module 2 Flashcards
What is the three stage process of assessment?
- Information input- collecting information from appropriate sources to address the referral question and help formulate assessment goals and working hypotheses,
- Information evaluation- the interpretation and integration of assessment data, and
- Information output- the biopsychosocial formulation, conclusions, and recommendations.
What approaches should a psychological assessment include?
Assessments should include a variety of approaches and methodologies, for example, reviewing case history data, gathering information from third parties (such as teachers, parents, employers, or the person who made the referral), clinical interviews (structured, unstructured, or semi-structured), role-plays (e.g., ask the client to act or respond as if they were in a particular situation), behavioural and naturalistic observation, and/or using standardised psychological tests (checklists, rating scales, questionnaires, or neuropsychological tests).
What is the primary purpose of psychological assessment in adults?
The primary purpose of psychological assessments in adult inpatient and outpatient mental
health settings is to evaluate patients’ cognitions, affect,
behaviors, personality traits, strengths, and weaknesses
in order to make judgments, diagnoses, predictions, and
treatment recommendations
What are the two founding premises of psychological assessment?
psychological assessment of adults in mental health settings is based on two founding premises: assessments must be evidence based and multimodal.
What is incremental validity
When a component of a psychological assessment adds information above and beyond what
can be gained from other components, it is said to have
incremental validity (Sechrest, 1963).
It is not merely sufficient that the component provides unique information;
it is necessary that it provides unique information that is
relevant to the referral question.
If a method or instrument
provides significant incremental validity when predicting conceptually relevant criteria, it is contributing useful
information to the assessment.
McFall (2005) expressed
the concern that there is not a widely accepted benchmark
for determining the meaningfulness of such contributions.
What two major concerns for evidence-based assessment did Hunsley and Mash identify?
Hunsley and Mash (2005) highlighted two other major
concerns for evidence-based assessments: gaps in psychometric data, and training and practice.
First, there is
not enough information available about all psychological
assessments to determine their utility with all individuals. It is important to ensure that an assessment has
adequate reliability and validity for use with each particular client, taking into account the measure’s normative
sample (e.g., such variables as age, gender, and race).
Second, many of the methods that have previously shown
utility in evidence-based approaches are underrepresented
in both clinical training and practice. Increasing demands
by third parties (e.g., insurance companies) for evidence-based assessments may influence some clinicians to move
toward these practices (Barlow, 2005). It is vital that clinicians receive the necessary training to evaluate and
implement such practices.
What are some concerns with EBP?
As stated previously, some individuals (e.g., McFall, 2005) question the lack of research
standards for determining the utility of a practice, such as
the lack of a widely accepted benchmark for determining
incremental validity.
Some clinicians are also concerned about the use of EBPs placing too many restrictions
on clinical decision making (Nathan, 1998; Wilson, 2010).
The APA’s Task Force (2006) emphasized the importance
of clinical decision making by stating that the clinician
must choose which practices are suitable for each individual client, even when using EBPs
On a related note,
many clinicians are also wary of the restrictions that may
be imposed by third parties (e.g., insurance companies),
Should approaches to psychological assessment be multimodal?
The approach to psychological assessment in mental
health settings should also be multimodal. One assessment
tool is not sufficient to tap into complex human processes.
Moreover, given that empirical support is critical to the
validity of a psychological assessment, it is just as essential that there is concordance among the results from the
client’s history, structured interview, self-report inventories, and clinical impression.
etiological
causing or contributing to the development of a disease or condition.
What are some critiques of the DSM?
- It is based on a medical model and does not consider
underlying processes or liabilities (i.e., it is concerned
only with the signs and associations of the disorder). - The DSM-IV-TR is categorical in nature, even though
human nature, mental illness, and mental health are
distributed dimensionally. Failure to recognize both
adaptive and maladaptive levels and constellations
of symptoms and traits may provide an incomplete
or inaccurate picture of an individual’s functioning
(Lowe & Widiger, 2009; Widiger, Livesly, & Clark,
2009). Overlapping category boundaries (or poor discriminant validity; McFall, 2005) frequently result in
multiple diagnoses and the problem of comorbidity
(Barron, 1998; Brown & Barlow, 2009). Moreover,
a categorical approach does not provide as powerful predictions about etiology, pathology, prognosis,
and treatment as a dimensional approach (Gunderson,
Links, & Reich, 1991). - The DSM-IV-TR does not address etiological contributions to disorders and how they affect the manifestation
and outcome of disorders (Joyce, 2008). - The Axis I and Axis II disorder criteria represent a
consensual opinion of a committee of experts that
labeled a particular pattern of symptoms of a disorder
rather than relying on extensive empirical evidence and
ensuring the collection of data from a variety of sources
(cf. Clark, 2005). - The DSM-IV-TR is skewed toward the nomothetic end
of the spectrum, resulting in static diagnoses whose
operational definitions may be inaccurate, unsupported
by research findings, and camouflage questionable construct validity (Barron, 1998). - The DSM-IV-TR requires a specific number of symptoms to achieve a specific diagnosis, which disregards
individuals with subthreshold symptoms regardless of
level of impairment and may result in false negatives
(Beals et al., 2004; Karsten, Hartman, Ormel, Nolen, &
Pennix, 2010).
