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: Quantitative designs: 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