Module 2 Flashcards
What are the three main stages of the assessment process?
1) Information input - collecting info from sources, address the referral question, formulate assessment goals and working hypotheses
2) Information evaluation - interpretation and integration of assessment data
3) Information output - biopsychosocial formulation, conclusions and recommendations
Sellbom et al: What are the two founding premises of psychological assessment?
Assessments must be evidence-based and multimodal
Sellbom et al: What does multimodal mean?
A multimodal approach means to corroborate a range of different sources to best understand the client. Eg: client’s history, structured interview, self report inventories, and clinical impression.
Sellbom et al: What are the benefits of a multimodal approach?
Increases reliability of info
Draws on the strengths of each test while reducing the limitations of each one
Minimises bias associated with particular measures
Leads to a more confident diagnosis
When various tests are inconsistent, this can reveal important info about the test-taker
Sellbom et al: What are some of the limitations of the DSM-IV-TR?
1) It is based on a medical model and does not consider underlying processes or liabilities (ie it is concerned only with the signs and associations of the disorder
2) It is categorical in nature, even though human nature, mental illness, and mental health are distributed dimensionally
3) It does not address etiological contributions to disorders
4) Axis I and II represent a consensual opinion of a committee of experts not extensive empirical evidence
5) It is skewed towards the nomothetic end of the spectrum
6) It requires a specific number of symptoms to achieve a diagnosis, ruling out people with subthreshold symptoms regardless of their level of impairment
Sellbom et al: What were the two major shifts/advances made going into DSM-V?
1) A cross-cutting assessment domain - eg: measuring depressed mood, anxiety, substance use or sleep problems for all patients in a mental health centre
2) Moving away from the 10 diagnostic categories of personality disorders and instead having 6 broad personality trait domains onto which people can be mapped
Sellbom et al: What are the 4 types of assessment instruments discussed in this article?
1) Interviews
2) Self-report inventories
3) Performance-based techniques
4) Cognitive testing
Sellbom et al: What are the 4 major considerations when deciding which tests to use?
1) The test’s psychometric properties
2) Clinical utility
3) Client factors
4) Clinician variables (eg: clinical expertise)
Sellbom et al: With regards to psychological assessments, what is incremental validity?
Incremental validity is the extent to which a new assessment/test provides information over and above that of the assessments/tests already used. If you choose to use an additional number of tests, each needs to bring something new to the table
Sellbom et al: What are the 3 levels of interpretation of psychological tests?
Level 1: Concrete level, recognise scores only, don’t draw any conclusions
Level 2: What are the patterns in the scores? Are there significant differences?
Level 3: Interpret the scores in the larger context, incorporate details specific to the client
Sellbom et al: What are the 4 stages of the assessment procedure?
1) Referral question
2) Preliminary information
3) Assessment procedure
4) Treatment recommendations
Sellbom et al: In terms of the assessment procedure, what 6 areas need to be explored?
1) Informed consent
2) Presenting problems and symptoms
3) Psychosocial background history
4) Clinical interview
5) Diagnostic clarification
6) Personality profile, coping, self-concept, and interpersonal styles
Sellbom et al: What are some potential issues specific to the assessment process?
1) Time constraints
2) Severity of psychopathology may affect self-reports
3) Comorbidity
4) Risk of harm to self or others
5) Environmental influence
Sellbom et al: Define formulation
“The process by which we systematically, comprehensibly, and objectively assemble and integrate available information to arrive at an understanding of what is happening with the patient.”
What is face validity? Provide an example. What are the advantages and disadvantages?
Face validity refers to what a test/item appears to be measuring.
For example, the item “I think newborn babies look very much like little monkeys” measures one’s tendency to care for others. It has low face validity.
Low face validity can be advantageous, as it reduces personal bias (i.e. in example above, people will be motivated to show they’re caring, so this low face validity question removes this bias). A disadvantage of low face validity is that is makes what is being measured questionable
What is content validity?
Content validity refers to whether the items on a test represent the domain the test aims to measure.
It depends on how the developers of the test defined the domain - what they called “apple” might not be what you now call “apple”. You have to go beyond just looking at the title of the scale.
What are the two types of criterion-related validity? Define each.
Concurrent validity - the extent to which scores are related to a currently available criterion
Predictive validity - the extent to which scores can predict future performance on another relevant criterion (eg: can scores on a depression scale predict clinical diagnosis of depression?)
What are the two types of construct validity? Define each with examples.
Convergent validity - the extent to which two theoretically related constructs have correlated scores (eg: happiness and contentment)
Divergent/discriminant validity - the extent to which unrelated constructs have uncorrelated scores (eg: happiness and sleep quality)
What is test-retest reliability?
