Transcript Clinical Assessment

Chapter 13
Clinical Assessment
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Clinical Assessment
• To determine which DSM–IV-TR classification is appropriate
• To see whether neurological impairment exists
• To help decide which type of treatment, counseling, or therapy would
be most appropriate
• To prescribe the proper instructional strategies
• To identify the client’s assets, achievement, aptitude, or personality to
guide in rehabilitative, therapeutic, or educational planning
• To determine whether an inmate should be considered for a release
program
• To evaluate the effectiveness of treatment, counseling interventions,
and group sessions
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Behavioral Assessment
• Behavioral assessment centers on the
circumstances of behavior rather than the
reasons for it.
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Behavioral observation
Observation, normally of a specific, observable set
of behaviors.
Observation might describe or identify the following
components:
1.
2.
3.
4.
5.
6.
7.
Purpose and object of the observation
Physical environment
Acts or events that have taken place
Time dimensions
Actors or people observed
Goals of the persons observed
Feelings of the observer
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Behavioral Observation Form
Instructions: Think of a particular student you feel concerned about and check off
any items that apply to the student's recent behavior.
Behavior
❒ Withdrawn, isolated
❒ Erratic, inconsistent
❒ Mood swings
❒ Inappropriate laughter
❒ Class clown
❒ Drowsy, sleeping in class
❒ Obscene language, gestures
❒ Rebellious, argumentative
❒ Talks about drugs, "partying"
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Academic
❒ Sudden decline in grades
❒ Short attention span, easily distracted
❒ Daydreams, "spaces out"
❒ Hyperactive
❒ Lacks motivation, apathetic
Attendance
❒ Frequent absences or lateness
❒ Frequent requests to go to the
restroom
❒ Found hanging around inside or
outside school
Self-monitoring
The client focuses on targeted behavior.
• Give explicit definitions and examples of the targeted events and
explain their possible relevance to the problem at hand.
• Give explicit monitoring instructions on how to record the behavior.
• Illustrate the use of the form or recording device and provide practice
exercises.
• Ask the client to repeat the target definitions and self-monitoring
instructions.
• Test client understanding of the assignment.
• Check with the client during the period specified for any questions or
problems.
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Personality Assessment
• Specific Domain
– Depression
– Anxiety
– Eating disorders
– Childhood disorders
– Other “Axis I” disorders
• Comprehensive
– Personality disorders
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Interviews
• Structured
• Unstructured
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Structured Interviews
• Interviewer asks each interviewee exactly the
same questions in the same manner.
• A specific set of questions is usually read to the
client.
• Ensures that specific information will be collected
from all clients, and does not require as much
training because all interviewers have a list of
questions in a prescribed order.
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Unstructured Interviews
• Psychosocial
• Psychiatric interview
• Intake interview
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Unstructured Interviews
• Counselor-made questions with “client responses” and
“counselor observations” recorded by the counselor.
• No standardization of (a) questions or (b) recording of
client responses.
• Allows client a chance to determine what is important to
talk about; it allows the counselor to pursue important but
unanticipated topics; and it provides an opportunity to
judge the client’s behavior in an unstructured situation.
• Counselors may follow a general interview format.
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
The Unstructured Interview Format
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3.
4.
5.
6.
7.
8.
9.
10.
Identifying Information
Presenting Problem
History of Presenting Problem
Family History
Relationship History
Developmental History
Education/Employment History
Medical History
Substance Use
Previous Counseling
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Interview Checklists
There are a wide variety of interview checklists available to
help clinicians organize the information gained in the
interview and help structure the interview. Some examples
follow:
• The Mental Status Checklist—provides a comprehensive
examination of the mental status of the client.
• The Personal History Checklist—facilitates recording
personal history during intake sessions for children,
adolescents, and adults.
• The Personal Problems Checklist—provides a list of
common problems for each age group.
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Mental Status Exam
• Appearance: well-groomed, disheveled, unkempt, cooperative,
unruly
• Mood: depressed, sad, angry, euphoric, worried, anxious
• Affect: labile, appropriate, flat, constricted
• Thought Content: hallucinations, delusions, obsessive thoughts
• Thought Process: linear, tangential, flight of ideas, incoherent,
racing thoughts
• Speech (rate, volume): normal, pressured, rapid, slow, soft, loud
• Psychomotor (physical movement): agitated, restless, normal, rapid,
slow
• Orientation: X3
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Suicide Risk Assessment
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•
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•
•
•
Suicidal ideation
A plan
High lethality
Few inhibitors
Low self-control (especially drinking or using drugs)
Previous attempts
Gender—men try more lethal means; women try more
often
• Recent stressful event
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Neuropsychological Assessment
A neuropsychological assessment typically evaluates multiple areas of
functioning. Used to assess the following:
• Learning disabilities
• Attention deficit disorders
• Neuropsychiatric disorders (e.g., pervasive development disorders,
Tourette syndrome, anxiety and depression)
• Closed head injury (e.g., concussion, as opposed to “penetrating” head
injury)
• Seizure disorders
• Brain tumors
• Strokes
• Effects of toxic substances (e.g., lead poisoning)
• Genetic disorders (e.g., Turner syndrome, Williams syndrome)
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Cognitive Impairments
• Memory (retrieval/encoding)
• Processing speed (the speed with which you can perform cognitive
activities such as recognizing simple stimuli (+++, ***), identifying
letters or words, or naming successive numbers printed on a page)
• Learning
• Attention
• Decision-making
• Language
• Judgment
• Orientation in time and space
• Problem-solving
• Verbal communication
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Behavioral Impairments
• Eating, dressing, toileting (e.g., unable to dress without
help; becomes incontinent)
• Interests (e.g., abandons hobbies)
• Routine activities (e.g., unable to perform household
tasks)
• Personality (e.g., inappropriate responses, lack of
emotional control)
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
A typical neuropsychological examination will
evaluate:
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•
Orientation
General intellectual functioning
Memory: ability to learn and remember new information
Attentional capacity and concentration
Language
Visuoperception
– Visuoperception is the ability of the brain to understand what it is seeing.
Patients with visuoperception problems may have difficulty in such areas as
reading and recognizing faces or common objects.
• Sensorimotor functioning
– psychomotor speed (ability to rapidly process and produce oral and written
information), fine-motor control and dexterity, and visual acuity
• Ability to self-monitor and correct one's behavior
• Academic achievement
• Personality functioning
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
What does a neuropsychological
examination find out?
• Learning disabilities
• Attention deficit disorders
• Neuropsychiatric disorders (e.g., pervasive development disorders,
Tourette syndrome, anxiety and depression)
• Head injury
• Seizure disorders
• Brain tumors
• Strokes
• Effects of toxic substances (e.g., lead poisoning)
• Genetic disorders (e.g., Huntington's disease, Williams syndrome)
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Instruments for Neurological
Assessment
• Halstead-Reitan Neuropsychological Test Battery
• Lauria-Nebraska Neuropsychological Battery
• Kaufman Short Neuropsychological Assessment
Procedure
• Quick Neurological Screening Test
Robert J. Drummond and Karyn Dayle Jones
Assessment Procedures for Counselors and Helping Professionals, 6 th edition
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.