PL3257 Ch5 Assessment: Overview

Psychological Assessment

An iterative decision-making process in which data are systematically collected on the person(s). Data include history/biography, physical, social and cultural environments. Assessments are undertaken to address specific goals (eg, a referral question/assessment question).

Intervention-focused assessment service

Assessment is a first step to planning and providing effective intervention. Pretreatment data can be used to compare with data during and after treatment.

Assessment vs Testing

Assessment is an umbrella term. Tests are smaller than assessments. Assessment is more complex and multifaceted. It requires an integration of the client's biography and clinical observation. The result of an assessment is a coherent, unified description of the client (or the selected aspects of the client's experience that was assessed). Testing occurs when a particular device is used to gather a sample of behaviour from the client. Psychologists are very likely to use tests, but the test results are just part of the bigger picture. More likely to use Tests instead of Assessments for children. Children are in a process of rapid cognitive, physical and emotional development. They may not be there voluntarily (referred to psychologists by parents/teachers). Assessment would require integration of information from multiple methods, informants and settings. These make the final assessment outcome difficult and may not be accurate.

Purpose of Psychological Assessment

Assessment-focused Service vs Intervention-focused Service

Classification of phenomena

Central feature to social science. Requires the collection of data in an Assessment Process.

Ethical Considerations

Clinical Psychology is founded on 2 pillars: Science and Ethics. Informed consent. Confidentiality and Limits to Confidentiality (Harm to self/others). Ethical responsibility to be knowledgeable about test properties (Standardization, Reliability, Validity, Norms), proper use and interpretation of tests, test strengths and limitations.

Diagnosis

Diagnosis is a simple label that help clinicians communicate with each other and search for scientific literature. It provides key information on the types of treatment options that have been found to be effective in clinical trials.

Evidence-Based Assessment

EBA = an approach to psych eval that uses research and theory to guide: (a) The selection of variables to be assessed for a specific purpose (b) methods and measures to be used in the assessment (c) manner in which the assessment process unfolds. It simply means, the assessment process is a decision-making process that clinicians must go through every time with a new client. They must formulate and test their hypotheses and adjust by integrating data obtained throughout the assessment.

Treatment Monitoring

Explicit tracking of progress through the use of specific questions or psychological measures. It allows for modification of treatment, in cases where client is doing better or worse than expected. Routine treatment substantially affects outcome. Reduces deterioration rate and increases successful treatment rates.

Base Rate of a problem/diagnosis

Frequency with which the problem/diagnosis occurs in the population.

Treatment Evaluation

Outcome vs Intake data. Outcome data can indicate how well an entire system of care is functioning, and average performance across psychologists. Learn from above average psychologists. Shows the typical range of outcomes that clients experience and the nature and duration of treatment required to obtain successful outcomes. Allows clinicians to see if the treatment is working and discuss problems with clients, and consider modifying treatments.

Assessment Process

It involves a gathering and integration of multiple types of data from multiple sources and perspectives. 1. Initial understanding 2. Gathering of preliminary info 3. Refinement of understanding 4. Alteration to assessment activities Until enough information is collected to make a clinical judgment/diagnosis.

Norms

Norms = Reference information. Specific criterion-related cut-off scores. Have to consider the quality of the normative sample - the test population being used must be representative of the general population. If the sample came from a convenience sampling (eg, participants are undergrads of NUS), then it is a problem. In Wechsler tests, poopulations come from across the country in different countries, so it is more reliable. We may need to develop multiple norms for a test based on the group that is being assessed (age, ethnicity, etc). Developmental norms = Used when the psychological construct being assessed develops systematically over time (eg, child intelligence).

Testing Practices in Clinical Psychology

Not all tests have psychometric vigour. Many psychologists simply use the tests that they have been trained to use, instead of assessing for themselves what is a good test to use. That means, their training is flawed.

