Chapter 13 revised - Caroline Paltin, Ph.D. Licensed
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Transcript Chapter 13 revised - Caroline Paltin, Ph.D. Licensed
Using Assessment in Counseling
Chapter 13
Introduction
Skilled counselors know how and when to either gather
more assessment information or apply information
gathered previously
Informal and formal assessments play a role in:
Treatment planning
Monitoring client change
Evaluating the effectiveness of counseling
Treatment Planning
Varies with client
Assessment of functioning
Statistical/actuarial methods vs. clinical judgment
Gather quality information and evaluate it with a
scientific approach
More than just diagnosis
Treatment Matching
Beutler, Malik, Talebi, Fleming, & Moleiro (2004)
suggested client characteristics to consider in treatment
selection:
Functional impairment
Subjective distress
Problem complexity
Readiness for change
Reactant/resistance tendencies
Social support
Coping style
Attachment style
Treatment Matching
Assessment should also focus on identifying and
enhancing human strengths and optimal functioning
Positive Psychology – focuses on developing strengths
and enhancements of well-being, while not ignoring
weaknesses
One area to consider when assessing strengths is optimism –
hopeful expectation and general expectancy that the future
will be positive
Case Conceptualization and Assessment
Model for case conceptualization (Meir, 2003)
Step 1: Identify the initial process and outcome elements
Step 2: Learn etiology of client problem
Step 3: Choose interventions for selected problems
Step 4: Consider the time frame of interventions and outcomes
Step 5: Represent the conceptualization explicitly
Step 6: Include at least one alternative explanation
Step 7: Consider the model’s balance between parsimony and
comprehensiveness
Monitoring Treatment Progress
Counselors have responsibility to monitor clients’ progress
during treatment and determine if clients are making positive
gains
History of outcome research:
1970s: research had demonstrated that most people who received
psychological interventions benefitted, but 5-10% got worse (Lambert,
Bergin, & Collins, 1977)
1980s: managed care began playing significant role in cost
containment
1990s: outcome assessment began playing critical role in clinical
care, insurance companies became interested in identifying clients
who would not benefit from psychotherapy
Monitoring Treatment Progress
Clients have better therapeutic outcomes when
clinicians receive feedback about client progress
during therapy
Client self-report is important source of information
for outcome assessment
Goal Attainment Scaling (GAS)
More continuous outcome assessment and more formal
Client and counselor select an indicator for each therapeutic
goal behavior, affective state, or process that represents
goal and can be used to indicate progress
Monitoring Treatment Progress
Gather baseline information at the beginning
Symptom Checklist – 90 – Revised (SCL-90-R)
Outcome Questionnaire (OQ-45.2)
Explain to client why data are being collected and
share results
Using Assessments for Evaluation
and Accountability
Two major types of evaluation:
Formative – continuous or intermediate evaluation
typically performed to examine the process
Summative – more cumulative and focused on endpoint
or final evaluation (the product)
Steps for conducting an evaluation study:
Defining evaluation study focus
Determining design
Selecting participants
Selecting Assessments or measures
Data Analysis
Defining Evaluation Study Focus
Practitioners need to determine what services they
want to evaluate
There needs to be a direct connection between the
services provided and the outcome measures used
Determining Design
Information needed:
Qualitative, quantitative, or both
Quantitative designs:
Intrasubject
Pre-test, intervention, post-test
Intersubject
Randomized clinical trial is gold standard intervention group,
placebo/control group
Wait-list control group often used to address ethical issue
presented by traditional placebo/control group
Selecting Participants
Qualitative studies: sample is usually smaller than
for quantitative studies
Quantitative studies: a larger sample size allows
for more power in statistical analyses
Selecting Assessments or Measures
Assessing outcome involves (Hill & Lambert, 2004):
1.
2.
3.
4.
5.
Clearly specify what is being measured
Measure change from multiple perspectives
Use diverse types of assessments
Use symptom-based and atheoretical measures
Examine patterns of change as much as possible
Scheme for Selecting Outcome Measures (Olges, Lambert, & Fields,
2002)
Content
Social level
Source
Technology
Time Orientation
Outcome Assessment in
Mental Health Settings
Managed care agencies, third-party payers significantly
influence provision of mental health services
Commonly used instruments:
Beck Depression Inventory
State-Trait Anxiety Inventory
Symptom Checklist–90–Revised
Minnesota Multiphasic Personality Inventory II
Dysfunctional Attitude Scale
Hassles Scale
Schedule for Affective Disorders and Schizophrenia
Outcome Questionnaire (OQ-45.2)
Outcome Assessment in
Career Counseling
No standard battery of instruments used
Many studies have examined career maturity and
decidedness vs. concrete career outcomes
Practitioners may want to consider measures of
effectiveness of career counseling other than career
maturity and career decidedness
i.e., employment, job satisfaction, quality of life
Outcome Assessment in
School Counseling
ASCA National Model (ASCA, 2005) states that school
counseling programs are data driven
Availability of instruments to evaluate school counseling
programs is minimal relative to mental health and career
counseling
Consider using multiple measures from multiple perspectives
Students
Teachers
Parents
Other members of the community
School Counseling Program Evaluation Scale (SCoPES; Whiston &
Aricak, 2008)
Data Analysis
Descriptive information vs. statistical analysis
Effect size
Consult with researchers on methodological or statistical
questions