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Screening and Assessing for Screening and Assessing for Mental DisordersMental Disorders

Developed by DATA of Rhode Island through a special grant from the RI Department of Human

Services

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What is screening and What is screening and assessmentassessment

Screening and Assessment – encourages Screening and Assessment – encourages the description of a process rather than the description of a process rather than the study or identification of diagnosis of the study or identification of diagnosis of specific conditions.specific conditions.

It is the first major step in problem It is the first major step in problem recognition and intervention. recognition and intervention.

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GOALSGOALS

To familiarize trainees with common To familiarize trainees with common mental disorders experienced by persons mental disorders experienced by persons with disabilitieswith disabilities

to introduce workers to a variety of to introduce workers to a variety of techniques to help screen and assess techniques to help screen and assess clients for mental illnessclients for mental illness

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The Purpose of an assessing The Purpose of an assessing processprocess

Identification of problems/needsIdentification of problems/needs

Identification of strengths and assetsIdentification of strengths and assets

Determine if there is immediate risk or Determine if there is immediate risk or threatthreat

Identify Special considerationsIdentify Special considerations

Engage in recovery processEngage in recovery process

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Client’s Approach to the interviewClient’s Approach to the interview

Voluntary versus InvoluntaryVoluntary versus Involuntary

Purpose or MotivePurpose or Motive

Client’s ExpectationsClient’s Expectations

Client’s Perception of the workerClient’s Perception of the worker

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Role PlayRole Play

The cat ladyThe cat lady

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Workers Approach to the interviewWorkers Approach to the interview

Orientation – enforcer of the rules, Orientation – enforcer of the rules, caseworker ???caseworker ???

Personal Feelings, Value & BeliefsPersonal Feelings, Value & Beliefs

Understanding the Client & the “Problem”Understanding the Client & the “Problem”

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Interpersonal Characteristics of an Interpersonal Characteristics of an Effective WorkersEffective Workers

EmpathyEmpathy

GenuinenessGenuineness

WarmthWarmth

RespectRespect

Positive regardPositive regard

Healthy BoundariesHealthy Boundaries

Ability to understand the client from their Ability to understand the client from their perspectiveperspectiveFreedom to be oneself; lack of phoninessFreedom to be oneself; lack of phoninessQuality of being open, responsive toward Quality of being open, responsive toward clientclientAbility to convey clients have the power Ability to convey clients have the power to change & participate in the processto change & participate in the processAbility to accept clients despite their Ability to accept clients despite their negative behavior, attitudes or demeanornegative behavior, attitudes or demeanorMaintain an appropriate role with a client Maintain an appropriate role with a client that is neither over-involved or overly that is neither over-involved or overly distantdistantIt is important that we explore It is important that we explore these attitudes as some may these attitudes as some may enhance your work and some may enhance your work and some may be counterproductive.be counterproductive.

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Interviewing Skills and ProcessInterviewing Skills and Process

A variety of interviewing skills can be used A variety of interviewing skills can be used to gather useful information to better to gather useful information to better understand a persons mental statusunderstand a persons mental status

A process for conducting a screening A process for conducting a screening interview interview

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Interview Phase 1Interview Phase 1

Introduction – Develop an understanding Introduction – Develop an understanding about the reason for the interviewabout the reason for the interview

Major tasks – development of rapport & Major tasks – development of rapport & establishment of trust establishment of trust

Clarifying purpose on interviewClarifying purpose on interview

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Interview Phase 2Interview Phase 2

Exploration Exploration

Major tasks – development a better Major tasks – development a better understanding for the presenting problemunderstanding for the presenting problem

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Interview Phase 3Interview Phase 3

Hypothesis Testing – develop inquiries to Hypothesis Testing – develop inquiries to test the hypothesis trying to put the test the hypothesis trying to put the problem into more of a contextproblem into more of a context

Major tasks – delve into other areas or Major tasks – delve into other areas or situations in client’s life that may relate to situations in client’s life that may relate to problemproblem

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Interview Phase 4Interview Phase 4

Feedback/summarize – Worker Feedback/summarize – Worker highlights the screening/assessment highlights the screening/assessment findings with the clientfindings with the client

Works with client toward a common Works with client toward a common understandingunderstanding

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Interview Phase 5Interview Phase 5

Wrapping up –4 critical questions in the last 5 Wrapping up –4 critical questions in the last 5 minutes: minutes:

1.1. Is there anything else you want to tell me that you Is there anything else you want to tell me that you feels is important?feels is important?

2.2. Have we left anything out?Have we left anything out?

3.3. Do you have any questions for me?Do you have any questions for me?

4.4. Where do we go from here?Where do we go from here?

Major tasks – develop a plan geared toward Major tasks – develop a plan geared toward the attainment of mutually agreeable goalsthe attainment of mutually agreeable goals

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Using Collateral InformationUsing Collateral Information

Often times the worker will have collateral Often times the worker will have collateral information regarding client behavior.information regarding client behavior.

