PROVIDED AS INFORMATION ONLY ASSESSMENTS Assessment requires knowledge: Counselor need to understand various models and approaches to clinical evaluation for addictive disorders and their appropriate uses, including screening and assessment for addiction, diagnostic interviews, mental status examination, symptom inventories, and psycho-educational and personality assessments. Counselors must know specific assessment approaches for determining the appropriate level of care for addictive disorders and related problems. Counselors need to understand the assessment of bio-psychosocial and spiritual history, and understand basic classifications, indications, and contraindications of commonly prescribed psychopharmacological medications so that appropriate referrals can be made for medication evaluations and so that the side effects of such medications can be identified. Assessment requires skills and practices: Counselors select appropriate comprehensive assessment interventions to assist in diagnosis and treatment planning, with an awareness of cultural bias in the implementation and interpretation of assessment protocols. Counselors must demonstrate skills in conducting an intake interview, a mental status evaluation, a bio-psychosocial history, a mental health history, a psychological assessment for treatment planning and case management and a cultural formation interview.

• Counselor screen for psychoactive substance toxicity, intoxication, and withdrawal symptoms; aggression or danger to others; potential for self-inflicted harm or suicide; and co-occurring mental and/or addictive disorders. Helps clients identify the effects of addiction on life problems and the effects of continued harmful use or abuse.

• Counselors apply assessment of clients’ addictive disorders to the stages of dependence, change, or recovery to determine the appropriate treatment modality and placement criteria in the continuum of care.

Assessments includes all of the following: Historical perspectives concerning the nature and meaning of assessment; basic concepts of standardized and non-standardized testing and other assessment techniques, including norm-referenced and criterion-referenced assessment, environmental assessment, performance assessment, individual and group test and inventory methods, psychological testing, and behavioral observations; statistical concepts, including scales of measurement, measures of central tendency, indices of variability, shapes and types of distributions, and correlations; reliability; validity; social and cultural factors related to the assessment and evaluation of individuals, groups, and specific populations; and ethical strategies for selecting, administering, and interpreting assessment and evaluation instruments and techniques in counseling.

ASK YOURSELF: "What treatment, by whom, would be most effective for this individual, with that specific problem, and under these circumstances?"

ASSESSMENT INTRODUCTION FOR THE CLIENT “I would like to understand the problems that bring you here so that I can help you more effectively. I want to know about your experience and ideas. I will ask some questions about what is going on and how you are dealing with it. There are no right or wrong answers. I just want to know your views and those of other important people in your life.” ETHICAL ASSESSMENTS Assessment is ongoing and forms the basis of an integrated treatment plan. Be culturally sensitive when assessing. Assess multiple facets including development, behavior, mental, and physical health:

• Explore infancy and early childhood experiences • Explore strengths and resources • Explore self-management skills • Explore communication skills • Explore interpersonal skills • Explore task skills • Explore personal behaviors • Explore awareness of emotional and environmental triggers • Explore parenting attitudes and competencies • Explore family backgrounds explore marital relationships • Explore sibling relationships • Explore current support systems • Explore stressors and stress management • Explore rules, roles, and boundaries

Look at your information from a variety of paradigms: psychodynamic, family systems, developmental, attachment, and cognitive.

ASSESSMENTS AND TESTING • Counselor must administer test under the same conditions that were established

in their standardization. • Counselor does not permit unsupervised or inadequately supervised use of tests

or assessments unless the test or assessments are designed, intended and validated for self-administering and/or scoring.

• Counselor recognizes the effect of age, color, race, culture, disability, ethnic group, religion, sexual orientation and socioeconomic status on test administration and interpretation and place test results in proper perspective with other relevant factors.

• Counselor indicates any reservations that exist regarding the validity of a test in norms for the person being tested.

ASSESSMENT CONSIDERATIONS MARGINALIZATION: The process of being relegated to the “sidelines” of society-excluded- as a function of individual or group traits that are targets of oppression.

