Detailed notes for the capita selecta elective: Diagnostic models and strategies. Guaranteed a good grade (7-8 minimum) if these notes are studied and understood properly.
To answer referral questions, the psychologist needs an estimate of the patient’s premorbid
level of functioning, history of problems and symptoms, results of tests and knowledge
of patient’s everyday behaviours. This data is gathered through semi-structured interviews.
Chapter 2: Context
The framework for the report:
The context affects the choice of assessment procedures, the relationship between the
psychologist and the client, the interpretation of results, the conclusions that are
drawn from the assessment, and the final report.
Psychological reports about a single client vary depending on the context of the
evaluation.
The following are useful factors to consider when thinking about the context of an
assessment;
Initiation and funding of assessment:
Clients can be referred for assessments through numerous pathways (physician,
lawyer, parole officer, courts, companies)
The conversation initiating the referral is only the starting point for determining
who wants to know something about the client and why.
The funding often determines ownership of the assessment and its primary
audience. Assessment paid for by a school has a different purpose than if paid by
the parent.
Once we determine who initiated and who is paying for the assessment, it
becomes clear whether the client is a willing participant.
Why was the client referred? Implicit and explicit reasons for referral:
, Often a referral is made for administrative rather than clinical reasons – to
determine if the client is eligible for certain services or accommodations. In
such cases, the assessment serves a gatekeeping function.
In other cases, the assessment serves a clinical function, or indicate
educational needs.
Can also have a forensic purpose – legal system. Psychologist must determine
reason for referral.
The reason for referral can be easily misunderstood by the psychologist.
Sometimes the intention of the assessment can be tacit or hidden.
An explicit question is one that is clearly stated by the referral source “Does
Antony have depression?. Implicit questions are those ferreted out by the
psychologist as she considers all aspects of a case “Does Antony need court-
ordered treatment for depression?
Recall, it is vital to determine if the assessment is meant to serve clinical,
educational, gatekeeping or a combination of these functions.
Primary and secondary audiences for the findings:
The primary audience for the findings is the person to whom the original
report is sent to (often the person who made the referral). The report must
therefore address the needs of this audience in their language.
The secondary audience are those who see the report in the future. We need to
keep them in mind when writing the report but should not direct the report to
them.
Client and clinician attributes:
Client attributes include barriers to communication or emotional limitations of
the client. Gender and age also influence the outcomes of assessment (rape
victims).
Another one is the client’s motivation for the assessment. Is the client
withholding information because of fear for ramifications?
Cultural factors are important to understand
Systems issues:
Must describe the system in which the assessment takes place. It is essential to
determine how the assessment fits into the bigger picture for the client, and it
is not possible to make this determination without some understanding of how
the pieces of the system work.
System factors also play a part in determining the resources that can be
brought to bear on a problem.
Chapter 3: Cultural competence in psychological assessment
What is cultural competence?
Cultural self-awareness;
Occurs when the clinician becomes more informed about her own cultural
background and the influence it might have in her clinical work. This includes
the beliefs, values and presumptions as a result of one’s lineage.
She understands that each person lives within the context of a cultural group,
the values and lifestyles of which may vary from that of the clinician’s own.
Knowledge of diverse cultures;
, Clinician should have some expertise about the cultural background of his
clients.
Clinicians can gain knowledge of diverse cultures in indirect or direct ways.
Indirect include reading about cultural groups or watching documentaries.
Direct include interacting with members of the group.
The heterogenous nature of cultural groups stem from differences in
acculturation – the way individuals balance multiple cultural influences.
Culturally appropriate clinical skills;
Involve what the clinician actually does with the client. The techniques that a
clinician chooses should be in harmony with the way that client lives.
We must avoid microaggressions – comments or actions that take place
between members of different cultural groups that convey negative or
stereotypical views and that can make the recipient feel inferior or invalidated.
Do not ask if you have a boyfriend. The client might be gay or bisexual.
Rather ask are you currently in a relationship.
Also includes linguistic decisions. Sometimes use an interpreter if needed who
is not related or a friend to the client, is the same gender and similar age and
who is aware of the confidentiality guidelines.
Cultural competence in clinical interviews:
Sometimes it is useful to invite a community leader or religious healer into the
session to better understand the culture
The style of questioning: people with a high willingness to share personal
information and high levels of verbal ability may be comfortable with open-
ended questions.
Open-ended questions might be a poorer fit for clients whose cultural
background influences them to see the interaction with the interviewer as an
interaction with an authority figure whom they should allow to dominate or
control the session. These clients might not feel comfortable extending their
answers beyond a sentence or two for fear of disrespecting the expert.
Open-ended questions might also cause discomfort in clients whose problems
include issues that, according to their own cultural beliefs, bring shame to
themselves or their families.
Cultural differences in the appreciation of time
Nonverbal behaviour – Afros maintain more eye contact than Whites
Speak about time at Awladouna – test instruments were attested by the ministry of
education to be consistent with the local culture.
Evidence based practice in psychology is defined as “the integration of the best available
research with clinical expertise in the context of patient characteristics, culture and
preferences”.
Defining evidence-based assessment:
The focus of the definition is on the extent to which there is sufficient empirical
evidence to consider a technique as evidence-based in the first place.
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