clinical psychology

1. The Behavioral AssessmentThe Behavioral Assessment
Through Interviews,Through Interviews,
Inventories And Check ListsInventories And Check Lists
Lecture 22Lecture 22

2. CLINICAL ASSESSMENTCLINICAL ASSESSMENT
DEFINITION:-DEFINITION:-Clinical assessment involves anClinical assessment involves an
evaluation of an individual’s strengths andevaluation of an individual’s strengths and
weaknesses, a conceptualization of the problem atweaknesses, a conceptualization of the problem at
hand (as well as possible etiological factors), andhand (as well as possible etiological factors), and
some prescription for alleviating the problem; all ofsome prescription for alleviating the problem; all of
these lead us to better understanding of the client.these lead us to better understanding of the client.

3. PURPOSE:-PURPOSE:- The capacity to solve clinicalThe capacity to solve clinical
problems is directly related to the skill inproblems is directly related to the skill in
defining them. “Think before you act”—this isdefining them. “Think before you act”—this is
the essence of the assessment or diagnosticthe essence of the assessment or diagnostic
processprocess
THE REFERRALTHE REFERRAL
 The assessment process begins with a referral.The assessment process begins with a referral.
Someone—a patient, a teacher, a psychiatrist,Someone—a patient, a teacher, a psychiatrist,
a judge, or perhaps a psychologist—poses aa judge, or perhaps a psychologist—poses a
question about the patient.question about the patient.
 E.g., “Why is Johnny disobedient?” or “WhyE.g., “Why is Johnny disobedient?” or “Why
can’t Alice learn to read like other children?”can’t Alice learn to read like other children?”

4. BEHAVIORAL ASSESSMENTBEHAVIORAL ASSESSMENT
 Making a careful assessment of the patient and hisMaking a careful assessment of the patient and his
life circumstances before, during, and followinglife circumstances before, during, and following
treatment is one of the most distinguishing featurestreatment is one of the most distinguishing features
of the various clinical procedures.of the various clinical procedures.
DEFINITION OF BEHAVIOR:DEFINITION OF BEHAVIOR:
Two broad categories:Two broad categories:
1. Respondents1. Respondents are the antecedent-controlledare the antecedent-controlled
behaviors which function in a reflexive manner.behaviors which function in a reflexive manner.
 Respondents include, Somatic reflexes, EmotionalRespondents include, Somatic reflexes, Emotional
reactions and other responses of the smoothreactions and other responses of the smooth
muscles, glands, and heart, and Sensationsmuscles, glands, and heart, and Sensations

5. For example, a sudden, unexpected noise mayFor example, a sudden, unexpected noise may
cause a person to hear the noise (an auditorycause a person to hear the noise (an auditory
sensation), to jump (a somatic reflex), and tosensation), to jump (a somatic reflex), and to
be afraid momentarily (an emotionalbe afraid momentarily (an emotional
reaction).reaction).
2. Operants2. Operants
include, Actions,Instrumental responsesinclude, Actions,Instrumental responses
of the smooth muscles, glands, an heartof the smooth muscles, glands, an heart
and Cognitionsand Cognitions

6. ASSESSMENT TASKSASSESSMENT TASKS
 IDENTIFY: -IDENTIFY: - The behavior therapist needs toThe behavior therapist needs to
identifyidentify all of the antecedents which areall of the antecedents which are
affecting the patient’s target behaviorsaffecting the patient’s target behaviors
 CLASSIFY: -CLASSIFY: - Once this information has beenOnce this information has been
obtained, it needs to beobtained, it needs to be classified.classified.
 PROPHESY (Predict): -PROPHESY (Predict): - AlthoughAlthough
prophesyingprophesying is not an activity which wouldis not an activity which would
seem to attract most behavior therapists,seem to attract most behavior therapists,
most engage in some form of prediction.most engage in some form of prediction.