• Marginalization reflects the active combination of oppressions and exclusion • Marginalization reflects dominant class “codes” for inclusion/exclusion,

superiority/inferiority, normality/abnormality and desirability/undesirability • Marginalization results in decreased access to meaningful participation in the

larger community: its history, its norms, its resources and its services • Marginalization results in increased, or at least protected, access for the

dominant (aka privileged) class • Marginalization assures increased exposure to social injustice

Marginalization results from oppressive processes, particularly in the form of microaggressions.

• Microaggressions convey the “active manifestation” of oppressive cultural views that create and sustain marginalization

• Microaggressions enforce marginalization through processes of imposition and deprivation: imposition of false beliefs and abusive messages and deprivation of access to resources and opportunities

• Microaggressions create the interminable quality of marginalized existence. ASSESSMENT CONSIDERATIONS

MICROAGGRESSIONS: These are the brief and commonplace daily, verbal, behavioral and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative (trait driven) slights or insults to the target person or group.

• While any one microaggression may seem inconsequential, the continuous, accumulating nature of these unpredictable indignities damages health.

• The combination of uncertainties, helplessness and the “catch-22” entrapment degrades self-esteem, perceptions of reality, relationship styles, capacity to trust and often, the “willingness to try”.

• Because microaggressions are often perpetrated unconsciously and unintentionally, and are thus “invisible” in the experience of the offender, recipient experience most often goes unaddressed, and therefore unresolved.

• The intention to diminish our vulnerabilities to perpetrate microaggressions is actualized (a) in translating “I didn’t mean to do harm” into “I mean not to do harm” and (b) through a keen awareness of our own histories of experiencing microaggressions.

• Microaggressions can be experienced at the individual, community and organizational levels.

• Microaggressions permeate community “knowledge” of groups and thus impose expectations and limitations on individuals.

ASSIGNMENT (Self-reflection and/or Group Discussion) When you meet Asian American or Latino American clients, do you tend to expect that the individual is foreign born? When working with clients, do you ignore their skin color and treat everyone the same. If yes, is this best practice? Based on skin color or ethnicity, do you expect some clients to be of higher intelligence than others? Should individuality, autonomy, self-examination and self-efficacy be emphasized in all mental health treatment? Do you use your own history of experiencing oppression and marginality as the framework for interacting with clients about their life experiences? Is it possible with hard work and persistence to break through cultural barriers equally for everyone?

ASSESSMENT AND SUICIDE RISK There is no pure legal duty to prevent suicide—the duty is to intervene appropriately—the law recognizes limits in the ability to stop a determined person from suicide. The duty to intervene is judged according to the degree of suicidal risk exhibited by a client and the counselor's ability to accurately assess and control that risk. The counselor's liability increases as the risk of suicide increases and the counselor is able to foresee and control the client's actions. Since the clinician in an inpatient facility can control the patient's behavior more than in an outpatient setting, liability is greater when suicide occurs in a hospital, day treatment, or residential care facility. Law and Ethics in Suicide Intervention: Suicide is not only one of the riskiest cases for a counselor clinically and spiritually, but legally as well. Professional clinicians are increasingly at legal risk for the suicide of their clients and patients. Indeed, the clinician working in an inpatient or restrictive treatment setting has a strong duty to intervene in the life of someone judged to be a substantial risk for suicide. In contrast, a pastor in a church setting may be ethically and morally, but not legally, bound to a duty of suicide intervention. SUICIDE ASSESSMENT Assessment of suicidal risk involves gathering information from multiple sources across a number of key variables. The essential two-part question of suicide assessment is: Is this person at risk for committing suicide, and If so, how serious is the risk? The competent counselor will assess this risk according to history, trait, mood, personality, and situational factors. Begin counseling with assessment of suicide risk. The easiest way to get information about suicide risk is to ask questions at the beginning of counseling. Structuring assessment this way and addressing these questions on initial interview puts clients more at ease as they see it as part of the routine we follow with all new clients. Evaluate suicide risk across key variables. Risk for suicide increases according to:

