1. Structured and Standardized Assessments
Blake Beecher
Eastern Washington University

2. Learning Objectives:
Increase knowledge about the role and purpose of structured assessments
Increase knowledge how to address findings of structured assessments
Become familiar with frequently used structured assessment tools
Become competent in administering, interpreting, and scoring above assessments
Demonstrate ability to administer, interpret, and utilize an assessment in demonstration with peer

3. What is a standardized measure?
Measures designed in such a way that the questions, conditions for administering, scoring procedures, and interpretations are consistent and are administered and scored in a predetermined, standard manner. Vary in what they measure; type; perspective of user Uniform procedures for scoring & administrating a “test” Enough info to judge whether test is appropriate for your situation

4. Factors in Selecting Measures
Easy
Quick
Not expensive
Non-offensive (non intrusive)
Supported by research
Is applicable to your setting
Gives you beneficial information

5. Purpose What is the problem being measured?
Substance Abuse?
Depression?
Cognition?
How sensitive or appropriate is the measure?
What is the benefit of using this measure?

6. Interpretation Clearly stated (clinical cut-offs) Enough information
Do you understand how to use and interpret the assessment tool?

7. Validity
Does the measure actually measure the presenting issue? Does it measure what it’s supposed to?
Does the measure reflect the range of the severity problem?
Does it increase if expected?

8. Reliability How consistent, stable or dependable is the measure?
Would repeated testing yield the same result?

9. Advantages of Standardized Measures
Efficiency
Accessibility
Comparability
Neutrality
Evaluation friendly

10. Disadvantages Psychometric problems, norms
Limits of what the test measures
Practical problems
Agency problems
Ethical problems

11. Administration
Ask permission Be clear on objectives of test, how it will be used Would you rather I read it to you? Stress importance of accurate responses Home, office, waiting room? How often?

12. Common Assessments which may be used in Integrated Healthcare
DSM Diagnosis
Mental Status Exam
Depression (PHQ9)
Bipolar (MDQ)
SAFE-T suicide screen
Trauma Screen (PC-PTSD)
Substance Abuse (CAGE aid)
Mini Mental State (brief cognitive screen)
Pediatric Symptom Checklist
Activities of Daily Living (Katz)

13. Diagnostic and Statistical Manual of Mental Disorders
To provide clear descriptions of diagnostic categories in order to enable clinicians and investigator to diagnose, communicate about, study, and treat people with various mental disorders

14. International Classification of Disease (ICD-10)
Comprehensive classification system of medical conditions and mental disorders Official medical and psychiatric classification of diseases used throughout most of the world

15. ICD-10 VS DSM-IV-TR
Both are the classification systems and fully compatible, although the wording may differ.
All of the DSM-IV-TR categories are found in ICD-10 but not all ICD categories are found in DSM-IV.

16. Multiaxial System Axis I: Psychiatric Diagnoses
Axis II: Personality Disorders
Mental Retardation
Axis III: Medical Diagnosis
Axis IV: Psychological and Environmental Stressors
Axis V: The Global Assessment of Functioning (GAF)

17. Axis I: Clinical Disorders1
Anxiety Disorders
Mood Disorders
Substance-related Disorders
Schizophrenia and Other Psychotic Disorders
Delirium, Dementia, and Amnestic and other Cognitive Disorders
Mental Disorders Due to a General Medical Condition
Eating Disorders
Adjustment Disorders

18. Axis I: Clinical Disorders2
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual and Gender Identity Disorders
Eating Disorders
Sleeping Disorders
Impulse-Control Disorders
Adjustment Disorders

19. Axis II: Personality Disorders3
Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder Personality Disorder not Otherwise Specified Mental Retardation
Cluster A: Odd, Eccentric
Cluster B: Emotional, dramatic, erratic
Cluster C: Anxious, fearful
Broken into 3 clusters. Sometimes diagnoses will state “cluster B traits”

20. Axis III: General Medical Condition
Infection and parasitic disease ( )
Neoplasms ( )
Endocrine, nutritional, and metabolic disease and immunity disorders ( )
Disease of the blood and blood-forming organs ( )
Disease of the nervous system and sense organs ( )
Source: DSM-IV, P28
Patient’s report
Family’s report
MD Physical exam
Medical record

21. Common Medical Conditions (Axis III) in Integrated Healthcare
Obesity Diabetes Hypertension Heart Disease Arthritis Injuries Respiratory Diseases (many related to smoking)

22. Axis IV: Psychosocial and Environmental Problems
Problems with Primary Support Group
Problems Related to the Social Environment
Educational Problems
Occupational Problems
Housing Problems , Economic Problems
Problems with Access to Health Services
Problems Related to Interaction with the Legal System
Other Psychological and Environmental Problems

23. AXIS V: Global Assessment of Functioning
Reports the clinician’s view of the client’s overall level of functioning at the time of the interview. Uses a global assessment of functioning scale (GAF) that ranges from a score of 100 (high) to 1 (low). It is reported as (e.g.) GAF=65.

24. Axis V: Global Assessment of Functioning Scale
100-91: Superior functioning, no symptoms 90-81: Absent or minimal symptoms, good functioning in all area 80-71: Transient and expectable reactions to psycho social stressors 70-61: Some mild symptoms, some difficulty in social, occupational, or school functioning

25. Axis V: GAF Scale
60-51: Moderate symptoms, moderate difficulty in social , occupational, or school functioning 50-41: Serious symptoms, serious impairment in social, occupational, or school functioning 40-31: Some impairment in reality testing or communication or major impairment in several areas-work, school, family relations, judgment, thinking or mood

26. Axis V: GAF Scale
30-21: Behavior is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment 20-11: Some danger of hurting self or others, or gross impairment in communication 10-1: Persistent danger of severely hurting self or others, or serious suicidal act with 0: Inadequate information

27. Multiaxial Diagnostic Schema Example
Axis I: Major Depression Disorder
Alcohol Abuse
Axis II: No Diagnosis
Axis III: Hypertension, Diabetes
Axis IV: Social Isolation, unemployed, housing problems,
Axis V: GAF=40 (current)

28. ADDRESSING Guideline to Assess for Client Cultural Influences4
A ge and generational influences D isability status (developmental disability) D isability status (acquired physical/ cognitive/psychological disabilities) R eligion and spiritual orientation E thnicity S ocioeconomic status S exual orientation I ndigenous heritage N ational origin G ender

29. Activity
Break into groups of 3 to practice one or more of the structured instruments covered. 1 SWer, 1 client, and 1 observer. Have the student client play the role of a client they are familiar with. After 5-7 minute interaction, stop, all members discuss for 2-3 minutes, then rotate.

30. References
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. (p. 26)
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. (p. 27)
Hays, P.A. (1996). Addressing the complexities of culture and gender in counseling. Journal of Counseling and Development, 74,