Exam 2 Flashcards
What time of data do we use in assessment to help make our decisions?
- BASERATES for how they were before.
- self reports
- reaction time based assessment (that are compared with norms on meaningful variables.)
- School records
- how someone presents in the room with you
- observations in natural settings
Decisions in assessment are subjective and subject to cognitive bias, what does this mean for analyzing data?
it means that we are going to be looking at data in different ways.
have to look at bias to make sure that the assessments we do are valid
examining bias is important so we are making ethical decisons
what does it mean that psychological assessment is systematic?
- there is a plan for how the assessment will go
- there is an order in which we execute that plan
- all practitioners will execute the assessment in a particular way
Goals and measures vary in assessment.. what does that mean?
goals help set a road map for what the assessment is going to look like.
going to use different materials and measures depending on the goal of assessment
When do we not provide feedback (back to client) on the assessment?
- ## court mandated
What are some qualities that a psycholigist is supposed to have at the point of licensure?
- apply knowledge of individual and cultural characteristics in ax and dx
- effective interviewing
- instruments selected are based on normed data (carrying out the appropriate tests)
- administer and score the instrument following guidelines and psychometric research
- interpret and syntesize information from multiple sources
-formulate diagnosis, recommendations, and professional opinions using relevant criteria
- communicate the results form assessment in an integrative manner
- evaluate the effectiveness of psychological services (e.g., what treatment you would recommend for [i.e, PTSD])
What are STAND ALONE assessments?
Services conducted primarily to provide information on a persons psychological functioning.
intent: CONCLUSIONS and RECCOMENDATIONS about a persons functioning.
-providing information to the REFERRAL source
- e.g., custody, screening, return to work, forensic, psychodiagnostics
what is intervention focused assessment?
When assessment is not a stand alone service but is the first step in providing intervention..
intent: to IMPROVE the persons functioning.
- providing information on types of treatment that would benefit the client
- shared with client and clinicians..
- this type of assessment will give us a good baseline for where someone is at before treatment.
Breakdown of STAND ALONE assessments… what are all the components that are in it?
- screening
(focus on prevention) - diagnosis
- prognosis
- treatment recommendations
Evidence based assessment
the use of research and theory to guide
a) the variable assessed
b) the methods and measures
c) the manner in which the assessment unfolds
define: screening
identifying individuals who have / are at risk for developing problems of a clinical magnitude, and who may have not sought out assessment services
goal: identify those who might require services
+ early identification and treatment
define: case formulation
a description of the patient that provides information on his or her life situation, current problems, and a set of hypothesis linking psychosocial factors with the patients clinical condition
define: prognosis
predictions made about the future course of a patients psychological functioning based on the use of assessment data in combination with empirical literature.
define: base rates
the frequency with which a problem or diagnosis occurs in a specific population
What is a “true positive”
the prediction that an event would occur is true.
(correct prediction)
what is a true negative?
prediction of a non-event was accurate (no diagnosis was warranted, or the suicide attempt did not occur)
what is a false positive?
psychologist predicts an event will occur, but the vent does NOT occur..
e.g., ADHD diagnosis, but person does not have ADHD
what is a false negative?
an event occurs, but it was NOT predicted by the psychologist. (e.g., failure to diagnose someone with a personality disorder)/.
Accuracy is the combination of 2 concepts… What are they & what do they mean?
1) sensitivity:
the number of times an event is predicted.. (the proportion of true positives identified by assessment)
( true pos (divided by) true pos + false neg) = sensitivity
2) Specificity:
# of times a non-event is predicted..
- the relative proportion of true negatives.
true neg (divided by) true neg + false positive
What is the first step in treatment planning?
assessing how well the client fits with the population the norms were created from
Useful treatment plans MUST cover 3 things, what are they?
1) problem identification = a clear statement about the problem to be addressed..
2) Treatment goals = Goals must be specified. Both ultimate and intermediate treatment goals
3) Treatment Strategies & Tactics = general approach to addressing clinical problems & descriptions of tactics to provide details on specific tasks, procedures and techniques..
e.g., strategy = emotionally focused couples therapy
tactic = work on emotionally connecting this week.
Define: treatment monitoring
what does it include?
