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Chapter 13Clinical Assessment
Robert J. Drummond and Karyn Dayle JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
Behavioral Assessment
• Behavioral assessment centers on the circumstances of behavior rather than the reasons for it.
Robert J. Drummond and Karyn Dayle JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
Behavioral observationObservation, normally of a specific, observable set
of behaviors. Observation might describe or identify the following
components:1. Purpose and object of the observation2. Physical environment3. Acts or events that have taken place4. Time dimensions5. Actors or people observed6. Goals of the persons observed7. Feelings of the observer
Robert J. Drummond and Karyn Dayle JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
Behavioral Observation Form
Behavior
❒ Withdrawn, isolated
❒ Erratic, inconsistent
❒ Mood swings
❒ Inappropriate laughter
❒ Class clown
❒ Drowsy, sleeping in class
❒ Obscene language, gestures
❒ Rebellious, argumentative
❒ Talks about drugs, "partying"
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
Instructions: Think of a particular student you feel concerned about and check off any items that apply to the student's recent behavior.
Robert J. Drummond and Karyn Dayle JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
Robert J. Drummond and Karyn Dayle JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
Interviews
• Structured
• Unstructured
Robert J. Drummond and Karyn Dayle JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
Unstructured Interviews
• Psychosocial
• Psychiatric interview
• Intake interview
Robert J. Drummond and Karyn Dayle JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
The Unstructured Interview Format
1. Identifying Information2. Presenting Problem3. History of Presenting Problem4. Family History5. Relationship History6. Developmental History7. Education/Employment History8. Medical History9. Substance Use10. Previous Counseling
Robert J. Drummond and Karyn Dayle JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
Suicide Risk Assessment
• 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 eventRobert J. Drummond and Karyn Dayle JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
Neuropsychological AssessmentA 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
A typical neuropsychological examination will evaluate:
• 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All 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 JonesAssessment Procedures for Counselors and Helping Professionals, 6th editionCopyright ©2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.