assessment_in_counseling_20151104230017 Flashcards
Biases are…
built into the instrument
We cannot ever have an instrument that’s…
culturally fair
In a non-standardized test, the bias is in…
the administrator of the test
Assessments are created with the assumption that…
all test-takers have had an equal chance to learn the material and will have an equal chance to do well
Why would someone not have an equal chance to do well on an assessment?
Educationally deprived & low educational support in families
Why is the Culture-Fair Test of Intelligence not used often (except in research)?
It doesn’t predict grades
What is on the Culture-Fair Test of Intelligence?
Mostly pictures, very few words
What items are usually over-diagnosed?
Women - personality disorders (borderline, histrionic…)Men - anti-social personality disorderSexual Minorities - panic disorderLess formal education - schizophrenia
What items are usually under-diagnosed?
African-Americans - depression
What items are usually mis-diagnosed?
Autism is often misdiagnosed as an intellectual disability in African-Americans
What are the aspects of test-sophistication (aka practice-effect)?
Faking a test (depends on level of crazy)Motivation to answer correctly/incorrectlyLanguage abilitiesInsight to self (children have a hard time)Acculturation (appropriate for culture group)
Accommodations for Disabilities
Sign languageLip readerSomeone to read for themScribeBrailleTime limit changesMore breaksComputer or paper testsAllowing food and drinks (those with medical issues like diabetes)
Anytime you change the test for a disability…
you change the test (scoring will be a little different)
What must be done with employment testing?
the test MUST accurately reflect what will be done on the job
Types of vocational assessment (besides tests):
Job SamplesOn the Job Assessment
A counselor attends closely to testing conditions.
Test administration
A counselor reviews and applies scoring procedures.
Test interpretation
A counselor presents a comprehensive picture using several assessment data sources.
Communication of findings
A client completes a satisfaction form at the end of a comprehensive session.
Outcome assessments
Type of assessment that allows information to be obtained from many people within a short period of time at relatively little cost.
Group assessments
Type of assessment that permits counsellors to adapt the test administration to the needs of the client.
Individual assessment
This type of assessment includes intelligence tests, ability tests, personality inventories, interest inventories and values inventories.
Standardized tests
This type of assessment includes rating scales, projective techniques, behavioral observations, and biographical measures.
Nonstandardized tests
This type of assessment involves informal and flexible procedure often used in individual and group counseling. Focused on increasing client self-awareness within a session. Ex: simulation exercises, projective techniques, and card sorts.
Qualitative assessment.
When raters show a tendency to generalize from one aspect of the client to all other aspects
Halo effect
The tendency to rate all people as “average” or near the middle of the rating scale
Error of central tendency
The tendency to rate the characteristics of people more favorably than they should be rated.
Leniency error
Semantic differential techniques
Requires raters to rate concepts (my job) by bipolar scales/rank-order scales.
Situational tests require
The person to perform a task in a situation that is similar to the situation for which the person is being evaluated.
These assessments use vague or ambiguous stimuli to which people must respond (e.g., inkblots)
Projective assessments
These observations refer to behaviors that can be observed and counted.
Behavioral observations
Precontemplation stage
Individuals are not especially state of their problems and gave no plans to change their behavior in the foreseeable future.
Contemplation stage
Individuals are aware of their problems but have not yet made a serious commitment to do anything about them.
Preparation stage
Individuals have begun to make small changes in their problematic behaviors, with the intention of making more complete changes within one month.
Action stage
When individuals successfully change their behavior for short periods of time
Maintenance stage
When individuals have maintained the behavioral and attitudinal changes that have occurred for 6+ months
The best general source of information about commercial tests
Mental Measurements Yearbook (MMY)
The notion that data sometimes can be affected by what the administrator expects to find.
Expectancy effect it Rosenthal effect
The notion that counsellors who seek to confirm negative stereotypes, intentionally or unintentionally, during test administration influence test performance.
Stereotype threat
A counselor and client consider various assessment methods
Test selection
The ____ was established in 1985 as a forum for counseling and education related associations to collaborate for the common good for fair, accessible, and appropriate use of tests. Goal was to improve test use through education, not to limit test access
Joint Committee on Testing Practices (JCPT)
What is reliability?
