Psy 672

Introduction to Assessment II

Spring 2009

Prof. Elaine Heiby

Class hours and location: Thursdays 9:30 a.m. - noon; Gartley 13

Office hours: by appointment [e-mail: heiby@hawaii.edu]

Course information on web: www2.hawaii.edu/~heiby/

Purposes of course: Develop traditional psychological assessment skills with a focus on semi-structured interviewing of current and past functioning, the administration of objective tests, case presentations, and report writing.

Required readings:

Manuals for WAIS-III, WISC-IV, WMS-III, MMPI-2, MCMI-III, LNNB (complete battery and the screening version), SCID-I, SCID-II, and any other standardized test used during the semester

Evans, D.R., Hearn, M.T., Uhlemann, M.R., & Ivey, A.E. (2008).  Essential interviewing: A programmed approach to effective communication, 7th edition. .Belmont, CA: Thomson Brooks/Cole

Sample psychological assessments and test results (provided via email)

No suicide contract http://www.suicide.org/no-suicide-contracts.html

Suicide risk assessment http://www.gp-training.net/protocol/psychiatry/suicide.htm

Mini Mental State Examination http://www.chcr.brown.edu/MMSE.PDF

Required resources in CSP Test Library:

Antony, M.M., Orsillo, S.M., & Roemer, L. (2001).  Practitioner's guide to empirically based measures of anxiety. New York: Kluwer Academic/Plenum Publishers

Fischer, J. & Corcoran, K. (2000).  Measures for clinical practice: A sourcebook: Volume 1 couples, families, and children. New York: The Free Press OR Fischer, J. & Corcoran, K. (2007).  Measures for clinical practice and research: A sourcebook: Fourth edition: Volume 1: Couples, families, and children. New York: Oxford University Press.

Fischer, J. & Corcoran, K. (2000).  Measures for clinical practice: A sourcebook: Volume 2 adults. New York: The Free Press OR Fischer, J. & Corcoran, K. (2007).  Measures for clinical practice and research: A sourcebook: Volume 2: Adults. New York: Oxford University Press.

Nezu, A.M., Ronan, G.F., Meadows, E.A., & McClure, K.S. (Eds.).(2000).  Practitioner's guide to empirically based measures of depression. New York: Kluwer Academic/Plenum Publishers

Other instruments in the  CSP Test Library or CBT Clinic

Required assessments (number may vary owing to availability of professional clients):

Conduct 3 psychological assessments with professional clients. For each professional client, develop a written psychological evaluation report and provide case presentations (2 presentations per client). Identify the client as Client 1, Client 2, and and Client 3 to preserve anonymity. You may also assign a pseudonym to each client.

Each of the 3 assessments will involve at least two sessions with a professional client and must include the following:

FIRST SESSION: Confidentiality information; Intake Form

FIRST SESSION: A semi-structured interview of presenting problem(s) and client history, which may be supplemented with a background questionnaire. Audtiotape the semi-structured interview and submit the audiotape to the Instructor ASAP.

FIRST SESSION: A broad band (mulit-scale) measure of psychopathology (MMPI or MCMI or SCID-I). Select at least one broad band test for each first session; Be sure to administer the MMPI, MCMI, and SCID-I at least once.

FIRST OR SECOND SESSION: A screen for basic cognitve functioning using the Mini Mental State Exam (MMSE).

FIRST CASE PRESENTATION: The first case presentation involves a summary of the client’s presenting problem(s), background, and the results of the Intake Form and broad band (multi-scale) measure of psychopathology. Outline your presentation according to Sections I, II, III, IV, and V of the Psychological Evaluation Report. In addition, present the scores (and profile if applicable) of the broad band measure of psychopathology. You are strongly advised to draft these sections of the Report to guide this first case presentation.

SECOND SESSION: A measure of cognitive-intellectual functioning (WAIS-III or WMS-III or LNNB). An individualized battery of narrow-band neuropsychological tests may be substituted for the LNNB if justifiable. Select one cognitive-intellectual test for each assessment. Be sure to administer the WAIS-III, WMS-III, and LNNB (or an individualized neuropsychological test battery) at least once.

SECOND SESSION: Individualized measures of behavioral problems and potential behavioral and situational causal variables (assets and deficits).