7.  SPECIFYSPECIFY SpecifyingSpecifying precise goals,precise goals,
methods of intervention, and therapeuticmethods of intervention, and therapeutic
agents is an important part of theagents is an important part of the
behavioral assessment process.behavioral assessment process.
 EVALUATION: -EVALUATION: - The final assessmentThe final assessment
task,task, evaluation,evaluation, can be broken down intocan be broken down into
three subcategories:three subcategories: process evaluationprocess evaluation,,
outcome evaluationoutcome evaluation, and, and follow-upfollow-up
evaluationevaluation..

8. THE BEHAVIORAL TRADITIONTHE BEHAVIORAL TRADITION
3 ways it differs from traditional assessment:3 ways it differs from traditional assessment:
 SAMPLE VERSUS SIGN:-SAMPLE VERSUS SIGN:-
When test responses are viewed as a sample, oneWhen test responses are viewed as a sample, one
assumes that they parallel the way in which a personassumes that they parallel the way in which a person
is likely to behave in a nontest situation. Thus, if ais likely to behave in a nontest situation. Thus, if a
person responds aggressively on a test, one assumesperson responds aggressively on a test, one assumes
that this aggression also occurs in other situations asthat this aggression also occurs in other situations as
well. When test responses are viewed as signs, anwell. When test responses are viewed as signs, an
inference is made that the performance is an indirectinference is made that the performance is an indirect
or symbolic manifestation of some other characteristic.or symbolic manifestation of some other characteristic.
Goldfried (1976)Goldfried (1976)
 For the most part, traditional assessment hasFor the most part, traditional assessment has
employed a sign as opposed to sample approach toemployed a sign as opposed to sample approach to
test interpretation. In the case of behavioraltest interpretation. In the case of behavioral
assessment only the sample approach makes sense.assessment only the sample approach makes sense.

9. FUNCTIONAL ANALYSIS:FUNCTIONAL ANALYSIS:
 This means that exact analyses are made of theThis means that exact analyses are made of the
stimuli that precede a behavior and the consequencesstimuli that precede a behavior and the consequences
that follow it.that follow it.
To change an undesirable behavior, the clinician mustTo change an undesirable behavior, the clinician must
 Identify the stimulus conditions that precipitate it andIdentify the stimulus conditions that precipitate it and
 Determine the reinforcements that follow.Determine the reinforcements that follow.
 The behavior of concern must be described inThe behavior of concern must be described in
observable, measurable terms so that its rate ofobservable, measurable terms so that its rate of
occurrence can be recorded reliably. Bothoccurrence can be recorded reliably. Both antecedentantecedent
conditionsconditions andand consequence eventsconsequence events are thus carefullyare thus carefully
elaborated.elaborated.
 A functional analysis reveals thatA functional analysis reveals that stimulusstimulus is followedis followed
byby behaviorbehavior which in turn is followed by consequence.which in turn is followed by consequence.

10. Concept of Organismic variablesConcept of Organismic variables
 Most behavioral therapists have broadened theMost behavioral therapists have broadened the
method of functional analysis to include “method of functional analysis to include “organismic”organismic”
variables as well.variables as well.
 OrganismicOrganismic variablesvariables include physical, physiological,include physical, physiological,
or cognitive characteristics of the individual that areor cognitive characteristics of the individual that are
important for both the conceptualization of the client’simportant for both the conceptualization of the client’s
problem and the ultimate treatment that isproblem and the ultimate treatment that is
administered.administered.
 For example, it may be important to assess attitudesFor example, it may be important to assess attitudes
and beliefs that are characteristic of individuals whoand beliefs that are characteristic of individuals who
are prone to experience depressive episodes becauseare prone to experience depressive episodes because
of their purported relationship to depressionof their purported relationship to depression

11.  SORC MODEL: -SORC MODEL: - A useful model forA useful model for
conceptualizing a clinical problem from aconceptualizing a clinical problem from a
behavioral perspective is thebehavioral perspective is the SORC model.SORC model.
S = stimulus or antecedent conditions that bringS = stimulus or antecedent conditions that bring
on the problematic behavioron the problematic behavior
O = organismic variables related to theO = organismic variables related to the
problematic behaviorproblematic behavior
R = response or problematic behaviorR = response or problematic behavior
C = consequences of the problematic behaviorC = consequences of the problematic behavior

