Assessing Common Mental Health and Addiction Issues With Free-Access Instruments

Katie M. Sandberg, Taryn E. Richards, Bradley T. Erford

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781136626951
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

As healthcare costs rise, so too do the costs of assessment instruments, critical tools for mental health professionals. While some traditional assessment instruments have become prohibitively expensive, as with many other fields, the Internet offers a host of more affordable and equitable alternative assessment tools at little or no cost. The pitfall of this alternative, thus far, has been the lack of vetting and quality assessment. Assessing Common Mental Health and Addiction Issues With Free-Access Instruments fills this gap by providing the first analysis and assessment of these tools, provided by some of the leading names in mental health assessment instruments. This resource identifies the most efficient free access instruments and provides summary information about administration, scoring, interpretation, psychometric integrity, and strengths and weaknesses. The book is organized around the most common broad range issues encountered by helping professionals, and whenever possible, a link to the instrument itself is provided. This is an essential text for all mental health professionals looking to expand the scope and range of their assessment instruments.

CHAPTER 1

Introduction and Use of Free-Access Assessment Instruments

USE OF ASSESSMENT INSTRUMENTS

Along with health care in general, the costs of published assessment instruments and mental health assessment services continue to rise. However, the increasing prominence of the Internet has modified the landscape of mental health and addiction treatment services and can contribute to cost savings and higher quality services for helping professionals and their clients. Today, numerous moderate to high quality instruments are available for free use on the Internet. Unfortunately, few sources exist which systematically critique and vet the quality of these instruments. Therefore, the purpose of this book is to identify the most efficient free-access instruments, across common diagnostic categories, encountered by mental health professionals and to provide summary information about administration, scoring, interpretation, psychometric integrity, and strengths and weaknesses. It is our hope that helping professionals can use the recommended free-access instruments outlined in this book to enhance their assessment of the most commonly encountered broad range psychological issues. But first, let’s cover a few basics.

WHAT IS ASSESSMENT?

Those of us who join the helping professions likely do so based on innate desires to both understand and help others. We are drawn to the challenge of furthering our understanding of human thought and behavior in order to assist others in their journey through life. The most challenging part of our profession is that the uniqueness that makes each individual so fascinating also inherently makes his or her thoughts, beliefs, attitudes, and behaviors less predictable. Already unique at birth, human beings are constantly learning, growing, and changing as a result of their individual life experiences. So how can we possibly attempt to harness what we do know about human development, behavior, and cognition in order to enhance our understanding and ultimately provide the help that many individuals seek?

This is where assessment comes in. Although no clinician can ever expect to know everything about a client or be able to predict the client’s actions with perfect accuracy, assessment can help the clinician to narrow that which is unknown. Effective assessment can thus be likened to putting on a pair of eyeglasses, because it enables the clinician to sharpen his understanding of the client, focus more successfully on the most relevant clinical information, and gain confidence in his conclusions. Thus, using the best available assessment instruments can help clinicians gain clarity, focus, and confidence – all without the headache that comes from guessing one’s way through blurry and unknown territories without some expert help.

More specifically, assessment is defined as the systematic gathering and documenting of client information. This can include information about the individual’s knowledge, skills, attitudes, beliefs, and behaviors. Clinicians begin the assessment process the moment they meet their potential clients. From this point forward, clinicians continue to gather data, refine impressions, plan treatments, and evaluate treatment outcomes. At times, the assessment process is more formal or structured than at other times, but professional counselors are continually gathering information to aid in their understanding of their clients. It is imperative that practicing counselors use the best assessment tools at their disposal in order to efficiently and effectively help their clients.

The terms assessment and test are often, mistakenly, used synonymously. Assessments involve a systematic gathering of client information from multiple sources, while tests provide only one source of information about a client. Thus, assessments are distinguished from tests or instruments because testing is only one part of the assessment process. Tests yield important data about clients, but clinicians must use multiple sources of data and their own perceptions and judgments to make broad assessments. The instruments included in this book are mainly classified as tests. It is the responsibility of the professional counselor to supplement any knowledge gained from these recommended instruments with additional tests, observations, and clinical judgment, in order to best understand and help clients.

Because the majority of surveys, inventories, and instruments recommended in this book are categorized as tests, it is important to further define “tests.” Anastasi and Urbina (1997, p. 4) described a psychological test as “an objective and standardized measure of a sample of behavior.” The word measure tells us that the test will help us to determine “how much” of a construct or concept the client possesses. Knowledge of “how much” intelligence, depression, substance use, or extraversion the client possesses can help the clinician to predict client behaviors and analyze strengths and weaknesses in order to enhance understanding and treatment.