• Past suicide attempts and their seriousness • Communication of intent/denial of intent • Assessing the violent-angry-impulsive person • Professional counselor liability for suicide cuts across two issues: • The setting in which the crisis arises and the nature of the alleged harm • Whether it involved failure to take preventive action to avoid suicide or whether

the clinical behavior caused the suicide

SUICIDE RISK ASSESSMENTS A selection of SAMPLE QUESTIONS TO HELP ASSESS SUICIDE RISK

ü Past suicide attempts ü Age (risk increases with age) ü Expression of wish to die ü Means, availability, access to means of guns, pills, knives, etc ü Suicidal thoughts, feelings, plan of action ü Past suicide attempts or suicides by family members or close friends ü Level of depression (hopelessness, helplessness, sleep/eating patterns) ü Recent loss of a loved one (especially loss of a child or elderly spouse) ü Major psychiatric disorders (other than depression) ü Major recent physical illness, recent accident/crisis, chronic illness ü Past bouts with depression or hospitalizations, etc ü Financial problems ü Recent or chronic stressors (e.g. loss, separation, illness, life transition): ü Marital status (increased risk with single) ü Level of social support (increased risk with isolation) ü Sleep patterns (increased risk with too much or too little sleep) ü General level of impulse control ü Volatility of mood ü Drug and alcohol use/abuse/dependency ü Physical or sexual abuse in the family ü Sexual orientation (regarding comfort or discomfort level) ü Sense of humor, or ability to reflect cognitively on one's situation ü Level of cooperation with treatment ü Recent involvement in risky activities ü Excessively dependent on others ü Inability to take care of self or others

Summary of patient's suicide risk (circle one): High / Medium / Low / None Plan of action (see also treatment plan and/or suicide safety plan) q No action required q Suicide “Safety Plan” q Frequency of contact: sessions, phone, etc... q Voluntary hospitalization q Involuntary hospitalization q Further evaluation q Medication, medication evaluation q Obtain other medical or psychological records and consultation (with client authorization) q Other

SAMPLE TEXT: SUICIDE SAFETY AGREEMENT CAVEAT: No suicide document is a substitute to thorough clinical assessment, referrals, consultations, etc. Counselors must continue to monitor the situation and evaluate options even when client sign a safety plan. NOTE: The below paragraph is considered the minimum agreement. IT is best to complete a “suicide safety plan” instead. I, _____________________________________ agree that I will keep myself from harm. If I feel an impulse to hurt myself, I will call ______________ or 911, or the crisis hot line at ____________. I am aware that [counselor] may not be able to respond to a call right away and will utilize the other resources is needed. I have also read, signed, and have had explained to me the limits of confidentiality outlined in the consent form, especially in regard to clients who pose a danger to themselves or others. REMEMBER TO:

• Include appropriate lines for signature and date • Keep a copy od any document that was signed by a client in the client’s file

(hardcopy or electronic) • Copy to client optional, unless they request a copy

Suicide SAFETY PLAN are more beneficial and more relevant to current standard of care. See NEXT PAGE for information on Suicide Safety Plans…

SAMPLE TEXT: SUICIDE SAFETY PLAN CAVEAT: No suicide document is a substitute to thorough clinical assessment, referrals, consultations, etc. Counselors must continue to monitor the situation and evaluate options even when client sign a safety plan. NOTE: The below paragraph is considered the minimum agreement. IT is best to complete a “suicide safety plan” instead. A suicide safety plan is written sets of instructions as a contingency plan should client begin to experience thoughts about harming themself. It contains a series of gradually escalating steps that can be followed, proceeding from one step to the next, until they are safe. HAVE THE CLIENT WRITE OUT THE ANSWERS IN THEIR OWN HANDWRITING. Suicide safety plan should include the following elements, in the same order as presented below:

• When the Plan Should Be Used: This step will involve making yourself familiar with what types of situations, images, thoughts, feelings and behaviors might precede or accompany suicidal urges for you.

• What I Can Do to Calm/Comfort Myself If I Am Feeling Suicidal: Create a list for yourself of activities that are soothing to you when you are upset.