Individualized instruments will be determined from the results of the semi-structured interview and the broadband measure(s) of psychopathology administered during the first session and from consultation with the class during the first of two case presentations of the professional client. Individualized instruments may include a variety of objective tests designed to measure behavioral disorders, coping skill assets and deficits, and situational factors. These instruments will be taken from the required resources in the CSP Test Library or CBT Clinic. In addition, there may be a justification to administer the SCID-II and/or SCID-D during the second session.

SECOND CASE PRESENTATION: The second case presentation of the client should provide an integration of the entire psychological assessment. You are strongly advised to draft the Report for this second presentation.

Professional Clients

Each student will be assigned approximately 5 - 10 professional clients (i.e., undergraduate volunteers from Psy 371 who are role playing). If you would have a dual-relationship with a particular professional client, trade that client with a classmate. Contact professional clients ASAP to thank them for volunteering and to inform them you will contact them again to make appointments before the date indicated on the Estimated Course Schedule. Inform the professional client that he/she will earn 6 extra credits IF he/she appears for all scheduled appointments. Some volunteers may withdraw participation or fail to appear for some or all appointments. See the consent form for professional clients on the Psy 371 syllabus at http://www2.hawaii.edu/~heiby/

Keep track of professional clients and the number of hours of participation so they receive one extra credit for each hour or portion of an hour. Keep identifiers of professional clients separate from information obtained from the psychological assessment. Professional clients have volunteered for up to 6 hours. Provide extra credit information to the TA’s for Psy 371.

Direct Observation by Clinical Supervisors

Arrange with a class Clinical Supervisor to be observed at least once while conducting the following assessment devices: 1- semi-structured interview; 2 - MMSE; 3 - WAIS-III; 4 - WMS-III; 5 - LNNB [or a justifed individualized battery]; and 6 - SCID-I.

The following CSP students will serve as Clinical Supervisors:

1 - Chun-I Li : chuni@hawaii.edu

2 - Shana Golembo Smith: shanago@gmail.com

3 - Allison Love: arlove@hawaii.edu

4 - Qijuan Fang: qijuan@hawaii.edu

5 - Puihan Joyce Chao: chaopuihan@hotmail.com

chuni@hawaii.edu, shanago@gmail.com, arlove@hawaii.edu, qijuan@hawaii.edu,

chaopuihan@hotmail.com

Audiotaping

Audiotape all semi-structured and structured interviews for your own and the Instructor’s review. Critically analyze the interviews based on interviewing techniques and content. Provide yourself with constructive feedback to supplement the Instructor’s feedback. If necessary, problem-solve with the class, the Instructor, or a Clinical Supervisor. Submit to the Instructor all audiotapes of semi-structured and structured interviews. Destroy all audiotapes after the semester, per agreement with the professional clients.

Location of Assessment Sessions

You must reserve a room for each psychological evaluation session. Choose a room with privacy and that is quiet. Post a “do not disturb” note on the door. If you can hear people talking nearby, ask them to be quiet. When administering cognitive-intellectual tests, be sure the room has an appropriate table so that you can sit across from the professional client. Make sure there are no objects that can be used as weapons or projectiles. If possible, sit close to the door.

Submission of Psychological Evaluation Reports

Submit the psychological evaluation report for each client shortly after the second case presentation. The Instructor will edit but not grade the first draft of the report. Revise and re-submit the report within one week of receiving the edited draft. Revised reports will be graded.

Time Management

Arrangement of sessions with clients, observations by Clinical Supervisors, preparation of case presentations, and writing psychological evaluation reports requires time management skills. As noted above, I encourage you to draft/outline Sections I, II, III, IV, and V of the Psychological Evaluation Report and score the broadband measure of psychopathology ASAP following the first session with the professional client. Use this draft to organize the first case presentation on the professional client. Be prepared to present your initial case presentation at each class meeting following your first session with the professional client. Arrange the second session with the professional client ASAP after the first case presentation. Write up and submit to the Instructor your draft of the psychological evaluation report ASAP after the last session with the professional client. Upon receipt of feedback on the draft, revise and resubmit to the Instructor ASAP.

Grading:

Class attendance and participation is expected unless the student is indisposed.

