Basic Features of Clinical Assessment

Week Week 4

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Unit/Module chapter 3

[chapter 3], notes:

Assessment — is the collection and synthesis of information to reach a judgment. Clinical psychologists
collect and process assessment information that is more formal and systematic. Assessment is required to
describe a client’s problems, plan treatments, measure treatment effectiveness, conduct other kinds of
research, and answer questions asked of clinicians.
I. An Outline of the Assessment Process:

The assessment process consists of: 1)receive and clarify the referral question, 2)plan data collection
procedures, 3)collect assessment data, 4)process data and form conclusions, 5)communicate
assessment results.

Two questions must be answered before clinical assessment can begin:

“what do we want to know?”

“how best can we find out about what we need to know?”

1.Receiving and Clarifying the Referral Question:

An answer for the question “what do we want to know?”, depends on who requested the assessment and
for what purpose.

The referral source — the individual or organization requesting the assessment.

The referral question — the specific question or issue to be addressed in the assessment. It's important
bc it guides the choice of assessment instruments and guides the result interpretation/communication.

so, clinicians need to understand the context of the referral, clarify the purpose of the assessment to
the client, educate on what psy assessment can/can't reveal and educate on ethical constraints.

2.Planning Data Collection Procedures:

An answer for the question “how best can we find out what we need to know?”, is to begin planning
methods to collect data.

Factors that affect the selection of assessment instruments:

the referral question (most important);

the quality of assessment instrument or procedure (reliability, validity, usefulness);

the selection of instruments that are appropriate for each client in terms of their characteristics
(reading level);

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 To plan the assessment, clinicians consider various features of assessment instruments against time,
context, and the usefulness for clients/other referral sources.

3.Collecting Assessment Data:

Clinical psychologists collect assessment data from four main sources: interviews, observations, tests,
and historical records (case history data).

Clinicians use multiple assessment channels to cross-validate information about a wide variety of topics.

4.Processing Data and Forming Conclusions:

The data need to be transformed from raw form into interpretations and conclusions that directly address
the referral question.

this processing task can be challenging bc it involves making a mental leap from known data to
assumed truths based on that data.

the longer the leap from data to assumption, the more potential for errors in the inferences made.

Processing assessment data is complicated bc information from various sources (interviews, tests,
observations) must be integrated. And there are a few established guidelines for how to best combine all
the data.

5.Communicating Assessment Results:

The final stage is the creation of an an assessment report — an organized presentation of results.

Assessment reports must be clearly written and clearly related to the goal that started the assessment in
the first place.

II. The Goals of Clinical Assessment:

Most referral questions relate to diagnosis classification, description, treatment planning, or prediction:
1.Diagnostic Classification:

Diagnostic classification — is the labeling of psychological problems.

Reasons why accurate psychodiagnosis is essential:

proper treatment decisions often depend on knowing the specific mental disorder a client has;

accurate diagnosis is crucial for research into the causes of psychological disorders;

classification allows clinicians to communicate efficiently with each other about disorders;

A common nomenclature (naming system) in clinical psychology and psychiatry is the DSM.

2.Description:

Many clinicians seek more information beyond diagnostic labels. So, descriptive assessment is often
seen as more important than diagnostic classification.

Benefits of description-oriented assessment:

clinicians focus on clients’ assets and adaptive functions, not just to their weaknesses and problems;

descriptive assessment data is used to provide pretreatment measures of clients’ behavior to:
(1)guide treatment planning and (2)to evaluate changes in behavior after treatment.

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 it can improve measurement in clinical research;

The movement toward broad description of clients is time-consuming and expensive.

3.Treatment Planning and Treatment Assessment:

The basic medical-model of treatment planning assessment is to match specific treatments with specific
diagnoses.

However, treatment planning assessment goes beyond this model and instead it addresses the more
detailed question: “What treatment, by whom, is most effective for this individual with that specific
problem, and under which set of circumstances?”.

Ways to assess the results of treatment: questionnaires, client self-reports, tests, and other measures.

The goal of treatment assessment is to record outcomes quickly, efficiently, and accurately, and to
periodically review the data to measure clinicians' treatment strengths and weaknesses.

Discussing assessment methods and results with clients can have therapeutic value.

bc it encourages clients to be more objective in self-monitoring; it increases trust in the therapist and
treatment; and it provides an additional way of therapeutic interaction.

4.Prediction:
Clinicians make predictions about human behavior, which include prognosis, predicting future performance,
and predicting dangerousness:
Prognosis:

prognosis — refers to a prediction about the outcome of treatment; includes predictions about how
symptoms change without treatment or under certain circumstances.

clinicians rely on the DSM to improve prognosis.

clinicians can improve prognoses by considering various factors (social support/subjective distress)
beyond the diagnosis.

