Assessment in Clinical Assessment in Clinical PsychologyPsychology

Definitions of Assessment atDefinitions of Assessment at

1.1. Dictionaries define assessment as am estimate of Dictionaries define assessment as am estimate of value. A real estate assessor, for example, looks at a value. A real estate assessor, for example, looks at a house and estimates its value. house and estimates its value.

2.2. Assessment can be defines as the process of Assessment can be defines as the process of collecting information to be used as the basis for collecting information to be used as the basis for informed decisions by the assessor by those to whom informed decisions by the assessor by those to whom results are communicated. results are communicated.

3.3. The deeision – making process, based a pon the The deeision – making process, based a pon the collection of relevant information, using aformal set of collection of relevant information, using aformal set of ethical crileria, which contributes to an overall ethical crileria, which contributes to an overall evaluation of a person and his circumstances. evaluation of a person and his circumstances.

Clinical psychologists collect and process Clinical psychologists collect and process assessment information that is more formal assessment information that is more formal and systematic than that available to and systematic than that available to nonprofessionals, but because they are still nonprofessionals, but because they are still human beings, the quality of their human beings, the quality of their gudgments and decisions about clients can gudgments and decisions about clients can be threat- ened by the same sources of bias be threat- ened by the same sources of bias and error that affect everyone else. and error that affect everyone else.

Planning data Collection

Procedures

Collection Assessment

data

Data processingHypothesis

formation

CommunicatingAssessment

data

THE CLINICAL ASSESSMENT THE CLINICAL ASSESSMENT PROCESSPROCESS

Clinical assessment has been described in Clinical assessment has been described in various ways (Tallent, 1992), them portray it various ways (Tallent, 1992), them portray it as a process of gathering information to as a process of gathering information to solve a problem and recognize that, to be solve a problem and recognize that, to be most effective, assessment should be most effective, assessment should be organized in a sequence of system- atic, organized in a sequence of system- atic, logically related stepslogically related steps

Planning for AssessmentPlanning for Assessment

Two related question must be answered before Two related question must be answered before clinical assessment can begin (McReynolds, clinical assessment can begin (McReynolds, 1975): What do we want to know, and how 1975): What do we want to know, and how should we find out about it?should we find out about it?

The Case Study GuideThe Case Study Guide The Clinician s planes for exploring particular The Clinician s planes for exploring particular

levels from a rough outline of the assessment levels from a rough outline of the assessment task. Ideally, this outline, or case study guide, task. Ideally, this outline, or case study guide, will be broad enough to provide a general will be broad enough to provide a general overview of the client. Yet focused enough to overview of the client. Yet focused enough to allow coverage of all the more specific allow coverage of all the more specific question that the clinician wishes to address.question that the clinician wishes to address.

Levels of Assessment and Levels of Assessment and representative Data from Eachrepresentative Data from EachAssessment Level Type of DataAssessment Level Type of Data

Somatic Somatic Blood type, RH factor, autonomic Blood type, RH factor, autonomic stress response pattern, pattern and stress response pattern, pattern and liver function, genetic liver function, genetic characteristics, basal metabolism, characteristics, basal metabolism, visual acuity, diseases.visual acuity, diseases.

Physical Physical Height, weight sex, eye color, hair Height, weight sex, eye color, hair color, body type.color, body type.

Demographic Demographic Name. age address, telephone Name. age address, telephone number, occupation, income, marital number, occupation, income, marital status, number of children. status, number of children.

Overt Overt behavioral behavioral

Reading speed, eye hand Reading speed, eye hand coordination, frequency of coordination, frequency of arguments with other people, arguments with other people, conversation skill, interpersonal conversation skill, interpersonal assertiveness, occupational assertiveness, occupational competence, smoking habits. competence, smoking habits.

Factors Guiding Assessment Factors Guiding Assessment ChoicesChoices

Clinicians choices about how attention should be devoted to each assessment level, what questions to ask level, and what assessment techniques to employ are guided not only by their theoretical approach, but also by research on the reliability and validity of the interviews, tests, observation, and life records that serve as the main sources of assessment data in clinical psychology. Indeed, reliability and validity are the primary criteria by which any assessment instrument should be judged.

