1. Using Assessment in Counseling
Chapter 13

2. Introduction
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

3. Treatment Planning Varies with client Assessment of functioning
Statistical/actuarial methods vs. clinical judgment
Gather quality information and evaluate it with a scientific approach
More than just diagnosis

4. Treatment Matching
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

5. 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

6. Case Conceptualization and Assessment
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

7. Monitoring Treatment Progress
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

8. 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

9. 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

10. Using Assessments for Evaluation and Accountability
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

11. Defining Evaluation Study Focus
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

12. Determining Design Information needed: Quantitative designs:
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

13. Selecting Participants
Qualitative studies: sample is usually smaller than for quantitative studies
Quantitative studies: a larger sample size allows for more power in statistical analyses

14. Selecting Assessments or Measures
Assessing outcome involves (Hill & Lambert, 2004):
Clearly specify what is being measured
Measure change from multiple perspectives
Use diverse types of assessments
Use symptom-based and atheoretical measures
Examine patterns of change as much as possible
Scheme for Selecting Outcome Measures (Olges, Lambert, & Fields, 2002)
Content
Social level
Source
Technology
Time Orientation

15. Outcome Assessment in Mental Health Settings
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 Questionnaire (OQ-45.2)

16. Outcome Assessment in Career Counseling
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

17. Outcome Assessment in School 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)

18. Data Analysis Descriptive information vs. statistical analysis
Effect size
Consult with researchers on methodological or statistical questions