Assessments in Private Practice

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1 Mansfield Counseling Presents Assessments in Private Practice Jeffrey S Gallup MA LPC NCC 1

2 Using Assessments Facts, Theory, Ethics and Practical Applications 2

3 Objectives Using assessments - Facts, Theory, Ethics, and Practical Applications Understanding objective assessments Ethical considerations of using assessments Administering tests to children Detailing your findings

4 What is an Assessment? A professional uses a tool to gain information about a client. The point of assessment is often diagnosis or classification, & clarification. It is a way to understand someone to help you and them make informed decisions about their care and treatment. Rorschach Ink Blot

5 Objective vs. Projective Assessments Assessments can be classified as objective or subjective. Objective tools are questions with one correct answer. Subjective questions have more then one answer. Objective Assessment - Minnesota Multi-phasic Personality Inventory (MMPI) Projective Assessment - House Tree Person

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8 Scope of Practice - LPC Assessment which means selecting, administering, scoring, and interpreting instruments designed to assess an individual's aptitudes, attitudes, abilities, achievements, interests, personal characteristics, disabilities, and mental, emotional, and behavioral disorders and the use of methods and techniques for understanding human behavior that may include the evaluation, assessment, and treatment by counseling methods, techniques, and procedures for mental and emotional disorders, alcoholism and substance abuse, and conduct disorders, but does not include the use of standardized projective techniques or permit the diagnosis of a physical condition or disorder. Texas State Board of Examiners of Professional Counselors About the Profession - Scope of Practice

9 "Don't become a mere recorder of facts, but try to penetrate the mystery of their origin." Ivan Pavlov ( )

10 Epidemiological Surveys 46.4 Percent of Americans will meet the criteria for a DSM-IV-TR disorder at some point in their lifetime. Furthermore 27.7 percent of these manifest comorbidity. The use of standardized testing has proven significantly superior in terms of providing reliable and valid diagnoses. (Meyer, 2001; Dawes & Corrigan, 1974; Goldberg, 1970; Meehl, 1954; Wiggins, 1973)

11 Mental Health Assessments are Valid The validity of a diagnosis and validity of diagnostic tests is extremely important. Through meta-analytic reviews, Meyer and his colleagues drew comparisons between medical tests psychological tests. Finding that the validity coefficient for many psychological tests are the same as medical tests.

12 Aiding Treatment Effectiveness Assessments when completed early establish a baseline allowing before and after comparisons. Two immediate advantages gained from using an assessment at the beginning of treatment. You determine what is the actual problem. Allows you to triage what symptoms to address.

13 The presence of comorbidity and remarkable symptom overlap, among DSM-IV-TR diagnostic categories renders accurate diagnosis a daunting challenge with relying solely on the clinical method. (Krueger & Markon, 2006)

14 Expertise and Rapport Assessments show clients the evidence of our work. They see you as a professional using every tool at your disposal to help as an act of caring about them. Explaining results lets you develop rapport, and to probe further into areas that a client may not have discussed.

15 Improve Client Morale Positive results on assessments can be reinforcing to clients that they are making real improvements. This can increase a client s positivity leading to faster progress.

16 Decrease Early Termination If you have a client that maybe considering terminating their care before they should - early termination. Using assessments can help show them that have a need to continue therapy.

17 Early Termination According to PsychoTherapy.Net, nearly 20-57% (depending on the study) of first time patients do not return to therapy at all. Research shows that by using feedback techniques or questionnaires to measure client success and fulfillment in therapy, clinicians may be able to decrease the dropout rate by nearly 50-65%.

18 Accurate Diagnosis & Medical Problems Depression - OR - Metabolic Disorder

19 Assessment tools can help to clarify a diagnostic picture. Even when the labels we use are not important, tests may still provide valuable clues to creating and guiding your treatment plans. Occasionally we can catch a problem that you never anticipated. There are a variety of medical diagnoses that mirror psychological problems, such as ADHD -or- Other Neurodevelopment Profiles PTSD -or- Traumatic Brain Injury Panic Disorder -or- Thyroid Disorder Depression -or- Vitamin Deficiency Dementia -or- Deafness

20 Validity Checking Almost every assessment has built in methods by which to determine if they were being appropriate/open/ honest/consistent in their responses. The validity check can help lead greater understanding of your client.

21 Decrease Liability Objective testing is another step to having an evidencebased practice. Standardization also can reduce legal and ethical problems because it minimizes the prospect that unintended bias may adversely affect the patient.

22 Court Testimony Mental health professionals are allowed into Court because the work we do and the opinions we generate are founded in validated science. Yet attorneys are taught to challenge the clinician to explain to them the scientific basis for their opinion, or work to discover why that clinician cannot explain their opinion beyond intuition. Having accurate information can help your testimony stand during court appearances, and may save you from difficult cross examinations in court. When using instruments it provides you further clinical/relevant information to create your treatment planning. Be sure to read your ethics and particularly concerning using assessments.