Reliability: Reliability refers to consistency in or Reliability refers to consistency in or agreement among assessment data. It can be evaluated agreement among assessment data. It can be evaluated in several ways. If the results of repeated in several ways. If the results of repeated measurements of the same client are very similar, the measurements of the same client are very similar, the assessment procedures are said to have high test-retest assessment procedures are said to have high test-retest reliability, analogous to a bathroom scale that shows the reliability, analogous to a bathroom scale that shows the same weight when someone steps off and back on same weight when someone steps off and back on again. Another way to evaluate reliability is to examine again. Another way to evaluate reliability is to examine internal consistency. If data from one part of an internal consistency. If data from one part of an assessment-such as odd-numbered test items-are assessment-such as odd-numbered test items-are similar to other part-such as the even-numbered items-similar to other part-such as the even-numbered items-that assessment is said to be internally consistent. This that assessment is said to be internally consistent. This dimension has sometimes been called split-half dimension has sometimes been called split-half reliability. Finally, interrater reliability is measured by reliability. Finally, interrater reliability is measured by comparing the conclusions drawn by differ-ent clinicians comparing the conclusions drawn by differ-ent clinicians using a particular assessment system to diagnose, rate, using a particular assessment system to diagnose, rate, or observe the same client. The more they agree, the or observe the same client. The more they agree, the higher the interrater reliability.higher the interrater reliability.

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ValidityValidityyy.. The validity of an assessment method reflects the degreeThe validity of an assessment method reflects the degree to which it measures what it is supposed to measure.to which it measures what it is supposed to measure. The content The content validity of an assessment method is determined by how well it taps validity of an assessment method is determined by how well it taps all the relevant dimensionsall the relevant dimensions of its target.of its target. Predictive validity is Predictive validity is measured by evaluating how well am assessment forecasts events- measured by evaluating how well am assessment forecasts events- violent behavior suicide attempts, for ex- ample. When two violent behavior suicide attempts, for ex- ample. When two assessment devices agree about the measurement of the same assessment devices agree about the measurement of the same quality, they are said to have concurrent validity. Predictive and quality, they are said to have concurrent validity. Predictive and concurrent validity are subtypes of criterion validity. Finally, there is concurrent validity are subtypes of criterion validity. Finally, there is construct validity the unified validity of any assessment method construct validity the unified validity of any assessment method should be evil uated not only in terms of content, predictive, and should be evil uated not only in terms of content, predictive, and concurrent validity, but also in terms of how well the method taps concurrent validity, but also in terms of how well the method taps into the mental characteristics and processes of in tersest, whether into the mental characteristics and processes of in tersest, whether the construct to be measured has guided the development and the construct to be measured has guided the development and scoring of the method, and whether using the method results in scoring of the method, and whether using the method results in decisions about people that are unbiased and beneficial to them in decisions about people that are unbiased and beneficial to them in the short-run and the long-run.the short-run and the long-run.

Clinician-Specific Factors.. Clinicians Clinicians assessment choices are also influenced by assessment choices are also influenced by personal experiences and preferences. Clinical personal experiences and preferences. Clinical psychologists may tend to use, or avoid, particular psychologists may tend to use, or avoid, particular assessment methods simply because those assessment methods simply because those methods were either emphatic- sized or criticized methods were either emphatic- sized or criticized by faculty in their graduate training program. by faculty in their graduate training program. Similarly, those who find certain measurement Similarly, those who find certain measurement tactics tedious of unrewarding tend to seek tactics tedious of unrewarding tend to seek answers to assessment questions through other answers to assessment questions through other procedures with which they are more comfortable. procedures with which they are more comfortable. These per-sonal factors help explain why some These per-sonal factors help explain why some assessment methods continue to be used by assessment methods continue to be used by some clinicians even when research evidence fails some clinicians even when research evidence fails to support their reliability or validity.to support their reliability or validity.

THE GOALS OF CLINICAL THE GOALS OF CLINICAL ASSESSMENTASSESSMENT

The major goals of clinical assessment fall into three general categories; diagnostic classification description, and prediction.

Diagnostic Classification Once clinical psychologists began working with adult clients during

and after world War I, they came under the influence of medical personnel, particularly psychiatrists.

Accurate psycho diagnosis is important for several reasons. First, proper treatment decisions often depend on knowing what, exactly, is worming with a client (Vermande, ven den Bercken, &de Bruyn, 1996). Second, research into the causes of psychological disorders requires reliable and valid identification of disorders and accurate differentia- tion of one disorder from another. Finally, classification allows clinicians to efficiently communicate with one another about disorders in a professional"shirthand" (Sartorius et al ,1996).

Alternative Diagnostic Proposal.Alternative Diagnostic Proposal. Called the dimensional approacb, avoids the either- or Called the dimensional approacb, avoids the either- or

dichotomy by measuring people on a select number of dichotomy by measuring people on a select number of personality dimensions. Those dimensions might include personality dimensions. Those dimensions might include extroversion, openness to experience, conscientiousness, extroversion, openness to experience, conscientiousness, emotional stability, and agreeableness (the "big five"). One emotional stability, and agreeableness (the "big five"). One advantage of the dimensional approach is that it reflects advantage of the dimensional approach is that it reflects how normality shades into psychopathology rather than how normality shades into psychopathology rather than imposing an arbitrary boundary between the two. Another imposing an arbitrary boundary between the two. Another is that it allows persons to be described in terms of is that it allows persons to be described in terms of strengths and weak- nesses, correcting what many see as strengths and weak- nesses, correcting what many see as an overemphasis on pathology in current diagnos- tic an overemphasis on pathology in current diagnos- tic procedures. Other diagnostic proposals call for describing procedures. Other diagnostic proposals call for describing psychopathology in terms of spe- cific theories or psychopathology in terms of spe- cific theories or contextual principles contextual principles