12. BEHAVIORAL ASSESSMENT ASBEHAVIORAL ASSESSMENT AS
AN ONGOING PROCESSAN ONGOING PROCESS
Not aNot a one-shotone-shot evaluation performed before treatmentevaluation performed before treatment
is initiated.is initiated.
In fact,In fact, it is an ongoing process that occurs before,it is an ongoing process that occurs before,
during, and after treatment.during, and after treatment.
Behavioral assessment is important becauseBehavioral assessment is important because
 it informs the initial selection of treatment strategies,it informs the initial selection of treatment strategies,
 provides a means of feedbackprovides a means of feedback
 allows evaluation of the overall effectiveness ofallows evaluation of the overall effectiveness of
treatment once completed,treatment once completed,
 and highlights situational factorsand highlights situational factors

13. METHODS OF BEHAVIORAL ASSESSMENTMETHODS OF BEHAVIORAL ASSESSMENT
A wide range of methods has been developed forA wide range of methods has been developed for
use in behavioral assessmentuse in behavioral assessment
These methods and measures can be implementedThese methods and measures can be implemented
across the age range from children to adults and canacross the age range from children to adults and can
be used to examine different areas of functioningbe used to examine different areas of functioning
(e.g. classroom performance, marital communication,(e.g. classroom performance, marital communication,
psychopathology, social skills, Psycho physiologicalpsychopathology, social skills, Psycho physiological
functioning).functioning).

14. Assessment information can be drawn from differentAssessment information can be drawn from different
sources, includingsources, including
 Observation by clinicians or other trained observers,Observation by clinicians or other trained observers,
reports by the clients themselves, and rating byreports by the clients themselves, and rating by
significant others( e.g. Parents, Teachers, Spouses).significant others( e.g. Parents, Teachers, Spouses).
 Information can also be obtained about behavior inInformation can also be obtained about behavior in
different settings) e.g. Home, School, Work,different settings) e.g. Home, School, Work,
Community).Community).
 In the following sections we will describe two broadIn the following sections we will describe two broad
classes of behavioral assessment methods:classes of behavioral assessment methods:
behavioral interviewing, and self-report inventories &behavioral interviewing, and self-report inventories &
checklists.checklists.

15. BEHAVIORAL INTERVIEWINGBEHAVIORAL INTERVIEWING
 Used to obtain information that will be helpful inUsed to obtain information that will be helpful in
formulating a functional analysis of behavior.formulating a functional analysis of behavior.
 Focus on describing and understanding theFocus on describing and understanding the
relationships among antecedents, behaviors, andrelationships among antecedents, behaviors, and
consequences.consequences.
 Behavioral interviews tend to be more directive thanBehavioral interviews tend to be more directive than
other non-behavioral interviews, allowing theother non-behavioral interviews, allowing the
interviewer to obtain detailed descriptions of theinterviewer to obtain detailed descriptions of the
problem behaviors and of the patient's currentproblem behaviors and of the patient's current
environment.environment.

16. Behavioral interviews follow a four-step problem-Behavioral interviews follow a four-step problem-
solving format:solving format:
 Problem identificationProblem identification
 Problem analysisProblem analysis
 Assessment planningAssessment planning
 Treatment evaluationTreatment evaluation

17.  Thus, behavioral interviewing focuses not only onThus, behavioral interviewing focuses not only on
obtaining information within the interview session, butobtaining information within the interview session, but
also information on behavior outside the interview, inalso information on behavior outside the interview, in
the environment in which the behavior naturallythe environment in which the behavior naturally
occurs.occurs.
 One important reason that behavioral interviews areOne important reason that behavioral interviews are
more directive than most other kinds of interviews ismore directive than most other kinds of interviews is
that clients will often describe their difficulties in traitthat clients will often describe their difficulties in trait
terms.terms. ((beingbeing "anxious""anxious" oror "depressed""depressed" oror "angry“)"angry“)
 The behavioral clinician must then work with the clientThe behavioral clinician must then work with the client
to translate these broad terms into more specific andto translate these broad terms into more specific and
observable behaviors.observable behaviors.
 For example,For example, "being anxious""being anxious" may mean breathingmay mean breathing
rapidly, sweating profusely, an increase in heart raterapidly, sweating profusely, an increase in heart rate
etc.etc.

