Lecture 8

Assessment: Integration and

Clinical Decision Making

PART II: ASSESSMENT AND PREVENTION

Introduction
Lecture 5: Interviews and Observations
Lecture 6: Intellectual and Cognitive Measures
Lecture 7: Self Report and Projective Measures

As we described in Lecture 4, the clinical psychologist must examine all the assessment
information, consider both consistencies and contradictions in the information, generate final
hypotheses about the client, and formulate conclusions or clinical recommendations about the
client based on the overall picture emerging from the assessment.
Integrating Assessment Data
Case Formulation
Case formulation refers to the task of both describing the patient in his or her life context and
developing a set of hypotheses that pull together a comprehensive clinical picture in sufficient
detail that the psychologist can make decisions about treatment options.
- particularly useful when a patient has numerous or complex clinical problems
- allows the psychologist to make informed decisions about the timing, sequence, duration, and specific
focus of interventions
- Benefits include:
- Provides a way of understanding the connections between a patient’s various problems
- Provides guidance on the type of treatment to consider (including whether the treatment should be
conducted in an individual, couple, family, or group modality)
- Predicts the patient’s future functioning if treatment is not sought and how this functioning will be
different if treatment is successful
- Provides options to consider if difficulties are encountered in implementing and following through on
treatment
- Indicates options, outside of psychological services, for the patient to consider
- Provides alternative treatment options to consider if the initial treatment is unsuccessful
Integrating Assessment Data
Case Formulation
Steps in developing a case formulation:
- Develop a comprehensive problem list, including the patient’s stated problems and other problems
indicated by referral agents or identified by other informants during the assessment.
- Determine the nature of each problem, including its origin, current precipitants, and consequences.
- Identify patterns or commonalities among the problems; this may yield an indication of previously
unidentified factors that serve to maintain, exacerbate, or lessen the problems.
- Develop working hypotheses to explain the problems.
- Evaluate and refine the hypotheses, using all information gathered during the assessment and the patient’s
feedback on the hypotheses.
- If the psychologist moves from conducting an assessment to providing treatment, the hypotheses should be
reconsidered, re-evaluated, and revised (as necessary) based on data gathered during treatment.
Threats to the Validity of Assessments and Case Formulations
Patient/Client Factors
- people may selectively choose how they depict themselves during a psychological evaluation by consciously
highlighting either their strengths or their weaknesses (called impression management)
- people tend to over-report the frequency with which they engaged in socially desirable acts and to
underreport engaging in less desirable acts
- when recalling events, people tend to inaccurately describe the details of the event in a way that favors
them
- there is a tendency for individuals to exaggerate their level of ability prior to an injury
Threats to the Validity of Assessments and Case Formulations
Clinician Factors
- all clinicians are prone to bias, judgments that are systematically different from what a person should
conclude based on logic or probability.
- clinicians would often exhibit self-serving attribution bias, which involves people making more internal,
stable, and global attributions for positive events in their lives than they do for negative events.
- clinicians would overestimate their competence and the quality of the services they provide
- clinicians would also employ heuristics, mental shortcuts that people often use to ease the burden of
decision making.
- tend to result in errors in decision making and, thus, are at the heart of cognitive biases.

In all, biases and heuristics lead to errors in decision making.