Other criticisms of the DSM-IV-TR include excessive
focus on reliability at the expense of validity, arbitrary
cutoff points (Karsten et al., 2010), proliferation of personality disorders, and questionable validity of the personality
disorder clusters (Besteiro-Gonzalez)
What are some strengths of the DSM?
a common language in which to describe psychopathology
and personality (Widiger, 2005), attempts to address the
heterogeneity of clinical presentation of symptoms by
adopting a polythetic approach (Clarkin & Levy, 2003),
and includes several axes to take social, medical, and
economic factors into account. In summary, the DSMIV-TR is a descriptive nosology, ostensibly unbound to a
specific theory of development, personality organization,
etiology, or theoretical approach
What are two big shift changes with the DSM V compared to DSM IV
First, the American Psychiatric Association
task force (2011) proposed a cross-cutting assessment
domain, which focuses on general dimensions of psychopathology that are not specific to any particular syndrome or are associated with any set of diagnostic criteria.
Rather, these are domains that may be relevant to treatment planning, prognosis, and understanding diagnostic comorbidity—a phenomenon highly relevant in adult
mental health settings. Examples of cross-cutting domains
include measurement of depressed mood, anxiety, substance use, or sleep problems for all patients seen in a
mental health center. These can be used to determine general maladjustment as change subsequent to treatment.
A second major revision relevant to adult mental health
settings concerns the personality disorders. The task force
(American Psychiatric Association, 2011) proposed a
radical shift away from the 10 diagnostic categories in the
DSM-IV-TR to an entirely dimensional approach. They
are recommending six broad personality trait domains
onto which patients will be mapped—each with 4 to
10 specific facets. The proposed domains are negative
emotionality, detachment, antagonism, disinhibition, compulsivity, and schizotypy. Once the patient’s personality profile has been generated, it will be compared
to and mapped onto one of five personality disorder
prototypes: antisocial/psychopathic, borderline, obsessivecompulsive, avoidant, and schizotypal. There will not be
any prototypes reflecting histrionic, paranoid, schizoid, or
dependent personality disorders.
What are the five personality disorder prototypes? What prototypes will no longer be included?
They are recommending six broad personality trait domains
onto which patients will be mapped—each with 4 to
10 specific facets. The proposed domains are negative
emotionality, detachment, antagonism, disinhibition, compulsivity, and schizotypy. Once the patient’s personality profile has been generated, it will be compared
to and mapped onto one of five personality disorder
prototypes: antisocial/psychopathic, borderline, obsessivecompulsive, avoidant, and schizotypal.
There will not be any prototypes reflecting histrionic, paranoid, schizoid, or
dependent personality disorders. If the personality profile
does not match any of the five proposed personality disorder types, a diagnosis of “PD Trait Specified” will be
assigned. Finally, the patient will be tested on measures of
self- and interpersonal functioning. The patient will also
have to exhibit some form of self-oriented and/or interpersonal impairment to warrant a diagnosis (American
Psychiatric Association, 2011).
Should performance techniques be used in an adult mental health setting?
With
the exception of a selected group of indices from a reliably scored Rorschach administration, it is our opinion
within the context of evidence-based assessment that performance techniques are not appropriate for use in adult
mental health settings
Should clinicians screen for general intellectual functioning?
Many clinicians, including us, believe that it is important
to determine client cognitive status and a basic estimate of
intellectual functioning
Clinicians should, however,
obtain basic screens for intellectual functioning; in addition to determining potential impairment in such area (e.g.,
borderline intellectual functioning), such screens also provide the clinician with further information for client
When such motivations are expected,
particularly in light of an external incentive, symptom
validity tests (such as the Test of Memory Malingering
[Tombaugh, 1996]) may be necessary to ascertain appropriate effort.
What is the proposed 11-step model for assessment by Olin and Keatinge?
This, in turn,
generates a plethora of information and recommendations.
Olin and Keatinge (1998) have proposed an 11-step model
for the assessment procedure:
1. Determine the information needed to answer the referral question(s).
2. Identify who is to be involved.
3. Obtain informed consent and releases.
4. Collect and examine medical records.
5. Identify what is to be measured.
6. Identify and select appropriate measures.
7. Administer assessment and modify as needed.
8. Score measures and analyze and interpret results.
9. Seek consultation if necessary.
10. Write the report.
11. Provide feedback to appropriate parties.
What is the foundation of a psychological assessment?
Referral questions are the foundation of any psychological
assessment. They provide the rationale for conducting an
evaluation and dictate the types of questions to ask and
the selection of psychological tests to be employed.
What are some examples of a referral question
Examples of typical referral questions
include: clarify a previous working diagnosis or the referring physician’s impression of the client; differentiate the
client’s symptom presentation; identify the cause of the
client’s symptoms; and determine what characterological features may be interfering with the client’s ability
to engage in treatment
