Unit 6.1 DB: Network Development

Revisiting the Assessment Phase

· List the two areas of concern that are addressed when reviewing the problem.

· Describe the ways in which the continued assessment can change over time.

Developing a Plan for Services

· Identify the parts of a plan.

· Write a plan.

· See first-hand how a plan can change during the case management process.

· See how a client (Sharon Bello) and a case manager (Alma Grady) work together to develop a plan for services.

· Learn how goals and objectives are formulated.

Identifying Services

· Locate available services.

· Create an information and referral system.

Gathering Additional Information

· Compare interviewing and testing as data collection methods.

· Identify the types of interviews.

· Show how sources of error can influence an interview.

· Illustrate the role of testing in case management.

· Define test.

· Categorize a test.

· Identify sources of information about tests and the information that each provides.

· Learn about how to prepare clients for testing.

· Analyze the factors to be considered when selecting, administering, and interpreting a test.

· 8-1Introduction

· Although some agencies call the individuals they work with “clients,” we use the term “consumers.” We changed our language when we began to evaluate our services. These individuals actually come here for the services we provide. In other words, they actually “buy” our services. They could go elsewhere. Consumers choose agencies for a variety of reasons; we hope they see this agency as a welcoming and friendly place.

· —Case manager, family services, New York, New York

· We use the Millon Adolescent Clinical Inventory for each of our new clients who come to live with us. We call our clients “residents.” This inventory has 160 items. It is a questionnaire that addresses a range of issues, including personality patterns, expressed concerns, and clinical syndromes. First, we score the questionnaire, and then we identify issues of concern from the question and from the resident. Finally, the resident and the case manager together make a treatment plan that addresses the areas of concern.

· —Case and intake worker, emergency shelter, St. Louis, Missouri

· When I first meet clients during the interview, I help them understand what will happen if they join our program. We have some basic criteria, such as having a 9.5 in math and a 10.0 in reading on the TABE test. Plus, they have to be able to type 30 words per minute and have a minimum understanding of computers. If they join the program, they must attend classes on a regular basis. They may only miss 8 days within a 6-month period. That is difficult for some of them.

· —Case manager, welfare-to-work and case management services, Knoxville, Tennessee

· A caseworker at a school for the deaf also notes the importance of gathering information to see the big picture.

· One skill that I need in this job is to be able to talk with the different professionals, family, and friends of the children I work with. So many people have to be involved to address such complex problems. I search and search for all of the little pieces. But the job is still not done. I need to step back and see the big picture. This is the key to case management. Without a case manager or someone taking the case management approach, no one has the big picture.

· This chapter explores the planning phase of case management, when the helper and the client together determine the steps necessary to reach the desired goal. The activities involved in this phase include reviewing and continuing to assess the problem, developing a plan, using an information system, and gathering additional information. Running through our discussion in this chapter are two critical components of the case management process—client participation and documentation.

8-1aRevisiting the Assessment Phase

The next phase of case management begins with a review of the problems and strengths identified during the assessment phase. Before moving ahead with the process, the case manager will need to know if the problem has changed, if the same client resources are available, and if any shift in agency priorities has occurred. To complete the review quickly before moving into a planning mode, the case manager and the client examine two aspects of a case.

The first area of concern involves a review of the relevant facts regarding the problem. At this point, the case manager and the client revisit the identification of the problem. The initial question that the helper asks can help determine whether the problem still exists. Working with people requires an element of flexibility; clients’ lives change, just as ours do. Thus, the problem may have changed in some way: the client may have a different perspective on it; the participants may be different; or assistance may no longer be needed, appropriate, or wanted. Once the case manager has confirmed that the problem still exists and has documented any changes that have occurred, the problem itself is revisited. Is the problem an unmet need, such as housing or financial assistance, or is it stress that limits the client’s coping abilities or causes interpersonal difficulties? Is the problem a combination of several factors? This activity is best accomplished by talking with the client and reviewing his or her file. The client is still considered the primary source of information and a critical partner in the case management process. We return to Sharon Bello to illustrate reviewing the previous assessment.

My Story

Sharon Bello, Entry 8.1

Alma Grady

When I first started working with Sharon, I read through her file several times. Then, when she and I met for the first time, I asked her to tell me about herself. As the conversation continued, I asked her to help me think about my situation. I thought this would be a good way for us to get to know one another and begin our work together. When I read Sharon’s file, I could see her situation when she first came for services. But looking at the later entries, I could also see how her situation changed. When she first applied for services, we needed to verify her financial situation, confirm her physical disabilities, assess her vocational skills and interests, and assess her mental health needs. Everything to date has changed except her physical disabilities. Once she and I outlined a list of her first issues and then considered her status now, we agreed we needed to update her plan.

