Week 2 Assignment

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Introduction to Assessment Part 1

Introduction to Assessment Part 1 Program Transcript

[MUSIC PLAYING]

NARRATOR: How important are assessments in counseling? When do they occur, and how reliable should they be?

Doctors Tiffany Rush-Wilson, Matthew Buckley, Stacee Reicherzer, and Jason Patton explain how assessments are integral to counseling.

TIFFANY RUSH-WILSON: I want to talk a little bit about assessment and how we work with our clients to assess their diagnostic needs, their counseling needs. How do we go about assessing, and is it a static process or is it ongoing?

MATTHEW BUCKLEY: I think assessment is one of those things where counselors need to be assessment minded. What I mean by that is we always need to be aware of where our clients are and how they're progressing on many levels.

I use a lot of informal assessment in my work with clients. So it could be something as simple as saying to a client, last week you left here and you were pretty shaken with some of the things that you talked about. And you're struggling and kind of on a scale from 1 to 10, 10 being you feel real confident in the decisions that you've made and 1 you feel no confidence at all, where would you say you are at that point right now?

And that's really useful because a client says, well, I think I'm about at a seven. Wow, last week you noted that you were probably a four, so you've made some progress. They're able to kind of move into a place where they're thinking kind of like, where have I been, and where am I, and where am I heading? So that's a very simple, quick scaling technique to help clients.

Oftentimes, I'll say, how's this working for you now? If I have a client that who's experiencing some depressive symptoms, I'll assess, what are your eating habits like? How are you sleeping? Those are two areas that I think are real important in terms of like just checking in and making those assessments about how they're doing.

If a client expresses some suicidal ideation, I will do some assessment around that, around do you find yourself just saying like, I just wish I were dead, or do you actually have a plan? And do you have means whereby you could accomplish a suicidal gesture like that? So those are types of assessments that I think are really important to be aware of, just some examples.

Introduction to Assessment Part 1

TIFFANY RUSH-WILSON: Well, those are informal assessments. Do we also use formal assessments? And how do we know when to use which one? And how does this relate to treatment planning?

JASON PATTON: Well I think it's all part of the same process. I might say that assessments should be ongoing, iterative, and holistic. So it's something that you're always doing. It's something that evolves upon itself. And so you've thought about one thing and that may lead you to the next assessment. And I may be thinking about all of the things that are going on for this client.

I can think of an example of when I chose to use a specific instrument with a couple. They were having a lot of trouble understanding each other and understanding how they took in information. And so I decided, why don't we do the MBTI, the Myers-Briggs Type Indicator with them, and do it for each of them? And then maybe introduce them to-- it was Bates' Please Understand Me. And so they were able to read about how their partner was taking in information and how they see the world. Maybe it's a little bit differently than their own. And they were able to really respect each other in that process.

And I only thought to get to that assessment because we were constantly checking in with each other. We were misfiring. We weren't really understanding. And so it was just part of the assessment process.

TIFFANY RUSH-WILSON: And if we're writing a report about a client at some point, can we include both the informal and the formal assessment results?

STACEE REICHERZER: I would hope we would. I would hope we would. And I like the idea of doing assessments. And I think it's an important part of practice. And I like formal assessments because milestones and being able to measure where we started and track periodically where we're arriving is a significant part of our counseling journey. Because we want to know that what we're doing works. We want an evidence basis with this particular client. And so we want to use some form of assessment.

Certainly, informal goes a long way. But having a formal assessment tool that we're using as a periodic check-in, depending on the instrument and depending on its value for test and retest use, we really have a mechanism then for understanding-- wow, we started off with this baseline of a person being extremely depressed, all of these types of symptoms. And look at where we are now 5 weeks later, 10 weeks later, whatever period we're using. And we can measure then systematically what we've done and how well we've accomplished the goals that we set forth at the beginning of counseling.

First of all, we can see how much the client's grown and can actually help the client to use this information, sharing results and demonstrating what's happened. Also, there's value in being able to be accountable to the profession

Introduction to Assessment Part 1

that we're demonstrating and doing what we need to be doing with clients because this work that we do really does move a process along for a person and does create change.

TIFFANY RUSH-WILSON: I appreciate that you brought up the profession. How do we consider ACA when we do assessments? What ethical considerations do we need to keep in mind as we assess our clients?

JASON PATTON: I think it's important that a counselor never try to take on an assessment tool without being fully trained in the use of that assessment tool and must be really confident in whatever they're doing.

I wouldn't want to just go and look up a tool in some tests and measurements book and then just try to use it without ever having been introduced to it and having really studied it beforehand.

MATTHEW BUCKLEY: I think another useful, very important ethical guideline is to understand that any assessment instrument ever developed cannot capture the complexity of an individual. So I think responsible and ethical use of any instrument that's being used is to understand the limitations of the instrument.

When you administer an instrument, you get the results and you begin to interpret the results to the client, that you help them understand the limitation, the fact that it doesn't capture the essence of who they are, that there may be cultural limitations around who the population was normed around-- the development of that instrument, there are a variety of things.

And to help clients understand that this is one bit of information that might be helpful in helping them track where they've been, where they are, and where they're going.

