Standardised Assessment Flashcards
The Unstandardised Clinical Interview
An unstandardised clinical interview involves an open-ended, free-flowing interaction between the clinician and client.
The clinician conducting an unstandardised interview can steer the conversation to facilitate assessment of whatever constructs she or he determines is necessary, using whatever responses, questions, or observations she or he believes to be most relevant.
Shea’s (1988) Five Phase Unstandardised Clinical Interview
Phase One: introduction between the client and therapist, during which the client is educated about the assessment process.
Phase Two: involves the client’s account of the presenting problem(s).
Phase Three: the body of the interview, wherein the clinician attempts to gather more information about the presenting problem as well as related content pertinent to diagnosis and treatment planning.
Phase Four: consists of summarising the interview, and presenting the clinician’s current conceptualisation of the client’s problems, and how they may be addressed.
Phase Five: the normal conclusion of the interview and the exiting of the client.
The Bad Bits of Unstandardised Clinical Interviews
Unstandardised clinical interviewing is likely the least reliable and valid assessment approach (Maruish, 2008). For example, it can be susceptible to the introduction of clinician biases:
A client who is courteous and polite during the interview may be assessed, via the halo effect, as more competent and interpersonally effective than they actually are.
The clinician may be guided by his or her early inferences about a client, and probe for information that confirms such preconceptions i.e. confirmation bias.
The Bad Bits of Unstructured Clinical Interviews
Unstructured clinical interviews can also give rise to variability in diagnoses. Such variability partly stems from variation in the information gathered in the interview (information variance).
Diagnostic variability can also be affected by criterion variance (whether or not a client’s symptoms meet the threshold).
The Good bits of Unstandardised Clinical Interviews
particularly useful as a means of augmenting data from other modes of assessment
broad, open-ended questions may be more likely to result in them reporting their spontaneous thoughts, memories, and feelings
may also provide the clinician with a strong framework for establishing an effective rapport with the client
Standardised Clinical Interviews
The standardised interview is characterised by a predetermined set of questions that the clinician is directed to ask the client verbatim, in a precisely defined order.
The Good Bits of Standardised Clinical Interviews
Standardised interviews have become much more widely utilised in both applied and research settings in recent decades.
Because standardised interviews allow the clinician to systematically assess every symptom domain within all relevant diagnostic categories, using standardised queries, and well-operationalised coding criteria, this can reduce both criterion variance, and information variance.
The Bad Bits of Standardised Clinical Interviews
The precise phrasing and ordering of questions in a standardised interview are rigidly predetermined, and so this approach provides little freedom for the skilled clinician to tailor the process to optimally suit the needs of any particular client or to give the interview a more natural conversational feel.
Standardised vs. Unstandardised Clinical Interviews
When interviews are unstandardised, clinicians may overlook certain areas of functioning and focus more exclusively on presenting complaints. When interviews are highly standardised, clinicians can lose the forest for the trees and make precise but errant judgments… Such mistakes may occur when the clinician focuses on responses to specific interview questions (e.g., diagnostic criteria) without fully considering the salience of these responses in the client’s broader life context or without adequately recognising how the individual responses fit together into a symptomatically coherent pattern. . .
Semi-Standardised Clinical Interviews
The semi- standardised interview retains the major elements of the standardised approach, but differs by allowing the clinician some latitude in formulating his or her own follow-up queries to further probe relevant content domains (e.g. specific diagnostic criteria, client mental status, psychosocial functioning, symptom severity).
Structured Clinical Interview for DSM
The SCID is a semi-structured interviewing measure utilised in more than 1,000 published clinical research studies
All versions of the SCID begin with open-ended questions regarding demographic information, work history, chief complaint, history of present and past periods of mental illness, and assessment of current functioning. This less standardised portion of the interview allows for rapport building, and it can provide helpful context for the interpretation of subsequent answers in the diagnostic section.
The SCID comprises nine diagnostic modules:
Mood Episodes, Psychotic Symptoms, Psychotic Disorders Differential, Mood Disorders Differential, Substance Use, Anxiety, Somatoform Disorders, Eating Disorders, and Adjustment Disorders.
DSM Use of Term “Clinically Significant Disturbance”
For some disorders, inclusion of this term served to reduce false positives, but for other disorders it had little impact
Potential Biases in Clinical Judgement
Clinicians can fall prey to confirmatory biases and, thus, elicit the kind of information that confirms their hypotheses and hunches.
When making diagnostic or classification judgments, clinicians may rely on prototypes or exemplars, and judge the fit of their client to these prototypes rather than systematically evaluating their patient on specific diagnostic criteria.
Some clinicians are prone to overconfidence bias.
Clinicians can make erroneous judgments or predictions by not considering the relative frequency of the events they are judging. Rare, or low base rate, events are harder to accurately predict than more common events.
Tips for Conducting (an Unstandardised) Clinical Interview
Avoid a mechanical approach to covering the desired interview content areas i.e. maintain a conversational approach to asking questions and eliciting information, modifying the inquiry (as necessary) to ensure a smooth flow or transition from one topic to another.
Move from general topic areas to the more specific ones.
Begin exploration of content areas with open-ended inquiries, and proceed to closed-ended questions as more specificity and detail are required.
At the end of the interview, invite the individual to add other information that he or she feels is important for the clinician to know. Also, invite questions and comments about anything related to the interview or the assessment process.
Provide preliminary feedback to the individual based on the information presented during the interview.