3 audiotapes of semi-structured background interviews (3 @ 20 points each = 60 points)

1 audiotape of a structured interview (SCID-I or II) (20 points)

3 psychological reports @ 60 points each = 180 points

6 case presentations @ 10 points each = 60 points

Total = 320 points

288 – 320 = A

255 - 287 = B

< 255 = C

Estimated Course Schedule

Week/Date Topic and Readings

1 (1/15/09) syllabus review; outline of psychological evaluation reports; content of background interviews; ethical and diversity considerations

2 (1/22/09) interviewing skills [semi-structured] Evans et al. (2008) all chapters;

START COMPLETING EXERCISES IN BOOK; BRING BOOK TO CLASS

3 (1/29/09) interviewing skills [semi-structured] BRING EVAN’S ET AL. TO CLASS

4 (2/5/09) interviewing skills [semi-structured] BRING EVANS ET AL. TO CLASS; study MMPI, MCMI, SCID-I & II, WAIS, WMS, LNNB manuals & materials;

START FIRST SESSIONS OF ASSESSMENTS FOR 2 OF THE 3 CLIENTS

Workshops may be scheduled outside of regular class time and date; workshops replace class meetings; order of workshops may change depending on Clinical Supervisors’ schedules

5 (2/12/09) SCID-I & II administration workshop (Puihan Joyce Chao)

START FIRST SESSION OF ASSESSMENTS FOR THE 3rd CLIENT

6 (2/19/09) WAIS-III administration workshop (Chun-I [Jeanie] Li)

7 (2/26/09) LNNB administration workshop (Shana Golembo Smith)

8 (3/5/09) WMS-III administration workshop (Chun-I [Jeanie] Li)

9 (3/12/09) case discussions and presentations;

START SECOND SESSION OF ASSESSMENTS

10 (3/19/09) case discussions and presentations

START SUBMITTING FIRST DRAFTS OF REPORTS

11 (3/26/09) Spring Break

12 (4/2/09) case discussions and presentations

13 (4/9/09) case discussions and presentations

14 (4/16/09) case discussions and presentations

15 (4/23/09) case discussions and presentations

16 (4/30/09) case discussions and presentations

FINAL VERSION OF ALL PSYCHOLOGICAL REPORTS DUE NO LATER THAN 5/5/09

HOWEVER, FINAL VERSIONS SHOULD BE SUBMITTED ASAP FOLLOWING FEEDBACK ON THE DRAFT VERSIONS

Psychological Evaluation Report Outline

LABEL REPORT (PSYCHOLOGICAL EVALUATION)

TYPE “CONFIDENTIAL” AT TOP OF REPORT IN BOLD CAPS

INDICATE DATE OF REPORT

I. Client's Identifying Information

A. Pseudonym/Client #, age, date and place of birth, sex, citizenship/nationality, ethnicity, marital status, occupation

B. Reason for referral (professional client volunteer)

C. Diagnostic methods used and dates administered listed by whether administered by examiner or self-administered by client; give citation of lesser known tests (e.g., measures of behavioral and situational assets and deficits; single scale tests)

D. Examiner, credentials, and agency providing assessment

II. Presenting problem(s) along with precipitants, consequences, frequency, duration, and intensity as described by client; indicate source of all information (e.g., client self-report, Intake Form, referral agency, medical records); any examiner comments or inferences or hypotheses should be tentative and noted as such

III, Current Situation (living, working, school, relationships, stressors)

IV. Behavioral Observations [by the examiner]

A. Whether arrived on time for the appointments (note if had to be brought to the appointments)

B. Attitude toward examiner (e.g., hostile, guarded/apprehensive, suspicious, uncooperative, apologetic, indifferent/apathetic; cooperative, comfortable, friendly, open)

C. Appearance (e.g., unkempt, dirty, inappropriate attire [describe], poorly nourished; well- groomed, appropriately dressed)

D. Motor behavior (e.g., tense, restless, lathargic, relaxed) and note whether client exhibited odd mannerisms

E. Speech (e.g., mute, underproductive, lack of spontaneity, over-productive, unclear, pressured, disorganized; clear; unremarkable, etc.)

F. Apparent thought organization and content (e.g., loose association's, tangential, incoherent, perseverative, word salad, echolalic, neologistic, delusional, hallucinations, obsessions; organized; coherent, etc.)