Joint Summary

I wanted Sharon to describe her current issues (and then we will work on strengths). We constructed this description with Sharon taking the lead:

“I am doing well in school and making progress toward my employment training. I want to stay in school and attend a 4-year college to become a human services professional. My financial situation has improved, although it is still difficult for me to care for my children. I don’t have much extra support and lots of times my children need things for school and athletics. Although I am not so distraught about the death of Sean, I am still depressed. I go to see the psychiatrist to manage my meds for depression. Alma thinks that counseling on a regular basis might help. I also feel lots of stress with school and childcare demands.”

Sharon and I agree that we will:

· a)

Revise her educational goals

· b)

Re-assess her mental health status

· c)

Explore a part-time job at the college

· d)

Explore a paid internship at the college

Other techniques that are helpful in reviewing the problem are observations and documentation. In the course of receiving the application, conducting the intake interview, making a home visit, or all three, the case manager has opportunities to observe the client beyond the office setting. For example, these observations may be richer if they occur in the home or if the client is accompanied to the office by family members or a significant other. Information available from such observations includes the client’s thoughts, feelings, behaviors, and relationships. In the case of Sharon, Sharon and Alma agreed that they would work together to gain new information and reformulate her plan as needed.

Documentation in the case file also provides facts and insights about the client. Case notes, reports from other professionals, and intake forms help the case manager pin down past occurrences and pertinent facts about the present situation. Case managers who have a long history in service delivery may call on knowledge and experience from the past to understand a current case. Sometimes, knowledge comes from a case manager’s own perception, instinct, experience, or street know-how. Many case managers mention rapid insight they sometimes have about a client, the client’s environment, possible difficulties, and creative approaches to the case management process. This insight is treated as just one piece of information and must undergo the same scrutiny as the other information collected.

8-1cDeveloping a Plan for Services

· Draft 1: Ms. Merriweather will participate often in many of the Oakes programs that relate to sports, games, music, communication, exploring other cultures, and other educational programs as they are developed by the creative staff in the activities area.

· Draft 2: Ms. Merriweather will increase her social opportunities by participating in center activities.

A description of the plan is presented in Draft 1. In Draft 2, it is restated less ambiguously by defining who will help with medications and what the help entails.

· Draft 1: They will work with Ms. Merriweather and her numerous family members to help with medications.

· Draft 2: Nursing staff will develop a plan to administer Ms. Merriweather’s medication.

The goal in Draft 1 is to establish general physical goals for Ms. Merriweather. Draft 2 restates these goals in realistic and achievable terms.

· Draft 1: Ms. Merriweather will increase her range of motion, physical strength, and stamina.

· Draft 2: Ms. Merriweather will participate four times per week in an exercise program that includes walking, weight lifting, and stretching.

Thus, goals are an important part of the service plan. They increase the chance of solving the problem by providing direction and focusing attention on well-expressed, reasonable statements. Because formulating goals requires collaboration between the client and the case manager, writing them also highlights the shared responsibility for the case.

Once the client and the case manager have agreed on a broad statement of intent, it is time to identify the activities that will lead to the desired outcomes. This process continues as a cooperative effort between the client and the case manager. Activities are identified as objectives.

· Objectives are the basis for monitoring to determine whether objectives have been met, unless they can be measured.

· The objective provides a reference point from which a change in the target population can clearly be measured.

Achievable

· Objectives should be attainable within an implementation of your strategies and progress toward achieving your program goals. Objectives also help set targets for accountability and are a source for program evaluation questions.

Realistic

· Objectives are most useful when they accurately address the scope of the problem and programmatic steps that can be implemented within a specific time frame.

· Objectives that do not directly relate to the program goal will not help achieve the goal.

Time-Phased

· Objectives should provide a time frame indicating when the objective will be measured or a time by which the objective should be achieved.

Written

Each of us, whether consciously or unconsciously, has a convenient memory. We tend to remember the things that turn out the way we want them to and either forget or modify those things that do not go as we wish. If we did not put objectives in writing, then it would be relatively easy to look on accomplishments as if they were in fact planned objectives. On the other side of the coin, one of the sharpest areas of conflict among case manager, client, and supervisor is illustrated by phrases such as “I thought you were working on something else!” or “That’s not what we agreed to do” or “You didn’t tell me that’s what you expected.” Having objectives in writing will not eliminate all these problems, but it will provide something more tangible for comparison. Furthermore, written objectives serve as a constant reminder and an effective tracking device by which the case manager, the client, and the supervisor can measure progress.

Consistent with Resources

A statement of objective must be consistent with the available or anticipated resources.

Individually Accountable

Ideally, an objective should avoid or minimize dual accountability for achievement when joint effort is required. If dual accountability is needed, then assign specific tasks to each individual.

Consistent with Rules

Objectives must be consistent with basic agency policies and practices.

Voluntary

The client must willingly agree to the objectives without undue pressure or coercion.

Communicated Personally

The setting of an objective must be communicated not only in writing but also in face-to-face discussions with the client and the resource persons or agencies contributing to its attainment.