This information can come from many This information can come from many sources including: other persons, co-sources including: other persons, co-workers, client’s family or direct workers, client’s family or direct observationobservation

This collateral information often is what This collateral information often is what prompts your meeting with the clientprompts your meeting with the client

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Interview Techniques 1Interview Techniques 1

QuestioningQuestioning Direct Direct Open-endedOpen-ended

ExampleExample Client’s statement: “As a kid I was always in Client’s statement: “As a kid I was always in

trouble”trouble” Worker Response: : “What kind of trouble Worker Response: : “What kind of trouble

were you in?”were you in?”

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Interview Techniques 2Interview Techniques 2

ReflectionReflection Cognitive/ThoughtsCognitive/Thoughts Emotional/feelingsEmotional/feelings

ExampleExample Client’s statement: “I just can’t seem to get Client’s statement: “I just can’t seem to get

anywhere in my life.”anywhere in my life.” Therapist's Response: : “Your lack of Therapist's Response: : “Your lack of

progress frustrates you. Or sounds like your progress frustrates you. Or sounds like your feeling really stuck”feeling really stuck”

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Interview Techniques 3Interview Techniques 3

RestatementRestatement ParaphrasingParaphrasing Facilitates understandingFacilitates understanding

ExampleExample Client’s statement: “Thoughts are racing in my Client’s statement: “Thoughts are racing in my

mind. I just can’t concentrate. I’m so mind. I just can’t concentrate. I’m so confused.”confused.”

Worker Response: : “Sounds like these Worker Response: : “Sounds like these thoughts in your head are troubling to you. thoughts in your head are troubling to you. What kind of thoughts are they?”What kind of thoughts are they?”

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Interview Techniques 4Interview Techniques 4

ClarificationClarification QuestioningQuestioning ParaphrasingParaphrasing RestatingRestating

ExampleExample Client’s statement: It seems like I am F@$!Client’s statement: It seems like I am F@$!

#@ angry all the time.#@ angry all the time. Worker Response: : Is something going on Worker Response: : Is something going on

that is making you feel so angry?that is making you feel so angry?

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Interview Techniques 5Interview Techniques 5

ConfrontationConfrontation Discrepancy between what is observed & statedDiscrepancy between what is observed & stated Confrontation can be constructive or destructiveConfrontation can be constructive or destructive

ExampleExample Client’s statement: “I only drink a couple of times a Client’s statement: “I only drink a couple of times a

day and not every day.”day and not every day.” Worker Response: From our experience with you, you Worker Response: From our experience with you, you

drink every day and by evening you are slurring your drink every day and by evening you are slurring your words, unsteady on your feet and look drunk.”words, unsteady on your feet and look drunk.”

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Interview Techniques 6Interview Techniques 6

Self-disclosureSelf-disclosure Worker conveys personal experiences or feelingsWorker conveys personal experiences or feelings Intended to facilitate client self-disclosureIntended to facilitate client self-disclosure

ExampleExample Client’s statement: “People don’t understand what it’s Client’s statement: “People don’t understand what it’s

like not to be unable to remember. I’m so stupid.”like not to be unable to remember. I’m so stupid.” Worker Response: : “When I was in school, I was Worker Response: : “When I was in school, I was

dyslexic. But, you can still do well in life despite dyslexic. But, you can still do well in life despite having a problem. You’re not stupid, but we need to having a problem. You’re not stupid, but we need to find out why you have problems remembering and find out why you have problems remembering and what can be done.what can be done.

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Interview Techniques 7Interview Techniques 7

ExplorationExploration ““testing the limits” approachtesting the limits” approach How much insight the client has or how client How much insight the client has or how client

responds to pressureresponds to pressure

ExampleExample Client’s statement: “My father used to beat Client’s statement: “My father used to beat

me.”me.” Worker Response: : “I need a bit more Worker Response: : “I need a bit more

information. How does that effect you today?information. How does that effect you today?

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Interview Techniques 8Interview Techniques 8

Reframing Reframing Therapist restate client’s attitudes, thoughts beliefs or Therapist restate client’s attitudes, thoughts beliefs or

feelingsfeelings Used to promote new ways of thinkingUsed to promote new ways of thinking

ExampleExample Client’s statement: “I believe I will never change how I Client’s statement: “I believe I will never change how I

feel.”feel.” Worker Response: : “I hear that is how you feel right Worker Response: : “I hear that is how you feel right

now. That sounds like your depression talking. With now. That sounds like your depression talking. With some help that feeling can change.”some help that feeling can change.”