• What Are My Reasons for Living? Create a list that will help client refocus on the reasons to keep going

• Who Can I Talk To? Keep a list of contacts you can talk to if you are unable to distract yourself with self-help

• Who Can I Talk To If I Need Professional Assistance? Create a list of all professional resources available

• How Can I Make My Environment Safe? Plan what steps you can take to make yourself safe. IE: going to another location until the urges have passed or getting another person involved to help you.

• What To Do If I Am Still Not Feeling Safe: If all other steps have failed to keep you feeling safe, go to your nearest hospital emergency room and ask for assistance.

REMEMBER TO:

• Include appropriate lines for signature and date • Keep a copy od any document that was signed by a client in the client’s file

(hardcopy or electronic) • Copy to client optional, unless they request a copy

ASSESSMENTS HOMICIDE RISK Since it is impossible to predict with 100% accuracy dangerousness ahead of time, violation of a client's confidentiality must be undertaken with great care and in consultation with others. The art of counseling involves learning to discern what a client is really saying.

• When someone says, "I wish I (or someone else) was dead" are they talking suicide or homicide or just expressing frustration with their current stress levels or relationship difficulties?

How do we distinguish between the client who vents in scary ways and those who may carry out their threatening words? THE BEST PREDICTOR OF FUTURE VIOLENCE IS A HISTORY OR PATTERN OF PAST VIOLENCE.

• Good documentation is essential in every case, but with dangerous and threat-ening clients, it's critical.

• Make sure you have a treatment plan and you update and date it regularly. • In your case notes record specifically what a client said, your assessment of the

threat, what you did, and why you decided to do it. THE VIOLENT-ANGRY-IMPULSIVE PERSON WILL…

• Shows a history of violent and assaultive behavior—assault, hitting and injuring others, destroying or damaging property, and injury to self for such action;

• Reveals impulsive anger or rage that is explosively triggered by various people or events—the person quickly gets out-of-control and becomes destructive to things or people and relationships;

• Shows a tendency to hurt others and vengefully react when angry—using cutting, harmful words, hiding or destroying things special to the person who is the focus of one's anger;

• Projects blame onto others—is critical and condemning of others, while being unable to receive and reactive against any criticism from others;

• Justifies anger and harmful expression, unable to forgive, tending to hold grudges and resentments over a long period of time;

• Suppresses anger—deny anger in the face of obvious evidence—flushed face, clenched teeth and muscles, harsh and loud tone of voice, threatening posture;

• Represses anger—deny anger problems (contrary to history) without obvious anger signals—passive-aggressive, aloof, sarcasm-cynicism, conflict-avoidant; and

• Shows associated physical complaints and symptoms—gastric-intestinal distress, ulcers, spastic colon, headache, hypertension, and cardiac irregularities.

FEATURES of DANGEROUS

• Dangerous is defined as “attended with risk; perilous; hazardous; unsafe” • Danger is defined as “jeopardy; exposure to loss or injury; peril”

o Violent ideation: thoughts, fantasies, and dreams of violent acts; delusions or hallucinations commanding violent acts

o Violent Affect: person manifests intense, overwhelming rage, destructive impulses, drivenness, or fear of inability to control violent impulses

o Violent Behavior: physical agitation, accompanying psychosis, intoxication, or delirium; explosive rage; or domestic violence

In assessing dangerous behavior five components must be considered:

• Its nature • Extent

• Probability • Imminence

• Frequency Immediate danger signs of imminent violence:

• Motor activity is irritable with an inability to be calmed • Verbal indicators such as threats when stated loudly, defamatory statements,

and sexual verbal aggression • Nonverbal indicators include glaring eyes, demanding demeanor, tense, forward-

leaning posture, and a hyper-alert state ASSIGNMENT (Self-reflection and/or Group Discussion) Use the Internet or the DSM: What is the psychological profile of a dangerous person? What are the biological components of dangerousness? Sociocultural features of dangerousness? Developmental profiles of dangerousness?