My Story

Sharon Bello, Entry 8.2

I wanted you to see my revised plan that Alma and I wrote together. Alma and I worked on the Program Goal and Intermediate Objectives together. We made some changes because, right now, we both believe that I need some help. We also need some additional information because my life has changed since I began receiving services from the VR.

The document that we filled out and I signed, well, it is an official document. If you look at the conditions spelled out at the end of the document, then you can see all of the things about the plan that I have to agree to. I remember when I signed the first plan with Susan Fields; I was really scared that I would not be able to fulfill all of these requirements. Now, after I have changed my major and am more familiar with the agency, I still take those promises seriously, but I also know that the agency and especially my case manager are here to help me. I also know that we can change the plan if necessary.

Mary Sue Davis is an 86-year-old white married female. She recently placed her husband in a nursing home facility so that he can receive full-time care. Mrs. Davis has a severe heart condition and has been ordered by her physician to rest every 2 hours and to not travel by herself because of dizzy spells. The nursing home is now receiving her husband’s Social Security income. Mrs. Davis lives in a two-bedroom apartment. They have one son who lives an hour away and also has a heart condition. Mrs. Davis is requesting assistance with transportation to visit her husband on a more regular basis.

An interview with Mrs. Davis at her apartment revealed that her income consists solely of her Social Security checks. She does have Medicare to help with the costs of treatment for her heart condition. She currently uses public transportation (bus) to travel where she needs to go. During the interview, the service coordinator identified additional problems: the affordability of her current apartment, the availability of affordable housing, the need for an escort for travel, and possible grief issues regarding her husband’s condition, and placement in a nursing home.

Mrs. Davis agrees that she cannot afford her apartment and needs to seek more affordable housing. She is willing to apply for Community Action Committee (CAC) transportation that will pick her up at her door. She is very realistic regarding her husband’s condition. Although she wishes he could come home, she has accepted that he will most likely remain at the nursing home. She realizes that she has to take care of her own health, but at the same time she has to get things done, and there is not always somebody around to help.

Often planning is not quite so easy. Suppose Mrs. Davis refuses to rest as prescribed or is insistent that she will continue to ride the bus. Or perhaps there are no transportation services in her community, or agency rules limit services to those who have no other family. As you can see, a number of challenges may appear during plan development. Sources of these challenges include, but are certainly not limited to, clients themselves, family members, funding restrictions, agency policies and procedures, eligibility requirements, or lack of community resources. Barriers can also be more intangible, such as client values, the denial of problems, cultural prohibitions, reluctance, or lack of motivation. All of these possibilities present opportunities for the case manager’s resourcefulness and creativity, such as working with a client to develop a plan that is congruent with client values and desires, understanding cultural norms, mobilizing resources, consulting with colleagues, and networking with other agencies. Many of these challenges must be resolved to move forward with identifying services.

Class Discussion

Learning How to Evaluate Goals and Objectives

My Story

Alma Grady, Sharon Bello’s Case Manager, Entry 8.3

After Sharon and I developed her new service plan, I had to send the plan to my supervisor. In fact, after each meeting I have with one of my clients, I send a report to my supervisor. I fill out a special review request when a client’s service plan changes. My supervisor will review the requested changes in the plan and then make some suggestions, call me in for a special consultation if needed, and then approve or ask me to make revisions to the amended service plan. Usually I hear from my supervisor in approximately 1 week. Because I review my clients with my supervisor and my colleagues at a weekly staffing meeting, my supervisor is familiar with Sharon and the progress she is making toward meeting her goals.

I received an approval to proceed with the amended service plan. I will introduce how I begin my work with either a new plan or an amended plan, determining what is important. I describe how I make referrals and then coordinate the requests and care of the client. I followed three steps.

Step One

As new case managers build their list of professionals with whom they can consult, they expand the number of peers who can help them find services for clients.

Usually social services directories have two indices: one that is an alphabetical listing of agencies and one that is a categorical listing of services. Each entry in the directory lists the agency’s name, address, phone number, email addresses, URLs, and services. Also listed may be fees, hours of service, eligibility criteria, and sources of agency support. Many agencies also have discussion boards, Facebook pages, and accounts on Twitter and other social media. An example of an entry is provided here. The name of the agency, location, a site map, and a home page with a general description of the agency are provided.

· center for children, el paso, texas

· Our Site Map:

· Home

· About the Center

· Therapeutic Homes Program

· Runaway Shelter & STAR

· Healthy Families Initiative

· Contact

· Our Logo

· Donations

· Directions

· Employment Opportunities

· Runaway Shelter & Star

· (Services to At-Risk Youth)

The Center’s Runaway Shelter and STAR program serve 10- to 17-year-old runaway and homeless youths and their families, as well as youth and families that are at risk for abuse, delinquency, or family separation. The program’s purpose is to protect the safety and promote the healthy development of at-risk youth by providing each participant with an individualized program of shelter, counseling, skills training, and family reunification and support services.