DescriptionDescription For many clinicians today, descriptive assessment is more important For many clinicians today, descriptive assessment is more important

than diagnos- tic classification. Description-oriented assessment than diagnos- tic classification. Description-oriented assessment makes it easier for clinicians to pay attention to clients assets and makes it easier for clinicians to pay attention to clients assets and adaptive function, assessment data are used to provide pretreatment adaptive function, assessment data are used to provide pretreatment measures of clients behavior, to guide treatment planning, and to measures of clients behavior, to guide treatment planning, and to evaluate changes in behavior after treatment.evaluate changes in behavior after treatment.

PredictionPrediction The third goal of clinical assessment is to make prediction about The third goal of clinical assessment is to make prediction about

human behavior.human behavior. Predicting DangerousnessPredicting Dangerousness.. In fact, clinical psychologists find it difficult to In fact, clinical psychologists find it difficult to

predict dangerousness accurately (Monahan, 1988;Borum, 1996). predict dangerousness accurately (Monahan, 1988;Borum, 1996). One reason for this problem is that the base rate, or frequency with One reason for this problem is that the base rate, or frequency with which dangerous acts are committed in any group of people is usually which dangerous acts are committed in any group of people is usually very low.very low.

Sources of Assessment DataSources of Assessment DataInterview- Tests-Observations-and life recordsInterview- Tests-Observations-and life records InterviewInterview.. Interview mimic ordinary social interactions, thus providing Interview mimic ordinary social interactions, thus providing

a way of collecting simultaneous samples of a persons verbal and a way of collecting simultaneous samples of a persons verbal and nonverbal behavior. Second, interviews require no special equip-ment nonverbal behavior. Second, interviews require no special equip-ment and can take place almost anywhere. Third, the interview is highly and can take place almost anywhere. Third, the interview is highly flexible. The clinician is free to direct the inquiry to whatever topics flexible. The clinician is free to direct the inquiry to whatever topics and issues might help the assessment processand issues might help the assessment process..

ObservationsObservations.. "Action speak louder than words". A second "Action speak louder than words". A second advantage of observation is relevance to behaviors of greatest clinical advantage of observation is relevance to behaviors of greatest clinical interest. In spit of its advantages, observational assessment is not interest. In spit of its advantages, observational assessment is not problem free. As de- scribed in chapter4 the reliability and validity of problem free. As de- scribed in chapter4 the reliability and validity of observation data can be threatened by observer error or bias, observation data can be threatened by observer error or bias, inadvertent observer influences on behavior under observation and inadvertent observer influences on behavior under observation and specific situational factors. specific situational factors.

TestTest.. Tests can be easy, economical, and Tests can be easy, economical, and conveniently administered. Responses to most conveniently administered. Responses to most tests can be translated into scores, test data tests can be translated into scores, test data facilitate communication between professionals facilitate communication between professionals about a client. Finally, test data allow the clinician about a client. Finally, test data allow the clinician to compare a clients behavior with that of to compare a clients behavior with that of thousands of other who have taken the some test.thousands of other who have taken the some test.

Life RecordsLife Records. As they pass through life, people . As they pass through life, people

leave a paper trail consisting of school, work, leave a paper trail consisting of school, work, police, medical and financial records, letters and police, medical and financial records, letters and diaries, photographs, a wards, and the like. diaries, photographs, a wards, and the like.

The Value of Assessment Sources.The Value of Assessment Sources.Clinical Psychological seldom rely on a Clinical Psychological seldom rely on a

single sources of assessment data as they single sources of assessment data as they create a working image of a client. create a working image of a client.

It often takes multiple sources of It often takes multiple sources of assessment to separate those who engage assessment to separate those who engage in certain behaviors from those who do not in certain behaviors from those who do not engage in them engage in them

Processing Assessment Data Processing Assessment Data After assessment goals are established and data After assessment goals are established and data

are collected, the clinicians must determine what are collected, the clinicians must determine what those data meanthose data mean. . If information is to be useful in If information is to be useful in reaching the clinicians assessment goals, it will reaching the clinicians assessment goals, it will have to be transformed from raw into interpretation have to be transformed from raw into interpretation and conclusions.and conclusions.

Levels of Clinical InferenceLevels of Clinical Inference Clinicians’ judgments or inferences can be Clinicians’ judgments or inferences can be

characterized in terms of their goal, their level of characterized in terms of their goal, their level of abstraction, or their underlying theoretical abstraction, or their underlying theoretical approach to clinical psychology. approach to clinical psychology.