column A:


Column B:


Show them the photos of the courtroom and

ask them who sits where. As they name the

judge, jury, lawyer, etc, ask them the

following questions:

1. What is the job of the judge? (Make sure

that everybody plays fair. Decides whether I

am innocent or guilty if there is no jury.)

2. Can you talk to the judge? (Yes.) When

can you talk to the judge? (Only if she asks

me a question.)

3. What is the job of the jury? (Decides

whether I am guilty or innocent. If there is no

jury, the judge decides.)

4. Can you talk to the jury? (No.) When can

you talk to the jury? (Never.)

5. What is the job of your lawyer? (Tries to

help me out. Talks to me. Gives me advice.

Helps me figure out what to do what to say.

Listens to me when I talk to him.)

6. Can you talk to your lawyer? (Yes.)

When can you talk to your lawyer? (Before I

go to court. When I am in court.)

7. What is the job of the other side's lawyer?

(Tries to convince the judge or jury that I did

it.)

8. Can you talk to the other side's lawyer?

(Yes.) When can you talk to the other side's

lawyer? (Only when he asks me a question

when I am on the witness stand.)

A. How come the jury listens to your side of

the story? (They are supposed to listen to

my side and to the other side, then decide

whom they believe.)

B. How come the other side's lawyer wants

to make you look bad? (His job is to try to

make the judge or jury put me in jail.)

C. Who is on your side in the court? (My

lawyer, my family [depending on the charge].)

D. Who is not on your side? (The other

lawyer. The judge and the jury are neutral.

Some witnesses may not be on my side.)



Page 21

Module 2: Review of Courtroom Personnel

(continued)

Column A:


Column B:


9. What is a witness? (Somebody who was

there when it happens. They come in and talk

about what they saw.)

10. Can you talk to a witness? (No.) When

can you talk to a witness? (Never.)

11. If another person sits in the box, what

are they called? (A witness.) Are you

allowed to talk to them? (No.)

12. What do you do when someone is sitting

in the box talking? (Sit quietly. I can't talk to

them.)

13. What is your job when you go to court?

(To listen to everything that is happening. To

tell my attorney if I don't understand

something. To talk to my lawyer about my

case. Maybe to be a witness.)

14. Can you be a witness? (Yes.) When are

you a witness? (When I sit in the witness box.)

15. What is your job if you sit in the

(witness) box? (To tell the truth. To answer the

questions the lawyers and the judge ask me. To

tell the judge or my lawyer if I don't understand

the question.)

E. Is the judge on your side? (She is in the

middle/neutral. She does not take sides until

the end.)

F. Who's neutral? (The jury and the judge,

until the end when one of them decides about

my case.)

G. Show them the photograph of a witness

testifying and ask them who is sitting where.

As they name the judge, attorney, and

witness, you can review the above questions

with them to make sure that they

understand the scenario.



Page 22

II. WORKBOOK

C. Module 3: Review of Courtroom Proceedings, Trial, and Plea Bargain



Column A:


Column B:


1. What happens when you get to court?

(Many people in the court talk about you.

Your case is presented.)

2. Having a trial is different from just going

to court. There is a trial only if you plead not

guilty [innocent]. I you plead guilty or nolo,

there is no trial- instead, the judge just gives

you the sentence.

a). If you say you’re guilty, is there a trial? (No.)

b). If you say [plead] innocent, is there a

trial? (Yes.)

c). If you say [plead] nolo, is there a trial? (No.) [Because these are yes/no questions, repeat from a

different perspective to make sure the

client knows. e.g. What are your possible

pleas? [Guilty, innocent and nolo].

Which plea is it where they would have a

trial?]

3. What happens during a trial? (Both sides

get to tell their story. One side gets to go first,

then the other side gets to go. Each side asks

questions. The judge and jury listen to both

sides. Then they decide whether you are guilty

or innocent.)

4. There might not be a trial. If you just tell

them you are guilty or take a deal (nolo),

then you don't need a trial. If there is no

trial, what happens? (I take a plea/deal. The

judge gives me a sentence. They don't listen to

both sides. There is no jury.)

5. Taking a plea means that you admit you

did something bad, you are making a deal to

get any easier punishment . What’s good

about taking a plea? (It might keep me out of

jail. It might let me stay at group home.)

A. How come you have to go to court?

(Because they say I did something wrong, and

when they say you did something wrong, they

give you a charge and they take you to court.