Test-retest reliability refers to how consistent a test is over time
What is inter-rater reliability?
Inter-rater reliability refers to how ratings by different people agree with each other
What is inter-method reliability?
Refers to the consistency between two methods (eg: assessments) with identical content, but non-identical items. It is rare, but reduces the limitations of test-retest reliability (eg: participants remembering the questions)
What is internal consistency?
Refers to the consistency/inter-correlation of items within a test
What are the two most commonly assessed forms of reliability?
Internal consistency and inter-rater reliabiiity
What is the statistic used to measure internal consistency? What is a acceptable, good and excellent score?
Cronbach’s alpha
Acceptable = .6 to .7
Good = .7 to .9
Excellent = greater than .9
Why do we care about validity, reliability, standardisation and norms? How can we reduce measurement error?
We care about these things because when they are compromised, we have larger measurement error (observed value = true value + measurement error).
We can reduce measurement error by using psychometrically sound measures correctly, doing repeated measures, using latent variable modelling, and using confidence intervals.
What are 2 current trends in psychological testing?
1) A shift away from lengthy, expensive tests, to brief, inexpensive and problem-oriented tests. Part of this trend also involves unifying measures of the same constructs and getting researchers to have confidence in using newer scales (eg: PROMIS)
2) The integration of computers, smart phones and technology, which makes all aspects of psychological testing easier
What are the key differences between a clinical interview and a normal conversation with a friend?
A clinical interview has a specific purpose - to provide the psychologist with information to diagnose and treat the patient
A clinical interview has clearly defined roles - the psychologist and the patient
A clinical interview has a defined timeframe (eg: 1 hour session)
What are the two types of clinical interviews?
Intake interviews and Mental Status Exams (MSE)
What are 3 keys elements of any type of clinical interview?
1) Safe space for discussion
2) Confidentiality
3) Open-ended questions
What are 3 benefits of clinical interviews?
1) Uncovers information to diagnose and treat the client
2) Provides verbal and non-verbal information
3) Builds trust
What are 2 limitations of clinical interviews?
1) Can’t tell if the client is telling the truth or not
2) Possible biases of the psychologist
What is the difference between a therapeutic interview and an assessment interview?
Therapeutic interview = generic activities within a session designed to advance some treatment goal
Assessment interview = an array of activities in order to gain information that leads to the development of treatment goals and intervention plans or other decisions
What are the 4 different philosophical/theoretical orientations psychologists may have?
Psychodynamic, cognitive-behavioural, client-centred (includes humanistic and existential), and family systems
What are 2 recent trends in clinical interviewing?
1) Computer-assisted diagnoses and interviews (pretty good overall, but too many false positives)
2) Telepsychiatry (good for rural, reliable, good cost)
What are some recommendations to improve clinical interviewing?
Prepare for the interview
Determine the purpose of the interview
Clarify the purpose and parameters to the client
Conceptualise the interview as collaborative
Truly hear the interviewee
Use structured interviews
Encourage client to describe complaints in concrete behavioural terms
Complement the interview with other methods (eg: psychological testing)
Identify the antecedents and consequences of problem behaviours
Differentiate between skill and motivation
Obtain base rates of behaviours
Avoid expectations and biases
Use a disconfirmation strategy (look for info that disproves your hypothesis)
Counter the fundamental attribution error (when the cause of a problem is assumed to be due to one set of factors, when it’s actually due to another)
Delay reaching decisions while the interview is being conducted
Consider the alternatives
Provide a proper termination
What are the main sections of an MSE?
Appearance, behaviour and attitude Mood and affect Speech Thought (content and form) Perception (eg: hallucinations) Cognition (consciousness, orientation, attention, memory) Insight (understanding of their own condition) Judgment (ability to make decisions)
What are some features of good psychological reports?
Info is presented in small, digestible chunks
Well ordered, clear subheadings
Succinct examples provided
State test results without bias or judgment
Recommendations are specifically tailored to the individual
What are some features of poor psychological reports?
Language that lacks confidence (“he seems a bit unhappy”)
Dull terminology (“good”, “bad”, “happy”, “sad”)
Does not fulfil reason for referral
Presents therapeutic information
No specific recommendations
What are the main sections in a psychological report?
Referral - brief
Presenting problems - include client’s own words
Psychiatric history
Medical history
Forensic history
Substance use - why do they think they’re using it? Could be a coping mechanism
Current medication - itemised list
Family history - structure and relations, how do they fit into their family?
Findings from psychological tests - are they consistent with their presentation?
What are the 4 P’s of case formulation?
Predisposing
Precipitating
Perpetuating
Protective
