1. INTRODUCTION TO CLINICAL PSYCHOLOGY, THIRD CANADIAN EDITION by John Hunsley and Catherine M. Lee
Chapter 9

2. Overview Questions Integrating Assessment Data
Threats to the Validity of Assessments and Case Formulation
Case example
Psychological Assessment Reports and Treatment Plans
For next class

3. Integrating Assessment Data
The process of assessment
Clarifying the question that will be the focus
Generating hypotheses
Gathering data
Examining the data: looking at consistencies and contradictions
Formulating conclusions and making recommendations

4. In reporting data, the psychologist begins with the broad picture and then presents specific findings

5. Case Formulation Integrates material Addresses diagnostic issues
Hypotheses about development of problem
Hypotheses about maintenance of problem
Makes predictions about trajectory with and without treatment
Informs the treatment plan
Takes into account obstacles to implementing the treatment plan

6. What can we learn from TV about case formulation?
Medical/emergency room series?
Police/detective/crime scene investigation series?
In these shows, how are hypotheses generated and evaluated?
What happens when the professional/investigator believes too strongly in one hypothesis (i.e., confirmatory bias)?
Think of examples from TV shows that provide good and bad examples of how to formulate a case

7. Case formulation 1. Symptoms and problems
2. Underlying vulnerabilities
3. Stressors
Mechanism linking 1, 2, & 3 and maintaining the problem

8. Threats to the Validity of Assessments and Case Formulations
Patient/client factors
Retrospective recall
Possible biases in self-presentation (as presented in Chapter 8)

9. Threats to the Validity of Assessments and Case Formulations
Clinician factors
Biases and heuristics
Fundamental Attribution Error
Inattention to Base Rates
Belief in the Law of Small Numbers
Regression to the Mean
Inferring Causation from Correlation
Hindsight Bias
Confirmatory Bias
Representativeness Heuristic
Availability Heuristic
Affect Heuristic
Anchoring and Adjustment Heuristic

10. Improving the Accuracy of Clinical Judgment
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 established diagnostic criteria when making diagnostic decisions.
Use evidence-based decision aids, such as decision trees or clinical guidelines.

11. Improving the Accuracy of Clinical Judgment
In unstructured tasks, such as conducting interviews and reviewing assessment data, be as systematic, structured, and quantifiable as possible in order to obtain, consider, and use 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.

12. Case example: Alejandro:
Current context
Age 11 lives with his mother (39) and his sisters Clara (15) and Anna (9).
Mother and her three children have lived together in Canada since they moved to Canada from War-torn country last year
Alejandro has just completed grade 5.
Mother currently holds a part-time retail job that involves working four days a week from 3:00 to 7:00 p.m.
Mother has requested psychological services for her son.
Instructor can present Melissa from the text or another composite case (as has been done in these slides) and ask students to work in groups to generate hypotheses, identify sources of data, and after hearing summary information from instructor, to

13. Alejandro: Problems identified by adults in his life
Mother
Teacher
Overactive; does not respect limits
Hurts sisters when play fights get out of hand
Only does homework with supervision
When he does focus can get a lot done well
Easily distracted
Difficulty settling to work after recess
Recently did 3 items on math test then played games on his phone
Plays the ‘clown’ in class
Has hit a boy who repeatedly teased him

14. Alejandro What is the major question the assessment will address?
Hypotheses to explore?
Diagnoses to consider?
Types of assessment data that will help address the question?

15. Alejandro: Assessment results
Cognitive assessment:
Doing poorly on achievement tests
Performance affected by poor English skills
Observation:
School—distractible; plays the clown
Home—lack of supervision; extensive time watching TV
Rating scales:
borderline range for externalizing behaviours and attentional problems

16. Alejandro: Integrating data from
Interviews
Observations
Intelligence & achievements tests
Symptom checklists completed by different informants

17. Alejandro: Case formulation
How do we understand the development of his problems?
What is maintaining the problem?
What is the likely trajectory if there is no intervention?
What are the obstacles to treatment?

18. Psychological Assessment Reports and Treatment Plans
Importance of knowing the “audiences” for the report
Confidentiality and privacy considerations
Separating (and identifying) facts, client opinion, and psychologist opinion
Using computer-based interpretations of test results

19. Psychological Assessment Report
Identifying 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 behavioural observations
Test results (including interpretation of test scores)
Diagnostic impressions and case formulation
Summary
Recommendations

20. Treatment Plan Report Identifying patient/client information
Reason for referral
Evaluation of primary symptoms and problems
Diagnosis
Patient strengths
Treatment-related goals and objectives
Proposed treatment(s)
Potential barriers to treatment
Criteria for treatment termination or transfer to other service provider
Service provider responsible for treatment implementation and evaluation of treatment

21. Providing Assessment Feedback
Verify the general accuracy of the assessment results
Correct any errors or misunderstanding that occurred during the assessment process
Refine the interpretation of the results to ensure an optimal fi t 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

22. For next class…

23. Copyright Notice
Copyright © 2014 John Wiley & Sons Canada, Ltd. All rights reserved. Reproduction or translation of this work beyond that permitted by Access Copyright (The Canadian Copyright Licensing Agency) is unlawful. Requests for further information should be addressed to the Permissions Department, John Wiley & Sons Canada, Ltd. The purchaser may make back-up copies for his or her own use only and not for distribution or resale. The author and the publisher assume no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information contained herein.
All clipart courtesy of Microsoft.com