Clinical Assessments

The discussion in Chapter 13 was really timely for me this week, as I recently had a conversation with a colleague about her experiences working as a community counselor in a walk-in clinic. She interacted with a variety of clients who had serious issues such as anxiety and depression, eating disorders, and suicidal symptoms. After our conversation, I wondered how I would cope if presented with clients with these sorts of issues and was glad that I had the opportunity to learn more the tools available for assessing and then treating clients with mental disorders. Because I do not have any experience in this area, I appreciated knowing that there are structured interview questions available to determine whether a person meets the criteria for a certain disorder. Even the semi-structured interview questions are fairly specific, such as the SCID-CV Mood Disorder Module which appears in the book and ask questions about changes in general mood, weight, and interests. Unstructured interviews would be more difficult because they are counselor-directed, but they still assess some general domains, such as the presenting problem, family history, social and academic performance, medical background, and past experiences with substance abuse. Counselors are also encouraged to ask questions about the client's problems in three main areas, examining the onset/course of the problem, the severity of the issue, and the characteristics of the stressor itself (Drummond & Jones, 2010). I would really appreciate having these prompts available if I was ever in the position of having to diagnose a particular client on my own. The Mental Status Exam (MSE) is an important tool in clinical assessment, and it is one that I think that I would be fairly comfortable with as it is really descriptive, outlining specific questions in categories like appearance, attitude toward examiner, affect and mood, thought, orientation, memory, and concentration and attention. The book outlines a description of several general categories of MSEs which are fairly comprehensive in their own right, so I do wonder how long and cumbersome an actual assessment would be. In cases where a quick survey of functioning is required, the mini mental status exam may be more appropriate as it only focuses on cognitive questions and does not contain questions pertaining to mood and thought processes. It is commonly used in the evaluation of Alzheimer's disease or other forms of dementia, but I think that it could be helpful in evaluating other disorders which impact cognitive functioning (Drummond & Jones, 2010). Drummond, R. J. and Jones, K. (2010). Assessment Procedures for Counselors and Helping Professionals. Upper Saddle River, New Jersey: Pearson Education, Inc.

Clinical Assessment

Although this week's reading of Chapter 13 doesn't directly affect us as school counselors, it is an important area to consider when using referrals and working with other professionals to help a child.  Drummond and Jones (2010) did a good job laying out the purpose of clinical assessments and different instruments that may be beneficial for a majority of individuals.  For example inventories and checklists are popular ways to quickly and efficiently check for symptoms with a client.  An inventory such as the Beck Depression Inventory can provide a quick analysis of whether or not a client may be showing signs of depression and from there you can determine the severity and move forward (Drummond and Jones, 2010).  Another inventory that seemed to be a useful assessment was the Substance Abuse Subtle Screening Inventory.  This can be used to indicate those individuals who are showing a high risk for abusing substances.  An inventory like this can be a great indicator to future behaviors and areas to focus on during a session.

Another section of this chapter that I appreciated was going into detail about the DSM-IV-TR.  In undergrad I took a course on abnormal psychology in which we learned all about the DSM and how it is used to diagnose individuals.  Being a school counselor, it will be important to understand what diagnoses mean and how to read the codes given.  Drummond and Jones (2010) did a good job reviewing how the DSM is used and what information it provides.  This will also be helpful with the news of the DSM-V-TR coming out!

The last part of the chapter that I really related to was the observation portion of assessment.  It never really occurred to me what clinicians need to do in order to gather information through observation.  As a school counselor, we are lucky to have all the resources and opportunities that we do to interact with our students and gain different perspectives of their lives.  As a clinician who is observing a client, there is little variation in gaining new information.  Interviews can be done and assessment tools can be given but they are only being observed in one place, the office.  The chapter described how important it is to note different aspects of your client when they are with you during a session.  Things such as facial expressions, eyes, body, movements and clothes can tell a lot about an individual and I think even as a school counselor these could be important areas to consider.

