Initial Intake Process: Clinical Interview Training

1. Initial Intake Process:Clinical Interview Training McKay Sohlberg Jaime Lee February 2010 *note: refer to Initial Consult forms

2. Purpose of Consultation • Identify impact of cognitive impairments on daily functioning • Identify whether cognitive rehab would be beneficial • Identify and select treatment approaches

3. Prior to the Initial Evaluation… • Review available records • Diagnoses • Background information (family, education, vocational, military history) • Events thought to cause neurological impairment • Primary deficit areas • Co-occurring conditions

4. Interview Introduction • Orient client to the clinic • Inquire about special needs for comfort (seating preference, noise, lighting) • Describe purpose of visit • Complete initial paperwork (including permission to videotape) Watch the following clip of an introduction from an initial consultation and then answer the questions.

6. Questions • How does the interviewer explain the purpose of the visit? • How would you explain cognitive rehab to someone who was not familiar with our services? • What special needs might be an issue for Jeremy if he chooses to participate in therapy? Note that Jeremy starts to describe his problems with memory during the orientation. INTERVIEW TIP: Do not follow a strict script. An interviewer should respond naturally to the client and gather information as it comes.

7. Review of what is in records; Supplemental history Current living situation Current job; Avocational activites Typical day Enjoyable activites/ways to spend time Current cognitive concerns Strategies Previous therapies Supports Impact of cognitive concerns (school, home, work) Hope for therapy Clinical Interview Features Watch the next clip and answer the following questions.

9. Questions • Why did the interviewer probe about possible “issues” with the forestry job? (What hypothesis might she have been testing?) • Give an example of an open-ended question from the clip. • How does the interviewer begin to build rapport with Jeremy? • Describe one of the strategies Jeremy has discovered.

10. Clinical Interview Principles (from Sohlberg & Mateer, Ch. 13) • Simultaneously Mindful of three levels: • Words/message • Perceptions/feelings behind the words • Time restraints • Questioning: • Use open, closed questions as needed • Listening Skills • Active • Check for understanding • Natural • Rapport/Comfort • Read your client • Adjust according to client response

11. Watch next series of video clips for examples of the clinical interview principles on the previous slide. • Each video is followed by a set of comments or questions.

13. Question • How has the interviewer matched the demeanor of the client up to this point? • Does he appear comfortable? • How can you tell? • Was her joke (at the end of the clip) successful?

15. Comments/Questions • Interviewer gathers more information about children/family life/routines • Interviewer integrates information from chart review for follow-up questions • What might account for Jeremy’s difficulty with anger management and occasional outbursts?

17. Questions • Why is clinically relevant to gather information about a client’s substance use? • In this clip, the interviewer provides education about TBI and alcohol use/abuse. What responsibilities do clinicians have in this area?

19. Questions • In this clip, the interviewer completes the Compensation Techniques with the client which can provide additional useful information • What cognitive issue that Jeremy experiences frequently does the interviewer inquire further about? • How many calendars does Jeremy have? Why might this be useful clinical information? • What type of aid would Jeremy’s filing system be considered?

21. Comments • As interviewer completes the inventory, she summarizes/reviews the information he has provided, demonstrating active listening

22. In the next video, the interviewer continues to administer questionnaires. • This one is focused on identifying frequency of occurrence of different types of attention problems in the client’s day to day life.

23. Administering the APT-II Questionnaire

24. In the next few slides you’ll see the interviewer describe different options for therapy. • It is important to involve the client in the selection of therapy goals and treatment approaches. This is called “Collaborative Goal Setting.” • The interviewer only reviews options that she feels would be appropriate based on the information gathered in the interview.

26. Description of Attention Training and External Aid Therapy

27. Thoughts • The veterans are a unique ABI population with complicated medical and psychological histories in addition to their neurological deficits • In working with veterans, it’s important to demonstrate sensitivity and understanding. • Note how Jeremy appreciates the interviewers expression of gratitude for his service. He says: “You don’t hear that very often.”

29. In Summary • An effective clinical interview: • provides the clinician with needed information to select appropriate therapy options • Establishes a working therapeutic alliance with the client Note: this client’s interview was followed by an interview with his fiance. A reminder that it is important to involve natural supports in the therapy process.