Treatment Monitoring: Allows psychologist to change treatment in response to patient. e.g., shorten / alter
- tracking progress thorugh explicit measures like specific questionaires or psychological measures
- data on problems in the process of treatment and obstical patient encounters outside of therapy (not doing self assessments) are an opportunity to readjust treatment
monitoring = positive effects on treatment outcomes
Define Treatment Evaluation.. what does it involve?
basically tells you if the therapy was effective in a hcieveing the stated goals.. you compare the outcome data with intake data to see how much change happened..
- gives info on the nature & duration of the treatment needed
- typical treatment responses = profiles of symptom reduction and improvements in functioning over the course of the treatment.
How do you measure psychological functioning?
tests that requires norms, reliability and validity
What is the difference between assessment and testing?
testing is when a device is used to gather a sample or behaviour from a client. the scores are then assigned and compared against norms.
- “what is the score that someone has on their cognitive measure”
assessments address a specific question.. They
integrate life history, client observation and results from psychological tests, and people in the clients life…
- multiple sources of data including standardized testing an interviews.
- requires integration and interpretation
e.g., “do they have a learning disability, if so how can we deal with it”
How does assessing kids differ from assessing adults?
need a larger number of children and more variety of tests than would typically be used for an adult..
what are some psychometric elements that make a test scientifically sound and clinically useful?
- standardization (of stimuli, administration and scoring)
- reliability
- validity
- norms
What is standardization?
consistency across clinicians and testing occasions in the procedure used to administer a test..
what happens if you dont have standardization?
its impossible to replicate information gathered in assessment / cant generalize data
How does a clinical reduce variability in standardized testing?
giving specific instructions about the stimuli, administrative procedures, time limits, and types of verbal probes and responses.
What is reliability?
the consistency of the test / if all aspects of the test contribute to meaningful data.
e.g., IQ testing is generally reliable.. (if you test in grade 10 and then again in a few years you would expect a similar range).
- has to give accurate representation of some concept that we think its tapping into.
what is test-retest reliability?
the extent to which similar results would be obtained if the person was retested at the same point after the initial test.
what is internal consistency?
the extent to which all aspects of a test contribute to the overall score
what is inter-rater reliability?
the extent to which similar results would be obtained if by another scorer
Some things to know:
just skip to answer
- reliability for one demographic does not mean reliability for a different demographic
(we may have validated / normed a measure for one group, but it doesnt hold up with others)
- some tests dont need internal consistency (death of a loved one / stressful life event / job loss), all of those questions might not be related to eachother..
- same thing with test-retest reliability, you wouldn’t expect those items to stay the same.
what is the minimum reliability score for clinical tests…..
what is the minimum reliability score for research?
.90 for clinical testing
.70 for research
–> (.90) is important for clinical tests because it impacts error… important when working with cut off scores.. e.g., if a child is disabled or gifted.
What is validity?
does the test measure what it says it measures?
what is evidence of content validity?
test items are representative of all aspects of the underlying psychological construct that the test is designed to measure…
so… the content of the test is relevant to what the test is trying to measure.
what is evidence of concurrent validity?
the extent to which scores on the test are correlated with scores on measures of similar constructs..
like.. do two anxiety tests look the same?
what is evidence of predictive validity?
the extent to which the test predicts a relevant outcome
what is evidence of discriminant validity?
the extent to which the test provides a pure measure of the construct and is minimally contaminated by other psychological constructs..
if the test measures depression, it should measure depression more than anxiety.
what is evidence of incremental validity?
the extent to which a measure adds to the prediction of a criterion above what can be predicted by other sources of data…
does it do a better job at predicting something than other tests?
just because a test is valid for some groups does not make it valid for other groups
fun fact
why do you need norms?
they are essential for the meaningful interpretation of the results obtained from the client
- without, its impossible to determine any precise meaning of a test result
- have to know the range of scores and how most other people score
- gender norms / non-distressed vs. psychologically distressed norms / norms for Dif age groups
what is a convenient sample (for norms)?
undergrad students, hospitalized inpatients.. need to be skeptical because there was likely no effort to make sure they are the same age / race / sex / education level to the group of people receiving assessment
true or false: you want research participants to represent the national population from which the test will be used.
true
what are test norms?
percentile ranks, standard scores and developmental norms..
the amount of scores under thermal curve allows your to interpret thenormative meaning of a percentile rank and standard score.
when is the only time ‘informed consent’ is violated?
court mandated assessment, or when an individuals capacity to make decisions
e.g., a custody or legal thing that makes the person get a psych evaluation.
but most of the time, its the psychologists ethical responsibility to communicate the results of the assessment to the client and make sure they understand it.