 Knowing the process that clinicians go through in order to diagnose and work with clients gives me a new perspective on how I need to work with my students as well.  It really is important to keep so many areas in mind and to use any and every resource and opportunity you have in order to provide the correct help and interventions for a client.  In the future, I know that I will be able to work well with different professionals in the field having a basic understanding of what they do and what they can provide for a student.  The student's best interests are at heart.

Drummond, R. J. and Jones, K. (2010). Assessment procedures for counselors and

helping professionals. (7th ed.). Upper Saddle River, NJ: Pearson.

Clinical Assessments

There were many clinical assessments presented in chapter thirteen.  Clinical assessment determines whether or not a person has a mental disorder and if so diagnosis’s them.  According to Kessler (2005), it is estimated that 26.2 Americans over the age of 18 suffer from a mental disorder each year.  I never realized that diagnosing these disorders have become an integral part of a counselor’s job.  I knew that we would possibly come across various assessments but not to the extent of determining whether a child has a mental disorder.  In my mind that was a school psychologists or an outside agency that would determine that type of diagnosis.  Related to a diagnosis of a child, interviews were discussed and I feel as though with any type of assessment this is a vital piece.  Through interviews you are able to gain valuable insight and information pertaining to the client.  When completing the interviews I believe that you should be asking a variety people that come in contact with the person such as teachers, school personnel, parents, etc. as well as the child themselves.   

Next, one of the instruments that stood out to me was the suicide risk assessment.  The reason being is because when working in the high school I had a handful of students that made a threat to harm them self.  Even though they took it back and stated that they didn’t mean it, I explained that they still needed to talk with someone before I sent them home.  They didn’t understand what they big deal was and I told them that if they would go home and hurt themselves I would be liable and I would never be able to live with myself.  After hearing that they began to understand the steps I took.  Drummond and Jones (2010) state that health professionals strive to find accurate ways to assess suicide risk.  When thinking I could potentially be in the position to determine whether or not a student will harm themselves scare me.  I know that in the elementary school it is less likely but it still occurs.  Last year there was a fifth grader that wanted to take her life and the necessary steps were taken to help her.  They say that there is no “one size fits all” when determining the risk so there are many signs to look out for and behaviors you must be aware of.  Some warning signs that were mentioned in the chapter were giving away prized possessions, putting personal affairs in order, and radical changes in characteristics in behavior and/or moods.  In conclusion, being knowledgeable of the many assessments and warning signs is important when working with children.  Through this class, I was able to learn information related to assessment that I was never aware of.     

Drummond, R. J. and Jones, K. (2010). Assessment procedures for counselors and helping professionals. Upper Saddle River, New Jersey: Pearson Education, Inc.

Assessment

The chapter on assessment in education was very interesting due to the push of various assessments being administered to look at the students’ progress.  There are many reasons why schools use assessment such as kindergarten readiness, determination of whether or not a student has mastered a skill, placement, and identifying students with special needs.  Throughout this process, there are many people involved and it is important that everyone plays a role in the students’ education.  Next, it was noted the importance of the steps that should be followed in designing an assessment program.  First and foremost, it is vital that the goals and purposes be identified.  There has to be a reason and rationale behind the assessment or it will not be taken seriously.  Then, the information that is needed needs to be identified along with the instruments that will used to gain this powerful insight.  There are a variety of tests and you want to ensure that you are giving the appropriate test in order to receive the information you are looking for.  Next, you need to ensure that all staff members are properly trained and aware of their responsibilities in this program.  Finally, one of the most important steps is that the program is continuously monitored so that you are able to determine the effectiveness.  As a school counselor, you are required to present evidence of the success that comes out of the program and should be reviewing components regularly.