Because that's how the law works to decide if

I'm guilty or not guilty.)

B. Why don't you need a trial if you plead

guilty or take a deal? (Because they already

have an answer to the question since I told

them I’m guilty or that I did something bad.)



Page 23

Module 3: Review of Courtroom Proceedings, Trial, and Plea Bargain

(continued)

Column A:


Column B:


6. There are also some bad things about

taking a plea (making a deal). You must

give up some rights. If you take a deal, you

give up the chance to go to trial and let the

jury decide.

-You have to admit that you did something

bad.

-You don't get the chance to go back to court

and have them listen to your story again (an

appeal).

-You will definitely get some kind of a

punishment, even though you might get no

punishment if they found you not guilty at

trial.

What are the bad things about taking a

deal? (I may have to tell them I did something

bad, even if I didn't do it or if I don't want to. I

don't get a second chance to talk about the

charge. Nobody gets to listen to my side of the

story in court.)

7. Will you go to trial? (I won't know until me

and my lawyer talks. It isn't likely. Note: this

depends on the charge. Talk to the Forensic

Service about this.)

8. What happens when you take a plea

(make a deal)? (I have to say I did something

bad. I don't get a trial. I don't get a chance to go

back to court if I don't like how everything

turns out.)

C. How come you probably won't go to trial?

(Because they probably want me to

take a deal.)

D. When is it that there is no jury? (When I

take a deal.) How come that is? (Because

when I take a deal, there is no trial.)

E. What's in it for you if you take a deal? (I

probably won't have to go to jail. I'll probably

just get probation.)

F. When could you go to court and not have

a trial? (When you go to court, they

talk about your case and your court

dates. A trial is a special thing that

happens only if you say you are

innocent. If you say you are

innocent, they have a trial so they

can listen to both sides of the story

before the judge/jury decide who

they believe. If you say you're guilty

or take a deal, you do not have a



Page 24

trial.)



Page 25

II. WORKBOOK

D. Module 4: Review of Working with Attorney/Assisting in Defense



Column A:


Column B:


1. Who will you talk to before you go into

the courtroom? (My lawyer.)

2. Who can you talk to in court whenever

you want to? (My lawyer.)

3. You can also speak to other people in

court, but only when they ask you a

question. Who are these people? (I can only

talk to the judge when she asks me a question. I

can only talk to the other side's lawyer when he

asks me a question when I am on the witness

stand.)

4. Who can you never talk to in court? (I

can't talk to the jury. I can't talk to a witness.)

5. If you have to go to the bathroom while

you are in court, who can you tell this to? (My lawyer.)

6. If you don't understand what is being said

about you in court, who can you tell this to? (My lawyer.)

7. What do you say to him if you don't

understand what is being said? (I say, “I

don't know what is going on.”)

8. What are the things you need to tell your

lawyer? (Ask the client to tell you their story

of what happened. If there important parts are

left out, help them make it fluent, but don’t add

new material and don’t write down

incriminating information. If you don’t know

what happened, contact the Forensic Service

and we will discuss the police report].)

9.Let's go over the story of what happened.

(Review their version. Highlight important

details.)

10.What do you do if a witness tells a lie

about you? (Tell my lawyer.)

A. Why is it important to tell your lawyer if

you don't understand what is being said? (Everybody is here in court to talk about me.

My job is to make sure that I know what people

are saying about my case. I might miss

something.)

B. Let's talk about what you just told me

(question 9). What are the most important

things that you told me? Why are these

things important?

C. Why do you tell your lawyer if somebody

lies about you? (I'm not supposed to talk to the

witness myself. I need to tell my attorney

because the lie might make me look bad.)



Page 26



Page 27

Module 4:Review of Working With Attorney/Assisting in Defense

(continued)

Column A:


Column B:


11. What do you do if a witness says a mean

thing about you or something about you that

you don't like? (Tell my lawyer.)

12. What do you do if your lawyer tells you

to do something that you don't like? For

instance, what if he wants you to change

your story? (Tell my lawyer so we can talk

about it. Tell somebody that I know, like

[name of family member, staff person].)

13. What would you do if your lawyer wants

you to take a deal and you don't want to? (Talk to him about it. Tell him I don't want to.)

14. If you talk with your lawyer about a

deal, and he still wants you to take it, and

you aren't happy about it, who else can you

talk to? (Family member; staff member.)

