Assessment in counseling chapter 13

∗ 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

Using Assessment in Counseling

Chapter 13

∗ 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

Introduction

∗ Varies with client

scientific approach

Treatment Planning

∗ 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

Treatment Matching

∗ 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

Case Conceptualization and Assessment

∗ 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

Monitoring Treatment Progress

∗ 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

Using Assessments for Evaluation

and Accountability

∗ 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

Defining Evaluation Study Focus

∗ 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

Determining Design

∗ Qualitative studies: sample is usually smaller than for quantitative studies

∗ Quantitative studies: a larger sample size allows for more power in statistical analyses

Selecting Participants

∗ 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

Selecting Assessments or Measures

∗ 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 Assessment in Mental Health Settings

∗ 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

Career 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)

Outcome Assessment in

School Counseling

∗ Descriptive information vs statistical analysis

∗ Effect size

∗ Consult with researchers on methodological or statistical questions

Data Analysis