stand trial in pretrial forensic patients.Journal of the
American Academy of Psychiatry and the Law,
31 (1), 27–35.
Jackson v. Indiana, 406 U.S. 715 (1972).
Miller, R. D. (2003). Hospitalization of criminal
defendants for evaluation of competence to stand
trial or for restoration of competence: Clinical
and legal issues.Behavioral Sciences and the Law,
21 , 369–391.
Mumley, D. L., Tillbrook, C. E., & Grisso, T. (2003).
Five year research update (1996–2000):
Evaluations for competence to stand trial (adjudicative
competence).Behavioral Sciences and the Law,
21 , 329–350.
Noffsinger, S. G. (2001). Restoration to competency
practice guidelines.International Journal of Offender
Therapy and Comparative Criminology, 45(3),
356–362.
Sell v. United States, 539 U.S. 166 (2003).COMPETENCYASSESSMENT
INSTRUMENT(CAI)
The Competence to Stand Trial Assessment Instrument,
often called the Competency Assessment Instrument
(CAI), was developed in 1973 as a companion instru-
ment to the Competency Screening Test (CST) and
sought to standardize as well as quantify the criteria
for competence to stand trial. The instrument was cre-
ated by an interdisciplinary team of psychologists,
psychiatrists, and lawyers at Harvard’s Laboratory of
Community Psychiatry during a project funded by a
research grant from the Center for Studies of Crime and
Delinquency, National Institute of Mental Health. The
CAI addresses 13 functions related to the defendant’s
“ability to cope with the trial process in an adequately
self-protective fashion.”
Although the concept that a defendant must be com-
petent to proceed in the trial process has been generally
accepted in Western jurisprudence since the late 1700s,
the current standard for competence to stand trial in the
United States was laid out by the U.S. Supreme Court
in Dusky v. United States in 1960. In Dusky, the Court
held that for a defendant to be deemed competent to
stand trial, he or she must have “sufficient present abil-
ity to consult with his lawyer with a reasonable degree
of rational understanding” and “a rational as well as
factual understanding of the proceedings against him.”On the basis of the standard as set forth in Duskyas
well as reviews of appellate cases and legal literature,
observations of pretrial competence hearings, and inter-
views of attorneys and judges, the interdisciplinary
team conceptualized the standard of competence to
stand trial as having three parts: the ability to cooperate
with one’s attorney in one’s own defense, awareness
and understanding of the nature and object of the legal
proceedings, and understanding of the consequences of
the proceedings.
As one of the first semistructured measures of
trial competency, the CAI influenced the develop-
ment of nearly every other instrument that has been
created for competence to stand trial evaluations.
The administration time of the CAI is approxi-
mately 1 hour with relatively high functioning
defendants. The 13 areas of functioning addressed
by the CAI are the following:- Appraisal of available legal defenses
- Unmanageable behavior
- Quality of relating to attorney
- Planning of legal strategy, including guilty pleas to
lesser charges where pertinent - Appraisal of the role of persons involved in a trial
- Understanding of court procedure
- Appreciation of charges
- Appreciation of the range and nature of possible
penalties - Appraisal of the likely outcome
- Capacity to disclose to attorney the available perti-
nent facts surrounding the offense - Capacity to realistically challenge prosecution
witnesses - Capacity to testify relevantly
- Self-defeating versus self-serving motivation
(legal sense)
In the manual, the 13 functions are conceptually
defined with statements, and two or three sample
questions accompany each function.
Each functional item on the CAI is to be rated on a
five-point Likert-type scale, wherein a score of 1
relates to a total lack of capacity to function and aCompetency Assessment Instrument (CAI)——— 111C-Cutler (Encyc)-45463.qxd 11/18/2007 12:41 PM Page 111