PROTOCOL FOR DEALING WITH A DANGEROUS PERSON • Try not to be alone • Employ active listening • Express concern; exploring alternative to violence • Check for the here-and-now transference • Perform a mental status exam • Take a careful history • Inform about legal realities • Refer for psychiatric consultation; hospitalization; or call authorities

WORKPLACE VIOLENCE Factors that increase an employee’s risk of being involved in workplace violence

• Contact with the public • Exchange of money • Delivery of passengers, goods, or services • Having a mobile workplace such as a taxicab or police cruiser • Working with unstable or volatile persons in health care, social service, or

criminal justice settings • Working alone or in small numbers • Working late at night or during early morning hours • Working in high-crime areas • Guarding valuable property or possessions • Working in community-based settings

Prevention Strategies: Environmental Designs

• Cash-handling policies • Physical separation of workers from customers, clients, and the general public • The height and depth of counters are also important considerations in protecting

workers, since they introduce physical distance between workers and potential attackers

• Visibility and lighting • Numerous security devices may reduce the risk for assaults against workers and

facilitate the identification and apprehension of perpetrators • Personal protective equipment

Prevention Strategies: Administrative Controls

• Staffing plans and work practices • Increasing the number of staff on duty • Use of security guards or receptionists to screen persons entering the workplace

and controlling access to actual work areas • Work practices and staffing patterns during the opening and closing of

establishments and during money drops and pickups should be carefully reviewed for the increased risk of assault they pose to workers

• Policies and procedures for assessing and reporting threats allow employers to track and assess threats and violent incidents in the workplace

• Such policies clearly indicate a zero tolerance of workplace violence and provide mechanisms by which incidents can be reported and handled

• Training and education efforts are clearly needed to accompany such policies.

Prevention Strategies: Behavioral Strategies

• Training employees in nonviolent response and conflict resolution • Training that addresses hazards associated with specific tasks or worksites and

relevant prevention strategies • Training should emphasize the appropriate use and maintenance of protective

equipment, adherence to administrative controls, and increased knowledge and awareness of the risk of workplace violence

ASSESSMENT and the DSM-V

CAVEAT: Please refer to the dsm5.org website or the manual for exact wording of mental disorder definitions and other relevant details. The information provided here is an overview and an opportunity to see how the DSM-V relates to assessments. CURRENT DEFINITION OF MENTAL DISORDER (DSM-IV-TR) “Clinically significant behavioral or psychological or biological syndromes that are associated with present distress, disability, or significant impairment in important areas of functioning.” So if a person’s behavior does not cause them distress, disability or impairment, then they cannot be diagnosed with a mental disorder. EVOLUTION OF THE DSM AND THE DEFINITION OF A MENTAL DISORDER Additions to the definition of mental disorder include:

• Condition must draw concern from others in a relational, social, occupational, or vocational setting that requires a referral for treatment.

o A person can be syntonic (unaware, unconcerned), but the family has concerns. This might then require an involuntary commitment for a court-ordered evaluation.

• Must incorporate respect for age, gender, and culture-specific factors and sensitivity to these factors when making a diagnosis.

o Diagnoses must be respectful of cultural idiosyncratic behaviors. Culturally sanctioned behavior or cultural idiosyncratic behaviors are to be considered. Also, we must consider behaviors that are an expected response to a particular situation/event such as depression in response to grief is not necessarily a mental disorder. Further consideration needs to be given to the fact that behaviors may, or may not, be medical or biological illness in an effort to reduce pharmacological treatment, especially with children.

Conditions are something people have; and, the conditions are not to define the person. Counselors have the task of helping clients to not see the diagnosis as a self-definition. Disorders are quite often early life defense mechanisms that are now seen as dysfunctional and causing great distress in adult life. Many children go through childhood traumas. These kids develop defense mechanisms to survive and these become a part of who they are and how they react to stress. CAVEAT: If legal action or litigation is brought against a counselor the diagnosis they’ve given to a client is where apposing counsel will dig and try to prove incompetence. We need to follow DSM Criteria. As a counselor you must be familiar with the current version of the DSM and competent in its use. If at all possible, take your time when it comes to a diagnosis. Therapy is a relationship. All relationships start with unknowns. Relationships are about getting to know the person. Diagnostics are present in the therapy relationship, but we treat the person with the diagnosis, not the diagnosis. Therapy is a process, not an event. And, test and measurements can never be the source of diagnosis; it must be combined with clinical perceptions.