23 Court Testimony What someone presents as a fact may be classified as either a mistake, a delusion, the truth, or a lie. Many therapists ignore this reality. Attorneys are tasked with challenging bias in therapist testimony. Conversely, the absence of testing data provides an interesting line of inquiry for attorneys on what might have been learned, but was not.

24 When the expert is offered at trial, the objecting lawyer should again attack the individual components of the expert s qualifications and knowledge, as well as the application of the theory and/or conclusions offered. The lawyer should additionally attack the foundations and methodology used by the expert. Finally and most importantly the objecting should attempt to demonstrate an analytical gap between the expert s conclusions and the particular facts of the case on trial. - Judge Bill Harris, 233rd District Court

25 Admission and Exclusion of Expert Testimony Testimony is evaluated on the four basic components of qualifications, knowledge, helpfulness, and foundation. Qualifications - include education and experience, training, & specialized knowledge. Knowledge - the subject of your testimony must be scientific, technical, or other specialized knowledge. Helpfulness - the knowledge must be able to help the court to understand the evidence or determine a fact. Foundation - The material components of the expert s testimony must be reliable. Has the theory been tested Has it been subjected to peer review and publication Has the theory been generally accepted as valid by the scientific community

26 Many family law judges are rather lax in the admission and apparent consideration of expert testimony, particularly evidence offered by a variety of mental health professionals that are proffered as an expert witness. - Judge Bill Harris, 233rd District Court

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28 Challenging Self-Diagnosis An objective assessment tool can help you when you need to challenge a poor self diagnosis. Often we can spend a lot of time explaining to people that their diagnosis is not the most important piece of therapy.

29 Increase Rapport with Children When working with children, assessments can help you gain a third perspective about the child s problems after what their parents report and your interview with the child themselves. Reviewing assessments results with parents can help increase the understanding of their children s problems or behaviors, and give you further opportunities to educate parents.

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31 Reasons Professionals Do Not Utilize Assessment Tools Lack of Familiarity and Inadequate Training Infringes on the Clients Time Costs and Insurance Concerns

32 Lack of Familiarity Many therapists may take at least 1 class about assessments during graduate school. But have then they have little exposure or experience with any assessments after their one class. Often these assessments can be scored and interpreted quickly and easily. Quickly allowing you to gain experience. Many assessments are scored and interpreted the same way, allowing you to carry your skills across various assessments.

33 Inadequate Training Often there is an insufficient amount of training that addresses the process of selecting an efficient test battery, concisely interpreting the results, then easily communicating the results to others. Compounding this matter is the lack of available training resources in assessment and testing that address practical issues.

34 Infringement on Client Time Many assessments can be completed in about 5 to 10 minutes. This encourages clients to come back the next week. Gives you something to immediately talk about and assists you in getting right to their concerns vs. shooting the breeze.

35 Online & Computerized Assessments Saves time, no more hand scoring, and double checking to make sure that you added everything up correctly. No more lost forms, it used to be that if a paper form was lost or not returned you had to waste another administration. Whereas computerized forms you just resend the link. Increases your accuracy which in turn increases your validity. Report writing options you can get interpretive reports, comparative reports, or progress reports.

36 Costs Online and computer assessments typical cost less then 5 dollars per use. If the cost of a test is dollars, and you gain even three or more sessions from using testing tools then you will recover your expense quickly.

37 Insurance Companies When dealing with insurance companies by having objective testing results can help in completing chart reviews and decreasing the amount of time you spend discussing your treatment plans. Possibly because of the extra time to complete assessments during your sessions you could bill the insurance companies for CPT Code (55 min session) instead of the typical CPT Code (45 min session).

38 Major Test Publishers Western Psychological Services Pearson PAR Reviews and further information about each test can be found at the Buros Institute of Mental Measurements

39 Qualifications Level A: There are no special qualifications to purchase these products. Level B: Certification or Active Membership in a professional organization, a Master s Degree, and formal training in assessment usage. Level C: Licensure or certification to practice in your state in a field related to the purchase OR doctorate degree in a related field and formal training in clinical assessments.

40 Further Evaluation and Research The American Psychiatric Association is offering a number of emerging measures in section 3 of the DSM-5.

41 Ethical Considerations Part #1 Only you use tests that are appropriate to answer the questions that you have about your clients. Use assessments that are established by research as reliable and valid for the intended population. Test individuals in their native language and with tests at an appropriate grade or age level.

42 Ethical Considerations Part #2 Do not release test data, results, or materials without appropriate releases of information. Maintain the integrity and security of test materials and assessment protocols consistent with publisher contractual obligations and law. Remember that test scores obtained do not always represent a typical performance. Although it may be difficult to interpret the reason s for a person s poor performance it is important to note the conditions in which the tests were administered.

43 Informed Consent Always obtain consent before using assessment instruments, explaining to clients and parents the purpose of the tool used, and what information you plan on gaining.

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