Assessment: The Early Stages of Outcome-Informed Practice

Assessment: The Early Stages of Outcome-Informed Practice

Assessment is: • Systematic • collection • organization & • interpretation • of data related to a client’s functioning in order to make decisions or recommendations about intervention or other services

Assessment is not: • Random • Completion of the agency intake form • Confirmation of first impressions • Confirmation of eligibility for services • Collection of disconnected facts • Diagnosis • Ever complete

Assessment (cont’d) • Many approaches to assessment, based on • Agency purpose • Funding constraints • Understanding of human behavior & problems

Assessment (cont’d) • All approaches expect assessment will contribute to: • Forming good working relationships • Identifying client problems and goals • Integrating understanding of clients’ social contexts, obstacles to change, and strengths or resources • Informing intervention plans

Assessment (cont’d) • Assessment occurs within the: • Context of an agency or practice setting (which may prescribe or delimit the process) • Practitioner’s understanding of human development and behavior and approach to practice

Approach to Assessment: The Scientific Method • Application of scientific knowledge—as demonstrated in EBP (necessary but not sufficient) • Method of practice wherein we systematically: • Construct hypotheses • Test those hypotheses • Revise those hypotheses in light of new knowledge • Think critically

Assessment by Scientific Method Scientific evidence Critical thinking

At the center of it all:Critical Thinking • Application of • logical principles, • rigorous standards of evidence & • careful reasoning to the analysis and discussion of data, claims, beliefs, or issues • “Thinking about thinking”

“Critical thinking involves clearly describing and carefully evaluating our claims and arguments, no matter how cherished, and considering alternative views when needed to arrive at decisions that do more good than harm”

Presenting Problem Problem offered by a client as a reason for seeking services

Problem Specific situation, condition, or concern that needs to be addressed in order to achieve a desired goal, including difficulties or deficiencies to be remediated or prevented as well as assets and strengths to be enriched May turn out not to be the presenting problem

Which are problems? • Susan is depressed. • Matt wants to find a wife and build a strong relationship. • Alex’s boss doesn’t appreciate him. • Mark and his partner Steve fight all the time. • Janice wants to be more self-confident • Dina has an over-developed ego

Problems • Conceptualization influenced by your practice model • Moving from a client’s initial problem statement to the working problem list is a matter of adding more specificity to the client’s articulation of his problems, • This process involves the basic skills of reflective listening, hypothesis-generation, and hypothesis-testing

Measurement Systematic process that involves assigning labels (usually numbers) to characteristics of people, objects, or events using explicit and consistent rules so, ideally, the labels accurately represent the characteristic measured

Advantages of measurement: • Objectivity • Greater ease in monitoring • Better understanding of problem • Greater ease in setting goals

Objective (Adjective) Judgments that are relatively less influenced by personal feelings, beliefs, experiences, interpretations or other biases or prejudices

Ease of Monitoring • “So, how was your week?” • Contrast to: • How many hours of sleep did you get each night? • How many evening social events did you attend this week? • Let’s compare your scores on the Generalized Anxiety Scale for this week to your scores for last week.

Understanding of Problem • Measurement can provide: • Detail • Clarity • Context

Ease in Setting Goals • Which provides the best basis for setting intervention goals? • George feels “really down” • George scores in the clinical range on the Beck Depression Inventory • George hates himself • On a typical day, George has 11 negative thoughts about himself

Confirmation Bias Tendency to gather evidence that confirms one’s preconceptions by emphasizing or pursuing supporting evidence while dismissing or failing to seek contradictory evidence

Confirmation Bias • This client looks depressed. • “Are you sleeping normally?” • “How is your appetite?” • “Do you feel sad?”

Falsification Deliberate process of seeking information to discount or disprove a hypothesis or theory • “Tell me about the last thing you did that was really enjoyable.” • “What makes you the happiest?” • “When was your last medical checkup?”

Measurement Methods • Standardized scales • Individualized rating scales • Behavioral observation • Self-monitoring

Triangulation • Engineering term that describes a process of collecting data from several different nearby locations to verify the location of a geographical point • In assessment, emphasizes collection of data from several sources and using different methods and procedures

Method Bias • Relationships in data resulting solely from the particular type of measurement procedure or data source, e.g.: • All filled out by same person • All self-report measures

Goal • General and abstract statement of a desired outcome for which an intervention is implemented, e.g.: • Reduce depression • Lose weight • Get a new job

Goals • Often, but not always, goals are mirror images of problems • preventive (e.g., prevent alcoholism and related problems) • protective (e.g., protect current level of health) • promotional (e.g., promote healthy family relationships and interactions) • rehabilitative (e.g., complete court-mandated class after arrest for driving and drinking)

Goals (cont’d) • Can be formulated in terms of increasing something positive or decreasing something negative • Should indicate change in a client’s real-world functioning or quality of life that is sufficient or meaningful to the client, significant others, and/or society at large

Considerations in Goal Formulation • Stated in terms of outcomes for the client, when possible in client’s own words • Specify what clients will be doing to show that they have achieved goals • Specify when, where, and with whom clients will do something

Good goals? • Tim and Ann will spend pleasant time together everyday • Roger will get along well with his fellow students • Eileen will further develop her super-ego • Juan will get his B.A. • Miranda will stop thinking irrationally • Shevonne will reduce her depression score by one standard deviation

Objective (Noun) Specific and concrete statement detailing a desired outcome of an intervention along with measurable criteria used to define and evaluate client success (e.g., to reduce the level of depression on a particular standardized scale to below a certain score, a benchmark)

Diagnosis Classification of individuals based on the basis of a disease, disorder, abnormality or set of characteristics; in psychiatry usually based on the Diagnostic and Statistical Manual (APA, 2000)

Diagnosis • Is not assessment • Does not necessarily guide intervention • Should be pursued using the scientific method: • Hypothesis-testing • Rule out several potential diagnoses • Should not be set in stone

Case Conceptualization/Formulation Integration of a client’s circumstances with knowledge of theory of human behavior or change, including hypotheses about the mechanisms that are causing and maintaining problems and the plan for intervening with them in a particular individual

Assessment: The Early Stages of Outcome-Informed Practice