SAMPLE ASSESSMENT TEXT CAVEAT: For use in your own setting, forms must be personalizedto reflect your state’s relevant laws, ethical requirements for your licensing, and your own actual policies. CHECKLISTS MENTAL STATUS DESCRIPTION

• Presentation Mental Functioning o Appearance: Well Groomed / Unkempt / Unusual / Bizarre o Mood: Normal / Depressed / Anxious / Euphoric o Attitude: Cooperative / Friendly / Guarded / Exaggerates / Minimizes /

Suspicious / Hostile / Uncooperative o Affect: Appropriate / Expansive / Constricted / Flat o Speech: Normal / Slow / Detailed / Slurred / Incoherent o Motor Activity: Relaxed / Clam / Restless / Agitated / Tense / Tremors /

Tics o Orientation: Fully Oriented / Person Oriented / Place Oriented /

Disoriented o Simple Calculations: Accurate / Mostly Accurate / Mostly Inaccurate /

Totally Inaccurate o Immediate Memory: Intact / Partially Impaired / Mostly Impaired /

Severely Impaired o Remote Memory: Intact / Partially Impaired / Mostly Impaired / Severely

Impaired o Gen. Knowledge: Accurate / Mostly Accurate / Mostly Inaccurate / Totally

Inaccurate • Higher Order Abilities

o Judgment: Intact / Impulsive / Immature / Minimally Impaired / Moderately Impaired / Severely Impaired

o Insight: Intact / Limited / Very Limited / None o Intelligence: High / Average / Low / Retarded

• Thought Form/Content o Thought Process: Logical / Organized / Loose Association / Disorganized /

Flight of Ideas/ Mental Blocking / Obsessive o Delusions: None Evident / Persecutory / Actions Controlled / Thought

Controlled / Grandiosity / Bizarre / Somatic / Infidelity Delusions o Hallucinations: None Evident / Auditory / Visual / Olfactory

• Risk Assessment o Suicide Risk: None / Slight / Moderate / Significant / Extreme o Violence Risk: None / Slight / Moderate / Significant / Extreme o Child Abuse Risk: None / Slight / Moderate / Significant / Extreme

GENOGRAMS • Family • Emotional • Relational

SUICIDE RISKS

1. SUICIDE IDEATION: 2 months or more; there are psychiatric, psychological, or physical pain so severe it defines the person’s capacity to cope. Client views death as a remedy.

2. CHRONIC SUICIDE IDEATION: For over one year in duration. NOTE: Could be coupled with secondary gain: retaining a relationship; continue in counseling; getting SS disability benefits

3. SUICIDE ATTEMPTS: Lethal actions with intent to die. NOTE: Was the act accidentally rescued or lethality misjudged, or self-rescued

SYNTONIC or DYSTONIC

• Syntonic – emotionally responsive to surroundings: describes somebody who is emotionally attuned to his or her environment – according to beliefs: in ego psychology, used to describe behavior that does not conflict with somebody's basic attitudes and beliefs and, therefore, is not anxiety-provoking.

• Dystonic -- denoting aspects of a person's thoughts, impulses, and behavior that are felt to be repugnant, distressing, unacceptable, or inconsistent with the self-conception, or inconsistent with the rest of the personality. Describing elements of a person's behavior, thoughts, impulses, drives, and attitudes that are unacceptable to him or her and cause anxiety.

This assessment allows for client’s attitude considerations—their eagerness and motivation for therapy and the client’s awareness of a problem. Kids are, by nature, syntonic until they reach adolescents when they become more dystonic. Avoid anthologizing syntonic and dystonic; all behavior is purposeful. RATINGS:

1. Good/Fair Insight = dystoninc; client knows they have a problem and have insight into their problem(s); the “locu” of the client’s pain; the client is in the “contemplation stage of change”

2. Poor Insight = ambivalence; they know others are concerned but they are not. They see there’s a problem because others have a problem with them. Reluctant to change.

