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Clinical Psychology > Chapter 3: Basic Features of Clinical Assessment > Flashcards

Chapter 3: Basic Features of Clinical Assessment Flashcards

1
Q

Clinical Assessment

A

A process of gathering information to solve a problem; To be effective, assessment activities should should be organized in a sequence of systematic, logically related steps driven by a goal

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2
Q

Clinical Assessment Process

A 
Receive and clarify the referral question
Plan data collection procedures
Collect assessment data
Process data and form conclusion
Communicate assessment results
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3
Q

Referral Source

A

Person or agency requesting the psychological assessment

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4
Q

Referral Question

A

Question or issue to be addressed in the assessment; important because it shapes the clinician’s choice of assessment instruments, interpretation of results, and communication of results

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5
Q

Context of the Referral

A

Helps clarify the purpose of assessment;

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6
Q

Sources of Assessment Data

A 
Interviews
Behavioral Obserations
Psychological Tests
Case History Data
Therapist
Physician or Treatment Team
Client
School
Parent
Court
Employer, goverment agency, or other third party
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7
Q

Therapist

A

Would this person be a good candidate for group psychotherapy?
How effective have I been in treating with anxiety disorders?

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8
Q

Physician or Treatment Team

A

What is the correct psychological diagnosis for this client?
What cognitive and emotional limitations does this person have following her accident, and what strengths does she have to draw on during rehabilitation?

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9
Q

Client

A

What, if anything, should we do to salvage this marriage?

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10
Q

School

A

What is an appropriate educational placement for this child?
How should we intervene to help this student better manage violent tendencies and problems in relationships with peers and teachers?

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11
Q

Parent

A

Is my child suffering from depression and in need of counseling?
How can we help my child chope with the loss of his mother?
My child becomes very emotional and refuses to go to school: What can I do?

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12
Q

Court

A

Does this person pose an imminent threat of danger to himself or others?
Which custody arrangement is in the best interest of this child?
Is this client mentally able to understand the criminal charges against him and to assist an attorney in mounting a legal defense?

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13
Q

Employer, Government Agency, or other Third Party

A

Is this person suffering from a mental illness that would qualify him to receive disability payments?
What form of treatment would best help this person to resume productive employment, and for which types of employment would the person be best suited?

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14
Q

Factors which Affect the Selection Process

A

Quality of the assessment instrument or procedure
Characteristics of clients when deciding on assessments
Selecting instruments that are appropriate for each client in terms of reading level, length, and the like
Explanation of procedures and purposes of the assessment, using language that clients can understand

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15
Q

Value of Multiple Assessment Sources

A

Allows the therapist to cross-validate information about a wide variety of topics
Used to separate those who cannot engage in certain behaviors from those who do not engage in them
Useful in evaluating the effects of treatment

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16
Q

Processing Data and Forming Conclusions

A

Must be transformed from raw form into interpretations and conclusions that address a referral question
Processing task formidable because it reqires a mental leap from known data to what is assumed to be true on the basis of those data
Integration from various sources must be integrated

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17
Q

Assessment Report

A

Organized presentation of results; must be clearly written and clearly related to the goal that prompted the assessment in the first place

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18
Q

Psychodiagnosis

A

Proper treatment often depend on knowing what, exactly, is wrong with a client
Research into the causes of psyychological disorders requires reliable and valid identification of disordersa nd accurate differentiation of one disorder from another
Classification allows clinicians to efficiently communicate with one another about disorders in a professional shorthand

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19
Q

Treatment Planning

A

Identifying ideal connections between diagnoses and psychotherapy methods; What treatment by whom is the most effective for this individual with that specific problem, and under which set of circumstances

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20
Q

Goal of Clinical Assessment

A

Make predictions about human behavior; Includes prognosis, future performance, or dangerousness

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21
Q

Prognosis

A

Descriptions of how the symptoms of disorder might change with or without treatment
Predictions about the outcome of treatment: refer more generally to predictions about changes in symptoms without treatment and with certain circumstances
Information about: Client’s level of social support and subjective distress; Factors relating to the client, setting, or fit between client and therapist

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22
Q

Future Performance

A

Descriptions of how someone will perform in a given job or situation

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23
Q

Dangerousness

A

Descriptions of the likelihood of someone behaving violently toward the self or others

