Clinical Assessment (I) : The Assessment Interview

1. Clinical Assessment (I) : The Assessment Interview Aska Primardi

2. Clinical assessment • An evaluation of an individual's strengths and weakness • A conceptualization of the problem at hand (as well as possible etiological factors) • Some prescription for alleviating the problem • Lead us to a better understanding of the client • Assessment is not something that is done once and then is forever finished, it's ongoing process • Whether the clinician is making decisions or solving problems, clinical assesssment is the means to the end

3. The Referral • The assessment process begin with a referral • Someone (parent, teacher, psychiatrist, judge, psychologist) poses a question about the patient what influences how the clinician addresses the referral question?  answer : influenced by the clinician's theoretical commitments (pychodynamic, behavioral, cognitive-behavior. etc) 

4. The interview The assessment interview is at once the most basic and the most serviceable technique used by clinical psychologist General characteristic of interviews : • An Interaction • Interviews versus tests : interviews are more purposeful and organized than conversation but sometimes less formalized or standardized then psychological test • The art of interviewing computer-assisted interview assessment : many nonverbal cues, only clinicians are able to apply "clinical judgment", only clinicians can encode & process information

5. Interviewing essentials and techniques • The physical arrangements Few patients are likely to be open and responsive if :  Take place anywhere that 2 people can meet and interact, & Privacy and protection from interruptions • Note-Taking & recording To recall much from the earlier interviews

6. Rapport Definition : the relationship between patient and clinician. Rapport involves a comfortable atmosphere and a mutual understanding of the purpose of interview Characteristics : • Patients realize that the clinician is trying to understand their problems in order to help them 2. Patients accepts the clinician’s ultimate goal of helping. 3. Patients recognize that the clinician is not seeking a personal satisfaction in the interview

7. Communication • Beginning a session • Language • The use of question • Silence • Listening • Gratification of self • Impact of the clinician • The clinician's values and background

8. Five type of interview questions • Open-ended : gives patient responsibility and latitude for responding. Ex : "would you tell me about your experiences in the army" • Facilitative : encourage patient's flow of conversation. Ex: "Can you tell me a little more about that?" • Clarifying : encourages clarity of amplification. Ex:  "i guess this means you felt like....?" • Confronting : challenges inconsistencies or contradiction. Ex : "before, when you said....?" • Direct : once rapport has been established and the patient is taking responsibility. Ex : "what did you say to your father when he criticized your choice?"

9. Varieties of interviews (1) • The intake-admission interview Purpose : to determine why the patient has come to the clinic or hospital, & to judge weather the agency’s facilities, policies, and services will meet the needs and expectations of the patients • The case-history interview Purpose : to provide a board background and context in which both the patient and the problem can be placed

10. Varieties of interviews (2) • The mental status examination interview Purpose : to assess the presence of cognitive, emotional, or behavioral problems • The crisis interview Purpose : to meet problems as they occur and to provide an immediate resource

11. Varieties of interviews (3) • The diagnostic interview • Consists of a standard set of questions and follow-up probes that are asked in a specified sequence • Clinical psychologists evaluate patients according to DSM-IV criteria (ex : specific phobia section of the structured clinical interview for Axis I) • All patients or subjects are asked the same question • Interrater reliability : two clinicians who evaluate the same patient will arrive at the same diagnostic formulation

12. Reliability of interviews • Interrater / interjudge reliability : index of the degree of agreement between 2 or more raters of judges as to the level of a trait that is present or the presence/absence of a feature or diagnosis • Test-retest reliability : index of the consistency of interview scores across some period of time

13. Validity of interviews (1) • Content Validity : refers to the measure’s comprehensiveness in assessing the variable of interest (ex : measuring depression. Give multiple questions assessing various emotional, cognitive, & physiological aspects of depression) • Predictive validity : the degree to which interview scores can predict (correlate with) behavior or test score that are observed or obtained at the same point in the future

14. Validity of interviews (2) • Concurrent validity : the extent to which interview scores are correlated with a related, but independent, set of test/interview scores or behaviors • Construct validity : the extent to which interview score are correlated with other measures or behaviors in a logical and theoretically consistent way.