When are the only times you break confidentiality?
- suicide // a plan and means to carry out self harm.
- danger to other..
- child protection
- court supina.
- risk to driving (if they are drunk / high / processing speed is super low on a cognitive test you have to report it to ICBC)
(limits of confidentiality must be outlined in informed consent procedures)
Define: base rates (might be a double)
the frequency by which a problem occurs in the general population.
for most mental health disorders we see super low base rates…
they are super important to look at when we are making clinical predictions..
- e.g., schizophrenia 1%
- depression 10%
What are true events?
True positives..
False Negatives
a disorder is present.. it is true that the disorder is there… whether it is predicted or not.
What are True non-events?
True negatives
False positives
a disorder is not present.. it is true that it is not there, whether it is predicted or not.
what does informed consent involve?
- what the assessment will involve
- what reccomendations we are able to make
- what we are NOT able to do
- who will get a copy of the report.
- awareness of the limits of confidentiality
- responsible caring - selecting appropriate tools for the referral (idk if this is informed consent tho)
what are some examples of radicalized bias in psychological assessment?
- early IQ tests were developed to support the eugenics movement
- standford-binet test was constructed to determine minority groups were inferior.
- IQ and cognitive tests used to support deportations in US WW1
- racial segregation of students in school due to biasing in IQ testing.
what are some consequences of bias in psychological assessment for POC people currently
- bias adversely affects POC as norms and standardization are based on the dominant culture..
consequences:
- misdiagnosis,
- improper and determinative treatment
- lack of beneficial treatment, recommendations, referrals and services
Things psychologists must consider when assessing culturally diverse individuals:
- acculturation level
- English language proficiency and literacy
- sustainability of test norms for the client
- using best available measures for clients background
- discussing interpretation of finding with other colleagues who might have more expertise in the background your client is from
- aknowledge limitations of testing in the report.
- triangulation of test findings with other sources of information (clinical interview + informant report)
psychologists do not have “client privilege” - true or false
true…
not like lawyers where a clients gets to hold the privilege and decide if something is disclosed or not…
psychologists must report if someone is going to kill someone lol
what is an unstructured interview?
does not follow any sort of structure, all based on what the psychologist feels is the most important thing to follow in an interview.
we dont use unstructured interviews in assessment settings.
but we DO USE unstructured interviews in therapy settings.
what are some benefits of using unstructured interview?
- creates a safe environment for client to feel comfortable.
- positive relationship
- gather pertinent information (as long as the person isn’t tangential)
you get a sense of what is important to that person and what they are comfortable talking about. - can help the client feel comfortable opening up
What is the role of the psychologist in facilitating an unstructured conversation
(key skills)
- setting the context of what someone will be speaking to
- asking open and closed ended questions (pursuing a line of questioning)
- clarifying, reflecting, and paraphrasing
- silence (used to elicit more information from the client, or give them space to process).
what is an open ended question?
what are the pros and cons?
can be answered with anything…
- you get a ton of information..
- have to shade through what is useful and what is not
- can be hard to bring people back to topic if they are going on a tangent.
what is a closed question?
what are the pros and cons?
yes / no answers
pros: gives interviewer the ability to move through alot of relevant topics quickly
cons: surface level.
have to be careful not to ask leading questions
what is pursuing a line of questioning?
asking questions that centre around what the assessment is about.
what is clarifying in an interview?
attempted restating of a clients message, proceeded with a closed question (e.g., is that right)
it facilitates / inhibits spontaneous client talk
want to know exactly what someone means
- will probably be subject to our biases.
what is reflecting in an interview?
reflecting back what someone said.. they will often elaborate
what is paraphrasing in an interview?
reflection of rephrasing of what client said.
assures client you hear them accurately and allows them to hear what they said
paraphrasing is a tool to see if that is what the client really means
What are some issues with unstructured interviews?
- confirmation bias
- ranting
- low diagnostic reliability
Major differences between assessments and chats with friends lol
- painful topics
- innate power imbalances
- Disclosure
- confidentiality
- treatment notes
What sort of interview was created to increase diagnostic reliability?
semi-structured interviews
What is a semi-structured interview?
interviews with a specific format for asking questions and specific sequence in which questions are asked…
based on initial responses, the interviewer will ask follow up questions that help confirm or rule out possible diagnosis
what is the purpose of a semi-structured interview?
addresses almost any clinical issues.
provides diagnostic information
What are two examples of semi-structured interviews?
the SCID-5 and the SCIDpd
says things like:
- do you experience flashbacks, nightmares and avoidance
if someone says yes, you can ask them to elaborate.
the SCID-5 is the most widely used clinical interview in North America
(Structured clinical interview for DSM)
has different versions… what are they?