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24
Q

Prognosis for Predicting Future Performance

A

Helps in selecting people who are most likely to perform well in certain jobs

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25
Prognosis to Predict Dangerousness
Called forensic evaluations; can be evaluated in terms of the pattern of four possible outcomes
26
True Positive
When the clinician predicts dangerousness and the person behaves as predicted
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False Negative
When the clinican predicts no dangerousness and the person acts dangerously
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True Negative
When the clinician predicts there is no danger and the person does not behave dangerously
29
False Positive
When the clinician predicts dangerous behavior but dangerous acts do not occur
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Positive Predictive Power
Considered low when it is within 1% prediction
31
Negative Predictive Power
Greater than 99.9%
32
How to Emprove Prediction
Focus on four domains: Defendant's dispositional tendencies, Clinical factors, Historical Factors, Contextual Factors
33
Availability Heuristics
Judgments which rely too heavily on experiences that are recent or remarkable enough to make them especially available to recall
34
Illusory Correlations
Drawing false inferences from assessment data
35
Anhcoring Bias
When clinicians establish views of a client more on the basis of the first few pieces of assessment information on any subsequent information
36
Confirmation Bias
Tendency to interpret new information in line with existing beliefs
37
Statistical Prediction (Actuarial/Mechanical Predictions)
Involves inferences based on probability data and formal procedures for combining information, all usuallyd erived from research
38
Clinical Prediction
Involves inferences based on a practitioner's training , assumptions, and professional experiences
39
Conclusions of Statistical Vs Clinical PsucPrediction
Statistical/actuarial prediction generally outperforms clinical prediction Overall advantage for statistical prediction is modest, and occasionally clinical preduction does as well or slightly better, though not in any particular pattern of circumstances The superiority of statistical prediction is most evident in predicting violence and other low-base-rate events Practicing clinicians typically underutilize and undervalue actuarial prediction methods
40
Assessment and Treatment Tasks
Describing symptoms, personality, or behavior Making causal inferences and treatment decisions Deciding what to say next in a psychotherapy session
41
Psychometric Properties of Assessment Instruments
Reliability Validity Standardization Bandwidth-Fidelity Issues
42
Reliability
Consistency in measurement or agreement among different raters
43
Test-Retest Reliability
When the results of repeated measurements of the same client are very similar
44
Internally Consistent
If data from one part of the assessment are similar to other parts of the test
45
Inerrater Reliability
Measured by comparing the conclusions drawn by different clinicians using a particular assessment system to diagnose, rate, or observe the same client
46
Standard Error of Measurement (SEM)
Uses the concept of standard deviation and allows clinicians to estimate and resport a confidence interval for their assessment; error of measurement would be lower and reliability higher for measurement of concepts that are stable as opposed to undstable and for concepts that are precisely defined and measure
47
Validity
Reflects the degree to wich it measures what it is supposed to measure
48
Confidence Interval
If a clinician can estimate and report with 95% confidence, the client's true score is within 5 points in either direction of the score obtained on that test
49
Content Validity
Determined by how well it taps all the relevant dimensions of its target
50
Predictive Validity
Measured by evaluating how well an assessment forecasts events
51
Concurrent Validity
When two assessments agree about the measurement of the same quality
52
Criterion Validity
Measures how strongly an assessment result correlates with important independent criteria of interest
53
Construct Validity
Whe its results are shown to be systematically related to the construct it is supposed to be measuring; evaluated by determining whether a test or other assessment method yields results that make sense in light of some theory about human behavior and mental processes
54
Standardization
Designers of the test have given it to a large, representative sample of persons and analyzed the scores; is the size of the standardization sample large enough and representative enough
55
Badwidth-Fidelity Dilemma
Given limited time and resources, the more extensively clinicians explore a client's behavior, the less intensive each aspect of that exploration becomes
56
Bandwidth
Breadth of an assessment device
57
Fidelity
Exhaustiveness of the device
58
Broad Bandwidth, Low Fidelity
When a clinician tries to cover a long list of questions and the result would be superficial information about a wide range of topics
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Narrow Bandwidth, High Fidelity
If time is spent exploring the client's early childhood memories, the result would be a lot of detailed information about only one part of the client's life
60
Psychodynamic Assessment Outline
I. Historical Data - Present illeness with attention to associative linkages and Axis IV stressors, Past History will an emphasis on how the past is repeating itself in the present (Developmental History, Family History, Cultural Religious Background) II. Mental Status Examination - Orientation and Perception, Cognition, Affect, Action III. Projective Psychological Testing IV Psychological and neurological Examination V. Psychodynamic Diagnosis - Descriptive DSM diagnosis, Interactions among the Axes; Characteristics of the ego (Strengths and weaknesses, Defense mechanisms and conflicts, relationship to the superego), Quality of object relations (family relationships, transference-countertransference patterns, inferences about internal object relations), Characteristics of the self (self-esteem and self-cohesiveness, self-continuity, self-boundaries, and mind-body relationships), Attachment patterns/mentalization capacity, psychodynamic formulation using above data
61
Cognitive-Behavioral Assessment Outline
``` I. Patient name II. Diagnosis/symptoms III. Formative influences IV. Situational Issues V. Biological, Genetic, and Medical Factors VI. Strengths/Assets VII. Treatment Goals ```
62
Humanistically Oriented Assessment
Tests can be seful if they are processed in line with humanistic principles; Assessments, when conducted interactively between therapist and client, are useful
63
Cognitive-Behavioral Case Formulation Worksheet
Schemas Working Hypothesis Treatment plan
64
Communicating Assessment Results
Assessment results have maximal value if they are presented in reports that are clear, relevant to the assessment goals, and useful to the intended consumer; needs to be sufficiently problem-oriented to be used with clients seeking help, while also reminding the assessor to consider broader and less problematic aspects of a person's life
65
Criterion for Assessment Reports
Report Clarity Relevance to Goals Usefulness
66
Report Clarity
Misinterpretation of a report can lead to misguided decisions
67
Cryptic Brevity
Excessive Length
68
Contributors to Lack of Clarity
Excessive Length Excessively technical information (statistics or esoteric test scores) Lack of coherent organization
69
Core Competencies in Clinical Psychology Assessment
Understand the theoretical, empirical, and contextual bases of assessment Evaluate the psychometric properties of assessment instruments Successfully administer and interpret instruments designed to assess cognitive functioning, behavioral functioning, and personality Conduct and interpret clinical interviews and behavioral observations Formulate appropriate DSM diagnoses Recognize the limitations and appropriate uses of assessment instruments for special populations (clinical and linguistic groups, physically challenged, etc.) Integrate data from multiple assessment sources into emprirically grounded conclusions Effectively communicate results of assessments to others in written and spoken reports Understand and follow PAP Ethics Code Guidelines
70
Importance of Accurate Psychodiagnosis
Proper treatment decisions depend on knowing what, exactly, is wrong with a client Research into the causes of psychological disorders rerquires reliable and valid identification of discorders and accurate differentiation of one disorder from another Classification allows clinicians to efficiently communicate with one another about disorders in a professional shorthand

Clinical Psychology (7 decks)

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