Looking to see if you get the same results from the same test from the same person during a short amount of time
Instrument assessments look for _____, while personality tests look for _____.
growth; stability
Why do we need to be careful when assessing children for personality disorders?
They are still developing their personality
What is measurement error?
The goal is to reduce the error, but there is going to be some error in your test (known as “error score”)
What are the two parts (scores) of each test?
True score & error score
(T/F) No score will be perfectly reliable or perfectly without error.
True
What are correlation coefficients (aka reliability coefficients)?
When assessing reliability, the statistical measures that determine degree of relationship b/w two factors
What is the range of values for correlation coefficients?
-1 to +1
(T/F) No relationship will be perfect (score of -1 or +1)
True
(T/F) The bigger the number, the stronger the relationship
True
(T/F) If the number is “-“, there is a negative effect; as one factor increases, the other factor decreases
True
What are the base correlation coefficients for achievement tests an personality tests?
Achievement Test: .85-.90Personality Test: .50-.60
What are the types of reliability?
Test-retestSplit-halfAlternate formInter-rater reliability
What is test-retest?
Give test on one occasion, give test again later to same group of people and correlation the scores
What is alternate form in reliability?
Measuring same construct same way, but with different questions. Give test to a group of people then give the alternate version and correlate scores
What is the best way to assess reliability?
Test-retest combined with Alternate form.
What is usually used to assess reliability?
Split-half and inter-item (cheap and simple)
What is inter-rater reliability?
Whether different raters will have same results on same assessment
What is validity?
Does the test measure what it says it’s going to measure? Is the test measuring a construct adequately?
Validity Notes
More difficult to assess than reliabilityAssessments are usually only good for one of two assessments at most
What are the different types of validity?
Validity coefficientsFace validityContent validityCriterion related validityConstruct validityTreatment validity
What are validity coefficients?
The statistical measures that determine degree of relationship b/w two factors. - Usually lower than reliability coefficients.
What is face validity?
Does it look like the test is measuring what it is supposed to measure?- Should increase motivation for test-taker to do well
What is content validity?
Is the test assessing the appropriate content for the body of study that a group of students has gone through- Applies mostly to achievement tests- A group of experts looks at a group of items to make sure they fit
What is criterion related validity?
Comparing scores with performance
What are two types of criterion related validity?
-Concurrent validity: Give a new test at the same time as an older one measuring the same thing, then correlating their scores. The results should be equal - Predictive validity: Prediction of how well a person will do with a certain construct (ex: pilot training, ASVAB)
Can we predict low base-rate behaviors (suicide, murder)?
Can be done (Suicide and homicide prediction can be done, but has false-positives because it’s a low base-rate behavior (doesn’t occur very often), so the assessments can’t be used)
What is a low base-rate behavior?
A behavior (suicide and murder) that does not occur often.
What is a false-positive?
Saying someone is a certain way when they aren’t.
What is a false-negative?
Saying someone is not a certain way when they are.
What is construct validity?
Are you really measuring what you’re trying to, or you measuring something else?
Can you have a reliable test that is not valid?
Yes
Can you have a valid test that is not reliable?
No
Reliability is _____ the concept of validity.
subsumed under
What is treatment validity?
Do these tests and their results make any difference in treatment?- If the person tested concurs and is motivated to take the test, and the results are shared: then it will aid in treatment
What is a response-set (aka response style)?
- When you’re giving an instrument, and the person responds to that instrument in a way that are not what is looked for (through distortion or deception)- We want people to be honest on answers, but some people unintentionally distort subconsciously (ex: checking all “no” at doctor checklist)
What are validity scales used for?
Assessing for distortion
What tests use validity scales?
Any large, broad scale personality measure
If a person denies any negative behavior, they are probably…
lying. Every one has “chinks in their armor”
What will validity scales show?
Distortion - denial of all negative behaviorsInconsistencies A lot of blank answers A lot of “cannot say” answers”Yes” responses to extremely odd or infrequent behaviors
What are typical-response sets?
The tendency to say “yes” or “no” to certain questions.
Why would someone use a typical-response set?