G. Mood (e.g., depressed, anxious, angry, elated, flat, inappropriate; appropriate to content, euthymic, etc.)

H. Orientation to person, place, time as inferred by the examiner; report MMSE scores in section VI

I. Understanding of own condition (degree of insight and self-awareness)

J. Ability to relate to examiner (withdrawn, passive, regressed, aggressive, personable, assertive)

V. Background Information; for each assertion of fact, note if source of information is client self-report, background questionnaire, report of collaterals, information from medical, psychological, or legal records, etc.

A. Family history

B. Social history

C. Legal history

D. Educational history

E. Work history

F. Medical history

G. Past behavioral/psychological problems, diagnoses, situations (precipitants), treatments, response to treatment

H. Recreational history (e.g., hobbies, pleasure activities)

VI. Cognitive-Intellectual Evaluation [justify administration of each test]

A. Comment on judged validity of results and indicate any factors that may have affected test performance (e.g., examiner deviation from standard administration; client's lack of motivation, fatique, low stress tolerance, hostility toward examiner) and how scores may be expected to change with a lessening of these factors

B. Present scores and score interpretation guidelines of MMSE

C. Present total and subtest and index scores with population mean and std. deviation for WAIS, WMS, LNNB

D. Discuss subtest and index score scatter and intra-subtest variation

E.. Point out relative intellectual strengths and weaknesses

F. Comment on any signs of organicity or a learning disability

G. Speculate on client’s ability to use own intellectual resources in self-care and in

social, school, and vocational environments

H. Note whether scores converge or diverge with other indicators of cognitive-intellectual functioning (e.g., GPA, behavioral observations)

VII. Personality Functioning [justify administration of each test]

A. For each test administered, indicate:

1. Purpose of the test and why it was administered

2. Nature of the test (note number of items, scaling, score interpretation guidelines)

3. Any limitations of applying the test to the client (e.g., cultural or other differences from the standardization sample)

4. the obtained score(s), score interpretation, implication of score(s) obtained

NOTE: For normed tests, provide standardized score, population mean & SD, and cutoff score to place results in context; For content-referenced (criterion- referenced or client/subject referenced) tests, provide raw scores, relation of raw to degree of construct (e.g. higher scores indicate…), possible range, % of total, sample means, SD; cutoff scores; raw scores in terms of # of SD from sample mean; raw scores in terms of % of total; if M only, convert also to % of total; if M, SD, and cutoff scores are not available, note this lack of information

5. Whether score for each test converges/diverges with observations, semi-structured interview, and other test scores

B. List broad-band results (e.g., MMPI, MCMI, SCID-I) before narrow-band results

C. Organize narrow band individualized tests first by those used to provide converging information regarding problem behavior(s) suggested by Presenting Probems and the broad-band test(s); and then by those used to test hypotheses of behavioral/situational assets and deficits

D. Severity of problem(s) (frequency, intensity, duration, generality) and level of adjustment based on convergence/divergence of evidence from interview(s) and test scores

E.. Hypothesized determinants of the problem(s) or level of adjustment and evidence from interview and test scores

1.-conditions which intensify and alleviate condition

2.-the client's perceived origins of condition

3.-dysfunctional cognitive, affective, and motoric characteristics

4.-specific antecedents and consequences

F. Assets for change (behavioral and environmental)

VIII. Summary

A. Integrate relevant findings (convergent and divergent information)

B. Emphasize most important conclusions relevant to referral question

C. Definition of problem behaviors based on semi-structured interview and test scores

D. Indicate if there is a need for additional assessment and, if so, specify type and reason

IX. Diagnosis

A. note if there are conditions to be ruled out

B. note that the problems are not better accounted for by diagnoses with similar symptoms

C. list all 5 axes of a DSM diagnosis

X. Recommendations for further assessment if necessary; treatment (specify type) recommendations and rationale for each deficit that may contribute to the presenting problem; note assets that my facilitate adjustment; suggest tests that could be used to monitor treatment effects on problem and targeted deficits

XI. Signature, name, title, date; (ditto for supervisor if applicable)

Note: Attach all assessment materials (for class purposes only; do not include in an applied setting)

Common Semi-structured Interview Content

Purpose:

