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Assessment in counseling chapter 13

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):
1.

Clearly 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 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



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