- Social-desirability- Random answers (medical questionnaires)- Malingering- Factitious Disorder
What is malingering?
Deliberate distortion of a disorder for an external goal
Why would someone malinger?
- Getting medication- Getting disability- Staying out of jail
What is Factitious Disorder?
there is distortion, maybe marginally conscious, but no external goal except to be taken care of (an internal goal)
What is Factitious Disorder related to?
Munchausen disorder (a person getting their loved one sick to show how well they can take care of them)
We need to create an atmosphere of _____ to get the client to be honest and try their hardest on assessments.
Trust
Can a person be coached to act or look a particular way for an assessment?
Yes, depending on level of crazy.
What are the different types of assessments?
Norm-referencedCriterion basedSelf-reference based
What is a norm-referenced test?
Comparing a potential test-taker with original population used to develop test
What is a criterion based test?
Not comparing people against other people, but against a standard (ex achievement tests)
What is a self-reference based test?
Comparing someone against their own previous standard
What was the first test outside of US?
Binet Intelligence Test
What was the first intelligence test in US?
Stanford-Binet Intelligence Test
What is the Stanford-Binet Intelligence Test good at assessing?
Intelligence in children
What is the Army Alpha and Beta test?
A group intelligence test
What is the difference between the Army Alpha and Army Beta?
Army Alpha is for those who can read, while Army Beta is for those who cannot read
What is the mean score for most intelligence tests?
100
What is the MMPI used for?
Psychopathology
Can the MMPI be faked?
Yes, but it’s very difficult
There is very little overlap between interest and _____
Abilities (not everyone can do what they’re interest in)
During an assessment for high-stakes, you should…
Use multiple assessments, make decisions tentative and able to be changed
What is regression from the mean?
Scores that are on the very high or very low end of test- Be skeptical, when retested, their scores will most likely differ
What is a trait?
A psychological construct underlying a relatively enduring behavioral disposition
When we assess personality, we are assessing _____.
Traits
Your _____ makes you different from your family behaviorally.
Environment
Traits can change over time, but _____.
Slowly. When working with people (especially those with personality disorders) make sure to be patient…it will be a slow change
Most traits are on a _____.
Continuum
What is the “Big Five”?
5 broad, clinically relevant personality traits
What are types of the Big Five?
- Aggressiveness: genetic, high risk for criminality- Psychoticism: how connected to reality- Disconstraint: impulsive, risk-takers, less-traditional- Neuroticism: anxiety, self-critical, feel guilty- Introversion/low positive emotionality: susceptible to depression
Raw scores are:
Practically meaningless on standardized tests- Only one at hand that uses is Miller Analogies Test
What are Measures of Central Tendency?
When scores are distributed, the most commonly measured score
How is central tendency measured?
Mean, median, mode
What is variability?
How much scores spread out around the mean
What is variability measured?
Range (largest-smallest score)Standard Deviation (most commonly used)
What is a standard score?
What the raw score is turned into
Describe the characteristics of a normal curve.
- Shaped like a bell, symmetrical (Ex. Intelligence (normally distributed)- ~34% of scores will lie 1 SD above the mean and another ~34% will lie 1 SD below the mean- ~14% will lie b/w 1 and 2 SD above mean, and another ~14% will lie b/w 1 and 2 SD below mean- ~2% will lie b/w 2 and 3 SD above mean, and another ~2% will lie b/w 203 SD below the mean
What is the mean?
The middle of bell curve- Most mean score on IQ tests is 100; cannot cap out (we don’t know how high score can go - Hawkings, Michealangelo - or how low score can go)- Easiest quality to talk about that is normally distributed (Intelligence)
What is skewness?
Distributions that do not look normally distributed (the bell is curved more to the left or to the right, rather than symmetrical)
What is a norm?
The group the instrument was designed on- Most standardized instruments are norm referenced; scores from your client can be compared back to the original statistics of the norm group
What is a grade-equivalent score?
Used in education to see where the child is at in school - raw score turned into a grade equivalent- Most misinterpreted score, people automatically assume it means their kid is at that specific level- It means that their child took a test and did about the same as a student in the grade equivalent score would get if they took the same test
What is an age-equivalent score?