The STAR program of El Paso County serves young people and their families. They use programs that are brief or solution-focused and hope to provide support effectively and efficiently. They work with youth to develop positive self-esteem, develop anger management skills, and develop skills to face the everyday issues confronted at home and at school. There are several services or parts of this program, including positive parenting programs, individual programs, and group programs.

Want More Information? Social Service Directories

The Internet expands our knowledge of the services in our community. Test your ability to use the Internet to find services in any community of your choosing.

· Use search terms such as “social service directory” and “human service directory.” For services for specific populations or problems, search terms like “homeless services” or “veteran’s services.” NOTE: Placing quotation marks around a phrase directs the search engine to look for the entire phrase rather than the individual words in it.

· Narrow your search to a specific location or a specific age group. Report what you find to your classmates.

· Begin to build an electronic file of services in your own community. This will help you when you begin your field experience or internship as a case manager.

8-1fSetting Up a System

Whether recorded on cards or electronic files, this information is easy to use when identifying the client problem and matching it with a service. However, because a client rarely has only one problem, using the file may not be so simple. First, the client and the case manager must prioritize the problems. Once this has been completed, the case manager identifies which problems the agency will address and which ones need referral. These additional services can be found by checking the file. If there is more than one resource to serve the client’s particular need, then the case manager works to identify the agency that can meet the client’s needs in a manner responsive to the client’s values and concerns.

Deborah Caudill is an 18-year-old client who needs long-term counseling to work on the anger she feels toward her father for deserting the family when she was 11. Lou Levine, her case manager, knows that the counseling Deborah needs is beyond the scope of the services provided by the agency where Lou works. Two other agencies in their community offer long-term counseling for adolescents. Because Deborah and Lou agree that counseling would be beneficial, they discuss these two agencies. Deborah has questions about where the counseling is provided, whether it is group or individual counseling, and how much it will cost. Lou consults her file for the answers to these questions and provides Deborah with the information, and then they discuss the pros and cons of each option. The case manager’s file indicates that one center provides counseling services and is well known for its work with adolescents. In addition, the latest entry in the file indicates that Jane Barkley, a previous client, had a positive experience there.

Establishing and using an information and referral system requires certain skills of the case manager. Being able to identify the client’s problem, the community resources available to solve the problem, and the viable alternatives are all critical to the success of the system. Choosing a resource or a service requires the client’s participation. The client may have the final say in the selection of the agency or service, so the more accurate and complete the information about the agency, the better the decision will be. Finally, good research skills are helpful because the case manager continually works to locate potential community resource alternatives and to update data on existing agencies and services. These skills include computer searches, building networks, and experience.

Part of the development of a plan is identifying services to meet the client’s needs. The development of an information and referral system is useful here. Throughout plan development, data gathering continues to take place.

8-1gGathering Additional Information

The mental status examination is a special type of interview used to diagnose psychosis, brain damage, and other major mental health problems. Its purpose is to evaluate a person thought to have problems in terms of factors related to these problems. This type of interview requires the case manager to have some expertise on major mental disorders and the various forms of brain damage.

Voices from the Field

First-Person Account of Being Tested for Autism

My name is Ben. I just received a diagnosis of autism. This means that “I am on the spectrum.” All of my life I have known that I am different. I am 34, and this diagnosis has given me a new perspective. Finally, I think that my parents and I can move forward and not struggle with the fact that I am different. The fact that my difference is not their fault and is not my fault is liberating. It is just the way that it is. And there are ways that we can work with my life and their lives, and there is help that we can now ask for. The diagnosis was an interesting process. I think that, during the process, the individuals conducting the assessment were able to “know” what I have known all along and were able to see, in some way, the challenges and issues that I have always had.

One of the parts of the testing occurred during several interviews. The interview was called a developmental screening. The physician explained that this screening looks different for an adult. He and I focused on my experiences as a child and then on my experiences as an adult. The questions also tried to uncover what I had learned to do to either compensate for my autism or disguise or hide it from others. It helps that my parents and two of my aunts were able to participate, too. After the physician interviewed me, he interviewed each of them separately. The physician actually used a checklist screening that he uses with children when he spoke with my parents and two of my aunts. And he asked them about me as an adult.

To give you an example of the type of questions we discussed, you can find the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F; Robins, Fein, & Barton, 2009) on the Internet. He also used the M_CHAT-R/F with my mother, father, and two of my aunts. When you look at this form, it gives you some ideas about autism and what can be possible challenges and issues for individuals with autism.

I don’t understand all about autism and I still have much to learn. But I am encouraged that my life can improve, and I work with my physician and my parents. Because I am relatively newly diagnosed, I have much to think about and much to consider as I begin to live my life in a different way.

8-1jTesting

In the previous section, testing was recommended as one way to verify the information gathered in an interview. Most people encounter tests soon after beginning school. How we perform on tests affects our lives, and test scores have become key factors in many decisions. They influence placement in special academic classes; the assignment of labels such as high achiever, mentally challenged, and average; admission to schools and colleges; and job selection. In fact, test scores are more important today than ever before.