A test also helps clinicians to pinpoint a sample of behavior. Clinicians should ensure that the sample of behavior they obtain is representative of the client’s typical behavior. For example, a client may behave differently when in school, work, or home settings, or when surrounded by different individuals in his or her life. It is important that tests accurately represent as many potential domains as possible in order to assess a representative sample of behavior. Tests which provide representative samples of behavior are the most likely to yield valid scores.

Finally, instruments must be standardized and objective to be considered a psychological test. Standardization means that the test is administered, scored, and interpreted in the same way for every client. Thus, two clinicians administering the same test to the same client should obtain identical scores, because all other factors are held constant. Standardization thus ensures objectivity, such that clinician bias will not affect the client’s scores. It follows that, as tests are held to progressively higher standards of standardization, objectivity of interpretation inherently increases, as well.

Overall, test developers strive to produce high quality tests which will aid in the best possible understanding and treatment planning of client problems. Ultimately, it is the responsibility of the professional counselor to select the optimal psychological tests to use as part of the assessment process. Thus, professional counselors must seek to select the best psychological tests to use with various populations based on psychometric strengths and a judicious evaluation of the test’s advantages, disadvantages, and ethical considerations.

In addition, prudent test authors caution clinicians that test results should always be supplemented with additional testing and clinical judgment. Although this point will be reiterated throughout the text, it should be emphasized that using multiple sources of information to understand the client and plan treatment is always the best course of action.

PURPOSES OF ASSESSMENT

There are four main purposes of assessment: (a) screening, (b) diagnosis, (c) treatment planning and goal identification, and (d) progress and outcome evaluation (Erford, 2013). The majority of the assessment instruments covered in this book are most appropriate for use in screening, treatment planning, and progress evaluation. Assessment for the purpose of diagnosis is not as well represented among these instruments, because diagnosis requires a trained professional to use multiple sources of information in combination with clinical judgment to make well-informed diagnoses. Thus, the singular psychological tests included herein do not provide adequate information for clinicians to make diagnoses, although they are certainly useful in informing preliminary predictions which clinicians can pursue further with additional assessment.

SCREENING

Screening instruments are used to determine whether further diagnostic assessment is necessary or warranted. Consequently, screening instruments are typically relatively brief; thus, they likely do not comprehensively cover all possible aspects of the psychological construct in question. Screening instruments are sometimes held to lower psychometric standards than diagnostic instruments. However, the accuracy of screening instruments is just as vital as the accuracy of diagnostic instruments, because accurate screening instruments can save both the client and practitioner time, money, and emotional distress.

Screening instruments usually compare an individual’s test score to a fixed cut-off score to determine if additional assessment is warranted. Cut-off scores are often set so that an individual must exceed a certain threshold of symptom quantity, frequency, or intensity in order to warrant clinical attention. Alternatively, some screening instruments are based on population norms, and cut-off scores identify those individuals who score in the extreme highest or lowest percentiles (i.e. <5th percentile or >95th percentile).

Clinicians ideally want to maximize accurate decisions and minimize inaccurate decisions when using screening instruments. Accurate decisions include identifying true positives, or clients who have the condition and are identified by the screening test as having the condition, as well as true negatives, or clients who do not have the condition and are identified by the screening test as not having the condition. Inaccurate decisions, on the other hand, include identifying false positives, or clients who do not have the condition but are identified by the screening test as having it, and false negatives, or clients who do have the condition but are identified by the screening test as not having it. False positives result in a waste of time and money and can negatively affect the falsely identified client through labeling bias and emotional distress. False negatives are even more problematic than false positives, because those who actually have the condition in question are unable to access further testing which leads to diagnosis and treatment. Thus, these individuals slip through the cracks of the system and are forced to endure the problems of their conditions without clinical treatment.

Test authors and reviewers commonly report the accuracy of their screening tests by describing the instrument’s sensitivity, specificity, false positive error, false negative error, and efficiency. Sensitivity refers to the instrument’s ability to accurately identify true positives, while specificity refers to the instrument’s ability to accurately identify true negatives. Both sensitivity and specificity should ideally be maximized in order for a screening instrument to accurately classify the majority of cases. For example, if an anxiety instrument yields a sensitivity of .90 and a specificity of .85, this means that 90% of individuals with anxiety were correctly identified as having anxiety while 85% of individuals without anxiety were correctly identified as not having anxiety. These values also tell us that 10% of individuals who truly did have anxiety were missed by the instrument and 15% of individuals who did not have anxiety were incorrectly identified as having anxiety. Depending on the goals and preferences of the researcher or clinician, and the intended purpose of the screening instrument, these values may or may not be acceptable. For some instruments, changing the cut-off score to a more extreme or less extreme value allows the clinician to maximize either sensitivity or specificity, depending on his preferences.