3. Absent Insight = syntonic; client does not see the problem or any problem at all. Resistant to therapy; no motivation to change.

ASSESSMENTS of CLIENT FACTORS: • Biological factors: genetic, potential predisposition’s, biochemical agents • Development factors: physical development, psychosocial development,

cognitive development and psychogenetic predisposition’s • Social-interactive factors: culture, family or system, parent/child relationship,

family attitudes, socioeconomic and community ASSESSMENT of CLIENT STRESSES

• Psychological vulnerabilities: person response to stress, arousal rate, intensity, temperaments and cognitions

• Socioenvironmental stresses: status of current primary relationships, use of substance, socioeconomic status and changes

ASSESSMENT of CLIENT HISTORY:

• DATA BASES: o Cross-sectional items: (a point in time) are presenting complaints,

relevant history and mental status (consciousness, attentions span, orientation, memory, concentration and judgment).

o Longitudinal items: (over a lifetime) include family constellation and history, psychosocial history, educational history, employment history, legal problems, drug and alcohol history and medical history.

ASSESSMENT of CLIENT’S PERCEPTION OF INFLUENCE 1. To what extent do you feel your opinion, creativity and capabilities have influence in your__________________________? (a) Home (b) School (c) Work place (d) Place of worship (e) Neighborhood (f) Community (g) Social circles 2. For each area above, describe how your access (or lack of access) to influence happens? 3. How do you feel about these experiences when they happen and after they have happened? 4. Over time, what decisions have you made about your place and importance within your ___________________________? (a) Home (b) School (c) Work place (d) Place of worship (e) Neighborhood (f) Community (g) Social circles 5. How do you cope with, or try to change, your place and importance in these areas of your life? 6. Please check any of the following personal traits that you believe determine your access to influence

AGE ATHLETIC ABILITIES GENDER CLOTHES RACE PERSONAL HABITS ETHNICITY NEIGHBORHOOD RELIGION WEIGHT INDIGENOUS HERITAGE HEIGHT NATIONAL ORIGIN SKIN COLOR INCOME BIRTH DEFECT SOCIAL ECONOMIC STATUS SEXUAL ORIENTATION PHYSICAL DISABILITY SCHOOL(S) ATTENDED EDUCATION LEVEL GRADES/GPA/LEARNING PROBLEMS HEALTH STATUS SEXUAL HISTORY SOCIAL CIRCLE OTHER

ASSESSING SEVERITY INDEX ACROSS TIME AND CIRCUMSTANCES THE SEVERITY INDEX: 0 = no impairment 1= mild impairment 2= moderate impairment 3= severe impairment

• The 0-1 means the person does NOT qualify for a mental health disorder DX; insurance will not reimburse. You can see the person but it’s private pay.

• The 2-3 means they require a mental health disorder; insurance reimburses; at these levels a Dx is valid.

ASSESSING CLIENT STRENGTHS • What kinds of things do you do well? • Tell me about some of your satisfactions and successes? • What are things you enjoy doing well? • What have you noticed that you do in the past that helps you? • Which of your jobs lasted the longest? Did you do anything to help this happen? • What is keeping you—right now—from doing worse than you are? • Which of your good points about yourself do you forget most often?

ASSESSMENTS MUST SHOW RESPECT FOR AGE, GENDER, AND CULTURE o Diagnoses must be respectful of cultural idiosyncratic behaviors.

Culturally sanctioned behavior or cultural idiosyncratic behaviors are to be considered. Also, we must consider behaviors that are an expected response to a particular situation/event such as depression in response to grief is not necessarily a mental disorder. Further consideration needs to be given to the fact that behaviors may, or may not, be medical or biological illness in an effort to reduce pharmacological treatment, especially with children.

ASSESSMENT QUESTIONNAIRE: GETTING TO KNOW YOUR CLIENT

• What problems or concerns bring you to the clinic? (If patient only mentions symptoms, probe: Anything else?)