Research version - covers most DSM diagnosises
Clinical version - shorter - covers disorders that are common in clinical settings
personality disorder - detailed evaluations of all 10 DSM personality disorders
Clinical trials version - tailored to the needs of treatment trials
What is the Clinical Version of the SCID-5 like?
- opens with less structured questions.
- designed to build rapport
- then structured questions geared towards diagnosis
- NOT completely standardized
- time consuming
- about as much validity as the the DSM5
ADIS-5 (Anxiety and related disorders interviewing schedule for DSM)
what sort of interview structure?
what does it focus on?
how many versions of it are there?
Semi structured
- Anxiety and anxiety comorbid disorder (depressive, substance related disorders, somatic symptom disorders)
- 2 versions for adults:
1. current diagnosis only.
2. current symptomology and lifetime history. - 1 version for youth
(includes things like feeling thermometers)
How do we adapt tests for kids?
- break it up, do activities
- the language we use
- attention span (length of sessions, capacity)
What are some things we can do to make the client feel more comfortable in evaluation?
- relaxing environment
- body language
– mirroring people
– modeling calm behaviour
– nodding to let people know you’re listening - small talk off the bat
What are some general issues we might face in an interview with ‘skills in questioning’
- dont want to make it seem like an interrogation
- reading the room
- finding discrepancies between a clients body language and behaviour helps find good information..
- you can reflect this too
What are some skills in listening that you can demonstrate within an interview?
- mirroring body language - leaves a person with the sense that you are trying to understand them
- want to attend to their emotions (e.g., if the affect is changing through out the interview).
- start with small talk: pronouns, DOB - not just jumping into trauma lol
- demonstrate unconditional positive regard, empathy, and being yourself
- “accurate empathy” = being able to understand someones life experience without diving into sympathy
What is attending behaviour?
eye contact, leaning forward, head nods, facial expression….
facilitates / inhibits spontaneous client talk
what is summarization?
brief review of several topics covered during the session
purpose: enhances recall of session content and ties together or integrates themes covered in a session
What are Cultural Formation Interviews?
focuses on the POV of client and people in clients social network..
explores client’s presenting problems, the problems meanings, and avenues for dealing with it..
takes into account ethnic, socioeconomic, regional, and spiritual variables..
(e.g., not interpreting things as lack of social engagement / lack of eye contact as negative if they could be coming from a religious / cultural difference)
goal is to be able to understand the client holistically, so we can make the best recommendations that will land for them
giving the power back to people because they are experts of their own experience
clinical needs to evaluate their cultural blind spots and biases.
what are microagressions?
slights, misunderstandings, and unwanted assumptions on part of the psychologist.
What are some phrases that would be involved in pursuing a line of questioning?
- Tell me more about…
- Can you explain what you mean by…
- Give me an example…
- What does depressed mean to you?
- I want to be sure I understand…
- Help me understand what you mean by out of control…
- What happens when…
- Describe what it’s like when…
- Tell me about the last time that…
- you are essentially trying to define the problem that you are pursuing
problem definition involves 3 main question themes: what are they?
Frequency
Intensity
Duration
Why is clinical goal setting SO IMPORTANT?
1 thing in therapy, it is what we are working towards… its an objective goal to show that therapy is working..
if there are no objective goals/ markers.. then its hard for people to see theres a difference.
AVOID: dead persons goals
measuring progress is imperative - need to OPERATIONALIZE it.
“ if you were less anxious, what would that look like”
– you can MEASURE that.
operationalizing becomes very important
what are SMART goals?
- specific
- measurable
- attainable
- relevant
- timely
the goal must be important to the client and expressed in positive terms
define: suicide
an intentional, self inflicted act that results in death
What does the degree of risk for suicide include?
- history
(like history of abuse or ACEs) - accute condition
(are they actively manic, in psychosis, in a depressive episode?) - present. plans,
(do they have the means / tools to carry out suicide) - current ideation
(the level of intent - coping via self harm or are they going to end their life in an immediate context) - available support networks…
what is a warning sign?
things that can set the action of suicide in motion in the near future