NU Dasmarinas Psychology Lecture 6 PDF

Interviewing, Test Selection, and Administration/Scoring Lecture 2 PSYCH ASSESSMENT  Process of Assessment Hypothesis Testing Model 1. Referral question 2. Conducting a clinical interview 3. Choosing a battery of tests 4. Administering, scorin...

Interviewing, Test Selection, and Administration/Scoring Lecture 2 PSYCH ASSESSMENT  Process of Assessment Hypothesis Testing Model 1. Referral question 2. Conducting a clinical interview 3. Choosing a battery of tests 4. Administering, scoring, and interpreting tests 5. Integrating and conceptualization 6. Writing psychological assessment report 7. Providing feedback to the client/referral source  REFERRAL QUESTION It determines what needs to be It should be noted that very often the answered for the assessment to referral question and the presenting be helpful. problems can be different The professional needs to be extremely clear to the client what is or what is not possible to answer in a psychological assessment The Clinical Interview  Clinical Interview It is a dialogue between the clinician and client that is designed Again, why do we need to help the psychologist diagnose the underlying problem of the to conduct this? individual and help formulate a treatment plan “Conversation with a purpose” Besides using it as a tool for assessment, we conduct clinical interviews because we want to built TRUST and RAPPORT with them.  Clinical Interview 3 major components of a clinical interview Presenting Problems This is a typical framework used to collect essential information, but and History it does not recommend a specific method or an order in which to do so. Biopsychological “Funnel” method - this structure evaluation first uses broad, open-ended questioning, followed by more and more specific questions as needed Psychosocial evaluation  Clinical Interview Presenting Problems and Biopsychological Psychosocial evaluation History evaluation Includes assessment of Developmental history Family history dangerousness to self and others Psychiatric history Educational and vocational history Alcohol and substance Criminal and legal history abuse history Medical history Social history Family medical and Psychosexual history psychiatric history Cultural framework  Presenting Problem and its History Presenting Problems - includes whatever complaint the individual identifies as the reason for the Components of the Presenting assessment Problem Current Stressors Often relatively straightforward, but sometimes factors can Cognitive status complaints get in the way of it being clear. Emotional status complaints Suicidal ideation A detailed history of the problem is absolutely needed: When it began (date of onset) Homicidal and aggressive ideation If there was a precipitating event How continuous the problem is Any previous assessments done  Biopsychological Evaluation Biopsychological evaluation is important in understanding the actual content of the problem, including the symptomatic and medical features of what may be impairing the client’s functioning and the contextual information related to more physical, bodily, and somatic aspects of the client’s history and current functioning Assessors should ask specific questions about symptoms related to different psychiatric diagnoses and should observe them during the clinical interview and the entire assessment  Biopsychological Evaluation Developmental History It begins with specific questions about the early developmental environment, including: Problems during mother’s pregnancy labor/delivery Significant events during infancy and childhood Developmental milestones Childhood behavioral problems Significant accidents/traumas It is important to note that clinicians may not have an easy time getting all of these data.  Biopsychological Evaluation Psychiatric History History of psychiatric symptoms Any psychiatric treatment in the past History of psychiatric medication, if any Reviewing previous records and speaking to previous treating clinicians allows you to obtain as much data and information as possible, which provides a more comprehensive assessment of the individual.  Biopsychological Evaluation Alcohol and Substance Abuse History Past and present use of alcohol (even social use) Substance types Onset of use Length of time and duration of use Amount of use Any previous treatment of use It is also important to ascertain whether the individual feels that their use of substances has positively or negatively impacted their life. Additionally, attitudes about using and quitting can be extremely useful later on in the assessment process.  Biopsychological Evaluation Medical History Past and present medical status (serious hospitalizations, major illnesses) Date and onset Medications taken if any Treatments It will be important to note any temporal relationships between changes in the medical history and in the presenting problem and psychological symptomatology.  Biopsychological Evaluation Family Medical and Psychiatric History Any significant medical and psychiatric illnesses in both immediate and distant Why do you think this family is important? Knowing this information about someone who has come in for an assessment can alert the assessor to possible symptoms or to view current or past problems in a different light A significant example of the impact of heredity is the It may be especially important to point out to the research suggesting that an individual whose parent client that psychiatric illnesses are often has bipolar disorder is at much higher risk for undiagnosed. developing a mood disorder (Downey & Coyne, 1990; Hammen, Burge, Burney, & Adrian, 1990; Weissman et al., 2006)  Psychosocial Evaluation Designed to examine the social, inter-personal, and experiential–functional aspects the individual’s world, with both its intrapsychic and interpersonal demands The scope of the presenting problem often reaches beyond individual symptoms. It is essential to consider that symptoms are manifested within a larger context of relating to others and that, as such, they will likely be affecting interpersonal functioning, educational and work functioning, and many other areas of life.  