The case manager needs an appropriate level of testing knowledge to use tests as a resource. Because tests have assumed such importance today, particularly in decision making, case managers must think carefully about the role of testing in their work with clients. To make proper use of test results, one must understand the test being used, including the purpose of the test, its development, its reliability and validity, administration and scoring procedures, the characteristics of the norm groups, the cultural dimensions, and its limitations and strengths. This section presents an overview of these areas.

8-1kWhat Is a Test?

There are a number of other categorization schemes for tests. Individual tests, such as the WAIS or the projective techniques, are administered to one person at a time. Group tests are administered to two or more examinees at a time. The Revised Beta Examination and the Otis Lennon School Ability Test are group tests, although they can also be administered on an individual basis. Tests can also be classified as standardized or informal. Standardized tests are those that have content, administration and scoring procedures, and norms all set before administration. Informal tests are developed for local use. An example is the test your instructor will give to you to measure your mastery of this course material. Verbal tests use words, whereas nonverbal tests consist of pictures and require no reading skills. Tests in which working quickly plays a part in determining the score are speed tests. Tests such as the Revised Beta Examination are closely timed. In contrast, power tests have no time limit, or one that is so generous that it plays no part in the score.

As you begin to explore the testing literature, you will discover that testing has a language of its own. Recognizing the categories and knowing their meanings will help you develop the vocabulary to understand testing concepts and the advantages and limitations of tests. Selecting tests requires an understanding of the terms that follow.

· Edition: the number of times a test has been published or revised

· Forms: equivalent versions of a test

· Level: the group for which the test is intended (e.g., K–3 is kindergarten through third grade)

· Norm: the average score for some particular group

· Norms table: a table with raw scores, corresponding derived scores, and a description of the group on which these scores are based

· Percentile rank: the proportion of scores that fall below a particular score

· Reliability: the extent to which test scores or measures are consistent or dependable—that is, free of measurement errors

· Test: a measurement device

· Test administrator: the person giving a test

· Test profile: a graph that shows test results

· Validity: the extent to which a test measures what it claims to measure

· Test selection: where to find out about available tests and how to select a test

There are many sources of information about tests, ranging from test publishers to reference books available in the library. These sources refer to journal articles that provide more detailed information about a test. The general information about a test can help you narrow the choices to those of interest, and it is for these tests that more specific information is gathered. Let us begin with the more general information.

Thousands of commercially available tests in English are described and critically reviewed in the many editions of the Mental Measurements Yearbook, or MMY, published by the Buros Institute of Mental Measurements at the University of Nebraska–Lincoln. Begun in 1938 by Oscar K. Buros, the MMY provides comprehensive reviews of tests by almost 500 notable psychologists and education specialists (Kaplan & Saccuzzo, 2013). For each test included in the MMY, there is a detailed description and price, followed by references to articles and books about the test, along with original reviews prepared by experts. The MMY contains no actual tests.

Once you have narrowed your choice, specimen sets of tests are available for purchase from test publishers. Although there are approximately 400 companies in the test industry, the top 10% are responsible for 90% of the tests used in the United States. Test publishers have catalogs that provide lists of tests and test-related items sold by that company. Companies usually offer specimen sets for sale: the test manual, a copy of the test, answer sheets, profiles, and any other appropriate material related to a particular test. The test manual—the best source of information about a particular test—provides statements about the purposes of the test, a description of the test and its development, standardization procedures, directions for administration and scoring, reliability and validity information, norms, profiles, cultural dimensions, and a bibliography. This specific information can help the case manager decide whether to use the test.

Once available information about a particular test is gathered, the case manager decides whether to select it. Then, the second question surfaces: what are the criteria for selection? One helpful source of information is Standards for Educational and Psychological Testing, published by the American Psychological Association. The Standards is a technical guide that provides the criteria for the evaluation of tests. Among the standards discussed are validity, reliability, cultural dimensions, test administration, and standards for test use. Any case manager who is involved in testing should carefully review the complete standards.

8-1mCriteria for Selection

Many considerations go into the decision to use a test. Three primary considerations are validity, reliability, and usability. This section provides a brief overview of each consideration by defining each, identifying the types, and discussing how to evaluate, including the issue of bias. For more information, consult the Standards for Educational and Psychological Testing or testing textbooks that present this material in more detail.

The issue of bias is important to consider when considering testing and determining what particular tests to use. Bias refers to both technical and social aspects of the test. For example, if a test if technically biased, then this means that the test has different validity for a specific population (Whiston, 2012). Social bias means that the test, although valid, still might be unfair. We explore both technical and social bias here.