            The next important section that that stood out to me was the competencies for school counselors.  It makes me wonder how counselors are held accountable for these competencies.  When reviewing the areas that a counselor should be aware of, I question how knowledgeable the counselors are in my district due to assessment being a limited role they play.  The school psychologists are the ones that administer the various assessments and discuss the results.  I feel that as teachers we analyze data all the time and determine what we need to do next.  As practicum is right around the corner, I am interested to see the difference of the classroom compared to the counselor’s world.  After taking program development as well as this class, there have been many questions that I am curious about in terms of what happens within my district and what I will have to do as a future counselor.  In conclusion, there has been more of a focus on assessment and we need to be conscious when looking at data that will be presented to us and determine what the next steps are.  It is very important that everyone plays a vital role in a child’s education and as a school counselor we can advocate for that to ensure success.

Drummond, R. J. and Jones, K. (2010). Assessment procedures for counselors and helping professionals. Upper Saddle River, New Jersey: Pearson Education, Inc.

Post #13: Clinical Assessment

              This week’s reading on clinical assessment helped me to put some pieces together.  I recently read an intake report for one of my students who came to us right after inpatient treatment.  While reading the report, I noticed that the student was assessed using the multiaxial diagnostic system, but at that point I was not clear on what the axes actually were.  The process of using this system reminded me of the process a medical doctor might take when trying to diagnose a patient’s illness or condition.  A doctor would have their patient describe their symptoms, when the symptoms had started, the severity of the symptoms, and any changes in the patient’s environment that might be contributing to the patient’s symptoms.  Of particular interest to me while reading about the 5 axes of the mental diagnostic system was Axis IV: Psychosocial and Environmental Problems.  Last week, I wrote about the importance of environmental assessment in education.  Drummond and Jones (2010) point out that environmental problems can “(a) be a factor in initiating mental disorder, (b) be a factor in exacerbating a mental disorder, or (c) develop as a consequence of the mental disorder” (p. 281).  The interrelatedness of environment and mental disorders is somewhat fascinating to me.  The unfortunate reality is that changing one’s environment is not always within one’s power.  Many of my current students are in that position.  The environments that they are coming from are not ideal in many ways; however, since they are minors, their options are somewhat limited.  My heart breaks for my students when they tell me their stories.  The hardest thing for all of us to do is to figure out how to cope with whatever situation we find ourselves in.  If we can’t change our environment or situation, how might we change ourselves in order to survive?  What things do we actually have control over and how can we make the best of difficult situations?  As a mandated reporter, I also have to decide when it might be time to make a call to Child and Family services if a student’s situation warrants that.  This is a responsibility that I believe will only grow when I become a school counselor.

                Another point that I found interesting in this week’s reading was that “unstructured interviews are the most frequently used type of interview in clinical assessment” (Drummond & Jones, 2010, p. 284).  Upon further consideration, I guess this makes sense, as counselors are most likely doing unstructured interviews when clients or students first come to their office to ask for help.  While not following a script, counselors should be well-versed in addressing all of the bases in assessing a student’s problem.  The axes of the multiaxial diagnostic system could provide a good framework for creating questions that address all the domains of the presenting problem(s).

Reference

Drummond, R.J. & Jones, K. (2010). Assessment procedures for counselors and helping professionals ( 7^th ed.). Upper Saddle River, NJ: Pearson.

Blog #13

           After taking the Multicultural Counseling course last semester, I became aware of many of the issues or circumstances that can come up when counseling certain clients.  As I learn about many of the different assessment tools available, I am also realizing that I need to be very sensitive to the cultural biases that may be present.  The text mentions, “Each cultural dimension has unique issues and concerns.  Thus, to be effective counselors must possess a depth of knowledge concerning the culture of clients as well as an awareness of available resources for acquiring information about persons of diverse cultures (Dana, 2005).”  I absolutely believe that many people working in schools, or making any kind of decisions in schools, don’t have enough knowledge about all types of cultures.  Maybe it could be the school counselor’s job to educate the staff on how to be more culturally aware.

            I do really appreciate some of the information that the text shares in Chapter 15.  Many of the topics mentioned throughout the Chapter, I have not even thought about.  The Chapter gives good tips and advice on how to handle certain clients in different situations, and also discusses sensitivity issues that can come up.  For example, I would have never known how to handle giving an assessment to a client who has a visual or hearing impairment.  Also, many of the tables throughout the Chapter provide useful information on how to handle clients with certain disabilities.  I don’t have much direct experience working with these types of clients, so any help that can be provided is much appreciated. 

