Psychological assessment Flashcards
(165 cards)
1
Q
What is psychological assessment?
A
Formal process using validated and reliable measures for psychological or cognitive functioning
2
Q
Describe different types of referrals
A
Employment capacity assessment diagnosis treatment planning management
3
Q
Types of assessments?
A
Questionnaires, surveys, structured and semi-structured interviews, behavioral observations, puzzle-like activities
4
Q
Psychological Assessment reflects the values and priorities of…
A
the dominant culture.
5
Q
Psychological assessment in Australia
A
is an individualistic, capitalist euro-centric society so assessment tools are primarily individualistic.
6
Q
Why conduct an assessment?
A
To provide a valid answer to a referral question. The responsibility rests with the psychologist to refine and clarify the question
7
Q
what is the referral context?
A
The referral question may be present in a variety of contexts affecting the structure and content of recommendations
8
Q
Referral settings are generally in
A
psychiatric, general medical, legal, academic, or psychological private clinics.
9
Q
Decision-maker roles
A
A psychologist will act as a consultant in psychiatric, medical, and academic settings while being the main decision-maker in private practice.
10
Q
Psychiatric settings referrals center around
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characterization and treatment planning
11
Q
Psychiatric conflicts
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different conceptual models. Medical model vs people/societal model.
12
Q
General medical referrals center around
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investigating psychosocial factors which maintain medical symptoms
13
Q
Legal referrals center around
A
custody decisions, not guilty by insanity, sentencing decisions, risk of reoffending
14
Q
Legal conflicts
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care in the use of diagnosis language as legal terms can differ ie insanity is a legal term
15
Q
Academic referrals can assess
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cognitive functioning
career planning
behavioral issues
16
Q
Academic clients
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students, teachers, parents
17
Q
Academic considerations
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should consider the family and school environment as children are heavily influenced by their system. Physical issues - vision, hearing, endocrine function
18
Q
Psychology clinical practice assessment depends on…
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the presenting issue, philosophical stance, resources of setting, and preference of the client.
19
Q
Dual roles of psychologist
A
as therapist and assessor - thought as to how to approach assessment in a client-centered therapeutic manner (without bias)
20
Q
Dudgeon et al. 2014
A
research finds that culture-neutral assessments are difficult to create.
21
Q
Why understand referral settings?
A
to avoid administrating useless tests and information in unique settings
22
Q
Why investigate referral motive?
A
The evaluation may not be needed
23
Q
Referral assessments must be in response to a specific…
A
question where an answer and decision must be made.
24
Q
Exploring and clarifying
A
teasing out the referral questions rests with the clinician to put the client’s problem into a practicable context
25
Limitations and advantages of psychology assessments should be…
clearly defined for the client
26
Psychiatric settings / the psychiatrist has multiple roles which are
ward administrator, therapist, and physician
27
Potential conflict - psychiatric -
| Patients may be frustrated if a psychiatrists multiple roles…
are not clearly defined resulting in resistance and defensiveness
28
Potential conflict - psychiatric 2
Therapist bias, psychiatrist may have unreasonable expectations, countertransference of patient
29
Ward administrator referrals center around
suicide risk, admission and discharge, suitability for medical procedures
30
Psychiatric primary focus
custody, freedom of patient, the safety of society. paradigm shift from 40 years ago when the focus was on diagnosis and treatment
31
Psychiatric/Psychologist relationship
Should be aware of medical models, terminologies, and legal and custodial responsibilities in providing advice. Legal or hospital policy may require a traditional diagnosis.
32
Decision-maker - psychiatric
A psychiatrist is a decision-maker - may describe antipsychotics, electroconvulsive, or psychotherapy to patients.
33
Psychological advice should be translated into a conceptual model…
understandable for a psychiatrist which is task orientated
34
General medical referrals
underlying psychological disorders, emotional factors, neurological deficit, chronic pain, chemical dependency
35
General medical issues
two-thirds of patients have primarily psychosocial difficulties, those patients with a medical diagnosis, 20-50% also have a psychological disorder
36
Decision -maker in medical referrals
Physician
37
Assessment in general medical can be
complex requiring more than one assessment
38
Neuropsychological role
investigate the nature and extent of lesions on the brain, emotional status, extent of disability, treatment planning, cognition rehabilitation, vocational training, and readjustment of family and friends.