TIFFANY RUSH-WILSON: I want to piggyback on that point. That's an excellent point. And what I wanted to ask next was, what types of multicultural considerations do we need to keep in mind as we assess our clients?

STACEE REICHERZER: The thing that's often true is that instruments have been normed according to very general populations. And so whatever was accessible at the time that the test was developed is oftentimes the group that was used to norm the test.

If we are working with a population that differs somehow from that group, we really care about that. And we want to know, is this going to be an accurate instrument, in fact, for measuring my client population? Is for instance, trauma survival really the same for these two populations-- the ones that the group is tested on and perhaps this group of migrant workers and their families that I'm seeing here at this agency?

Introduction to Assessment Part 1

Well, that's a hard thing to necessarily know how to answer. And oftentimes, I think that we may do some experimentation. And fine, is this instrument really valid? Is it working out? Am I seeing what I should be seeing, or are the other there other variables that seem to be occurring that this instrument doesn't seem to capture or to really accurately measure in my client population's world? So those are the things that we really need to think about.

Because in a globally diverse society, it's very, very difficult to find instruments that are going to capture all of the various elements that people may have gone through. People lead enormously complex lives. And so there's always going to be some of that. The test was normed on people who were different than this population or whatever. And so we want to understand everything with a bit of relativity. And understand this is a great instrument, but it's a tool and there may be some flaws. And until we really have seen evidence that this instrument is really valuable for assessing, as from my earlier example, migrant workers, then we really want to take the whole thing with just a grain of salt.

MATTHEW BUCKLEY: I think a great example of that and an assessment process-- it's also a kind of an instrument, but assessment process that's often used when diagnosing clients is the mental status exam. And there, there are aspects of the mental status exam that I think really violate some cultural norms that some cultures have.

For example, cognitions and orientation to reality. I mean, there are some cultures who very much rely upon and value things that might be considered by another culture as supernatural or even delusional. And so being able to have a sense of who you're working with and where they're coming from and understanding the limitations of that mental status exam, I think is a very, very important thing. Because I think that there are some individuals that have been labeled or diagnosed incorrectly because there was a cultural difference.

TIFFANY RUSH-WILSON: And along those nomathetic lines, we have to look at ideographic differences, too. For instance, I once had to assess a boy who violated a zero tolerance policy at a school by telling some girl he would kill her. And when his mom came in she said, I can't believe we're here. That's just the way he talks. I'm so angry with him, I could just kill him. And it allowed me to see that this was the way they spoke. And we have to be aware of the language that our clients use, both individually and as a group, so that we can better understand what they're talking about as we assess them. We have to do a little bit of qualitative research ourselves into that.

Stacee, you brought up an interesting point about how tests are normed. Can you talk a little bit about tests being developed fairly? Do think there might be bias at times? What were you talking about?

Introduction to Assessment Part 1

STACEE REICHERZER: I appreciate you asking. And I think the thing that we have to recall as counselors is that all of these instruments, including the Diagnostic and Statistical Manual and all of the assessment instruments that are used to assess various disorders and things like that, have been developed by people. They were professionals, certainly well trained, certainly well crafted in their knowledge, but they're still people. And people who are existing within a certain space and time and who have their own biases, who have their own limitations of thought and understanding of the world around them.

And so oftentimes, what happens is that we see instruments that reflect really a very different worldview than what a client population is going to believe is true. And I think that we have to understand that test assessment development is an ongoing iterative process. These tests that have been used over time have developed progressively with one more use after another.

And when we found out that-- wow, we are now asking a question that seems to really have some bias. For example, with the Beck Depression Inventory, there was a revision made because it was deemed to be very patriarchal. There was an element that was really going to norm women to be more depressed or to show more depressed than men. That had to be changed when we realized that we were really skewing a lot of data whenever we assessed women and they always came out as more depressed. And those are the kinds of things that we have to understand about test development.

These are imperfect instruments. And that they continue to develop over time as we see work with more populations. And we start noticing that, well, this is an instrument that captures a lot of information, but there's also a way in which this actually can serve to marginalize somebody. And to really work to transform that in an important way. So be always considerate, I would say, when you're assessing an assessment instrument and determining its value to recognize that the folks who wrote this did their best based on their knowledge and worldview. But as a counselor-- as me, you, Matt, Jason-- we might also have knowledge about our client populations and their cultural nuances and the experiences that they bring in that these test developers didn't.

TIFFANY RUSH-WILSON: So can we use these tests? If I was working with migrant workers, would these tests be appropriate for use if they weren't normed on this particular population?

MATTHEW BUCKLEY: I really appreciated what Stacee said about that, because I think what really needs to be the guide is your work with the client and the knowledge that you have on the client. If the assessment seems to be additive to that, then it's going to be helpful in some way, but also to be aware that it could actually be harmful.

Introduction to Assessment Part 1

I think it was a great example of the Beck Depression Scale. That's why on some basic level you see different versions of a particular assessment tool developmentally. I mean, there are child versions. There are adolescent versions. There are adult versions because you can't assess an adolescent the same way that you would an adult. But I think being aware and being guided by what is your experience in working with the client, I think is really important.