Used in education to see where the child is at in school with children around their age. Misleading as well.
What is a rank score?
Where scores are listed in order of rank (simplest)
What is a percentile rank score?
Scores tell client how many people they scored better than on that test admin. “If a person has a percentile score of 85, that means 85% of people scored lower than that person” don’t ever turn it around- National Percentile Rank: Same but compared nationally- Raw scores converted to percentiles end up at the ends of the distribution
What is a problem with the percentile rank score?
Dramatic difference b/w scores that change on the ends of distribution than scores that are towards the middle of distribution- There are less scores to compete with at the ends, so change is more noticeable
What is a standard score?
Raw score, converted to a score that tell you how far the raw score is from the mean in standard deviation units.
What are two types of standard scores?
Z Score and T Score
What is a Z Score?
Changes mean to 0 and SD to 1- Scores given in SD “score fell 1.5 SD above mean”
What is a T Score?
Common on standardized tests; Raw score converted to T score has mean of 50 and SD of 10- Scores given in SD
What is the mean and SD of the SAT?
m500, SD100
What is the mean and SD of the ACT?
m15, SD5
What is an IQ score?
Intelligence Quotient (not a quotient anymore, it’s a standard score). Tells you how far your score deviated in SD from other people your age.- People are starting to equate IQ score with innate intelligence; which is not true, IQ scores can change
What is the prior ratio IQ?
mental age:chronological age
What is the mean and SD of the Stanford-Binet Intelligence Test?
M100, SD15 or 16
What is the Standard Error of Measurement (SEM)?
When you take a test of almost every kind, every test has a standard error for the score that has been calculated (differs for every test)
What is a confidence interval?
Take score obtained and you can say with some degree of certainty that the administration of this instrument, this person made this score + or - the standard error- This is how you establish a reliability estimate for any individual score (it’s the SEM)
When looking at scores, the ones in the _____ are always the most reliable b/c they’re least apt to change. The ones at the _____ are apt to change the most when giving the same test to the same person
middle; ends
Do not confuse percentiles with _____
Percentages
_____ can cause over, under, and mis-diagnosis.
Bias
The sex of a clinician _____ make a difference with bias.
Does not
Clinical diagnosis may be responding to _____.
Stereotypes
One controversy in diagnosis is making _____ parts of a person’s life into pathology.
Normal parts (ex, PMS now in DSM-V)
What are the suggested areas for clinical assessment in women?
- Abuse and Trauma- Care-taking responsibilities- Health status- Substance use- Gender-role messages- Relationship beliefs- Previous therapy- Communication- Attribution style- Ability to self-nurture- Career/Employment concerns- Resource assessment- Ego strength
What aspects of abuse and trauma should be considered?
- Sexual, physical, emotional- Messages received about what abuse is, how to manage it
What aspects of care-taking responsibilities should be considered?
- Can be very susceptible to depression from taking care of children, parents, spouses, whomever (age, disability, medical issue)
What aspects of health status should be considered?
- Eating issues, sexual or reproductive issues, significant health issues, medication- Can cause client to be overwhelmed, especially when it happens at same time as other issues- Always ask clients what medications they are on and what for; side effects can affect the person
What aspects of substance use should be considered?
Prescribed and anything else (remind of confidentiality), find out what the street names are for anything they are taking
What aspects of gender-role messages should be considered?
- What client believes their role as a woman or man is and how comfortable with it- There’s no specific question, you just need to pay attention
What aspects of relationship beliefs should be considered?
The quality of their relationships
What aspects of previous therapy should be considered?
- Find out their experiences, type, and what was useful for them- Readiness to be involved in treatment: have to assess whether they’re ready for the counseling relationship; some just want to talk, don’t want help; people change at their own pace (frustrating for us)
What aspects of communication should be considered?
- Help people develop social skills - Assertion vs aggression: A lot of issues will be related to assertion (telling people what you think, feel at the time you feel as though you need to)- Aggression issues as well, but not as much as assertion
What aspects of attribution style should be considered?
