Understanding Assessment

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1 Understanding Assessment Wilson Kenney, PhD

2 Disclosures and Comments Unpaid presentation The majority of my assessment work is paid by the indigent defense fund and via private assessment work I have contracts with Marion County Juvenile Justice, Marion County Health Department and Addictions and Mental Health to provide a variety of assessment and consultation services I serve on the Marion County Subcart Committee regarding concerning sexual behavior in children who are to young to be adjudicated I provide occasional pro-bono consultation to Marion County District Attorney s office and provide occasional pro-bono training to Salem Police Department I am a member of the Oregon Forensic Evaluator Panel

3 Indicators you might need an assessment

4 The Players Psychologists: PsyD: CBT Based PhD: Orientation Varies Psychiatrists: MD: Medical Model Master Level Clinicians MA/MS/MSW/MEd Eclectic

5 The concept Can behavior be explained? The pond vs. the stream Static vs. dynamic The frog Medical model vs. contextual model

6 Why or why not assess? Upsides Deeper understanding of complex individuals Great at answering specific questions Norm Based comparisons on: Intelligence Neuropsych Behavior Personality Adaptability Risk Context may be considered Downsides Evaluator dependent Slow (I mean really slow) Unresponsive to changes Limited relevance Expensive

7 Domains Psychological Cognitive Personality Psychopathology Behavior Adaptive Neuropsych Forensic Competency REI Mens Rea Dim Cap Mitigation Presentencing Risk Psychosexual Threat Suicide

8 Tools Norm Based Projectives Other

9 What is norm based?

10 Good Psychological Assessment Includes Informed Consent Careful Examination of Documentation Mental Status Exam Interview/s Test Administration

11 Clinical Interviewing On the importance of being a bloodhound Bio/Psycho/Social Narrative On the importance of context Jack & Jill Different from therapy Eliciting Symptoms Using the client s language

12 Psychological Assessment: Cognitive/Intelligence Popular Instruments Differential Ability Scales-2 Wechsler Intelligence Scales for Children-5 Stanford Binet Intelligence Test Woodcock Johnson-4 Wechsler Abbreviated Intelligence Scales-2 What they (mostly) tell you: Verbal Ability Reasoning Working Memory Processing Speed How/Why is this relevant?

13 Psychological Assessment: Personality Popular Instruments Jesness Inventory-2 Minnesota Multiphasic Personality Inventory-A Personality Assessment Inventory-A Millon Adolescent Personality Inventory What they (mostly) get at Testing Approach Social Maladjustment Mood Anxiety Thought disorder Temperament Personality Features Openness Contentiousness Extraversion Agreeableness Neuroticism

14 Psychological Assessment: Psychopathology Popular Instruments Beck Depression Inventory Trauma Symptom Checklist for Children Gilliam Autism Rating Scale Multidimensional Anxiety Scale for Children Connors-3 (ADHD) Rorschach Inkblots

15 Psychological Assessment: Behavior Popular Instruments Behavior Rating Inventory of Executive Functioning Behavior Assessment System for Children Connors-3 Gilliam Autism Rating Scale Typically provide multisource analysis

16 Psychological Assessment: Adaptive Popular Instruments Scales of Independent Behavior Vineland Adaptive Behavior Scales Adaptive Behavior Assessment System Data is only as good as their relationship to the child

17 Good Psychological Reports Include Referral Source & Questions List of Data Sources Documents Reviewed People Interviewed Instruments Used Summary of documents Description of setting Description of Informed Consent Mental Status Physical/Behavioral Emotional Interpersonal Cognitive Description of Interview/s Client s words Description of testing results with interpretation Synthesis of information Diagnoses Case Formulation Recommendations

18 A bit more on case formulation Different from diagnoses Should be data based In layman s terms Answer the referral question Nexus is the key

19 A bit more on recommendations Should address referral questions Should be supported by case formulation Should discuss remediation in real-world terms May include: Placement Supervision Additional Assessment

20 How to prepare for assessment Know what you want to know: make it clear to the evaluator what your specific questions are. Don t be afraid to ask evaluators how they intend to address the referral question. Be thoughtful about the information you want the evaluator to review. A brief letter can be incredibly helpful in outlining the case and voicing your concerns. Don t pay for information you don t want.

21 Psychosexual Assessment

22 Psychosexual Assessment An unequivocal mess No clear guidelines regarding who can administer Results vary wildly as a function of administrator Potentially selfincriminating Poorly defined What you get varies as a function of the evaluator s training and orientation

23 Psychosexual Assessment: Typical Problems Informed consent/competency Limited testing Misuse of risk assessment Misuse of polygraphy Case formulation is not data based Conclusions go beyond data Poorly developed recommendations Very dependent on selfreport

24 Psychosexual assessment: Bare Minimum Psychological Assessment Plus: Sexual Development Sexual History Sexual Fantasies Sexual Behaviors Estimation of Risk Case Formulation Recommendations Supervision Placement Treatment Further Assessment

25 Psychosexual Assessment: Goals Determine offender typology Determine supervision needs Determine remediation needs Estimate risk

26 How an Offender Gets Constructed: Equifinality Cause A Cause B Cause C Biological/Genetic Factors Pedophilia Low IQ Left handed Short Psychopathy Outcome Environment/Exposure Trauma/Reactivity Pornography Sexualized Environment The Role of Masturbation

27 Typologies Much debate but 1. Normal Sexual Exploration Needs guidance, education and limit setting 2. Sexually Reactive Behaviors Sexually preoccupied and anxious Needs sexual victims therapy and supervision 3. Extensive Mutual Sexual Behaviors Often have history of abuse and abandonment Seeking connectedness Needs social skills training, therapy and supervision 4. Children who Molest Predatory, obsessed, remorseless, compulsive Needs vary

28 Psychosexual Assessment: Be afraid of SO treatment SO Treatment Mostly CBT/psychoed based Not great for: Low Cognitive Learning Disabled Autistic Pedophilic Socially Maladjusted Seriously Mentally Ill Traumatized Kids Works pretty well for socially inept, average IQ, with few complications

29 Psychosexual Assessment: Thinking about treatment SO-Specific Individual Treatment Group therapy Contextual Systemic Psychoeducational Systemic CBT/DBT/ETC. Insight Oriented Experiential Behavioral Cognitive Behavioral Behavioral

30 Psychosexual Assessment: Matching Tx to Typology Considerations Cognitive Ability Mental Illness Behavioral Issues Supervision Needs Familial Concerns Social Maladjustment Sexual Deviance Substance Use Contextual Factors

31 Psychosexual Assessment: Thinking about Risk Static Dynamic General Conditional Actuarial Based Risk Assessment Structured Professional Judgment JSOAP ERASOR DASH

32 Psychosexual Assessment: More about polygraphy Estimated around 70% accuracy in best situation Not great for: Socially Maladjusted Mentally Ill Neurologically Atypical Low Cog Medicated Best in treatment context when used thoughtfully

33 Plethysmography Not normed Similar problems as with polygraphy Unsure what results mean Can drive treatment in strange ways

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