Chapter 3: Basic Features of Clinical Assessment Flashcards
Clinical Assessment
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
Clinical Assessment Process
Receive and clarify the referral question Plan data collection procedures Collect assessment data Process data and form conclusion Communicate assessment results
Referral Source
Person or agency requesting the psychological assessment
Referral Question
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
Context of the Referral
Helps clarify the purpose of assessment;
Sources of Assessment Data
Interviews Behavioral Obserations Psychological Tests Case History Data Therapist Physician or Treatment Team Client School Parent Court Employer, goverment agency, or other third party
Therapist
Would this person be a good candidate for group psychotherapy?
How effective have I been in treating with anxiety disorders?
Physician or Treatment Team
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?
Client
What, if anything, should we do to salvage this marriage?
School
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?
Parent
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?
Court
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?
Employer, Government Agency, or other Third Party
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?
Factors which Affect the Selection Process
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
Value of Multiple Assessment Sources
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
Processing Data and Forming Conclusions
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
Assessment Report
Organized presentation of results; must be clearly written and clearly related to the goal that prompted the assessment in the first place
Psychodiagnosis
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
Treatment Planning
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
Goal of Clinical Assessment
Make predictions about human behavior; Includes prognosis, future performance, or dangerousness
Prognosis
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
Future Performance
Descriptions of how someone will perform in a given job or situation
Dangerousness
Descriptions of the likelihood of someone behaving violently toward the self or others
Prognosis for Predicting Future Performance
Helps in selecting people who are most likely to perform well in certain jobs
Prognosis to Predict Dangerousness
Called forensic evaluations; can be evaluated in terms of the pattern of four possible outcomes
True Positive
When the clinician predicts dangerousness and the person behaves as predicted
False Negative
When the clinican predicts no dangerousness and the person acts dangerously
True Negative
When the clinician predicts there is no danger and the person does not behave dangerously
False Positive
When the clinician predicts dangerous behavior but dangerous acts do not occur
Positive Predictive Power
Considered low when it is within 1% prediction
Negative Predictive Power
Greater than 99.9%
How to Emprove Prediction
Focus on four domains: Defendant’s dispositional tendencies, Clinical factors, Historical Factors, Contextual Factors
Availability Heuristics
Judgments which rely too heavily on experiences that are recent or remarkable enough to make them especially available to recall
Illusory Correlations
Drawing false inferences from assessment data
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
Confirmation Bias
Tendency to interpret new information in line with existing beliefs
Statistical Prediction (Actuarial/Mechanical Predictions)
Involves inferences based on probability data and formal procedures for combining information, all usuallyd erived from research
Clinical Prediction
Involves inferences based on a practitioner’s training , assumptions, and professional experiences
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
Assessment and Treatment Tasks
Describing symptoms, personality, or behavior
Making causal inferences and treatment decisions
Deciding what to say next in a psychotherapy session
Psychometric Properties of Assessment Instruments
Reliability
Validity
Standardization
Bandwidth-Fidelity Issues
Reliability
Consistency in measurement or agreement among different raters
Test-Retest Reliability
When the results of repeated measurements of the same client are very similar
Internally Consistent
If data from one part of the assessment are similar to other parts of the test
Inerrater Reliability
Measured by comparing the conclusions drawn by different clinicians using a particular assessment system to diagnose, rate, or observe the same client
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
Validity
Reflects the degree to wich it measures what it is supposed to measure
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
Content Validity
Determined by how well it taps all the relevant dimensions of its target
Predictive Validity
Measured by evaluating how well an assessment forecasts events
Concurrent Validity
When two assessments agree about the measurement of the same quality
Criterion Validity
Measures how strongly an assessment result correlates with important independent criteria of interest
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
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
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
Bandwidth
Breadth of an assessment device
Fidelity
Exhaustiveness of the device
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
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
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
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
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
Cognitive-Behavioral Case Formulation Worksheet
Schemas
Working Hypothesis
Treatment plan
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
Criterion for Assessment Reports
Report Clarity
Relevance to Goals
Usefulness
Report Clarity
Misinterpretation of a report can lead to misguided decisions
Cryptic Brevity
Excessive Length
Contributors to Lack of Clarity
Excessive Length
Excessively technical information (statistics or esoteric test scores)
Lack of coherent organization
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
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