Validity, the most important of the three considerations, is the extent to which a test measures what we actually wish to measure. Think about a time when you have had to move furniture. A yardstick was probably helpful to you as you measured the available space and the piece of furniture for a fit. Much experience has confirmed the validity of a yardstick as a tool for measuring length. Validity works the same way for a test, which is a tool for measuring behavior. Among the questions related to validity are the following: How well does a given math test measure math achievement?, Could we make predictions based on those scores?, and Does this test measure other qualities as well? These questions are answered as content-, construct-, and criterion-related validity are established for a test. (These terms are likely to appear in the test manual’s section on validity.)

There are ways in which a test might not be valid for a specific race, culture, or linguistic group (Whiting & Ford, 2009). First, the test takers may lack the situation, education, or opportunity to gain knowledge that helps them answer the question. For example, a rural student might not understand questions that use city references. A second example occurs when an individual provides a “correct answer” from his or her own culture. Unfortunately, the answer is scored “wrong”; the right answer represents a different culture. A third example of bias occurs when the structure of the question or its wording does not make sense to the test-taker. The format is unfamiliar.

Reliability, the second consideration, is the degree of consistency with which a test measures whatever it is measuring—the degree to which test scores are free from errors of measurement. Such errors result in inconsistent scores from one test form to another or from one testing time to another; these changes are not attributable to factors such as the examinee’s motivation, fatigue, anxiety, or guessing.

As with validity, a review of the reliability evidence of a test takes into account any errors of measurement in light of the test’s intended use. For example, split-half reliability, which is often used with longer tests, yields an inflated estimate of reliability when applied to speed tests. Test–retest reliability (which involves testing the same group with the same test on two occasions) would not be appropriate for tests in which memory plays a role from one testing situation to another. When reviewing reliability evidence, it is also important to read the descriptions of the number and characteristics of the sample, the testing situations (including the interval between administrations), and the reported reliability estimates. This information should be evaluated in relation to the test’s intended use.

The final consideration is test usability, which includes all the practical factors that are part of a decision to use a particular test. The factors include economy, test administration, social bias, and interpretation and use of scores. The following questions relate to usability.

· ECONOMY

· Can we reuse the test booklets?

· Are separate answer sheets available?

· How easy is it to score the test?

· TEST ADMINISTRATION

· Are the instructions clear and complete?

· Is close timing critical?

· What is the layout of test items on the page (print size, clarity of pictures, and so on)?

· Can the test be administered via computer?

· SOCIAL BIAS

· Are there specific populations (races, ethnic groups, or linguistic groups) that do not score “well” on a test?

· Are there negative consequences relating to, for example, school placement or job placement (Whiston, 2012)?

· Is the test fair to those taking it?

· INTERPRETATION AND USE OF SCORES

· Are scoring keys and instructions provided?

· Are norms included for appropriate reference groups?

· Is there evidence that test scores are related to other variables?

· Is there a clear statement about the function of the test and its development?

· Are there multicultural considerations?

8-1nAdministration and Interpretation

The test manual is an important source of information about the administration of a test and the interpretation of test scores. It should identify any special qualifications in training, certification, and experience that are necessary for the people who will administer and interpret the test. Needless to say, only individuals who have the training and experience for using tests should be entrusted with them. The test manual also describes the recording and scoring of answers. Can answers be recorded in the test booklet? Are separate answer sheets available? If the answer to both questions is yes, then are the results interchangeable? Also described in the test manual are procedures to facilitate the use of the test and reduce bias. Information about the interpretation of test scores will be included; in some cases, handouts are provided. Note that it is the responsibility of the test administrator to read the manual carefully and to be knowledgeable about the test and its uses.

Standardized test administration procedures are important. Many sources of error can influence test scores, and some relate directly to test administration. The testing situation itself is influenced by various factors, including the lighting, ventilation, room temperature, crowding, adequate work space, and noise level.

The test administrator’s behavior can also be a source of error. Giving extra help, pointing out errors after the test begins, establishing varying degrees of rapport with different examinees, and allowing additional time all influence test scores. The administrator of a test should eliminate as many of these conditions as possible before beginning the test and avoid deviating from the standardized procedures.

Today, computer-assisted test administration is a reality. In this testing situation, test items are presented via a computer terminal or a personal computer, and an automatic recording of test responses occurs. There are two important advantages to testing by computer:

· (1)

standardization of administration and scoring and

· (2)

bias control.

If a test is administered via computer, then it is important to ensure that the items are legible, the screen is free from glare, and the terminals are properly positioned.

What about the client who cannot read, or who reads below fifth-grade or sixth-grade level? Or one who has impaired vision or hearing? Or a person with epilepsy who is heavily sedated, causing his or her motor processes to slow down? An initial strategy is to find individual psychological tests that can accommodate the client’s problems and still measure interests, intelligence, achievement, aptitudes, or personality. The limitations of each disability need to be carefully considered in relation to the person’s ability to perform on a test. For example, a client who writes slowly because of a disability should not be given a test that places a premium on speed. In some testing situations, however, special consideration cannot and should not be given to a person with a disability. If a client has an amputation below the knee and is interested in attending college, then he or she needs no special considerations when taking the SAT. The limitations imposed by the disability do not interfere with the traits measured by the SAT. When adjustments are made for the person with a disability, avoid deviating from standardized procedures as much as possible. The reason for using tests is to obtain an objective comparison of the individual with a standardized group. If the test is administered in a nonstandardized way, then the norm-based scores obtained are not accurate.