Assessment-focused assessment service

Primarily to provide information that can be used to address a person's current or anticipated psychosocial deficits. Typically, assessment is used for other functions than intervention (Eg, court of criminal law, divorce custody, protection and treatment, etc). Because of the decisions based on assessment, evidence-based assessment tools are required. Psychologists need to take note of Referral Factors (Assessment is requested by self or other people/organizations, the intended use of assessment results, motivation of person to cooperate, potential bias in reporting).

Treatment Planning

Provides a clear focus for treatment. Gives client realistic expectations about the process and likely outcome of treatment. It is the process by which information about the client's context is used in combination with the scientific literature on psychotherapy to develop a proposed course of action that addresses the client's needs and circumstances. By working together to come up with a treatment plan, the therapist and client establish a good foundation to navigate challenges of psychotherapy. It also ensures ownership and truly informed consent for the procedures. A treatment plan covers 3 areas: Problem identification, Goals, Strategies and tactics. (Strategies = general approach; Tactics = details of specific tasks).

Assessment for Screening

Purpose of screening = Identify individuals who may have problems of a clinical magnitude or who ay be at risk for developing such problems. (Usually in context of a routine organization procedure, eg schools, military, corporate, hospital).

Reliability

Reliability consists of internal consistency, test-retest reliability and interrator/interscorer reliability. Reliability = Consistency of tests. Internal Consistency = Whether all aspects of the test contribute in a meaningful way to the data obtained. Test-Retest Reliability = Whether a person tested at different times would obtain similar results. Interrator/Interscorer Reliability = Whether results would be the same if the test was conducted/scored by other evaluators. Reliable results are necessary for generalizing test results beyond immediate assessment situations. Reliability also accounts for Purpose of the test and Population it is being used with. It is a subjective measure. However, reliability is important for administrative issues, such as a child's measured intelligence, an accused's mental state, etc, for subsequent actions of special needs school program and fitness of trial.

Additional concepts of Accuracy

Sensitivity (Proportion of true positives identified by the assessment) { (#true positive)÷(#true positives + false negatives) } Specificity (Relative proportion of true negatives) { (#true negatives) ÷ (#true negatives + #false positives) }.

Standardization

Standardization implies consistency across clinicians and testing occasions. It reduces variability. However many psychologists have abandoned standardized tests for personalized tests for better fit, such as the thematic apperception test.

Psychometric Considerations

Standardization, Reliability, Validity, Norms.

Psychological Testing

Test = Process used to collect and interpret the behavioural sample. Testing occurs when a particular device is used to gather a sample of behaviour from the client. "An evaluative device or procedure in which a sample of an examinee's behaviour in a specified domain is obtained and subsequently evaluated and scored using a standardized process." Focus: Scientifically accurate and valid information.

Case Formulation

The use of assessment data to develop a comprehensive and clinically relevant conceptualization of a patient's psychological functioning.

Concepts of Accuracy

True Positive (A prediction that an event will occur was accurate). True Negative (A prediction that an event will not occur was accurate). False Positive (A prediction that an event will occur but did not occur). False Negative (A prediction that an event will not occur but did occur).

Prognosis/Prediction

Use of assessment data and relevant empirical literature to make predictions about the future course of a patient's psychological functioning. Note: Psych studies deal with future outcomes at the group level. It is probabilistic information. Therefore, accuracy is a challenge. There are variables involved: Time, Cost, Consequences, Base rate of the predicted outcome.

Validity

Validity = The degree to which the test truly measures what it purports to measure. Content Validity = Whether the test items are representative of all the underlying psychological constructs that the test is supposed to measure. Concurrent & Predictive Validity = Whether the test provides daa consistent with theoretical postulates associated with the phenomenon being assessed. Discriminant Validity = Whether the test provides a relatively pure measure of the construct that is minimally contaminated by other psychological constructs. Incremental Validity = (In Clinical Assessment) The extent to which a measure adds to the prediction of a criterion above what can be predicted by other sources of data (above and beyond?). Again, Validity is subjective. It is not dichotomous (valid/invalid). It is conditional within certain parameters. Have to take into account contextual differences (individual, culture, language, age, gender, etc).