Threats to the Validity of Assessments and Case Formulations
How do we improve the accuracy of clinical judgement?
- Use psychological tests that are directly relevant to the assessment task and that have strong psychometric
qualities.
- Check for scoring errors when using test data.
- Use computers as aids in the collection, scoring, and interpretation of clinical data whenever possible.
- Use normative data and base rate information whenever available.
- Use DSM (or ICD) criteria when making diagnostic decisions.
- Use decision aids, such as decision trees or clinical guidelines
- In unstructured tasks, such as conducting interviews and reviewing assessment data, be as systematic and
structured as possible in obtaining, considering, and using all relevant information.
- Be aware of relevant research in psychological assessment, psychopathology, and prevention/intervention.
- Be aware of personal biases and preconceptions
- Be self-critical: search for alternative explanations for hypotheses and challenge evolving case
formulations.
- Seek consultation from other professionals when unsure of the accuracy of conclusions
- Don’t rely on memory, and don’t rush any conclusion or decision.
Psychological Assessment Reports and Treatment Plans
The assessment process culminates in writing a report and, usually, presenting the assessment
findings to the individual or individuals who were the focus of the assessment.
- can be used as a legal document
- the psychologist must be cognizant of the potential uses of the report and the “audiences” for the report
- important when the person being assessed is in a potentially adversarial position with the agency that
requested the assessment
- Care must be taken to minimize or eliminate any stigmatizing or objectionable terms or descriptions in the
report
- it is also crucial that the psychologist clearly attribute who said what
- ex. If based solely on client self-report, a statement such as “His father physically assaulted him on
numerous occasions” should be written as “The client reported that his father had physically assaulted
him on numerous occasions.”
Psychological Assessment Reports and Treatment Plans
Report writing principles
- Identify common themes, integrating the findings across assessment procedures
- Use all relevant sources of information about the client (including reliable and valid test results, behavioral
observations, individual test responses, interview data, and case history) in generating hypotheses,
formulating interpretations, and making recommendations.
- Be definitive when the findings are clear; be cautious when the findings are inconsistent or problematic
- Use concrete examples to enhance the report’s readability.
- Interpret the meaning and implications of a test score rather than simply citing test names and scores
- Refrain from making diagnoses solely on the basis of test scores; consider all sources of information.
- Communicate clearly and eliminate unnecessary technical material in order to enhance the report’s
readability.
Psychological Assessment Reports and Treatment Plans
Sections of a Typical Psychological Report
- Patient/client information
- Reason for referral
- Background information (including, as relevant, developmental history, educational history, employment
history, family history, relationship history, medical history, history of symptoms and disorders)
- Assessment methods (including tests administered)
- Interview data and behavioral observations
- Test results (including interpretation of test scores)
- Diagnostic impressions
- Summary
- Recommendations (for treatment plan)
Mostly done in single-spaced pages; the content and structure depends on the reasons for the
assessment.
Psychological Assessment Reports and Treatment Plans
Treatment plans differ from the typical assessment report: they primarily focus on using the
assessment data to develop and structure a plan for intervening with the patient.
- should also include some consideration of whether psychological treatment is warranted or appropriate at
this time
- involves problem identification, delineation of the aims and goals of treatment, and the strategies and
tactics involved in the planned treatment
- Specific attention is also paid to the need for ongoing evaluation of the patient’s functioning
- treatment impact is important in determining whether it should be discontinued or other options
should be considered
- elements;
- Evaluation of primary symptoms and problems - Proposed treatment(s)
- Diagnosis - Potential barriers to treatment
- Patient strengths - Criteria for treatment termination or transfer to other
service provide
- Treatment-related goals and objectives - Service provider responsible for treatment implementation
and evaluation of treatment
Psychological Assessment Reports and Treatment Plans
Assessment Feedback
- nowadays, it is commonplace for those who were assessed to also receive feedback from the clinical
psychologist involved, not just to those who requested the assessment in the first place.
- feedback yields an opportunity for the psychologist to verify assessment findings and conclusions and to
help clients begin to use the assessment findings in making modifications in their lives
- purposes;
- Verify the general accuracy of the assessment results
- Refine the interpretation of the results to ensure an optimal fit with the individual’s life circumstances
- Put the individual’s symptoms, problems, and experiences in the context of his or her life history and
current life circumstances
- Provide some psychological relief for the individual by presenting an integrated picture that helps
make sense of the individual’s difficulties
- Provide concrete information about steps the individual can take to address personal difficulties
- Help the individual identify potentially stressful situations that can exacerbate difficulties
- Collaborate with the individual in creating therapeutic goals that build on personal strengths
Psychological Assessment Reports and Treatment Plans
Therapeutic Model of Assessment
- a cognitive-behavioural therapy that utilizes feedback as part of the process
- in this model, clients are active participants in all phases of the assessment
- includes discussing the reasons for assessment, observing the test results, and interpreting the test scores
- focus;
- develop a strong working alliance with the client
- work collaboratively in defining the client’s goals for the assessment
- explore the assessment data with the client
- clients receiving therapeutic assessment developed stronger working alliances with the psychologists and
were less likely to prematurely terminate treatment