15. The other side's attorney may try to

confuse you on the witness stand. When

they ask you a question that you don't

understand, what would be the wrong thing

to say? (Yes, I understand.) What will you say

instead? (I don't know what you are saying.

Ask me again.)

D. Why do you tell your lawyer if somebody

says things about you that you don't like? (I'm not supposed to talk to the witness myself.

I need to tell my attorney because I want to

look as good as possible.)

E. Why is that important? (Because my

lawyer should help me in court. If I don't feel

comfortable with my lawyer, I should tell

somebody.)

F. Why is that? (Because it's my choice about

whether I want to take a deal if they offer me a

deal. I have my rights.)

G. Take the client through several examples

of leading questions. Try to get them to

follow your lead, and then show them how

they are being led so that they will recognize

the pattern themselves. Then, work with

them to resist answering leading questions,

and have them practice asking for

clarification if they do not understand a

question. The Forensic Service will go over

specific examples with you before training.

H. If somebody you know got arrested for

stealing and he really didn’t do it but he

wanted to take the deal, why is that a

problem? (Then go through examples; e.g.

“This is John. He is the defendant. This is

Mr. Smith, his lawyer. What is John accused



Page 28

of?”



Page 29

II. WORKBOOK

E. Module 5- Tolerating Stress of Proceedings



Column A:


Column B:


1. How are you supposed to behave in court?

(Be nice. Don't yell. Talk to my lawyer.)

2.Can you laugh in court? (No.) [Repeat

yes/no questions from a different perspective.]

3. Is it good to sit quietly in court? (Yes.)

4. Does that mean you can never talk in

court? (No. I can talk in court sometimes.)

5. Can you tell jokes/yell/etc. in court? (No.)

[Repeat yes/no questions from a different

perspective.] Why not? (Because going to

court is serious. Because I have to look good.)

6. Is it good to talk quietly in court? (Yes.)

7. Can you get mad in court? (Yes, but I can't

yell or scream.) What do you do if you are

getting very upset? (Tell my lawyer. Ask to

take a break.)

8. Can you walk around in court? (Not while

they are talking about my case.) [Repeat yes/no

questions from a different perspective.] Why

not? (Because I have to look good. Because it's

not allowed.)

9. What would happen if you got up and

talked directly to the judge? (They would tell

me I have to sit down. They might get upset.)

10. What would happen if you got angry and

screamed and yelled in court? (They would

take me out of the courtroom.)

A. Why can't you laugh/yell/scream in

court? (Because I have to look good. Because

going to court is serious.)

B. Why is it important to speak up in court?

(Because they are talking about me. Because I

have to stand up for myself. Because I have to

understand what is going on.)

C. Why is it important to not stand up and

move around when court is going on? (It

would make me look bad. I need to look good

to help my case.)



Page 30

Module 5- Tolerating Stress of Proceedings

(continued)

Column A:


Column B:


D. Make some direct comments on the

client’s emotions and behaviors, and work

with them to extinguish negative behaviors.

[For example: I notice that when we talk

about court, you giggle a lot. Why is that?

Can you do that when you are in court?

How come? Let's practice talking with your

lawyer right now. I want you to talk about

your case without giggling.]

E. Make some direct comments on their

emotions and behavior, and work with them

to promote positive behaviors. [For

example: You are doing a good job talking

about your case. Make sure that you talk

about this with your attorney - it's

important.]



Page 31

II. WORKBOOK

F. Photographs

PHOTO 1: Overview of Courtroom Personnel

PHOTO 2: The Judge



Page 32

II. WORKBOOK

F. Photographs (continued)

PHOTO 3: The Defense Attorney and The Client

PHOTO 4: The Prosecuting Attorneys



Page 33

II. WORKBOOK


PHOTO 5: The Jury

PHOTO 6: Examination of Another Witness by the Prosecution



Page 34

II. WORKBOOK


PHOTO 7: Examination of Another Witness by Defense Attorney

PHOTO 8: Swearing In Of the Client as a Witness



Page 35

II. WORKBOOK


PHOTO 9: Direct Examination of Client

PHOTO 10: Cross-Examination of Client



Page 36

III. ANSWER SHEETS

Client’s Name: Trainer’s Name: Date:

Module I Answer Sheet: Purpose of Training; Review of Charges, Pleas, and Potential

Consequences

Scores

#

Responses/Comments Poor

Fair Good

1.

2.

3.

4.

5.

6.

7

A.

