Basic Features of Clinical Assessment 1

PSYC 350 (Ch 3)

Goals of Clinical Assessment

 1. Diagnostic Classification
 2. Description
 3. Treatment Planning
 4. Prediction

Goals of Clinical Assessment: Diagnostic Classification

 Diagnostic classifications are useful:
 For proper treatment decisions
 For research into the causal pathways
 For efficient communication between professionals

 Categorical approach (Diagnostic and Statistical Manual of Mental Disorders;

DSM-IV) vs. dimensional approach

DSM-IV Multi-Axial System

 Axis I: clinical disorders, including major mental disorders, as well as
developmental and learning disorders
 Axis II: underlying pervasive or personality conditions, as well as mental
retardation
 Axis III: acute medical conditions and physical disorders (like brain injuries)
 Axis IV: psychosocial and environmental factors contributing to the disorder
 Axis V: Global Assessment of Functioning or Children’s Global Assessment Scale
for children and teens under the age of 18 (ranges from 0 -100; 100 superior functioning,
no clinical problems at all)

Goals of Clinical Assessment: Descriptive Assessment

 Depends on psychologists’ orientation:
 Cognitive-behavioral: Antecedents, thoughts, and behaviors
 Psychodynamic: Ego strengths and weaknesses, cognitive functioning,
defense mechanisms, quality of family etc.

Common Features
 Descriptive data
 Historical data
 Presenting problem and current circumstances/situational issues
 Past history with emphasis on how the past might have led to the present
issue
 Past history of medical and mental problems
 History of past treatment
 Mental status exam (orientation, cognition, affect, action)

Orientation-Specific Assessments: Psychodynamic

 Developmental history
Basic Features of Clinical Assessment 2
PSYC 350 (Ch 3)

 Characteristics of ego
 Quality of object relations
 Characteristics of the self
 Attachment patterns
 Case formulation

Orientation-Specific Assessments Cognitive-Behavioral

 Diagnosis/symptoms
 Historical setting events
 Current situational determinants of the problem
 and related irrational cognitive patterns (A – B – C model)
 Consequences of the problem
 Biological, genetic, medical factors
 Strengths/assets
 Case formulation and treatment goals

Cognitive-Behavioral Model: ABC Model of Psychological Disturbance

EVENT  AUTOMATIC  EMOTIONS &

THOUGHTS BEHAVIORS

Goals of Clinical Assessment: Treatment Planning

 Diagnostic decisions inform treatment planning (ideally so for empirically
supported treatment movement)
 In practice: Unique characteristics of a case and overlapping/comorbid
psychological problems make it harder to plan treatments based on diagnostic decisions

Goals of Clinical Assessment: Prediction

 Predicting prognosis
 Predicting future performance
 Predicting dangerousness
 Very difficult due to low base rates of dangerous acts (an overwhelming
number of false positives for homicide)
 To err on the side of caution, clinicians tend to overpredict dangerousness

Limits in Clinical Intuition (Judgment and Decision Making)

 Availability heuristic
 A mental rule of thumb whereby people base a judgment on the ease with
which they can bring something to mind.

Limits in Clinical Intuition

 Anchoring bias
 A mental shortcut whereby people use a number or value as a starting
point and then adjust insufficiently from this anchor
Basic Features of Clinical Assessment 3
PSYC 350 (Ch 3)

 Confirmation bias
 The tendency to interpret new information in line with existing beliefs
Limits in Clinical Intuition
 Memory difficulties
 Lack of adequate or consistent feedback
 Personal and cultural biases (gender, age, health status, ethnicity etc.)
 Antisocial personality disorder vs. Histrionic personality disorder

Clinical vs. Statistical Prediction

 Statistical prediction
 “Inferences based on probability data and formal procedures for
combining information, all usually derived from research”

 Clinical prediction
 “Inferences based on a practitioner’s training, assumptions, and
professional experiences.”

Clinical vs. Statistical Prediction
 Statistical prediction generally outperforms clinical prediction
 The overall advantage is modest (Aegisdottir et al., 2006; Grove et al., 2000)
 The superiority of statistical prediction is most evident in predicting violence and
other low-base-rate events
 Practicing clinicians typically underutilize statistical methods

Improving Clinical Judgment

 Increase familiarity with research literature on clinical judgment and
statistical/clinical prediction

ASSESSMENT PROCESS:
1. Receive & Clarify Referral Question, 2. Plan Data Collection strategies, 3. Collect
Data, 4. Process Data and Form Conclusions, 5. Communicate Assessment Results

Assessment Process: Data Collection Procedures

 4 sources of assessment data: 1. Interviews, 2. Behavioral observations,
3.Psychological tests, and 4. Case history data

 How to select assessment instruments

 Quality of the measure
 Relevance of information
 Practical considerations (time, context, usefulness to clients and referral
sources)
Quality of the Measure: Reliability
 Test-retest reliability: Consistency in measurement
 Interrater reliability: Agreement among different raters
 Internal consistency: if one part of the test is similar to another part of the test
Basic Features of Clinical Assessment 4
PSYC 350 (Ch 3)

 Statistics
 Standard Error of Measurement (SEM) – low for measures of stable
concepts
 Confidence Interval (usually 95% CI)

Quality of the Measure: Validity

 Definition: The degree to which an assessment method measures what it is
supposed to measure
 Content validity: how well it measure all the relevant dimensions of a concept
 Criterion validity
 Predictive validity: how well a measure predicts/forecasts events
 Concurrent validity: two measures agree about the assessment of one
concept
 Construct validity: when a measure’s results are shown to be systematically
related to the construct it is supposed to be measuring

Relationship between Validity and Reliability

 Reliability and validity are matters of degree

 A measure cannot be any more valid than it is reliable
 If an instrument is reliable, this does not assure that it is valid

Quality of a Standardized Measure

 Look at the size of the standardization sample was large enough and
representative enough
 Look at the characteristics of the standardization sample (i.e., cultural differences)

Whether to Choose Computerized Tests

Advantages
 Time economy
 Reduce cost of assessment
 Improve reliability
 Eliminate tester bias
 Incorporate statistical information and complex decision processes
Disadvantages
 Too mechanical and restrictive
 Conducted less flexibly
 Observation and history may have significant information not captured via
computers
 Ethical issues (who is responsible in case of judgment errors)
 New discoveries are less likely

Bandwith-Fidelity Dilemma
 Bandwith: the breadth of an assessment device (Superficial information about a
wide range of topics)
Basic Features of Clinical Assessment 5
PSYC 350 (Ch 3)

 Fidelity: the depth or exhaustiveness of the device (A lot of detail about a few
topics concerning the client)

Next Steps in Assessment Process:

 3. Collecting Data
 Value of multiple assessment sources

 4. Processing Data and Forming Conclusions

 Transformation of raw data into interpretations and conclusions that
address referral question
 Integrate info from various sources

 5. Communicating Assessment Results

 Report writing – clear, concise, related to the referral question, and useful

Ethical Considerations
 Need for utmost concern for:
 How psychological assessment data are being used
 Who should have access to the confidential material
 The possibility of improper and irresponsible interpretation and the impact
on the client
 Guided by laws and ethical principles and guidelines outlined by APA