Psychosocial Evaluation Family History Current and past family structure # of siblings, if any Who are the primary caregivers of the client Civil status, romantic relationships Any other info regarding family, relationships You should get a description of the relationship, including its history and the quality, in the words of the person being assessed Any significant history within the family, such as traumas or deaths, should also be included in this part of the assessment  Psychosocial Evaluation Educational and Vocational History Educational history Highest level of education completed School History Learning disabilities Special education Repeating grade? Attentional problems in school (e.g. hyperactivity) Behavioral and emotional problems in school Vocational and Occupational History Current job (if any) Performance and satisfaction in it Past jobs Performance and satisfaction in it Career aspirations  Psychosocial Evaluation Criminal and Legal History Current Criminal and legal involvement (if any) When it comes to criminal and legal history, it is extremely Nature of involvement important to be aware of subtle and slight reactions Impact of involvement in daily life on your part, including facial expressions. To elicit the most Past criminal and legal involvement (if any) open and honest responses from the client, you have Nature of involvement to work hard to appear nonjudgmental and difficult to shock Impact of involvement in daily life when discussing illegal activity It is absolutely necessary to assess past legal involvement, including whether or the individual is on probation or parole, because this will inform how best to proceed with the assessment.  Psychosocial Evaluation Social History Why do you think this Current social support system is important? Number and quality of friends/social supports Best friends Current romantic relationship Social history History of interpersonal difficulties History of romantic relationships  Psychosocial Evaluation Psychosexual History When dealing with psychosexual functioning, Sexual orientation and identity you as a clinician need approach it as Current sexual activity straightforward and unapologetic as possible. Frequency Partners Level of satisfaction Past sexual activity Pubertal onset History of sexual activity History of sexual abuse, trauma, violence Although this part of the psychosocial evaluation may be more relevant in some cases than others, it is important to at least rule out the possibility that psychosexual issues may be affecting an individual’s current psychological functioning.  Psychosocial Evaluation Cultural Framework Language Cultural, racial, and ethnic identity Spiritual and religious identity Sexual and gender identity Socioeconomic status Immigration history (if any) MENTAL STATUS EVALUATION  Mental Status Evaluation While the client is a major source of information, every person’s awareness is limited. Therefore, one of the most important tools for evaluating a person's current functioning is clinical observation. The mental status evaluation (MSE) is a useful way of organizing clinical observation data and was designed as a method for identifying, in particular, individual characteristics that are outside of the normal range of functioning.  Mental Status Evaluation Appearance Speech and Mood and Thought Cognition Prefrontal and Language Affect Process and Functioning Behavior Content Grooming Speech Self- Goal-directed Attention Judgement Patterns reported thinking and Mood Concentr ation Motor Receptive Observed Hallucinations Memory Planning Activity Language affect and delusions and Impulse Control Relatedness Expressive Mood-affect Depressive Insight Language congruence and anxious ideations Suicidality and homicidality  Appearance and Behavior Grooming CONSIDER THE FOLLOWING: Motor Activity/coordination behavior Relatedness Man comes in with disheveled hair, shirt tucked halfway, zipper down, collar askew comes in for clinical interview One of the most important indicators of current functioning Woman comes in wearing inappropriately Appearance and behavior can, even before testing, clue you tight and seductive clothing, comes in for in to the possibility of some reasons for functional assessment regarding custody of her impairment children Woman comes in, makes very little eye contact, looks down at the floor, fidgets with her hands, and does not seem to answer questions directly  Speech and Language Speech Patterns CONSIDER THE FOLLOWING: Receptive Language Client who comes in for an assessment - Language comprehension and during the clinical interview does not Expressive Language seem to understand clearly the questions - individual’s actual use of language you are asking, despite the fact that you are being clear and simple in your A person’s language functioning critically affects your ability language. to adequately assess them in all other domains of functioning. Client who comes in with loud, pressured, cluttered speech. Her expressive language is so pressured that she trips over her words, stutters, and at times gets so overwhelmed by the rate of her words that she cannot get a single one out  Mood and Affect Self-reported mood Observed affect Mood-affect congruence Mood - refers to the current emotional state of the individual, as reported by the client themselves Affect - refers to the observed emotional state of the individual, This mood- incongruent affect may inform you such as what their facial expression or general body language about their levels of insight, their feelings communicates to you as the assessor. about mental illness, or even fears of being diagnosed as depressed. Mood-affect congruence- refers to the difference between what the individual reports and what you observe as a clinician  Thought Process and Content Goal-directed thinking Hallucinations and delusions Ex. a client who comes in and seems to be thinking Depressive and anxious ideations quite slowly and in a concrete way. When you ask Suicidality and homocidality him about his difficulties, he can consider only very specific, concrete examples, such as getting fired from Thought process - refers to how an individual thinks, whether his job recently and not understanding why in a goal-directed, logical way or in a way that suggests some problem in thinking, such as tangential, circumstantial, magical, or concrete thinking Ex. An individual who, when asked questions, consistently goes off topic in a seeming stream-of-consciousness delivery is an example of a tangential thought process.  Cognition Alertness Attention Concentration Memory Although cognitive functioning will be tested later in testing, it is important to note in the clinical interview any abnormalities as well. Ex. a client who looks sleepy, slumped in the chair, and looking at the floor through the clinical interview  Prefrontal Functioning Judgement Planning Insight Behavioral observation will not be enough when it comes to measuring these, but it is important to measure them broadly as well. Planning – how well the individual seems to consider the future when acting; how well they feel they control their impulses. Insight – how aware the persons is that they have difficulties/needs support and that they play a part in their own problems/issues to be addressed. SELECTING PSYCHOLOGICAL TESTS  Test Selection Considerations Concerns ANSWERS THE REFERRAL QUESTION Faking Expertise and familiarity Time Efficiency Good psychometric properties Functional utility Examples of Tests Examples of Tests Examples of Tests End of Discussion!