Initial Assessment in Mental Health Care Settings

1. Initial Assessment in Mental Health Care Settings

2. Types of Initial Assessment Procedures: • Clinical Interviews. • Behavioral Observations. • Symptom/Problem Checklists. • Symptom-Focused Inventories. • Personality Inventories.

3. Problem Checklists: • May be customized for one’s agency based on typical presenting problems. • Provides a quick overview of client’s reported problems. • Easy to administer, score, & interpret. • Low cost. • Lack of normative comparisons. How severe is the problem or how does the client compare to others? • Exaggerated problem presentation. Client might check every item on list.

4. Advantages of Objective Assessment Inventories over the Clinical Interview

5. College Adjustment Scales (1991) • Screening inventory for identifying common problems presented by students at university counseling centers. • Standardization sample: 1,146 college students. • Fair psychometric characteristics. • 108 items. 4-point Likert scale. • Administration Time: 15-20 minutes. • T-Scores > 60 (84th percentile) deserve further attention. T-Scores > 70 (98th percentile) are significant.

6. Anxiety. Depression. Suicidal Ideation. Substance Abuse. Self-esteem Problems. Interpersonal Problems. Family Problems. Academic Problems. Career Problems. College Adjustment Scales: Subscales

7. Symptom-Focused Inventories • Beck Depression Inventory (BDI). • Outcome Questionnaire 45. • Youth Outcome Questionnaire. • Brief Psychiatric Rating Scale. • Connor’s Rating Scales.

8. Beck Depression Inventory (BDI-II): • 21 items to which clients respond using a 4-point Likert scale (0 to 3). • Items cover various dimensions of depression representative of DSM-IV symptoms (cognitive, affective, behavioral, somatic, & suicidal ideation). • Sensitive to change: Good outcome measure. • Easy to administer, score, & interpret. Only takes 5-10 minutes to complete & score.

9. Interpretation of BDI Scores 0 to 13 = minimal 14 to 19 = mild 20 to 28 = moderate 29 to 63 = severe

10. Outcome Questionnaire-45 • Brief screening and outcome evaluation instrument designed to measure common presenting problems. • 45-items. 5-point Likert scale. • Administration time: 5-10 minutes. • Easy to administer, score, & interpret. • 3 Domains: Subjective Discomfort, Interpersonal Relationships, & Social Role Performance. • Critical items: suicidal ideation & drug abuse. • Good psychometric qualities. • Excellent outcome measure: sensitive to short-term changes. • Low cost: one-time licensing fee. Individual: $60.

11. OQ-45 Interpretation • Total Scores above 63 are considered to be significant. • Raw scores can be converted to standard scores based on several normative groups. For example, college students can be compared to a sample of undergraduates (n = 235) who had a mean score of 42.15 and a standard deviation of 16.61. z = obtained score-42.15/16.61

12. Youth Outcome Questionnaire • Parent-report instrument to identify their children's (ages 4-17) behavioral problems and evaluate treatment outcome. • Completed at intake to provide a baseline and administered over the course of treatment to monitor progress. • 64-items. 5-point Likert scale. • Administration time: 5-10 minutes. • Scores are comparable to scores obtained on the Child Behavior Checklist (CBCL) • Low cost: one-time licensing fee. Individual: $60.

13. Y-OQ Subscales • Intrapersonal Distress. • Somatic. • Interpersonal Relations. • Critical Items (inpatient treatment). • Social Problems. • Behavioral Dysfunction.

14. Additional Rating Scales • Brief Psychiatric Rating Scale. • Conner’s Series. • Hamilton Rating Scale for Depression. • Derogatis Psychiatric Rating Scale. • Global Assessment of Functioning (GAF) Scale (Axis V from DSM-IV).

15. Brief Psychiatric Rating Scale • Clinician-rated assessment of 18, severe clinical symptoms (e.g., depressive mood, disorientation, grandiosity). • Ratings should be on a 20-30 minute clinical interview. • Originally developed to evaluate efficacy of medications with severe inpatient populations (e.g., schizophrenics), but it has also been used to evaluate outpatient psychotherapy. • Public-Domain instrument.

16. Conner’s Rating Scales-Revised • Purpose: assess ADHD and co-morbid problems in children & adolescents. • Ages: 3 to 17; Self-Report: 12 to 17. • Parent, Teacher, & Self-Report scales available in long and short versions. • Standardization sample: >8,000.

17. Benefits of the CRS-R • Collection of information from multiple informants. • Items and scales are directly connected to DSM-IV criteria for ADHD. • Assess other problems typically associated with ADHD disorders. • Shorter versions of the inventory are useful for treatment monitoring and outcome evaluation.

18. Oppositional. Cognitive Problems. Hyperactivity. Anxious-Shy. Perfectionism. Social Problems. Psychosomatic Conners’ Global Index (Restless-Impulsive & Emotional Lability). ADHD Index. DSM-IV Symptom subscale (Inattentive & Hyperactive-Impulsive). Scales on the CPRS-R:L

19. Butcher Treatment Planning Inventory • Newly developed personality inventory for both treatment planning & outcome evaluation. • Designed to measure both current symptoms and personality variables that should be considered in planning intervention strategies. • 210 True-False items. • 14 Scales. • Easy to administer, score, & interpret (scored using templates). • Administration Time: 20-40 minutes. • Disadvantage: lengthy intake measure.

20. BTPI: Validity Scales • Inconsistent Responding: Did client cooperate with assessment? • Overly Virtuous Self-Views: Is the client minimizing or denying problems? • Exaggerated Problem Presentation: Is the client overemphasizing the existence & severity of problems? • Closed-Mindedness: Is the client guarded, defensive, or closed to making changes?

21. BTPI: Treatment Issues Scales • Problems in Relationship Formation: Difficulties in forming & sustaining interpersonal relationships. • Somatization of Conflict: Existence of physical complaints and the tendency to develop somatic symptoms in response to stress. • Low Expectation of Benefit: motivation for change as well as attitudes & expectations concerning therapy. • Self-Oriented/Narcissism: self-centered or feels mistreated by others. • Perceived Lack of Environmental Support: Does client have external social support? Does she feel overwhelmed by current problems?

22. BTPI: Current Symptoms • Depression: sadness, hopelessness, & suicidal ideation. • Anxiety: distress, tension, worry, and concentration problems. • Anger-Out: irritability, aggression, may be vindictive, anger control problems. • Anger-In: low self-worth, blames oneself for whatever goes wrong. • Unusual Thinking: unusual thoughts & behaviors (e.g. belief in clairvoyance), paranoid ideation.

23. Goals of Interviewing

24. Types of Interviews

25. Pros and Cons of Interviewing

26. Interviewing Principles

27. Important Information

28. Important Information

29. Additional Information • Developmental tasks. • Family History. • Cultural background. • Educational history. • Employment history. • Social Support/Interpersonal Issues. • Religion/Spirituality. • Prior attempts at solving the problem. Typical coping strategies.

30. Appearance. Behavior. Mood & Affect. Attitude toward examination. Speech/language. Cognition. Perceptions. Orientation (person, place, time). Memory. Judgment. Insight. Intellectual Functioning. Mental Status Examinations Purpose: observe symptoms of mental impairment in a controlled, interpersonal setting.