Chapter 13 Clinical Assessment Robert J. Drummond and Karyn Dayle Jones Assessment Procedures for Counselors and Helping Professionals, 6 th edition Copyright

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


Behavioral Assessment

• Behavioral assessment centers on the circumstances of behavior rather than the reasons for it.


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


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❒ Withdrawn, isolated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.


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.



Personality Assessment

• Specific Domain – Depression

– Anxiety

– Eating disorders

– Childhood disorders

– Other “Axis I” disorders

• Comprehensive – Personality disorders


Interviews

• Structured

• Unstructured


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.


Unstructured Interviews

• Psychosocial

• Psychiatric interview

• Intake interview


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.


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


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.


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


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)


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


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)


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


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)


Instruments for Neurological Assessment

• Halstead-Reitan Neuropsychological Test Battery• Lauria-Nebraska Neuropsychological Battery• Kaufman Short Neuropsychological Assessment

Procedure• Quick Neurological Screening Test


Documents

Chapter 13 Clinical Assessment Robert J. Drummond and Karyn Dayle Jones Assessment Procedures for Counselors and Helping Professionals, 6 th edition Copyright