INTRODUCTION TO PSYCHOLOGICAL ASSESSMENT Clinical Psychological Assessment o Process of systematically gathering information about a person in relation to his or her environment so that decisions can be made based on this information that are in the best interests of the individual Compas and Gotlib Steps towards Assessment o Referral question deciding on what is being assessed Many sources self family member teacher judge Issue may or may not be the referral question Examples of Referral questions Is there a significant psychological problem What s the nature of the problem One of emotion thought or behavior What are the possible causes what happens if it s untreated What treatment is likely to help What are the strengths of the individual Patient Targets of Assessment Biological age developmental level sex race temperament physical symptoms medical history psychophysiological processes HR BP Affective mood and affect past and present feelings about illness treatment health care providers coping strategies and history social support network Cognitive thoughts style intelligence education understanding about disease and treatment perceived meaning attitudes and expectations religious beliefs perception of control Behavioral play activity level interactions with family friends and providers health habits compliance ability to control symptoms behavior Family Targets illness in family Physical home setting economic resources size of family familial pattern other Affective family members feelings reactions about patient illness and treatment Cognitive Parents knowledge about illness and treatment attitudes and past family psychiatric history expectations intellectual resources Behavioral patient care reinforcement parenting family routines family system and roles sibling behavior communication patterns familial models for symptoms Sociocultural Context Targets Physical social services financial resources social networks primary supports friends school setting flexibility Affective Sentiment of culture regarding patient illness and treatment Cognitive Current knowledge attitudes toward patient and illness Behavioral customs in symptom reporting and help seeking laws regulating health practice school and employment policies ethnic customs o Determining the goals of assessment Diagnosis Determination of severity of problem Risk screening for future problems Evaluation of the effects of treatment Predictions about the likelihood of future behaviors o Selecting standards for making decision How to define if a problem exists Normative standards o Where does this person lie in comparison to others normal curve o Test results are converted to standardized scores Self referent standards change over time o Collecting data Methods of Assessment Clinical Interview primary method structured or unstructured Questionnaires Diaries Behavioral Observation Psychophysiological Measures Archival Data Types of Interviews o To determine whether to intake the client into the agency or refer Intake Interviews elsewhere Diagnostic interviews o To provide DSM diagnosis o Structured interviews often used Advantages Minimize subjectivity enhance reliability Disadvantages rigid limited to DSM more qns than necessary Semi structured interviews include some structure but also some flexibility or opportunities to improvise o Examples of structured clinical interviews Diagnostic Interview Schedule Structured Clinical Interview for the DSM Mental Status Exam o Widely used in medical settings o Observations of how a client is functioning at that time Appearance behavior psychomotor activity Attitude toward examiner Affect mood speech and thought perceptual disturbance orientation to person place and time Memory and intelligence reliability judgment and insight Crisis Interviews o Assess problem and provide immediate intervention o Clients are often considering suicide or other harmful acts Specific Interviewer Responses Open ended and closed ended questions o Open spontaneous responses form clients Tend to elicit long answers o Closed less elaboration quick and precise answers Reliability Can we trust the data Reliability consistency of measurement o Test retest reliability correlation 0 80 suggests reliable o Internal consistency reliability Degree to scores on items measuring same thing are related ex Average of all possible correlations between two halves of measure coefficient alpha or Cronbach s alpha 0 70 suggest reliability o Inter rate reliability Validity degree to which it reflects the construct of interest Kappa coefficient reflects correlations between 2 raters Content validity has content appropriate for what is being measure Construct validity degree to which measure reflects features of construct factor analysis Criterion related validity degree to which measure of construct is related to other measures of the construct o Convergent validity correlates with other measures of the same thing o Discriminant validity does not correlate with measures of something else o Making judgments and recommendations Common errors in clinical assessment Errors of selective attention o Confirmatory biases weight data that confirms our beliefs o Confidence in our hypotheses grows over time even in absence of data Errors in retaining and accessing information ex matching new case with old one in memory Errors in judgment illusory correlation Clinical vs Statistical Prediction Paul Meehl 1954 Book suggesting that combining information to form clinical judgments more accurate when statistical than subjective Grove et al o Clinical vs mechanical prediction meta analysis of 136 studies o Mechanical methods of combining data to form conclusions 10 more accurate than clinical regardless of judgment task experience of clinician or type data o Clinical predictions particularly bad when relying on unstructured clinical interviews o Communicating information Written psychological reports CLINICAL NEUROPSYCHOLOGY Clinical Neuropsychology Study of the relation between brain function and behavior measuring functioning of the brain o Deals with the understanding assessment and treatment of behaviors directly related to the functioning of the brain Neuropsychological Testing o Measures cognitive functioning impairment of brain and its specific components or structures o Also helps to make prognosis plan rehab determine eligibility for accommodations o Often used after a head injury a brain illness or prolonged alcohol or drug use o