            Changing up topics, I also really appreciate being able to watch everyone’s interpretation videos.  The experience of actually doing the interpretation session was pretty amazing in itself, but I am also enjoying the entire process overall and am gaining an immense amount of knowledge based on the feedback that everyone is receiving.  Ami’s session really gave us a good idea of how a true session could go in the “real world”.  I am also looking forward to receiving feedback about my own interpretation session, mostly because I am really curious to hear what I could have done better and what I did well.  I truly enjoy the “hands on” approach to this class.  I also believe that I will able to take the feedback that I have received, and apply it to my job as a school counselor. 

Drummond, R.J. & Jones, K. (2010). Assessment procedures for counselors and helping professionals ( 7^th ed.). Upper Saddle River, New Jersey: Pearson Education Inc.

Week 13

I made several connections with this week's reading, both related to multicultural assessment and to assessment of people with disabilities.  Reading about the multicultural bias in tests further supports my argument that PSSA testing is simply not appropriate as a measure of student achievement.  The notion that 100% of students should be “proficient” on PSSAs by 2014 is absurd, especially when many immigrants from a variety of countries move into schools each year and are expected to acquire grade-level reading and writing skills by the spring time!?  In addition, perhaps some of these students have never taken a standardized assessment.  PSSAs assume test-wiseness.  This is precisely why schools have been forced to “teach to the test,” which is not authentic nor valuable learning, in my opinion. 

Drummond & Jones (2010) identified internal structure as a form of test bias.  I wondered if the PSSA vs. the PSSA-M (M stands for modified) would be an example of this, even though it was discussed under the multicultural assessment section.  The modified PSSA was offered only for 2 years; the state no longer offers the PSSA-M.  The content of the modified version was the same, but structurally a little different in order to accommodate primarily for reading disabilities. The problem with the PSSA-M was that students could only take it if they were in the general education setting for the particular modified test they were taking (i.e. to take the modified reading test they had to be in general education reading).  This is a little backwards since the students who are in the learning support setting are generally the ones who need the most modifications!  I know for sure that the PSSA-M was an example of test modifications, as discussed on page 334 (Drummond & Jones, 2010).  In addition to this, it is very common for students with disabilities to take the tests in an alternate, small group location.  They are also given extended time on tests, although all students are now able to do so on the PSSAs.  Making such modifications reminds me of the saying that “fair isn’t everyone getting the same thing.  Fair is everyone getting what they need to be successful.”  I try to instill this way of thinking in my students (easier said than done!).

Drummond & Jones (2010) also discuss motivation and anxiety as test taker factors.  Motivation and anxiety are factors that can affect anyone.  Motivational factors are those that I especially experience when giving PSSAs.  Students absolutely despise taking these tests, and see no value in them for their lives (can you blame them?)  I have had a number of students color in patterns on the scantron sheet or even downright refuse to complete the test.  This, in turn, creates unnecessary anxiety for teachers, administrators, and the school district in general, because we cannot “afford” low test scores.  The emphasis on tests absolutely does not create a climate conducive for authentic learning.

           

When reading about assessment of individuals with visual impairments and of those with hearing impairments, I thought of a situation that one of the speech therapists told me about.  There is a new student at our district’s high school who is both legally blind and deaf.  Apparently she can see a little if something is right up to her face, so the professionals working with her need to set aside their sense of personal space.  I would be interested to know how people have made modifications with assessing her, as that would certainly take some creativity and patience to do so.  

I think that in any testing situation, it is important to consider potential bias or necessary modifications and accommodations in order to best serve the student.  I thought the authors did a great job outlining some of the important issues related to assessment issues with diverse populations.

References

Drummond, R. J. & Jones, K. (2010). Assessment procedures for counselors and helping

professionals. (7th ed.). Upper Saddle River, NJ:Pearson.