When the test is given to people who are different from the groups that the test was designed for and normed on, it is more difficult to get accurate results. The instructions, item content and format, methods of answering items, and many other aspects of the test have been designed to make it useful for a specific population. Knowledge of disabilities can help you decide whether modifications are needed. If deviation from established procedures or content is necessary, then it is best to consult with a colleague who has psychometric expertise.

Once the standard scores are available, it is time to interpret the test. There are two essential steps in test interpretation: understanding the results and communicating them to another person (orally or in writing). The following suggestions will guide your preparation for test interpretation.

· Know the test—its purpose, development, content, administration and scoring procedures, validity and reliability, cultural perspectives, and advantages and limitations.

· Avoid technical discussions of tests. Use short, clear explanations of what you are trying to communicate.

· Use the test profile as a graphic presentation of the test results. The examinee may find this easier to follow as you explain the score.

· Explain what the score means in terms of behavior.

· Go slowly. Give the examinee time to process the information and react.

Tests are helpful tools for measuring traits common to many people. A score helps show where a person stands in a distribution of scores of peers. How high or low a score is does not measure an individual’s worth or value to family, friends, or society. A guiding principle for professionals who use tests is to consider scores as clues. They do mean something, but to know what, we must consider each examinee as an individual, combining test evidence with everything else we know about the person. It is unsound practice for case managers to base important decisions on test scores alone. It is important to remember this in test selection, administration, and interpretation.

8-1oSpecific Cultural Guidelines

· Review norming data and sample sizes; although diverse groups can be proportionately represented in the standardization sample, their actual numbers may be too small to be representative, thus hindering generalizability.

· Include culture-fair or culture-reduced tests in the assessment or decision-making process; these tests are designed to minimize irrelevant influences of cultural learning and social climate, thereby producing a clearer separation of ability or performance from learning opportunities. Nonverbal intelligence tests, with their reduced cultural and linguistic content, fall into this category,

· Always use and interpret test scores with testing principles and standards in mind.

Voices from the Field

Culturally Sensitive Interview Questions

As discussed in this chapter and in other chapters in this text, culture plays a critical role in the case manager’s interaction and success with the client. Interviewing clients with sensitivity requires a desire to understand the client and cultural competence and skills. Gulanti (2008) suggests using the 4 Cs of questioning to explore case manager and client awareness of culture. The four questions relate to calling (i.e., naming or labeling), causation, coping, and concerns. Each question is designed to help case managers understand the client’s perspective.

Question 1: What do You Call Your Problem (Issue, Strength, Barrier)?

This question allows the case manager to enter the world of the client. How we name aspects of our lives provides us information about culture, values, beliefs, and personalities. As clients answer this question, we communicate to the client that we are interested in them and their experiences; this begins building the foundation on which trust develops. Responses also help case managers understand how clients conceptualize their situations.

What Do You Think Caused Your Problem (Issues, Strengths, Barriers)?

Answers to this question allow case managers to understand the power structure in the client’s world. Causes of or relationships to the issues at hand might be scientific, social, emotional, educational, financial, or spiritual, and they may reflect an internal or external locus of control. During the assessment and planning phase of case management, the view of the client must be considered. Then, the intervention, from the client perspective, is related to perceived cause.

How Do You Cope with This Problem (Issues, Strengths, Barriers)?

When the case manager asks this question, he or she learns much about the culture of the client and what interventions are important to the individual, as well as what is available within the cultural context. Sometimes clients have tried nontraditional or non-Western approaches and are reluctant to share this knowledge. They fear ridicule. Asking this question and validating the approaches the client has taken help build client strength and empowerment.

What Concerns Do You Have regarding Your Problem (Issues, Strengths, Barriers)?

Hopefully, as the client answers this question, the case manager learns about the client’s worries, fears, and sense of seriousness of the problem, and possibly his or her concerns about working with the case manager. Addressing these concerns demonstrates respect. It also helps the case manager understand any potential barriers during the case management process.

Alma Grady, Sharon Bello’s Case Manager, Entry 8.4

· an abdominal exam

· a neurological exam

· a circulatory exam

· an exam related to gender, in Sharon’s case perhaps a breast exam and/or a pelvic exam

The exam will probably also include laboratory exams looking at blood count and urinalysis (Web MD, 2014).

Sharon stated she was familiar with an annual exam and she knew what to anticipate. I also helped Sharon prepare a list of information and questions for her doctor. Sharon’s list included the following:

· a)

description of her anxiety and stress;

· b)

description of her depression; and

· c)

her concern about sleeplessness.

Sharon also wanted to tell her physician about her current life, including financial concerns, concern for caring for her children, and the love of and stresses of going to school.

