Ch 9: Assessment: Integration and Clinical Decision Making Flashcards
What is the process of assessment?
- clarifying the question that will be the focus (ex. effects of trauma)
- generating hypotheses
- gathering data
- examining the data: looking at consistencies and contradictions
- formulating conclusions and making recommendations
What are the goals of a case formulation?
- describes client and provides relevant information
- integrates assessment material
- addresses diagnostic issues
- hypothesizes about development and maintenance of problem
- informs treatment plan
- takes into account obstacles to implementing treatment plan
Why may case formulation differ by clinician?
- clinician’s orientation may influence flavour of case formulation
- but almost always focus on symptoms and problems, relationship history, and the development/maintenance of the symptoms/problems
What two types of factors are threats to the validity of assessments and case formulations?
- client factors
- clinician factors
What are client factors?
- retrospective recall (memories not always accurate)
- possible biases in self-presentation (fake good or bad, inconsistent answers)
- inconsistencies in data from multiple raters (youth, parent, teachers)
What are two general clinician factors?
- biases: judgments that are systematically different from what a person should conclude based on logic or probability
- heuristics: mental shortcuts that ease the burden of decision-making but are prone to errors
What are some clinician biases?
- self-serving bias: believe something great we did is because we are great, and something wrong is situational
What are some clinician heuristics?
- fundamental attribution error
- representative heuristic
- confirmatory bias
- inferring causation from correlation
What is fundamental attribution error?
- someone does something outside of norm and you assume it is because of their personality and not the situation/environment
What is representative heuristic?
- we have some evidence or knowledge and make our assumptions without seeking more
What is confirmatory bias?
- tendency to search for, interpret, or favour information in a way that confirms one’s prior beliefs or hypotheses
What are the consequences of clinician factors?
- missed diagnosis, misdiagnosis and malpractice
How can the accuracy of clinical judgment be improved?
- be methodical and evidence-based!
- relevant psychological tests with strong psychometric qualities
- check for scoring errors
- use computers as aids
- use normative data and base rate info
- use established diagnostic criteria
- use evidence-based decision aids
- be systematic and structured in unstructured tasks
- stay atop research
- be aware of personal biases
- be self-critical
- seek consultation
What does a case formulation chart look like?
- 4 p’s
- biological, psychological, relationships, environment
What does the case formulation report include?
- diagnostic considerations
- hypotheses
- prognosis
- treatment recommendations
What is important to consider for psychological assessment reports and treatment plans?
- know the audiences for the report (client/family, teachers/schools, legal system, insurance company)
- confidentiality and privacy considerations
- separating facts, client opinion and psychologist opinion
- computer interpretations can help but should not be inserted word-for-word
What are the stats on reports?
- surveys of American and Canadian psychologists: <25% of former and 60% of latter provide copy of report to client
What is included in a psychological assessment report?
- reason for referral
- identifying patient/client info
- background info
- assessment methods
- interview data and behavioural observations
- test results
- diagnostic impressions and case formulation
- summary
- recommendations
What is included in a treatment plan report?
- identifying client info
- reason for referral
- evaluation of primary symptoms and problems
- diagnosis
- patient strengths
- treatment-related goals
- proposed treatments
- potential barriers
- criteria for treatment termination
- service provider responsible for treatment implementation and evaluation of treatment
What are the reasons for providing assessment feedback?
- verify general accuracy of assessment results and correct any error/misunderstandings
- ensure interpretation of results fits with client’s circumstances, experience, and life history
- provide psychological relief for the client by presenting integrated pictures of difficulties
- help client identify potential perpetuating factors
- collaborate with client in creating therapeutic goals that build on personal strengths