39
Psychologist role
Presurgical evaluation to assess stress reaction, early signs of psychological disorder, other contributing factors in the environment, future prospects
40
Legal Context
may be consulted to assess reliability and quality of info presented by the witness. competency of accused, specifics of a crime, false confessions, insanity plea, jury selection, false confessions, brain damage assessment, confinement, level of dangerousness, rehab programs, malingering and deception, custody issues
41
1 in10 cases will require a
| Psychologist to explain
conclusions, generalisability and explain the scientific method. The defense may attempt to discredit testimony and credibility.
42
Legal terms
nuances in legal terminology should be understood to avoid negative consequences i.e incompetence, reasonable certainty, insanity
43
Potential conflicts - legal
insanity plea - ambiguity around term, and difficult to evaluate malingering to receive lighter sentences.
44
Potential conflicts - legal 2
prediction of dangerousness. While violent and self-destructive behaviour has a low base rate, the cut off criteria produces false positives. This is because it is acceptable to to err on the side of caution.
45
Child custody
central consideration is in the child's best interest, mental health of parent, quality of love and affection, nature of parent-child relationship, long-term effects of the decisions on the child.
46
Correctional settings
managing a person vs rehab program. Level of suicide risk, appropriateness of dormitory vs shared room, possible harassment from other inmates, degree of dangerousness to others.
47
Rehab recommendations - legal context
may consider personality, educational level, interests, skills, and abilities related to employment.
48
Academic context
nature and extent of a child’s learning difficulties, measuring intellectual strengths and weaknesses, assessing behavioral difficulties, creating an educational plan, estimating a child’s responsiveness to intervention, and recommending changes in a child’s program or placement
49
An evaluation should be sensitive to
the interactions among a child’s abilities, diversity considerations, the child’s personality, the characteristics of the teacher, and the needs and expectations of the parents.
50
Observation
between the teacher and child should be observed, as sometimes a teachers style and interaction may be the problem.
51
Limitations of traditional testing
limited range of information as children are not reliable self-reporters and parents/caregivers may be biased.
52
Combination of tests
tests combined with family and classroom assessment may be needed
53
Resistance may be legal or ethical regarding
the scope of services the school can provide or the information a a psychologist can ask of the parents.
54
Labelling a child a problem child
obscures other complex factors such as marital discord, disturbed teacher, misunderstanding between parent and teacher or school and parents. Disordered school system or family difficulties.
55
Psychology reports
should focus not only on a child’s
| weaknesses but also on his or her strengths.
56
Recommendations are most effective when
there is a thorough understanding of the community, the school system, and class room environment.
57
Recommendations can
specify skills to be learned, how these will be learned, hieracy of objectives, , techniques to reduce behaviours that make learning difficult
58
A psychological report
should be followed with with continuous monitoring
59
The psychoeducational assessment of children should be carried out in two phases.
the first phase assesses the child’s learning environment.
60
The second phase involves a comprehensive assessment
of intellectual abilities, academic skills, adaptive behavior, and screening out any biomedical disorders that might disrupt learning. Intellectual abilities might involve memory, spatial organization, abstract reasoning, and sequencing.
61
A child will not perform effectively unless
the have adaptive abilities, such as social skills, adequate motivation and attention, and the ability to control impulses.
62
In contrast to the medical, legal, and educational institutions where the psychologist typically serves as a consultant to the decision-maker, the psychologist working in a psychological clinic often is
the decision-maker.
63
Types of referrals in psych private clinic
individuals who are self-referred for which extensive psychological testing may not be relevant as their diagnoses and issues may be relatively straightforward.
64
Treatment assessments in a psychological private clinic can involve
brief instruments which can help develop treatments that will speed the rate of improvement as well as optimize the outcome
65
Other types of clients in psych private practice
self-referred clients about whom the psychologist may question whether the treatment available in a psychological clinic is appropriate. e.g extensive medical problems, individuals with legal complications that need additional clarification, and persons who may require higher levels of care may be necessary to obtain additional information through psychological testing.
66
The main purpose of testing in private practice
aid in decision making rather than to serve as a direct source of help for the client or aid in understanding unclear diagnoses or whose treatment has stalled or plateaued.
