SCREENING AND ASSESSMENT
- SOPHIA A. JOHNSON
1. Psychologist in Private Practice
Client #1, who is a 28 year old, married, father of a 2 year old and a 6 month old infant, has been referred to our private practice by his office’s free counseling resources. He recently lost a job promotion and also feels overwhelmed at home with a new born baby and all the adjustments that comes with a newborn. No longer enjoys hanging out with friends or family, often refuses to get out of bed when he does not have to work. His wife is also finding it hard to get him to participate in the care of their children, he is no longer affectionate and loving as he once was. He is cynical, aggressive and pessimistic about things he would normally see the beauty in.
Chief Complaint: “I just can’t seem to be happy with anything anymore. I’m miserable and I’m making everybody around me miserable.” Assessment will be conducted by our in house psychologist.
The contextual considerations that apply to this client is that decision regarding assessment is solely based on the consultation from the psychologist. This may impact the assessment plan as “the psychologist may question whether the treatment available in the psychological clinic is appropriate” (Groth-Marnat, p. 46), because they may have extensive medical problems, or possible need for inpatient treatment.
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As a means of getting to know and understand the client outside of regular observation during the initial interview, the psychologist could administer a personality assessment to aid in understanding the whole person, this will also help to identify any other underlying issues if client needs to be referred to another practitioner.
One ethical concerns that could relate to the assessment process of this client is the security and usage of the information shared, privacy and confidentiality of data gathered during assessment process. Another ethical concern that may arise is the qualifications of the attending psychologist. According to the (BACB, 2010), “1.03 one must maintain competence in their area of expertise through professional development” in order to effectively serve and offer services.
Client #2: 41 year old, recently divorced female with no children and high school education
Chief Complaint: “No matter what I do, I cannot relax, I am always stressing out about something. I feel like I’m going crazy.”
Client #2 was referred to the private practice by her general practitioner to consult with our psychologist because her inability to relax has caused her blood pressure to rise and medication does not seem to be having an effect on bringing her numbers down. Changes to her pressure has seemed to increase during her divorce proceedings.
She was not previously diagnosed as being hypertensive, however, hypertension does run in her family. Since her divorce she is concern about her financial future and blaming herself for her marriage ending. She has also been evaluation her chose in not returning to school to get a better education, she had hoped to start a family and then return to school after the children themselves had started school. All those dreams now seem so far away and her future looked empty and hopeless, she anxious and scared of what the future holds for her.
The private practice contextual considerations are self or professional referral, sole decision makers are the client and the psychologist. Clients of this nature are usually self-referred and are trying to find release from some inner turmoil. The contextual consideration would impact a plan assessment for client #2, because extensive assessment is usually not required for these cases. However, the best method of gathering information would be through the use of interviews, which will be best conducted using the semi-structured method to allow the patient to share openly, but still allow the clinician to be able to focus on the required questions that must be asked to when conducting a functional assessment.
Some ethical concerns that may affect client #2 is the test construction pertinent to the issues of this client, avoidance of harm and exploitation, “disclosures about exceptions to confidentiality” (Nagy, 2011); “invasion of privacy” and how much will be required to be shared and if shared how will the information be used and guarded once documented.
2. School Psychologist
Client #1: 7-year-old second-grader from intact family that recently moved into the school district
Referral Problems: academic difficulties related to reading and writing, social difficulties with peers.
Our 7 year old second grader is part of a military family and moves around quiet often with his family. His father is an air force pilot and is often away for a long period of time, his mom also works. He receives love and attention when they are available but is often left on his own. He spends most of his time building toy planes because he hopes to someday be a pilot like his Dad.
Contextual considerations for client #1 in this setting the decision to be assessed came from an educational setting as a referral by his teachers and school counselor. The decision was unified by a group who has his best interest at heart because they all believe he has the potential to excel. According to study conducted by (Sattler, 2001), when evaluating the extent and nature of a child’s learning difficulties the assessment process must be sensitive to the interactions, personality and characteristics of the child, as well as the expectations of those requesting the assessment” (Groth-Marnat, p. 44)
In this setting an adult has to give consent for all assessment and determination for placement change. The individually oriented assessment is carried out through direct observation in the child’s natural environment. Other assessment methods that may be employed is the “WISC-III, Stanford Binet test for intellectual abilities” (Groth-Marnat, p. 44), observation of behavior and interactions with teachers and students will also be rated. Most importantly is the test administered must be appropriate for a 7 year-old.