- What does a person attribute the good and bad in their life to? - To themselves, to others? Blame themselves or blame others- Cognitive distortion (both males and females): constantly blame themselves- The goal is to get person to connect what they feel, with what they say, with how they act
What aspects of career and employment concerns should be considered?
Enjoyment of work, lack thereof
What aspects of the ability to self-nurture should be considered?
- Self-care, the ability to take care of yourself- Does client take time for themselves, can they, are they willing to?- Taking time away from responsibilities- Healthier diets, exercise, good relationships
What aspects of the resource assessment should be considered?
Financial independence
What aspects of ego strength should be considered?
- How strong a core a person has, applies to women and men - Intangible, no specific questions, no formula, but clinicians should still look for that core so they can understand how resilient or fragile a person is- Can take a while to really be certain- Be careful about misinterpreting this strength
What is a mental status examination?
Not a one-time assessment, usually conducted over time to see changes in mental status
What are we concerned about when client walks in the door?
- Engaged in self-care?- Alertness- Speech- Behavior- Orientation- Mood- Affect- Thought Processes- Thought Content- Memory / Ability to perform calculations, see abstract- Sensorium / Sensory Distortions- Judgement- Anxiousness- Chemical Use
What do we mean by the client’s self-care?
- Well fed, well cared for, appropriate clothing for season, clean clothing, clean body- For kids, does it look like they are being cared for?
What do we mean by the client’s level of alertness?
- Are they attending to their environment and people around them?- Delusional people (with hallucinations) have a hard time attending to other people when the “voices are talking”- Drowsy?- If so, why?
What do we mean by the client’s speech?
- Are they normal in tone, volume, and quantity?- Pressured-speech (and rapid)? Could be taking a stimulant, manic- Coherent? Clear in speech, usually clear in thinking- Slurred? Could be drinking, pain-meds, a downer- Neologisms - made up words (common in psychosis)- Word Salad - words put together that have no relationship- Pronoun Reversal - Third person, but using pronouns (he or she) instead of their name- Muteness - could be due to medical issue or refusal to talk- Window into a person’s thinking, their thought-process
What do we mean by the client’s behavior?
- Is person cooperative or resistant, how are they acting?- There are many reasons why someone will refuse to cooperate, so it’ll only give you basic info, but not really insight into why they won’t cooperate
What do we mean by the client’s orientation?
- Does person know the time, place, and who they are?- Could be substance abuse, psychosis- When looking at elderly people in nursing homes, they might be off on time and date because there are few references to this in that location. Take that into account
What do we mean by the client’s mood?
- Mood generally currently and in last few months- How severe the mood is, and do they reach a level of diagnosis or are they sub-clinical?- Depressive people do worse in morning than afternoon- Ask how they fill most of their day (what do they do)- How long they’ve felt that way- Depressed, agitated, manic
What do we mean by the client’s affect?
- An indicator of mood, how the client looks- Eye contact, excitable, tone change?
What do we mean by the client’s thought processes?
- Do they have unrelated thoughts, bouncing from one topic to another rapidly- Are they fixated on a specific thought or action (OCD, phobia, eating disordered, Asperger’s…)? Can be very difficult to break up the fixation
What do we mean by the client’s thought content?
- Are they delusional, paranoid, phobic, hallucinating, suicidal, homicidal?- If a person has persecution type delusions, you want to look into that but very stealthily (don’t get sucked into it)
What do we mean by the client’s memory, ability to perform calculations, use abstract?
- Executive functioning: the ability to organize thoughts, think clearly, remember things, to plan- Psychosis has impaired executive functioning
What do we mean by the client’s sensorium or sensory distortions?
- Hallucinations (visual, auditory, kinesthetic, gustatory, and olfactory)- You need to investigate these; if person is seeing a person and talking to them:- “I would like to ask a question, but would like your permission. I’m sorry if this does not apply to you. Would you please introduce me to who you’re talking to?”- If the person acknowledges voices, ask what the voices are saying
What do we mean by the client’s judgment?
- Looking at behavior (past and current) to see how their judgment is- Suicidal and homicidal persons - you do NOT want to mistake their judgment
What do we mean by the client’s anxiousness?