67
Other types of referrals that involve children are
referrals by their parents for school or behavioral problems and referrals from other decision-makers. When referrals are made for poor school performance or involving legal complications, special precautions must be taken before testing.
68
Referrals for children
it is important to obtain all information regarding these events. After the referral has been clarified, the clinician may decide to have a meeting with different individuals who have become involved in the case, such as the school principal, previous therapists, probation officer, attorney, or teacher
69
Psychological clinic context
the psychologist is the main decision maker
70
What type of referrals? Psychological clinics
Self-referred clients. Clients who may not know what is wrong and require assessments.
71
The main purpose in psychological clinical assessment
is to aid in decision-making, as the client may need more complex assistance e.g medical, legal, or psychiatric attention.
72
Referral sources are often vague. It is the responsibility of the clinician to
develop an understanding of the complexity - i.e social, family, interpersonal and sequence of events.
73
Knowledge of settings
clinicians responsibility to develop knowledge re setting when writing reports.
74
Conflicting values and beliefs
clinicians should assess how the values of setting conflict with their own set of beliefs ie. corporal punishment, and electroconvulsive therapy. Consider changing the relationship if there is a conflict.
75
Limitation of assessment - test results alone are not sufficient to…
understand the whole picture and complexity of presenting issues.
76
Criticism of ethical practice of assessment
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used in inappropriate contexts
confidentiality
cultural bias
invasion of privacy
release of test data
use of tests inadequately validated
```
77
What are the most important guidelines and issues for the ethical practice of assessment?
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Develop a professional relationship
Informed consent
labeling and restriction of freedom
competent use of assessment instruments
Interpretation and use of test results
communicating test results
maintenance of test security
and release of test data
```
78
what is the significance of a professional relationship?
The quality of the relationship builds rapport. Conditions of the relationship are agreed upon, and relevant information is provided followed by a signed consent.
79
What influence does Verbal reinforcement and rapport or culturally relevant feedback have on test results ?
can influence test results. The level of rapport should be kept constant from one test to the next.
80
Feldman & Sullivan, 1971
Enhanced rapport with older children involving verbal reinforcement and friendly conversation has been shown to increase WISC-R scores by an average of13 IQpoints compared with an administration involving more neutral interactions. nearly 1 SD.
81
Witmer, Bornstein, & Dunham, 1971
mildly disapproving comments, such as “I thought you could do better than that,” resulted in significantly lowered performance when compared with either neutral or approving comments
82
Fuchs and Fuchs (1986)
on average, IQ scores were 4 points higher when the examiner was familiar with the child being examined than when he or she was unfamiliar with the child. This trend was particularly pronounced for children from lower socioeconomic status.
83
Lefkowitz &Fraser, 1980; Sattler, 1973a, 1973b; Sattler &Gwynne, 1982)
Little evidence to support the belief that African American students have lower performance when tested by European American examiners, it has been suggested that African American students are more responsive to tangible reinforcers (money, candy) than are European American students, who generally respond better to verbal reinforcement (Schultz & Sherman, 1976).
84
Terrell, Taylor, and Terrell (1978)
demonstrated that the main factor was the cultural relevance of the response. They found a remarkable 17.6-point increase in IQ scores when African American students were encouraged by African American examiners with culturally relevant comments such as “nice job, blood” or “good work, little brother.” Thus, positive rapport and feedback, especially if that feedback is culturally relevant, can significantly improve test performance.
85
R. Rosenthal, 1966
researcher/examiner’s expectations can influence another person’s level of performance
86
Client’s relative emotional state.
advisable to discontinue testing because situational emotional states may significantly influence the results of the tests. examiners should consider the possible effects of emotional factors and incorporate these into their interpretations.
87
Sattler, Hillix, & Neher, 1970; Sattler & Winget, 1970)
indicated that the more the examiner likes the client, the more likely he or she will be to score an ambiguous response in a direction favorable to the client. Higher scores can occur even on items in which the responses are not ambiguous (Egeland, 1969; Simon, 1969).
88
Limitations to confidentiality
occur in situations involving child/elder abuse, danger to self or others, and information that has been requested based on a subpoena.
89
Informed consent issues
Many formal consent forms are written at a level far above the reading comprehension level of a large proportion of clients
90
Rationale for testing
should be described to the client in a general way rather than showing specific subscales etc.
