Using Assessment in Counseling Chapter 13 Introduction ∗ Skilled counselors know how and when to either gather more assessment information or apply information gathered previously ∗ Informal and formal assessments play a role in: ∗ Treatment planning ∗ Monitoring client change ∗ Evaluating the effectiveness of counseling Treatment Planning ∗ Varies with client ∗ Assessment of functioning ∗ Statistical/actuarial methods vs clinical judgment ∗ Gather quality information and evaluate it with a scientific approach ∗ More than just diagnosis Treatment Matching ∗ Beutler, Malik, Talebi, Fleming, & Moleiro (2004) suggested client characteristics to consider in treatment selection: ∗ Functional impairment ∗ Subjective distress ∗ Problem complexity ∗ Readiness for change ∗ Reactant/resistance tendencies ∗ Social support ∗ Coping style ∗ Attachment style Treatment Matching ∗ Assessment should also focus on identifying and enhancing human strengths and optimal functioning ∗ Positive Psychology – focuses on developing strengths and enhancements of well-being, while not ignoring weaknesses ∗ One area to consider when assessing strengths is optimism – hopeful expectation and general expectancy that the future will be positive Case Conceptualization and Assessment ∗ Model for case conceptualization (Meir, 2003) ∗ Step 1: Identify the initial process and outcome elements ∗ Step 2: Learn etiology of client problem ∗ Step 3: Choose interventions for selected problems ∗ Step 4: Consider the time frame of interventions and outcomes ∗ Step 5: Represent the conceptualization explicitly ∗ Step 6: Include at least one alternative explanation ∗ Step 7: Consider the model’s balance between parsimony and comprehensiveness Monitoring Treatment Progress ∗ Counselors have responsibility to monitor clients’ progress during treatment and determine if clients are making positive gains ∗ History of outcome research: ∗ 1970s: research had demonstrated that most people who received psychological interventions benefitted, but 5-10% got worse (Lambert, Bergin, & Collins, 1977) ∗ 1980s: managed care began playing significant role in cost containment ∗ 1990s: outcome assessment began playing critical role in clinical care, insurance companies became interested in identifying clients who would not benefit from psychotherapy Monitoring Treatment Progress ∗ Clients have better therapeutic outcomes when clinicians receive feedback about client progress during therapy ∗ Client self-report is important source of information for outcome assessment ∗ Goal Attainment Scaling (GAS) ∗ More continuous outcome assessment and more formal ∗ Client and counselor select an indicator for each therapeutic goal behavior, affective state, or process that represents goal and can be used to indicate progress Monitoring Treatment Progress ∗ Gather baseline information at the beginning ∗ Symptom Checklist – 90 – Revised (SCL-90-R) ∗ Outcome Questionnaire (OQ-45.2) ∗ Explain to client why data are being collected and share results Using Assessments for Evaluation and Accountability ∗ Two major types of evaluation: ∗ Formative – continuous or intermediate evaluation typically performed to examine the process ∗ Summative – more cumulative and focused on endpoint or final evaluation (the product) ∗ Steps for conducting an evaluation study: ∗ Defining evaluation study focus ∗ Determining design ∗ Selecting participants ∗ Selecting Assessments or measures ∗ Data Analysis Defining Evaluation Study Focus ∗ Practitioners need to determine what services they want to evaluate ∗ There needs to be a direct connection between the services provided and the outcome measures used Determining Design ∗ Information needed: ∗ Qualitative, quantitative, or both ∗ Quantitative designs: ∗ Intrasubject ∗ Pre-test, intervention, post-test ∗ Intersubject ∗ Randomized clinical trial is gold standard  intervention group, placebo/control group ∗ Wait-list control group often used to address ethical issue presented by traditional placebo/control group Selecting Participants ∗ Qualitative studies: sample is usually smaller than for quantitative studies ∗ Quantitative studies: a larger sample size allows for more power in statistical analyses Selecting Assessments or Measures ∗ Assessing outcome involves (Hill & Lambert, 2004): Clearly specify what is being measured Measure change from multiple perspectives Use diverse types of assessments Use symptom-based and atheoretical measures Examine patterns of change as much as possible ∗ Scheme for Selecting Outcome Measures (Olges, Lambert, & Fields, 2002) ∗ Content ∗ Social level ∗ Source ∗ Technology ∗ Time Orientation Outcome Assessment in Mental Health Settings ∗ Managed care agencies, third-party payers significantly influence provision of mental health services ∗ Commonly used instruments: ∗ Beck Depression Inventory ∗ State-Trait Anxiety Inventory ∗ Symptom Checklist–90–Revised ∗ Minnesota Multiphasic Personality Inventory II ∗ Dysfunctional Attitude Scale ∗ Hassles Scale ∗ Schedule for Affective Disorders and Schizophrenia ∗ Outcome Questionnaire (OQ-45.2) Outcome Assessment in Career Counseling ∗ No standard battery of instruments used ∗ Many studies have examined career maturity and decidedness vs concrete career outcomes ∗ Practitioners may want to consider measures of effectiveness of career counseling other than career maturity and career decidedness ∗ i.e., employment, job satisfaction, quality of life Outcome Assessment in School Counseling ∗ ASCA National Model (ASCA, 2005) states that school counseling programs are data driven ∗ Availability of instruments to evaluate school counseling programs is minimal relative to mental health and career counseling ∗ Consider using multiple measures from multiple perspectives ∗ Students ∗ Teachers ∗ Parents ∗ Other members of the community ∗ School Counseling Program Evaluation Scale (SCoPES; Whiston & Aricak, 2008) Data Analysis ∗ Descriptive information vs statistical analysis ∗ Effect size ∗ Consult with researchers on methodological or statistical questions [...]...Defining Evaluation Study Focus ∗ Practitioners need to determine what services they want to evaluate ∗ There needs to be a direct connection between the services provided and the outcome measures used Determining Design ∗ Information needed: ∗ Qualitative, quantitative, or both ∗ Quantitative designs: ∗ Intrasubject ∗ Pre-test, intervention, post-test ∗ Intersubject ∗ Randomized clinical trial... significantly influence provision of mental health services ∗ Commonly used instruments: ∗ Beck Depression Inventory ∗ State-Trait Anxiety Inventory ∗ Symptom Checklist–90–Revised ∗ Minnesota Multiphasic Personality Inventory II ∗ Dysfunctional Attitude Scale ∗ Hassles Scale ∗ Schedule for Affective Disorders and Schizophrenia ∗ Outcome Questionnaire (OQ-45.2) Outcome Assessment in Career Counseling ∗ No... of instruments used ∗ Many studies have examined career maturity and decidedness vs concrete career outcomes ∗ Practitioners may want to consider measures of effectiveness of career counseling other than career maturity and career decidedness ∗ i.e., employment, job satisfaction, quality of life Outcome Assessment in School Counseling ∗ ASCA National Model (ASCA, 2005) states that school counseling. .. data driven ∗ Availability of instruments to evaluate school counseling programs is minimal relative to mental health and career counseling ∗ Consider using multiple measures from multiple perspectives ∗ Students ∗ Teachers ∗ Parents ∗ Other members of the community ∗ School Counseling Program Evaluation Scale (SCoPES; Whiston & Aricak, 2008) Data Analysis ∗ Descriptive information vs statistical analysis... specify what is being measured 2 Measure change from multiple perspectives 3 Use diverse types of assessments 4 Use symptom-based and atheoretical measures 5 Examine patterns of change as much as possible ∗ Scheme for Selecting Outcome Measures (Olges, Lambert, & Fields, 2002) ∗ Content ∗ Social level ∗ Source ∗ Technology ∗ Time Orientation Outcome Assessment in Mental Health Settings ∗ Managed care...  intervention group, placebo/control group ∗ Wait-list control group often used to address ethical issue presented by traditional placebo/control group Selecting Participants ∗ Qualitative studies: sample is usually smaller than for quantitative studies ∗ Quantitative studies: a larger sample size allows for more power in statistical analyses Selecting Assessments or Measures ∗ Assessing outcome involves ... (Lambert, Bergin, & Collins, 1977) ∗ 1980s: managed care began playing significant role in cost containment ∗ 1990s: outcome assessment began playing critical role in clinical care, insurance companies... Defining evaluation study focus ∗ Determining design ∗ Selecting participants ∗ Selecting Assessments or measures ∗ Data Analysis Defining Evaluation Study Focus ∗ Practitioners need to determine... planning ∗ Monitoring client change ∗ Evaluating the effectiveness of counseling Treatment Planning ∗ Varies with client ∗ Assessment of functioning ∗ Statistical/actuarial methods vs clinical