photo of the 1st Choice team

Decades of experience. A better way forward.

1st Choice Competency Evaluations LLC was founded in 2025, but our team has decades of experience coordinating, facilitating, and delivering high-quality competency evaluations. We believe requesting and obtaining a competency evaluation should be easy, quick, and affordable. Years of experience have shown us how to do just that.

No one should be deprived of due process because of a long waitlist for a competency evaluation. No one should have to wait months for a competency determination.

We offer a better way.

Meet our team

Ellexis Ayers

Chief Administrator

Ellexis Ayers has built her career in social services, specializing in rehabilitative programming for both juveniles and adults involved in the justice system. With a strong foundation in advocacy and resource coordination, she brings deep experience navigating complex judicial processes. Ellexis is especially passionate about the critical intersection of mental health and the legal system. Over the past five years, she has developed specialized expertise in Iowa Code 812.3 and the competency process. She remains committed to client-centered, collaborative care and ongoing advocacy for individuals impacted by the justice system.

Jessica Nefzger, LISW

Chief Coordinator

Jessica Nefzger, LISW, brings over 20 years of social work experience, holding a Master of Social Work from the University of Iowa with a specialization in mental health and family-centered therapy. She has dedicated over a decade to providing mental health services within the correctional system, including education and assessment related to court competency and restoration. Her passion lies in serving individuals with chronic and complex mental health disorders and those involved in the justice system. Jessica is recognized for her expertise in assessing complex needs, advocating for vulnerable populations, and building strong rapport with clients during crises or challenging situations.

photo of Abraham Assad, MD

Abraham Assad, MD

Chief Evaluator

Abraham Assad, MD graduated from both medical school and the psychiatry residency program at the University of Iowa. He became interested in forensic psychiatry as a resident and has worked in correctional settings since 2013. Through his extensive experience in this unique environment, Dr. Assad has developed expertise parsing the challenging intersection of classical mental illness, substance use, and personality pathology. He is dedicated to raising awareness of the competency process, preventing the illegal incarceration of incompetent individuals, and preserving public trust in the justice system.