18. An excellent example of behavioral interviewing : the workAn excellent example of behavioral interviewing : the work
of psychologistof psychologist Russell BarkleyRussell Barkley and his colleagues, whoand his colleagues, who
have developed extensive interview protocols for use inhave developed extensive interview protocols for use in
the behavioral assessment ofthe behavioral assessment of ADHDADHD..
 The interviewer reviews a series of situations that areThe interviewer reviews a series of situations that are
frequent sources of problems between children andfrequent sources of problems between children and
parents.parents.
For example, parents may report that their child hasFor example, parents may report that their child has
temper tantrums, during which the child cries, whines,temper tantrums, during which the child cries, whines,
screams, hits, and kicks.screams, hits, and kicks.
 Additional information is then sort out.Additional information is then sort out.
 This situationally focused interview provides a detailedThis situationally focused interview provides a detailed
picture about how the parent perceives the antecedentspicture about how the parent perceives the antecedents
and consequences that surround the child's problematicand consequences that surround the child's problematic
behaviors.behaviors.

19.  In sum, behavioral interviewing is the first stepIn sum, behavioral interviewing is the first step
in conducting a comprehensive behavioralin conducting a comprehensive behavioral
assessment of a problem behavior andassessment of a problem behavior and
 the contextual variables that may be controllingthe contextual variables that may be controlling
the behavior.the behavior.
 A behavioral interview is more direct than areA behavioral interview is more direct than are
unstructured clinical interviews and focusesunstructured clinical interviews and focuses
explicitly on the occurrence (or non-occurrence)explicitly on the occurrence (or non-occurrence)
of specific behaviors.of specific behaviors.

20. INVENTORIES AND CHECKLISTSINVENTORIES AND CHECKLISTS
 Behavioral clinicians have used a variety of self reportBehavioral clinicians have used a variety of self report
techniques to identity behaviors, emotional responses,techniques to identity behaviors, emotional responses,
and perceptions of the environment.and perceptions of the environment.
 The fear Survey Schedule has been widely used ItThe fear Survey Schedule has been widely used It
consists of 51 potentially fear-arousing situations andconsists of 51 potentially fear-arousing situations and
requires the patient to rate the degree of fear eachrequires the patient to rate the degree of fear each
situation arouses.situation arouses.
Other frequently used self-report inventories includeOther frequently used self-report inventories include
 the Rathus Assertiveness Schedulethe Rathus Assertiveness Schedule
 the Beck Depression Inventory,the Beck Depression Inventory,
 the Youth Self Report andthe Youth Self Report and
 the Marital Conflict Formthe Marital Conflict Form

21.  Notably absent from this brief and partial listing ofNotably absent from this brief and partial listing of
inventories are instruments that have a psychiatricinventories are instruments that have a psychiatric
diagnostic orientation.diagnostic orientation.
 The focus of behavioral inventories is, in short,The focus of behavioral inventories is, in short,
behavior.behavior.
 Clients are asked about specific actions, feelings, orClients are asked about specific actions, feelings, or
thoughts that minimize the necessity for them to makethoughts that minimize the necessity for them to make
inferences about what their own behavior reallyinferences about what their own behavior really
means.means.
 The person’s perception of the social environment isThe person’s perception of the social environment is
also assessed.also assessed.