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Screening for Mental Status 1Screening for Mental Status 1

General AppearanceGeneral Appearance State of consciousness - on a continuum from State of consciousness - on a continuum from

alertness to comaalertness to coma Manner – on a continuum from manipulative Manner – on a continuum from manipulative

to gratefulto grateful Attitude – on a continuum from uncooperative Attitude – on a continuum from uncooperative

to cooperativeto cooperative Dress, hygiene Dress, hygiene

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Mental Status 2Mental Status 2

Physical BehaviorPhysical Behavior Overall profile of motor activities – gait, Overall profile of motor activities – gait,

frequency & speed of movement, rhythm & frequency & speed of movement, rhythm & coordination, & the presence of or absence of coordination, & the presence of or absence of abnormal movementsabnormal movements

Can range from hyperactive to hypoactive – Can range from hyperactive to hypoactive – foot tapping, pacing, restlessness or jerky foot tapping, pacing, restlessness or jerky shift of the body while sittingshift of the body while sitting

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Mental Status 3Mental Status 3

Affect & MoodAffect & Mood Affect is the emotional tone observed by the Affect is the emotional tone observed by the

workerworker Mood is self-reported & subjectively felt Mood is self-reported & subjectively felt

experience of the clientexperience of the client Evaluate: amplitude of emotions, range of Evaluate: amplitude of emotions, range of

affect, inappropriate mood, constriction in affect, inappropriate mood, constriction in range of affect, relatedness and labiality of range of affect, relatedness and labiality of affectaffect

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Mental Status 4Mental Status 4

Speech & ThoughtSpeech & Thought1.1. Quantity of thought – stream of thought & poverty of Quantity of thought – stream of thought & poverty of

speechspeech

2.2. Quality of association – continuity of thoughtQuality of association – continuity of thought

3.3. Content of thought – verbal expressions of Content of thought – verbal expressions of experiences, thoughts perceptions & feelings; experiences, thoughts perceptions & feelings; delusions, illogical thinking & obsessiondelusions, illogical thinking & obsession

4.4. Abstraction – ability to think symbolically & to Abstraction – ability to think symbolically & to conceptualize, problem solve & generalizeconceptualize, problem solve & generalize

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Mental Status 5Mental Status 5

Suicidal or Homicidal IdeationsSuicidal or Homicidal Ideations Assess for presence of absenceAssess for presence of absence Degree of lethalityDegree of lethality Reversibility/AmbivalenceReversibility/Ambivalence PlanPlan MeansMeans Identified victimIdentified victim Past attemptPast attempt Family historyFamily history Relation to SARelation to SA Contract for safetyContract for safety

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Mental Status 6Mental Status 6

Perceptual ProblemsPerceptual Problems Hearing, seeing Hearing, seeing HallucinationsHallucinations

AuditoryAuditoryVisualVisualOlfactoryOlfactoryHapticHaptic

DepersonalizationDepersonalization DerealizationDerealization

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Mental Status 7Mental Status 7

OrientationOrientation PersonPerson

What is your name? Who am I?What is your name? Who am I? Place Place

Address; locationAddress; location TimeTime

Day; month; year; time of dayDay; month; year; time of day SituationSituation

Fails to recall or know purpose of interviewFails to recall or know purpose of interview SpaceSpace

Geographic orientation to a new environmentGeographic orientation to a new environment

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Mental Status 8Mental Status 8

Attention & ConcentrationAttention & Concentration Attention – ability to attend to a stimuliAttention – ability to attend to a stimuli Concentration – concentrate on a task over Concentration – concentrate on a task over

time without being easily distracted by other time without being easily distracted by other environmental stimulienvironmental stimuli

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Mental Status 9Mental Status 9

MemoryMemory Immediate – ability to recall information Immediate – ability to recall information

within seconds or minuteswithin seconds or minutes Recent - ability to recall events from past Recent - ability to recall events from past

several days, weeks or monthsseveral days, weeks or months Remote- ability to recall events from many Remote- ability to recall events from many

years agoyears ago

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Mental Status 10Mental Status 10

Intellectual functioningIntellectual functioning PerceptionPerception MemoryMemory Language verbal and reading and writingLanguage verbal and reading and writing Motor abilitiesMotor abilities Abstract thinkingAbstract thinking

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Mental Status 11Mental Status 11

ReliabilityReliability Insight- client’s awareness of problems & exhibits Insight- client’s awareness of problems & exhibits

an understanding of the causes & developments of an understanding of the causes & developments of these problemsthese problems

Judgment –ability to adjust to social demands & to Judgment –ability to adjust to social demands & to deal appropriately with social encountersdeal appropriately with social encounters

Truthfulness – All clients will withhold some amount Truthfulness – All clients will withhold some amount of information from us and this is normal. of information from us and this is normal.

It is not our job to catch people in lies. It is to gather It is not our job to catch people in lies. It is to gather enough information that we can develop a enough information that we can develop a reasonable plan.reasonable plan.

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DemonstrationDemonstration

Role play of client intervewRole play of client intervew

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Where to from here?Where to from here?

Conclusion of a screening process is to identify Conclusion of a screening process is to identify the facts and the concerns not to render a the facts and the concerns not to render a diagnosisdiagnosisWe are looking to engage the person in a We are looking to engage the person in a common understanding of the issues and to common understanding of the issues and to engage in a a problem solving processengage in a a problem solving processIn the upcoming modules on “enhancing client In the upcoming modules on “enhancing client motivation for change and case planning, we will motivation for change and case planning, we will discuss how to move clients toward getting help discuss how to move clients toward getting help and how to develop action plansand how to develop action plans

QuestionsQuestions