civil_competencies_1_08

civil_competencies_1_08 - 1 Civil Competencies Civil...

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Unformatted text preview: 1 Civil Competencies Civil Competencies June 12, 2008 2 A list of possible civil competencies ¡ Work ¡ Drive ¡ Parent ¡ Make medical decisions ¡ Provide informed consent ¡ Care for oneself/property ¡ Enter into legal contracts 3 Assessment Steps (Moberg & Kniele, 2006) ¡ Interview, including collaterals ¡ Neuropsychological testing ¡ Functional ability assessment ¡ Review of legal standards 4 Rationales for Civil Competency Rules Rationales for Civil Competency Rules ¡ People have the right to self-determination (personal freedom preserved when possible) – “It’s your right” ¡ In decision-making, people have the right to reasonable, full disclosure ¡ Disabled people are entitled to services (social security determination, etc.) ¡ As before, competency is functional 5 Guardianship Guardianship ¡ What is guardianship (sometimes called conservatorship)? ¡ delegation, by the state, of authority over person or estate; general vs. specific guardianship ¡ Who qualifies? ¡ Incapacited person is “any person who is impaired by reason of mental illness, mental deficiency, physical illness or disability, advanced age…or other cause (except minority) to the extent that he lacks sufficient understanding or capacity to make or communicate responsible decisions concerning his person” ¡ More specific rules in some states require finding of inability to care for personal safety or to attend to food, shelter, clothing, or medical care, without which physical illness or injury would occur ¡ de facto (factual) vs. de jure (ruled) incompetence; civil commitment usually results in de facto incompetency 6 Guardianship (cont Guardianship (cont ’d ) ¡ Guardianship proceedings generally not rigorous ¡ Most states allow determination as to whether the alleged incapable person should attend hearing ¡ Getting out of incapacity is difficult ¡ Guardianship services ¡ Guardianship can be abused ¡ Three issues in guardianship determination ¡ whether a guardian is needed ¡ who the guardian should be ¡ what the guardian should do 7 Guardianship Questions ¡ Is a guardian needed? ¡ only an issue in “de facto” cases ¡ very loose and informal ¡ ambiguous standards; most states require finding “threshold” mental illness ¡ clinical evaluation: take care to evaluate what the person can and cannot do ¡ “Community Competency Scale” a good start, but little empirical data; requires person to perform actual tasks ¡ utilize ecological assessment ¡ home visit useful, analyze typical day ¡ guardianship of person vs. estate (not really different when estate is not complex) 8 Community Competency Scale Community Competency Scale ¡ Subscales: (akin to ADL’s) ¡ Judgment, Emergencies, Acquiring Money, Compensation for Incapacities, Managing Money, Communication, Care of Medical Needs, Adequate Memory, Satisfactory Living Arrangements, Proper Diet, Mobility, Sensation, Personal Hygiene, Maintenance of Household, Utilization of Transportation, Verbal-Math Skills...
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civil_competencies_1_08 - 1 Civil Competencies Civil...

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