Ch 9: Assessment: Integration and Clinical Decision Making

Question 1

What is the process of assessment?

Answer 1

• 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

Question 2

What are the goals of a case formulation?

Answer 2

• 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

Question 3

Why may case formulation differ by clinician?

Answer 3

• 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

Question 4

What two types of factors are threats to the validity of assessments and case formulations?

Answer 4

• client factors

- clinician factors

Question 5

What are client factors?

Answer 5

• 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)

Question 6

What are two general clinician factors?

Answer 6

• 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

Question 7

What are some clinician biases?

Answer 7

• self-serving bias: believe something great we did is because we are great, and something wrong is situational

Question 8

What are some clinician heuristics?

Answer 8

• fundamental attribution error
• representative heuristic
• confirmatory bias
• inferring causation from correlation

Question 9

What is fundamental attribution error?

Answer 9

• someone does something outside of norm and you assume it is because of their personality and not the situation/environment

Question 10

What is representative heuristic?

Answer 10

• we have some evidence or knowledge and make our assumptions without seeking more

Question 11

What is confirmatory bias?

Answer 11

• tendency to search for, interpret, or favour information in a way that confirms one’s prior beliefs or hypotheses

Question 12

What are the consequences of clinician factors?

Answer 12

• missed diagnosis, misdiagnosis and malpractice

Question 13

How can the accuracy of clinical judgment be improved?

Answer 13

• 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

Question 14

What does a case formulation chart look like?

Answer 14

• 4 p’s

- biological, psychological, relationships, environment

Question 15

What does the case formulation report include?

Answer 15

• diagnostic considerations
• hypotheses
• prognosis
• treatment recommendations

Question 16

What is important to consider for psychological assessment reports and treatment plans?

Answer 16

• 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

Question 17

What are the stats on reports?

Answer 17

• surveys of American and Canadian psychologists: <25% of former and 60% of latter provide copy of report to client

Question 18

What is included in a psychological assessment report?

Answer 18

• 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

Question 19

What is included in a treatment plan report?

Answer 19

• 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

Question 20

What are the reasons for providing assessment feedback?

Answer 20

• 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