Sharon also planned to ask the physician how the test results would be communicated to her. She decided to tell the physician that she would like to receive feedback during the exam. She also wanted a written report of the lab results and asked who she might talk to if she didn’t understand the lab results. She decided to ask the physician to if he would show her what sample results would look like and then explain to her how she should read these results. She also decided to ask her physician how she would know if any follow-up would be needed. And she wanted to know how to understand how her scores compared with others who took the test and what she should consider “normal.” I prompted her to plan to ask if her race or ethnicity made her more or less susceptible to specific problems.

Sharon and I agreed, and Sharon signed a permission form so I could follow-up with the physician if I had any questions. We also placed a discussion of the results of her physical for our next monthly meeting.

Summary of Testing

Test misuse can easily occur. Let us review some guidelines for the selection, administration, consideration of bias, and interpretation of tests.

First, case managers should select tests that they have carefully reviewed. The validity, reliability, cultural sensitivity, and usability of a test; its statement of purpose, content, norm groups, administration, and scoring procedures; and its interpretation guidelines should all be evaluated in light of the intended use. The case manager should check any reviews by experts to add to his or her knowledge of the test. It is also a good idea for the case manager to take the test.

Second, case managers should use only tests that they are qualified to administer and interpret. This often depends on one’s ability to read the manual. Other tests require advanced coursework and supervision or practicum experiences for proper administration and interpretation. Test catalogs usually indicate how much expertise is required for the tests listed. Another helpful source of information is the Standards for Education and Psychological Testing.

Third, case managers who administer tests have an obligation to provide an interpretation of the test results. An understanding of raw scores and their conversion to standard scores, coupled with the ability to communicate the meaning of the scores, is necessary to do this right. In addition, it is essential to be aware of the norm groups and their applicability to the examinee. Some groups, such as Latinos, African Americans, and rural populations, may be underrepresented in the establishment of norms. Follow guidelines to insure that you consider technical and social bias when performing testing and assessment.

Using the Checksheet to Prepare for Testing

As we indicated in the text, testing is an important part of the case management process. As an individual, small group, or class, recall a previous testing situation in which you were involved. Review the ways in which Alma Grady prepares her clients for a testing situation and write responses to those questions. In what ways were you prepared for the test you identified? Not prepared? What would have been the optimal way you could have been prepared for the testing?

Share this information with your classmates.

Deepening Your Knowledge: Case Study

Scarlett is a case manager at a state-supported boarding school for the blind in Denver, Colorado. She has 7 years of job experience working with recent graduates of the school as they prepare for the transition from the boarding school to independent living and work. All of the students are eligible for transitional services, but they have to agree to the services before they are provided. During the assessment phase, Scarlett focuses on strengths, needs, barriers, cultural issues, and vocational interests for each client. After completing pretransitional assessments for all clients, Scarlett reviews these assessments and then develops individual plans for service delivery.

One of her newest clients, Edward, is an only child who moved to Denver from rural Colorado to attend the school at age 6. He is 17, classified as legally blind, cannot have a driver’s license, and can see well at distances of 2 feet or less. At the age of 14, his parents were killed in an automobile accident and he has no known living relatives. Edward received counseling for his grief and excelled in his studies and social behaviors despite his challenges. While at school, Edward developed an interest in mathematics and computers. He benefitted from the excellent vision-impaired technology at the school. He would like to pursue his academic interests at the Denver Institute for Technology, a 4-year school where he has taken one class and met briefly with an admissions counselor. He plans to obtain a BS degree in computer engineering. Edward is open to help and has told Scarlett that he knows he needs assistance in applying to college, finding somewhere to live, developing a support network, and securing transportation.

Scarlett works with Edward to develop a written plan for service delivery, carefully documenting agreed-on goals, objectives, and specific interventions. Due to her experience at the school, Scarlett has an extensive referral information system including services for the visually impaired. This disability group has a well-organized collaborative of service providers and advocates. This task becomes easier in the case of Edward, because he wants to live and attend school locally. Scarlett, however, must set up many important aspects of service delivery so Edward can experience success in his goals.

Because Scarlett already has an assessment interview and case history information on file for Edward, she proceeds to planning specific interview and testing needs based on Edward’s disability, social position, and academic plans. Edward agrees to meet with Scarlett twice each month during his senior year at the school to begin working on his goals, objectives, and service delivery plan. At this time, Scarlett focuses her work with Edward on identifying testing goals and service providers for his unique needs.

Case Study Discussion Questions

1. What types of testing needs should Scarlett consider for her work with Edward? How can she work to help Edward understand the purpose of the tests and interpret the results?

3. What are some ways that Scarlett can empower Edward to begin working toward his short-term and long-term goals? Which areas might require special attention to advocacy?

Author Note: We think that it is important for you to review the chapter you just read. We suggest the following.

1. First, re-read the class discussion questions in the text and answer these as comprehensively as possible.