Transcript Document

Structured and Standardized
Assessments
Blake Beecher
Eastern Washington University
Learning Objectives:
1. Increase knowledge about the role and purpose of
structured assessments
2. Increase knowledge how to address findings of
structured assessments
3. Become familiar with frequently used structured
assessment tools
4. Become competent in administering, interpreting, and
scoring above assessments
5. Demonstrate ability to administer, interpret, and utilize
an assessment in demonstration with peer
What is a standardized measure?
Measures designed in such a way that the questions,
conditions for administering, scoring procedures, and
interpretations are consistent and are administered and
scored in a predetermined, standard manner.
Vary in what they measure; type; perspective of user
Uniform procedures for scoring & administrating a “test”
Enough info to judge whether test is appropriate for your
situation
Factors in Selecting Measures
Easy
Quick
Not expensive
Non-offensive (non intrusive)
Supported by research
Is applicable to your setting
Gives you beneficial information
Purpose
• What is the problem being measured?
Substance Abuse?
Depression?
Cognition?
• How sensitive or appropriate is the measure?
• What is the benefit of using this measure?
Interpretation
Clearly stated (clinical cut-offs)
Enough information
Do you understand how to use and interpret the
assessment tool?
Validity
Does the measure actually measure the presenting
issue? Does it measure what it’s supposed to?
Does the measure reflect the range of the severity
problem?
Does it increase if expected?
Reliability
How consistent, stable or dependable is the measure?
Would repeated testing yield the same result?
Advantages of Standardized Measures
Efficiency
Accessibility
Comparability
Neutrality
Evaluation friendly
Disadvantages
Psychometric problems, norms
Limits of what the test measures
Practical problems
Agency problems
Ethical problems
Administration
Ask permission
Be clear on objectives of test, how it will be used
Would you rather I read it to you?
Stress importance of accurate responses
Home, office, waiting room?
How often?
Common Assessments which may be
used in Integrated Healthcare
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DSM Diagnosis
Mental Status Exam http://aitlvideo.uc.edu/aitl/MSE/MSEkm.swf
Depression (PHQ9)
Bipolar (MDQ)
SAFE-T suicide screen
Trauma Screen (PC-PTSD)
Substance Abuse (CAGE aid)
Mini Mental State (brief cognitive screen)
Pediatric Symptom Checklist
Activities of Daily Living (Katz)
Diagnostic and Statistical
Manual of Mental Disorders
To provide clear descriptions of
diagnostic categories in order to
enable clinicians and investigator
to diagnose, communicate about,
study, and treat people with
various mental disorders
International Classification of
Disease (ICD-10)
Comprehensive classification system of
medical conditions and mental disorders
Official medical and psychiatric classification of
diseases used throughout most of the world
ICD-10 VS DSM-IV-TR
Both are the classification systems and fully
compatible, although the wording may differ.
All of the DSM-IV-TR categories are found in
ICD-10 but not all ICD categories are found in
DSM-IV.
Multiaxial System
Axis I: Psychiatric Diagnoses
Axis II: Personality Disorders
Mental Retardation
Axis III: Medical Diagnosis
Axis IV: Psychological and Environmental Stressors
Axis V: The Global Assessment of
Functioning (GAF)
Axis I: Clinical Disorders1
Anxiety Disorders
Mood Disorders
Substance-related Disorders
Schizophrenia and Other Psychotic Disorders
Delirium, Dementia, and Amnestic and other
Cognitive Disorders
Mental Disorders Due to a General Medical Condition
Eating Disorders
Adjustment Disorders
Axis I: Clinical Disorders2
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleeping Disorders
Impulse-Control Disorders
Adjustment Disorders
Axis II:
Personality Disorders3
Paranoid Personality Disorder
Cluster A: Odd,
Schizoid Personality Disorder
Eccentric
Schizotypal Personality Disorder
Antisocial Personality Disorder
Cluster B: Emotional,
Borderline Personality Disorder
dramatic, erratic
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Cluster C: Anxious,
Dependent Personality Disorder
fearful
Obsessive-Compulsive Personality Disorder
Personality Disorder not Otherwise
Specified
Mental Retardation
Axis III: General Medical
Condition
 Infection and parasitic disease (001-139)
 Neoplasms (140-239)
 Endocrine, nutritional, and metabolic
disease and immunity disorders (240-279)
 Disease of the blood and blood-forming
organs (280-289)
 Disease of the nervous system and sense
organs (320-389)
Source: DSM-IV, P28
Common Medical Conditions (Axis III) in
Integrated Healthcare
Obesity
Diabetes
Hypertension
Heart Disease
Arthritis
Injuries
Respiratory Diseases (many related to smoking)
Axis IV: Psychosocial and Environmental
Problems
 Problems with Primary Support Group
 Problems Related to the Social Environment
 Educational Problems
 Occupational Problems
 Housing Problems , Economic Problems
 Problems with Access to Health Services
 Problems Related to Interaction with the
Legal System
 Other Psychological and Environmental
Problems
AXIS V: Global Assessment of
Functioning
Reports the clinician’s view of the client’s overall
level of functioning at the time of the interview.
Uses a global assessment of functioning scale
(GAF) that ranges from a score of 100 (high) to
1 (low). It is reported as (e.g.) GAF=65.
Axis V: Global Assessment of
Functioning Scale
100-91: Superior functioning, no
symptoms
90-81: Absent or minimal symptoms, good
functioning in all area
80-71: Transient and expectable reactions
to psycho social stressors
70-61: Some mild symptoms, some
difficulty in social, occupational, or school
functioning
Axis V: GAF Scale
60-51: Moderate symptoms, moderate
difficulty in social , occupational, or
school functioning
50-41: Serious symptoms, serious
impairment in social, occupational, or
school functioning
40-31: Some impairment in reality testing
or communication or major impairment
in several areas-work, school, family
relations, judgment, thinking or mood
Axis V: GAF Scale
30-21: Behavior is considerably influenced by
delusions or hallucinations or serious impairment
in communication or judgment
20-11: Some danger of hurting self or others, or
gross impairment in communication
10-1: Persistent danger of severely hurting self or
others, or serious suicidal act with
0: Inadequate information
Multiaxial Diagnostic
Schema Example
Axis I: Major Depression Disorder
Alcohol Abuse
Axis II: No Diagnosis
Axis III: Hypertension, Diabetes
Axis IV: Social Isolation, unemployed,
housing problems,
Axis V: GAF=40 (current)
ADDRESSING Guideline to Assess for
Client Cultural Influences4
A ge and generational influences
D isability status (developmental disability)
D isability status (acquired physical/
cognitive/psychological disabilities)
R eligion and spiritual orientation
E thnicity
S ocioeconomic status
S exual orientation
I ndigenous heritage
N ational origin
G ender
Activity
Break into groups of 3 to practice one or more of the
structured instruments covered. 1 SWer, 1 client, and 1
observer. Have the student client play the role of a
client they are familiar with. After 5-7 minute
interaction, stop, all members discuss for 2-3 minutes,
then rotate.
References
1. American Psychiatric Association. (2000). Diagnostic
and statistical manual of mental disorders (4th ed.,
text rev.). Washington, DC: Author. (p. 26)
2. American Psychiatric Association. (2000). Diagnostic
and statistical manual of mental disorders (4th ed.,
text rev.). Washington, DC: Author. (p. 26)
3. American Psychiatric Association. (2000). Diagnostic
and statistical manual of mental disorders (4th ed.,
text rev.). Washington, DC: Author. (p. 27)
4. Hays, P.A. (1996). Addressing the complexities of
culture and gender in counseling. Journal of
Counseling and Development, 74, 332-338.