Chapter 13 revised - Caroline Paltin, Ph.D. Licensed

Using Assessment in Counseling
Chapter 13
 Skilled counselors know how and when to either gather
more assessment information or apply information
gathered previously
 Informal and formal assessments play a role in:
 Treatment planning
 Monitoring client change
 Evaluating the effectiveness of counseling
Treatment Planning
 Varies with client
 Assessment of functioning
 Statistical/actuarial methods vs. clinical judgment
 Gather quality information and evaluate it with a
scientific approach
 More than just diagnosis
Treatment Matching
 Beutler, Malik, Talebi, Fleming, & Moleiro (2004)
suggested client characteristics to consider in treatment
Functional impairment
Subjective distress
Problem complexity
Readiness for change
Reactant/resistance tendencies
Social support
Coping style
Attachment style
Treatment Matching
 Assessment should also focus on identifying and
enhancing human strengths and optimal functioning
 Positive Psychology – focuses on developing strengths
and enhancements of well-being, while not ignoring
 One area to consider when assessing strengths is optimism –
hopeful expectation and general expectancy that the future
will be positive
Case Conceptualization and Assessment
 Model for case conceptualization (Meir, 2003)
 Step 1: Identify the initial process and outcome elements
 Step 2: Learn etiology of client problem
 Step 3: Choose interventions for selected problems
 Step 4: Consider the time frame of interventions and outcomes
 Step 5: Represent the conceptualization explicitly
 Step 6: Include at least one alternative explanation
 Step 7: Consider the model’s balance between parsimony and
Monitoring Treatment Progress
 Counselors have responsibility to monitor clients’ progress
during treatment and determine if clients are making positive
 History of outcome research:
 1970s: research had demonstrated that most people who received
psychological interventions benefitted, but 5-10% got worse (Lambert,
Bergin, & Collins, 1977)
 1980s: managed care began playing significant role in cost
 1990s: outcome assessment began playing critical role in clinical
care, insurance companies became interested in identifying clients
who would not benefit from psychotherapy
Monitoring Treatment Progress
 Clients have better therapeutic outcomes when
clinicians receive feedback about client progress
during therapy
 Client self-report is important source of information
for outcome assessment
 Goal Attainment Scaling (GAS)
 More continuous outcome assessment and more formal
 Client and counselor select an indicator for each therapeutic
goal behavior, affective state, or process that represents
goal and can be used to indicate progress
Monitoring Treatment Progress
 Gather baseline information at the beginning
 Symptom Checklist – 90 – Revised (SCL-90-R)
 Outcome Questionnaire (OQ-45.2)
 Explain to client why data are being collected and
share results
Using Assessments for Evaluation
and Accountability
 Two major types of evaluation:
 Formative – continuous or intermediate evaluation
typically performed to examine the process
 Summative – more cumulative and focused on endpoint
or final evaluation (the product)
 Steps for conducting an evaluation study:
Defining evaluation study focus
Determining design
Selecting participants
Selecting Assessments or measures
Data Analysis
Defining Evaluation Study Focus
 Practitioners need to determine what services they
want to evaluate
 There needs to be a direct connection between the
services provided and the outcome measures used
Determining Design
 Information needed:
 Qualitative, quantitative, or both
 Quantitative designs:
 Intrasubject
 Pre-test, intervention, post-test
 Intersubject
 Randomized clinical trial is gold standard  intervention group,
placebo/control group
 Wait-list control group often used to address ethical issue
presented by traditional placebo/control group
Selecting Participants
 Qualitative studies: sample is usually smaller than
for quantitative studies
 Quantitative studies: a larger sample size allows
for more power in statistical analyses
Selecting Assessments or Measures
 Assessing outcome involves (Hill & Lambert, 2004):
Clearly specify what is being measured
Measure change from multiple perspectives
Use diverse types of assessments
Use symptom-based and atheoretical measures
Examine patterns of change as much as possible
 Scheme for Selecting Outcome Measures (Olges, Lambert, & Fields,
Social level
Time Orientation
Outcome Assessment in
Mental Health Settings
 Managed care agencies, third-party payers significantly
influence provision of mental health services
 Commonly used instruments:
Beck Depression Inventory
State-Trait Anxiety Inventory
Symptom Checklist–90–Revised
Minnesota Multiphasic Personality Inventory II
Dysfunctional Attitude Scale
Hassles Scale
Schedule for Affective Disorders and Schizophrenia
Outcome Questionnaire (OQ-45.2)
Outcome Assessment in
Career Counseling
 No standard battery of instruments used
 Many studies have examined career maturity and
decidedness vs. concrete career outcomes
 Practitioners may want to consider measures of
effectiveness of career counseling other than career
maturity and career decidedness
 i.e., employment, job satisfaction, quality of life
Outcome Assessment in
School Counseling
 ASCA National Model (ASCA, 2005) states that school
counseling programs are data driven
 Availability of instruments to evaluate school counseling
programs is minimal relative to mental health and career
 Consider using multiple measures from multiple perspectives
Other members of the community
School Counseling Program Evaluation Scale (SCoPES; Whiston &
Aricak, 2008)
Data Analysis
 Descriptive information vs. statistical analysis
 Effect size
 Consult with researchers on methodological or statistical

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