Ethical concerns are to ensure that no harm is done to the child, validity of test assessment data and use and release of assessment data. Labeling and restriction of freedom is also another ethical concern that may affect client #1 will the results impose any negative consequence that may affect his future or reinforce the behavior.
Client #2: 17 -year-old high school student
Referral Problems: failing grades, refused to follow course sequences, considering dropping out.
This client recently lost a parent and no longer feels apart of her home school environment, her single parent is struggling financially and have decided that it may be best to move closer to family in another state.
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Contextual considerations for client #21 in this setting is the decision to be assessed came as a referral by his teachers and school guidance counselor. Consent from an adult is also need as the child is under 18 years of age.
Ethical concern that may be of concern to client #2, Principle E: Respect for People’s Rights and Dignity (Ethical Principles of Psychologists and Code of Conduct, 2014), sharing of personal information gathered from the assessment with other teachers. Not because the client is underage, they can be forced to share thoughts they would otherwise prefer to keep hidden. Communication of test results is also of ethical concern, (Groth-Marnat) notes that feedback from the assessment must be presented in a clear, competent and understandable language for all to understand, without misinterpretation.
While a structured interview strategy is most reliable, a semi-structured interview strategy will yield more information as it gives the client and clinician more of a free style to engage and share information that may not otherwise be noted on the questionnaire.
The purpose of an assessment interview is to obtain authorization and to learn the client’s background history and any detail about the issue on hand, prior to embarking on an assessment plan. Verbal and face to face, using a semi-structured or structured format with the 17- year old high school student.
- Note taking and Recording of initial interview must be carried out
- Establish initial rapport
- Gather specific information, history and current and past school attendance and grades, family history
- History of problem
- Give the client an opportunity to ask questions and share information
Plan of assessment for Client #1: 7-year-old second-grader. (Steege, 2009), believes that “decisions regarding the development and evaluation of interventions with students who exhibit problem behaviors should be based on objective and accurate information”.
The most appropriate assessment for our 7-year old would be the Direct Descriptive FBA procedures
- Anecdotal and systematic observations
- Interval Recording Procedure (IRP)
- Extended functional analyses – “observation is carried out in the student’s natural environment, learning ability and interpersonal interaction is observed and measured” (Cooper 2007) (Groth-Marnat).
- Assessment of reinforcer preferences
Using this method will help us to (1) identify and gather information relating to our 7 year-old; (2) assess the nature and quality of the his learning environment; (3) administer the comprehensive assessment battery of test that takes into consideration academic and intellectual abilities, over several minutes for up to 30 minutes, ; (4) identify and describe any interfering behaviors; (5) Document and log academic and social performance; (6) create an intervention plan that will enable our 7 year-old to increase his academic performance and social interactions.
The value of using this method is the intervention plan that will be derived from the assessment will be focused on meeting the specific needs of our 7 year-old, by identify triggers, motivators and reinforcers, and using them to influence his actions and behavior in a positive and productive way.
Functional assessment utilizes multiple tools to assess and develop a plan assessment that will investigate the academic ability of our client giving us an insight into his cognitive abilities and interpersonal skills, and because the data is real-time it is evidence-based and makes for effective and unbiased decision.
BACB. (2010, June). BACB Professional and Ethical Compliance Code. Retrieved from BACB Professional and Ethical Compliance Code: //www.bacb.com/index.php?page=57
Ethical Principles of Psychologists and Code of Conduct. (2014). Retrieved from American Psychological Association : //www.apa.org/ethics/code/index.aspx
Groth-Marnat, G. (n.d.). Hand Book of Psychological Assessment. EBSCO Publishing.
Nagy, T. F. (2011). Essential Ethics for Psychologists. In T. F. Nagy, Ethics in Psychological Assessment (pp. 171-183). American Psychological Association.
Steege, M. &. (2009). Conducting school-based functional behavioralassessments:A practitioner’s guide(2nded.). New York, NY: TheGuilford Press.