B.

C.

8.

9.

10.

11.

12.

13.

D.

E.

14.

15.

16.

17.

18.

19.

Poor = Doesn’t answer questions, or says “I don’t know” or “I don’t remember,” or gets the concept wrong. Fair = Gives a limited description, mixes up answers, hard to understand replies.

Good = Gives a pretty complete, understandable and correct answer.



Page 37

III. ANSWER SHEETS


Module II Answer Sheet: Review of Courtroom Personnel

Scores

#


Fair Good

1.

2.

3.

4.

A.

5.

6.

7.

8.

B.

C.

D.

E.

F.

9.

10.

11.

12.

13.

14.

15.

G.

Poor = Doesn’t answer questions, or says “I don’t know” or “I don’t remember,” or gets the concept wrong.

Fair = Gives a limited description, mixes up answers, hard to understand replies. Good = Gives a pretty complete, understandable and correct answer.



Page 38

III. ANSWER SHEETS


Module III Answer Sheet: Review of Courtroom Proceedings, Trial, and Plea Bargain

Scores

#


Fair Good

1.

A.

2a.

2b.

2c.

3.

4.

B.

5.

6.

7.

C.

8.

D.

E.

F.





Page 39

III. ANSWER SHEETS


Module IV Answer Sheet: Review of Working with Attorney/Assisting in Defense

Scores

#


Fair Good

1.

2.

3.

4.

5.

6.

7.

A.

8.

9.

B.

10.

C.

11.

D.

12.

E.

13.

14.

F.

15.

G. (use extra pages if needed)





Page 40

III. ANSWER SHEETS


Module V Answer Sheet: Tolerating Stress of Proceedings

Scores

#


Fair Good

1.

2.

3.

4.

5.

6.

7.

A.

B.

8.

9.

10.

11.

C.

D.

E.





Page 41

IV. REFERENCES

1. Appelbaum, K: Assessment of criminal justice related competencies in defendants with

mental retardation. The Journal of Psychiatry and Law, Fall 1994

2. Appelbaum, K and Appelbaum, P: Assessment of criminal justice related competencies in

defendants with mental retardation. The Journal of Psychiatry and Law, Fall 1994

3. Black’s Law Dictionary, Abridged Sixth Edition, West Publishing Co., 1991

4. Bonnie, RJ: The competence of criminal defendants with mental retardation to participate in

their own defense. The Journal of Criminal Law and Criminology 1990, 81:419-446

5. Coles, EM: Assessment of understanding by people manifesting mental retardation: a

preliminary report. Perceptual and Motor Skills 1996, 83: 187-192

6. Donohue M and Walters T: Welcome to program II: the trial competency program.

Atascadero State Hospital, California.

7. Everington C: The competence assessment for standing trial for defendants with mental

retardation (CAST-MR): a validation study. Criminal Justice and Behavior, 1990, 17: 147-

168

8. Grisso T: Evaluating competencies: forensic assessments and instruments. New York,

Plenum Press, 1986

9. Longhurst TM, Berry GW: Communication in retarded adolescents: response to listener

feedback. American Journal of Mental Deficiency 80: 158-164, 175

10. Luftig RL, Johnson RE: Identification and recall of structurally important units in prose by

mentally retarded learners. American Journal of Mental Deficiency 1982, 86: 495-502

11. Kamphans, RW: Conceptual and psychometric issues in the assessment of adaptive behavior.

The Journal of Special Education 1987, 21, No. 1: 27-35

12. Mercer CD, Snell ME: Learning theory research in mental retardation: implications for

teaching. Columbus, Merrill, 1977.

13. Sigleman CK, Winer JL, Schoenrock CJ: The responsiveness of mentally retarded persons to

questions. Education and Training of the Mentally Retarded 1982, 17: 120-124

14. Sigleman CK, Budd, EC, Spanhel CL, et al.: When in doubt, say yes: acquiescence in

interviews with mentally retarded persons. Ment Retard 1981, 19: 53-58

15. Smith, SA: A quick screening test of competency to stand trial for defendants with mental

retardation. Psychological Reports 1995, 76: 91-97



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IV. REFERENCES (continued)

16. Rhode Island Developmental Disabilities Council card: Helpful hints on how to deal

with a suspect, victim, or witness who may have a disability.

17. Rhode Island General Laws 40.1-5.3.

the slater method: an educational tool to ......returning your client to court: an educational tool...

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