• What troubles you most about your problem? • How would you describe your problem to someone else? • Is there a specific term or expression that describes your problem? • Why do you think this is happening to you? • What do you think are the particular causes of your [PROBLEM]? • What, if anything, makes your [PROBLEM] worse, or makes it harder to cope

with? • What have your family, friends, and other people in your life done that may have

made your [PROBLEM] worse? • What, if anything, makes your [PROBLEM] better, or helps you cope with it more

easily? • What have your family, friends, and other people in your life done that may have

made your [PROBLEM] better? • Is there anything about your background, for example your culture, race,

ethnicity, religion or geographical origin that is causing problems for you in your current life situation?

• On the other hand, is there anything about your background that helps you to cope with your current life situation?

• Sometimes people consider various ways of making themselves feel better. What have you done on your own to cope with your [PROBLEM]?

• Often, people also look for help from other individuals, groups, or institutions to help them feel better. In the past, what kind of treatment or help from other sources have you sought for your [PROBLEM]?

• What type of help or treatment was most useful? Why? How? • What type of help or treatment was not useful? Why? How? • Has anything prevented you from getting the help you need-- for example, cost

or lack of insurance coverage, getting time off work or family responsibilities, concern about stigma or discrimination, or lack of services that understand your language or culture?

• Is there anything about my own background that might make it difficult for me to understand or help you with your [PROBLEM]?

• How can I, and others at our clinic, be most helpful for you? • What kind of help would you like from us now, as specialists in mental health?

TESTS and MEASUREMENTS • Counselor must administer test under the same conditions that were established

in their standardization. • Counselor does not permit unsupervised or inadequately supervised use of tests

or assessments unless the test or assessments are designed, intended and validated for self-administering and/or scoring.

• Counselor recognizes the effect of age, color, race, culture, disability, ethnic group, religion, sexual orientation and socioeconomic status on test administration and interpretation and place test results in proper perspective with other relevant factors.

• Counselor indicates any reservations that exist regarding the validity of a test in norms for the person being tested.

ASSESSMENT FALLACIES WITH TESTING Mismatched Validity

• Some tests are useful in diverse situations, but no test works well for all tasks with all people in all situations. To determine whether tests are well matched to the task, individual, and situation at hand, it is crucial that the counselors ask a basic question at the outset: Why am I conducting this assessment?

Confirmation Bias • Often we tend to seek, recognize, and value information that is consistent with

our attitudes, beliefs, and expectations. If we form an initial impression, we may favor findings that support that impression, and discount, ignore, or misconstrue data that don't fit. To help protect against confirmation bias, it is useful to search actively for data that disconfirm our expectations, and to try out alternate interpretations of the available data.

Un-standardizing Standardized Tests • Standardized tests gain their power from their standardization. Norms, validity,

reliability, specificity, sensitivity, and similar measures emerge from an actuarial base: a well-selected sample of people providing data (through answering questions, performing tasks, etc.) in response to a uniform procedure in (reasonably) uniform conditions. When we change the instructions, or the test items themselves, or the way items are administered or scored, we depart from that standardization and our attempts to draw on the actuarial base become questionable. It is important to administer only those tests for which there has been adequate education, training, and supervised experience. It is our responsibility to recognize the limits of competence and to make sure that any assessment is based on adequate competence in the relevant areas of practice, the relevant issues, and the relevant instruments.

Perfect Conditions Fallacy • Counselors should strive to discover if the person their assessing for a job, a

custody hearing, a disability claim, a criminal case, asylum status, or a competency hearing took standardized psychological tests and completed other phases of formal assessment under conditions that significantly distorted the results. (For example, the person may have forgotten the glasses they need for reading, be suffering from a severe headache or illness, be using a hearing aid that is not functioning well, be taking medication that impairs cognition or perception)

Ignoring Effects of Audio-recording, Video-recording or the Presence of Third-party Observers

• Empirical research has identified ways in which audio recording, video-recording, or the presence of third parties can affect the responses (various aspects of cognitive performance) of people during psychological and neuropsychological assessment. Ignoring these potential effects can create an extremely misleading assessment.