91
Invasion of privacy
defined privacy as “the right of the individual to decide for him/herself how much he will share with others his thoughts, feelings, and facts of his personal life.” This right is considered to be “essential to insure dignity and freedom of self-determination” (p. 2).
92
Issue of privacy occurs mainly in
personality tests, as items relating to motivational, emotional, and attitudinal traits are often disguised. Thus, persons may unknowingly reveal characteristics about themselves that they would rather keep private. Similarly, many individuals consider their IQ scores to be highly personal.
93
Australian Psychological Society (APS) position statement
psychologists must be competent in administering and interpreting any test they use and assessments must be conducted with a clear view to benefitting the client and ‘doing no harm’.
94
APS guidelines state that
Clients need to give informed consent and consideration must be made regarding confidentiality and who will be made aware of the assessment findings.
95
Ethical guidelines - Labels
impact of labels and the potential for stigma.
96
Ethical cultural considerations
Linquistic equivalence
Conceptual equivalence
Metric equivalence
97
What is Linguistic equivalence?
Has the test been translated accurately?
98
What is conceptual equivalence?
Do the concepts mean the same for all parties from different cultures?
99
What is metric equivalence?
Does the instrument have similar psychometric properties across groups? For example, if the test is intended to predict college performance for one demographic group, does it also apply to other groups?
100
Why is cultural awareness important in testing?
It is important to be aware of any cultural discrepancies that might affect the assessment and thereby skew the results.
101
What are the steps of Culturally appropriate assessment testing processes
Proactive steps
Assessment outset
Assessment process
Results reporting
102
Describe step 1
Proactive steps before the assessment require that practitioners receive and
maintain formal training in culturally appropriate assessment.
103
Describe step 2
practitioners - comprehensive interview with their client before deciding on the assessment processes and use of any formal testing (if that seems appropriate).
Exploration of cultural history, contact with other cultural groups, acculturation status and stress, and some assessment of language and language skills. This may include using an interpreter and/or the translation of the material. A crucial element of this stage is to explain fully and document the limitations of any testing protocol that may be used.
104
Describe step 3
The assessment process requires that practitioners recognize and document the impact of language and non-verbal communication. Proactive training should alert the assessor to the potential impact of culturally relevant international variables.
105
Describe step 4
The interpretation and reporting of results require that practitioners incorporate cultural explanations and avoid labeling in the final stage when interpreting the results.
106
The ethical code of the American Psychological Asso-ciation (2002) on the release of information.
can be released only with the permission of the client. exceptions regard the rights of minors or when clients are a danger to themselves or others.
107
What is inviolacy?
inviolacy involves the actual negative feelings created when clients are confronted with the test or test situation. Inviolacy is particularly relevant when clients are asked to discuss information they would rather not think about.
108
Labelling
Many psychiatric diagnoses present a possibility of creating a self-fulfilling prophecy based on the expected roles associated with a specific label.
109
Self-acceptance of labels
Clients may use their labels to excuse or deny responsibility for their behavior.
110
Sense of helplessness vs sense of responsibility
persons see themselves as helpless, passive victims under the power of mental health “helpers” (Szasz, 1987). This sense of helplessness may serve to lower people’s ability to deal effectively with new stress. In contrast to this sense of helplessness is the belief that clients require an increased sense of responsibility for their lives and actions to effectively change their behavior.
111
Labeling and creativity
can limit progress and creativity in an individual or a system.
112
To correctly administer and interpret psychological tests,
an examiner must have proper training with lengthy supervised experience
113
Tests
should only be used for what they were designed to be valid.
114
Test norms and materials can become
outdated.
115
A rule of thumb
clinicians should stay updated on the past 10 years of research
116
Feedback and results
should use clear and everyday language
117
Maintaining test security
is an ethical legal obligation related to trade secrets and agreements made with test publishers.
118
Security of assessment results
only client is allowed to see them or those designated by client
119
Medical context conflict
all medicals have access to medical chart - which reflects conflict between psychological and medical privacy guidelines.
120
Compromised when many corporations have access
for example - legal, insurance companies, referral source, and rehab provider
121
Test data vs test scores
test data refers to raw and scaled scores, such as subscale scores and test profiles. test materials refer to “manuals, instruments, protocols, and test questions or stimuli.