Predicting future performance:

clinicians are asked to predict job performance of ppl employed by businesses, government agencies,
military.

at first, the clinician must collect and examine descriptive assessment results to make predictions.

to understand how well someone will do in a specific job or situation, clinicians need empirical evidence
(real data) that shows which qualities reliably (consistently) predict good performance.

Predicting dangerousness:

predicting dangerousness (forensic evaluations) involves evaluating the risk of harm or violence.

clinicians find it difficult to predict dangerousness accurately bc the base rate (frequency with which
dangerous acts are committed in any group of people) is usually very low.

false negatives (predicting that dangerous people are safe) are more serious than false positives
(predicting that safe people are dangerous) ⇒
for the safety, over-predicting the dangerousness is
favored.

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 guidlines for predicting dangerousness: (1)predict the level of risk (high/moderate/low) rather than
whether someone will/won’t commit an act; (2)use validated assessment instruments designed for
predicting dangerous behaviors; (3)combine evidence on defendant's dispositional tendencies, clinical
factors, historical factors, and contextual factors.

III. Clinical Judgment and Decision Making:

Clinical Intuition:

Empirical research does not support the idea that clinicians have special deductive capabilities. Clinical
intuition is believed to be unreliable.

Clinicians are susceptible to cognitive biases and habits that can lead to errors in their judgment:

the availability heuristic, when people rely too heavily on recent and remarkable experiences, can
lead to judgment errors;

clinicians tend to display an anchoring bias in which they establish their views of a client more on the
basis of the first pieces of assessment information than on any subsequent information;

a confirmation bias (the tendency to interpret new information in line with existing beliefs) may cause
clinicians to ignore or distort contradictory evidence to fit initial impressions;

Having additional information increases the clinicians' confidence in their judgments, but in really it
contributes to increased error, particularly when the predictors are not precise.

Clinicians may misremember information or fail to gather important information, which can affect the
accuracy of their judgments.

Clinical and Statistical Prediction:

Statistical (actuarial) prediction relies on probability data and formal procedures derived from research,
while clinical prediction is based on a practitioner's training, assumptions, and professional experiences.

Statistical/actuarial prediction generally outperforms clinical prediction. The overall advantage for
statistical prediction is modest, with occasional cases of clinical prediction performing as well or slightly
better.

Clinicians often fail to appreciate the limits of their clinical intuition, making them vulnerable to criticism.

Improving Clinical Judgment:

The generally superior performance of actuarial models need not be seen as a sign of professional
failure.

Clinical experience and judgment do improve with more years of practice, although the improvement is
modest.

Clinical judgment can be enhanced through repeated use of intuition, combined with timely feedback
about the accuracy of predictions, and learning about new research findings.

IV. Psychometric Properties of Assessment Instruments:

Factors in determining a clinician’s choice of assessment tools: (1)the assessment goal, most important;
(2)reliability, (3)validity, (4)standardization, (5)utility. 8
Reliability:

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 Reliability — refers to the consistency in measurement or to the agreement among different judges or
raters.

Ways to evaluate reliability:

test-retest reliability — a consistency in repeated measurements of the same item.

internal consistency (split-half reliability) — if data from one part of an assessment are similar to data
from other parts, that assessment is said to be internally consistent.

interrater reliability — is measured by comparing the conclusions drawn by different clinicians using a
particular assessment system to observe the same client. The more they agree, the higher the
interrater reliability of the instrument.

Validity:

Validity — reflects the degree to which it measures what it is supposed to measure.

Ways to evaluate validity:

content validity — is determined by how well it taps all the relevant dimensions of its target.

criterion validity — measures how strongly an assessment result correlates with important
independent criteria of interest.

predictive validity — is measured by evaluating how well an assessment forecasts events (violent
behavior or suicide attempts).

concurrent validity — when two assessment devices agree about the measurement of the same
quality.

construct validity (comes first) — an assessment device has good construct validity when its results
are shown to be systematically related to the construct it is supposed to be measuring.

Standartization:

Standartization — means that a test/assessment instrument is given to a large and representative

sample and is analyzed for an average score in a population.

Key considerations for a clinicians:

whether the size of the standardization sample was large enough and representative enough;

whether the particular client being tested is similar enough to the sample on which that test was
standardized;

V. Communicating Assessment Results:

Report clarity is a basic attribute of and the first criterion for a report. Misinterpretation of a report can
lead to misguided decisions.

Relevance to goals: a report’s lack of relevance is due mainly to the clinician’s failure to keep established
assessment objectives in mind.

Usefulness of reports: a useful report should provide new and important information about the client,
beyond what is already known.

a feature of assessment reports that reduces their usefulness is overgenerality, or the tendency to
write in terms that are so ambiguous they can be true of almost anyone.

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 VI. Ethical Considerations in Assessment:

Clinicians must understand the limitations of their assessments and how they will be used, following
federal and state laws and the APA Ethical Principles of Psychologists and Code of Conduct.

Ethical decision-making often involves considering various laws, professional codes, and individual
concerns.

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