- How anxious or nervous the client gets, how worried- Difficulty sitting still, physical symptoms (sweaty, can’t catch breath, racing heart, stomachaches, headaches, TMJ, back pain, neck pain, joint pain, vertigo, muscle ticks, sleep disturbances)
What do we mean by the client’s substance abuse?
- ALWAYS ask about chemical use (drugs, alcohol, and medications)- Make them list everything very specifically, amounts, and how long (including prescriptions)- A lot of psychosis can be caused by chemical use- You won’t be able to tell if mood issues were caused by alcohol or unrelated to alcohol unless they stop using for months
When we assess for suicide risk, what are common factors we are interested in?
- Do they have a history of (suicide attempts, family suicide, psychiatric issues, treatment)- What are their social supports?- How long they’ve been thinking about it? Adolescents are impulsive, adults think about it for a long time usually- Environmental issues - what’s their life like?- Specificity: do they have any plans for how they will do it, given away possessions, written a note (or thought about what will go into the note). The more specific they are, the more likely they are very close to doing it- Lethality: how likely is the action going to kill them? Jumping, guns, and hanging are more lethal than others, the probability the person is going to carry it out, - The availability of means: do they have the means to kill themselves (a weapon, the rope, ect…), do they know how?
Who are most commonly a suicide risk?
- History of attempts- Family history of attempts- Depressive- Bipolar disorder- Schizophrenia- Alcohol dependent- Eating disorders- Teenagers- Older age (45+) (suicide climbs as they age, women level off around 50, men never level off - goes up until they die)
Although a person may be suicidal, we need to also make sure the person is not _____.
Homicidal
Ask specifically for suicide…
“Have you, and are you, thinking about hurting yourself?”
Ask specifically for homicide…
“Have you, and are you, thinking about hurting someone else?”
Research suggests that asking the question _____.
Does not cause the thinking- Evidence that talking about the thoughts may diffuse to some extent, the desire to commit. However, it’s not 100% and you shouldn’t rely on it
What is the standard of care?
- Using appropriate assessments- Protecting the client- Covering your butt
With regards to standard of care, explain use of appropriate assessments to assess the client risk of suicide/homicide.
- Very thorough assessment, document EVERYTHING- This is not the time to leave things out for ethical issues
With regards to standard of care, explain protecting the client when assessing their risk of suicide/homicide.
- Tell them, “I am professionally bound to call and express my concerns about your welfare”- If they walk out, you must let them, but try to find out where they’re going…make every possible effort to let people know your concerns (family, police, magistrate)- If there is a specific person/place, contact that person/place and let them know!- Document it- Try to contact the person to come back in
With regards to standard of care, explain protecting your butt when assessing client risk of suicide/homicide.
Must document 2 things in order for client to be committed- Must be a threat to themselves or others- Must document a real, serious mental illnessDo not state, “I am attempting to predict suicide;” instead, say “I am attempting to predict suicide risk
What two things must be documented for the client to be committed?
- Must be a threat to themselves or others- Must document a real, serious mental illness
How do we predict risk of suicide/homicide?
- Clinical History- Mental Status Exam- Consulting with significant others (third parties)- Specificity, lethality, and availability of means- Assessments to help with risk: Beck Depression Inventory, Beck Hopelessness Scale, and Beck Suicide Ideation Scale. Beck theorized that high levels of hopelessness are more predictive of suicidal attempts than depression-People get emotional blinders - cannot see a way out
What is a delusion?
A belief that is not real that is held very close to the person (bizarre and not bizarre, grandeur and persecution). They don’t necessarily go away once treated for whatever issue they have
What is an analgesic?
Pain-killers
What are characteristics of aspirin?
Is a good medication for mild to moderate pain- Will relieve pain- Anti-inflammatory agent (system wide)- Reduces fever- Take if having a heart attack
Do not give aspirin to children under the age of _____.
12; will cause Reyes Syndrome
What is a NASID and list three examples.
Non-steroidal Anti-Inflammatory Drug; Aspirin, Ibuprofen, Naproxen
As dosage levels of NASIDs increase, complications ____.
Increase
What are complications of NASID use?
- NASID overdose- Liver and kidney damage
Overdose of NASIDs is usually seen in ______.
Adolescent girls