(a) build context for test results

(b) obtain client’s perspective of problems, current situation, background

(c) generate hypotheses of causal & maintenance variables

I. Presenting Problem:

A. What brought you to clinic? How would you describe your major concerns?

B. When first noticed the problem(s)?

C. What other difficulties experiencing (work/relationships/family/health)?

D. Changes in frequency of problem(s)

E. Antecedents/consequences of problem(s)

F. Intensity and duration of problem(s)

G. Previous treatment(s) and results

H. Own attempts to solve problem(s)

I. Medical problems

J. Expectations for change/treatment

II. Family Background:

A. Occupation and education of biological parents (socioeconomic level)

B. Occupation and education of caregivers and of siblings

C. Family history of behavioral problems/alcohol & drug abuse

D. Family history of medical problems and current health status

E. Marriages/separations/divorces

F. Urban vs. rural upbringing

G. Cultural background

H. Is English first language? Language spoken at home

I. Family relationships

III. Childhood & Development:

A. Birth & delivery (premature, low birth weight, mother illnesses, using alcohol or drugs, emotional state, anoxic, normal, etc.)

B. Developmental Milestones (walking, talking, toilet training); normative, delayed, advanced

C. Relationship with family/home atmosphere; supportive, conflicted, neglectful

D. Major childhood illnesses and medications

E. History of head injury (with loss of consciousness)

F. History of seizures

G. History of abuse (physical, emotional, sexual)

H. Major childhood events (divorce, frequent moves, deaths)

IV. Academic History:

A. Grammar school

1. Favorite subjects

2. Difficult courses

3. Grades

4. Special education and if held back one or more grades

5. Hobbies/activities/interests

6. Peer relationships

7. Family relationships

8. Major life changes/events

9. Acting out (legal, sexual, substance abuse)

10. Medical conditions/health

B. Middle school

1 — 10 above

11. Reaction to puberty

12. Dating and sexual orientation and gender identity

C. High school and College

1 — 12 above

13. Career/occupational interests

14. Satisfaction with life goals

15. Marriage/significant other

16. Economic stability

V. Middle and Late Adulthood

1. see IV, A — C above as relevant

2. Reaction to declining abilities

3. Self-concept

4. Spiritual beliefs

VI. Mental Status

A. Observation

1. appearance

2. consciousness

3. psychomotor behavior

4. mood

B. Conversation

1. attention and concentration

2. speech and apparent thought content

3. orientation

4. memory

5. perception

6. affect

7. medically unexplained somatic symptoms (somatoform, dissociative)

8. paroxysmal attacks (i.e., sudden increase in symptoms and emotions)

9. executive functioning

10. insight

11. judgment

GENERAL DSM-IV DIAGNOSTIC CATEGORIES

1. cognitive impairments

2. pattern of substance abuse

3. psychotic symptoms

4. mood disturbances

5. irrational anxiety, avoidance, increased arousal

6. physical complaints or anxiety about illness (somatoform)

7. factitious behavior

8. dissociative problems

9. sexual problems and gender identity

10. eating disturbances

11. sleeping problems

12. problems with impulse control

13. adjustment problems

14. autism

15. mental retardation and learning disorders

16. cluster A personality dx (paranoid, schizoid, schizotypal)

17. cluster B personality dx (antisocial, borderline, histrionic, narcissitic)

18. cluster C personality dx (avoidant, dependent, obsessive-compulsive)

19, Not otherwise specified; behavior results in distress and/or dysfunction

General Techniques Of Interviewing

Goals:

1. Establish rapport

2. Explain confidentiality and its limitations (physical harm to self or others)

3. Observe indicators of mental status

4. Elicit information to specify problems and context

5. Hypothesize causal and maintenance factors and related empirically supported treatments

6. Hypothesize diagnosis on 5 DSM Axes

1. Strategies for rapport SEE EVANS ET AL. ESSENTIAL INTERVIEWING

A. Put the client and yourself at ease

B. Show compassion (acceptance, empathy, understanding, unconditional positive regard)

C. Assess level of insight (client's view/understanding of the problem)

D. Show expertise

E. Establish leadership

F. Balance the roles (not a friendship)

G. Develop trust

2. Strategies to elicit information SEE EVANS ET AL. ESSENTIAL INTERVIEWING

A. Start with open ended questions

B. Become more focused with closed ended questions

C. Request clarification and specification when needed

D. Avoid leading questions that reflect your ideas/assumptions/values

E. Reflect to empathize and verify understanding

F. Probe for suspected problems and related factors

G. Connecting/interrelating information

H, Direct and steer the interview with transitions

I, Confront resistance and denial or lack of awareness

J. Summarize

Basic Principles Of Assessment Interviewing

(Evans et al.)

