Practical application of the MacArthur competence assessment tool-criminal adjudication (MacCAT-CA) in a public sector forensic setting.

Several instruments have been developed to assess defendants' competence to stand trial (CST). These instruments have become increasingly sophisticated mainstays of CST evaluation research. Less is known, however, about their clinical utility. Continuous quality-improvement (CQI) efforts within forensic practice are one means of helping ascertain the effectiveness and efficiency of the use of these measures, especially in public sector settings. In this article, the authors describe a CQI project examining the use of the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) on an inpatient forensic evaluation service. Results of a small, local CQI project cannot be generalized to all settings. However, from this CQI experience, the authors found the MacCAT-CA to be advantageous in assessing CST in certain defendants. Given some limitations of its practical utility, including its use with defendants putting forth poor effort, those with significant cognitive impairments, and those from various cultural backgrounds, the authors did not find that it would be an efficient practice to utilize the instrument in all CST assessments within a busy, public sector, inpatient forensic evaluation service. Having the instrument available for use as an adjunct to a clinical interview in particular cases may offer the most advantage. In addition, it is a useful tool for educating trainees about complex CST domains. This case-based CQI project reveals some basic strengths and weaknesses of the instrument and offers direction for further exploration in a systematic research study.