122
Exception of the release of test materials
release of test materials would constitute a breach of trade secrets, copyright, and the conditions of purchase (Behnke, 2004). One exception may be released to persons who are properly qualified (Tranel, 1994). Another exception is when a subpoena specifically squashes these terms of purchase, copyright, and trade secrets.
123
Guidelines for assessing diverse groups
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Language skills
cultural competency
cultural/racial identity
test equivalence and appropriate use of instruments
Diagnostic issues
Interpretation guidelines
```
124
Describe what may be needed in relation to Language skills
conduct assessment in the native language if needed (translator).
125
Issues with language
the client may struggle with English and appear uncooperative or flat. Instruments may need to be translated into the native language.
126
Cultural competency of clinicians
begins with self-exploration of personal histories, attitudes, and knowledge.
127
Service etiquette
For example, Native Americans are comfortable with minimal formality whereas Asian Americans expect more formal interactions. Other factors - are eye contact, physical proximity, the volume of voice, and the extent to which emotions are conveyed.
128
Cultural/racial identiy
cultural identity varies according to the extent that a person identifies with his or her culture. Some individuals have quite strong identifications with their cultures.
129
Level of identity
assessed informally through interview. formal instruments can help with assessing language proficiency/preference, religious beliefs, foods, family structure, value orientation, socioeconomic status, collectivism/individualism, and culture-specific traditions, customs, and identifications.
130
Differences within cultures
India and Asia - regional differences in culture
| Hispanics - Mexico, Spain, Argentina
131
Test equivalence and use of instruments involves
the client’s level of acculturation, language preference, language proficiency, availability of translations of the instrument, whether the construct is the same for the client’s culture, availability of norms, and availability of possibly more appropriate alternatives specific to the client’s culture.
132
When or not to use an instrument in CALD populations
At the core of whether or not the test is appropriate is evaluating the equivalence of the test. Equivalence can be organized according to linguistic, conceptual, and metric equivalence.
133
If a test is not equivalent it may result in
Bias towards minority groups
134
critics believe that psychological tests are heavily biased in favor of, and reflect the values of...
European American, middle-class society
135
Linquistic equivalence
which is whether the test has been translated accurately. In back-translation, once the test is translated, it is then translated back into the original language. If the mean-ings of the items are still the same, then the back-translation helps to ensure that the translation is conceptually adequate.
136
Language - Idioms, pictures
need to be comparable
137
Conceptual equivalence
which requires the constructs to have the same meaning in various cultures. More collectivist cultures may emphasize the obligation to the group or family as being a more important aspect of dominance than individualistic cultures. It should be noted that various aspects of conceptual equivalence may emerge during translations of the test. For this reason, linguistic and conceptual equivalence are somewhat overlapping strategies.
138
Metric equivalence
Assessing the extent to which the psychometric properties are different can include evaluating such areas as content, criterion, and construct validity. Note that a prerequisite for metric equivalence is that conceptual equivalence needs to be demonstrated first
139
Tests - unfair for various groups in what ways
```
participants may not know the host country's political system;
lack of familiarity with middle class culture;
facts and idioms known for ethnic groups; may not have had the opportunity to learn re host country. Differences in socioeconomic status. effects of discrimination, level of acculturation, gaps in skills, genetic differences.
```
140
Tests reflect
unequal environments and opportunities- inequalities for minorities.
141
Diagnostic issues
cultural concepts of distress may result in misdiagnosis. E.g depression might be presented in physiological terms within some cultures, dhat syndrome is a cluster of anxiety, depression, and somatic complaints.
142
Interpretation guidelines
Acculturation, equivalence, cultural competence, and the client’s self-description within the context of his or her culture all need to be taken into account.
143
clinicians need to be both flexible and sensitive
For example, the pathological aspects of a high score on MMPI-2 Scale 6 (Paranoia) may need to be moderated if elevated for a client who has experienced significant racial discrimination. Similarly, indicators of emotional expressiveness on the Rorschach may need to be modified if the person’s emotional responses seemed to be “blunted” due to struggles with English as a second language.
144
Selecting psycholgoical tests
The most important factor in test selection is the extent to which the test is useful in answering the referral question.