In addition, false positive error and false negative error values identify the percentage of false positives and false negatives that an instrument identifies. The efficiency of an instrument can be calculated by finding the ratio of total correct decisions to total overall decisions. Overall, when accurate decisions are maximized and inaccurate decisions are minimized, the efficiency of an instrument will be high.

Many of the instruments included in this book were designed to be screening instruments. They thus provide an efficient first step in the assessment process and enable the practitioner to identify which clients need further diagnostic assessment. Habitual use of these screening instruments in practice can save the mental health practitioner a great deal of time and money. The use of screening instruments in schools, doctors’ offices, and research settings is also advantageous, because individuals with less clinical training are often qualified to administer these simple, yet efficient and effective, initial assessment instruments.

DIAGNOSIS

After screening instruments have been used to identify likely diagnostic cases, the clinical practitioner must use diagnostic assessment to determine whether these clients represent true cases. Diagnostic assessment is thus a much more detailed and comprehensive analysis of an individual, often involving a battery of tests. Clinicians must undergo substantial training and spend a considerable amount of time using multiple measures in diagnostic assessment to make a more definitive classification decision.

Diagnostic assessment can be used for the sole purpose of gathering extensive information about client strengths and weaknesses to enhance normal development, such as when a client presents for career counseling or premarital counseling. But it is most often used for the purpose of classifying an individual into a diagnostic category. Most professional counselors, psychiatrists, psychologists, and social workers use the Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5) (APA, 2013) to make such classifications, which is the equivalent of the International Classification of Diseases (ICD) for physicians. The DSM-5 delineates specific, standardized, criteria which clients must meet in order to be diagnosed with various psychiatric conditions.

Clinical diagnosis with the use of the DSM-5 is thus helpful, because it allows clinicians to enhance their understanding of the disorder in general and then apply that knowledge to select the most appropriate interventions for maximally effective treatment. However, widespread use of the DSM-5 is not without criticism. Because society attaches a stigma to mental illness, diagnostic labels may exacerbate the stigma by enhancing the public’s view of those with mental illness as different to the average individual (Corrigan, 2007). The repercussions of being a member of a stigmatized group, and the potential harmful effects of labeling, can be devastating. In addition, over-reliance on the DSM-5 for diagnosis can cloud the clinician’s ability to consider alternative explanations for abnormal behavior (Duffy, Gillig, Tureen, & Ybarra, 2002). Therefore, clinicians are urged to take the utmost care and follow standardized procedures in order to accurately diagnose their clients.

TREATMENT PLANNING AND GOAL IDENTIFICATION

One of the most important purposes of assessment is to assist clients and counselors in goal identification and thereby inform treatment planning. Well-defined, measureable, goals are crucial for the counselor and client to evaluate progress throughout the counseling process and make any necessary adjustments or changes.

Initial assessment procedures, often composed of standardized tests and interviews, can help the counselor uncover the most notable strengths and weaknesses of the client. This individualized information is incredibly useful in planning the most effective treatment for each client. For example, one of the instruments reviewed herein, the Autism-Spectrum Quotient, assesses the extent of autistic traits in adults with normal intelligence (Baron-Cohen, Wheelwright, Skinner, Martin, & Clubley, 2001). A client’s responses on this instrument could show a clinician the domains in which a client is most resourceful and those which prove more challenging. For example, a client’s responses might indicate that he has poor social skills but impressive imagination. The clinician could then use knowledge of these strengths and weaknesses to set treatment goals and gain insight into those individualized treatment options whi...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Dedication
• Contents
• Chapter 1. Introduction and Use of Free-Access Assessment Instruments
• Chapter 2. Assessment of Anxiety Disorders
• Chapter 3. Assessment of Mood Disorders
• Chapter 4. Assessment of Addiction and Related Disorders
• Chapter 5. Assessment of AD/HD, Disruptive, Impulse Control, Obsessive Compulsive and Related Disorders
• Chapter 6. Assessment of Disorders on the Autistic and Schizophrenic Spectrums
• Chapter 7. Assessment of Eating Disorders
• Chapter 8. Assessment of Trauma and Stressor-Related Disorders
• References
• Index