22. RATING SCALESRATING SCALES
 Clinical psychologists have developed a numberClinical psychologists have developed a number
of rating scales and behavior checklists.of rating scales and behavior checklists.
 These measures are intended to provideThese measures are intended to provide
information on a wider range of an individual'sinformation on a wider range of an individual's
behavior over a longer period of time than isbehavior over a longer period of time than is
possible with direct observation.possible with direct observation.
 Rating scales have been developed to assessRating scales have been developed to assess
problem behaviors in children, adolescents, andproblem behaviors in children, adolescents, and
adults.adults.
 Examples: EBDS and CAASExamples: EBDS and CAAS

23.  Children's behavior may differ in criticalChildren's behavior may differ in critical
ways depending on whether they are atways depending on whether they are at
home, at school, alone, or with peers, andhome, at school, alone, or with peers, and
it is important to obtain samples or reportsit is important to obtain samples or reports
of their behaviors in these differentof their behaviors in these different
settings.settings.
 It is also important that ratings ofIt is also important that ratings of
children's behavior be obtained fromchildren's behavior be obtained from
different people, or informants, in thedifferent people, or informants, in the
children's liveschildren's lives

24.  A number of different rating scales have been developedA number of different rating scales have been developed
to assess problem behaviors in children and adolescents.to assess problem behaviors in children and adolescents.
 Most widely used rating system for child and adolescentMost widely used rating system for child and adolescent
psychopathology, however, are the checklists developedpsychopathology, however, are the checklists developed
by Achenbach and his colleagues.by Achenbach and his colleagues.
 Rating scales have also been developed to assessRating scales have also been developed to assess
behavior problems in adults.behavior problems in adults.
 e.g., thee.g., the Hamilton Rating Scale for DepressionHamilton Rating Scale for Depression,,
 thethe Yale­Brown Obsessive­Compulsive ScaleYale­Brown Obsessive­Compulsive Scale,,
Goodman et al., 1989).Goodman et al., 1989).
 As is the case with most rating scales, the total score of allAs is the case with most rating scales, the total score of all
items can be used as an index of the severity of theitems can be used as an index of the severity of the
particular disorder.particular disorder.

25.  Psychometric properties of the rating scales.Psychometric properties of the rating scales.
 Both the child and the adult measures haveBoth the child and the adult measures have
good internal consistency and test-retestgood internal consistency and test-retest
reliability.reliability.
 Currently these behavioral rating scales areCurrently these behavioral rating scales are
used more frequently in clinical research thanused more frequently in clinical research than
they are in clinical practice.they are in clinical practice.
 But as more data accrue, demonstrating theBut as more data accrue, demonstrating the
scales' utility in formulating effective treatmentscales' utility in formulating effective treatment
plans, this situation should change.plans, this situation should change.

26. TECHNOLOGICAL ADVANCEMENT IN BEHAVIORTECHNOLOGICAL ADVANCEMENT IN BEHAVIOR
ASSESSMENTASSESSMENT
 The availability of laptop and hand-held computersThe availability of laptop and hand-held computers
facilitates the coding of observational data byfacilitates the coding of observational data by
assessors.assessors.
 Hand-held computers can be assigned to clients soHand-held computers can be assigned to clients so
that clients can provide real-time self-monitoringthat clients can provide real-time self-monitoring
data.data.
 Hand-held computers can be programmed toHand-held computers can be programmed to
prompt clients to respond to queries at specifiedprompt clients to respond to queries at specified
times of the day or night.times of the day or night.

27.  Data from either laptop or hand-heldData from either laptop or hand-held
computers can be loaded onto othercomputers can be loaded onto other
computers that have greater processingcomputers that have greater processing
and memory capacity so that observationsand memory capacity so that observations
can be aggregated, scored and analyzed.can be aggregated, scored and analyzed.

28. ConclusionConclusion
 Behavioral assessment differs from traditionalBehavioral assessment differs from traditional
assessment in several fundamental ways.assessment in several fundamental ways.
 Behavioral assessment emphasizes directBehavioral assessment emphasizes direct
assessments (naturalistic observations) ofassessments (naturalistic observations) of
problematic behavior, antecedent (situational)problematic behavior, antecedent (situational)
conditions, and consequences (reinforcement).conditions, and consequences (reinforcement).
 It is also important to note that behavioralIt is also important to note that behavioral
assessment is an ongoing process, occurring at allassessment is an ongoing process, occurring at all
points throughout treatment.points throughout treatment.