145
Examples of selecting appropriate tests
An assessment of neurological patients might use tests sensitive to the cerebral deficit; patients with depression might be given the Beck Depression Inventory–II (A. T. Beck, Steer, & Brown, 1996); and patients with pain might be given the McGill Pain Questionnaire (Melzack, 1975), Millon Behavioral Health Inventory (Millon, Green, &Meagher, 2000), or Illness Behavior Questionnaire (Pilowski, Spence, Cobb, & Katsikitis, 1984).
146
Test selection should be selected according to
practitioner’s training,
| experience, personal preferences, and familiarity with relevant literature
147
Issues with tests
Faking = malingering (inconsistent effort). Some speciality instruments are designed to detect faking.
Time and cost - shorter forms of instruments can be used (this is not valid for cognitive tests)
148
Statistical formulas
personnel decisions, academic predictions, and some clinical decisions (recidivism rate, suicide risk), clinicians may be advised to use statistical formulas. The two basic approaches for combining test results are multiple regression equations and multiple cutoff scores. Multiple regression equations are developed by correlating each test or subtest with a criterion. The higher the correlation, the greater the weight in the equation. The correlation of the entire battery with the criterion measure gives an indication of the battery’s highest predictive validity.
149
Computer-assisted assessment
Use of computers can
save valuable professional time, potentially improve reliability and fidelity to standardized administration, reduce possible tester bias, and reduce the cost to the consumer by improving efficiency
150
Limitations of computer-assisted assessment
Butcher et al.
(2004) concluded 60% of the interpretations were appropriate. Although this finding generally supports the use of computer-based interpretations, the fact that 40% or more of interpretations were not considered accurate means that the computer-based interpretations should be carefully evaluated.
151
practitioners should not blindly accept computer-based narrative statements but rather should ensure
statements are both linked to empirically based research and placed in the context of the unique history and unique situation of the client.
152
APS - Position statement - The interpretation of the results of a psychological test and the integration of these results with other assessment information (e.g., interviews, observations)
must be undertaken by psychologists who have a sound knowledge of the administration, scoring and interpretation of the particular test instrument being used and of the psychological theory and test theory underlying that test,and the context in which the test is used.
153
The administration and scoring of a psychological test is
undertaken by a psychologist who is fully familiar with the test or can be undertaken by a person with training in the administration and scoring of tests working under the direct supervision of a psychologist.
154
Psychologists ensure that they select and use psychological tests that are based soundly on
theory, have adequate psychometric properties, are appropriate to the testing situation, and take account of client characteristics including age, gender, cultural background, language ability, and mental state to ensure that the testing will yield meaningful information about the individual or individuals being tested.
155
Psychological tests and test materials are stored securely in accordance with legislative requirements.
Protection from inappropriate public exposure to psychological tests and test materials, including test protocols or record forms, is the responsibility of the psychologist.
156
Aboriginals and assessment
the misuse of assessment has perpetuated stereotypes based on race, culture and ethnicity.
157
Much of the suspicion that Aboriginal people have regarding assessment derives from
its political nature as a process of social and cultural control.
158
Historically assessments of Aboriginal peoples have been
deeply rooted in a power differential (coloniser vs colonized)
159
What is the assessment? Aboriginal context
Australia has a Western medical model focused on the individual. This model leads to poor outcomes for Aboriginal populations.
160
The need for culturally appropriate assessment
For Aboriginal people, mental health is holistic - social, emotional, spiritual, and cultural life of people and communities. Wellbeing = strong body, mind and spirit.
161
Psychologists should
use culturally appropriate assessments, take into account cultural issues and comply with principles and practices relevant in national, state, and local guidelines, policies, and frameworks.
162
Assessment guidelines and standards acknowledge that
assessment should be systemic taking into account individual, family, and community factors to avoid misdiagnosis.
163
DSM 5 contains
questions that acknowledge the intersection of conceptions of race and mental illness that can affect the overall SEWB and mental health of groups/individuals.
164
Reports show that
Aboriginals with a disability face multiple layers of discrimination resulting in underrepresentation in receiving a positive diagnosis, treatment and care.
165
Criticism of the DSM guidelines
pathologizes the ordinary. Focuses on deficits and problems at the expense of personal achievements, resources, and aspects of functioning or wellbeing. Risks of overdiagnosis, discrimination, stigma - undermining self-efficacy and motivation (APS).