1. Attending

appropriate eye contact

professional posture

facial expression reflective of content

gestures consistent with content

caring tone of voice

rate of speech not rapid

focus on client's topic rather than introducing a new one

direct topic back to client

talk much less than the client

talk should clarify the problem

uses silence to allow client to think/show respect/signify agreement

encouragement to continue talking

attend to nonverbal behavior (glances, gestures, bodily reactions, tone of voice, pauses)

calibrate above according to cultural norms

2. Effective questioning

open-ended: for broad information from client's perspective

what for facts

how for a subjective view

could/can you for more detail/example

why: avoid using

gives client opportunity to relay idiosyncratic information

helps clients clarify their concerns

puts clients at ease

good way to begin an interview

facilitates elaboration of a point

elicits examples

closed-ended: for specific information

use less frequently than open-ended

do not ask a series of closed-ended questions

ask only one question at a time

do not use leading questions that reflect your ideas/assumptions/values

when client is answering, provide minimal encouragements

e.g., uhm-hmm, and then

repeat a word in the client's sentence

nod

eye contact

calibrate above according to cultural norms

3. Paraphrase

restate the main ideas the client has relayed

do not change the meaning of what client said

do not imitate client's words

checks your understanding

helps client verbalize thoughts and feelings

gives direction to the interview

use when client seems threatened by discussion of feelings

calibrate above according to cultural norms

4. Summarizing

systematically integrates the important ideas the client has relayed

provides a overview for client and helps him/her reorganize thoughts

helps discovery of themes

directs the interview (transition or conclusion)

use when client rambles

introduce interview by reviewing past session

calibrate above according to cultural norms

5. Reflecting feelings

empathy of affective aspect of what client is saying

empathy of affective aspect of client's nonverbal behavior

use a range of words to increase chance of identifying correct feeling

identify the full range of emotions the client exhibits

identify mixed emotions

identify feelings toward the interviewer

clear and concise

do not use exact words used by client

focus on current feelings

helps client become aware of their feelings

helps client accept and explore emotions

demonstrates your understanding of the client's experience

establishes rapport

calibrate above according to cultural norms

6. Communicating feeling and immediacy

identify feelings you have in response to the client verbally and nonverbally

communicate them when your feelings are not biased or judgmental

models expression of feelings

models trust in a relationship

promotes mutual communication

resolves tensions and discomforts

identifies incompatibilities

helps resolve client's trust issues or dependency

maintain appropriate eye contact and posture

use present tense verbs

include reaction to what is said and what is omitted

follow-up if needed nondefensively

calibrate above according to cultural norms

7. Confronting

focuses on observed discrepancies of strengths and weaknesses

state the discrepant elements and encourage the client to explore them

helps client identify contradictions and solve them

use only after rapport is established

use when client is threat to self or others

use when client has unrealistic goals

be tentative

be prepared to explore feelings

do not use if feeling angry toward client

do not confront with accusations, judgments, or solutions

calibrate above according to cultural norms

8. Self-disclosing

sharing personal information with client

remember the interviewer does not have confidentiality

should be of benefit to client and not to self

models disclosure of information

increases trust

helps client focus on problems and resources

do not take center stage from client

use after rapport is established

use in moderation

calibrate above according to cultural norms

9. Information sharing

provide the client with facts relevant to his/her needs

qualify evidential base of facts

admit when you do not know desired facts

offer to find requested facts if feasible to do so

do only if client seems receptive

be clear, concise, specific, and concrete

break down information into small units

check that client understands accurately

correct if client does not understand

provides direction of the interview

presents feedback

provides alternative perspectives and resources

calibrate above according to cultural norms

NOTE: additional interviewing techniques are interventions such as interpretation, cognitive-restructuring, behavioral rehearsal, etc.