Health Behavior Assessment Mr. Lema, Isaac Clinical Psychologist 23rd November 2015

Health Behavior Assessment Learning Objectives Understand the meaning of assessment and principle of measurement Familiarize with different methods used in behavioral assessment 23 November 2015 Health Behavior Assessment

Health Behavior Assessment Outline Introduction Behavioral Assessment Context in Clinical Setting Assessment Tools Principles of Measurement Assessment on Learning Theories Skinner’s Analysis of Behavior Problems in Assessment 23 November 2015 Health Behavior Assessment

Health Behavior Assessment Introduction Assessment is the process of gathering information about peoples symptoms and the possible causes of those symptoms Information to inform diagnosis Diagnosis label attached to a set of symptoms that tend to occur with one another 23 November 2015 Health Behavior Assessment

Behavioral Assessment Context in Clinical Setting Differs from traditional assessment in 3 ways Interested in samples of behavior, not behavior as a sign of internal processes In behavioral assessment, test / interview responses are interpreted as “samples” of behavior that are thought to generalize to other situations In traditional assessment, interpret test data as “signs” of internal processes 23 November 2015 Health Behavior Assessment

Behavioral Assessment Context in Clinical Setting … Functional Analysis, a very concrete method, is employed to understand behavior Assessment is an ongoing, active part of all phases of treatment Not just always in the back of clinician’s mind, as in other types of treatment 23 November 2015 Health Behavior Assessment

Functional Behavioral Analysis / Functional Analysis Derived from Skinner’s work with SR learning SORC model ABC model (very similar) Isolates a target behavior for analysis and understanding in a very concrete, prescript manor 23 November 2015 Health Behavior Assessment

SORC Model for Conceptualizing a Behavior S = stimulus or “antecedent” factors which occur before target behavior O = organismic variables relevant to target behavior Physical / medical / cognitive / psychological aspects of the client; that are relevant to treating the target behavior R = the response; the target behavior C = consequences of target behavior 23 November 2015 Health Behavior Assessment

Health Behavior Assessment Example of SORC model S – Stimulus: a child is ignored by her peers in class O – Organismic: the child has previously been diagnosed with ADHD) R – Response: She increases the volume of her voice (i.e., yells) C – Consequences: her peers pay attention to her, some role their eyes 23 November 2015 Health Behavior Assessment

Skinner’s Analysis of Behavior ABC of operant conditioning Antecedents (the stimulus conditions) Behaviors (or operant) Consequences (what happens as a result of the operant behavior – reinforcement or punishment) 23 November 2015 Health Behavior Assessment

Health Behavior Assessment Assessment Tools Clinical interviews or initial interview Unstructured Structured Test / screening tools Checklists, rating scales, self rating scale 23 November 2015 Health Behavior Assessment

Method Studying Behavior Observation Naturalistic or Controlled Observation Assess deficits in skills or way of handling situations Controlled Performance Techniques Self-Monitoring Role-playing Inventories, Checklists Cognitive-Behavioral Assessments 23 November 2015 Health Behavior Assessment

Method Studying Behavior … Self monitoring Keep track of the number of times per day s/he engages in a specific behavior and the conditions under which this behavior happens 23 November 2015 Health Behavior Assessment

Behavioral Interviews Behavioral interviews: ask questions focused on target behaviors Goal: help clinician gain general perspective of problem behavior and the variables that perpetuate it Understand antecedent factors May use structured diagnostic interview Not different from traditional interview in format, only in focus 23 November 2015 Health Behavior Assessment

Principles of Measurement Reliability Consistency of an individual’s score on repeated testing provided that the property being tested has not changed (Sims & Hume,1984) Validity Ability of a test to measure what is claimed to measure (Sims & Hume,1984) 23 November 2015 Health Behavior Assessment

Principles of Measurement … Prevalence The total number of existing cases among the whole population Incidence Number of new cases of a disease during a specified period of time related to the number of persons at risk of contracting the disease 23 November 2015 Health Behavior Assessment

Principles of Measurement … Prevalence A single point in time (point prevalence) or Over a period of time (period prevalence) and expressed as a percentage or when very small, as per 1000 population Prevalence is expressed as a percent, e.g. the prevalence of smoking in the S.A. in 1999 was 24%, or as a decimal, 0.24 23 November 2015 Health Behavior Assessment

Principles of Measurement … Prevalence is a “cross-sectional” measure, i.e. it is measured at one point in time Prevalence includes both “old” and “new cases”, i.e. both people who began smoking prior to 1999 and those who just began in 1999 23 November 2015 Health Behavior Assessment

Principles of Measurement … Prevalence is a measurement of the burden of illness Unlike incidence, it provides an estimate of the burden of disease If the prevalence of Type II diabetes is 3% in the U.S, that suggests that 7.65 million (0.03 X 255 million) people have this disease, a substantial number 23 November 2015 Health Behavior Assessment

Principles of Measurement … Incidence It may be measured either as a risk or as a rate Is the probability that a person initially free from the disease develops it at some time during the period of observation Expressed as a percentage or per 1000 persons . 23 November 2015 Health Behavior Assessment

Principles of Measurement … The incidence rate is the rate of contracting the disease among those still at risk e.g. diarrhea Because the incidence measures the number of NEW events, it provides an index of the speed or velocity of propagation of a disease in a population 23 November 2015 Health Behavior Assessment

Principles of Measurement … Changes in incidence over time, either up or down, suggest that a disease may be waxing or waning in importance. 23 November 2015 Health Behavior Assessment

Challenges to validity and Reliability Reliability & validity influenced by complexity of behavior observed level of training, experience of observer(s) unit of analysis chosen & coding system used influence of observation on target (problematic) behavior generalizability of observations to other settings/situations 23 November 2015 Health Behavior Assessment

How to Study Child Behavior Chart method Plotting a misbehavior Graph method 23 November 2015 Health Behavior Assessment

Problems in Assessment It is often difficult to obtain accurate information on children’s problems because children are unable to report their thoughts and feelings Parents and teachers may provide information about children They can be biased in their own assessment of children’s symptoms and needs 23 November 2015 Health Behavior Assessment

Problems in Assessment … When the clinician and patient / client are from: Different culture Language difficulties Cultural expectations 23 November 2015 Health Behavior Assessment

Health Behavior Assessment Conclusion Grows from Behavior Theory / Learning Theory Aspects of it can be easily combined with other forms of assessment 23 November 2015 Health Behavior Assessment

Health Behavior Assessment References Gross, R. (2010) Psychology the Science of Mind and Behaviors 6th edition; Macmillan Company Richard, G (2010) Psychology The Science of Mind and Behaviour; 6th Edition. Hodder education Santrock John W. (2006) Educational Psychology; second edition. Mc Graw Hill Publisher Sims, ACP & Hume, WI (1984) Lecture Notes on Behavioral Sciences   23 November 2015 Health Behavior Assessment